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Background
France is often presented as a model for care for people who use drugs thanks to its high availability of opioid agonist treatments (OAT) as well as HCV treatment. The French harm reduction model is strong thanks to sustainable State funding but is embedded in a prohibitive regime. We studied the access to harm reduction services and care and their social determinants.
Methods
We implemented a sociological mixed-method (Coquelicot-study) that includes a quantitative survey (with a time location sampling plan) among 2125 people who use drugs recruited in 195 harm reduction services and drug treatment centers in 27 cities. We conducted descriptive and multivariate analyses on access to care and harm reduction services (OAT, syringes, hospital care). We also did semi-structured interviews with a diverse sample of people who use drugs and with professionals (medical doctors, pharmacists, harm reduction workers).
Results
The experiences of recent care refusals were as follows: 24% for OAT prescription, 21% for sterile syringe delivery in pharmacy, 17% for medical care. In multivariate analysis, living in very precarious conditions and having a psychosis (based on a psychiatric scale) were the main risk factors associated to refusals. Surprisingly, being a migrant was a protective factor. The qualitative interviews helped to understand the social context of refusals. Migrants under-reported care refusals because they considered that they are better considered in France compared to their country of origin (mainly from Eastern Europe). Some pharmacists and medical doctors said they refused to deliver harm reduction tools and to give care to people who use drugs because they disapproved people behaviors in line with the French law that forbids drug use and conservative media government discourse.
Conclusion
Implementing harm reduction policy in a prohibitive regime is a challenge that can produce stigma and care exclusion for people who use drugs.
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