Health Benefits and Public Order Improvements After The Implementation of DCRs in France. Results From The COSINUS Cohort Survey

Author: Marie Jauffret-roustide Perrine Roux Cécile Donadille Sébastien de Dinechin Laelia Briand-Madrid Marc Auriacombe Laurence Lalanne

Theme: Epidemiology & Public Health Research Year: 2022

Background: Compared to other European countries, France was late in implementing drug
consumption rooms (DCRs), due to political controversy. Thanks to activism protest and to alliances
with local politicians, two DCRs opened in Paris and Strasbourg in 2016. Their effectiveness has been
evaluated using the COSINUS cohort, a scientific evaluation requested by the French government.
Methods: COSINUS is a 12-month prospective cohort study of 665 PWID in France studying DCR
effectiveness on PWID health and public order. We collected data from face-to-face interviews at
enrolment, and at 6 and 12 months follow-up. PWID were recruited in two cities with a DCR (Paris
and Strasbourg) and two other without DCRs (Bordeaux and Marseille). After adjusting for other
correlates (p-value<0.05), the impact of DCR exposure on each outcome was assessed using a twostep Heckman mixed-effects probit model, allowing us to take into account the correlation between
repeated measures and to adjust for potential bias due to non-randomization between the DCRexposed and DCR-unexposed groups.
Results: Regarding HIV and HCV exposure, DCR-exposed participants were less likely to report injection
equipment sharing ([95%CI]: =-1.14 [-1.91;-0.36]).
Regarding public order, DCR-exposed participants report significantly less injecting mainly in public
spaces ([-0.56 [0.88; -0.24], p<0.001) and less likely to have committed a crime in the past month
(-1.10 [-1.93;-0.27], p=0.007).
Conclusions: This is the first time at an international level that DCRs effectiveness has been evaluated
by using a control group. Our findings show that DCRs are highly effective to improve the PWID’s and
the public peace for DCR’s residents. Our scientific evaluation allows DCRs to be included in a Public
Health Law in 2022 for strengthening and disseminating DCRs at a national level. The design of our
French DCR evaluation may be helpful for other European countries to implement evidence-based
policies in the harm reduction area.
Disclosure of interest statement: All authors have no conflict of interest to declare.

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