Studies carried out

ACTIVITY REPORT OF THE OFDT FOR THE PERIOD 1999-2002

I

At the end of 1998, the directors gave the OFDT priority lines of work for the years 1999-2001 that were confirmed at the end of 2001 for 2002. These were as follows:

The OFDT’s field of competence will henceforth cover all psychoactive substances, namely drugs, alcohol, tobacco and psychotropic medicaments. Its monitoring must therefore be progressively extended from the field of illicit drugs alone to cover all psychoactive substances.

The OFDT, as French focal point of the REITOX network, will fulfil the obligations described in the REITOX work programme as defined each year by the EMCDDA. It will also play an active part in other work of the EMCDDA that comes within the priority lines of work defined above.

MONITORING AND IMPROVEMENT OF INDICATORS In order to provide the most exact measurement possible of the incidence of drugs and drug use, the OFDT will analyse the existing indicators and suggest suitable measures to improve the quality and reliability of sources within the various ministries and other organisations. If gaps are identified, the OFDT will initiate work to fill them.

TREND MONITORING The objective is to have real-time knowledge of the trends in consumption, methods and their consequences and the nature of products in circulation. A dual system will therefore be established: a “sentinel surveillance network” to monitor trends in the contexts of use, making use both of the existing arrangements and of ad hoc “sensors” (TREND project) and a system for collecting analyses of products in circulation (SINTES project). Such a system will also make it possible to respond to the demands of the joint European action on synthetic drugs.

EVALUATION OF PUBLIC POLICIES In the field of evaluation, the OFDT is charged with:

defining an overall framework for the evaluation of public policies, developing methodologies and know-how based, where appropriate, on work in other countries and establishing and following to their conclusion evaluations of public actions and spot and short term studies falling within this general plan.

ASSESSMENT Within its field of competence, the OFDT will respond to requests for assessment or intervention from the main French and international bodies. The OFDT could be called on as an expert by local or national players seeking validation of an observation method.

DISTRIBUTION AND PROMOTION The OFDT must be in a position to distribute and promote its work, including that carried out outside its field of competence, amongst a public of “specialists”

(decision-makers, informed professionals, researchers etc.). It must become a point of reference for those seeking information on these topics. The OFDT will periodically draw up an assessment of the incidence of drugs and their use by publishing a report on indicators and trends.

This note relates the implementation of its lines of work.

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Leadership of working groups

During this period, the OFDT took steps to establish close links with the existing topical working groups on alcohol and tobacco (IDA and IDT) or to create new ones on illicit drugs (working groups on requests for treatment, mortality and trafficking):

ƒ Alcoholism Indicators Group (IDA)

ƒ Indicators and Data on tobacco Group (IDT)

ƒ Illicit Drug Indicators Group (IDI)

ƒ Mortality Group (users of illicit drugs)

ƒ Trafficking Group

All these working groups now come under the OFDT umbrella. Each of them has defined its objectives and working method. They are not only collecting points for available data but also sources of proposals on the means required to improve the data.

With the support of these various working groups, the OFDT has made particular efforts to promote the harmonisation of the collection of data from persons in difficulty with psychoactive substances and taken into treatment by the various professionals and bodies working in the field of addiction. The observation arrangements in this domain were, in fact, marked by a wide dispersion and considerable lack of coherence, giving rise, most often, to an impossibility of comparing the results of the various surveys. In addition this situation tends to lead to a degree of demobilisation of workers in the field whose time is taken up replying to surveys putting questions that are similar but always differently worded.

It therefore seemed necessary to work with the institutions and professionals concerned on the definition of a minimum core of common questions that can be used equally well by specialised structures (CSST [Specialised Drug Addict Treatment Centres] and CCAA [Alcoholic Outpatient Treatment Centres]) and by liaison teams working in hospitals and with urban doctors. The purpose of these questions is to be equally useful in epidemiological surveys and in the activity reports of the various structures involved. This minimum list of questions must also be compatible with the recommendations of the European Monitoring Centre aiming to make comparisons possible between the various countries of the EU. This debate, conducted chiefly within the IDI Group, was the subject of a report summarising the main points and making a number of proposals. The common core questions have been selected and validated or are being validated by professionals in the various types of structures. It now remains to implement the information collection instruments incorporating this work.

Also falling within this harmonisation framework is the scientific and technical support supplied by the OFDT to the DGS [General Health Authority] for the exploitation of the activity reports of the CCAA and the CSST. The data collected (from 1994 to 2000 for the CCAA and from 1998 to 2000 for the CSST) constitute a precious source of information both for immediate needs and for the establishment of a more coherent information gathering system. The summary reports on the system specialising in alcoholism for the years 1999 and 2000 were drawn up jointly by the OFDT and the DGS.

Studies carried out

During the three years under consideration, the monitoring centre has carried out a number of studies, the results of which have contributed to the knowledge of drug consumption and its health and social consequences (see list of studies in appendix).

Since 1999, the OFDT has made efforts to draw the attention of the DREES [Directorate for Research, Studies, Evaluation and Statistics] and the DGS to the problem of European harmonisation of the statistics of drug users taken into treatment. In 2000, the DREES accepted the principle of recasting this survey in order to improve the quality and relevance of the data collected (in particular, by including the urban medical sector in the field of enquiry) and to incorporate the recommendations of the European protocol on the recording of requests for treatment. Proposals in this sense were made by the IDI working group, co-ordinated by the monitoring centre, in the framework of a report finalised in 2002 on the system of information regarding illicit drug users.

The taking into treatment of drug users by general practitioners is not covered by the existing government survey system. This led to the OFDT’s repetition in 2000 of the survey of general practitioners carried out by EVAL [independent public health studies office] in 1992, 1995 and 1998.

The OFDT was asked by the DREES and the ORS [Regional Health Observatory] to participate in the design and financing of a survey “on a given day” to be carried out amongst patients coming to consultations in urban surgeries or in hospital (fully hospitalised). The main purpose of this survey is to measure the prevalence of alcohol problems amongst these patients.

