The National AIDS Council (NAC) observes that recent years have featured major progress in the reduction of the risks generated by the use of drugs, especially where such use is intravenous. It also notes the emergence of new forms of polydrug consumption associated with high levels of health-related and social risk and combining consumption of both legal and illegal drugs.
In this context, on 21 June 2001 the NAC, an independent institution with the task of providing formal opinions to the authorities on matters relating to the combat against the human immunodeficiency virus (HIV), adopted an Opinion recommending to the authorities that they strengthen public health policy on drug use.
All drugs, whether or not their use is authorised, are likely to lead to risks for the physical and social well-being of those who take them, especially where certain types of drug-associated behaviour are concerned. Drug users, who generally lead precarious existences and who frequently have problems with the criminal justice system, are also made even more vulnerable by their poor physical and mental state.
HIV continues to spread through sexual or blood contact. Although the estimated prevalence of infection in the intravenous drug-using population has declined over the last decade, HIV infection nevertheless continues to affect 15 % to 20 % of this group. The various hepatitis viruses – mainly hepatitis C, which affects an average of between 50 % and 70 % of drug users – have lengthened the already long list of medical conditions to which drug-takers are exposed.
Control of these different infections requires not only that the whole range of health-related risks be taken into account, but also the social dangers. Where drug consumption is concerned, it also justifies concerted action taken resolutely within the framework of an approach focused on public health.
Since the Opinion issued by the NAC in 1993, new ways of seeing the issues, made necessary by the AIDS epidemic, have shaped the policy implemented by the public authorities. Despite this, however, the maintenance of a policy which vacillates between treatment and punishment, and which is largely attributable to the state of French legislation on narcotics and existing prejudice against drug users, continues today to impede the implementation of risk reduction strategy.
Starting out from the above observations, the National AIDS Council is now making a series of recommendations to the legislature and the authorities at national and regional levels. The Council recommends that policy on drug use should be based on a different hierarchy of priorities : primary and secondary prevention, reduction of damage to physical and social well-being, treatment, and law enforcement activity focused on halting the development of health-related and social risks.
Specially, the National AIDS Council :
suggests that thought should be given to the abandonment of the criminalisation of personal use of narcotics in private ;
recommends that the exclusion of imprisonment as a possible penalty where the use of narcotics is the sole offence should be confirmed, even where such use is in public or involves more than one drug-taker ;
proposes legislation to guarantee the provision of treatment, along with measures to limit risk and damage arising from drug use, for all individuals wherever they may be – even in prison.
The NAC calls on the French authorities to make a major effort on primary and secondary prevention of risk behaviour, on a stepping up of the effort devoted to risk reduction, and a broadening of the ways in which medical treatment may be provided. Finally, it is the responsibility of all governmental authorities at the levels of region, département and municipality to commit themselves resolutely to a strategy of support for prevention, and for acceptance of drug users in health and welfare facilities.
The conclusions of the National AIDS Council equate neither to condemnation nor to approval of drug-taking, of which the Council is aware of the dangers. Those conclusions are aimed solely at ensuring that there is a clear focus on a public health objective, over and above any ethical stance on the import of the behaviour involved.