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 2008-2011 National Plan against drugs and drug addiction (MILDT) 2010-2014 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. laurent.michel@croix-rouge.fr laurent.michel@croix-rouge.fr Centre Pierre Nicole 27, rue Pierre Nicole 75005 Paris, France THANK YOU !