French People’s positions on supervised injection facilities for drug users

Abstract

Background Supervised injection facilities have been set-up in many countries to curb the health risks associated with unsafe injection practices. These facilities have, however, been met with vocal opposition, notably in France. As harm reduction policies can only succeed to the extent that people agree with them, this study mapped French people’s opinions regarding the setting-up of these facilities. Method A sample of 318 adults--among them health professionals--were presented with 48 vignettes depicting plans to create a supervised injection facility in their town. Each vignette contained three pieces of information: (a) the type of substance that would be injected in the facility (amphetamines only, amphetamines and cocaine only, or amphetamines, cocaine and heroin), (b) the type of staff who would be working in the facility (physicians and nurses, specially trained former drug users, specially trained current drug users, or trained volunteers recruited by the municipality), and (c) the staff members’ mission (to be present and observe only, technical counselling about safe injection, counselling about safe injection and hygiene, or counselling and encouragement to follow a detoxification program). Results Through cluster analysis, three qualitatively different positions were found: Not very acceptable (20%), Depends on staff and mission (49%), and Always acceptable (31%). These positions were associated with demographic characteristics--namely gender, age and political orientation. Conclusion French people’s positions regarding supervised injection facilities were extremely diverse. One type of facility would, however, be accepted by a large majority of people: supervised injection facilities run by health professionals whose mission would be, in addition to technical and hygienic counselling, to encourage patrons to enter detoxification or rehabilitation programs.

A qualitative study of professionals’ perspectives on the ethics of medically-delivered safer injection education for people who inject drugs

“…In France, professionals and policymakers were very cautious with HR measures which resulted in a significant delay of French HR implementation compared to other European countries. The moral interpretation of this delay, attributing it to the social representation of the injectable drug use as a “moral vice”, is predominant for French social studies scientists [ 2 , 15 ].…”

“…In commentary to this legal document included to the French Public Health Code, morality is defined as referring to the societal norms and to the laws of the democratic society. It is worth reminding that, in 2016, the National Council of the Order of Doctors, the authority ensuring French physicians’ compliance with medical ethics and deontology, was opposed to the opening of first French DCF [ 2 ].…”

“…Indeed, it could be seen as symbolical or practical participation in a “deviant” process which is completely disconnected from medical care, and even as endorsing the continued IV drug use. Yet, qualitative literature regarding French public opinion on injection HR in DCF seems to indicate that their acceptability increased if health professionals ran these structures and actively encouraged PWID to stop their use [ 2 ].…”

“…In our study, some interviewees argued that the most prominent in HR countries shared cultural features which favored a more pragmatic rather than moral perspective on HR. Studies in French general population, although limited by the convenience sampling, indicate that the acceptability of DCFs in France depended on interviewee’s political orientation with more conservative interviewees having more difficulties in accepting DCFs [ 2 ]. A certain antagonism to the HR from conservatively oriented political actors was observed in Canada in 2007 [ 26 ].…”

“…It is well known that drug injection carries significant health risks (viral transmission, bacterial infections, vascular complications, overdose, etc.) [ 1 , 2 ] Also, the intravenous (IV) drug use is seen as a signature of a particularly severe addiction, and is often associated with significant socio-economic difficulties in people who inject drugs (PWID) [ 3 ].…”