APPENDICES TO PART THREE

Preamble

Article L. 3125-1 of the Public Health Code, enacted by the Public Health Policy Act of 9 August 2004, provides a reference framework for harm reduction activities aimed at drug users. Those involved, whether health or social work professionals or members of associations, as well as the people targeted by these activities, must be protected from incrimination for use or incitement to use during these interventions. The services responsible for combating drug trafficking and use must be able to clearly recognise the actors and activities involved in harm reduction. Associations carrying out harm reduction activities should make themselves known to the project leader in the department where their head office is located. Finally, local residents and the elected representatives who represent them must be involved in these activities by being informed of the principles that guide them, their procedures and their results, in order to encourage them to take root and make the reduction of nuisance and stress part of their objectives. Harm reduction is based both on interventions aimed directly at consumers and on the mobilisation of services or associations that can promote their inclusion in the community through consultation and mediation for the benefit of users and all residents of the areas concerned.

I. - Objectives of harm reduction activities

The objectives of harm reduction activities aimed at drug users are :

1° To prevent severe acute or chronic infections, in particular those associated with the shared use of injection equipment ;

2° To prevent acute intoxication, in particular fatal overdoses resulting from the use of drugs or their combination with alcohol or medication;

3° Preventing and treating acute psychiatric disorders associated with drug use;

4° Referring patients to emergency services, general care, specialist care and social services;

5° Improving their physical and mental health and their social integration (housing, access to social services and facilities in particular).

II. - Methods of intervention

Intervention methods may include

1° Making contact in places frequented by the target group or in dedicated premises;

2° Reception ;

3° Distributing and promoting hygiene and prevention materials;

4° Information on the risks associated with drug use and how to prevent them;

5° Personalised advice in the form of interviews and information;

6° Referral and support to general or specialist care services;

7° Referral to and support for social services;

8° Providing rest areas;

9° Providing food and drink;

10° providing hygiene services: toilets, showers, washing machines, ironing equipment, etc. ;

11° Organising mutual aid and peer support;

12° Emergency accommodation;

13° Assistance in accessing rights;

14° Providing nursing care;

15° Health education;

16° Providing lockers for the personal belongings of homeless people;

17° Recovery of used equipment and treatment of septic waste;

18° Installing distributors of prevention materials.

On-site analysis of products, which only makes it possible to predict whether the substance sought is present or not, without allowing identification of the substances used in the composition of the tablets (in particular a Marquis-type colorimetric reaction), is not authorised.

III. - Distribution of prevention material

This is aimed at

1° Prevention of human-to-human transmission of infectious agents and septic risks: alcohol swabs, sterile water bottles, sterile filters, sterile cups, syringes, equipment for smoking or inhaling cocaine, crack or heroin, bandages, etc;

2° Prevention of sexual transmission of infections:

female and male condoms, lubricating gels;

3° Accident prevention: in particular breathalysers.

IV. - Information on the risks associated with drug use and their prevention

Preventive information may be disseminated using any form of written, computerised or audiovisual medium, or by telephone message. The cultural codes and language of the target population, which are intended to make it easier to understand and accept preventive messages, may only be used to describe preventive behaviour, gestures and procedures, and the risks of products or their combinations.

They may not be used to present products in a favourable light. The legal framework governing drug use must be explained.

The information covers :

1° Diseases (in particular HIV, HBV and HCV infection), how they are transmitted and how to prevent them;

2° Vaccinations, in particular against HBV and tetanus;

3° Screening for HIV infection and hepatitis;

4° Risks associated with the use of narcotics, their association with alcohol or medication, as well as those specific to certain practices or methods of administration. In this context, the effects sought by users may be described;

5° The sensory, psychological or somatic signs of intoxication endangering the vigilance or life of the consumer;

6° The time it takes for these signs to appear after consumption;

7° First aid measures to be taken while waiting for the emergency services to intervene;

8° Complications of injection;

9° Complications of other methods of administering products;

10° Actions and procedures designed to prevent the human-to-human transmission of infectious agents, particularly with regard to the preparation and injection of substances and the disposal of potentially dangerous waste;

11° Actions and procedures designed to prevent complications of injection;

12° The treatments available and their methods;

13° Specialist care services and how to access them;

14° Social telephone services;

15° emergency numbers;

16° General care or social assistance services accessible within the perimeter of the intervention site.

V. - Dissemination of health alerts

Harm reduction initiatives use all appropriate means to disseminate information to consumers present on their intervention site:

1° Health alerts on the toxicity of products issued by the health or police authorities;

2° Information on the composition of products that could increase the risks.

VI. - Places of intervention

To facilitate contacts with consumers and improve their effectiveness, harm reduction activities are carried out during the day and at night, including weekends and public holidays. These activities may be carried out in dedicated premises or in buses, but also in :

1° Public places frequented by users (streets, green spaces, stations, etc.);

2° Temporary festive events;

3° Commercial or private premises, including nightclubs, with the agreement of the owners or managers;

4° Housing estates, in consultation with the residents;

5 premises inhabited by unauthorised occupants.

VII. - Participants in harm reduction activities

Harm reduction activities are carried out by health, social and educational professionals, humanitarian associations, community health associations or specialist associations. Workers may be paid or volunteers. When drug users take part in harm reduction activities as prevention workers, they refrain from using illegal narcotics during these activities.

VIII. - Confidentiality

Drug users are welcomed in such a way as to ensure their anonymity. Discussions with staff are confidential. Any individual written or computerised information gathered in this context must be kept in conditions which guarantee the confidentiality of the information, in accordance with the law.

IX. - Participation in monitoring psychoactive substance use and patterns of use

Harm reduction teams may participate in the collection of data for the purpose of monitoring the nature and toxicity of the substances consumed by users, as well as consumption patterns, prevention and recourse to care, as part of research or monitoring systems.

X. - Participation in the testing of new prevention tools or strategies

Harm reduction teams may take part in the evaluation of new prevention tools or strategies designed to improve prevention and adapt it to changes in use, in the substances consumed and their associations, or in the consumer population.