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Ilhame Anwar,1 Aissatou Faye,1 Jessica Pereira Gonçalves,1 Laélia Briand Madrid,1 Gwenaëlle Maradan,2 Laurence Lalanne,3,4,* Marie Jauffret-Roustide,5– 7,* Marc Auriacombe,8– 10,* Perrine Roux1 1Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France; 2ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France; 3INSERM 1114, Department of Psychiatry and Addictology, University Hospital of Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, 67000, France; 4Department of Psychiatry and Addictology, University Hospital of Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, 67000, France; 5CERMES3 (Inserm U988/UMR CNRS 8211/EHESS/Paris Descartes University), Paris, France; 6British Columbia Center on Substance Use, Vancouver, Canada; 7Baldy Center on Law and Social Policy, Buffalo University, New York, NY, USA; 8Univ. Bordeaux, Bordeaux, France; 9Addiction Team (Laboratoire de psychiatrie)/SANPSY, CNRS USR 3413, Bordeaux, France; 10Pôle Addictologie, CH Charles Perrens and CHU de Bordeaux, Bordeaux, France*These authors contributed equally to this workCorrespondence: Ilhame Anwar, Sciences Economiques et Sociales de la Santé et Traitement de l’Information Médicale (SESSTIM), Faculté des sciences médicales et paramédicales, 27 Bd Jean Moulin 13385 Marseille Cedex 5, Marseille, France, Email ilhame.anwar@inserm.frPurpose: Injection drug use is strongly associated with stigmatization by loved ones, healthcare providers, and society in general. This stigmatization can have negative consequences on the health of people who inject drugs (PWID) and limit their access to care. Women who inject drugs face greater stigma than men because of gendered social norms and the intersectional effect between gender and drug use identities. For this analysis, we aimed to study discrimination - which is closely linked to stigmatization - experienced by PWID, considering the intersectionality between drug use discrimination and gender discrimination in the French context.Methods: We used data from the COSINUS cohort study, conducted between June 2016 and May 2019 in four French cities. We selected 427 of the 665 PWID who regularly injected drugs enrolled in COSINUS, at three months of follow-up, and performed multivariable logistic regression to identify factors associated with self-reported drug use discrimination.Results: Women comprised 20.6% of the study sample. Sixty-nine percent of the participants declared drug use discrimination and 15% gender discrimination. In the multivariable regression analysis, PWID who had hurried injection out of fear of being seen were almost twice as likely to have experienced drug use discrimination (OR [95% CI]: 1.77 [1.15, 2.74], p = 0.010). Likewise, women experiencing gender discrimination were almost three times as likely to have experienced drug use discrimination (OR [95% CI]: 2.84 [1.07,7.56], p=0.037).Conclusion: Women who inject drugs experienced gender and drug use intersectional discrimination. This could be a reason for the low attendance rates of women in healthcare settings. In addition, discrimination negatively impacted injection drug use practices (eg, hurried injection), particularly for people with unstable housing who injected in public spaces. We recommend introducing adapted services in healthcare facilities for women who inject drugs, and creating a favorable social and physical environment for all PWID in order to improve their health and access to care.Keywords: gender, injection drug use, intersectionality, discrimination

Background The effectiveness of drug consumption rooms (DCRs) for people who inject drugs (PWID) has been demonstrated for HIV and hepatitis C virus risk practices, and access to care for substance use disorders. However, data on other health-related complications are scarce. Using data from the French COSINUS cohort, we investigated the impact of DCR exposure on non-fatal overdoses, abscesses and emergency department (ED) visits, all in the previous 6 months. Methods COSINUS is a 12-month prospective cohort study of 665 PWID in France studying DCR effectiveness on health. We collected data from face-to-face interviews at enrolment, and at 6 and 12 months of follow-up. After adjusting for other correlates (P -value < 0.05), the impact of DCR exposure on each outcome was assessed using a two-step Heckman mixed-effects probit model, allowing us to adjust for potential non-randomization bias due to differences between DCR-exposed and DCR-unexposed participants, while taking into account the correlation between repeated measures. Results At enrolment, 21%, 6% and 38% of the 665 participants reported overdoses, abscesses and ED visits, respectively. Multivariable models found that DCR-exposed participants were less likely to report overdoses [adjusted coefficient (95% CI): −0.47 (−0.88; −0.07), P  =   0.023], abscesses [−0.74 (−1.11; −0.37), P  <   0.001] and ED visits [−0.74 (−1.27; −0.20), P  =   0.007]. Conclusion This is the first study to show the positive impact of DCR exposure on abscesses and ED visits, and confirms DCR effectiveness in reducing overdoses, when adjusting for potential non-randomization bias. Our findings strengthen the argument to expand DCR implementation to improve PWID injection environment and health. [ABSTRACT FROM AUTHOR]

