The lower risk consumption room is a cornerstone of the care of drug users

What is the height for a doctor? To spread, like a virus, of fake news about health. This is precisely what is responsible for Philippe Juvin, professor of medicine, anesthesiologist-resuscitator and candidate to represent Les Républicains in the presidential election of 2022. At the time of the right-wing debate broadcast on BFM TV, he says without a shadow of a doubt the following: ” No scientific argument supports the opening of the shooting rooms. I therefore propose to close them. »An assertion in contrast to the current consensus in the field of addictology where the risk reduction (DRR) that these lower risk consumption rooms (SCMR) allow, is essential.

A solid consensus in the field of addictology

Let’s be clear: Mr. Juvin is wrong. ” There are a lot of scientific elements and cost / benefit analyzes, whether for users (infections, overdoses, abscess, etc.), for public health or for the reduction of public nuisances (waste used syringes, street injection, etc.) which attest to the usefulness of SCMRs. The community of addictology researchers is fairly unanimous on this subject ”, affirms Benjamin Rolland, professor of addictology at the university hospital center (CHU) of Lyon, author with other specialists of a international scientific synthesis on the efficiency of consumption rooms.

However, Mr. Juvin, in his intervention, qualifies the big study comparative study of the National Institute for Sciences and Medical Research (Inserm) ” of level arguments Preparatory course ”, In other words, the beginning of primary school. We did not know that students of this school level mastered the notion of theoretical framework, the calculation of Odds Ratio (OR) or the epidemiology of sexually transmitted diseases like the Human Immunodeficiency Virus (HIV). The latter concludes, in France, to a modest interest of the SCMR: ” THEThe results of this report are slightly disappointing but this report was a comparative analysis and it should be remembered that in France, unlike the situation in Canada or Australia, we were not starting from zero! Risk reduction structures have already existed for a long time in our country ”, recalls Benjamin Rolland.

What is Philippe Juvin’s strategy worth?

After denying the interest and relevance from an entire section of scientific literature, the candidate for the primary of the right exposes us his solution: ” Give the hospital the means to take care of them [les usagers, ndlr] and give the police the means to arrest them “. The professor of medicine did not respond to our request, so we could not clarify exactly what he meant by that. Nevertheless, it seems that there is a strong similarity between the will of Mr. Juvin and the therapeutic injunction. of the 1970 law which constitutes the legislative genesis of the toughening of the repression against drug consumption.

Yet we know this solution is doomed to fail. First, thanks to empirical arguments: “ Police arrests followed by therapeutic obligation have never worked since the adoption of the law ”, underlines Yann Bisiou, doctor in private law and criminal sciences, specialist in criminal law concerning drugs. Second, thanks to scientific arguments so dear to Mr. Juvin: “ It is now clear, in addictology, that forcing a treatment is counterproductive. For this to work, it is necessary to create a therapeutic relationship of trust, gradually improve their state of health and support them to motivate them to want to enter into a stopping process, but only when they wish. Confidence is the pillar of effectiveness in addictology ”, Benjamin Rolland attests.

Regarding its security strategy, this still seems to testify to its ignorance in the field. Indeed, prohibition and criminalization of drug users has not always been the rule. : “Before 1970, the political regime was flexible towards drug users. This law is a radical repressive turn. Previously, the private use of narcotics did not come under the yoke of the law. At that time, various factors such as the declaration of war on drugs in the United States, theemergence counter-culture and drug addiction, which is becoming a public health problem, are pushing countries around the world to review their legislation ”, explains Alexandre Marchant, doctor of history, author of a work resulting from a thesis on the fight against drugs between 1945 and 2017.

And this law will entail its share of unexpected problematic consequences, including the prison closed for ordinary users. A problem still relevant given that in 2015, according to the International Prison Observatory, 3,390 users have been in prison. However, we know that the prison locks the user in a deviant trajectory and does not solve the problem ofaddiction. For Alexandre Marchant, this law is the heart of the problem: “ Dfor 50 years, this law has not changed despite the problems it has caused. Measures were created in response to the difficulty of applying it like tickets, but we have never questioned the very foundations of this law, namely, to consider the drug user as a criminal ”. Like the alcoholic who was first considered a thug at the end of the 19th century^e century, the drug user is first perceived as such before being considered as a sick person.

A moral posture fraught with consequences

Philippe Juvin speaks of an infringement of the law where the Minister of the Interior Gérald Darmanin would surely evoke a ” moral defeat “. In terms of normative ethics, the repressive and prohibitive policy is strictly deontological. We could translate his argument by ” we do not allow decriminalization, legalization or support for consumption because drugs are bad “. If we are interested in a more consequentialist analysis of the problem, prohibition seems to be the worst solution: ” Despite this repressive approach, France is the first, or the second country depending on the year, with the rate of prevalence highest for the consumption of cannabis in Europe. This shows well enough that repression does not work, even if it must be admitted that France has a so-called mono-product specificity. In other words, 90% of drug use in the territory is concentrated on cannabis ”, points out the expert in criminal law Yann Bisiou, and doctor in private law and criminal sciences.

Reduce or prohibit: you have to choose

The opening of SCMRs (lower risk consumption rooms) participating in DRR (risk reduction) is not compatible with the current prohibition: ” There has been a continuing ambiguity between the law and the RDR for twenty years. The latter has great difficulty settling in France because it contradicts the law. It is necessary to go so far as to carry out subterfuge by evoking the experimental status of the SCMR so that the projects are accepted ”, indignant Alexandre Marchant who evokes cultural reasons to partly explain this phenomenon: “ There is a sacralization of the law in France in comparison with other countries. It is idealized and often seen as the expression of the general will “. However, in our time, a majority of French people seem in favor of decriminalization of cannabis.

The DRR paradigm fits into a modern vision of addictology which considers the environment psychosocial of the individual as absolutely necessary for his healing. In this regard, Yann Bisiou evokes the effectiveness of social measures as a “home” first of all: “ First of all, getting people off the streets is more effective than any treatment. The SCMRs participate in this social support for users ”.

Subsequently, the support must obviously lead to awareness of the user. This is good, given that this is their goal and that the health professionals working in these structures are trained for it: ” We must support the user in his consumption with the hope of ultimately treating him by giving him a secure social framework, creating links and trust ”, says Alexandre Marchant, doctor of history.

What are we waiting for?

Scientific knowledge does not tell us what to do. If Philippe Juvin is wrong when he says that none of the scientific arguments support the opening of the SCMRs, we must recognize that the latter do not tell us whether we should fight against drugs or not. Still, it looks like that’s what everyone wants to do. And in this case, each of these arguments makes sense in the same direction.

At a more political level, as Alexandre Marchant mentioned, it would seem that these are the postulates initials which constitute our archaic stereotypes concerning the criminalization of drug users that must be reviewed in order to hope to see a change: ” We must move towards a citizen approach to the fight against drugs. People should have the right to use harmful substances. As long as we do not think in this perspective, we will not start off on the right foot ”. This implies abandoning the ban and relying on information, prevention and support. In fact, it would seem that this is the most effective way to fight against drug use according to the sciences that study these problems.