France

"The latest available data in terms of levels of illicit drug use among adults in France come from the 2023 EROPP survey. In 2023, cannabis is still by far the most widely used illicit substance, with 50,4 % of people aged 18-64 having already tried it, and 10,8 % claiming to have used it during the last 12 months.

"Among last year users aged 18 to 64 years (11%) according to the 2017 Health Barometer Survey, the proportion of those at high risk of problem cannabis use (according to the Cannabis Abuse Screening Test, CAST) is 25%, i.e. 2.3% of the French population aged 18 to 64 years in 2017.

"In 2022, cannabis was also the most widely used illicit drug during adolescence, particularly among boys.

"These observations are made in the context of the dynamism of supply in France, particularly with local herbal cannabis production (both industrial plantations and home cultivation), while the resin market is innovating and diversifying.

"The results of the 2023 EROPP survey on representations, opinions and perceptions regarding psychoactive drugs are expected at the end of 2024 will make it possible to reflect on how the French perceive drugs, as well as their consumption of other psychoactive substances and in particular cocaine, given that its use has risen sharply in recent years."

"In France, the regime applicable to the use of drugs and trafficking was established by Law no 70-1320 of 31 December 1970 on health measures to fight drug addiction and combat the trafficking and use of poisonous substances. The provisions of this law were since codified in the French Public Health Code (CSP in French).

"The penalties incurred by the perpetrators of drug-related offences depend on the severity of the offences committed (see T1.1.1), thus the illicit use of drugs (Art. L.3421-1 of the Public Health Code) is less severely punished than drug trafficking (Art. 222-34 et seq. of the Penal Code) or related offences (money laundering, failure to provide proof of resources corresponding to one's lifestyle, etc.), because the perpetrator is considered by the law to be a delinquent as well as a patient. The criminalisation of drug use is reflected in a wide range of responses: some suspend or cancel prosecution but are still sanctions, such as alternatives to prosecution or fixed penalty notices; others result in legal proceedings, which may lead to a fine or other types of sentence (or even, sometimes, imprisonment).

"Although French law makes no distinction between drugs as some countries do, it distinguishes between the illicit sale and supply of narcotics to a person in light of their personal use and other situations. Repeated offences are more severely sanctioned (see T1.1.2).

"There are no specific laws regulating new psychoactive substances (NPS). The rationale for classifying a NPS on the list of narcotics is both individual (each prohibited substance is named on the list) and generic (See T1.1.3).

"In 2023, new developments include the extension of the trial on the use of medical cannabis, Medical addiction microstructures, and the addition of synthetic opioids, CBD derivatives, and some new synthetic cannabinoids on the list of narcotics (see T3)."

"In 2023, cannabis is still by far the most widely used illicit substance, with 50,4 % of people aged 18-64 having already tried it, and 10,8 % claiming to have used it during the last 12 months (Spilka et al. 2024).

"The last year prevalence of use has remained stable since 2014. In the same way, regular use (at least 10 times in the last 30 days prior to the survey) has stabilised in recent years to reach 3.4% in 2023.

"In 2023, men were more affected by cannabis use than women: 57.6% had smoked it before, compared to 43.4% of women. They are also twice as likely to have used it in the 12 months prior to the survey (14.5% compared to 7.2% of women), and to use it every day (3.2% compared to 1.4% of women).

"In 2023, around 60% of 25–44-year-olds had tried cannabis, but only 36.5% of 55–64-year-olds."

"Among first-time clients entering specialised drug treatment in 2021, or most recent year available, with heroin as their primary drug, 19% (down from 38% in 2013) reported injecting as their main route of administration. In this group, levels of injecting vary between countries, from less than 10% in Denmark, Spain, France and Portugal to 60% or more in Czechia, Estonia, Latvia, Lithuania, Romania and Slovakia."

"In 2023, the total number of people charged for the use of narcotics in France was around 260,300. Most of the people prosecuted for drug offences were charged for simple use (84%). The number of people arrested for trafficking offences is way lower (48,300 in 2023). As of September 2020, simple use violations can be sanctioned by a criminal fixed fined (AFD in French). In 2023, the Interior Ministry’s statistics department made a list of more than 160,000 criminal fixed fines, thus demonstrating the significant growth of this measure to tackle drug use (particularly those of cannabis). Since 2022, a criminal fixed fined have become the main response to drug use. However, these progressions are very contrasting geographically. Most of the fines relate to the use of cannabis (almost 98%), far ahead of cocaine (less than 2%), with other products accounting for virtually no share."

"According to the results of the EROPP survey, in 2023, almost 1 in 10 adults (9.4%) had used cocaine at least once in their lifetime, compared to 5.6% in 2017, which is the most significant increase in number of percentage points (+3.8% percentage points), measured among all illicit substances other than cannabis. Current cocaine use is consistent with this increase, rising from 1.6% in 2017 to 2.7% in 2023.

