Viewpoint

Supervised consumption rooms: The French Paradox

Although injecting drug use was identified as a political problem in France after the student revolt of May 1968, the implementation of two related public health measures – the liberalization of syringe sales in 1987 followed by access to opioid substitution treatment in 1996 – only occurred with the advent of AIDS (Jauffret-Roustide, 2009). In 2006, when risk reduction was formally recognized in France in public health law, both these measures were included in official policy. In France, where legislation is still repressive (drug use is punishable by law), this harm reduction policy is frequently contested by parliamentarians who perceive it as a form of pro-drug use proselytism. Currently, the number of people injecting drugs in France is estimated to be 80,000. This group is characterized by a high level of financial and social instability, a situation which often leaves them with no choice but to inject in public places. In terms of public health, the prevalence of Hepatitis C among drug users is high (60% of users according to available data) as is the prevalence of health risk practices associated with injection (Jauffret-Roustide et al., 2009).

In recent years the health problems associated with injecting drugs in public places have led professionals and scientists to call for a change in French risk reduction policy. They believe that policy should no longer be based on issues of morality and ideology but on international scientific evidence. This is in keeping with the Vienna Declaration which urges that risk reduction policies be based on evidence-based medicine (Wood et al., 2010).

In this context, the Ministry of Health commissioned a group of scientific experts in 2010 to examine the feasibility of experimenting with supervised consumption rooms in France. Following initial investigations, focusing particularly on experiences of other countries (approximately 100 consumption rooms have been established worldwide since the 1980s), this group determined that such experimentation was appropriate and relevant (Bello et al., 2010). This scientific announcement was followed by a great deal of media coverage, taking the debate into the public arena for the first time in 2010. It re-emerged in 2012, during the most recent general election.

Public authorities remain hesitant about implementing the 2010 expert recommendation. This may be partly due to the fact that politicians cite conflicting results from scientific studies and opinion polls about public acceptance of the idea of consumption rooms.

In this article we analyze the social and political issues associated with the creation of supervised consumption rooms in France and the role of public opinion polling in public health policy-making. We present results from various polls and scientific studies on the social acceptability of consumption rooms and the impact which these have had on the French debate.