The French Approach to Controlling Opioid Crisis

Before her book published last month, Juliette Boudre says she knew little of other families struggling with addiction. Her book, "Mom, Don't Let Me Fall Asleep," recounts how her son's descent into drug abuse led to his death in 2016. Boudre now says she receives dozens of emails a day from others across France whose children or family members are suffering from addiction or who died of an overdose. Boudre says most media attention on opioids, a subject rarely discussed in France, focuses on the crisis in the United States.

"They never talk about what's happening in France," Boudre says. "There's fear and shame, and people feel very alone. People need help, and there isn't enough." Boudre's concerns are well founded. The number of people across France who annually die from opioid overdose is a fraction of the number in the U.S. But in recent years deaths in the country from opioid abuse have risen considerably, stirring new public concern here.

"There is a risk of an epidemic in France, but we're still in a situation where we can avoid it," says Nicolas Authier, a psychiatrist with SOS Addictions who specializes in pharmacology and addiction and is the director of the French Observatory of Analgesic Drugs (OFMA). "We have unfortunately benefited from the North American opioid crisis and are even more vigilant about prescriptions and proper use."

In the U.S., 42,249 people died in 2016 from opioid overdoses from a population of 323 million, according to the U.S. Department of Health and Human Services. By comparison, 349 people in France died of overdoses in 2016, according to a report by the European Monitoring Center for Drugs and Addiction (EDMCCA) among a population of 66 million people. "The situation isn't comparable to the U.S., but we have seen an increase in misuse of these drugs. We're trying to be cautious," says Nathalie Richard, the agency's deputy director for analgesics, narcotics and addiction drugs.

Misuse became personal for Boudre, whose son Joseph became addicted to benzodiazepines in middle school after they were prescribed for sleep troubles. At 16, he began buying the weak opiate codeine over the counter to get high. He spent much of his middle school and high school years in and out of rehab, trying to get clean.

"Opioids made the situation worse because they're much stronger. They're the next step," Boudre says. "He wanted to stop, but it took over his body." A mix of benzodiazepines and fentanyl, which Joseph bought on the street believing it was morphine, killed him. "When we prescribe these medications too quickly, all other treatments seem ineffective in comparison," Authier says. "With fentanyl in France, most of the problems are with patients who don't have cancer. So (French doctors) aren't always respecting the proper terms of prescription."

Many observers say the opioid abuse crisis in the U.S. can be traced to 2000, when Congress passed the Pain Relief Promotion Act of 2000, which made treating chronic pain a priority. French authorities preceded the U.S. with a similar law in 1994 that counseled doctors to take pain treatment more seriously. Today, France is still far from experiencing its own opioid crisis, which local health authorities attribute to several factors. The ANSM says prescriptions in France are highly regulated and monitored: Opioid prescriptions are limited to 28 days, and French doctors have been generally nervous about prescribing opiates, the agency says. Labs also aren't allowed to market drug ads directly to consumers.

"In the United States, pharmaceutical companies have enjoyed infinitely greater freedom than in France, but also in Europe in general, to push for the sale of these drugs," says Dr. Agnès Cadet-Taïrou of the OFDT. The ANSM is educating doctors and patients about the risks of opioids in France, with a network of observatories throughout the country monitoring use. "It's important to validate and repeat information. It seems simple, but we often have the most trouble with communication," Authier says.

Naloxone, the drug that blocks opioid overdoses, is regularly distributed to high-risk users. A safe drug consumption room, Gaia, opened in Paris in 2016 and serves about 200 drug addicts every day with free needles and a safe space to shoot up – most often crack or Skenan, a strong prescription opioid sold on the streets – while offering access to optional counseling from social workers, psychiatrists and other health authorities. Authier says French authorities are creating a system to monitor social networks.

Even if such measures prevent opioid use from reaching crisis levels in France, Authier says the country is still left with the problem of easing chronic pain. "Unfortunately, there's very little therapeutic innovation for pain relief."

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