"Lifetime use of MDMA, which also mainly affects men (11.7% compared to 4.9% of women), rose sharply between 2017 and 2023 (increasing from 5.0% to 8.2%), and its current use has doubled (from 1.0% to 1.8%), 25–34-year-olds being the most likely to have tried it (13.8%). This increase was proportionally greater for women (0.6% to 1.3%) than men (1.5% to 2.4%).

"In 2021, the number of cocaine hydrochloride users in the previous 30 days was estimated to be 141 000 individuals (136 000-147 000), with a prevalence of 3.5‰ (3.4‰ – 3.6‰). The number of crack cocaine users has also increased: 48 400 (45 600-51 100) in 2021 vs 42 800 (40 900-44 700) in mainland France in 2019, i.e. a prevalence of 1.2 per 1 000 individuals aged 15 to 64 (1.1-1.3). This estimate confirms the constant increase observed since 2010 (12 800, (12 000-14 000) i.e. a prevalence of 0.31 per 1 000 (0.29-0.33))."

"The results of the ENCLASS survey (the union of the HBSC and ESPAD surveys, both conducted in school settings) are consistent with the ESCAPAD survey in terms of the particular use of cannabis among young people in France (OFDT 2024).

"In 2022, among junior high school students, the lifetime use of cannabis decreased in comparison with 2018, as did last month use, falling from 6.7% to 5.3%, and from 4.5% to 2.8%, respectively. Daily and regular use of cannabis remain marginal and affect 1% of junior high school students.

"In high schools, in 2022, the diffusion of cannabis had also slowed down since 2018. Lifetime use of this substance, which affected a third of high school students (33.1%) in 2018, affected less than a quarter of them in 2022 (22.5%). Last year use decreased by 9 percentage points (17.6% vs. 26.5%), and last month use by almost 6 percentage points (10.6% vs. 17.3%), while regular use halved (2.9% vs. 6.2%).

"Among drug users seen in CAARUDs, cannabis plays a predominant role in substance use in 2019, three quarters of them had used it in the month before the survey, half of them on a daily basis (Cadet-Taïrou et al. 2020). The TREND scheme shows that cannabis is particularly present in the poly-consumption of users in very precarious situations on the one hand and among people frequenting techno parties on the other."

"Lifetime use of MDMA, which also mainly affects men (11.7% compared to 4.9% of women), rose sharply between 2017 and 2023 (increasing from 5.0% to 8.2%), and its current use has doubled (from 1.0% to 1.8%), 25–34-year-olds being the most likely to have tried it (13.8%). This increase was proportionally greater for women (0.6% to 1.3%) than men (1.5% to 2.4%)."

"In 2021, the number of cocaine hydrochloride users in the previous 30 days was estimated to be 141,000 individuals (136,000-147,000), with a prevalence of 3.5‰ (3.4‰ – 3.6‰). The number of crack cocaine users has also increased: 48,400 (45,600-51,100) in 2021 vs 42,800 (40,900-44,700) in mainland France in 2019, i.e. a prevalence of 1.2 per 1,000 individuals aged 15 to 64 (1.1-1.3). This estimate confirms the constant increase observed since 2010 (12,800, (12,000-14,000) i.e. a prevalence of 0.31 per 1,000 (0.29-0.33))."

"The data available have limitations in respect to quality and coverage, however, the information available suggests that heroin was only present in the majority of overdose deaths in a relatively small number of EU countries. A significant share of overdose deaths was reported by Austria (67%), Italy (56%), Ireland (46% in 2017), Poland (44% in 2016) and Romania (43%). In 7 other European countries, heroin was found in approximately a quarter to a third of reported overdose deaths: Portugal (37%), Slovenia (33%), Denmark (36%), France (33% in 2020), Türkiye (32%), Spain (28% in 2020) and Norway (23%). In 2021, in the north of Europe, less than 1 in 6 overdose deaths in Finland, Sweden and in the Baltic countries was reported to involve heroin."

"In France, a study conducted by the French Addictovigilance Network clearly showed a 2.5‐fold increase in the number of ketamine users among people with substance use disorders between 2012 and 2021 [9]. This finding is even more alarming given that the number of daily users, users with distress at discontinuation and users with addiction were also found to be increasing. In 2023, it was estimated that 2.6% of adults aged 18–64 in France had experience with ketamine [8]."

