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This article presents original mixed method research to describe the use of rare illicit psychoactive substances, with special emphasis on crack cocaine in France. We first introduce a unique monitoring system committed to the observation of hard-to-reach populations. Qualitative findings rely, among others, on perennial ethnographic studies and field professionals’ knowledge to provide guidance to estimate the number of crack cocaine users. We then rely on a set of multilevel capture-recapture estimators, a statistical procedure to indirectly estimate the size of elusive populations. Since prior field evidence suggests an increasing diversity in crack cocaine users’ profiles, we provide a measure of heterogeneity to assess which estimator better fits the data. The calculated estimates are then critically reviewed and debated in light of the previously gathered information. Our results uncover both individual and institutional heterogeneity and suggest that the spread of crack cocaine in France initiated earlier than originally thought. Our case study underlines the need for field-driven assessments to put quantitative results into perspective, a necessary step to tailor efficient health policy responses.

This exploratory analysis of time-series cross-sectional data provides insights on trends in age at first injection among people who inject drugs in France, and on associations with recent risky injecting behaviors. Data were collected from a national survey conducted in harm reduction facilities in five phases between 2006 and 2015. Standardized questionnaires collected information on demographics, substance use, and route of administration, as well as lifetime and past-month injection. Descriptive and multilevel models were applied to account for the hierarchical structure of the data. Prevalence of lifetime and past-month injection remained stable over time, while the prevalence of daily injection increased significantly. Mean age at first injection only appeared to increase for data collected after 2010. Gender differences in mean age at first injection decreased over time, suggesting the development of converging patterns of initiation independent of sex. After controlling for covariates, early initiation of injection was unrelated to daily injection or material sharing, and associated with the number of recently injected substances. Early initiation is likely a predictor of injected polysubstance use. Findings are relevant to the planning, implementation, and evaluation of prevention programs.

Introduction and aims New psychoactive substances (NPS) represent hundreds of novel compounds. However, the general public might not be familiar with the overarching term NPS. This can result in both under- and over-reporting of NPS use. Design and methods The study analysed the last-year prevalence of NPS use in an online survey conducted across I-TREND project countries (the Czech Republic, the Netherlands and Poland). Self-reported NPS use was assessed within two types of questions-a generic and a checklist question. We analysed prevalence for each question separately, incorporated the free-text probe 'other' that followed them, and combined the two questions into a conservative and an inclusive estimate. Results Including free-text responses to the 'other' categories increased prevalence of NPS use (from 51% to 56% for the checklist question and 25% to 32% for the generic question). Taking an inclusive approach to estimating prevalence (i.e. indicating NPS use in either a generic list or from the checklist) yielded a higher prevalence estimate (60%, 95% confidence interval 58-62%), compared to a more conservative approach in which NPS use had to be affirmed by both questions (27%, 95% confidence interval 26-29%). Discussion and conclusions Generic questions might lead to notably lower estimates of self-reported NPS use in comparison to checklists. However, creating relevant checklists is challenging and lengthy survey instruments have limitations. Further surveys might benefit from featuring a combination of the strategies used in this study-a single (generic) question involving a number of locally specific NPSs and a free-text 'other' probe.

Introduction and Aims Field studies have indicated a recent increase in heroin availability and use in France, and yet very little is known about the mechanisms underlying heroin retail prices. This paper offers a first attempt at identifying the determinants of heroin pricing, to measure quantity discounts and assess the influence of purity on street prices, while controlling for a geographical effect. Design and Methods Data on heroin samples were collected during 2011 in seven urban areas of metropolitan France. Ordinary least squares regression was used to model the associations between price, quantity, purity and other independent variables. Results Quantity remains the most influential variable on heroin pricing. We estimate that a 10% increase in the size of a transaction leads to a 2.3% decrease in the unit price. Assessed purity proved to be significant, although in modest proportion. Sociodemographic characteristics, such as gender, users' experience and relationships with dealers, proved to be insignificant. Heroin retail prices vary according to a geographical gradient related to the routes of entry and distribution. Discussion and Conclusions As a credence good, heroin retail prices in France are affected by more than simply the traditional supply and demand relationship. The results of this study also underline the limitations of a quantitative framework and should be complemented by further ethnographic research to obtain an in-depth understanding of local markets. Policies should be designed to better take local disparities into account.[Lahaie E, Janssen E, Cadet-Tairou A. Determinants of heroin retail prices in metropolitan France:Discounts, purity and local markets. Drug Alcohol Rev 2015;00:000–000]

