ID: HR19-607

Presenting author: Elisabeth Avril

Presenting author biography:

Elisabeth AVRIL is general practitioner and director of Gaia Paris association whose missions are developing harm reduction among people who use drugs (NSP, low threshold OST program, DCR, hepatitis project, outreach work and DCR). As a clinician, she is involved in HIV and HVC treatment of PWUD and substitution therapy.

Management of drug users with psychiatric disorders in the first drug consumption room in France.

Elisabeth Avril, Céline Debaulieu

In 2016 the first Drug Consumption Room opened in France after years of political debate and combatting misperceptions of the local neighborhood that perceived this intervention as controversial. The DCR is located in the heart of a mayor drugs scene, in the North-East of Paris.
Being the only service of this type in Paris, this low threshold service aims to include the most precarious people who use drugs. Among them some are suffering from psychiatric disorders, bringing major challenges to internal management as well as occasionally causing disorder in public space, which the DCR team is taken to resolve in order to prevent renewed opposition from the neighborhood.

Since the opening of the DCR, 1094 beneficiaries have been registered with an average rate of 180 visits per day. With the additional outreach activities the program reached up to 5 000 precarious drug users. An estimated 15 to 20% are suffering from psychiatric co-morbidity. A partnership was launched with the psychiatric and addiction department of the local university hospital, including in- and outpatient programs for substitution therapies and drugs withdrawal management.

Working with precarious population requires from the team to adapt to the needs of each individual while preserving the general operational framework of the DCR. In order to professionally address these challenges, a psychiatrist, out-posted from the hospital, started consultations once a week in the DCR and thus strengthened theoretical and practical knowledge of the team about psychiatric disorders. Meanwhile, two time slots of psychiatric consultations were dedicated to DCR clients at the addiction ward.

In 2017 fifteen clients with severe disorders have been referred to the inpatients psychiatric and addiction ward, 9 were admitted at the withdrawal unit. Intense collaboration with the psychiatrist helped the team to improve crisis management behaviors in the DCR and increased linkage to care.