An initiative of the Transport Ministry led to the introduction of a first legislative text, known as the Gayssot law (18 June 1999), laying down the principle of systematic testing of all drivers involved in fatal road accidents. The purpose of this law is to establish a study to determine whether there is a correlation between the taking of narcotics and road accidents. The OFDT has been charged (by the decree of 27 August 2001) with launching and managing this road safety study. A steering committee and scientific committee have been set up. A research team has been selected as part of a call to projects procedure. It has the responsibility of implementing the study and is to submit its conclusions in 2004.

Remaining in the road safety field, the OFDT has found that the data giving information on the implication of alcohol in road traffic accidents have not been kept up-to-date since the mid- nineties. The OFDT has therefore approached the INRETS [national transport and safety study institute] and concluded a study agreement to reopen the exploitation of the databases fed by road traffic accident reports. The study report is to be delivered to the OFDT at the end of 2002.

The monitoring centre has produced a new estimate of the number of problem users of opiates and cocaine by applying and cross-checking various methods. As a part of this work, the OFDT entrusted the ORS Midi-Pyrénées with a multi-centre study (Lens, Lille, Marseilles, Toulouse and Nice) leading to estimates of local prevalence.

The OFDT has also set up a study of mortality amongst drug users taken in for questioning, based on matching the record of persons taken in for questioning of the OCRTIS [Central Office for the Repression of Drug-related Offences], the index of individuals of the INSEE [National Institute for Statistics and Economic Studies] and the register of causes of death of the INSERM [National

connected with obtaining the agreement of the Ministry of the Interior and the CNIL [data protection], the comparison of the files was carried out during summer 2002 and the results should be available at the end of the year.

Finally, mention should be made of the follow-up work on studies started in the call for tenders of 1997 which, with two or three exceptions, has led to the publication and distribution of all the studies financed. The studies published following this call for tenders continue to be the subject of requests to the OFDT.

Local indicators

A database of departmental indicators (ILIAD) has been devised and regularly updated in order to meet the great need of professionals in the field on this subject. The unceasingly growing demands for the availability of departmental and regional indicators have led the OFDT to develop responses (inclusion of the database on a CD-ROM and then on the Web-site).

The OFDT has also met with a wide demand for the supply of regional and departmental indicators to partner administrations (MILDT [Interministerial Mission for the Fight Against Drugs and Drug Addiction], DGS, DHOS [Directorate for Hospitalisation and Organisation of Treatment]) for use in the determination of budgetary allocations at the various local levels. The ILIAD database has been progressively improved and enriched, especially in the areas extending the field of establishment monitoring.

System of surveys of the general population

The establishment of a permanent system for monitoring the consumption of and attitudes to drugs amongst the general population, one of the objectives of the government’s three-year plan 1999- 2001, has been concluded. This contributes to making good one of the major gaps in the French statistical system by giving a measure of the extent of the incidence of drug use in France and a precise picture of French opinion on the matter. This system has four components.

The Health Barometer 2000 is a telephone survey of the general population (15-75 years of age) based on a random, nationally representative sample (N=13,685), carried out and co-ordinated by the French Centre for Health Education (now Institut national de la prévention et de l’éducation à la santé [National Institute for Prevention and Health Education]). This survey covers a number of topics with regard to behaviour and opinions in France in respect of health. The OFDT participates in the preparation and analysis of the Health Barometer, linking an approach of partnership and trend monitoring with a research approach. For the 2000 survey, the OFDT made a major contribution to the consideration of methods (especially the construction of an argument for presentation to the CNIL in favour of questioning red-listed households), to the questionnaire and to the training of the interviewers. In addition, the field monitoring, re-coding and preparation of the database and analysis were carried out in partnership.

The European School Survey Project on Alcohol and Other Drugs (ESPAD), carried out in schools by voluntary questionnaire, took place in 1999 in some thirty European countries. The French contribution to this survey was carried out by the INSERM in partnership with the OFDT and the Ministry for National Education, Research and Technology. The French sample reached 11,870 pupils in both public and private schools. Two reports have been published on the basis of this survey, which will be repeated every four years.

The Survey of Health and Behaviour on Call-Up and Preparation for Defence Day (ESCAPAD) has been carried out every year by the OFDT since 2000. The French youngsters fill in an

unsupervised questionnaire on health, life-style and the consumption of psychoactive substances.

For this survey, the OFDT assembled and co-ordinated a group of experts to refine the procedure and the questionnaire. The survey has been declared appropriate by the CNIS [national council of statistical information], been awarded the public interest label by the Comité du Label and obtained a favourable opinion from the CNIL. The sample for 2002 (N=16,280) includes boys and girls aged 17 and 18.

Finally, in 1999, the OFDT established a three-yearly survey of Perceptions and opinions of the French population regarding psychotropic products (EROPP), carried out amongst a representative sample of the French population aged from 15 to 75 (N=2,000). The responsibility for carrying out this survey lies entirely with the OFDT: survey preparation and concept, training of interviewers, field monitoring, test analysis, use of the database and statistical analysis etc. The declaration of appropriateness of the CNIS, the public interest label and the favourable opinion of the CNIL have also been obtained.

In collaboration with a team lead by Prof. Reynaud, the OFDT is participating in the organisation of a survey intended to improve the detection of problem use of cannabis. The OFDT is participating in the collection of data from 3000 young recruits in high schools and universities and will carry out the statistical analysis of the data and, in particular, the comparison of the various diagnostic tests included in the survey. The results of this study will make it possible to propose, in 2003, a simple module of questions to estimate the frequency of problem cannabis use in the general population. A clinical qualitative validation of this module is proposed on a dynamically changing body of patients undergoing treatment for addiction.

Main contributions

9 Measurement of experience and use of psychoactive substances in the French population as a whole (Health Barometer surveys):

Certain substances are becoming increasingly widespread, including ecstasy and amphetamines, the experimentation with which has more than doubled from 1995 to 1999, increasing, amongst 18-44 year-olds, from 0.7% to 1.6% for women and from 1.8% to 3.5% for men.

