Chemsex refers to sexualized drug use among men who have sex with men (MSM). Chemsex practices lead to problematic substance use, but sexuality can also deviate toward loss of control and harmful consequences, leading to sexual addiction. However, the determinants of sexual addiction in chemsex have been poorly investigated so far. In a 353-individual sample of MSM seeking addiction treatment for problematic chemsex, sexual addiction was screened using the Sex Addiction Screening Test. Sociodemographic and clinical characteristics were also assessed, including an assessment of all drugs reported as problematic by participants, but also psychiatric history, including psychiatric hospitalizations, other medical conditions, and at-risk practices of chemsex (e.g., slam, that is, injection drug use), or previous history of overdose, respectively. Using a stepwise logistic regression model, we explored the factors associated with sexual addiction. Multivariable analyses found that, compared to other MSM, those with sexual addiction (n = 39, 11.0

BACKGROUND:Opioid agonist treatment (OAT) is the mainstay for opioid use disorder (OUD). Long-acting injectable buprenorphine may address limitations of daily medications by reducing treatment burden and improving engagement. This study assessed retention and patient-reported outcomes with Buvidal® in France. METHODS:This multicenter, observational, retrospective study analyzed medical records of adults diagnosed with OUD who received ≥1 Buvidal® injection between July 2021 and August 2023. The primary endpoint was retention at 6 months. Key secondary endpoints included changes in opioid consumption, perceived improvement in OUD using the Patient Global Impression of Change (PGIC) scale, distancing from OUD, reduction in craving, and satisfaction with Buvidal® treatment. RESULTS:Among 101 participants (mean age 43.9 years; 72.3% male; 98.0% switched to Buvidal® from previous OAT), 74 (73.3%) were retained on Buvidal® at 6 months. Of those using non-prescribed or misused opioids at baseline, decreased consumption of non-prescribed or misused opioids during treatment with Buvidal® was reported by 80.0% (16/20) of retained participants and 66.7% (8/12) of non-retained participants. A significantly higher proportion of retained than non-retained participants reported improvement in OUD on PGIC (85.1% [63/74] vs 40.7% [11/27]; P < .001), increased distancing from OUD (90.5% [67/74] vs 70.4% [19/27]; P = .02), and reduced craving (91.9% [68/74] vs 66.7% [18/27]; P < .001). Satisfaction with Buvidal® was high overall (89.1% [90/101]), with 98.6% (73/74) of retained participants satisfied compared with 63.0% (17/27) of non-retained participants (P < .001). Among retained participants, 91.9% (68/74) expressed willingness to continue Buvidal® treatment beyond 6 months. CONCLUSIONS:Nearly three-quarters of participants initiating Buvidal® were retained in treatment at 6 months. Patient-reported outcomes indicated high satisfaction, perceived improvement in OUD, and reductions in opioid consumption and craving, even among individuals largely stabilized on OAT at baseline. These findings suggest that Buvidal® may support sustained engagement and meaningful improvements in patient experience under real-world conditions.

BACKGROUND:The "Centre Ressource Lyonnais des Addictions Médicamenteuses" (CERLAM), i.e., Lyon Resource Center for Prescription Drug Addiction, is a specialized addiction unit for all types of prescription drug use disorders. Using the structured initial assessment of the center, the specific profile of patients with prescription opioid (OUD) or benzodiazepine use disorder (BUD) was explored. METHODS:The structured initial CERLAM assessment includes age, gender, international standardized classification of education (ISCED), DSM-5 criteria for OUD or BUD, Hospital Anxiety and Depression Scale (HADS), World Health Organization Quality of Life - 26-item version (WHOQOL-BREF), and Pittsburgh Sleep Quality Inventory (PSQI), respectively. Two multivariable logistic regression models explored the profile of OUD (vs. non-OUD) patients and BUD (vs. non-BUD patients), providing adjusted odds ratios and their 95% confidence intervals (aOR[95%CI]). RESULTS:One hundred and eighty-four patients were included (54.9% females; mean age 44.7±13.4 years), among whom 107 (58.2%) had an OUD, and 86 (46.7%) a BUD. When compared with non-OUD patients, those with prescription OUD were more frequently females (aOR=1.97 [1.04-3.73]), had a lower ISCED (aOR=0.55 [0.42-0.72]), and a lower physical WHOQOL-BREF score (aOR=0.93 [0.88-0.99]). By contrast, when compared with non-BUD patients, those with BUD had a greater ISCED (aOR=2.04 [1.54-2.72]), reduced psychological (aOR=0.93 [0.87-0.99]) and social (aOR=0.86 [0.76-0.96]) WHOQOL-BREF scores, greater HAD depression (aOR=1.10 [1.03-1.18]) and PSQI (aOR=1.13 [1.04-1.23]) scores, respectively. CONCLUSION:In patients with prescription drug use disorders, those with BUD and those with OUD exhibit specific sociodemographic and psychological features, that need to be identified and treated independently.

