Fears That Reticent Mayors May Hinder Rollout of French Drug Consumption Rooms
Harm reduction breakthrough in France as Senate approves drug consumption rooms amid fears that unwilling mayors may refuse these vital outreach measures.
Despite receiving a huge majority (185-30 in favour) in the right wing-dominated French Senate voting to approve a six-year trial of drug consumption rooms (DCR), political resistance remains high and only two cities - Paris and Strasbourg - have officially applied to the scheme.
The first DCR should open in Paris early next year in the Lariboisière hospital situated in the 10th district. Initially planned to be community-based, metres away from the famous Gare Du Nord train station, the site was altered due to neighbourhood opposition reported news service Europe 1.
Responding to local residents’ concerns about increased crime and public nuisance in the area, the 10th district’s mayor instead decided to open the DCR in Lariboisière hospital with a separate entrance.
Strasbourg has submitted an application to open a DCR and the mayor has publicly committed not to "leave fragile people suffering from an addiction adrift, even if they are breaking the law", reported French newspaper 20 Minutes.
Strasbourg, and the surrounding Alsace area, is a border region with a high drug supply where 47 percent of people who inject drugs had a form of hepatitis in 2011, according to the Expert Service to Combat Viral Hepatitis in Alsace.
In response to this alarming situation, the deputy mayor of Strasbourg hopes to open a hospital space for between eight and ten people who use drugs providing an everyday service, reported French medical newspaper Le Quotidien du médecin. The mayor believes the centre should be in a hospital and near the emergency services to minimize objection from neighbours and because people who use drugs problematically need easy access to medical services.
In order to monitor which drugs are used, drug users will have to complete a questionnaire and show which drugs they are carrying before being permitted to enter the consumption room. To avoid overdoses drug users will be asked to rest in a relaxing room before leaving, the nascent project’s director Daniele Bader-Ledit told L’Alsace.
Although Marisol Touraine, Minister of Social Affairs and Health, has not confirmed the application of a third city, it is highly likely that Bordeaux will follow this reformist momentum. 20 Minutes reports that the right-wing mayor, Alain Juppé, is thinking about applying for a DCR - a hopeful sign that these measures could obtain bipartisan support.
Volunteer cities must apply to participate in the trial and each project will be managed by a local organisation. Drug users, who must be over 18, will be permitted to consume drugs under the supervision of a team of health professionals with access to sterile equipment and facilities. Only hard drugs are allowed and drug users must bring their own drugs. To avoid encouraging drug use or experimentation, urine tests and anonymous "drug declarations" are planned reported newspaper FranceSoir.
Some large cities have decided to reject this harm reduction approach. Despite a group of experts estimating the city needs three DCRs, the mayor of Marseille Jean-Claude Gaudin has moved away from his previous reformist position to recently reject opening these centres according to France Bleu.
Nice’s mayor Christian Estrosi also seems to take a harder line compared to his 2012 less-clear cut position, reported Nice-Matin. Rejecting the clear evidence in favour of introducing DCRs, Estrosi has stated that DCRs encourage people to use drugs and their introduction is the first step toward legalizing drugs.
The evidence on DCRs however clearly points to their effectiveness in getting people who use drugs problematically into treatment, reducing the spread of disease and preventing overdose deaths.
In Spain for example, overdose deaths decreased from 1 833 in 1991 to 773 in 2008 after the introduction of these facilities and new HIV infections among clients dropped from 19.9 percent in 2004 to 8.2 percent in 2008.
Two years after Vancouver set up Insite a medically supervised injection site with treatment facilities, overdose deaths fell 35 percent within 500 meters of the facility compared to just 9 percent in the city as a whole. Insite has been shown to prevent approximately 35 cases of HIV per year and to increase uptake of drug detoxification services by 30 percent.
With a Hepatitis C infection rate of 41.7 percent and 7.2 percent HIV positive rate according to Harm Reduction International, France’s 122,000 injecting drug users need public officials to pursue a pragmatic, evidence-driven response. There are at least 98 DCRs in 66 cities around the world; the first opened in Switzerland in 1986. This harm reduction measure is far from a new solution and the evidence shows that they work.
Drug consumption rooms are more than just places to inject drugs safely. They are places where the most marginalized people who use drugs can be offered medical services, counselling and a measure of stability in what can be very chaotic lives.
Concerns have been raised about possible aggressive police targeting of people who use drugs in the streets around these drug consumption rooms. L’Alsace reports that a “neutrality zone” will be set up approximately 200 or 300 meters around the site in which drug users will be safe from arrest for drug possession, as long as they are only carrying drugs for personal use.
However, the police attitude toward drug users is uncertain. Police officers may respond with an enforcement crackdown; as in 1992 where they arrested people in possession of small quantities of drugs near a Doctors of the World mobile dispensary where sterile syringes were being distributed.
As ever with harm reduction policy, nothing can be taken for granted. Political interests remain the top priority, as illustrated by the Senate vote in which the majority of right-wing senators chose to be absent. The success of this six-year trial period will in all likelihood depend on the whims of public approval.