"In the present study, the overall percentage of drivers who tested positive for ketamine in a roadside oral fluid test was 2.6%. This percentage was higher than that described by Gish et al. in samples collected at a music festival in southwest France (1.4% in 2017 and 0.4% in 2019) [17], but also higher than the prevalence previously reported in the driver population of other countries [18, 19, 20, 21] where the highest prevalence was found in Australia in 2012 (1.5%) [18]. While the nature of the musical event may partly explain the difference observed in our study (rave party) with that of Gish et al. (rock festival), regional disparities in illicit drug use may exist. The percentage of ketamine positivity observed in our study during the last 7 months of 2020 was of the same order as those previously described, but cannot be compared to earlier data from our region since ketamine in oral fluid samples was unfortunately not tested in our laboratory before May 2020. However, we report a significant increase in ketamine use in 2021 compared to 2020, which is consistent with the study led by the French Addictovigilance Network, where the number of ketamine users with a substance use disorder in the OPPIDUM programme increased 2.5‐fold between 2012 and 2021 [9]. In this study, we also observed a higher number of ketamine‐positive cases in the summer and autumn. This observation is consistent with the evolution of ketamine use from a confidential one, at high doses in free parties and in the party scene in the 2000s, to a large one, in a ‘techno and electro’ festive context during festivals, in bars or in clubs [22, 23, 24]. It is now more common to consume ketamine in trace amounts, as consumers are no longer looking for hallucinogenic properties, but rather for a more moderate stimulant effect. The higher consumption of ketamine during the summer period reported in the present study is consistent with those reported in Toulouse (southwestern France) since 2017, in relation to a diffusion of this substance from alternative parties to electronic parties. Indeed, the latter are more frequent in the summer period and the larger number of participants in outdoor events is also a source of increased diversity and availability of substances [25]. In addition to summer and autumn, a marginal use of ketamine in winter was observed in our region during a rave party in January 2023. The same situation was observed in Toulouse during techno‐house and industrial techno parties in 2018, underlining the trivialized consumption of ketamine by techno partygoers. In this study, we cannot exclude the possibility that drivers attending supervised events, such as music festivals, which require prior authorization from the prefecture and are associated with more pronounced and systematic control, were included, thus introducing a possible bias. On the contrary, it should be noted that the use of the DrugWipe®5S as a roadside screening test in accordance with French regulations did not allow for the direct detection of ketamine [11]. This may have introduced a potential underestimation and selection bias among drivers tested for drug use, but this may be limited as 95.4% of the ketamine‐positive drivers identified in this study were polydrug users, mainly using COC, THC and AMP. Interestingly, this problem could be easily overcome by using some rapid oral fluid tests such as DrugWipe® 6S, Ora‐Check®, SalivaScreen®, OratectXP®, which are able to detect ketamine at cut‐offs of 5 to 50 ng/mL for ketamine and 30 to 75 ng/mL for norketamine [26, 27]. Finally, among the ketamine users, we do not exclude the possibility of having included depressed persons using the antidepressant esketamine. Indeed, the dextrorotatory isomer of ketamine (s‐ketamine) cannot be differentiated from ketamine by our non‐chiral chromatography method, whereas major depression has been reported to favour drug of abuse consumption [28]. However, the study by Baudot et al. showed that only a small number of patients are treated with esketamine in France [29], limiting the bias introduced by our analytical method."

"In France, as elsewhere, people who inject drugs (PWID) faced a dramatic HIV epidemic in the 1990s. In response, the French government’s harm reduction policy, which first developed programmes for access to sterile injection material in 1987, extended access in 1994 to include syringe vending machines and the sale of ready-to-use injection kits (Steribox) in community pharmacies,¹ as well as new state-funded needle exchange programmes (NEP).² These public health initiatives were concomitant with opiate maintenance treatment (OMT) programmes with methadone (available since 1994) and buprenorphine (available since 1995)^{3 4} and HAART for HIV-infected individuals.⁵ HIV prevalence in PWID dramatically decreased from 40% to 20% in 14 years from 1988 to 2002,^{2 6} with a prevalence in 2011 of 10%.⁷ An estimated 77% to 85% of opioid-dependent individuals in France are currently treated with OMT."

"Alcohol and tobacco consumption levels are by far those which cause the most serious extent of damage, either on the health or social level, or with regard to potential dependency."

"The use and possession of illicit drugs are criminal offences in France. The law itself does not distinguish between possession for personal use or for trafficking, or by type of substance. However, the prosecutor will opt for a charge relating to use or trafficking based on the quantity of the drug found and the context of the case. An offender charged with personal use faces a maximum prison sentence of 1 year and a fine, although in minor cases prosecution may be waived or simplified. The maximum sentence increases if the offender endangered users of transport or if the offence was committed by a public servant while on duty. As with many crimes, sentences may be doubled in the event of a subsequent offence within a 5-year period.

"A directive of 9 May 2008 defined a ‘rapid and graduated’ policy. In simple cases, drug users may receive a caution, but for all offenders aged over 13 years this should usually be accompanied by a requirement to attend a compulsory drug awareness course, introduced in March 2007, for which an offender may have to pay. Drug-dependent individuals would continue to receive the therapeutic injunction directing them to treatment. If there are aggravating circumstances, such as recidivism, imprisonment may be imposed. In 2012, a directive establishing a criminal policy strategy for drug-related crimes reiterated that, when sentencing, courts should take into account simple drug use or drug dependence. The application of educational and health measures is prioritised for both simple drug law crimes and minors.

"Drug supply is punishable with imprisonment of up to 5 years and a fine, or 10 years in specified aggravating circumstances. Sentences of up to life in prison and a fine of up to EUR 7.5 million is possible for criminal groups engaged in drug trafficking. In France, new psychoactive substances are controlled under the Criminal Code, which lists them as drugs based on a decision of the Ministry of Social Affairs and Health. Since 2012, generic classifications of chemical groups have also been introduced, with a ban on most cathinones having been implemented that year, followed by synthetic cannabinoids and 25xNBOMe (phenethylamine) derivatives in 2015, and fentanils and more cathinones in 2017."

