Published on June 18, 2007
The french paradoxe: Substitution treatments success: The french paradoxe: Substitution treatments success How to be successful with scare, hypocrisy, and ignorance. The problem (1): The problem (1) In France, drug use is still assimilated to heroin and injection. Our law is targeted on it (in mixing cure and prison) Most of the specialized medical sector is also based on heroin cure treatments and post-cures treatments Most of the representations of the real drug user, including for drugs users themselves, are based on the injected heroin addicted. Exemple: cannabis smokers, extasy consumers, even some cocain addicts speak about themselves as non drugs users-non toxicomanes-Because they are not consuming heroin by injection The problem (2): The problem (2) consequences of this obsession and confusion between drugs addiction and injection of heroin : - Repression at a very high level - Aids and hep. C epidemy at a very high level - Scare of the society at a very high level This is the very chance of substitution treatments (and incidently of self support) in France First Paradox:: First Paradox: Scare is the main explanation of the incredible liberalism of the french substitution system regarding to the repression of drugs use. toxicomanes used to fright french society during the 70’s, 80’s, and the main course for reassurance was there rehabilitation by medecine. The late arrival of harm reduction materials cause a feeling of guiltyness among specialists. Substitution treatments(S.T.) allowed the medical system to take the place of the police. from criminality to long term desease Second paradox: a high level of repression makes good pupils for treatments : Second paradox: a high level of repression makes good pupils for treatments A lot of heroin users were only sick from prohibition ; The cure was very simple: a secured access to opiates and a care about the prohibition injuries (aids, hep etc…) With this simple care, a lot of french d.u. became patients( first with morfin and second mainly with buprenorfin) Last paradox:substitution treatments success: the big secret: Last paradox:substitution treatments success: the big secret 100 000 people are taking opiates in a nearly clandestine way. No major campaign on the subject in the direction of users, nor in the general population The reason why: always scare, but this time, scare of the election (the 'dealers en blouse blanches' syndrom) The big hypocrisy: the question of pleasure (1)The health authorities point of view: The big hypocrisy: the question of pleasure (1) The health authorities point of view Substitution treatments has been sold to french society as a simple medication : the medication wich cures addiction ('le médicament qui soigne la drogue'). In french the word 'drogue' is very distinct from the word 'médicament'. The big difference is a moral casualtie: 'drogue' include pleasure 'médicament'means end of pain. For the french health authorities, S. T. should appear as'medicament' : -Subutex® has been chosen to be the main s.t. cause of his supposed non euphoric properties. The question of pleasure(2)The patient’s point of view: The question of pleasure(2) The patient’s point of view For most of drugs users s.t. seems to be 'drogues' and not only 'médicaments' (that’s why it is efficient). From the beginning the question of confort (better word than 'pleasure') is included in the s.t. whole problem. But Hypocrisy is shared by patients. They understand that pleasure should be hidden to be tolerated. Consequences: Subutex® has been injected in a controversial proportion. There is a cocaine progression beside methadon increase. Alcool and benzodiazepins are consumed in a small proportion -Black market of s.t is increasing(blackmarcket change the statute of 'medicaments' into 'drogue') EGUS: to Break the ignorance: EGUS: to Break the ignorance This question of pleasure has been central in the first official meeting of people living with substitution treatments, organized on june 5th 2004 in Paris, by ASUD and Act-Up . First meeting organized for 10 years of s.t. Substitution users demands: Substitution users demands The twelve EGUS demands (Etats Généraux des Usagers de la Substitution) has been established during the 1st general session of substitution treatments users held on 5th of june 2004 at the European Hospital Georges Pompidou, in Paris. N°1 Enlarge the offer of substitution treatments (heroin, morphin, codein) with galenics appropriate… N° 2 Priority to the patient choice in the matter of molecule and dosage… N4… Knowledge of the usefulness of therapeutic alternation… Conclusion : Conclusion S.T. brings a new reality in the matter of medical prescription. A new relationship with physicians based on a more equal knowledge about the substances A new relationship with prescription based on the place of confort, or pleasure (both things very difficult to assess with analysis). In fact, it is the place of the patient, who moves from object to subject. The reality of the disease step back in the same time than moral repression. The objectiv is not to ill drugs users, but let them cure themselves in the way they want.