Le traitement par buprénorphine est régulièrement utilisé pour le traitement du trouble de l’usage d’opioïdes, et le recours à ses formes d’action prolongée est croissant. Ceci soulève des interrogations chez les professionnels de santé lorsqu’une prise en charge antalgique s’avère nécessaire, en raison de ses propriétés pharmacologiques. Cet article propose une synthèse des données pharmacologiques actuelles et de leur impact sur la gestion de la douleur, aiguë ou chronique, programmée ou non. Des mises au point pratiques sont formulées selon le type de douleur, la galénique utilisée (buccale ou sous-cutanée), et les contextes cliniques.Les données disponibles confortent le maintien de la buprénorphine dans la majorité des situations, y compris en contexte chirurgical et suggèrent qu’un recours raisonné à une antalgie multimodale permet une prise en charge efficace et sécurisée. L’arrêt de la buprénorphine, longtemps recommandé pour laisser la place à une antalgie conventionnelle par opioïde agoniste complet, apparaît désormais comme une option minoritaire, à réserver à des cas exceptionnels et anticipés.La prise en charge des patients recevant de la buprénorphine ne doit pas être perçue comme une contrainte, mais comme une situation d’adaptation pharmacologique fondée sur des principes aujourd’hui bien établis.

Opioid medications play a central role in pain management but are associated with significant risks, including dependence, opioid use disorder (OUD), and overdose. In response to rising concerns, the French National Authority for Health convened a multidisciplinary working group to develop updated guidelines on the appropriate use of opioids. These recommendations, grounded in the high-level international evidence and developed through a rigorous formal consensus method, represent the most comprehensive and recent guidelines addressing the entire opioid pharmacological class, regardless of indication. The first part focuses on the clinical use of opioid analgesics in acute and chronic pain, both cancer-related and non-cancer-related. The guidelines emphasize prudent prescribing, prioritization of non-opioid therapies, and the integration of multimodal analgesia. Specific clinical situations are addressed, including management in primary care, emergency settings, postoperative care, inpatient treatment, and the perioperative management of patients already receiving opioids or opioid agonist treatment. Practical tools such as equianalgesic conversion principles, criteria for opioid rotation, and strategies to minimize adverse effects are provided to support prescribers. By considering opioids as a single pharmacological class, these guidelines enable consistent principles to be applied across diverse clinical contexts, from the initiation of short-term opioid therapy to the safe management of patients with complex dependence profiles. Although developed in France, the recommendations are intended to have international relevance, given their reliance on global evidence and their focus on balancing effective pain relief with risk reduction. A second part, addressing the prevention and management of OUD and overdoses, complements the present manuscript.

