DRUG
USE IN France : TOOLS AND TRENDS IN 2001
Appearance before the
Canadian Senate Committee on Drugs
October 1, 2001
Jean-Michel Costes, Director, OFDT
The OFDT: An Independent Agency Serving Public Authorities
Background, status,
organization
It has been confirmed in France over
the past twenty years, and particularly in the last three public-sector reports
on the fight against drugs and drug addiction (Pelletier, Trautmann and Henrion),
that there is a need to establish a mechanism for monitoring and disseminating
information on drugs and drug addiction among decision makers and scientists.
In late
1995, as a result of those recommendations, public authorities created the
French Monitoring Centre for Drugs and Drug Addiction (OFDT) in the legal form
of a public interest group (GIP). The
GIP format was chosen for the OFDT after much debate (three years of
consultations). It gives the centre
autonomy in its mission to monitor as opposed to coordinate and act under
the authority of the MILDT [inter-ministry mission to fight rugs and drug
addiction] and separate legal status since it operates under the rules of public
accounting and is subject to monitoring by the Court of Auditors.
The OFDT
Board of Directors includes representatives of:
§
the State: the
various ministries involved in the fight against drugs and drug addiction, i.e.
Employment and Solidarity, Health, Municipalities, Justice, Defence, the
Interior, Foreign Affairs, Budget, Youth and Sport, Education, Research and the MILDT;
§ public and private corporations: the national documentation network Toxibase and the Fédération Nationale des Observatoires Régionaux de Santé (FNORS).
The OFDT bases its initiatives on the expert report of a Scientific Committee
made up of representatives of the main data-producing bodies and influential
individuals appointed in a personal capacity.
These influential people are recognized for their expertise in fields
that fall within the objectives of the group. The Scientific Committee is
consulted on projects that make up the OFDT’s
programme and formulates opinions on projects and their organization and results.
The OFDT
team (25 strong) includes people who specialize in the various fields
(epidemiology, sociology, statistics, evaluation, etc.) included in “poles”
within the OFDT that encompass its missions and tasks: surveys of the general
population; recent trends; indicators; evaluation of public policy; enhancement
of information; and joint services (technical, secretarial, financial).
The OFDT
is a forum in which many different approaches and competencies can interact with
and enrich one another. It carries
out its activities in conjunction with existing mechanisms and so as to avoid
duplication.
Within
the context of Europe, the OFDT is, for France, the focal point of the REITOX
(European information network on drugs and drug addictions) network set up by
the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA).
Almost
all of the cost of the OFDT’s activities is covered by a government grant from
the interministry allocation for the fight against drugs and drug addiction.
The OFDT’s European activities are covered by the EMCDDA.
The projected budget for 2001 was 23 million francs, of which 10 million
francs was earmarked for research.
Missions,
initiatives
The
OFDT’s missions are set out in the agreement creating the public
interest group: monitoring of drugs and drug addiction; compilation, analysis,
summary and dissemination of data, and quantitative and qualitative improvement
of data; receipt, dissemination and enhancement of analyses in all areas related
to drugs and drug addiction; expertise and research in those fields.
Under the three-year plan adopted on June 16, 1999, the main missions of
the OFDT were broadened to include legal substances: alcohol, tobacco and
psychoactive medication.
The
OFDT’s work priorities are:
Monitoring and
improvement of indicators
The OFDT
analyses available indicators on drugs and drug use. It suggests measures for improving the quality and
reliability of sources from different ministries and agencies. If weaknesses come to light,
the OFDT supports efforts to rectify them. One example is the mechanism the OFDT put in place in 1999 to
monitor drug use in the general population on an ongoing basis by conducting or
arranging to have outside teams conduct period drug use surveys.
Monitoring of trends
Monitoring
is carried out by a network of local monitors in urban areas and at special
events, the “recent trends and new drugs” mechanism, a system for analysing
and classifying samples of synthetic products and the database SINTES [national
identification system for toxins and other substances].
