Latest news with #substanceUse
Medscape
16-06-2025
- Health
- Medscape
Craving management workshops and peer-led support are helping French prisons reframe addiction as a healthcare issue.
The most recent congress of the French association of healthcare professionals working in the prison service (ASPEP), held in Paris, revisited the issue of substance use disorders among incarcerated individuals. For many years, drug use in prisons was met with ambiguity — or even outright denial — by authorities. The prison administration maintained the somewhat simplistic belief that because drug use is illegal, it could not exist in a system where the law is meant to prevail. This perspective began to shift in the early 1980s, when concern over the transmission of HIV and hepatitis from injectable drug use prompted a more serious response. However, the focus at the time remained on controlling infectious disease risk rather than addressing addiction as a medical condition. That era has since passed. Today, prison authorities — working alongside healthcare professionals — acknowledge the reality of both drug use and addiction within correctional settings. A major step forward came in May 2024 with the publication of the first national statistical survey on substance use in French prisons: The ESSPRI study (Survey on Health and Substance Use in Prisons), led by the French Monitoring Centre for Drugs and Drug Addiction (OFDT). The study reflects a growing commitment among the medical community to objectively assess and address substance use behind bars. The survey was conducted between April and June 2023 and included approximately 1000 inmates aged 18 years or older. It assessed their use of psychoactive substances. The results — revisited at the March ASPEP congress — revealed significant levels of substance use: 63% of inmates reported daily tobacco use (compared with 25% of adult men in the general population) 26% reported using cannabis (vs 3% outside prison) 14% had used other illicit substances (including cocaine, crack, MDMA, and heroin) since being incarcerated Targeted Policy Recommendations By contrast, alcohol use within French prisons appears relatively low: Only 16% of inmates reported drinking alcohol while incarcerated. However, this is likely due to limited availability rather than a voluntary choice to abstain. Based on its findings, the OFDT identified three broad patterns of substance use among inmates: One third — primarily younger inmates — regularly use both tobacco and cannabis. One third use only tobacco. One third — often older inmates — do not use any psychoactive substances. The OFDT called for health policies that reflect these actual patterns of use. In particular, they recommended that prevention and treatment strategies within prisons focus more specifically on tobacco and cannabis, which are the most widely used substances. Transition After Release Across France, various initiatives have emerged to improve addiction care in correctional settings. However, program implementation remains fragmented, as most addiction services are organized independently by individual prison-based addiction treatment centers (known as CSAPAs). Despite this lack of coordination, some initiatives are particularly noteworthy. At the Bois-d'Arcy remand center in Yvelines, for example, CSAPA staff have introduced 'release kits' to support continuity of care for inmates with substance use disorders as they transition back into the community. This post-release period is a time of heightened vulnerability, marked by unstable living conditions and an increased risk of high-risk behaviors. In fact, post-release mortality — primarily due to suicide or overdose — is 3.6 times higher than during incarceration. The release kits, developed collaboratively with inmates and grounded in harm-reduction principles, are available in three versions tailored to individual needs: Basic kit: Includes key information, such as emergency contact numbers and referral options for addiction specialists. Kit for crack and cocaine users: Offers harm-reduction materials and substance-specific guidance to promote safer consumption practices. Kit for individuals who inject drugs: Contains sterile injection equipment and a dose of naloxone for emergency overdose reversal. Workshops to Address Craving At Baumettes Prison in Marseille, France, the local CSAPA has developed a program focused on managing craving — the intense urge to use substances experienced by individuals with addiction. Care is delivered through therapeutic workshops codesigned with inmates. These consist of four weekly group sessions facilitated by two healthcare professionals. Each group includes up to six participants and encourages open discussion of cravings and coping strategies, with a strong focus on shared experience and peer support. 'We explore how patients perceive their cravings and work to activate their psychosocial skills so they can draw on their own internal resources,' explained Camille Normandin, Elisa Carta, and Damien Mauillon during a presentation at the recent ASPEP congress. The workshops provide education on the physiological mechanisms underlying craving, while also helping participants develop personalized relapse prevention strategies. Inmates are encouraged to identify their own high-risk situations and develop tailored solutions to avoid giving in to urges. While pharmacologic substitution therapies are addressed, 'the real focus is on empowering inmates to draw on their own experiences and insights,' emphasized the CSAPA team from Baumettes. The ASPEP congress also served as a platform for healthcare professionals working in the prison system to call for better coordination of addiction services and, importantly, for more transparent and stable funding — which they described as inconsistent and difficult to track across facilities.