"Cannabis remains the main substance involved in arrests for drug-related offences, regardless of the grounds for arrest, accounting for 90% of arrests for use and 70% of use-dealing and trafficking cases in 2011.

"Way behind cannabis, heroin and cocaine are the main substances involved in drug-related arrests (accounting for 5.4% and 3.5% of usage-related arrests, respectively).

"We should point out the relative importance in France of the number of arrests related to the misuse of medicines (particularly HBD, aka Subutex®, but also unspecified substances, used in spite of the absence of any proof of a prescription), and those for hallucinogenic mushrooms."

"Cannabis
"According to OCRTIS 214 the median price for herbal cannabis in 2011 was approximately €7.50 per gram and ranged from €5.80 to €10 per gram. This price is up compared with previous years (€6.50 in 2009 and €7.00 in 2010). According to the TREND price barometer, the median price for herbal cannabis is around €10 (Gandilhon et al. 2011). This upward phenomenon is explained by the fact that an increasing percentage of consumers appear to display a marked preference for high-quality products.

"The wholesale price, as measured by the police, stands at €3,000 per kilogram.

"For the OCRTIS, the median price of cannabis resin has remained stable. In 2011, it was still €5 per gram. This observation was confirmed by the TREND system, since the median price per gram is approximately €5. The wholesale price of cannabis resin for the same year was €2,000 per kilogram.

"Heroin
"According to the OCRTIS in 2011, the median price for a gram of brown heroin was approximately €35, down more than 10% compared with 2010. If this downward trend continues, this would indicate a certain trend reversal since the price per gram had been stable since 2007. Nevertheless, over the longer term, the trend is clearly downward since the price of a gram of heroin in the early 2000s was approximately €60. For 2011, the TREND system reported a stabilisation of the price at around €40.

"The wholesale price for brown heroin has also decreased to approximately €10,500 per kilogram.

"Misuse of substitution products
"Since 2008, the price per 8 mg tablet of HDB marketed as Subutex®, the only (or almost only) form available on the black market in major urban centres, rose slightly to €5.50-5.60 in 2011 compared with the €4 price of previous years (Cadet-Taïrou et al. 2010b). This price increase is believed to be related to difficulties in keeping the market supplied due to the strict prescription control measures put in place by health authorities.

"The price of a 60 ml vial of methadone ranges from €5 to approximately €20, depending on the location.

"Cocaine
"The price per gram of cocaine hydrochloride has remained stable for five years after having been halved compared to the late 1990s. In 2011, the median price according to the OCRTIS was approximately €60. However, TREND’s observation was different, reporting an upward trend with prices closer to €65 in cities and over €70 on the festive scene. Nevertheless, it is still too early to draw any conclusions from this observation.

"The wholesale price, which also remained stable, was €30,000 per kilogram."

"The number of problem drug users estimated at national level varies from 222,000 (multiplier applied to arrest data) to 340,000 (multivariate indicator method), corresponding to a prevalence of 5.5 per thousand and 8.4 per thousand, respectively, depending on the method employed. The multiplier method applied to treatment data gives an intermediate prevalence of 7.5 per thousand. Estimates based on arrest data are lower than the other two estimates, especially for those obtained with the multiplier method, with no cross-checking between confidence intervals. In 2006, the range of values adopted at national level, i.e. 210,000 to 250,000 users, corresponded to the overlap zone of confidence intervals calculated for each estimation method. Adoption of the same principle for the 2011 data led to disgard the multiplier method applied to arrests. The only estimates retained were based on treatment data and the multivariate indicator. A rather large range in values was thus obtained, namely 275,000 to 360,000 problem drug users. The upper and lower prevalence limits associated with these estimates are 7 per thousand and 9 per thousand. This result places France on an upper average ranking in terms of European Union statistics, with prevalences rounding similar levels to that observed in western European countries such as Italy, Spain and the UK, although markedly superior to Portugal and Germany."

"France continues to be a major transshipment point for drugs moving through Europe. Given France‘s shared borders with trafficking conduits such as Spain, Italy, and Belgium, France is a natural distribution point for drugs moving toward North America from Europe and the Middle East. France‘s overseas territories‘ presence in the Caribbean, its proximity to North Africa, and its participation in the Schengen open border system, contribute to its desirability as a transit point for drugs, including drugs originating in South America. France‘s own large domestic market of cannabis users is attractive to traffickers as well. Specifically, in descending order, cannabis/hashish originating in Morocco, cocaine from South America, heroin originating in Afghanistan and transiting through Turkey, Belgium, and the Netherlands, and ecstasy (MDMA) originating in the Netherlands and Germany, all find their way to France."