Opioid use disorder (OUD) and overdoses represent critical challenges linked to the widespread availability of opioid medications. To address these risks, the French National Authority for Health convened a multidisciplinary working group to develop comprehensive guidelines on the prevention and management of OUD and overdoses. These recommendations expand on the second part of the guidelines, which specifically addressed the prevention and management of OUD and overdoses. Grounded in the highest level of international evidence and developed through a rigorous formal consensus process, the guidelines emphasize appropriate opioid prescribing as the cornerstone of prevention. They provide practical recommendations for identifying patients at risk, detecting problematic use early, and initiating opioid agonist treatment when indicated. The role of naloxone as an essential tool to prevent fatal overdoses is highlighted, along with strategies for coordinated and multidisciplinary care across diverse healthcare settings. By integrating prevention, treatment, and harm reduction measures, these guidelines seek to balance legitimate access to opioid analgesics with robust safeguards against opioid use disorder and overdose. Although developed within the French healthcare system, their strong evidence base and underlying clinical principles make them applicable to international practice. Together with the first part on pain management, they constitute one of the most comprehensive and up-to-date sets of recommendations on the safe and effective use of opioid medications.

Background: Gabapentinoids are ligands of a brain calcium channel, which are approved for different indications, including epilepsy, neuropathic pain, or generalized anxiety disorder. Among gabapentinoids, pregabalin has been increasingly associated with a risk of pregabalin use disorder (PUD). To date, there is no recommended medical treatment for PUD. However, gabapentin, which has a lower abuse potential, could be used as a substitution therapy to reduce pregabalin withdrawal and craving.Objectives: To report on the experimental use of high dose of gabapentin among those with PUD.Methods: Case series of four patients (3 males and 1 female) with severe PUD (average daily doses ranging from 1,200 to 8,400 mg of pregabalin), in whom high dose of gabapentin was prescribed as a substitution treatment.Results: Upon gabapentin being administered as substitution therapy for pregabalin, all four patients experienced intense craving and distress. Despite receiving high doses of gabapentin, due to the observed levels of craving and distress, all four patients had to be rapidly switched back to pregabalin.Conclusions: Preliminary clinical findings suggest that gabapentin is unlikely to be a suitable, lower-risk alternative treatment for people with PUD. Additional examination of candidate medications, including other gabapentinoids, could be useful to identify an effective treatment for PUD.

AIM:The long-acting buprenorphine Buvidal® is a recent type of opioid agonist treatment (OAT) used for opioid use disorder (OUD). It was initially suggested to preferentially use Buvidal® for specific OUD populations, including people in prison, or patients in recovery and on sublingual buprenorphine. We conducted a national study to examine whether the profile of patients treated with Buvidal® in France matched these initial recommendations. METHODS:A retrospective cross-sectional study was conducted in 13 national addiction centers (outside prison), using the individual medical records of patients initiated on Buvidal®. Baseline characteristics were collected and described, including sociodemographic features, comorbid medical conditions, concurrent substance use and prescription drug misuse, and OAT features before Buvidal® initiation, respectively. RESULTS:In total 101 patients (72.3% males, mean age 43.9±11.3years) were identified, which corresponded to one sixth of all patients treated with Buvidal® in France at the time of the study. Of them, 36 (36.4%) of them were professionally active, 35 (35.4%) were durably inactive, and the rest in an intermediary situation. Furthermore, 90 (90.0%) patients had at least one medical comorbidity (all types), and 83 (83.0%) at least one psychiatric comorbidity. Most frequent non-psychiatric comorbidities were chronic pain (n=20, 20.0%) and chronic viral infection (n=16, 17.8%). Current use of psychoactive substances included cocaine and crack (n=43, 42.6%), heroin (n=19, 18.8%), but also misuse of prescription drugs (n=20, 20%), mainly opioid analgesics. Moreover, 99 (98.0%) patients had an OAT before Buvidal® initiation, including 7 (8.1%) patients on methadone. CONCLUSION:The profile of patients initiated on Buvidal® in France was extremely similar to that of patients treated for OUD in France, either in terms of social or clinical features. While initial recommendations essentially underlined the interest of Buvidal® for some niche populations, the on-the-ground practice reveals a more widespread use, including for unrecovered patients, or patients treated with methadone.

