Use of psychoactive substances in prison: Results of a study in the Lyon-Corbas prison, France.

BACKGROUND AND AIMS: In prison, in 2012, according to various sources, from 4 to 56% of the European inmate population used psychoactive substances (PAS). The aim of our study was to describe PAS consumption during incarceration in the prison of Lyon-Corbas, France. METHOD: A transversal descriptive study was conducted between September 23rd and September 27th 2013 among all inmates of this prison. We used an anonymous self-administered questionnaire, distributed at lunchtime and collected, the same day, at dinnertime, by the mental health service personnel. RESULTS: Among 785 inmates present at the time of the study in the prison of Lyon-Corbas, 710 were included and the response rate was 64.4% (95% CI [60.8-67.8]). Among 457 responding inmates, 16.4% (95% CI [13.2-20.0]) reported no PAS consumption. Among 382 consumers, 74.4% (95% CI [69.8-78.5]) used tobacco, 36.8% (95% CI [32.2-41.8]) cannabis, 30.4% (95% CI [25.9-35.1]) alcohol, 7.7% (95% CI [5.2-10.6]) heroin and 10.3% (95% CI [7.5-13.6]) cocaine. Furthermore, 15% of consumers had started PAS consumption during their incarceration. Among consumers of at least one PAS other than tobacco, cannabis and alcohol, the way of consumption was sniff for 60.0% (95% CI [48.5-70.2]) and injection for 31.0% (95% CI [21.6-42.1]). Use of several PAS at the same time and sharing sniffing and/or injection paraphernalia were other risky behaviors observed; 12% (95% CI [5.8-20.4]) of drug injectors declared using chlorine to sterilize their injection paraphernalia. CONCLUSION: Our study provides worrying data about PAS consumption in prison. The measures of prohibition do not prevent this consumption. There is even an initiation of consumption of PAS for 15% of the first-time incarcerated inmates. This finding should encourage public authorities to facilitate access of inmates to the care structures in prisons, to improve drug use prevention and care programs and to develop activities (sports, cultural, educational and vocational).

Consumption of psychoactive substances among 535 women entering a Lyon prison (France) between June 2004 and December 2008.

BACKGROUND: In France, recent data on the consumption of psychoactive substances (PASs) among women entering prison are virtually nonexistent. The objective of this study was to describe the characteristics of female entrants at Montluc prison in Lyon (France) and to estimate their PAS consumption. METHODS: Between June 1, 2004 and December 31, 2008, of 841 women entering the Lyon correctional facility, 535 had an entrance interview, conducted by a nurse, during which a questionnaire was systematically proposed; 306 detainees did not have this interview and could not be included in the study because of an immediate transfer to another prison or emergency hospitalization. Socioeconomic and incarceration characteristics, PAS consumption, as well as consumption level (occasional, regular, abusive or dependence) and psychological distress of the 535 interviewed detainees were systematically noted. This psychological distress was defined by the presence in the entrant talks or behavior suggesting clinical symptoms such as anxiety, depression, delusion, delirium, and mood or behavior disorders. Descriptive analysis was undertaken with the Chi(2) test and Fisher's exact test for differences between the proportions observed. RESULTS: The average age of the 534 responding detainees was 31.5 years; 59.2% had had no ongoing professional activity in the 12 months prior to incarceration, and 21.6% had already been imprisoned before; 37.5% of the entrants reported dependence on tobacco and 13.7% on alcohol; 6.6% reported regular, abusive use or dependence on cannabis, 20.4% on psychotropic medications, and 7.7% on other drugs (heroin, cocaine, synthetic drugs) in the 6 months preceding their incarceration; 39.2% of the consumers at risk reported using at least two substances; 7.1% of detainees were on opioid substitution treatment. A multiple correspondence factor analysis was used to note specific characteristics of three groups of PAS consumers. CONCLUSIONS: More frequent among young women detainees, overall PAS consumption was quite close to that of male entrants, was greater than in the general female population, and was very often accompanied by psychological distress. Effective screening upon entry into detention should be carried out so that female consumers can be offered psychological and/or psychiatric care adapted to a prison environment.

A randomized trial of viral hepatitis prevention among underprivileged people in the Lyon area of France.

