[Effectiveness of measures taken in France to reduce the risks of heroin addiction via intravenous route].

French policy towards illicit drug use is based on abstinence, and on withdrawal for drug-dependent users. Its basis is the December 31, 1970 law, which is still applicable, and prohibits the use of theses drugs, even in private. It provides for prison sentences for users who do not accept to be treated. Under the pressure of new events, in particular the epidemics of AIDS, hepatitis B and C, the reappearance of tuberculosis, and an increasing marginalization of drug users, a harm reduction policy was developed. The first measure taken was to authorize over-the-counter sale of syringes and needles in pharmacies in May 1987. It was only in 1993 that programs were established: needle exchange, methadone maintenance centers, drop-in centers, sleep in, and bus for care, involvement of general practitioners, improved access to hospitals, better medical care of prisoners, participation of associations of former users, and licensing of buprenorphine high dosage for the treatment of drug dependency. The results have been clear: the number of consultations in specialized treatment centers increased, the incidence of HIV decreased spectacularly, overdoses decreased substantially, and arrests for heroin use and misdemeanours declined. However, harm reduction policies do not solve all the problems. They are applicable only to intravenous heroin users, and don't avoid using others licit or illicit drugs. Substitute drugs can be injected or resold. Finally, the prevalence of hepatitis C infection has not significantly decreased and the decrease in HIV infections is less marked among young users and women.