MORTALITY AND DRUG ADDICTION

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MORTALITY AND DRUG ADDICTION

• François Hervé
• A.N.I.T.
• Glasgow 8 août 2005

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What are the facts?

• In the eighties, increase of the mortality
• Overdoses
• Aids
• By the time treatments where mainly
• Withdrowal (only 50 people in France in methadone
  programs)
• Psychosociological treatments in rehabilitation
  facilities
• No much consideration for the health of the
  patients, beside addiction

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Time for debates

• End of the eighties
• Debates about harm reduction
• Interest for foreign models
• Switzerland (4 pillars prevention, treatment,
  harm reduction, repression)
• Nederland (organisations of drug users)
• England (involvement of gps)
• Needle exchange
• Methadone and substitution
• ?1988 free access to serynges at chemists

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Time for action new policies

• Early nineties
• Beginning of harm reduction strategies
• Methadone (1994)
• Buprenorphine (subutex)(1996)
• Harm reduction facilities
• Needle exchange
• Street work

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EFFECTS ON THE NUMBER OF DEATH
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EVOLUTION OF DEATHS BY OD
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Number of deaths due to aids among injecting drug
users
Apparition of treatments Better acces to
treatments
24 of the deaths due to aids
?
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New cases of Aids among drug users
Harm reduction
30 of the new contaminations
2,8 of the new contaminations
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Development of the substitution treatments
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Rules for presciption
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CONCLUSION PART 1Good results

• The number of deaths by overdoses registred by
  the police decreases since 1995, after a maximum
  (564) in 1994 , 89 deaths in 2003.
• In 2003, héroïne is still the drug the most
  often involved in death by OD (39 of the cases)
  but the part of heroine decreases regularly (90
  in 1993 and 1994)
• An increasing proportion of deaths involves the
  use of medecine drugs, including méthadone and
  Subutex, (31 en 2003,15 en 1995).
• The number of overdoses due to cocaïne and
  ecstasy is also increasing (11 et 10 in 2003
  against less than 1 in 1995 for cocaïne and 7,5
  in 2001 for ecstasy). 

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Discussion Some hypotheses

• Less interest of the users for heroin,
• since the avability of substitution treatments
• because a bad image of heroin and injection
• Less injections
• Better knowledge of the treatment of OD by the
  emergengy medical units, and by the users.
• The important rise of overdoses in the late 80ies
  early 90ies could be due to the context aids,
  number of dying people, lack of treatments,
  leading to more self destructive behaviors the
  treatments of aids may have had more incidence on
  the diminution of deaths than the substitution
  treatments.

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CONCLUSION PART 1New problems

• Trafic 6 to 10 of the users divert 25 of the
  treatments? black market
• 6 of the individuals receiving a prescription
  over a 6 month period carry on a significant
  traffickng activity they receive more than 32 mg
  of HDB per day (51 mg on average) (CNAMTS)
• The average daily treatment is 9.6mg. On this
  basis
• Patients really engaged in long term treatment
  52000
• Patients receiving precriptions on an irregular
  basis about 22000
• Users of buprenorphine without precription at
  least 4000
• Misuse
• injecting, 11 in medical protocols, 54 for
  those who expect a product for getting  high 
• sniffing,
• Starting addiction with subutex
• ? important to know more about the behavior of
  the users
• ? No incidence on the number of drug users

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Evolution since 1992 of drug use, among 18-44
years old population

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Overmortality according to product involved in
the arrest
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Fighting drug related deaths Knowing more about
addictions

• Importance to have a good knowledge of
• The new drugs arriving on the market
• Their diffusion
• The new ways to use them
• The expectations and behaviors of the users

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Two Main systems of observation

• TREND (tendances récentes et nouvelles drogues)
  (New tendancies and new drugs)
• SINTES (Système didentification national des
  toxiques et des substances)(National System of
  identification of toxics and substances)

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TREND

• Objectives
• Give to the policy makers, professionnals and
  drug users some elements of knowledge able to
  modify their decisions or their practice
• Means
• A network of several sites collecting
  informations
• Continue collect and analysis
• Annual report

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TREND 2

• Combination of differents tools
• Focal groups
• Ethnographic observations
• Qualitatives questionnaries
• Quantitatives enquiries (in low threshold
  facilities)
• Interviews of ressource people
• Interviews of users

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TREND 3

• Who collects the data?
• Drug Users
• Ethnographic professionnals
• Members of the teams from harm reduction actions
• Teams involved in harm reduction on the techno
  scene
• Medical teams
• police

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TREND 4

• Data collected
• Characterics of users
• Ways to use drugs
• Social and health damages
• Perception of the drugs
• Ways to get drugs
• New populations of users
• Treatment of the information about drug by the
  media (press)

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SINTES (Système National dIdentification des
Toxiques et des Substances)

• Objectives
• identify new tendencies or new drugs
  (identification of new molecules or new
  association of molecules, by the mean of analysis
  of synthetic drugs)
• Methodology
• Continue Collect of the drug by a network of
  actors (involved in prevention, harm reduction)
• Files coming from the laboratories of the police
  and the customs

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sintes
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SINTES (Système National dIdentification des
Toxiques et des Substances)

• Diffusion of information N1week
• Annual report

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Conclusion

• 564?89 death (at least)
• What had an impact on drug related deaths?

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• To be as near as possible of the drug users, when
  and where they use drugs
• More consideration for their health
• A better knowledge of behaviors and substances
• A better communication betwen policy makers,
  professionnals, and drug users

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BUT
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Have we solved the addictions problems with new
policies?
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No.

• We just change it.