BACKGROUND: We compared the efficacy of two viral hepatitis B and C (VHBC) screening strategies, relative to no intervention, among underprivileged people (UP) living in shelters in the Lyon area. METHODS: Eighteen of 37 shelters were randomly sampled after stratification based on the accommodation capacity and the screening centres/shelters distance. Through randomization, the S0 strategy (no intervention), the S1 strategy [group information (GI) and referral for screening] and the S2 strategy (GI and in situ screening) were each applied in six shelters. A standardized questionnaire was offered to each participant. Follow-up of positive cases was organized via the reference centre of VHBC of Lyon. RESULTS: The screening completion rate (SCR) among 1276 included subjects in S0, S1 and S2 was 1.5, 42.8 and 59.7%, respectively (P < 10(-6)). This rate was higher in S2 regardless of the sociodemographic variable considered. Odds ratios (OR) of screening completion (SC) was significantly higher in S1 versus S0, OR = 49.8 [95% confidence interval (CI): 26.1-102.1], in S2 versus S0, OR = 98.5 (95% CI: 51.9-200.8) and in S2 versus S1, OR = 2.0 (95% CI: 1.3-2.9). Age, country of birth and professional inactivity were independently associated with SC. CONCLUSIONS: Health authorities must ensure widespread screening of UP, which is more effective when conducted in shelters than in screening centres.

[Characteristics of alcohol-dependent male inmates]. / Caractéristiques des personnes alcoolodépendantes incarcérées en maison d'arrêt.

OBJECTIVE: The objective of this study was to compare social and penal characteristics and consumption of psychoactive substances by alcohol-dependent and non-dependent inmates of the Lyon's prison in 2004. METHODS: The study was carried out among 2033 male adults incarcerated between January 1st and December 31st 2004. An administered questionnaire was proposed during the arrival visit to record social, administrative and penal data. Use of tobacco, alcohol and illicit drugs was quantified. RESULTS: In all, 1898 questionnaires were analysed. Comparison between alcohol-dependent (n=356) versus non alcohol-dependent inmates (n=1542), revealed that the alcohol-dependent population was older, mean age (34 years old versus 30 years, p<0.001), and had a higher unemployment rate (50% versus 39.4%, p<0.001). Alcohol addicts were more often repeated offenders (62% versus 50.7%, p=0.001), had a higher rate of Subutex mixture (11% versus 3.2%, p<0.001) and presented more psychic suffering (21% versus 6%, p<0.001). Multivariate analysis identified use of psychotop drugs, use of psychoactive substances, age and familial situation as significantly and independently associated with the abusise alcohol consumption. CONCLUSION: Because of an elevated prevalence of alcohol dependence among arriving penitentiary inmates, effective screening is needed to prevent withdrawal syndrome and propose care adapted to the specific features of this dependent population: social insecurity and polydrug abuse.

[Psychoactive substance use among newly incarcerated prison inmates]. / Consommation de substances psycho actives chez les personnes entrant en prison.

The objective of this study was to describe the population of incoming prisoners in Lyon's prisons and to estimate the proportion of those who are drug users in order to adapt the psychological care which is made available at the time of entrance. During the entrance interview briefing session, a questionnaire was given to each new adult male inmate between January 1st and December 31st 2003. The mean age of new prisoners was 31 years old: 68.5% did not have regular employment in the last 12 months prior to their incarceration, and 52.8% had already been previously imprisoned. More than 64.0% of inmates declared either a regular use, an abusive use or dependence on tobacco, 16.5% on cannabis, 16.1% on alcohol, 2.5% on psychotropic medication, and 4.1% on other drugs (heroine, cocaine, or synthetic drugs). Moreover, 42.0% of drug users declared either a regular use, abusive consumption or dependence on at least two psycho active substances. These results confirm the need for effective screening for drug use upon entry into prison as a means of ensuring that appropriate psychological and/or psychiatric care of drug users, which is suitably adapted to the prison environment, can be provided.

[Knowledge of hepatitis B and C among underprivileged people]. / Connaissances des populations précaires à propos des hépatites virales B et C.

