“DRUG POLICY AND PUBLIC HEALTH PROMOTION IN FRANCE”

Jean-Luc Romero,

Conseiller Régional d’Île-de-France ;

President of “Local Representatives Against Aids” (ELCS)

October 2003

Abstract of the speech given at the Lisbon International Symposium on Global Drug Policy,

23-25 October 2003, Lisbon

In France, according to the law on drug addiction, a very repressive public health law dating back from 1970, a drug user can be put in prison for one year and fined more than 3000 euros.

Since in France we decided to deal with all the drugs on an equal footing, among which alcohol, the debate on drug users has been very difficult. One has to think that even in a country as France, the land of Bordeaux and Cognac, alcoholism is a sensitive issue. The “alcohol lobby” in France is powerful since half of the MPs come from wine or alcohol production areas.

Actually, we had to wait until HIV AIDS appeard to be able to develop a new approach towards risk reduction. No longer only a criminal one, but also seeing the drug user as a victim. In 1985, it was proposed to sell needles freely…but it was not accepted, as it was during election time. In 1987 injection needles were put on sale in pharmacies. Every improvement in risk reduction was gained only because of the spreading of AIDS. Michèle Barzach was then the minister of Health and Jacques Chirac, Prime Minister at the time of the approval of the scheme.

If 1987 saw the free sale of needles in pharmacies, 1993 was the time when substitution treatment started with very few places (50). Methadone and Subutex treatments were offered much later on. Needle exchange places are areas where drug users can wash, eat, do their laundry. The “Little Prince Strategy” Idea is to start a dialogue between the users and the care workers there, offering free tests on hepatitis and AIDS.

This policy has not been fully approved by the population, although there has never been a public debate on this issue. We could see a public opposition rising when the first “boutiques” came out. The problems became more obvious through the boutiques and then people started to talk about it.

In 1995 when we decided to start a Local Representatives association, ELCS (Elus Locaux Contre le Sida), we thought that we could play a role in the policy approach. ELCS particularly works in the field of AIDS prevention.

There are many elected officals in France different levels, as in many as all the other European countries put together. Risk reduction is not easy to apply peacefully as a policy.  We take the view that it is much better if it is explained to the local population. For instance, when Marseille authorities decided to set up 9 needle exchange points throughout the city, the decision led to a huge polarised debate, with a very vindictive extreme right voicing anger against the project.

The results of this policy are hard to quantify. 100 000 to 150 000 people are affected by AIDS in France. Full-blown AIDS figures do exist, but they are not very telling. Since no compulsory declaration system was established before January, 1^st, 2003, no precise figure is available before that date. Though, a real advance has to be noted: in 1995, one fourth of AIDS cases were needle infected. In 2003, this percentage is around 4%.  A few years ago, we didn’t even believe that such good results could be obtained.

However, at the same time heterosexual spread increased…

Today, probably 70 % of heroine users have Hepatitis C. In France the crucial  debate at the moment is the security issue. The good results should be looked at, as in Marseille we find a real decrease that is completely corresponding to the substitution and risk reduction policy. If there is a political consensus on these issues, there is no much debate around them. No political party really opposes the consensus, with the notable exception of the Front National which makes a bit less that 20% of the votes.

There are still many taboos, around the issues of risk reduction: “boutiques”, “kit sniff”, (helping reducing the risk of Hepatitis C) needles, are hard to distribute, in prisons especially, even if there are substitution treatments. Some politicians are not even sure of the value of state sponsored risk reduction programs regarding needles. The same politicians are against the free distribution of subutex, even though prescribed by the municipal health authorities. The consequence is that there is a black market of subutex in the major cities.

However, the health vision seems to be going away from the repressive approach. Treating all drugs may they be legal or illicit. The Government takes the view that all drugs have to be treated in the sameway wich is a very important advance. Risk reduction among the drug users.

So far, there is no legal base for risk reduction policies, they are all against the 1970 law. Successive health ministers could actually and hypothetically be taken to court for acting against the law !

The actual Government seems to wish to reform the 1970 law: the PM asked the chair of the joint mission on drugs and drug addictions (MILDT) to advise the government on this project.

In France, according to the 1970 law, you can be imprisoned for the mere use of drugs. Even though the law is not fully applied, 200 people are still put in prison every year for personal use. A new law should be passed in 2004 in which jail sentences will probably be removed.

Surely we are not yet in a depenalisation or legalisation debate. Maybe we can follow the Swiss and Dutch examples ?

When Europe has a common policy, France might then go down this path. But, so far, we do not have a Europe of joint drug policy.

To conclude on the global fund against AIDS, involved in this fight, I am very sad to see that there is only 4Bn USD dedicated to this fund.  This is shameful, because it’s necessary to have 10 Bn USD to stop the epidemic. France, taking a right step, decided to triple its contribution to the fund and raise to 150 million its current contribution. President Chirac also asked Europe to give 1Bn USD for the fund from the EU budget.

We have to bear in mind that 10 Bn USD  is really nothing compared to the cost of a war in Iraq, the war against terrorism (200Bn UDS) or even a Football worldcup.