9 Measurement of experience and use of psychoactive substances at the end of adolescence (ESCAPAD surveys):

At 18 years of age, one French male in two has already smoked cannabis at least once compared with one female in four, less than 4 males in ten having done so in the last month.

9 Measurement of the change in consumption from one generation to another (ESCAPAD surveys):

From 1993 to 1999, the percentage of young people between the ages of 14 and 18 who had experimented with tobacco rose by 20 points.

9 Scientifically robust international comparisons of drug consumption levels amongst young people (ESPAD 1999).

In 1999, France was the European country with the highest cannabis consumption by 16 year-olds.

9 Understanding the reality of consumption behaviours (e.g. multiple consumption, problem use), as a function of the substance consumed and associated risk factors (ESPAD, ESCAPAD and Health Barometer surveys):

In 2000, 14.6% of men and 4.1% of women showed signs of problem use of alcohol

9 Estimation of the number of problem users of opiates and cocaine and proportion of these who benefit from substitution treatment (OFDT-InVS [health-watch institute]) In 1999, the number of users of opiates and cocaine “with problems” was estimated at between 150,000 and 180,000, of whom nearly half are receiving substitution treatment.

9 Analysis of the trends of indicators of the health consequences of drug use (OFDT- InVS-INSERM-OCRTIS):

The prevalence of HIV continues the downward trend started in the nineties (16% in 1999), the prevalence of HCV is increasing and has reached a very high level (63% in 1999).

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The information system, Recent Trends and New Drugs (TREND)

France has a system of information on drugs and addictions covering several fields. However, this system is based, essentially, on sources of information about the most widespread substances (alcohol, tobacco, medicines and cannabis) and with a considerable delay in yielding results. The OFDT’s information system, Recent Trends and New Drugs (TREND) aims to identify and understand new tendencies.

The initial system was validated on the occasion of the adoption on 16 June 1999 by the government of the three-year plan to combat drugs and prevent dependency. An initial protocol was put in place in 1999 following a concerted effort between ministries. The major gain for public health policy represented by a better knowledge of synthetic drugs and the relevance of the project in this sense were recognised by all the ministries. The initial protocol proposed, in particular, a specific system for the collection of information from 10 urban sites in mainland France and from the techno-festive scene as well as a system of information on synthetic products (SINTES).

An external evaluation was instituted from the start of the project. Its results were made public in 2000 and contributed to the drafting of a new protocol, put in place in 2001.

The project protocol, amended and validated by the interministerial committee has the following broad lines.

ƒ The TREND aims to make available to decision-makers, professionals and users, knowledge of new developments in the use of drugs that may influence their decisions or working practices. It is interested in methods of substance use, substances, associated damage, the ways in which substances are acquired, new user populations and in perceptions.

ƒ The operational steps in the system are the identification, description and understanding of new developments in connection with drugs and the distribution of the information produced.

ƒ The information collecting system includes partnerships with existing systems and the development of information systems for this specific purpose. These specific information systems include a network of local sites, a system of information on synthetic products (SINTES) and a media-watch. These information collecting systems, taken together, should maker it possible to produce short-delay (SINTES), medium-delay (bulletins) and annual (TREND report) information at the national level. This information should be an aid to decision-makers, professionals and users in adjusting their strategies and practices.

The network of local sites

Thirteen co-ordination units for local TREND sites have been set up (Paris suburbs, Bordeaux, Dijon, Guyane, Lille, Lyon, Marseilles, Martinique, Metz, Toulouse, Paris, Rennes, La Réunion).

Their task is to:

ƒ identify and assist the various partners (institutions and persons) likely to be able to supply relevant information on new developments,

ƒ provide for the collection of information using various methods that may change with time (ethnographic monitoring, focus groups of professionals from health and repression fields, quantitative and qualitative horizontal studies of front-line structures),

ƒ provide a local point of contact for partners and users of the TREND/OFDT system,

ƒ produce a local annual report from the data produced by the TREND/OFDT system,

ƒ ensure that good use is made at the local level of the local and national results produced by the TREND/OFDT system,

ƒ contribute to the definition of six-monthly revisions of the specific on-site data collection system for the TREND/OFDT system.

The SINTES information system

The SINTES information system is centred on synthetic substances (e.g. ecstasy), whatever their presentation (tablet, capsule, powder, liquid…). Its purpose is, by building up a database of the results of toxicological analyses of synthetic substances, to identify new trends (epidemiological monitoring) and new substances (identification of previously unknown molecules or associations of molecules). This database is, above all, a tool to assist in public decision-making. Furthermore, this system makes it possible to respond to the obligations proposed under the European common action plan of 16 June 1997 setting up a rapid alert system for the appearance of new synthetic substances.

The information sources for the SINTES system include the laboratory networks of the repressive services and the social health collection network specific to the TREND project.

Three laboratory networks of the repressive services supply the OFDT, at regular intervals, with the description, photograph and results of toxicological analyses of samples of synthetic drugs seized by the services charged with controlling the supply of illicit drugs (customs, police, gendarmerie) and sent to their laboratories for analysis.

A network of social health partners collects samples of synthetic drugs from consumers. This collection system was re-organised in 2002 to come closer to nine of the ten mainland sites of TREND. The collection co-ordination structures have the responsibility of identifying and assisting the collectors, defining local collection strategy, controlling quality of collection and information sheets and forwarding sheets photos and samples.

A collection context sheet is filled in for each collection. Three collection contexts are possible:

ecstasy family, new substance, dangerous substance. Apart from information about the sample, it includes anonymous information about the user and the collection context. The context sheet is sent to the OFDT while the sample is sent to one of the five partner laboratories for analysis.

The laboratories send the results of their observations (description, photo, toxicological analysis) to the OFDT as quickly as possible. These results are added to the database and, where appropriate, are speedily spread over the information network.

Currently, the SINTES database contains the descriptions of over 5000 samples of which 3000 were seized by customs, the police and the gendarmerie and 2000 were collected (with context sheets) by the social health network.

Investigations specific to the TREND system

These are either investigations of scenes where consumption patterns are little known or in-depth descriptions of a new development identified by TREND in order to gain a better understanding.

