[Harm reduction centers ("CAARUD"): privileged places for warning signal detection in addictovigilance]. / Les CAARUD, lieux privilégiés d'émergence de signaux pour l'addictovigilance.

This study aims to describe profile and consumptions of subjects suffering a substance use disorder recruited in harm reduction centers (HRC, French "CAARUD", 156 included subjects in 7 centers) for the 2010 OPPIDUM survey, performed by the French CEIP-Addictovigilance network, in order to compare them to subjects included in ambulatory care centers (ACC, French "CSAPA", 3549 subjects included in 80 centers). Subjects recruited in HRC are younger and more precarious; they consume more illicit drugs, and prescription drugs known to be diverted (methylphenidate, morphine, ketamine,…). They consume less opiate maintenance treatment, antidepressants and psychotics. Obtaining and consumption modalities are also different (more illegal acquisitions for prescription drugs, more intravenous route use and less nasal route use in HRC). HRC are privileged places for watching substance use disorder (abuse, dependence) or prescription drugs diversions, and for early warning signal detection in addictovigilance.

[General Practitioners' Contribution to Dependence Assessment: the OPEMA Programme]. / Observation des pharmacodépendances en médecine ambulatoire : le programme OPEMA.

Aim. This study presents the OPEMA (Observation des pharmacodépendances en médecine ambulatoire) programme and the main results of its last annual survey (november 2010). Method. Collected data concern mainly subjects' sociodemographic situation, their state of health and their current consumption of psychoactive substance. Results. In 2010, 1394 subjects have been included, describing 2 450 consumptions of psychoactive susbtance. Their mean age is 38,2±12,7 years. Eighty-six per cent have a stable accomodation and 52% are in employment. Fifty-six percent of included subjects present a psychiatric comorbidity. Among included subjects, HIV and HVC prevalence is respectively 3% and 20%. Fourty-five percent of included subjects have been using intraveinous route, 6% of whom using it currently. Eighty-two percent consume opiate maintenance treatment and 29% benzodiazepines. Conclusion. The OPEMA programme supplement the french pharmacodependence assessment system with collecting data from general practitioners, and promotes a global knowledge of dependent subjects' state of health.

Which psychoactive substances are used by patients seen in the healthcare system in French overseas territories? Results of the OPPIDUM survey.

Addiction to illicit substances or medicines is influenced by cultural, religious, ethnic factors as well as local availability. The purpose of this study was to evaluate the profile of drug users and characteristics of the psychoactive substances used in French overseas territories, using data from the OPPIDUM survey. OPPIDUM is an annual, nationwide, multicentric, cross-sectional study based on specialized care centres that included subjects presenting a drug addiction or under opiate maintenance treatment. The current study includes data from the 2012 and 2013 surveys and focuses on patients included by drug addiction centres located in French overseas departments and territories: French Pacific Ocean (French Polynesia, New Caledonia), French Americas (Guadeloupe, Saint Martin, French Guiana) and Reunion Island. Data from metropolitan France (2013 survey) were included as reference. Two hundred and forty-five patients were included. The sex ratio was 3.7 for the Pacific Ocean, 3.5 for the French Americas and 3.3 for Reunion Island. Cannabis was consumed in all the territories, from 50.8% in Reunion Island to 81.7% in Pacific Ocean. Cocaine was most frequently consumed in the French Americas (61%), mainly in the 'freebase' form (91%), whereas 6.5% of cocaine users in metropolitan France did so. Problematic use of medicines was most frequent in Reunion Island. Heroin seems rarely used in all overseas territories. This study highlights the complexity of substances used in French overseas territories, which often differ from that in mainland France. The relative difference between different areas provides valuable information for future investigations and possible interventions.

OPPIDUM surveillance program: 20 years of information on drug abuse in France.

It is important to assess drug abuse liability in 'real life' using different surveillance systems. Some are based on specific population surveys, such as individuals with drug abuse or dependence, or under opiate maintenance treatment, because this population is very familiar with drugs and is more likely to divert or abuse them. In France, an original surveillance system based on this specific population and called 'Observation of illegal drugs and misuse of psychotropic medications (OPPIDUM) survey' was set up in 1990 as the first of its kind. The aim of this article is to describe this precursor of French drug abuse surveillance using different examples, to demonstrate its ability to effectively give health authorities and physicians interesting data on drug abuse. OPPIDUM is an annual, cross-sectional survey that anonymously collects information on abuse and dependence observed in patients recruited in specialized care centers dedicated to drug dependence. From 1990 to 2010, a total of 50,734 patients were included with descriptions of 102,631 psychoactive substance consumptions. These data have outlined emergent behaviors such as the misuse of buprenorphine by intravenous or nasal administration. It has contributed to assess abuse liability of emergent drugs such as clonazepam or methylphenidate. This surveillance system was also able to detect the decrease of flunitrazepam abuse following implementation of regulatory measures. OPPIDUM's twenty years of experience clearly demonstrate that collection of valid and useful data on drug abuse is possible and can provide helpful information for physicians and health authorities.