First year assessment of the French « cannabis outpatients clinics » J.M. Costes, I. Obradovic (OFDT) REITOX Academy Berlin, 29-30 March 2007

Presentation overview Context of cannabis outpatients clinics implementation Which public reached ? Which activity done ? Conclusions

Presentation overview Context of cannabis outpatients clinics implementation Which public reached ? Which activity done ? Conclusions

Frequency of cannabis use in the general population Cannabis is the most widely used illegal psychoactive drug in France, particularly amongst young people. In 2005, at the ages of 17, LTP is about 50% Regular use (10 or more times in the last month) is 6 15 %

Goals of cannabis clinics Risk-assessment of cannabis use Brief advice for cannabis users at risk Brief intervention for cannabis users in abuse Referral to a specialized treatment unit for cannabis-dependent outpatients with withdrawal symptoms. Terms of reference One of the central aims of the French current Drug Strategy (2004-2008) is to reduce cannabis use among young people. To be effective in helping young cannabis users avoid addiction problems, the Strategy has set up a new public setting combining prevention and treatment, based upon specific outpatients clinics targeting cannabis users. Start in march 2005 : 250 outpatient clinics open

SIMCCA (monthly indicator system) A survey of 4,202 outpatients (2005) Monitoring system SIMCCA (monthly indicator system) A survey of 4,202 outpatients (2005) resp. rate : 95% RECAP : a centralized national reporting system for substance abuse treatment SIMCCA Exhaustive monthly indicator system minotored by Internet Response rate : : 80% a survey aiming to categorise admitted members of the public, to qualify the nature of consultations (average number of consultations, type of monitoring, reception personnel, advice offered) and to describe professional practices (use of tools for assessment, advice offered, etc.) The survey on people admitted for cannabis consultation was conducted using an anonymous questionnaire addressed to professionals having seen patients (or their family and friends) between 15th March and 15th April 2005: this population was subsequently monitored up to 30th June 2005. Response rate : 95% 230 services, 4200 outpatients RECAP on process to be set up, canabis clinics will be included in the future My presentation will be focused on the survey

Presentation overview Context of cannabis outpatients clinics implementation Which public reached ? Which activity done ? Conclusions

Clients admitted in the cannabis clinics The first year, have seen : 15 000 users + 12 000 users’ family or friends When it is an user’s family member it is 2 times as much mothers

The sociodemographic characteristics of the outpatients 4 boys for 1 girl Average age is 21 A quarter of users are minors (under 18)

Frequency of cannabis use among outpatients 2/3 regular users, a third of users are the subject of dependency diagnosis Intensité : 5 joints ou + un j de conso = 30à 42%, selon l’âge Cannabis users attending consultation are distinguished by experimenting with the drug at an earlier age than that of general population(14.5 vs 15.2 G 18 ans) The use of psychoactive legal drugs is common among users admitted for consultation Tabac : 9/10 smoke tobacco 8/10 daily Experimentation with ecstasy seems widespread:( it is seen in one user in four aged between 17 and 18 years old (4 % of the general population)). Nevertheless, this level of experimentation is only slightly higher than that among regular cannabis users within the general population (21%)

Sources of referral 3 main reasons for attended with quite the same number of people : from a judicial injunction upon the suggestion of a third party (family and friends or educational environment, school doctor, social worker, other) through own free reasons for attending consultations are structured differently according to sex : Boys, there are more attendances from a judicial injunction Among girls, there are more self referrals

Sources of referral (2) Under the age of 20, the consultation is, in almost 50 % of cases, sought by the user upon suggestion by a third party. ■ Between the ages of 20 and 28, the user’s request is most frequently brought about by a legal decision (46 %), particularly among boys. ■Above the age of 29, voluntary self-referrals predominate. (more than 60 % of reasons for attending).

Cannabis use diagnosis Harmful or dependent users account for three quarters of people who have sought a consultation of their own free will (31 % of all users admitted) . On the other hand, among those attending due to court referral (38 %), the proportion of profiles of abusive consumption or cannabis dependency is low. Within this population, reported consumption is often occasional or “at risk”. Finally, users directed towards a cannabis consultation by a third party (31 %) are divided between “problematic” use (approximately 60 %) and occasional use (40 %).

Presentation overview Context of cannabis outpatients clinics implementation Which public reached ? Which activity done ? Conclusions

Routine activity indicators There are significant disparities between different clinics: more than half of all consultation centres (56 %) see fewer than 15 people per month and 3 % see more than 60. Only 15 or 20 % of the clinics do half of activity

Activity : number of visits The average number of consultations per person during the period of the survey (14 weeks) is slightly higher than 2. As we might expect, the number of consultations is closely linked to the type of diagnosis made at the time of the first meeting: Among those having a single consultation, we find a predominance of one-off users (almost 70 %), while longer courses of consultation (4 consultations or more) focus on a population of users with a diagnosis of harmful use or dependency (73 %)

Activity : follow-up after 1st visit depends on the diagnosis of use made in the first consultation. Half of “one-off” users were not seen again after a first consultation. In the case of harmful use or dependency, 8 users in 10 are followed up after the first visit the number of referrals to other agencies increases with the “seriousness “of the diagnosis of use

Dropout rates The survey makes it possible to measure the drop-out level, drop out, namely the percentage of those attending who have not attended an appointment made for the first, second or third consultation. around 30% of clients abandon treatment or follow-up. The risk factors that predict dropout from cannabis outpatients clinics are longer waiting times as well as the profession of the health practitioner in charge at treatment entry.

An effective programme Actually reaching the target population Conclusions (1) Outcomes An effective programme Actually reaching the target population Low drop out rates 15 000 drug users seen, about 30 000 people seen the first year Cannabis consultations have been successful in reaching the targeted section of the public About 30 %

High rates of legal system involvement Conclusions (2) issues under discussion High rates of legal system involvement Waiting period between two visits The specificity of the whole setting Which place for this particular public How to improve the follow-up and minimize the drop out ? What is the specificity of this setting. Considering the results of the first application of TDI protocol in France. On more than 45 000 data providing by specialized centers, for 65 % of first demand, the main drug is cannabis.

OBSERVATOIRE FRANÇAIS DES DROGUES ET DES TOXICOMANIES (French monitoring Centre for Drug Addiction) 3, Avenue du Stade de France 93218 St Denis la Plaine cedex Tel : + 00 33 (1) 41 62 77 16 - Fax : + 00 33 (1) 41 62 77 00 Email : ofdt@ofdt.fr - Website : www.ofdt.fr