For example, in 2001/2002, two scenes were explored (the rock festival scene and professional circles) and two developments (new heroine users and the use of Rohypnol®)

Information produced by the TREND system

Since its inception, the system has produced a great deal of information and data:

ƒ speedy information regarding certain problem samples collected by INTES (e.g. high doses of MDMA), certain newly found substances (2CB, PMA etc.), the presence of substances where doubt exists,

ƒ a database, accessible to project partners on the Internet or on CD-ROM, contains the identification and composition of over 3,500 samples,

ƒ information bulletins and summary notes for decision-makers, professionals and users are produced periodically,

ƒ reports on recent national trends have been published every year since 2000 (3^rd report in June 2002), topical reports on specific investigations carried out as a part of TREND have also been published.

Main contributions

9 Detection of new developments in drug use (TREND).

The availability and consumption of cocaine is spreading in both urban areas and on the party scene (1999, 2001, 2002).

The use of Buprenorphine in high doses is increasingly observed amongst users of opiates (2001, 2002) The use of ketamine remains limited to a small number of people but is more easily observed in France (2002)

9 Exploration and understanding of new developments in drug use (TREND).

Consumption of Rohypnol® without prescription in 2001.

New uses of heroine in France in 2001.

9 Making recent information available to public decision-makers

Thirteen local site reports, Neocodion note for the DGS, Methadone note for the DGS…

9 Knowledge of synthetic drugs consumed (SINTES).

In 2001, in tablets sold as “ecstasy”, MDMA was found alone in 65% of samples, another active substance associated with MDMA in 22%, other active substances without MDMA in 10% and no active substance in 3% of samples.

9 Response to the European joint action on synthetic drugs

Notification to the European drugs and addiction monitoring centre of the identification by SINTES of TMA-2 and 2C-T-2 (2002).

9 Contribution to the alert system of the General Health Authority (DGS)

Provision, in collaboration with the CEIP [dependency information centres], of an information note on the identification by SINTES of Tiletamine, a veterinary anaesthetic similar to ketamine (2002)

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Development of a method for conducting an evaluation project

In carrying out its tasks, the OFDT has developed the appropriate expertise and methods for evaluation procedures. In particular, it has concentrated on building up a partnership with the various ministries and/or professionals concerned in order to draw up the specifications of evaluation projects. This work, in preparation for the evaluations, leads to a better-defined order. It has three parts:

ƒ an assessment of the state of knowledge and available information in the field to be evaluated,

ƒ the definition of the evaluation questions,

ƒ the definition of the recommended methods for carrying out the investigations.

The call for tenders and selection of the service providers to carry out the evaluations is entrusted to the OFDT, which selects the evaluation teams by competition between public or private bodies within a limited circle. Seven calls for tenders were organised between 1999 and 2001. The study specifications ensure that quality aspects are respected by setting up steering committees and by providing for monitoring progress of the study at the evaluating office. On average, between five and seven steering committee meetings, bringing together all the partners associated in the evaluation project, are organised during the evaluation exercise. Throughout the process, they can draw on the competencies and qualifications of the scientific advisors of the OFDT and, in particular, the Evaluation Commission. A referee from the commission is nominated for each evaluation. He is involved at the key stages in the process and invited to the steering committee meetings (especially for hand-over).

A summary table for “overall assessment of the quality” of studies has been established by the OFDT. This is filled in at the end of each evaluation by the expert(s) chosen to measure the scientific value of the product delivered by the evaluation team. This procedure gives the scientific guarantor the opportunity to propose, in writing, the modifications that he considers necessary and to state whether he considers publication appropriate. Taking all the expert appreciations of the evaluations carried out by the OFDT together, we note that the average assessment of satisfaction of demands, suitability of method and soundness of analysis is good – which is witness of quality fulfilment of the public order from the stage of definition of the stakes to the delivery of results. The clarity of the report (in terms of readability and with regard to the conclusive nature of the study) receives a more varied judgement and the impartiality of the conclusions is sometimes called into question by the experts. This may be explained, in part, by the absence of an organised circle of evaluators in the field of the combat against addiction.

Programme for the overall evaluation of the three-year plan

An overall evaluation procedure has been initiated and approved at interministerial level. It includes:

the mandate for the evaluation of the three-year plan, granted by the Permanent Interministerial Committee for the Fight against drugs and drug addiction to the OFDT (26 September 2000), which

the frame of reference of the three-year plan, identifying the priority lines of the three-year plan that can be evaluated.

The mandate sets down four priority evaluations of specific programmes, as follows.

The departmental conventions on legal and health objectives (CDO). This evaluation assesses the interministerial arrangements for the co-ordination between judicial actions and health actions with regard to persons in police hands with problems of abuse of and dependency on psychoactive substances. The final report, including an analysis of the arrangement with conclusions and recommendations, was delivered by the ACADIE evaluation team in July 2002.

The interministerial training aspect of the three-year plan. This evaluation assesses the implementation of the objective of the plan aiming to update and harmonise the knowledge of all professionals likely to be involved in combating drugs. The final report, including an analysis of the arrangement with conclusions and recommendations was delivered by C3E in June 2002.

Departmental prevention programmes The purpose of this evaluation is to bring to the fore the key success elements for the drawing up and putting in place of the departmental prevention programmes and the foundations of an optimum national co-ordination for the implementation of these decentralised programmes. The final report, including an analysis of the system, conclusions and recommendations, was submitted in June 2002 by EVALUA.

The experiences of reconciliation of the treatment structures specialising in addictive behaviour.

This evaluation is still being carried out by the consultants from the company, CEMKA-EVAL.

The preliminary work for drawing up a final evaluation report, planned for the end of 2002, made it possible to define eight evaluation questions about the actual implementation of the measures or actions in the plan. Beyond this examination of the progress in realisation and the difficulties encountered in the implementation of the orientations of the plan, the report will also address, once the data are available, the effects of certain arrangements. This document will include a proposal of monitoring indicators.

Evaluation of more specific facilities

Furthermore, within the framework of its mandate, the OFDT implemented evaluations of particular facilities.

