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New OST Clinical Guidelines in French prison setting L Michel, Centre Pierre Nicole, French Red-Cross O Maguet – C Calderon, CCMO Conseil.

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Presentation on theme: "New OST Clinical Guidelines in French prison setting L Michel, Centre Pierre Nicole, French Red-Cross O Maguet – C Calderon, CCMO Conseil."— Presentation transcript:

1 New OST Clinical Guidelines in French prison setting L Michel, Centre Pierre Nicole, French Red-Cross O Maguet – C Calderon, CCMO Conseil

2 Background 1994 : Care organization under the responsibility of the Ministry of Health 1996 : OST approval in France, including prison setting few months later 2001 : request for OST clinical guidelines in prison setting (National OST commission– Ministry of Health) 2003 : First Official report on OST – Literature review – Qualitative study : sanitary and security staffs but also prisoners – 13 recommendations (access to OST, continuity of care, urine testing, training,….)

3 Background National Plan against drugs and drug addiction (MILDT) National Strategic Plan ”Health policy for prisoners” (Ministry of Health/Justice) OST coverage (2011) : 8% of the prison population (1,6%-40%)  Actualization of the OST recommendations : – Request and support from the MILDT and Ministry of Health – Ministry of Justice concertation

4 Methodology Based on the 2003 recommendations Including conclusions or recommendations from recent reports – Expertise Collective on harm reduction for drug users (Inserm collective expertise, 2010) – PRI 2 DE survey : availability and accessibility of harm reduction measures in French prison setting (including OST) (Michel L, BMC Public Health, 2011) Equity of access to care not yet acquired – Access to both OST still limited – Frequent dosage limitations – Buprenorphine tablets crushed in 1/5 prisons – Continuity of care after release to be improved

5 Methodology Sanitary staffs participation: – 4 focus groups across France (Paris, Lyon, Bordeaux) involving 35 participants from 30 prisons (doctors, nurses, social workers, psychologist…) with a qualitative analysis – Main issues discussed : OST care organization, OST prescription and treatment delivery

6 Emerging problems Misuse/trafic management OST switch (MMT Buprenorphine) Conditions of the continuity of care (level of proof ?) at entry, before release Conditions of OST initiation ? What about custody initiation ? Conditions for delivery ? – Daily ? Several days ? Crushed tablets ? Urine testing Need for Training

7 The New OST Guidelines 15 individualized and updatable cards: – 4 “contextual” cards OST legal frame in prison setting, recent changes in care organization for drug users in prison, persistent barriers to treatment access, guidelines description and its methodology,

8 The New OST Guidelines 11 “clinical or organizational ” cards – clinical evaluation at prison entry – urine testing – OST prescription at entry – OST prescription renewal – OST pharmaceutical process in prison setting – considerations on OST switch – OST delivery – OST misuse management – management of other prescriptions (benzodiazepines++) – comprehensive care – continuity of care after release

9 Diffusion ? Soon… All sanitary units Prison staffs … and all drug units in the community to help them to adjust their practices Still a major concern with harm reduction policy

10 Centre Pierre Nicole 27, rue Pierre Nicole Paris, France THANK YOU !


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