En France, d’après les dispositifs de pharmacosurveillance DRAMES et DTA, la majorité des décès sont liés à un opioïde. La naloxone, antidote spécifique des surdoses des opioïdes, est utilisée en milieu médical depuis les années 1970. Depuis 2016, des formes de naloxone prêtes à l’emploi sont disponibles. Actuellement, l’usage de la naloxone prête à l’emploi reste sous-utilisé pour plusieurs raisons (méconnaissance de la naloxone prête à l’emploi par certains professionnels et usagers, contraintes réglementaires, stigmatisation, méconnaissance des risques…). Dans ce contexte, il est important d’accompagner les professionnels à mettre en place des programmes naloxone pour sensibiliser les usagers et de leur entourage au risque de surdose lié aux opioïdes et au bon usage de la naloxone. Cet article décrit tout d’abord les différentes formes de naloxone prête à l’emploi disponibles en France puis présente aux professionnels du champ addictologique comment structurer un programme naloxone. Pour illustrer ces propos, les actions du programme POP « Prévention et réduction des risques des surdoses liées aux Opioïdes en région PACA » seront détaillées.

INTRODUCTION:Opioid use disorder (OUD) is a chronic and severe psychiatric condition defined by a level of opioid use which significantly impairs interpersonal and social functioning. In the biopsychosocial model of addiction, research has shown that psychiatric, sociological and neurobiological factors individually affect OUD severity. However, how these factors interact in the determination of OUD severity remains poorly understood. METHOD AND ANALYSIS:The Epigenetic Bonds of Opioid Use Profiles are a multidisciplinary project whose primary objective is to characterise psychiatric and social factors of OUD in a large cohort of patients. The secondary objectives are, first, to correlate psychosocial severity with blood-derived epigenetic biomarkers to provide a deeper understanding of determinants of OUD and, second, to examine over a 2 year follow-up the correlation between the evolution of OUD and psychosocial severity with epigenetic biomarkers at inclusion. An additional objective is to analyse the impact of drug consumption rooms on access to care for most severely affected patients with OUD. In total, 300 opioid users will be recruited at supervised injection sites in Strasbourg and Paris and at addiction care centres in Strasbourg and Lyon to explore four psychiatric (substance use disorders beyond opioids, depression, anxiety, post-traumatic stress disorder) and five social (social support and status, traumatic experiences, housing, imprisonment, access to care) factors. Opioid users will be followed for 24 months and reassessed for psychosocial factors at 3, 6, 12, 18 and 24 months. Opioid consumption will be measured in all subjects using questionnaires, complemented by toxicological screenings (mass spectrometry). Finally, DNA methylation and gene expression will be characterised in capillary blood using next-generation sequencing. Mixed models will be used to model the primary and secondary outcomes. ETHICS AND DISSEMINATION:This ongoing study was approved by the French Ethics Committee 'Sud Méditerranée III' of University Hospital of Nîmes (approval 2023-2024, protocol IDRCB number 2022-A02477-36) and authorised by the French Data Protection Authority (authorisation decision DR-2023-277 in December 2023). Results will be presented in international and national conferences and published in peer-reviewed international journals. TRIAL REGISTRATION NUMBER:NCT06021548.

