Economic analysis

1.4.1. Public expenditure

The budget resources allocated to combat drugs and drug addiction come mostly from the State and the French national health insurance fund. The latest data available on “drug” credits used by administrations are from 2010 (RAP, or Annual Performance Report 2010 annexed to the 2010 loi de règlement des comptes (PLFR or Amended Initial Budget Act) and the drug and drug addiction DPT for 2012). With respect to national health insurance spending in the area, the funding of addiction treatment structures (CSAPAs, CAARUDs and CTs) represents the area of highest expenditure. The most recent official data for this expenditure category also comes from 2010. The following table presents 2010 expenditures that may be attributed to the joint contributions of the French government and French national health insurance. The healthcare

70 Loi n°2008-1443 du 30 décembre 2008 de finances rectificative pour 2008 (NOR BCFX0826279L).

71 MILDT note no. 451 of 28 July 2009 for the attention of the regional project managers overseeing the fight against drugs and drug addiction under the supervision of regional Prefects, with respect to the reform of the regional support system.

expenditures on the direct healthcare costs of primary care and hospital care are not considered in the estimates performed for 2010.

Table 1-1: Total public expenditure attributable to the 2010 drug policy (in € million) Sector Cofog1 2010

Spending on Defence, Public order& Safety and customs departments and indirect taxes to fight against narcotics trafficking and the black market for drugs

S1311 Gf02 Gf03 Gf04

685.98

Spending on universal prevention and selective prevention

S1311 Gf09 Gf07

332.97

Spending on healthcare and indicated prevention S1311 Gf07 369.53

Spending on Research & Development S1311 Gf07 11.47

Spending on training

S1311 Gf02 Gf03 Gf04 Gf07 Gf09

11.51

Spending on the coordination of the drug policy

S1311 Gf03 Gf07 Gf09 Gf10

2.58

Spending on observation and assessment (OFDT and DAR)

S1311 Gf03 Gf07 Gf09 Gf10

5.88

Total 1419.93

Source: Table created by the OFDT using RAP and DPT data from 2010, 2011 and 2012.

Note: The latest year available for medication reimbursement amounts from the ADELI list of health professionals is 2009. The amount of OST medications reimbursed by the national health insurance scheme in 2009 was €88.87 million

Cofog: United Nations Classification of Government Functions.

Public expenditure on implementing the governmental and French national health insurance drug policy in 2010 was in the region of €1,420 million. Since the data is not available, this estimate does not include French national health insurance expenditure on reimbursing OSTs. In 2009, the amount reimbursed by the national health insurance scheme was €88.87 million.

Assuming that the difference between reimbursed amounts in 2009 and 2010 will be minimal, the 2009 reimbursements can be used indicatively to establish a forecasted amount for OST medication reimbursement in 2010. This assumption is based on qualitative data collected within

the scope of the TREND survey. These data support the idea of an emerging "saturation" effect on treatment demand by users and greater accessibility to heroin on local markets. By integrating the 2009 reimbursements, public spending attributable to the drug policy reaches

€1,510 million in 2010. Moreover, the two main limitations of this estimate pertain to the failure to take into consideration the main expenditure areas of prison administration and health services (direct costs of providing primary care and hospital care in the field). These categories of expenditures have been estimated for 2003 by Kopp and Fénoglio (Kopp et al. 2006b). The cost of treatment for the illicit drugs was estimated at somewhere between €573 and €632 million.

Expenditures for alcohol-related treatments were estimated between €5,467 million and €6,156 million. Treatment costs of tobacco-related health problems were estimated in the range of

€15,537 and €18,254 million. Taking into account inflation since 2003, such estimates on expenditures in health-related problems would have reached €689.50 million for illicit drugs,

€6,646.50 million for alcohol and €19,322.50 million for tobacco, in 2010. In the area of prison, Kopp and Fénoglio (Kopp et al. 2006b) referred to €219.79 million in 2003, of which €200.49 accounts for illicit drug-related convictions, and €19.30 million for drink driving convictions. After inflation since 2003, such estimates on incarceration spending would have reached €229 million and €22 million in 2010, respectively. Including these estimates on health and prison services, updated after inflation, the total spending will be somewhere close to €28 billion in 2010 (licit and illicit drugs). This estimate accounts roughly for 1.5 percent of the GDP in 2010 (GDP accounts for €1,931.4 billion in 2010) or 6.6 percent of the State’s budget which accounts for a spending of €435.37 per habitant.

1.4.2. Budget

The funding presented here comes from the “Narcotics” support fund. The proceeds from the sale of assets confiscated within the scope of criminal proceedings for narcotics cases in 2011 were €22.76 million. Of this amount, €18.81 € was redistributed by the MILDT in 2011 to the French ministries responsible for implementing the drug policy.

This “Narcotics” support fund was created in March 1995⁷² at the initiative of the 1993 Interministerial Committee Against Drugs and Drugs addiction. The management of the allocation of the proceeds of assets confiscated from drug dealers remains the responsibility of the MILDT. Preparatory work for the 17 March 1995 decree revealed that the distribution to the various relevant ministries of the allocated amounts from the support fund is established as follows: 90% of the amount should be redistributed to the ministries in charge of fighting against trafficking and enforcing the law to fund the acquisition of equipment or services intended for the fight against drugs; the remaining 10% can be used to fund prevention activities carried out by the relevant ministries.

Since the 9 July 2010⁷³ law that entrusted the centralised management of amounts seized to a public establishment to which jurisdictions should refer (AGRASC), contributions to the

“Narcotics” support fund have only risen.

72 Décret n° 95-322 du 17 mars 1995 autorisant le rattachement par voie de fonds de concours du produit de cession des biens confisqués dans le cadre de la lutte contre les produits stupéfiants (NOR BUDB9560005D) et arrêté du 23 août 1995 fixant les modalités de rattachement par voie de fonds de concours du produit de cession des biens confisqués dans le cadre de la lutte contre les produits stupéfiants (NOR SANG9502738A).

73 Loi n° 2010-768 du 9 juillet 2010 visant à faciliter la saisie et la confiscation en matière pénale (NOR JUSX0912931L).

1.4.3. Social costs

For the last ten years, the Observatoire français des drogues et des toxicomanies (OFDT, or the French Monitoring Centre for Drugs and Drug Addiction) has repeatedly worked on estimating the social cost of licit and illicit drugs. The first study (Kopp et al. 1998) dates back to the 1990s and examined the possible calculation methods. The initial estimates were presented in the Kopp and Fénoglio report (Kopp et al. 2000) on Le coût social des drogues (the social cost of drugs). This initial work estimated the annual costs of the illicit drugs to society to be

€2,035.24 million. Regular estimates have been carried out since then. There are two reasons for the need to continually re-estimate these figures: the appearance of new data that were initially unavailable (e.g. treatments for certain diseases) and the need to consider new calculation methods. Hence, the 2006 study assessed the social cost of illegal drugs to be

€2,824.44 million in 2003 (Kopp et al. 2004). Compared to the 2000 estimate, the social cost of illicit drugs was only multiplied by a factor of approximately 1.39.