"France has recorded national estimates of the number of problem drug users since the mid 1990s. The last estimate produced by the OFDT relates to 2011 data and follows on from earlier estimates in 1995, 1999 and 2006. The definition of problem drug use has, however, changed from one study to the next: in 1995, the inclusion criterion for this category was the use of opiates; in 1999, this criterion was extended to include cocaine. The definition proposed by the EMCDDA in 2004 was adopted for the 2006 and 2011 estimates: the concept of problem drug users includes users (between 15 and 64 years of age) of all drugs administered intravenously or regular users of opiates, cocaine or amphetamines. There is, however, a slight difference between the approach used in France and EMCDDA recommendations. In the studies conducted in 2006 and 2011, all patients who had consumed the aforementioned substances or administered drugs intravenously within 30 days prior to the study were considered to be problem drug users. The use of this inclusion criterion does not, however, indicate whether use has been ongoing for one year – a condition stated in the European protocol. The purpose of this criterion was probably to exclude “occasional” users. In practice, almost all recent users of these substances or of intravenous drugs seen in treatment and harm reduction centres are long-term users."

"The estimate of the number of new HIV patients since HIV reporting became mandatory in 2003 was 55,168 on 31 December 2010 137. Given reporting delays and under-reporting, in 2010 the number of positive notifications was estimated at 6,265, which is slightly lower than the two preceding years (6,341 in 2009 and 6,340 in 2008).

"In 2010, people infected through intravenous drug use represented no more than 1.13% (71/6,265) of these new cases of infection. The most frequent contamination route is heterosexual intercourse (57% of cases) followed by homosexual intercourse between men (40%) (Cazein et al. 2011). It is still too early to assess the impact of the recommendations (generalised screening and repeated screening amongst exposed populations) of the 2010-2014 French national HIV-AIDS and Sexually Transmitted Infection plan on HIV surveillance data. In 2008, the incidence of HIV amongst IDUs was estimated at 86 per 100,000 person-years [95% CI, 0-192] (Le Vu et al. 2010). (Table 6-1).

"The number of new AIDS cases amongst IDUs has fallen continuously since the mid-1990s. Whereas IDUs represented a quarter of the people diagnosed at the AIDS stage at that time, they represented only slightly fewer than 8% in 2008 and approximately 5% in 2010 (provisional data)."

"Data from the death registry reveal a constant increase in the number of drug-induced deaths from 2003 to 2008, and even until 2009 if we limit the age range to 15-49-year-olds, amongst whom the large majority of cases were due to overdose.

"DRAMES [Drug and Substance Abuse Related Deaths (ANSM)] provides information on the substances that are the main cause of deaths by overdose. In 2009, illegal drugs were the main cause, as the main product, of death in slightly more than half of the cases (53%), followed by substitution treatments in approximately 34% of cases and opioid medications (excluding substitution treatments) in almost 13% of cases. Overall, opioids were chiefly involved in 87% of cases and cocaine (alone or combined with other substances) in approximately 12%. The rise in the number of overdoses between 2006 and 2009 is explained by an increase in the number of deaths from heroin overdose (+ 44 cases) and methadone overdose (+ 27 cases)."

"We currently have relatively accurate information about the number of people receiving care in the specialist centres. The CSAPAs [National Treatment and Prevention Centre for Substance Abuse] are required to provide the administrative authorities with an annual activity report containing certain information about people received during the previous year (see Appendix IV-P). The response rate for these reports is close to 90% annually and almost 100% over a two-year period. Based on these reports, it is possible to estimate at approximately 96,000 the number of people who were seen in the outpatient CSAPA in 2008¹²⁸ for their problem with illegal drugs. This includes overlapping, although these should not make up more than 5% of the total. Compared to the outpatient CSAPA, very few people, slightly fewer than 2,000, appear to be accommodated in a residential treatment centre, some of whom are already included in the figures for the outpatient CSAPA. In fact, these centres send a large number of patients to the residential centres where they are then housed. The number of people seen for a problem with illegal drugs in 2008 in prison CSAPAs can be estimated at 5,000.

"The only national data available for primary care is for people receiving substitution treatment. In 2010, as was previously mentioned, approximately 145,000 people were refunded by social security for their substitution treatment. Some of these may also have been monitored jointly or in succession by a CSAPA during the year.

"As regards hospitals, national data obtained from the PMSI medicalised information system programme are available 129 specifying the number of hospital admissions in the departments of medicine, surgery and obstetrics with a primary diagnosis of behavioural disorders related to the use of psychoactive substances, excluding alcohol and tobacco (ICD 10 diagnosis: F11 to F16, F18 and F19). There were approximately 7,500 hospital admissions in 2011, 1,900 of which concerned opiate users, almost 2,200 sedatives and hypnotics, around 1,000 cannabis users and 1,600 polydrug users. It should be noted that this data does not include attendance at emergency departments or those monitored on an outpatient basis for hospital addictions clinics. Overlapping also exists between hospitalised patients and those seen in specialist centres or primary care."