Introduction. - Young individuals constitute a key population for the screening of problematic use of substances (PUS), but they are not likely to seek support and are hard to reach. Targeted screening programs should thus be developed in the places of care they may attend for other reasons, including emergency departments (EDs). We aimed to explore the factors associated with PUS in young people attending an ED; we measured the subsequent access to addiction care after ED screening. Methods. - This was a prospective interventional single-arm study which included any individual aged between 16 and 25 years who attended the main ED of Lyon, France. Baseline data were sociodemographic characteristics, PUS status using self-report questionnaires and biological measures, level of psychological health, and history of physical/sexual abuse. Quick medical feedback was provided to the individuals presenting a PUS; they were advised to consult an addiction unit, and contacted by phone at three months to ask whether they had sought treatment. Baseline data were used to compare PUS and non-PUS groups using multivariable logistic regressions, to provide adjusted odds ratios (aORs) and 95% confidence intervals (95% CI), with age, sex, employment status, and family environment as the adjustment variables. The characteristics of PUS subjects who subsequently sought treatment were also assessed using bivariable analyses. Results. - In total, 460 participants were included; 320 of whom (69.6%) were presenting current substance use, and 221 (48.0%) with PUS. Compared to non-PUS individuals, PUS ones were more likely to be males (aOR = 2.06; 95% CI [1.39-3.07], P < 0.001), to be older (per one-year increase: aOR = 1.09; 95% CI [1.01-1.17], P < 0.05), to have an impaired mental health status (aOR = 0.87; 95% CI [0.81-0.94], P < 0.001), and to have a history of sexual abuse (aOR = 3.33; 95% CI [2.03-5.47], P < 0.0001). Only 132 (59.7%) subjects with PUS could be reached by phone at 3 months, among whom only 15 (11.4%) reported having sought treatment. Factors associated with treatment seeking were social isolation (46.7% vs. 19.7%; P = 0.019), previous consultation for psychological disorders (93.3% vs. 68.4%; P = 0.044), lower mental health score (2.8 +/- 1.6 vs. 5.1 +/- 2.6; P < 0.001), and post -ED hospitalization in a psychiatric unit (73.3% vs. 19.7%; P < 0.0001). Discussion/Conclusion. - EDs are relevant places to screen PUS in youth, but the level of seeking further treatment needs to be substantially improved. Offering systematic screening during an emergency room visit could allow for more appropriate identification and management of youth with PUS.

Despite being among the most effective treatments for opioid use disorder, methadone is largely unavailable in the United States, due primarily to federal and other policies that limit its availability and regulate clinical decisions about doses, visit frequency, and drug testing. There is unprecedented momentum to change decades-old US methadone policies. Yet uncertainty remains as to whether reforms will be adopted and how policies will be implemented. France has among the best methadone access and lowest overdose death rates worldwide. 87 % of French people with opioid use disorder receive methadone or buprenorphine, versus an estimated 13-20 % in the US. France's opioid-related overdose rates are far lower than the US. This article compares French and US systems, including current and proposed US policies, and underscores potential implications for US policymakers.In France, methadone can be initiated in specialty addiction settings and hospitals, with subsequent handoff to primary care. Methadone can be dispensed in community pharmacies and filled like other opioids, without requirements for supervised dosing. Decisions about visit frequency, medication doses, and drug testing are governed by clinical best practices and patient-clinician shared decision-making. In the US, methadone for opioid use disorder is regulated unlike any other medication (including methadone for pain) and is governed by strict federal controls, including from law enforcement and healthcare. With few exceptions, methadone for opioid use disorder is only available in Opioid Treatment Programs. US clinicians cannot prescribe methadone for opioid use disorder. Federal rules determine minimum visit frequency, initial dose limits, and other conditions of treatment, which states may further limit.Policies assert strong influence on patient experience, treatment access, and health outcomes. Despite being less restrictive than the US, the French model includes limits designed to avoid or minimize potential harms. French policies have important implications for potential US reforms.

BACKGROUND:Cannabis use frequently starts during adolescence and young adulthood and can induce psychosocial and health consequences. Young people constitute hard-to-reach populations. Emergency departments could constitute a key care setting to identify cannabis use and its consequences among young people. OBJECTIVES:To estimate the rate of cannabis use in the 16- to 25-year-old population visiting the emergency department for any reason and to assess the psychosocial factors associated with cannabis use. METHODS:This was a cross-sectional study among young people who attended the emergency department, over 5-months. Data were sociodemographic characteristics, self-administered questionnaires for problematic substance use screening, and urine drug screening samples. They were classified in the cannabis use (CU) group if they had a positive urine screen or reported cannabis use in the previous month. Characteristics of individuals in the CU and non-CU groups were compared. RESULTS:A total of 460 participants were included, of whom 105 were in the CU group. Cannabis users were more likely to be male (aOR = 1.85; [1.18-2.90]), to be unemployed (aOR = 1.77; [1.03-3.04]), to have a lower mental health status score (aOR = 0. 82; [0.75-0.90]), to report a history of sexual abuse (aOR = 2.99; [1.70-5.25]), and to have a positive AUDIT screen (aOR = 4.23; [2.61-6.86]). CONCLUSIONS:The emergency department is a primary care setting for young people, which is conducive to screening for substance use. Cannabis users can be assessed and referred to adapt their treatment, given their lack of adherence to the traditional addictology care system.