The evaluation of the Listening Points, initiated at the request of the DGS and the MILDT [Interministerial Mission for the Fight Against Drugs and Drug Addiction], was carried out by the RESSCOM [sociological research and evaluations on health an social matters and community actions] association. It included two complementary sections. On the one hand, a quantitative study made it possible to typify the Listening Points, analyse their history, their accessibility, the extent to which social and psychosocial problems are taken into account and to characterise populations. On the other hand, an in-depth qualitative study has made it possible to identify the problems of being a listening post, the levels of “professionalism”, the matching of responses to needs and integration into the environment.

The “Médecins du Monde Paris methadone bus” mobile facility for the treatment of addicts on methadone substitution, set up in January 1998, is one of the first French experiments in this direction. In 1999, the OFDT was required to set up an evaluation in this institutional context of research and experimentation with new social health facilities. This evaluation, carried out by the

IREP and the INSERM, covered, on the one hand, the activities of this facility and it users (effectiveness of the implementation) and, on the other hand, the resulting changes (effectiveness of results) in terms of access to the social health circuit (capture/relay role), of effects on consumption practices, on health and on the social rehabilitation of dependent persons.

Having been engaged by “Foster Families” commission of the ANIT, the addictive practices office (formerly SP3) of the DGS, jointly with the MILDT, has mandated the OFDT with the first national evaluation of the facility. The facility is made up of volunteer families, fostering expenses paid, and CSST to which they are attached and which support them in this task and provide therapeutic follow-up of the addicts fostered. The origin of the request for evaluation and the participatory nature of the evaluation process made this a pilot study for the various parties involved. The evaluation report, drawn up by CEMKA EVAL and GSP Conseil, presents a state of affairs for the active networks and an in-depth study carried out in four networks of the practices and perceptions of the central CSST.

The DAP (Direction de l'administration pénitentiaire [Directorate of the Prison Administration]), together with the DGS and the MILDT, named the OFDT as prime contractor for the evaluation of the “prison leavers units”. The OFDT commissioned a team of the ORS Provence-Alpes-Côte d'Azur to evaluate the eight “prison leavers units”. These units are intended to prepare inmates for leaving prison. Their objective is the social treatment of addiction through collective preparation for leaving (based on group dynamics) and follow-up after leaving to facilitate recovery of autonomy and socio-professional rehabilitation. A first evaluation report, validated by the OFDT and which appeared in April 2001, analyses the establishment and contribution of these facilities. A comparative study of mortality amongst former beneficiaries of stays in leavers units and other inmates of the Fresnes prison centre will be the subject of a second report that is now being published.

At the request of the MILDT and the DGS, the OFDT carried out an evaluation of the “Programme of risk reduction and social mediation in the 18^th arrondissement of Paris”. This evaluation gave an appreciation of the effectiveness of the programme with respect to its initial objectives and from the points of view of users and residents (interviews and opinion poll). One of the final objectives of this evaluation was to define the main recommendations for improvements in the operation and, if appropriate, to extend this type of operation to other agglomerations.

After ten years of the application of the “Evin law”, the public authorities (MILDT, MEN and DGS) have decided to make as complete and objective an assessment of the state of affairs as is possible with regard to the prohibition of smoking on school premises. This survey, carried out in a very large representative sample of public and private schools, colleges and upper schools, has a double objective: to know the present state of practices and attitudes with regard to smoking in educational establishments and to measure the efforts accomplished by the education community in combating it. The results were presented on the occasion of the international anti-smoking day in May 2002.

Situation of preventive actions in France

The APPRE programme, Preventive actions and projects – a census, for the description of actions financed by decentralised funding in the field of prevention of use, abusive and dependent behaviours and risk reduction in connection with psychoactive substances was launched in 2000.

This programme has its origins in the sub-commission, Definition of a methodological framework for the elaboration of departmental prevention programmes (1999), that sought to provide

to the realisation of departmental preventive programmes. The adaptation of the European EDDRA questionnaire to the French context gave rise to the APPRE questionnaire.

More than half of all departments have returned APPRE questionnaires to the OFDT, combining the two collections of information organised in 2000 (539 preventive actions) and 2001 (561 preventive actions). The number of documents and their quality vary considerably from department to department. Nevertheless, the collaboration of the local players forms a foundation for a system of information that should make it possible to contribute descriptive elements for a situation assessment of preventive actions that has never yet been carried out in France.

A particular effort has been made to feed information back to the local players in order to motivate those active in the field and offer a useful tool for the realisation of projects. Departmental and national topical summaries (horizontal summary, action methods, populations concerned, budgetary aspects, quality control), have been distributed and are available on CD-ROM and on the Internet.

Furthermore, a summary of the data to be found in the activity reports of “drugs and dependence” project managers was drawn up by the OFDT in 2001 (70 departments responded to the questionnaire). This source of general information on the activity of the departments in combating addiction has not been systematically exploited. Nevertheless, it makes useful information available that cannot be deduced from the activity reports of the specialised structures.

It also gives information on the co-ordination between the local players in the departments and shows up, in certain cases, failing partnerships, under-utilised resources etc. This source of knowledge regarding the real territorial differences in anti-drug policies seems to be a potential aid to public policy decisions that is, as yet, under-exploited.

Main contributions

9 Departmental conventions on objectives

“the analyses reveal a certain number of effects that question the system with regard to its development (a diversity of actions financed that confuses the setting of priorities, a significant autonomy of providers that represents, in a certain number of cases, a brake on real partnership in controlling the system, difficulty of local and national evaluation, high cost in time and energy for the institutional personnel managing the system, whose commitment sometimes tends to fall with time in spite, it must be said, of strong support for the idea of the MILDT’s three-year plan).”

“Another strong recommendation of the evaluation was to create the conditions for setting up effective partnerships. It seems necessary to make the project managers who are responsible for managing the system more available for this purpose. Moreover, there is nothing against a system on several levels: a) a minimal system to be established in each department and corresponding to national policy lines, b) a

“toolbox” that can be applied in accordance with local needs. More generally, it would be beneficial to study the techniques of methodological assistance and of broadening the range of tools available to the project managers.

