1. THE 6 TH NATIONAL SCIENTIFIC CONFERENCE ON HIV/AIDS State of the art and new perspectives in drug addiction treatment Dr L Michel, MD, PhD Inserm U1178 Centre Pierre Nicole/French Red Cross Paris

2. The 6 th National Scientific Conference on HIV/AIDS Drug dependence 1.Addiction is a disease 2.Addiction is a brain disease, but not only –Genetic, environmental and social factors… –Psychological factors 3.Addiction is a chronicle disease 4.Addiction is treatable

3. The 6 th National Scientific Conference on HIV/AIDS Comprehensive care 1.Combination of –Medical + psychosocial interventions –Harm reduction interventions 2.Multidisciplinary, integrated and long-term approach (guidelines for the treatment of drug dependence: a European perspective, EMCDDA, 2011) –Relapse belongs to the recovery process 3.Gold standard for opioid dependence –Opioid agonist treatment + psychosocial intervention

4. The 6 th National Scientific Conference on HIV/AIDS Abstinence rates are higher in patients receiving psychosocial interventions Psychosocial interventions: cognitive and behavioural approaches contingency management Techniques (WHO, 2009)

5. The 6 th National Scientific Conference on HIV/AIDS Reach all populations Enlarge treatment options –Improve existing options Methadone induction in primary care in France (ANRS- Methaville) 6 months buprenorphine implants (Rosenthal, 2013) Naltrexone implants (3-6 months): –«Better designed research is needed to establish the safety and efficacy of naltrexone implants. Until such time, their use should be limited to clinical trials » (Larney, 2014)

6. The 6 th National Scientific Conference on HIV/AIDS Reach all populations Enlarge treatment options –Create new options Oral 24h morphine release: Austria, Switzerland, Slovenia, and UK soon Diacetylmorphine: Switzerland, Neederland, Denmark for injecting drug users Injectable buprenorphine (Bup IV trial, France)

7. The 6 th National Scientific Conference on HIV/AIDS Improve damages prevention 7 Curr Opin HIV AIDS 2012, 7:362–368

8. The 6 th National Scientific Conference on HIV/AIDS Improve damages prevention Medication assisted treatment –Opioid agonist treatments efficient to prevent HIV & HCV (Tsui, 2014 ; Nolan, 2014) –Preventive impact enhanced if strategies combined Substance-use treatment + support for safe injection more effective at reducing HCV seroconversion (Hagan, 2011) –Van den Berg (2007): Full participation in harm reduction programmes including NEP + OST at adequate dosage (≥ 60mg methadone/day)

9. The 6 th National Scientific Conference on HIV/AIDS Improve damages prevention Needle and syringes programs –ANRS-AERLI program (France): educational intervention on risks associated with drug injection (Roux, 2015) HCV transmission related to –Sharing paraphernalia (Pouget 2012) –Pipe and straw sharing (Jauffret 2009, Aaron 2008) –Supervised consumption rooms: prevent individual and social damages related to drug use practices (Potier, 2014) To be opened in 2016 in Paris, Strasbourg, Bordeaux ?

10. The 6 th National Scientific Conference on HIV/AIDS Improve damages prevention Decrease mortality related to overdoses –Spread of nasal naloxone among DUs (January 2016) Reach High risk populations –Prison setting: reach a principle of equivalence for harm reduction measures (ANRS-Pride program)

11. The 6 th National Scientific Conference on HIV/AIDS Stimulant use and dependence No agonist treatment Main treatment modality: psychosocial interventions –cognitive-behavioural therapy –contingency management Research –Trials with methylphenidate, naltrexone, antipsychotics, dexamphetamine, butyrylcholinesterase (cocaine metabolism), anti-cocaine vaccine, varenicline

12. The 6 th National Scientific Conference on HIV/AIDS Prevent ! Delaying drug use onset –Every year use of a substance is delayed, the risk of developing a substance use disorder is reduced Use specific tools for teenagers prevention –Working on emotions rather than drugs dissuasion Use specific therapy for young drug users –Multidimensional family therapy

13. The 6 th National Scientific Conference on HIV/AIDS Perspectives Future: –Interventions on the reward circuitry ? UNGASS 2016: –Special Session of the United Nations General Assembly on the World Drug Problem Ending the drug war ?