Country overview: France
- Situation summary
- Data sheet
- Barometer
Contents
- Drug use among the general population and young people
- Prevention
- Problem drug use
- Treatment demand
- Drug-related infectious diseases
- Drug-related deaths
- Treatment responses
- Harm reduction responses
- Drug markets and drug-related offences
- National drug laws
- National drug strategy
- Coordination mechanism in the field of drugs
- Drug-related research
| Year | France | EU (27 countries) | Source | ||
|---|---|---|---|---|---|
| Population | 2008 | 63 753 140 | 497 455 033 | Eurostat | |
| Population by age classes | 15–24 | 2008 | 12.7 % | 12.6 % 1 | Eurostat |
| 25–49 | 34 % | 36.3 % 1 | |||
| 50–64 | 18.6 % | 18.4 % 1 | |||
| GDP per capita in PPS (Purchasing Power Standards) 2 | 2007 | 109.2 | 100 | Eurostat | |
| Total expenditure on social protection (% of GDP) 3 | 2006 | 31.1 % p | 26.9 % p | Eurostat | |
| Unemployment rate 4 | 2008 | 7.7 % | 7 % | Eurostat | |
| Unemployment rate of population agends under 25 years | 2008 | 19.1 % | 15.5 % | Eurostat | |
| Prison population rate (per 100 000 of national population) 5 | 2006 | 91.6 | Council of Europe, SPACE 2006.1 | ||
| At risk of poverty rate 6 | 2006 | 13 % | 16 % 7 | SILC, 2007 |
|
p Eurostat provisional value.
1 2007 figures.
2 Gross domestic product (GDP) is a measure of economic activity. It is defined as the value of all goods and services produced less the value of any goods or services used in their creation. The volume index of GDP per capita in Purchasing Power Standards (PPS) is expressed in relation to the European Union (EU-27) average set to equal 100. If the index of a country is higher than 100, this country's level of GDP per head is higher than the EU average and vice versa.
3 Expenditure on social protection contains: benefits, which consist of transfers, in cash or in kind to households and individuals to relieve them of the burden of a defined set of risks or needs.
4 Unemployment rates represent unemployed persons as a percentage of the labour force. Unemployed persons comprise persons aged 15 to 74 who were: (a) without work during the reference week; (b) currently available for work; (c) actively seeking work.
5 Situation of penal institutions on 1 September, 2006.
6 Share of persons aged 0+ with an equivalent disposable income below the at-risk-of-poverty threshold in the current year and in at least two of the preceding three years.
7 EU-25 countries.
Drug use among the general population and young people
Between 1992 and 2005, general population surveys reported cannabis as the most widely used illicit substance. Lifetime prevalence rates for cannabis among adults aged 15 to 64 years increased from 21.9 % in 1999 to 26.2 % in 2002. The latest results (2005) among 15–64 year olds indicate a lifetime prevalence of cannabis use of 30.6 %. In the same age group, reported lifetime prevalence was 2.6 % for cocaine (2.2 % in 2002; 1.5 % in 1999) and 2 % for ecstasy (0.9 % both in 2002 and 1999). In 2005, survey results also showed that among younger adults (15–34 years old), the lifetime prevalence was 43.6 % for cannabis, followed by 3.7 % for ecstasy and 3.5 % for cocaine. For the same age group, the last year prevalence was reported to be 16.7 % for cannabis, 1.2 % for cocaine and 1 % for ecstasy. Among the younger adults, last month prevalence of cannabis use was 9.8 % whereas prevalence for other substances were all below 1 %.
According the latest ESCAPAD survey involving a nationwide sample conducted in 2008 among the youth aged 17 years, in 2008, 42.2 % had tried marijuana or hashish at least once in their lifetime (49.4 % in 2005). Lifetime prevalence was reported to be 3.2 % for cocaine (2.5 % in 2005), 2.7 % for amphetamines (2.2 % in 2005), 2.9 % for ecstasy, 1.1 % for heroin, 1.2 % for LSD. Among the same age group, results indicated 35.9 % for the last year prevalence of cannabis use (41.3 % in 2005) and 24.7 % for the last month prevalence of cannabis use (27.9 % in 2005). Lifetime prevalence of cannabis use was 46.3 % among males and 37.9 % among females.