9 Interministerial training

“It appears that the training tools developed by the MILDT find acceptance amongst the players in the field.

However, the public reached remains limited and consists mainly of professionals who have already benefited from training in this topic or already specialising in the field of drugs. If the knowledge acquired by those benefiting from this training remains uncertain, there is not doubt that the cross-sector nature of the participants and the inter-professional exchange are the strong points of these “new” training sessions.

Overall, therefore, the evaluation validates the main training options supported by the MILDT, especially the multi-disciplinary nature of the content, the range of professions represented in both contributors and audience and the provision of time for the exchange of ideas.”

“In the light of these results, presented to the Permanent Interministerial Committee in June 2002, the key questions for the support of this strategy are the means to be employed to attract “uninformed”

professionals to the training sessions on the subject of drugs in order to favour the exchange and spread of information on the most relevant experiences in order to face the quantitative challenge of the number of professionals to be trained. The study shows that it would be beneficial to define more precisely, both quantitatively and qualitatively, the public to be addressed and their requirements in training about drugs.”

9 Departmental prevention programmes

“The implementation of this departmental policy has not interfered with the operation of the services involved but has allowed a real dialogue, a broadening of partnership and a recognition between services.

The most important wishes of the “drugs and dependence” project managers are for: the publication of prevention methods and tools and of examples that make it possible to define the prevention perimeter, the evaluation, at the present stage, of their actions with regard to prevention, the allocation of more personnel (deputy and/or secretary) and the possibility of longer term financing. The lack of continuity in the post is also a major obstacle to the implementation of these programmes. The recommendations drawn up following this evaluation have been discussed in steering committee with the participation of the Education Department and were presented in July 2002 to the chairman of the MILDT, at the same time as a full report on the evaluation.”

“the recommendations emphasise the need: to maintain a coherent strategic approach, especially when opening consideration of local prevention policy to all the departmental players concerned with the question of drugs or with the public at risk, to put more real emphasis on local realities in terms of the population to be covered (speaking both quantitatively and qualitatively) and the results considered to be priorities and to promote training for and exchanges between those in contact with young people, to ensure that project managers have the capacity for daily management of the projects, to maintain the contributions of the MILDT to project managers and departmental players (credits and tools).”

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Assessments

Beyond the programme of work fixed for the year by its Board of Directors, the monitoring centre must be in a position to respond to requests for assessments coming from members of the group or from external research teams.

For a simple request for a methodological opinion or for an in-depth assessment of a major research project, the OFDT has three different “resources” available that can be called on to contribute: the permanent researchers in the four units, the members of the scientific college (individually or through the commissions) and, finally, external experts.

The requests covered in the period 1999-2001 related to two main fields: the treatment of the users of illicit drugs, especially substitution treatments, and prevention.

In the field of treatment, two main projects have engaged significant resources: the situation assessment regarding substitution treatments and the double follow-up study of patients on Subutex® (ECAT project). For the latter project, the role of the OFDT was to provide a quality process (implemented by an independent ad hoc scientific committee) and to ensure that the results obtained are used in the evaluation work programme. The submissions of the OFDT could have arisen from a request for a scientific or technical opinion on study or research projects developed elsewhere. Thus, by way of example, the OFDT has given opinions on projects relating to: the prescription of Subutex® and methadone to patients looked after in addict care centres, the medical prescription of morphine sulphate as a substitution treatment, the future of two groups of addicts in prison, one of which is undergoing substitution treatment – UCSA of Fleury-Mérogis, the establishment of a communication schedule on treatment communities.

In the field of prevention, the OFDT has also been called on to give opinions following requests to its partners such as the request from the secretariat of the Commission for the Validation of Prevention Tools for an assessment of the validation procedure with a view to its improvement.

In parallel, in another field of expertise, the OFDT has produced various summaries intended to accompany the implementation of public policies at national and local levels: MILDT communication plan, no smoking day, the Ministry of Health’s alcohol plan… The monitoring centre is now receiving increasingly frequent requests, as an expert, from political sources – presidential hearings, working groups of the Senate and the National Assembly – and scientific sources – hearings in the framework of assessments by the INSERM.

Finally, the monitoring centre has made frequent contributions to the principal national and international seminars and colloquia as an expert or to present its work. It can now guarantee a contribution to the principal national and international seminars and colloquia in its field of competence.

Promotion and distribution

The period 1999-2001 was marked by a sharp rise in the capacity for the promotion of the work of the monitoring centre through the various publications produced and the creation and updating of the Web-site, drogues.gouv.fr.

In January 2002, the monitoring centre published the fourth edition of its report, “Drugs and Dependence: Indicators and Trends”, thereby responding to the expectation expressed by the public authorities at the time of its foundation: that a report on the state of the drugs and dependence problem should be drawn up periodically by an independent organisation. The assessment of the situation presented in this report give a better insight into the extent and complexity of the problem, its recent development and the public systems implemented to face up to it. It has been very widely distributed (12,000 copies printed, 8,000 distributed) amongst decision-makers, professionals and researchers in the field. Its main points have been widely presented by the media.

The “red and blue collection”, a platform for the publication of the studies carried out by the monitoring centre itself or carried out by partners at its request, has developed in the direction formats nearer to those used for general publication. The formula has stabilised, for the reports, at wide distribution in A5 format. In three years, 30 reports have been published and distributed with an average of 1200 copies each.

The publication, Trends, launched in 1999 and aimed at decision-makers, professionals and researchers in the field saw its frequency of appearance increase to 10 issues per year in 2001. In total, 18 issues have already been published (6,000 copies of each issue). Like the other publications of the centre, this is now checked by professional proof-readers.

The arrival of Alain Labrousse in September 2000 (made available by his ministry to the OFDT for two years) and the work allocated to him have made it possible to launch a new publication on international drugs trafficking under the name of Drugs, international traffic, which appears on paper once a quarter and in electronic form twice a quarter. 17 issues have been produced.