The goal is to learn more about emerging trends in substance use,
patterns and impact of use, and the types of products being used.
Evaluation of public
policy
The OFDT
helps develop a general framework for evaluating public policy.
It develops methodologies and expertise based on foreign efforts, where
applicable. It initiates and
follows through on evaluations of public undertakings, including national
policies and international cooperation projects.
Expertise
The OFDT
responds to requests for expertise and intervention from major bodies in France
and around the world. It may also
be contacted by local or national players interested in having their projects
validated.
Distribution and
promotion
The OFDT
produces publications to promote its work and studies and research in the area
of drugs and drug dependency.
Monitoring
methods: information sources
The
information sources used by the OFDT can be divided into five broad categories.
Surveys of the general
population
These
surveys are based on respondents’ statements.
This type of investigation is aimed at measuring behaviour, attitudes and
opinion among all or part of the population regarding substance use.
The method consists in asking a representative sample of the target
population to answer questions. The
advantage of surveys is that they directly measure the phenomenon, particularly
the scope of the phenomenon, in the general population and are a fairly accurate
gauge of changes. It is sometimes
difficult, however, to identify from these surveys behaviour that is relatively
uncommon. The results provide an
image of reported use that may or may not be the same as actual use.
Records
National
statistics derived from mandatory declarations (death, AIDS, etc.) can also be
used to estimate some substance abuse from the standpoint of damage caused.
Administrative statistics
Administrative
statistics and studies targeting a specific population defined by the
institution that works in the particular field (for example, health/patients,
justice/prison inmates) offer a glimpse of the phenomenon of drug use from a
specific perspective. The hidden
population not seen by the institution is by definition not included in these
statistics.
These
information sources are particularly valuable in analysing major trends because
of their continuity, regularity and availability. They must nevertheless be used carefully, and it is important
to bear their limits in mind. The
indicators they produce are “indirect indicators”; the inertia inherent in
the process through which they are produced usually makes it impossible to shed
light on recent trends. Moreover,
these information sources pose specific problems: limitation of their
theoretical scope, reliability, duplication, etc.
Qualitative studies
Special
studies look at subgroups of the population directly affected by drug use but
not selected institutionally. Ethnographic
studies are an example. Apart from
providing a quality description of drug use and behaviour, this type of approach
addresses the “hidden” part of the phenomenon: people who are not seen by
any institution. These special
studies describe behaviour qualitatively but do not measure the scope of that
behaviour.
Monitoring of emerging
phenomena
Since
1999, the OFDT has had a specific mechanism for monitoring emerging phenomena
(TREND). The mechanism comprises a
network of observers (or “sentinels”) who focus on the “urban element”
(marginalized drug addicts) and the “party element” (drug users who go to
night clubs and “techno” gatherings) and a system for collecting and
analysing synthetic drugs. This
mechanism, a hybrid of the various methods described above, is unique in what it
monitors: emerging phenomena. It
does not preclude statistical methods, but the information it provides is
primarily qualitative: field observations which, when cross validated and
analysed, bring to light trends which complement the findings of surveys and
ongoing statistics.
Illegal drugs in
France: trends in 2001
Perceptions,
opinions
The
French have a very clear hierarchy of drugs based on potential hazard: heroin,
cocaine and, to a lesser degree, ecstasy are far and way the leaders, while
marijuana, alcohol and tobacco are considered to pose less of a risk.
Perceptions
are linked to certain personal characteristics, primarily age and pattern of
use. This is particularly evident
in the case of marijuana: the perception of the potential danger of marijuana,
the belief that marijuana use leads to the use of harder drugs and questions
about the legal status of the drug depend very much on whether or not the person
has used marijuana.
Public
acceptance of French policy on drugs is strong: the public is generally
supportive of measures to reduce risks but still wants to retain the existing
prohibition. Two thirds of the
public in France still think marijuana should be an illegal drug; the others
think it should be regulated.
Drug
use
Legal
and illegal drugs
A
very large majority of the general adult population (18-75 years of age)
in France has experimented with legal drugs.