Introduction Les acteurs du champ socio-sanitaire de Mayotte, departement francais depuis 2011, alertent vers 2013 sur le developpement de la consommation d’une substance appelee « Chimique ». Elle contient des nouveaux produits de synthese (NPS), essentiellement des cannabinoides synthetiques (CS) [1] commandes en ligne puis melanges localement a du tabac. Cette communication explicite les facteurs ayant favorise la diffusion d’une consommation de NPS vers le jeune public, situation particulierement redoutee au plan sanitaire [2] , [3] . Methode En 2017, l’OFDT a realise un etat des lieux pour l’Agence regionale de sante de l’Ocean Indien [4] a partir d’une analyse documentaire [5] , [6] , [7] , [8] , [9] , [10] et de l’utilisation des outils qualitatifs mobilises par le dispositif TREND pour trianguler l’information : groupes focaux, reunions d’equipes, entretiens (dont 17 usagers), observations ethnographiques. Resultats En 2010, un individu d’origine metropolitaine commande des CS par Internet pour pallier ses difficultes d’approvisionnement en cannabis. Il partage puis vend ; de confidentiel l’usage s’elargit progressivement sur Mamoudzou, jusqu’a atteindre, en 2013, de jeunes adultes et des adolescents. La diffusion dans ces classes d’âge vulnerables [11] , fortement socialisees entre pairs, entraine un pic d’intoxications et une visibilite notable des effets indesirables dans l’espace public (pertes de connaissance, somnolence, agitation). En 2017, moins d’intoxications sont repertoriees, l’experimentation semble reculer chez les moins fragiles (souvent bien inseres scolairement) mais le produit diffuse geographiquement sur le territoire mahorais. Les situations d’addiction concernent prioritairement les tres nombreux jeunes precaires, marques par l’absence de structure familiale protectrice, les experiences traumatisantes, le manque de perspectives, les difficultes quotidiennes et l’inaccessibilite des aides. L’elargissement du marche a partir des, desormais multiples, importateurs de NPS, socialement bien inseres, a profite de reseaux de distribution deja structures via des bandes delinquantes, bien implantees sur les territoires qu’elles controlent, du caractere tres lucratif du trafic face a la situation economique locale, du controle difficile des NPS et de la mise a profit volontaire de leur caractere rapidement addictif. Discussion et conclusion Le developpement particulierement rapide de la consommation de CS a Mayotte contraste avec la dynamique des NPS en France metropolitaine, demontrant ainsi l’importance des facteurs contextuels dans la diffusion d’une substance psychoactive.

Cet article porte sur les carrieres d’usagers de cocaine inconnus des institutions socio-sanitaires et repressives. Il presente les resultats d’une enquete conduite par entretiens semi-directifs aupres de 50 usagers appartenant a cette population cachee. Les auteurs retracent les differentes etapes des carrieres en portant une attention particuliere aux frequences d’usage mais aussi aux contextes de consommation, aux significations de l’usage ainsi qu’aux dynamiques de groupe faconnant les parcours individuels.

Field studies have indicated a recent increase in heroin availability and use in France, and yet very little is known about the mechanisms underlying heroin retail prices. This paper offers a first attempt at identifying the determinants of heroin pricing, to measure quantity discounts and assess the influence of purity on street prices, while controlling for a geographical effect.Data on heroin samples were collected during 2011 in seven urban areas of metropolitan France. Ordinary least squares regression was used to model the associations between price, quantity, purity and other independent variables.Quantity remains the most influential variable on heroin pricing. We estimate that a 10% increase in the size of a transaction leads to a 2.3% decrease in the unit price. Assessed purity proved to be significant, although in modest proportion. Sociodemographic characteristics, such as gender, users' experience and relationships with dealers, proved to be insignificant. Heroin retail prices vary according to a geographical gradient related to the routes of entry and distribution.As a credence good, heroin retail prices in France are affected by more than simply the traditional supply and demand relationship. The results of this study also underline the limitations of a quantitative framework and should be complemented by further ethnographic research to obtain an in-depth understanding of local markets. Policies should be designed to better take local disparities into account.[Lahaie E, Janssen E, Cadet-Taïrou A. Determinants of heroin retail prices in metropolitan France:Discounts, purity and local markets. Drug Alcohol Rev 2016;35:597-604].