"In 2011, almost half of new patients (48%) were treated in specialised treatment centres for problems associated with cannabis use. A majority (57%) of them stated using cannabis every day. The percentage of people treated for their cannabis use was much lower among women (35% vs. 51%). The proportion of people using it daily was slightly lower among men, but this difference was not very marked (57% vs. 61%).

"The proportion of first-time treatment patients stating that cannabis posed the biggest problem was higher than that recorded in all new patients (71% vs. 48%). The breakdown of the frequency of use was similar in the two groups. The large number of cannabis users among patients in treatment in France is partly the consequence of the large and still increasing number of arrests for cannabis use. In fact, some of the users who have been arrested were sent to treatment centres by the courts.

"After cannabis, opiates are the second product most often cited as causing the majority of problems: 41% of new patients fall into this category. Of these patients, 77% stated heroin, 5% methadone and 18% other opiates (primarily HDB) 131. Of these patients, heroin was most frequently used nasally (65%), but one in every five heroin users still injects. The monthly percentage of injectors is much higher (37%) amongst other opiate users. Among the opiate users, almost 80% consumed these substances on a daily basis and 11% took them regularly (i.e., several times a week).

"Women are treated less often than men for cannabis use. However, they are treated far more than men for their opiate use (50% vs. 38%), regardless of the type of opiate in question. They used the injection route slightly less often than men to consume heroin (22% vs. 24%), but as often for the other opiates.

"The percentage of first-time treatment patients listing opiates as the substance posing the most problems is far lower than that recorded for all new patients (20% vs. 41%). Distribution of frequency of use is similar in the two groups although there is a slightly higher proportion of daily use among first-treatment patients. This group administers fewer injections during the month (15% versus 21%)."

"From the different information sources, we can estimate that approximately 14 million syringes were sold or distributed to drug users in France in 2008. Comparing this number to the number of IV drug users (81,000 recent IV users) produces a ratio of approximately 170 syringes per user per year (Costes et al. 2009). This figure, which only represents an order of magnitude, may indicate rather high accessibility to syringes in France for IV drug users. The pharmacies play a key role and are involved in over two-thirds of the sale or distribution of syringes. However, a reliable evaluation of requirements together with an analysis of geographical disparities (accessibility of syringes in rural areas in particular) has yet to be carried out.

"No estimate has been completed since 2008 when 13.8 M syringes were estimated to be distributed or sold. Some data are, however, available for 2010. Almost 2.4 M Stéribox2® kits (kits containing sterile injection equipment) were distributed in pharmacies in 2010, which corresponds to 4.7 M syringes (2 syringes per kit) based on InVS SIAMOIS data. The distribution of Stéribox2® in pharmacies has thus been stable since the early 2000s. Dispensing machines outside CAARUD distributed 1.1 M syringes in 2010 based on the data provided by the Safe Association – a figure that has increased compared to 2007."

""Providing assistance in gaining access to OST [Opioid Substitution Treatment] and general care is one of the CAARUD’s [Support Centre for the Reduction of Drug-related Harms] primary missions:
"• 83% of the CAARUDs reported that they had set up access to OST (referral or monitoring)
"• of all of their activities involving access to hygiene and first aid, the most common procedures (35%) were body care, followed by nursing care (26%);
"• 84.7% of CAARUDs developed health education promotion activities, 75% of which were individual interviews and group sessions focussing on the risks related to substances and to modes of contamination.

"The CAARUDs saw 48,000 people in 2008. The new patient intakes per structure stands at an average of approximately 200 subjects, although in reality the figures varied greatly: 41 centres saw fewer than 200 people whereas 11 CAARUDs saw more than 1,000 155 (Chalumeau 2010).

"The role of the CSAPAs [National Treatment and Prevention Centre for Substance Abuse] in reducing risks, which is one of their missions, cannot be quantified in the absence of data."

"In 2010, 135 CAARUDs [Support Centre for the Reduction of Drug-related Harms] existed throughout France. These are medico-social centres funded by the French social security system. They operate in various places with diverse methods. Of these, 95% offer a stationary reception service, 66% have street teams, 47% operate in squats, 40% have mobile teams, 39% work with teams on the party scene and 28% have developed prison activities. They largely contribute to distributing clean injection equipment (3.8 million syringes in 2008) and other prevention equipment (e.g., ancillary injection equipment, condoms).

"The major activities undertaken by these units are: providing assistance with hygiene and first aid care, offering health education promotion activities, helping people get access to social services, following-up on administrative and legal procedures and seeking out urgent accommodation.

"More specifically, the 2008 CAARUD activities pertaining to distributing prevention equipment were:
"• syringes: 2.3 M single syringes and 530,000 kits (2 syringes per kit, i.e. approximately 1 M syringes) handed over personally and 200,000 kits (2 syringes, i.e. 400,00 syringes) via distribution machines managed by CAARUD (see below);
"• small injection equipment: 1.1
"• condoms: 782,000, 91% of which were male condoms
"• gel: approximately 292,000 units."

