RESUMO
Young, isolated migrants (YIMs) represent some particularly vulnerable populations that have arrived unaccompanied on the national territory and are particularly exposed to mafia networks, delinquency, and prostitution. YIMs thus cumulate social (e.g., precarity, or isolation), psychiatric (e.g., post-traumatic stress disorder, mood, or anxiety disorders), and addiction (e.g., prescription drug dependence) disorders. This addition of vulnerabilities makes the social and medical support difficult to operationalize as it requires multidisciplinary and coordinated programs. In Lyon, the 2nd-largest urban agglomeration in France, the "Dispositif d'accompagnement en Réseau pour l'accès aux soins psychiatriques et addictologiques des jeunes migrants en errance à Lyon" (DARJELY), ("Network System for supporting psychiatric and addiction care to YIMs in Lyon") has been implemented since early 2023 and gathers the following components: (i) a coordinating pair of professionals (i.e., a street worker and an addiction nurse) who ensure a case management of individual situations and articulate the medical and social support with external partners, (ii) an addiction medicine team, (iii) a psychiatric team working at the same place as the addiction medicine team, and (iv) a socio-educational team that can meet YIMs "in situ" and refer them into care, in particular toward teams (ii) and (iii). Overall, DARJELY is thus an innovative system which offers multidisciplinary and coordinated missions toward YIMs including: (i) meeting YIMs on the ground and referring them to specialized care units through the coordination team; (ii) orchestrating the follow-up with other social or medical stakeholders on the local territory; (iii) collecting and synthetizing data for local decision-makers and partners; and (iv) producing research data for improving the understanding of these hard-to-reach populations. All these missions meet current needs of public health regarding these complex populations whose number has been constantly increasing over the recent years.
RESUMO
BACKGROUND: Drug consumption rooms (DCRs) have been developed in cities with open drug scenes, with the aim to reduce drug-related harm. In Lyon, France's second-largest city, there is no distinct drug use area, which raised doubts regarding the need for a DCR. METHODS: We conducted a face-to-face survey of 264 people who use drugs (PWUDs), recruited in harm reduction or addiction treatment centers, in the streets or in squats. We assess their willingness to use a DCR, and we collected sociodemographic and medical features. Bivariable comparisons and analyses adjusted for sociodemographic parameters explored the association between willing to use a DCR and other variables, thus providing crude (ORs) and adjusted odds ratios (aORs) and 95% confidence intervals (95% CI). RESULTS: In total, 193 (73.1%) PWUDs accepted to participate (mean age 38.5 ± 9.3 years; 80.3% men). Among them, 64.2% declared willing to use a DCR. Being treatment-seeker (aOR 0.20, 95% CI [0.08-0.51]; p < 0.001) and not living alone (aOR 0.29; 95% CI [0.10-0.86], p = 0.025) were negatively associated with willing to use a DCR. By contrast, receiving precarity social insurance (aOR 4.12; 95% CI [1.86-9.14], p < 0.001), being seropositive for hepatitis C (aOR 3.60; 95% CI [1.20-10.84], p = 0.022), being cannabis user (aOR 2.45; 95% CI [1.01-5.99], p = 0.049), and reporting previous problems with residents (aOR 5.99; 95% CI [2.16-16.58], p < 0.001) or with the police (aOR = 4.85; 95% CI [1.43-16.39], p = 0.011) were positively associated. CONCLUSIONS: PWUDs, especially the most precarious ones, largely supported the opening of a DCR in Lyon, a city with no open drug scene.