Background: After the collapse of the Soviet Union at the beginning of the 1990s, people who inject drugs spiked in Eastern Europe. Facing local repression and an array of factors encouraging emigration, some users have migrated to France. This population now make up to a third of the patient list of some harm reduction services in Paris. This article aims to present original data on the sociodemographic profiles of these users, on their migration trajectory, their life conditions, and on the evolution of their drug use practices since arriving in Paris. Methods: Data were collected as part of the ANRS-Coquelicot Survey, an HIV and HCV seroprevalence study among French-speaking people who use drugs. A sub-sample of Russian-speaking drug users who had relocated from Eastern Europe to live in Paris completed a quantitative questionnaire (N = 150) and a qualitative semi-structured interview (N = 20). The survey aimed to describe participants' backgrounds, and a thematic analysis of interviews was conducted to explore participants' migration histories, their life conditions in Paris, and their drug use practices before and after arriving in France. Results: This study highlights the great vulnerability of the participating population, often following a loss of social status after migrating to France. Another important finding is that participants had better access to harm reduction tools and reduced their risk of exposure to HIV and HCV infections linked to needle sharing. Although 60% said they had already shared a syringe in their lifetime (49.9% of them in their home country), the proportions shrank to 13.9% after they arrived in France and to 9.3% in the month before the study, a proportion that is lower than among French-speaking people who use drugs. Conclusions: Our main findings on the profiles and behaviors of the study population lead us to make two recommendations: to offer stronger global care to these users in Paris and to reform drug policy in their home countries by integrating it into a public health approach. [ABSTRACT FROM AUTHOR]

People who use drugs (PWUD) are a key population for hepatitis B virus (HBV) vaccination and screening. We aimed to estimate the seroprevalence of HBs antigen (HBsAg) and self-reported HBV vaccination history in French PWUD attending harm reduction centres using data from the ANRS-Coquelicot multicentre survey conducted in 2011–2013 in 1718 PWUD. Self-fingerprick blood samples were collected on dried blood spots to detect the presence of HBsAg. HBsAg seroprevalence was estimated at 1·4% [95% confidence interval (CI) 0·8–2·5]. It varied between PWUD born in high (7·6%, 95% CI 2·7–19·1), moderate (2·2%, 95% CI 0·8–5·7) and low (0·7%, 95% CI 0·3–1·5) endemic zones. Factors independently associated with HBsAg carriage were being born in a moderate or high endemic zone or reporting precarious housing. Self-reported HBV vaccination history varied from 47·4% in high endemic zones, to 59·3% and 62·6% for moderate and low endemic zones, respectively. Our results suggest that drug use plays a small and substantial role, respectively, in HBsAg carriage in PWUD born in high/moderate and low endemic zones. [ABSTRACT FROM PUBLISHER]

Abstract Background Overpopulation, poor hygiene and disease prevention conditions in prisons are major structural determinants of increased infectious risk within prison settings but evidence-based national and WHO guidelines provide clear indications on how to reduce this risk. We sought to estimate the level of infectious risk by measuring how French prisons adhere to national and WHO guidelines. Methods A nationwide survey targeting the heads of medical (all French prisons) and psychiatric (26 French prisons) units was conducted using a postal questionnaire and a phone interview mainly focusing on access to prevention interventions, i.e. bleach, opioid substitution treatment (OST), HBV vaccination and post-exposure prophylaxis (PEP) for French prisoners. Two scores were built reflecting adherence to national and WHO international guidelines, ranging from 0 (no adherence) to 10 (maximum adherence) and 0 to 9 respectively. Results A majority (N = 113 (66%)) of the 171 prisons answered the questionnaires, representing 74% coverage (46,786 prisoners) of the French prison population: 108 were medical units and 12 were psychiatric units. Inmate access to prevention was poor. The median[IQR] score measuring adherence to national guidelines was quite low (4.5[2.5; 5.5]) but adherence to WHO guidelines was even lower 2.5[1.5; 3.5]; PEP was absent despite reported risky practices. Unsuitable OST delivery practices were frequently observed. Conclusions A wide gap exists between HIV prevention policies and their application in prisons. Similar assessments in other countries may be needed to guide a global policy reform in prison settings. Adequate funding together with innovative interventions able to remove structural and ideological barriers to HIV prevention are now needed to motivate those in charge of prison health, to improve their working environment and to relieve French prisoners from their currently debilitating conditions.

