Medication use and misuse among illicit drug users in France Lisbon Addictions 2017 Paper session 31: Spotlight on the misuse of medicines Aurélie Lermenier-Jeannet Agnès Cadet-Taïrou 25 October 2017 www.ofdt.fr

Conflict of interest I have no conflict of interest with any industry.

Support centres for the reduction of drug-related harms (CAARUDs) in France Mission: implementing harm reduction measures related to psychoactive substances use and promoting access to care and social benefits A little part of illicit drug users (75 000 individuals) No requirement to stop using drugs Mainly problematic users with a precarious lifestyle 1

ENa-CAARUD survey: key data Population surveyed: all users met in harm reduction facilities or by their mobile teams during the period Period: from 14 to 20 September 2015 (outpatient admissions by week>30) or 27 September 2015 (smaller centres) Data collection: 143 out of the 167 CAARUDs / 3 129 individuals included Method: questionnaire completed during a face-to-face interview conducted by staff members (social workers, educators, nurses…) Editions: 2006, 2008, 2010, 2012, 2015 Aim: monitoring the characteristics of drug users in CAARUDs (and improving the responses of professionals and public authorities) 2

ENa-CAARUD 2015 survey The last edition, in 2015, permitted to investigate the use of medications and to better know the framework of their use (and misuse) via 3 indicators: routes of administration desired effects medical prescription or not … for each medicine proposed in the questionnaire: buprenorphine, methadone, slow-release morphine, codeine, other opiate medications (fentanyl, oxycodone, tramadol…), benzodiazepines, Ritalin® (methylphenidate) and Artane® (trihexyphenidyl) 3

Medications used by CAARUD clients in the month prior to the survey Source: ENa-CAARUD 2015 (OFDT) 4

Frequency of use of each medicine among users in the month prior to the survey (% of users) Source: ENa-CAARUD 2015 (OFDT) 5

Injection of medications during the month prior to the survey (% of users) Source: ENa-CAARUD 2015 (OFDT) 6

Snorting medications in the month prior to the survey (% of users) Source: ENa-CAARUD 2015 (OFDT) 7

“Getting high” as sought effect of use (% of users) Source: ENa-CAARUD 2015 (OFDT) 8

Prescription of medications used during the month prior to the survey (% of users) Source: ENa-CAARUD 2015 (OFDT) 9

Synthetic indicator: misuse of medications by CAARUD clients in France in 2015 Source: ENa-CAARUD 2015 (OFDT) 10

Focus on opioid substitution medications (OSM) ¾ of buprenorphine or methadone users declared to be involved in an opioid substitution treatment (OST) under medical supervision Among them: - Methadone misuse: 7% - Buprenorphine misuse: 52.5% Among 19% of slow-release morphine users (sometimes used as OSM even if there is no marketing authorisation for this indication in France), only a quarter of them declared to do so in the framework of an OST and half stated to seek to « get high ». 11

Conclusion Some medications are clearly misused by French drug users in harm reduction facilities: it’s the case particularly for slow-release morphine, Ritalin® and Artane®. But sometimes, it’s more difficult to assess the situation, particularly when it concerns substitution medications (and specifically buprenorphine). In numbers, among the 75 000 CAARUD clients in France, buprenorphine misuse concerned approximately 15 000 individuals and slow-release morphine misuse about 11 000 users. 12

Thank you for your attention… Questions?! www.ofdt.fr