Les médicaments psychotropes, du fait de leurs propriétés psychoactives, peuvent entrainer un risque d’abus et de dépendance. Malgré des règles strictes de prescription et de délivrance, leur consommation s’effectue parfois hors prescription médicale ou sans respect des indications ou des consignes de prescription. Ces mésusages peuvent être associés à une obtention illégale du médicament.Sollicité par la Mission interministérielle de lutte contre la drogue et la toxicomanie (Mildt), cette expertise collective fait le point sur la consommation de médicaments psychotropes en France et analyse les diverses formes de mésusage selon les populations et les contextes. L’expertise fait également le point sur la dépendance à ces médicaments, sur les règlementations et les dispositifs de surveillance de l’abus et de la dépendance, en France et au plan international.

This article presents a research device (drawn up by the ‘Observatoire francais des drogues et des toxicomanies’ or OFDT) for exploring drug consumption practices among ‘hard-to-reach users’. The OFDT’s aim is to put forward a coherent and precise understanding of phenomena relating to drug use and to monitor developments from a national perspective, despite regional differences. The scope of observation focusses on the primary areas of drug use in France. The analysis over time of quantitative and qualitative data also made it possible to divide up the theoretical and heterogeneous unit formed by drug users (DUs) in terms of population types and sub-populations. They have different characteristics and engage in different practices, which do not always develop in the same way. Sometimes they are geographically unstable. The OFDT’s experience of probability studies on DUs or populations with a high prevalence of drug use is applied in a ‘capture-recapture’ study that aims at estimating the prevalence of problematic drug use in six French cities and a quantitative survey based on a sampling plan with an ethnographically based approach in party environments with a focus on electronic music. These complex sampling studies prove indispensable, in particular in measuring the prevalence of drug use in populations not exclusively made up of drug users. However, we believe that, on their own, they cannot measure a phenomenon or monitor its developments since there are several sources of bias associated with sampling and the collection of data in surveys on hard-to-reach populations. We believe that comparing their results not only with the quantitative data from other sources, in particular the time series collected from users of centres for DUs but also with ethnographic data is indispensable in order to monitor these trends.

Background There is little knowledge about the composition and cocaine content of street cocaine, nor about what users know about it. Method 373 cocaine users were face to face interviewed between May and December 2006 about the last sample of cocaine they had consumed and residual amounts of the substances actually used were analysed using gas phase chromatography coupled to mass spectrometry (GC–MS). Users rated the perceived quality of their product ("good", "average", "poor"), its "estimated percentage of cocaine" and any cutting agents it contained. Price, quantity, place of purchase (street, dealer's premise, appointment), mode of administration (sniffing, injection, smoking) and the supposed nature of the sample (natural, synthetic, no distinction ever made) were also reported. Perceived quality was modelled using multivariate multinomial regression. Results The median cocaine content was 22%. Altogether, 343 samples contained cocaine, among which 75% contained at least one adulterant. The most frequently occurring were phenacetin (54% of the samples), caffeine (17%), paracetamol (14%), diltiazem and lidocaine (11%). Users showed relatively poor discrimination concerning cocaine purity, and only 12% reported at least one of the detected adulterants. The major determinants of their perception of cocaine quality were: place of purchase, natural origin, price per gram, actual cocaine content and mode of administration. Conclusion The composition of street cocaine is largely unknown to users. Users' perceptions of cocaine quality are based partly on false beliefs and certain administration modes. This may contribute to favouring very risky practices. The effects of adulterants on users' health should be investigated.

This qualitative research implemented in France between 2004 and 2007 is based on 30 in-depth interviews carried out with individuals who consumed hallucinogenic plants or mushrooms at least six times during the year preceding the interview. The interviews were recorded, retranscribed, and an analysis of their content applied for the textual data. The study focuses on drug users and the meanings they attach to their drug use. These meanings involve three different representations of the drugs: “enchanting plants,” “disorientation plants,” and “visionary plants.”