Prevention
The French prevention strategy embraces all psychoactive substances, both illicit and licit, according to a general harm reduction framework. Prevention of drug use in France is coordinated at the central level by The Inter-ministerial Mission for the Fight against Drugs and Drug Addiction (MILDT) and the ministries with which it liaises. Nonetheless, at a decentralised level (region, department, city), prevention actors enjoy considerable independence in terms of organisation and implementation of interventions.
In France, universal prevention is mostly carried out in the school environment, with the educational community being largely involved in the coordination and implementation of prevention activities. As part of the 2003–08 drug prevention and education plan, the MILDT and the Ministry of Education, assisted by several institutional partners, have drawn up an intervention guide for school environments, aimed at preventing addictive behaviour. This guide is today circulated in all French primary and secondary schools. The use of this guide is strongly encouraged, but is not compulsory. The guide clearly presents the authorities’ position concerning the content of drug prevention messages, and the need for a long-term strategy which is constantly developing and which tackles the problem at an early stage. Information on prevention interventions is collected in Relion survey in nine out of 26 regions. A national coverage of the above mentioned survey is planned for 2010.
Selective and indicated prevention is mainly the responsibility of specialised associations. Since 2005, 250 outpatient cannabis abuse clinics have been opened throughout France to carry out early intervention. Environmental strategies on alcohol and tobacco are well developed and have big political support.
Problem drug use
A national problem drug use estimate was made in France in 2006, using several data sources. A combined estimate based on three figures was 230 000 with a confidence interval between 210 000 and 250 000 (5.9 per 1 000 inhabitants aged 15–64 years, ranging from 5.4 to 6.4). This estimate is significantly higher than the one obtained in 1999. Local estimates carried out in 6 cities ranged from 7.6 per 1 000 in Rennes to 10.8 per 1 000 in Lille.
The EMCDDA defines problem drug use as intravenous drug use (IDU) or long duration/regular drug use of opiates, cocaine and/or amphetamines. Ecstasy and cannabis are not included in this category.
Treatment demand
Treatment demand data in France is mainly collected from specialised drug addiction treatment centres. In 2007, a total of 120 outpatient centres submitted data out of the 198 centres, 12 inpatient centres submitted data out of the 37 centres and 4 treatment units in prison submitted data out of the 16 units. Data on clients entering low threshold agencies are collected through a different system.
In 2007, a total of 32 542 clients entered treatment, of which 9 702 were first-time clients. Data on all clients entering treatment suggest that 48.8 % of all clients reported cannabis as their primary drug, followed by 39.8 % for opioids and 6.9 % for cocaine. Among first-time treatment clients, 65.3 % were treated for cannabis, 26.4 % were treated for opioids and 5.3 % for cocaine. It is important to note that in France, specialised consultation centres for young users, mainly for cannabis users, were created in 2005.
In 2007, 37 % of all clients entering treatment were aged less than 25 years. A higher percentage in age distribution was reported among new treatment clients, with 53 % being under the age of 25 years. As far as gender distribution is concerned, 82 % of all clients entering treatment were male, whereas 18 % were female. A similar distribution in gender distribution was reported among new treatment clients with 84 % for male and 16 % for female.
Drug-related infectious diseases
There are no national estimates on prevalence rates for drug-related infectious diseases among injecting drug users in France. As regards new AIDS cases, and based on data collection between 2003 and 2006, each year in France between 6 000 and 7 000 people discover that they are HIV positive. Contamination through intravenous drug use accounts for only 2 % of these new infections. As regards the number of new AIDS cases among injecting drug users, this figure has continued to fall from the mid-1980s onwards. Although injecting drug user cases accounted for a quarter of the people diagnosed with AIDS in the mid 1980s, this share dropped to 8 % in 2006.
Drug-related deaths
Data on drug-related deaths in France are collected by the National Registry of Medical Causes of Death. In 2006, 305 drug-related deaths were recorded (299 in 2005). Opioids remain the main cause of death in cases where only a single substance was detected, followed by deaths related to cocaine use. In the vast majority of cases, death is reported as occurring as a result of polydrug use, without it being possible to determine which specific substances were detected.