BACKGROUND: Prevalence for hepatitis B (HBV) and C (HCV) viruses infection are particularly high among underprivileged persons (UPP) related to the use of injecting drug, residence in high endemic countries or a low rate of condom use in case of multiple sexual partners. It is important to know whether these persons are well aware of prevention measures for these infections. The aim of our study was to evaluate the knowledge of preventive measures among UPP and, at the same time, among health- and social-care workers (H/S-CWs). METHODS: The study was conducted in 68 salvation settings. The H/S-CWs filled out once 9-item self-administered questionnaires on HBV and HCV, concerning the illnesses, and their transmission, prevention, and screening. A similar questionnaire was proposed by H/S-CWs, to UPP after each interview. All answers were grouped into 4 categories: true (one right item or more), false, unknown, no answer. RESULTS: One thousand nine hundred twenty one questionnaires were collected: 312 were from H/S-CWs and 1609 from UPP. The answer rate was 100% for H/S-CWs and 92.7% among the UPP population. Knowledge about HBV and HCV was better for H-CWs compared to S-CWs. For HBV, routes of transmission was the best known field (85.2% of right answers) and use of blood sample screening was the least known field (54.2%). Vaccination was advanced by 50.6% of H/S-CWs. For HCV, routes of transmission were also the best known field (65.9%) while preventive measures were frequently unknown (22.0%). Among the UPP, blood sample screening was the best known field for HBV (34.5% of right answers) as for HCV (27.5%). Knowledge about the routes of transmission and the populations at risk was very low for HBV (28.2% and 15.5%) and for HCV (9.4% and 5.1%). The analyses of each response showed that the rates of wrong answers were much higher for H/S-CWs compared to UPP. On the other hand the rates of "unknown" answer were higher in the UPP. This finding suggests that H/S-CWs had a false perception of knowing relevant information on HBV and HCV. The high proportion of no answer among UPP confirmed their ignorance of those diseases. CONCLUSION: The UPP needs appropriate information on HBV and HCV. This information could be delivered by H/S-CWs. However, preliminary training, particularly for S-CWs, might improve their insufficient knowledge at the present time.

[Medical follow-up of patients with positive serology for hepatitis C virus]. / Prise en charge médicale des malades séropositifs pour le virus de l'hépatite C.

OBJECTIVE: A screening campaign requested by the French Health Insurance Fund was performed in the Lyon area to access the prevalence of anti-hepatitis C virus in patients from 271 general practitioners and to observe the follow-up of the patients with had positive serology. A total of 101 patients had already had hepatitis C virus antibodies and 30 patients had newly detected antibodies against hepatitis C virus. All subject received appropriate medical care. The aim of this study was to analyse medical follow-up. METHODS: Follow-up was performed for one year by the patient's general practitioner or a specialist of liver disease. Clinical, biological, histological and virological data were collected and treatment was proposed when appropriate. Information was gathered anonymously by phone. RESULTS: Follow-up was regular for 28 patients (93%). During this follow-up, ALAT levels remained within the normal limit for 13 patients (43%) and 6 of them had undetectable viral RNA by PCR. In the other patients (50%), a liver biopsy was affered to 11 patients (40%), and performed in 9 (30%). Treatment was started in 8 patients. CONCLUSION: The results of this study on medical follow-up are satisfying. The general practitioner plays a key role in the follow-up of patients infected by hepatitis C virus.

[Surveillance of laboratory based infections by biological and medical analyses: review of the literature]. / La surveillance des maladies infectieuses basée sur les laboratoires d'analyses biologiques et médicales: revue de la littérature.

Infectious disease surveillance is one of the priorities of public health programmes. This review aims to describe laboratory-based infection surveillance systems. The following surveillance networks are described: the Belgian microbiology network, AIDS surveillance in Philadelphia, EPIBAC, and the Salm-Net network. Laboratory-based surveillance provides the advantage of constituting an easily accessible computerised data bank that allows for studying age-old tendencies and evaluating the effectiveness of certain prevention programmes. The main inconveniences remain with the difficulty of eliminating duplications as well as the lack of clinical information. These difficulties can be surmounted by improving communication systems among the diverse participants in the network with electronic mail. Such surveillance systems will facilitate information exchanges at both the national and international level.

[General practice patterns in hepatitis C virus mass screening in the Lyons region]. / Pratique des médecins généralistes en matière de dépistage du virus de l'hépatite C dans la région lyonnaise.

