Toxicomanies: la politique de réduction des risques en France et en Espagne

Abstract

Harm reduction policies, such as needle exchange programs, injection centers, and substitution treatments, attempt to reduce the health and social damage associated with illegal drug use. Such policies were introduced in France and Spain in response to the urgent health threat that AIDS posed to injecting drug users.This analysis of harm reduction policies as of 2003, in France and Spain, includes a review of the literature and relevant legal and administrative provisions; collection of indicators likely to illustrate the health effects of these policies; analysis of available information and information systems, to examine comparability; and finally, comparison of these indicators.Differences between France and Spain led to easier integration of harm reduction into global drug policy in Spain, while there was some resistance to its acceptance in France. Nonetheless, impact indicators follow the same trends in both cases. Implementation of harm reduction policies has been followed by a reduction in injection practices, HIV prevalence, and deaths from overdoses among injecting drug users. The prevalence of HIV among this population has fallen substantially more in France than in Spain.The impact of harm reduction policies in France and Spain appears very positive, although any effect on Hepatitis C virus remains unclear, probably because of the virus's inherent characteristics of resistance and infectiousness. The reasons for the more marked difference in HIV prevalence in France may be that sharing practices are more widespread in Spain than in France, that the proportion of injecting drug users with HIV at the beginning of the epidemic was higher in Spain, or that the impact of substitution treatments has been stronger in France because of different modes of management.