Legal drugs have been repeatedly or regularly used by large segments of
the population and account for a very large proportion of the damage associated
with drug use.
Experimentation
with and especially current use of illegal drugs are less common.
Drugs other than marijuana, which one person in five in France has tried,
involve only a small percentage of the population.
Drug
use is more prevalent in men than in women and more common among younger adults,
with the exception of alcohol (use increases with age) and prescription drugs
(use increases with age and is more prevalent in women).
In
the 1990s, tobacco use declined, use of alcohol and psychotropic drugs remained
steady (with the exception of antidepressants, use of which increased), and
marijuana use increased.
The
findings among youth are fairly similar, although there are some dramatic
differences. In contrast to the
trend among adults, tobacco use among young people is rising, and the gap
between the number of girls and the number of boys who smoke is narrowing.
Use of psychotropic drugs not prescribed by a physician is up sharply,
especially among boys.
Increased
marijuana use is much more prevalent among young people.
Experimentation with the drug in late adolescence has crossed the
symbolic 50% threshold
Use
of other drugs has not attained the levels of marijuana use, but there are
indications that young people, particularly in party situations, are trying and
using a wider array of drugs: mushrooms, synthetic drugs and, to a lesser
degree, cocaine.
Young
people are usually introduced to the three main drugs in the following order:
alcohol (13 years), tobacco (14 years) and marijuana (15 years).
Use of these three drugs is very much interconnected.
Marijuana
Marijuana
use has increased sharply in recent years, especially among young people..
In
2000, one in five people in France had tried marijuana.
By late adolescence, a majority of young people have experimented with
the drug.
Marijuana
use among young people is for the most part casual, although it does become more
regular and more intense with age. Among
19-year-old boys who had tried marijuana (60%), more than one in three used the
drug regularly or heavily.
Marijuana
use occurs in all social classes. It is still very much linked to age and, to a lesser degree,
sex: use is high among adolescents and young adults, then drops off and becomes
marginal after the age of 50; use is more prevalent among males.
However, the difference between the sexes is less pronounced among
younger users.
Marijuana
use is very often associated with use of tobacco and alcohol.
In party situations, marijuana is very common, used alongside stimulants
and hallucinogens where they are encountered.
Ecstasy
and amphetamines
Ecstasy
use was first observed in France in the early 1990s and has grown steadily
since. Experimentation with the
drug and especially its current use are still fairly limited, however.
The drug is apparently used only by young adults in party situations.
Experimentation
among the adult population is low (0.7% for women and 2.2% for men between the
ages of 18 and 44). Among young
people, experimentation ranges from 1% to 7% depending on sex and age.
Amphetamine
use has a longer history, but like ecstasy, experimentation with and current use
of amphetamines are still limited.
Experimentation
among the adult population is low in the 18-44 age group (1.2% for women and
2.3% for men). Among young people,
experimentation ranges from 1% to 4% depending on sex and age.
Fewer
women report having tried ecstasy and amphetamines. For both sexes, prevalence
increases with age.
Use
of ecstasy and amphetamines is often associated with use of other legal and
illegal drugs, primarily alcohol, tobacco and marijuana.
This is especially true in party situations, where these substances are
associated with other stimulants and hallucinogens.
LSD,
mushrooms and other hallucinogens
Experimentation
with and current use of LSD, mushrooms and other hallucinogens are relatively
limited among the general population. Use
of these substances is primarily limited to young adults and party situations,
where there has been an increase in recent years.
Among
the adult population, experimentation with LSD is low in the 18-44 age group
(1.5% for women and 3.5% for men) and relatively higher at the two extreme ends
of the age range. This is
attributable to the higher incidence of experimentation among young people today
and in the 1970s. Among youth,
experimentation ranges from 1% to 5% depending on sex and age.
Mushroom
use is relatively more common than LSD use among young people; experimentation
can be as high as almost 9% (19-year-old boys).
As
with all illegal drugs, fewer women report having tried LSD and mushrooms.