A study on the screening practices for hepatitis C was carried out among a sample of 786 general practitioners in the Lyon region. The sample comprised three groups: 272 doctors who had participated in a study of this screening, 242 doctors who had not responded to the request for participation, and 272 doctors who had refused to participate. Overall, 88.5% of the doctors surveyed had prescribed at least one HCV serology in the last 12 months, 82% had at least one HCV positive patient and of them, 59.3% had partly or completely screened these patients. The only differences between the three groups are related either to their belonging to an HIV or drug addict care network, or to a particular medical practice (study of allergies, sexology, nutrition, etc.). In fact, the first prescribe more among groups at risk and the second prescribe less and have fewer HCV positive patients.

Screening campaign of hepatitis C among underprivileged people consulting in health centres of Lyon area, France.

BACKGROUND: A screening campaign for hepatitis C virus (HCV) infection was carried out in eight health centres of Lyon from June 2003 until March 2004. The population targeted for screening was underprivileged individuals without any social insurance, protected by Couverture Mutuelle Universelle or Aide Médicale Etat (AME), to estimate the prevalence of anti-HCV antibodies in this population and to identify associated risk factors. METHODS: After training in HCV infection and screening, 43 general practitioners participated in the campaign. Information about patient socio-demographics and risk factors was collected prior to proposing screening serology. Blood samples were often taken in health centres. Follow-up of positive cases was organised via the Reference Centre of HCV Infection in Lyon with possible specialised consultations in health centres. RESULTS: The average age of the 988 individuals in the campaign was 37 years; 51% were women; 54% had a foreign nationality; 21% lived in sheltered accommodation; 19% were lodged in third-party accommodation; 9% were homeless; and 57% possessed less than euro562 (Revenu Minimum d'Insertion level). Screening was not proposed to nine patients because of medico-psychological problems. The acceptance rate for screening was 98.8% (967/979), and testing was carried out on 97.6% of these subjects (944/967). The prevalence of anti-HCV antibodies in the sample was 4.7% (44/944) (95% CI = 3.4-6.2). Nearly 80% of positive cases were unknown prior to the campaign. Multivariate logistic regression modelling identified lifetime injection drug use [odds ratios (OR) = 15.99; P < 0.0001], lifetime medical care in a foreign country (OR = 4.46; P = 0.001), and wearing tattoos (OR = 2.75; P = 0.048) as significant risk factors for carrying anti-HCV antibodies. Characteristics independently associated with HCV seropositivity were age between 40 and 49 years, AME benefits, and no social insurance. CONCLUSION: Wide acceptance of screening, high prevalence of anti-HCV antibodies (much higher than in the French population in general), a high proportion of positive cases unknown beforehand, and satisfactory follow-up of seropositive patients are all factors which support the need for a screening campaign targeting HCV infection in underprivileged persons living in France.

Prevalence of hepatitis C infection among general practice patients in the Lyon area, France.

STUDY OBJECTIVE: To estimate the prevalence of hepatitis C virus (HCV) infection among patients in general practices. DESIGN AND PARTICIPANTS: A screening campaign requested by the French Health Insurance Fund and involving 271 general practitioners (GPs) and 96% of the 95 medical laboratories was conducted in the Lyon area. Each GP participated for one week and offered an HCV screening to all patients aged 18-69 years during this period. Risk factors were estimated by a medical questionnaire (MQ) filled in by the physician. MAIN RESULTS: From May to October 1997, 11,805 subjects were recruited into the study. Among them, 101 were known HCV positive. The MQ was filled up in 86% of the 11,704 remaining patients. Only 59% of those (6876/11,704) went to a laboratory to be tested. Fifty-one were ELISA positive of whom 30 were confirmed by RIBA or PCR. If we add 101 patients that were known HCV positive and estimate the prevalence among patients who did not go to the laboratory, this study gives a total estimated prevalence of 1.3%. CONCLUSIONS: The prevalence of HCV infection among patients of GPs is about 1.3%, very close to the estimate in the French general population. The substantial number of patients known HCV positive is probably related to the participation of GPs sensitised to HCV issues and who already have screened most of their HCV patients.