"For the last ten years, the Observatoire français des drogues et des toxicomanies (OFDT, or the French Monitoring Centre for Drugs and Drug Addiction) has repeatedly worked on estimating the social cost of licit and illicit drugs. The first study (Kopp et al. 1998) dates back to the 1990s and examined the possible calculation methods. The initial estimates were presented in the Kopp and Fénoglio report (Kopp et al. 2000) on Le coût social des drogues (the social cost of drugs). This initial work estimated the annual costs of the illicit drugs to society to be €2,035.24 million. Regular estimates have been carried out since then. There are two reasons for the need to continually re-estimate these figures: the appearance of new data that were initially unavailable (e.g. treatments for certain diseases) and the need to consider new calculation methods. Hence, the 2006 study assessed the social cost of illegal drugs to be €2,824.44 million in 2003 (Kopp et al. 2004). Compared to the 2000 estimate, the social cost of illicit drugs was only multiplied by a factor of approximately 1.39."

Laws & Policies

"The 2011 national strategies of the governmental policy are set forth by the 2008-2011 government action plan against drugs and drug addiction. The forward-looking 2011 report by the MILDT (Mission interministérielle de lutte contre la drogue et la toxicomanie, or the French Interministerial Mission for the Fight Against Drugs and Drug Addiction) revealed that nearly all of the government’s objectives had been achieved. Furthermore, between 2011 and 2012, three other national plans integrated and reinforced the health measures set forth in the 2008-2011 drugs plan: the 2009-2012 'hepatitis' plan, the 2009-2013 'cancer plan' and the new 2010-2012 'detainee' plan supervised by the French Ministry of Health and Sports with the participation of the French Ministry of Justice.
"Public expenditure on implementing the governmental drug policy and French national health insurance in 2010 was approximately €1,510 M. This estimate does not take into account expenditure attributable to prison administrative services or major hospital or primary care costs. These expense categories have been estimated within the scope of previous studies. Kopp and Fénoglio estimated the costs of treatment attributable to drug-related health problems at €21.58 billion in 2003; prison expenditures were estimated at €219.79 million (Kopp and Fénoglio, 2006b). After inflation, these estimates would have accounted for €26.66 billion and €0.25 billion in 2010 respectively. If we consider these latest categories of expenditure up-dated after inflation, public spending attributable to the drug and addiction prevention policy is somewhere close to €28 billion in 2010 (licit and illicit drugs). This estimate accounts roughly for 1.5 percent of the GDP in 2010 (GDP accounts for €1,931.4 billion in 2010) but also for 6.6 percent of the State’s budget which accounts for a spending of €435.37 per habitant."

"A drug user is an individual who consumes a narcotic substance. The legal authorities often liken the possession of small quantities of narcotics to use. They also equate the cultivation of cannabis to use when the substance is intended for personal consumption.
"Any drug related offence exposes a person to being arrested by the police, a gendarme or a customs officer and will, in principle, be referred to the judicial system. Offences are examined on a case-by-case basis by the public prosecutor who, based on the principle of the 'opportunité des poursuites' (appropriateness of proceedings), may decide to take legal action against the offender, to simply close the case or to propose other measures as an alternative to legal proceedings. This principle enables judicial responses to be adapted to each individual situation by providing a progressive response in accordance with the seriousness of the acts committed. It also explains the differences in penal practices employed by the courts."

"The initial interministerial anti-drug plan dates back to 1983. The 2008-2011 'Government Action Plan Against Drugs and Drug Addiction' includes almost 200 measures for prevention, enforcement, health/social care, research, observation, training and international cooperation. Priority is given to preventing people from taking drugs from the get-go, since the age of first-time use is younger and younger. This targets young people and those close to them (such as parents and educators).
"The Plan mentions several priorities for enforcing the law: alcohol abuse among the youngest users, drug related offences and/or tobacco use in public establishments, cannabis trafficking, seizure and court-ordered confiscation.
"It provides for new treatment and social integration modalities, particularly for minors, pregnant women or parents of young children, cocaine or crack users and newly-released convicts. The plan aims to increase housing capacity for addicts in vulnerable conditions.
"Finally, with respect to international policy, the 2008-2011 plan has three major objectives:
"• reinforcing (within a multilateral, European and bilateral framework) actions deployed at every stage along the trafficking routes (particularly in western Africa and the Mediterranean) in order to choke off the cannabis and cocaine supply sources in Europe and heroin outlets in central Europe and the Balkans;
"• setting up of increasing numbers of agreements with the countries concerned in order to simplify international action against the diversion of chemical precursors (particularly in Afghanistan);
"• and finally, boosting Mediterranean cooperation to coordinate the fight against drugs in the Mediterranean area.
"The 2012 electoral calendar postponed the adoption of the 2012-2015 'Government Action Plan Against Drugs and Drug Addiction'.
"The preceding plan (2004-2008) was inspired by a policy that mainly targeted young people and prevention, with a particular focus on 'halting the spread of cannabis' among adolescents and young adults. Without abandoning these efforts, the 2008-2011 Plan emphasises enforcing the law through targeted communication campaigns. The government plan can also be seen as a continuation of the French Ministry of Health’s 2007-2011 Plan for the treatment and prevention of addictions, adopted in November 2006 42, which seeks to structure and enhance the availability of existing facilities and programmes (hospitals, health/social care centres and in primary care settings)."