Abstract Background Epidemiology of HCV infection among drug users (DUs) has been widely studied. Prevalence and sociobehavioural data among DUs are therefore available in most countries but no study has taken into account in the sampling weights one important aspect of the way of life of DUs, namely that they can use one or more specialized services during the study period. In 2004–2005, we conducted a national seroepidemiologic survey of DUs, based on a random sampling design using the Generalised Weight Share Method (GWSM) and on blood testing. Methods A cross-sectional multicenter survey was done among DUs having injected or snorted drugs at least once in their life. We conducted a two stage random survey of DUs selected to represent the diversity of drug use. The fact that DUs can use more than one structure during the study period has an impact on their inclusion probabilities. To calculate a correct sampling weight, we used the GWSM. A sociobehavioral questionnaire was administered by interviewers. Selected DUs were asked to self-collect a fingerprick blood sample on blotting paper. Results Of all DUs selected, 1462 (75%) accepted to participate. HCV seroprevalence was 59.8% [95% CI: 50.7–68.3]. Of DUs under 30 years, 28% were HCV seropositive. Of HCV-infected DUs, 27% were unaware of their status. In the month prior to interview, 13% of DUs shared a syringe, 38% other injection parapharnelia and 81% shared a crack pipe. In multivariate analysis, factors independently associated with HCV seropositivity were age over 30, HIV seropositivity, having ever injected drugs, opiate substitution treatment (OST), crack use, and precarious housing. Conclusion This is the first time that blood testing combined to GWSM is applied to a DUs population, which improve the estimate of HCV prevalence. HCV seroprevalence is high, indeed by the youngest DUs. And a large proportion of DUs are not aware of their status. Our multivariate analysis identifies risk factors such as crack consumption and unstable housing.

Introduction: The co-use of stimulants and opioids, including opioid agonist treatment (OAT), is very prevalent worldwide. A large body of data exists on the association between stimulant use and its health complications, and on OAT effectiveness among people with opioid use disorder. However, few data exist on stimulant-opioid co-use among people receiving OAT. Using data from the COSINUS cohort study, we investigated the association between the type of OAT and problematic stimulant use among persons who inject drugs (PWID)., Methods: COSINUS is a 12-month French cohort study of 665 PWID. Data were collected in face-to-face interviews at enrolment, at 6 and 12 months. We defined problematic stimulant use as daily use of and/or injecting stimulants. We used Bayesian model averaging (BMA) to identify factors associated with problematic stimulant use., Results: At baseline, 76% (n = 505) of the participants reported problematic stimulant use. The optimal model from the BMA estimation showed that, after adjusting on social precarity and daily injection, participants on prescribed morphine sulfate as an OAT (compared with methadone) and those who use daily unprescribed buprenorphine were less likely to report problematic stimulant use., Discussion and Conclusions: Our work highlights the high prevalence of problematic stimulant use among PWID in France but also the potential association between the type of OAT taken and stimulant use, by suggesting a protective effect of morphine sulfate on stimulant use. Since it has a higher intrinsic activity than other opioids, PWID on this OAT may be less interested in stimulants. Our findings warrant further investigation in clinical studies., (© 2024 The Author(s). Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