Treatment responses
The Inter-ministerial Mission for the Fight against Drugs and Drug Addiction (MILDT) is responsible for defining, setting up, and coordinating drug-related policy on illicit and licit drugs. Three systems are concerned with drug treatment: a specialised addiction care system operating within medico-social establishments, a general care system comprising hospitals and GPs and a risk-reduction system. The provision of treatment to drug users falls under the responsibility of the regional and local authorities. Since 2003, drug treatment has been financed by the French social security system.
Almost all of the 100 sub-regional administrative areas across France have at least one specialised drug addiction treatment centre. These centres provide three types of services: (i) outpatient care, (ii) inpatient care, and (iii) treatment for prison inmates. In 2005, there were a total of 209 outpatient treatment centres, 41 inpatient treatment centres and 16 prison treatment centres. Furthermore, both pharmacologically-assisted and drug-free treatments are provided in the same drug addiction treatment centres.
Since 1995, substitution has constituted the main form of treatment, and has been integrated into a total therapeutic strategy for drug dependence. Both methadone and high dosage buprenorphine (HDB) are used for substitution treatment, though HDB, introduced in 1996, is now the most widely prescribed substitution substance.
In France, GPs are significantly involved in the initiation and continuation of HDB treatment. Several circulars regulate the dose, place of delivery and duration of treatment. Since January 2002, doctors working in a health unit may also prescribe methadone to drug addicts highly dependent on opiates, outside the context of specialised drug addiction treatment centres and hospitals.
In 2007, an estimated 120 000 clients were in substitution treatment, (80 % high dose buprenorphine and 20 % methadone). HDB is mainly provided by GPs while methadone is mainly provided by addiction treatment centres (CSST).
Harm reduction responses
The Governmental Plan to fight drugs and drug addiction (2008–11) makes harm reduction one of the five axes on which the strategy is built. Since 2004, harm reduction policy has been incorporated into public health regulations and state jurisdiction. Harm reduction is officially defined as intended to prevent transmission of infections, death from overdose by intravenous injection of drugs and social and psychological damage linked to drug addiction by substances classified as drugs.
Services relating to the reduction of risk and harm in France have been implemented to complement the specialised drug treatment centres. A network of 120 low-threshold agencies (CAARUD), which receive funding directly by the public health insurance, forms an important component of the response. Harm reduction services provided include: the open sale of syringes in pharmacies (since 1987), syringe exchange programmes (130 in 2006), 40 drop-in centres for drug users, emergency services and methadone buses in order to improve access to substitution treatment. Front-line and outreach teams improve the service provision to drug users further. Syringes are also available from 225 dispensing machines and pharmacies sell state-subsidised sterikits (latest available sterikit sales data: 6.6 million in 2003). Overall, the risk and harm reduction system covers most of the French territory, partly due to the sale of syringes through pharmacies. In 2007, 4.8 million syringes were distributed from specialist agencies, excluding sterikit and other non-subsidised pharmacy syringe sales.
Screening of infectious diseases is facilitated by the existence of free, anonymous screening centres (Centres de dépistage anonymes et gratuits, CDAG). In 2002, 386 of such centres operated in the community and 109 inside prisons (no more recent data available). Hepatitis B vaccination is recommended for infants and it is mandatory only in some specific health occupations where employees are at risk. However, a circular dated February 2008, creating the CSAPA (treatment centre dedicated to the care of drug and alcohol addictions) recommended free vaccination of hepatitis B to any drug-users attending a treatment centre.
Drug markets and drug-related offences
Illegal drugs are trafficked via France to the Netherlands, Belgium, the United Kingdom and Italy, and to the United States in case of synthetic drugs. As in most EU countries, cannabis is the most available and accessible of all illicit substances. In France, 86 % of drug-related offences in 2006 concerned cannabis and 75 % of all seizures in 2006 were cannabis-related. The proportion of drug offences involving cannabis has been increasing since 1997 in France. Heroin availability remains comparatively low. The number and proportion of arrests for use and trafficking related to heroin has shown a downward trend since 1998, while the number of seizures has remained low but stable.
