2023-09-27 13:51:45
A study confirms the benefit of lower risk consumption rooms (SCMR) in the fight once morest infectious transmission and calls for strengthening the existing system.
The French policy for reducing the risks of transmission of HIV and hepatitis C viruses among people who consume substances by injection includes, in particular, access to sterile syringes and lower-risk consumption rooms (SCMR). The evaluation of the effectiveness of the first SCMR deployed in France in 2016 was entrusted to Inserm by the Interministerial Mission to Combat Addictive Behavior. In this context, a team of researchers from Inserm, CNRS, EHESS, the University of Strasbourg, Aix-Marseille University and the University of Bordeaux, through interviews with drug users participating in the Cosinus cohort, evaluated the effectiveness of SCMR in reducing risky practices – and in particular the sharing of injection equipment. Their results show a 90% reduction in the risk of sharing equipment between people with access to consumption rooms and those with access to other types of risk reduction structures. This work published in Addiction confirms the interest of SCMR in the fight once morest infectious transmissions and calls for strengthening the existing system.
Among people who inject substances, sharing equipment such as needles or syringes is one of the main risk factors for transmission of the HIV and hepatitis C viruses. In France, the establishment of programs to reduce the risks linked to substance use (associated with access to antiretroviral drugs for HIV-positive people) has greatly contributed to the reduction in the prevalence of HIV among substance users (by 40 % in 1998 to 11% in 2011). On the other hand, the hepatitis C epidemic remains uncontrolled with 64% of users HIV positive in 2011.
Lower risk consumption rooms (SCMR) – today called “addiction care centers” – allow users to consume in good conditions of hygiene and safety, with easy access to sterile injection equipment for use. unique, under the supervision of trained staff. In addition to directing users to appropriate social and medical services, they provide access to so-called “opioid agonist” treatments (OAT).[1] and offer the possibility of being screened on site for hepatitis C. Previous studies have shown in several countries that these SCMRs present themselves as an effective means of reducing the risky practices of users of injecting substances, of reducing the injections performed in public spaces, to break the chains of infectious transmission and to prevent overdoses.
As part of the fight once morest the hepatitis C epidemic, the government set up in 2016 for a test period of 6 years, two SCMRs open to those over 18, in Paris and Strasbourg. The Interministerial Mission to Combat Addictive Behaviors has entrusted Inserm with the evaluation of their effectiveness in terms of public health and peace.
A research team involving researchers from Inserm, CNRS, EHESS, the University of Strasbourg, Aix-Marseille University and the University of Bordeaux, worked to evaluate the impact of consumption rooms in France on the sharing of injection equipment and on access to hepatitis C screening tests and opioid agonist treatments thanks to the French Cosinus cohort including 662 users of (illegal) injection substances or medication) (see box). Thanks to questionnaires, the researchers were able to compare the declarative data obtained between participants having access to a SCMR (36% of participants) and those not benefiting from this type of infrastructure but having access to other types of structures or harm reduction programs (64%).
While more than 25% of participants reported being infected with hepatitis C, the results of this study show that 1% of participants with access to consumption rooms said they were likely to share their injection equipment compared to 11% of those who did not. not having access to these places. “This represents a 90% reduction in the risk of material sharing by SCMRs, declares Marie Jauffret-Roustide, Inserm researcher and co-author of this work, which shows that, in the French healthcare context, these places would have a positive impact on practices with an infectious risk of HIV and hepatitis C.”
On the other hand, no significant difference between the two groups was visible in the screening for hepatitis C or in the follow-up of opioid agonist treatment. “This can be explained by the fact that the French care model now makes it possible to systematically offer hepatitis C screening in risk reduction sites,” explains Perrine Roux, Inserm researcher who co-authored the publication. Furthermore, if there is wide access to OAT in our country, according to our study, very many people who access consumption rooms in Paris use morphine sulfates without a prescription, which is not yet considered officially as a TAO: this might give an undervalued result for consumption rooms”, add Marc Auriacombe and Laurence Lalanne, doctors and co-authors of this work.
The study, consistent with previous work, shows that precariousness, the use of stimulants (particularly crack) and daily injections are factors associated with practices at risk of HIV and hepatitis C infection. Reporting having hepatitis C was also associated with sharing injection equipment; an association which is not found here among HIV-positive people, but which highlights the interest in implementing programs to limit the sharing of equipment to control the hepatitis C epidemic.
“Our results argue for the importance of implementing actions complementary to those already existing, to better combat viral transmissions within the community of people who consume substances. In particular, develop addiction care stops but also facilitate access to more diversified opioid agonist treatments and offer comprehensive care”, concludes Marie Jauffret-Roustide. It also invites continued monitoring of these people in order to confirm the positive impact of consumption rooms on risky practices.[2].
En savoir plus sur la cohorte Cosinus La cohorte française longitudinale Cosinus (Cohort to identify structural and individual factors associated with drug use) a suivi 665 personnes de plus de 18 ans qui consomment des substances par injection à Bordeaux, Marseille, Paris et Strasbourg, entre novembre 2016 et mai 2018. Les participants ont été recrutés au sein de programmes de réduction des risques à Bordeaux et Marseille et de salles de consommation à Strasbourg et Paris. Les objectifs de cette cohorte étaient d’évaluer l’impact des salles de consommation à la fois sur les risques de transmission des virus du VIH et de l’hépatite C via le partage du matériel d’injection, sur l’accès au dépistage de l’hépatite C et sur l’accès aux TAO. Suite aux premiers travaux parus sur le sujet, le gouvernement a décidé en 2021 de créer les haltes soins addictions qui devraient combiner des lieux de réduction des risques des pratiques d’injection avec un accès aux soins (dont psychiatriques) amélioré pour une approche globale de prévention des risques pour les usagers de drogues injectables. À ce jour, aucune halte soins addictions n’a été implantée mais les résultats de la cohorte Cosinus plaident en faveur de leur mise en place.
[1]Opioid agonist treatment makes it possible to treat addiction or use disorder to opioids (heroin, oxyodone, fentanyl, etc.) by administering to the patient methadone or buprenorphine, two “long-acting” opioids. Where the former have a rapid mode of action generating an immediate “peak of pleasure”, which contributes to the addictive effect, the latter act slowly and without a peak of pleasure. On the other hand, they protect once morest the effects of withdrawal for 24 to 36 hours without causing a peak in pleasure and allow the person with addiction to stabilize their condition by reducing craving (the irrepressible urge to consume) at the origin of involuntary relapses. .
[2] It is in this context that the Bebop cohort, funded by the Public Health Research Institute, will be implemented in Paris, Strasbourg and Lyon at the end of 2023.
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