Introduction La prégabaline est un médicament autorisé pour le traitement de la douleur neuropathique, l’épilepsie et le trouble anxieux généralisé. Cependant, la prégabaline est également de plus en plus détournée et mésusée, aboutissant à des troubles d’usage ou addictions. Pour cette raison, les autorités sanitaires françaises ont décidé en 2021 de classer la prégabaline comme assimilé stupéfiant, en imposant sa prescription sur « ordonnance sécurisée ». Notre étude visait à évaluer l’impact de cette mesure réglementaire sur la consommation de traitements. Matériel et méthodes En utilisant des données provenant d’un échantillon national représentatif de 12 690 officines françaises (OpenHealth), nous avons comparé les dispensations sur l’année pré- vs post-changement réglementaire. Les paramètres analysés étaient : (1) le nombre de prescriptions de prégabaline dispensées, (2) la présence ou non d’opioïdes et/ou benzodiazépines co-dispensés chez les personnes recevant de la prégabaline, et (3) le nombre de prescriptions dépassant la dose maximale recommandée de 600mg par jour. Résultats Suite au changement réglementaire, on a observé une réduction de 22,7 % du nombre de dispensations de prégabaline. Parallèlement, il y a eu une diminution significative des prescriptions co-dispensées d’opioïdes (18,4 % contre 11,6 %, p<0,001) et de benzodiazépines (21,4 % contre 11,7 %, p<0,001). Les prescriptions dépassant la dose maximale recommandée pendant la période de l’étude ont chuté de 10,6 %. Ces prescriptions suprathérapeutiques représentaient 2,5 % des dispensations sur l’ensemble de la durée d’étude. Conclusion La réglementation adoptée en 2021 par les autorités sanitaires françaises a significativement réduit la dispensation totale de prégabaline dans les pharmacies communautaires, y compris les prescriptions à haute dose, même si le niveau de réduction reste limité en pratique.

Background Pregabalin is a drug approved for neuropathic pain, epilepsy and general anxiety disorder. However, pregabalin is also an increasing cause of diversion and misuse, and, for this reason, the French health authorities have decided in 2021 to classify it as a narcotic drug, requiring secured prescription pads. Our study aimed to evaluate the impact of this measure on pregabalin dispensation patterns. Methods Using data from a national representative sample of 12,690 French community pharmacies, we assessed the impact of the new regulatory framework, implemented in June 2021, on the total monthly quantity of pregabalin dispensed by conducting an interrupted time-series (ITS) analysis. We built a counterfactual model to predict what would have happened without the intervention. We conducted the same analyses in the subsample of pregabalin dispensations exceeding the maximum recommended dosage of 600 mg per day. Additionally, we compared (1) the number of pregabalin dispensations (2) the co-dispensing of opioids and/or benzodiazepines one year before and one year after the regulation. Results Following the regulatory change, there was an immediate and significant drop of 38,475,375 mg (95 %CI [-66,931,799 mg; -10,018,951 mg] in pregabalin dispensations. This decline continued in the following months, with a decrease of 4,788,107 mg (95 %CI: [-8,888,326 mg; -687,888 mg] per month. The counterfactual model predicted that, without the intervention, there would have been no notable change in pregabalin dispensations. The ITS analyses showed no significant change in pregabalin dispensations following the new regulation for the subsample with doses exceeding 600 mg per day. Concurrently, there was a significant decrease in co-dispensing of opioids (18.4 % pre-regulation versus 11.6 % post-regulation, p < 0.001) and benzodiazepines (21.4 % pre-regulation versus 11.7 % post-regulation, p < 0.001). Conclusion The constraining regulation adopted in 2021 by the French health authorities significantly curtailed total pregabalin dispensing in community pharmacies. Our findings underscore the importance of regulatory measures to limit the misuse of a prescribed medication.