In 2007, a total of 133 566 drug related offences were reported, out of which 82.8 % were cannabis related offences, followed by 7 % for heroin related offences and 5.4 % for cocaine related offences. In 2007, the number of cocaine seizures increased with a total of 4 051 seizures when compared to 2006 whereas, the quantity of cocaine seizures decreased with a total of 6 579 kg of seized cocaine. Furthermore, in 2007 a significant increase was reported in the number of herbal cannabis and cannabis resin seizures as compared to 2006. In 2007, there were a total of 11 381 herbal cannabis seizures and 66 500 of cannabis resin seizures.
In 2007, the average price for herbal cannabis stabilised at EUR 7/gram, a slight increase on previous years. The average price of cannabis resin was around EUR 6/gram, in line with the previous years, and may decease to EUR 4 or even EUR 3 when bought in bulk. In 2007, the average price of brown heroin was about EUR 42/gram. In 2007, the average prices for cocaine remained stable compared to 2006, at EUR 60/gram.
National drug laws
Use or possession of illegal drugs is a criminal offence in France. The law itself does not distinguish between possession for personal use or for trafficking, nor by type of substance. However, the prosecutor will opt for a charge relating to use or traffic that is based on the quantity of the drug found and the context of the case, according to a circular to prosecutors in 2005. This circular stated that any legal action before the magistrates’ courts must remain exceptional and should be reserved for recidivists or users refusing to submit to alternative measures. An offender charged with personal use only faces a maximum prison sentence of one year and a fine of up to EUR 3 750, though prosecution may be waived. Alternatives to prosecution may include voluntary payment of a fine or non-remunerated work useful to society. Prosecutors may also prioritise treatment approaches for small-time offenders, both those related to personal drug use or other minor crimes. Drug users may also receive a caution, which may be accompanied by a request to contact social or health services obliging the person to undergo treatment or counselling. Since 2007, a non-addicted offender may have to pay up to EUR 450 for a compulsory drug awareness course. Drug trafficking is punishable with imprisonment of up to 10 years, or up to life in prison in case of particularly serious offences, and a fine of up to EUR 7 600 000.
National drug strategy
The current French ‘Action plan on drugs, tobacco and alcohol’ (2008–11) was adopted in July 2008. The plan includes 193 measures covering many aspects of drug addiction.
A key theme of the plan is the focusing anew of prevention on the onset of illicit drug use and on alcohol abuse, by curbing their everyday acceptance. The emphasis is placed on:
- prevention and, in particular, the interest attached to reminding individuals of drug-related laws and the central role played by parents;
- awareness-building messages aimed at avoiding or at least delaying experimentation, including with alcohol (among the measures envisaged, we should mention a ban on selling alcohol to minors, a ban on consuming alcohol on the public highway around educational establishments and a ban on fixed-price or ‘all you can drink’ offers or ‘freebies’);
Where punishments are concerned, efforts to stamp out sources of supply will include:
- an intensification of the fight against cannabis (particularly ‘home growing’) and the misuse of psychotropic medicines;
- increased international police cooperation between the European Union Member States and the nations on the Mediterranean south shore;
- tougher economic penalties for traffickers.
Coordination mechanism in the field of drugs
The Inter-ministerial Committee on Drugs is the authority in France designated to prepare the decisions of the government in all domains related to the drug problem, and this committee approves the national plan on drugs. The committee is placed under the authority of the Prime Minister and is composed of ministers and state secretaries.
The Inter-ministerial Mission for the Fight Against Drugs and Drug Addiction (Mission interministérielle de lutte contre la drogue et la toxicomanie, MILDT) prepares, coordinates and partly implements the decisions of the committee. There are also regional, local and territorial project managers (chefs de projet) who are responsible for implementing the national plan.
Drug-related research
In France, Inter-ministerial Mission for the Fight Against Drugs and Drug Addiction (MILDT) coordinates all aspects of the government’s drug-related research, including its promotion and funding. Several major academic research centres and governmental agencies including the national focal point itself, (French Monitoring Centre for Drugs and Drug Addiction) cover a large scope of research areas, ranging from neuroscience, through public health and clinical research, to social sciences. The two main national priorities in this area are to actively support policy for the development of new knowledge, and to promote the synthesis and dissemination of scientific findings and knowledge. Dissemination is also part of the mandate of the national focal point which, together with an extensive publishing effort in international scientific journals, promotes the use of research results in practice and policymaking. Recent drug-related studies mentioned in the 2008 French National report mainly focused on aspects related to prevalence of drug use in different settings.