LSD
and mushroom use are often associated with use of other legal and illegal drugs,
primarily alcohol, tobacco and marijuana. This
is especially true in party situations, where these substances are associated
with other stimulants, ecstasy in particular.
Cocaine,
crack
Use
of stimulants in general and cocaine in particular seems to have increased in
recent years, especially among specific populations (people attending parties
and opiate addicts).
Experimentation
with and especially current use of cocaine are still relatively limited: in
2000, one person in five in France had tried cocaine.
Among
the adult population, the highest levels of experimentation are generally in the
18-44 age group and especially the 35-44 age group (1.6% for women and 4% for
men). Among young people,
experimentation ranges from 1% to
3% depending on sex and age.
Fewer
women report having experimented with cocaine, and for both sexes,
experimentation is most common among young adults.
Cocaine
use is often associated with use of other legal and illegal drugs, primarily
alcohol, tobacco and marijuana. This is especially true in party situations, where cocaine is
also associated with other stimulants and hallucinogens.
Heroin
and other opiates
Experimentation
with and especially current use of heroin and other opiates are still rare among
both adults and adolescents.
Among
the population 18 to 44, 0.4% of women and 1.7% of men have tried heroin.
Among school-age youth, 0.8% of girls and 1.4% of boys 14 to 18 said they
had taken heroin during their life.
In
all age groups, there are more male users than female users.
Occasional
heroin use is associated with use of other legal and illegal drugs, primarily
alcohol, tobacco and marijuana. This is especially true in party situations, where heroin has
recently become associated with other stimulants and hallucinogens.
Heroin
addiction is far more limited despite a higher social profile (an estimated 150
to 180,000 “problem” cocaine or opiate users, most of them opiate users).
Multiple
drug use
Among
adults, more than 15% of the population between the ages of 18 to 44 make
repeated use of alcohol, tobacco and/or marijuana.
This pattern of use is far more prevalent among people who have
experimented with at least one illegal drug (primarily marijuana).
Marijuana users also commonly use alcohol and tobacco; these behaviours
can be concomitant.
Among
youth, multiple use of drugs – primarily tobacco, marijuana and alcohol
– is even more common because of the high level of marijuana use: almost one
youth in four in late adolescence is a multiple user.
The behaviour is more common in males and increases in frequency with
age.
In
party situations and among illegal drug abusers or addicts, multiple drug use is
a widespread phenomenon. It is a
response to the regulatory effects of various psychoactive substances:
sedatives, stimulants and hallucinogens.
Health
and social implications
Legal
and illegal drugs
Legal
drugs have the most serious impact on health.
An estimated 45,000 people a year die in France as a result of alcohol,
while 60,000 die as a result of smoking. At
present, the number of deaths attributed annually to illegal drugs cannot be
estimated; the only data available are overdose deaths reported by police
departments and AIDS deaths among drug users (there were approximately 300 such
deaths in 2000).
The
impact of various drugs on mortality cannot be fully compared because of the
incomplete data on illegal drugs and because the estimated deaths do not pertain
to the same population. It is
primarily a population over the age of 60 in the case of alcohol and tobacco and
a population with an average age of 30 in the case of illegal drugs.
Heroine,
other opiates, cocaine and crack
Heroin
continues to be the most problematic illegal drug.
Heroin is still the drug most likely to force illegal drug users to seek
health care or use social services. Cocaine
use is also more common, particularly in conjunction with opiates.
Much
of the population affected by opiate or cocaine addiction are involved in health
care and social services; specifically, they are undergoing substitution
treatment. The establishment and
rapid growth of substitution treatment in the mid 1990s dramatically changed the
way opiate users were handled. Today,
the vast majority of opiate users are receiving substitution treatment.
In early 2001, an estimated 84,000 opiate users were undergoing
substitution treatment; buprenorphine (74,000) was more commonly prescribed than
methadone (11, 000).