Abstract 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.

Le cannabis est la substance psychoactive stupéfiante la plus produite et la plus consommée dans le monde. L'Office des Nations unies contre les drogues et le crime estime à 209 millions le nombre d'usagers de cannabis dans le monde en 2020 et décrit, sur les dix dernières années, une augmentation de 23 % du nombre de consommateurs. En France, le niveau de consommation est l'un des plus élevés d'Europe. Le cannabis est classé sur la liste des produits stupéfiants, et la question de sa dépénalisation fait l'objet d'une attention particulière dans le débat public français. Sur les dix dernières années, devant l'apparente inefficacité des modèles législatifs purement prohibitifs, plusieurs pays ou états ont fait le choix de modifier leur législation à l'égard de la substance pour essayer notamment de mieux encadrer son circuit de fabrication et de distribution. Se pose ainsi la question en France, de réguler le trafic et l'usage du cannabis récréatif, dont l'usage constitue un enjeu fort de santé publique. Grâce aux expériences des pays qui ont régulé l'usage du cannabis récréatif dans le monde, il existe de nombreuses données observationnelles qui nous ont permis de tirer un premier état des lieux des conséquences de ces modifications législatives sur la santé des populations. Réalisation d'une synthèse bibliographique de la littérature médico-scientifique internationale entre 2019 et février 2023. Analyse en particulier des hospitalisations pour intoxication par le cannabis et les conséquences addictologiques, et également des données sur l'accidentologie liée au cannabis et la criminalité entourant le circuit de production et de vente illicite. Après analyse de la documentation (soit une centaine de publications ou rapports), il apparaît que l'implémentation des lois en faveur de la légalisation ou de la dépénalisation concernant le cannabis à usage récréatif est associée à des conséquences sanitaires sur les populations. Les différents résultats rapportés par les auteurs ont pu différer et s'avérer inconstants d'un pays à l'autre et d'un modèle législatif à l'autre. Le nombre d'admissions aux urgences pour un motif en lien avec une consommation de cannabis chez les adultes tend à augmenter. Chez les enfants, les hospitalisations pour une ingestion involontaire de cannabis sont aussi en augmentation. Un lien est suggéré entre la légalisation et une augmentation des diagnostics de troubles de l'usage de cannabis dans la population générale, bien que l'association soit complexe à établir. Les admissions pour sevrage en service d'addictologie semblent avoir diminué au sein de la population et en particulier chez les jeunes adultes; semble-t-il en raison d'une moindre perception des risques et des dommages liés à la consommation de cannabis du fait de son changement de statut. En ce qui concerne l'accidentologie, les résultats sont difficiles à analyser. Une élévation relative du nombre d'accidents de la route semble s'être produite à la suite du changement de législation dans certains pays ou États mais ce constat n'est pas unanime (biais méthodologique). Concernant la criminalité, les arrestations pour possession de cannabis ont significativement diminué, tout comme les saisies de cannabis dans certaines juridictions. Néanmoins, le marché illégal de cannabis continue d'opérer en parallèle du marché légal. L'impact de la législation sur les autres crimes reliés au cannabis reste difficile à établir. Les différentes méthodes législatives mises en place (légalisation, dépénalisation) pour réguler l'usage et le trafic de cannabis récréatif entraînent des effets plus ou moins marqués sur la santé des populations et leur sécurité. Ce travail met en exergue les effets et les limites du suivi de ces changements législatifs. Le changement de statut juridique du cannabis semble modifier non seulement les usages mais aussi la mise en application de modalités de contrôles entourant sa consommation et le suivi des conséquences sanitaires.