The monitoring centre has played an active part in the launch and updating of the Web-site drogues.gouv.fr, giving access to all its publications and to information specially prepared for surfers. It is also heavily engaged in the preparation of version 2, which is to be opened in 2002.

A working agreement between the OFDT and Toxibase, fixing objectives, a framework, and permanent working means, was signed in March 2000. This divides the partnership along several lines:

ƒ the participation of the OFDT documentation service in the system of monitoring, collection and analysis of the Toxibase bibliographic database,

ƒ permanent access to the Toxibase bibliographic database so that the OFDT can add to it,

ƒ the regular co-ordination of the partnership by working meetings,

ƒ the promotion of this partnership by all available means.

This framework agreement is complemented by annual work programmes. In this context, the OFDT has collaborated in the update of the Toxibase thesaurus. This work required the participation of all the researchers from April to June 2000 and then regular follow-up to ensure co- ordination with Toxibase. This is the first stage of an undertaking that should result in a rational document searching tool to be incorporated in version 2 of the Web-site drogues.gouv.fr.

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EMCDDA-Reitox

In its capacity as national focus (French representative at the EMCDDA), the monitoring centre has responded to the obligations in the various work programmes of the European Information Network on Drugs and Drug Addiction (Reitox): the national report, the joint action of 16 June 1997, the EDDRA programme, the key indicators and the source mapping.

Each year, the OFDT prepares a national report for the EMCDDA including: the analysis of epidemiological data, demand reduction, political and legislative changes, current trends and key topics (which change each year). It also updates a series of epidemiological tables with the available French data. The national report must be drawn up in accordance with the relevant guidelines, indicating any change or new development since the previous year.

In the framework of the joint European action of 16 June 1997 (early detection and monitoring of synthetic drugs), the OFDT is required to supply the EMCDDA with certain information from SINTES. The information required by the EMCDDA concerns, in particular:

ƒ physical and chemical description of the products and the names by which they are known,

ƒ an initial indication of the risks in connection with the use of this product,

ƒ information on the manner and extent of use or foreseeable use of this product as a psychotropic substance,

ƒ information on the health and social risks.

The obligations in connection with the EDDRA (Exhange on Drug Demand Reduction Action) programme are to promote the system with national partners (political and others), to collect information on new projects fulfilling the acceptability criteria and based on the EDDRA questionnaire, to update, as necessary, the existing projects and to participate in the European co- ordination meetings.

The various national focuses must participate in the efforts to arrive at reliable comparisons of information at the European level. To this end, they must actively promote, at the national level, the establishment of 5 key indicators devised by the EMCDDA and participate in the exchanges of information and activities at the European level to facilitate coherence between the Member States with regard to the establishment of these indicators. These indicators are as follows:

ƒ surveys of the general population,

ƒ prevalence,

ƒ demand for treatment,

ƒ mortality,

ƒ infectious diseases.

The OFDT is also actively involved in other co-operative actions with the EMCDDA. In particular, participation in its evaluation and contributions to its work such as that undertaken in the area of evaluation of the European action plan on drugs 2000-2004. The closeness of this partnership is illustrated by the secondment of an OFDT librarian to the documentation service of the EMCDDA for 6 months.

Following an initiative of the French presidency of the European Union, the OFDT has prepared a feasibility study project on the detection of new developments in connection with the use of drugs in Europe. The European Commission (call for tenders 2001 – DG SANCO) declared itself in favour of the project submitted by the monitoring centre (“Development of a European early identification function for emerging drug phenomena”). The OFDT has taken charge of the steering and co-ordination of this European project (8 countries are involved) with a duration of 18 months, starting from 31 December 2001.

International

The OFDT is actively involved in the European Union work towards the accession of the countries of Central and Eastern Europe to the Union. As a part of a twinning agreement between France and Slovakia, the OFDT made a direct contribution in 2000 as an expert to the part-programme

“development and strengthening of the information system”. A twinning agreement between France and Poland is being ratified. The OFDT contributed to the preparation of the project and will participate in the following activities: development of a monitoring system for drug problems, establishment of a Reitox focus.

The Canadian Senate Drugs Committee interviewed the Director of the OFDT on the model set up in France for monitoring the use of drugs. A Franco-Canadian partnership has been started with reciprocal visits and exchanges of work with the research teams (Quebec).

The OFDT also contributes to the statistical and epidemiological work of the major international bodies: assistance to the epidemiological group of the Council of Europe (Pompidou Group), national report for the PNUCID, working groups (alcohol and tobacco) of the WHO.

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Board of Directors and general meeting

The OFDT is headed by a board of directors made up of one representative of each of its members.

During the period 1999-2001, it had 12 meetings, making an average of 4 meetings per year. The first Chairman was Yves CHARPENEL, Director of Criminal Affairs and Pardons, replaced on 27 April 2001 by Robert FINIELZ.

Scientific College

A Scientific College, made up of institutions and personalities, is appointed for three years and proposed by its chairman. It is consulted with regard to the projects making up the group’s work programme and gives its opinions of the projects, their progress and their results. Renewed at the end of 1998, it has been chaired since 25 May 1999 by Claude GOT and has held 9 meetings.

Since 1999, five “specialist” commissions, drawn from the College, have been established. Chaired by a member of the College and managed by a researcher, they guide, support and validate the work carried out by the OFDT:

ƒ the “Indicators” commission,

ƒ the “Surveys of the general population” commission,

ƒ the “Recent trends” commission,

ƒ the “Evaluation of public policies” commission,

ƒ the editorial committee of the Trends revue.

Personnel and financial resources

On 31 December 1998, the OFDT had a permanent staff of 14, of which 1 made available, 1 additional duty, 1 secondment and 10 contractual agents (4 open-ended contracts, 6 fixed term contracts). On 1 October 2002, the OFDT had a permanent staff of 33, of which 1 made available, 1 additional duty, 3 secondments and 18 contractual agents (20 open-ended contracts, 8 fixed term contracts).

The financial resources of the OFDT have increased considerably during the period 1999-2001 (see budget statement in appendix). Its annual funding from interministerial credits of the MILDT, the main source of income, rose from 10 MF in 1998 to 23.4 MF in 2001.