"The harm reduction policy for drug users is the responsibility of the government (article L3121-3 of the French Public Health Code modified by the law of 13 August 2004 - art. 71 35). This harm reduction policy seeks to prevent the spread of infection, death by intravenous drug overdose and the social and psychological damage caused by narcotics use. The law of 9 August 2004 36, which established CAARUDs [Support Centre for the Reduction of Drug-related Harms], states that, along with other schemes, CAARUDs should be used to contribute to the harm reduction policy (article L3121-5 of the Public Health Code). CAARUDs are open to both individuals and groups, provide personalised advice and information to drug users, offer support to help drug users obtain access to treatment (which includes assistance with hygiene and access to basic emergency care), make referrals to specialised or general treatment systems, encourage screening for transmissible infections, help users gain access to entitlements, housing and professional integration or rehabilitation, provide equipment to prevent infection, and intervene locally outside the centre to establish contact with users. CAARUDs³⁷ provide social mediation to ensure good integration in their neighbourhood and prevent the public disturbances related to drug use. Their coordination with other organisations has been stipulated in a circular.³⁸"

"Since May 1987³⁹, the unrestricted sale of syringes has been authorised in retail pharmacies, pharmacies located inside healthcare establishments and establishments that focus exclusively on selling medical, surgical and dental equipment or that have a specialised department for such equipment. Since March 1995⁴⁰, these may be issued free of charge by any non-profit association carrying out AIDS prevention or harm reduction activities among drug users; these associations must meet the French Ministry of Health requirements described in the decree (article D. 3121-27 of the French Public Health Code). Providing syringes and needles to minors is only authorised by prescription (art. D.3121-28 of the French Public Health Code). However, neither pharmacies nor associations are legally bound to ask users to provide their identity or age since the 1987 suspension of the provisions of the 1972 decree.
"It is not legal to arrest someone on the sole charge of narcotics use in immediate proximity to a harm reduction or syringe exchange structure (for example, pharmacy SEPs). Furthermore, simply carrying a syringe is not sufficient evidence to justify an arrest.
"A national harm reduction standard for drug users has been prepared (art. D. 3121-33 of the Public Health Code) and approved via the decree of 14 April 2005⁴¹. Among other things, this stipulates that all participants, health professionals, social workers or members of associations, in addition to any persons to whom these activities are addressed, must be protected from accusations concerning drugs use or the incitation to use drugs during their work."

"Law enforcement measures against narcotics use are more severe in certain cases, such as when this use affects road safety.
"The law of 3 February 2003 17 introduced a new offence concerning any driver whose blood test reveals the presence of narcotics. These drivers risk a sentence of two years’ imprisonment and a €4,500 fine, and drivers who simultaneously use narcotics and alcohol risk up to three years' imprisonment and a €9,000 fine. The law of 18 June 1999 18 and its application decree (of 27 August 2001) 19 introduced mandatory drug use screening for drivers involved in a road accident that was immediately fatal or for drivers suspected of narcotics use who were involved in an accident that caused bodily harm. Since the 2011 adoption of the LOPPSI 2 law 20 (loi d’orientation et de programmation pour la performance de la sécurité intérieure, which covers French law enforcement activities), and its application circular of 28 March 2011, narcotics screening has become mandatory following road accidents that cause bodily harm, whether such accidents are fatal or not. Moreover, the circular 21 of 28 March 2011 on reinforcing the fight against unsafe road conditions enables, upon requisition of a French public prosecutor, random narcotics controls on all drivers (art. L.235-2 of the French Traffic Code, modified by article 83 of LOPPSI)."

"The 16 February 2012⁴⁹ circular established new criminal policy strategies to be adopted by the judicial authorities. While reiterating the need to consider investigative elements that suggest simple use or narcotics addiction and the principle of proportionality with respect to the seriousness of the alleged offence, the February 2012 circular emphasises the need for systematic penal responses and increasingly effective judicial measures. Jurisdictions are encouraged to implement primarily educational measures for initial simple use offences. Examples of these measures include drug awareness training course and health/social strategies for addicted users (drug treatment order). Responses to minors should be limited to educational and health measures. The circular also encourages courts and courts of appeal to develop partnerships with associations to ensure the efficacy of educational and health/social measures."

"In polls before 1999, the majority view which appeared to be defined is that prosecutions and legal penalties should be imposed on consumers of heroin and of cocaine (85% in favour), of cannabis (70%) or of alcohol (approx. 50%). However, polling of such opinions is very sensitive to the way in which questions are put: three quarters of interviewees in this way, were not in favour of the idea that drug addicts should be punished. Likewise, if the person and his individual freedom are emphasised rather than the legal aspects of the question of utilisation, then one third of interviewees, as in 1999, will be induced to express their consent for the proposal according to which the prohibition of smoking cannabis is an infringement of the right for free utilisation of one's own body."