The
vast majority of those undergoing treatment (70%) are being treated for opiate
abuse or addiction. Between 1997
and 1999, the number of people treated for opiate use stayed more or less the
same, whereas their relative share decreased, mainly because of increases
related to marijuana and cocaine. The number of people being treated by the
health and social services system for cocaine or crack use increased sharply
between 1997 and 1999. That
increase was mainly attributable to users who were already being monitored,
opiate addicts, many of them undergoing substitution treatment.
The
population of opiate users undergoing treatment continues to age.
The average age is increasing by about one year every two years: in
November 1999, the average age was 31 years and only a small minority (13%) was
under 25. Most were men (3 out of
4), and most were unemployed (more than 60%), although the proportion of people
with paying jobs has increased in recent years.
Most of these people (more than 70%) have already been treated for their
opiate use.
Among
people affected by opiate abuse or addiction, the old practice of intravenous
injection is very common; current practice is declining.
In
line with the development of the risk reduction policy and the development of
substitution treatment, the number of overdose deaths reported by police has
fallen sharply since 1994 (564 in 1994, 119 in 2000).
Heroin is still the most common factor in overdose deaths (70 of 119 in
2000).
The
decline in the prevalence of HIV that began in the early 1990s continues: 16%
for IV drug users in 1999. The
number of AIDS deaths among drug users continued to drop as it has since 1994
since the life expectancy of new recipients of antiviral treatment grows longer
(1,037 in 1994, 180 in 2000).
The
prevalence of hepatitis C has climbed very high: 63% among IV drug users in
1999.
Marijuana
and other drugs
The
number of people undergoing treatment for marijuana use increased significantly
between 1997 and 1999.
Marijuana
use is the reason for treatment in more than 15% of cases.
The
profile of persons being treated for marijuana use is very different from the
profile of opiate users: they are younger (25 years on average), more likely to
be in treatment for the first time (60%) and primarily referred by the courts
(25%).
In
the absence of data on the role of marijuana in traffic accidents and cancer,
marijuana use is not currently considered as having serious consequences
(morbidity and mortality).
Ecstasy,
amphetamines and hallucinogens account for a very small number of cases of
people undergoing treatment; the numbers seem to have been steady for the past
several years.
Multiple
drug use
More
than half of all drug users who have turned to the health care system are
multiple addicts. Opiates are a
prominent factor in multiple drug use. They
are associated with cocaine, marijuana, psychotropic drugs and alcohol.
Owing
to the clandestine nature of the illegal drug market, drugs may contain
psychoactive substances the interaction between which is largely unknown.
In the case of ecstasy, it is estimated that one third of the pills taken
contain several psychoactive substances.
In
2000, 45% (54) of overdose deaths reported by police showed the presence of more
than one substance. That percentage
has been rising in recent years.
Criminal
implications
Narcotics
offences led to more than 100,000 charges being laid in 2000.
The number of charges has been increasing steadily since the 1970s; most
of the charges are against users (95,000 for use or use/dealing, or 93.5% of the
total), marijuana users in particular.
Charges
for use can end up in court and result in conviction (15,000 in 1999).
Drug use is often accompanied by another drug offence (trafficking) or
some other type of offence. The
number of convictions for use has been steady for several years.
Incarceration for simple use is rare (approximately 400 in 2000) and has
been declining through the 1990.
Marijuana
Charges
for marijuana use or use/dealing rose dramatically during the 1990s.
It is far and away the substance most commonly involved in charges
against users (79,000 out of 90,000).
Marijuana
users are the youngest users against whom charges are laid (average of 22
years). Minors charged with
marijuana use are very much a minority, but their number is growing steadily and
the average age is getting lower and lower, the reverse of the trend among other
users charged with an offence.
Heroin
Heroin
is the second most commonly involved substance in charges of drug use or
use/dealing (5,800 in 2000), far behind marijuana (82,300 charges) and ahead of
cocaine (approximately 3,200 charges).
The
number of charges against heroin users has been declining since 1996.
