First results collected by Argos, DCR in Strasbourg opened in november 2016

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1 Photo Marine Saiah First results collected by Argos, DCR in Strasbourg opened in november 2016 Danièle BADER, Leader of Ithaque Association EMCDDA, DRID Meeting september 2017

2 A crossborder experimentation Germany Strasbourg inhabitants in Strasbourg inhabitants in the Eurometropole - More drug injectors than in the rest of France (2014: 12% IV drug users the last month vs 5,6% in the rest of the country (OFDT)

3 Ithaque Association A medicosocial structure created in 1993 in Strasbourg Harm reduction services: Mobile Needle exchange Program, outreach work Social intégration program for young DU (TAPAJ) DCR Argos

4 Ithaque Association Addictions treatment Center: providing OST, and specific consultations for young consumers and their family. Microstructures network (GP, social workers and psychologists, working together to treat addict patients) Prevention, formation and research activities

5 Historical background The authorization to open DCRs was laid down in a law issued in January 2016 reforming the health system in France. An experimentation of 2 DCRs during 6 years was at last possible. Earlier in 2011: Strasbourg City and Ithaque association organized a symposium at the European Parliament in Strasbourg, concerning DCRs in Europe. January 2013: Ithaque submitted a project with the support of the City and the MILDECA.

6 Historical background 7 th November 2016: Opening of Argos, inside the Central Hospital in Strasbourg Partnership: Ministry of Health, MILDECA, City of Strasbourg, Regional Health Agency, Eurodistrict (crossborder project), Police and Justice services.

7 Funding Investment Cost: euros Operating cost: euros a year, for 15 full-time professionals Main funding provider: National Health Insurance, French State

8 Interior outfitting 4 main spaces: 1 reception area 1 welcome area 1 consumption room, including a treatment room (6 injection places, 4 inhalation places, 2 sniffing places) 1 rest room 3 offices (GP, psychologist and social worker) devoted to medical consultations and individual interviews

9 Photo Marine Saïa

10 Reception area

11 Welcome area

12 Consumption room

13 Consumption room Photo Marine Saïa

14 Rest room Photo Marine Saïa

15 Daily services provided Schedules: from 13 to 19 H / 365 days/year Anonymous and free reception of adult drug users, in precarious situation (animals accepted!) Needle exchange program HIV, HCV and HBV screening, via rapid diagnosis tests (TROD) and by FibroScan ( 3 days per week) Individual councelling (harm reduction and health care), medical consultations, psychological and social interviews

16 Activity data for 10 months 348 different users in the program, among which 227 are using the consumption room (74% men, 25% women, 1% transgender) contacts 50 to 100 contacts/day currently syringes delivered

17 Argos activity for 10 months Monthly attendance

18 Age breakdown Median age : 37 years

19 Social data (for the last 6 months) Resources Employment: 21% Unemployment benefits: 11% Welfare benefits (RSA/AAH): 48.5% Other resources (mendicity, prostitution, etc.) : 7.5% No resources : 11.5% NR: 0.5%

20 Housing conditions 50% live in precarious housing conditions or are homeless

21 Judicial data Previous incarcerations

22 Consumption patterns Consumed substances Cocaine: 35% Skénan (morphine sulphate): 29% Heroin: 16.4% Buprenorphine: 14% Crack: 3% Speedball: 2% Others: 0.4% Benzodiazepines: 0.1% Amphetamines: 0.1%

23 Consumption patterns (2) Injection: 84.5% Smoked: 9% Sniff: 4.5% Inhalation: 2% A high number of intravenous comsumptions registered

24 Others services involved in drug users social and medical follow-up Addiction treatment centers (CSAPA): 29% Harm reduction centers (CAARUD): 8% Microstructures: 12% GPs: 37% Others: 10% NSR: 4% OST prescribed: Methadone: 45% ; buprenorphine: 32% ; Skénan: 15% NSR: 8%

25 Serologies Epidemiologic data HIV : 92% of the users report being seronegative HBV : 78% of the users report being seronegative No declared seropositivity to HIV and HBV HBV vaccination : only 45% Argos users report having a complete vaccination; 10% an incomplete vaccination; 16.5% don t know; 16.5% are not vaccinated.

26 Epidemiologic data (2) HIV, VHC, VHB Screenings: 44% of the screenings date from more than 6 months. 3% were never screened Hepatitis C: 71% HVC negative users, 7% are unaware of their serological status 22% report being positive 13 HCV+ detected at the DCR, 7 unknown, until now, by the concerned users

27 Overdoses In 2014, in our Region, for inhabitants, aged years: the ratio of OD was 1,6 / 0,8 in the rest of the Country. 184 Argos users report 248 loss of consciousness during the last year At the question «How many surdoses did you see around you the last year»: 74 surdoses are reported But inside the DCR, only 3 overdoses needed external emergency services, so far

28 Summary of our specificities A signifiant consumption of cocaine and opioids by injection A high number of injectors A high number of women using DCR services Few overdoses occured since the opening Few police controls in the neighbourhood reported by the drug users Few problems with the neighbourhood

29 Conclusion The DCR users are globally satisfied with the reception given to them, and with the safe conditions of consumption which are proposed An access to healthcare (OST, housing, global medical care) wished by the majority of them A housing project in process on the first floor of the DCR, dedicated specifically to Argos drug users

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31 Thank you for your attention Contact: Danièle Bader : daniele.bader@ithaque-asso.fr Association Ithaque ithaque@ithaque-asso.fr Argos, quai Menachem Taffel, Strasbourg