Background: Opioid Use Disorder (OUD) often provokes dramatic consequences in terms of increased morbi-mortality. Two medications have mainly been worldwide used for OUD (MOUD), buprenorphine and methadone. Recently, however, some reports have highlighted the use of Morphine Sulfate (MS) mainly obtained without a prescription but used as MOUD by opioid users and especially People Who Inject Substances (PWIS). We propose to characterize the prevalence and distribution of MOUD and MS use in PWIS., Methods: This study examines the use of MOUD and MS amongst French PWIS recruited in harm reduction facilities and drug consumption rooms in the context of the COSINUS (Cohort to assess structural and individual factors in drug use) study., Results: MOUD are prescribed, respectively, to one-third and one-fifth of PWIS, whereas a half of them declared MS consumption without prescription. MS users live with higher precariousness and are younger than non-users. MS is associated with salt cocaine and heroin use. It is often consumed with methadone and more rarely with buprenorphine and we hypothesized that this is probably linked to buprenorphine's pharmacological antagonism., Discussion: Our results show the high prevalence of MS consumption and highlight the importance of considering the highly restricted possibility of prescribing MS as MOUD. Its association with methadone raises the question of their synergistic action on craving and mental disorders. The profiles of opioid users who could benefit from MS with or without methadone must be examined to improve their care but with the utmost caution, given the risk of overdose.

The ANRS-Coquelicot survey has been carried out in France for 25 years, to monitor trends in infectious diseases (HIV and hepatitis B and C) among people who use drugs. In this article, we propose to open the black box of this monitoring experience, by describing and analysing some methodological, ethical and political issues involved in this type of survey. The ANRS-Coquelicot survey has carried out on five occasions in France (from 2002 to 2024) in several cities (from 1 to 27) among people who use drugs recruited in a large diversity of services including drug treatment centres, harm reduction facilities, residential services as well as outreach teams. The survey design included a Time Location Sampling combined with the Generalized Weight Share Method and was guided by a previous anthropological survey. Over time, some methodological challenges have been addressed such as convincing harm reduction providers and drug treatment professionals to welcome this sero-prevalence survey that was first envisioned as a form social control of people who use drugs as well as an evaluation of their professional practices. The implementation of a previous socio-anthropological phase played a major role in favouring the acceptability of the survey as well as in the improvement of the quantitative methodology for choosing the most adequate methodological tools for measuring risk exposure as well as allowing participants room to promote their experiences of the survey through self-narration. Conducting sero-prevalence surveys among time is a way to produce scientific knowledge but can also inform drug policies in order to enable more favourable environments for people who use drugs. This article is an opportunity to show the richness of surveillance surveys and how they can both produce new knowledge and be the subject of innovative methodological developments, as well as enabling the evaluation and orientation of harm reduction policies over time., Competing Interests: Declaration of competing interest Marie Jauffret-Roustide has no competing interest to declare., (Copyright © 2024. Published by Elsevier B.V.)

Background: The COVID-19 pandemic and the accompanying measures to mitigate infection affected many areas of society, including the supply and use of cannabis. This paper explored how patterns of behaviour among people who cultivate cannabis were affected by the COVID-19 pandemic and restrictions., Methods: An anonymous web survey of people who cultivated cannabis was conducted from Aug 2020 to Sep 2021, spanning 18 countries and 11 languages (N = 11,479). Descriptive statistics and mean comparison tests were conducted., Results: Most cannabis growers reported that their practices were relatively unaffected by the COVID-related restrictions. While 35.2 % reported difficulties buying cannabis from their usual dealer, <10 % stated that access to materials needed for growing was impaired during the pandemic. Over one-quarter (28.2 %) of respondents increased their cannabis use and 21.4 % also increased cannabis cultivation (more than twice as many as those who said they were growing less or not anymore) while COVID restrictions were in place. People who lost their job or were casually employed were more likely to increase use and cultivation. Overall, the pandemic had little impact on reasons for growing, however, difficulties obtaining cannabis were mentioned as the most prevalent COVID-19-related growing motive. A small number (16 %) reported starting their growing activity during the pandemic. Italian and Portuguese growers were more likely to report shortages in supply and increases in their growing activity., Conclusions: This study is the first to document an increase in cannabis cultivation activity following COVID restrictions. Increased home cultivation was not only driven by higher use as a result of home isolation, but also by disruptions of wider illegal cannabis supply. Limitations of this study include the non-representativeness of the sample as well as differences in approaches and duration of restrictions in different countries., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)