In 1999 and 2000, the offices were extended to accommodate the enlargement of the permanent team and the many working groups set up in the course of the centre’s activities. The floor area rented at 105, rue La Fayette has doubled. At the meeting of the interministerial committee for territorial planning and development of 9 July 2001, it was decided to move the OFDT to a decentralised location at Saint-Denis. The move has been endorsed in principle by the Board of Directors. The implementation of this decision is delayed by the difficulty in finding the required funding. A request has been made for a new measure in this sense in the PLF 2003.

At the end of 2000, the Court of Accounts undertook the examination of the administration and accounts of the OFDT for the period 1996 to 1999. In its report, it finds nothing making it possible to maintain that the credits were misused.

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Conclusions

The OFDT has done some serious groundwork on the improvement of the existing indicators. For this purpose, at the end of this period, it is running five multi-institutional working groups. It has also increased the available knowledge with regard to certain questions, such as the estimation of the number of problem drug users.

Furthermore, the efforts undertaken by the centre to establish a permanent system for monitoring consumption amongst the general population have filled one of the main gaps in the French system of information about drug users. In 2000, the first implementation of the survey in the framework of the defence preparation day (ESCAPAD) completed this system: the four surveys on which it is based were made during 1999 and 2000.

A system for detecting new developments (TREND), including two innovative tools, the network of TREND sites and the synthetic drugs monitoring system (SINTES), has been established. The information obtained has already shown its worth. Its evaluation, planned from the beginning, confirmed the value its contribution and enabled it to be adjusted meet its objectives. The effort devoted to this system has placed France at the centre of the joint European action on synthetic drugs as is evidenced by its recent contribution to the monitoring of the PMA and the steering that it provides, through the OFDT, of the study for the establishment of a mechanism for the detection of new developments in connection with drug use in Europe.

During this period, the OFDT also increased its activity considerably in a new direction: the field of evaluation. In its meeting of September 2000, the interministerial committee mandated the centre to evaluate the government’s three-year plan. Going beyond the preparation of this process and the evaluations of specific established or completed systems or actions, the centre undertook an in- depth work programme to contribute to an “evaluation culture” in this sector, in preparation for any evaluation of public policy. The most representative element in this regard is, without doubt, the dynamic created during the phases of collective elaboration of the evaluation questions.

The volume of work carried out on the basis of the orientation fixed for the centre by its Board of Directors is evidenced by the number of publications produced. The quantitative and qualitative development of the promotional supports of the work of the OFDT finds an echo in their growing audience amongst the professionals of the sector and the public at large.

All this progress has only been made possible by the commitment of a circle led by a permanently active team combining: institutional partners, players in the field and members of the scientific college. It is appropriate to underline this collective aspect of the OFDT’s activity.

Nevertheless, there remains a great deal to be done to increase our knowledge of drugs, their uses and the consequences of these uses. Thus it is, that for permitted drugs, the extension of the OFDT’s field of activity since 1999 has not yet caught up with the activities on illicit drugs. In the same way, certain topics, such as doping practices and the social consequences of drug use have so far only been touched on.

Outlook

Looking back on the way we have come, what are the challenges for the OFDT in the years to come?

To begin with, we must consider the discussion of the possible extension of the OFDT’s missions to the research field, as provided for in the government plan for 1999-2001 and examined in detail by the working group assembled under the aegis of the MILDT. The considerations of this group have come up with several options from linking the existing public interest group with a scientific interest group, through an extension of the mission of the public interest group to the management of research while including the public establishments of a scientific and technological nature in the board of management of the public interest group, to the creation of a national drug research agency. As the positions of the decision-makers concerned have not yet been fixed with regard to this question, the consideration of the lines along which the OFDT should work in the years to come is limited to the current mission: the monitoring of drugs, their uses and the consequences of these uses.

1. Consolidation of assets

The OFDT has established a range of tools that, in the long term, form a basis for monitoring the drug problem and will enable it, in particular, to reliably observe developments in the years to come. A major part of the available effort in the OFDT should be devoted to the maintenance of this system:

ƒ surveys of consumption and perceptions amongst the general population or young people,

ƒ monitoring and improvement of available indicators of the contexts and consequences of the consumption of various drugs,

ƒ monitoring of new developments (TREND).

2. Development of certain study topics

Based on the discussion of the past activities and outlook for the years to come that took place in the last meeting of the Scientific College and the considerations of this subject by the team, the following lines of work can be put forward:

ƒ further work on certain parts of the extension of the field of observation decided on in 1998, especially on psychotropic medicaments,

ƒ exploration (especially in surveys) of behaviours connected with those of drug consumption: doping practices and the pathological game,

ƒ strengthening of the monitoring of actions and players (numeration, perceptions),

ƒ establishment of indicators or studies of the social consequences of drug use, insecurity, delinquency etc,

ƒ development of descriptive tools to refine the quantification of problem users of alcohol and cannabis,

ƒ more in-depth analyses of the data available on: the morbidity of drug users (compared to general morbidity), the geographical distribution of use, age and generation effects.

3. Perpetuation of the evaluation process

Giving due consideration to the evaluation aspect in the determination and support of public policy on drugs and the implementation of the contributory systems is a long-term process.

To move in this direction, it would be necessary to incorporate the evaluation process further upstream in the preparation of the next government plan. A new evaluation mandate could then be incorporated in the plan itself.

With regard to particular evaluations, even before the necessary interministerial discussion of the subject, two areas seem essential:

ƒ evaluation of the impact of preventive actions,

ƒ evaluation of the impact of the risk and damage reduction strategy.

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In conclusion, we should remind ourselves of the double necessity for the OFDT: its autonomy coupled with close proximity to public decision-making. The balance here is difficult to maintain but must be preserved. It is based on the principle that ruled when the establishment was formed in 1995, in order that the public authorities could have the support of an organisation with complete scientific independence to report on the incidence of drug use. To this end, the Board of Directors decided, in December 2001, to provide the establishment with the necessary means to enable it to communicate, in an autonomous manner, the information that it produces.

Jean-michel COSTES Director