The proportion of heroin charges among the total number of charges is
also down (6.2% in 2000). The trend seems to be moving toward stabilization of the
number of charges, according to the latest data.
Cocaine, crack
Charges
for cocaine or crack use or use/dealing have skyrocketed over the past decade,
particularly since 1997. They are
still a very small minority compared with charges for marijuana use or
use/dealing (3,200, compared with 82,300), but they now equal half the number of
charges related to heroin (5,800).
The
average age of cocaine and crack users against whom charges are laid is
increasing. In 1999, the average
ages were 29 and 31 years respectively.
Ecstasy and amphetamines
Charges
for ecstasy use or use/dealing have soared over the past decade, with the
exception of 1998-1999. They are
still a very small minority in the total number of charges for drug use or
use/dealing (1,900 out of 94,300). Charges
related to amphetamines are fairly stable and marginal (about 100).
Ecstasy
users against whom charges are laid are more similar to marijuana users than to
heroin or cocaine users. They are
young, for the most part between 18 and 25.
LSD, mushrooms and other
hallucinogens
After a
net increase in the first half of the 1990s, the number of charges for LSD use
or use/dealing stabilized at a level that is still marginal compared to the
total number of charges (approximately 200).
In contrast, during the second half of the 1990s, the number of charges
related to mushrooms grew, although it is still small (approximately 150).
Supply of illegal drugs
The
supply of illegal drugs is dominated by marijuana, seizures of which have
tripled in quantity over the past decade. On
a global basis, the black market for marijuana, cocaine and synthetic drugs is
growing, while the heroin market appears to be stagnant.
The
number of charges and convictions for drug trafficking had been growing since
the early 1990s but was dropping at the end of the decade.
Data on charges in 2000 show the trend is turning around, with an
increase for all substances. Marijuana still leads the way, although less so regarding
prosecutions for drug use.
Marijuana
The
number of seizures and the quantities of marijuana seized are up.
Many of the seizures made in France involve hashish from Morocco.
Marijuana
is very accessible because of moderate prices and a plentiful supply.
The type of substances used varies greatly, particularly in terms of the
amount of active ingredient (THC) they contain.
Analysis of samples seized showed considerable amounts of highly
concentrated (THC >8%) cannabis resin in 4 out of 10 cases.
Heroin and other opiates
The
quantities of heroin seized were very much up and down in the 1990s.
After three consecutive years of sharp decline after 1996, a strong
increase was recorded in 2000 (440 kg). The
number of charges for heroin trafficking followed the same pattern, although the
increase in 2000 was smaller (1,200 charges).
Heroin
is less accessible now than it was in recent years in urban areas.
The opposite is true in the party sector.
Purity and prices seem to be dropping slightly at present.
Cocaine, crack
The
number of seizures and quantities of cocaine seized are up, but there are large
fluctuations from year to year depending on whether or not major special
operations are undertaken.
Cocaine
is increasingly accessible. The
price dropped substantially in the 1990s and appears to have stabilized.
Crack
seems to be a relatively localized phenomenon, still found primarily in the
Paris region and Antilles-Guyane.
Ecstasy and amphetamines
After a dramatic increase in the first half of the 1990s, ecstasy
seizures seem to have stabilized.
Ecstasy
and amphetamines are very accessible on the party circuit.
Prices have trended downward in recent years.
The
generic term “ecstasy” actually covers a very wide range of substances.
Pills sold under the name ecstasy do not always contain the desired
active ingredient (MDMA). They
often contain many active ingredients the interaction between which is largely
unknown, in particular drugs being used for other than their intended medical
purpose. When MDMA is present, the
amounts vary tremendously.
LSD, mushrooms and other
hallucinogens
After a dramatic increase in the first half of the 1990s, seizures of LSD
plummeted but then rebounded slightly in 2000. This does not appear to be an indication that LSD is less
available, as field observations show the opposite is true: LSD and other
hallucinogens, such as certain anesthetics used for other than their intended
medical or veterinary purpose (primarily ketamine) seem to be readily available,
particularly on the party circuit.