The french paradoxe: Substitution treatments success

1
The french paradoxe Substitution treatments
success

• How to be successful with scare, hypocrisy, and
  ignorance.

2
The problem (1)

• In France, drug use is still assimilated to
  heroin and injection.
• Our law is targeted on it (in mixing cure and
  prison)
• Most of the specialized medical sector is also
  based on heroin cure treatments and post-cures
  treatments
• Most of the representations of the real drug
  user, including for drugs users themselves, are
  based on the injected heroin addicted.
• Exemple cannabis smokers, extasy consumers, even
  some cocain addicts speak about themselves as non
  drugs users-non toxicomanes-Because they are not
  consuming heroin by injection

3
The problem (2)

• consequences of this obsession and confusion
  between drugs addiction and injection of heroin
• - Repression at a very high level
• - Aids and hep. C epidemy at a very high level
• - Scare of the society at a very high level
• This is the very chance of substitution
  treatments (and incidently of self support) in
  France

4
First Paradox
from criminality to long term desease

• Scare is the main explanation of the incredible
  liberalism of the french substitution system
  regarding to the repression of drugs use.
• toxicomanes used to fright french society during
  the 70s, 80s, and the main course for
  reassurance was there rehabilitation by medecine.
• The late arrival of harm reduction materials
  cause a feeling of guiltyness among specialists.
• Substitution treatments(S.T.) allowed the
  medical system to take the place of the police.

5
Second paradox a high level of repression
makes good pupils for treatments

• A lot of heroin users were only sick from
  prohibition The cure was very simple a secured
  access to opiates and a care about the
  prohibition injuries (aids, hep etc)
• With this simple care, a lot of french d.u.
  became patients( first with morfin and second
  mainly with buprenorfin)

6
Last paradoxsubstitution treatments success the
big secret

• 100 000 people are taking opiates in a nearly
  clandestine way.
• No major campaign on the subject in the direction
  of users, nor in the general population
• The reason why always scare, but this time,
  scare of the election (the dealers en blouse
  blanches syndrom)

7
The big hypocrisy the question of pleasure
(1)The health authorities point of view

• Substitution treatments has been sold to french
  society as a simple medication the medication
  wich cures addiction (le médicament qui soigne
  la drogue). In french the word drogue is very
  distinct from the word médicament. The big
  difference is a moral casualtie
• drogue include pleasure
• médicamentmeans end of pain.
• For the french health authorities, S. T. should
  appear asmedicament
• -Subutex has been chosen to be the main s.t.
  cause of his supposed non euphoric properties.

8
The question of pleasure(2)The patients point
of view

• For most of drugs users s.t. seems to be
  drogues and not only médicaments (thats why
  it is efficient).
• From the beginning the question of confort
  (better word than pleasure) is included in the
  s.t. whole problem.
• But
• Hypocrisy is shared by patients. They understand
  that pleasure should be hidden to be tolerated.
  Consequences
• Subutex has been injected in a controversial
  proportion.
• There is a cocaine progression beside methadon
  increase.
• Alcool and benzodiazepins are consumed in a small
  proportion
• -Black market of s.t is increasing(blackmarcket
  change the statute of medicaments into drogue)

9
EGUS to Break the ignorance

• This question of pleasure has been central in the
  first official meeting of people living with
  substitution treatments, organized on june 5th
  2004 in Paris, by ASUD and Act-Up .
• First meeting organized for 10 years of s.t.

10
Substitution users demands

• The twelve EGUS demands (Etats Généraux des
  Usagers de la Substitution) has been established
  during the 1st general session of substitution
  treatments users held on 5th of june 2004 at the
  European Hospital Georges Pompidou, in Paris.

• N1
• Enlarge the offer of substitution treatments
  (heroin, morphin, codein) with galenics
  appropriate
• N 2
• Priority to the patient choice in the matter of
  molecule and dosage
• N4
• Knowledge of the usefulness of therapeutic
  alternation

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Conclusion

• S.T. brings a new reality in the matter of
  medical prescription.
• A new relationship with physicians based on a
  more equal knowledge about the substances
• A new relationship with prescription based on the
  place of confort, or pleasure (both things very
  difficult to assess with analysis).
• In fact, it is the place of the patient, who
  moves from object to subject. The reality of the
  disease step back in the same time than moral
  repression.
• The objectiv is not to ill drugs users, but let
  them cure themselves in the way they want.