CTV News
11-06-2025
- Health
- CTV News
New safer supply clinic opens in Ottawa's Chinatown neighbourhood same day controversial clinic closes
An Ottawa councillor says it's 'incredibly frustrating' a new safer supply clinic opened in Chinatown on Monday, the same day a controversial clinic was set to close at the same location. The Northwood Recovery Clinic on Somerset Street West was expected to close on Monday, according to Coun. Ariel Troster. However, residents walking by the building Monday morning saw a clinic operating under the name New Dawn Medical. 'It's business as usual with exactly the same staff supposedly under new ownership, so there is a high level of frustration,' Troster told CTV Morning Live. According to New Dawn Medical's website, there are over 20 locations across Ontario that provide treatment for substance use such as opioids, alcohol and benzodiazepines. Troster says she spoke with the doctor overseeing New Dawn Medical on Tuesday evening. 'I'm really hoping we can work together to ensure community safety,' Troster said. 'I just do think that there are some real problems with the fact that there are no provincial regulations and they have no duty to inform us when a clinic of this nature is coming into the community. There are no regulations saying that they need to provide the level of wrap around support that an organization like the Somerset West Community Health Centre was providing.' The Northwood Recovery clinic opened on Somerset Street West in March, after initially operating in Hintonburg. The clinic billed itself as a safer supply site that provides legal drugs, like methadone, to help with addiction. 'The real genesis of this perfect storm in Chinatown started actually when the provincial government forced the Somerset West Community Health Centre to close both its supervised consumption site and its safe supply program,' Troster said. 'Both of those programs are being run to help people with serious addictions and it was being done in a way that was really accountable to the community.' The Somerset West Community Health Centre closed its supervised consumption site on March 1 following new rules that prevents sites near schools and childcare centres. Troster says since health care is a provincial responsibility, the city has no tools to prevent a clinic like New Dawn Medical or Northwood Recovery from opening. 'Safe supply is a really important health intervention for people with serious addictions; the intention is to ensure to make sure they're not taking poisoned street drugs,' Troster said. 'When it's done successfully, there are some community housing buildings where it's done within the building and people are able to take their medication on site. This private clinic model, that seems to be proliferating, it has really become the wild west and we're not seeing any provincial guardrails placed on clinics of this nature.'
Medscape
07-05-2025
- Health
- Medscape
Long-Acting HIV Injectable Effective Regardless of Viremia
TOPLINE: Long-acting antiretroviral therapy (LA-ART) maintained high viral suppression for 48 weeks in patients with HIV regardless of initial viremia. METHODOLOGY: Researchers examined viral suppression for 48 weeks following the initiation of LA-ART — a cabotegravir plus rilpivirine regimen — in patients with HIV comparing those with viremia (≥ 30 copies/mL of HIV RNA) with those without it. They included a total of 370 patients (median age, 44 years; 80% cisgender men), including 129 with viremia and 241 without it, by using data from electronic medical records between January 2021 and September 2024. Patients with viremia were required to attend monthly in-person visits, and injections were given bimonthly after 3 months if an undetectable viral load (< 30 copies/mL of HIV RNA) was achieved. TAKEAWAY: Patients with initial viremia had higher rates of substance use (60% vs 39%; P < .001), housing instability (51% vs 37%; P = .007), and low CD4+ counts of < 200 cells/mm 3 (77% vs 59%; P < .001) than those without it. (77% vs 59%; P < .001) than those without it. The median time to achieve an undetectable viral load in patients with viremia was 32 days (95% CI, 30-45). At 48 weeks, 98% of patients with initial viremia and 99% of those without it achieved undetectable viral loads, with no significant difference noted between both groups (P = .61). IN PRACTICE: 'In 2024, data from the program were cited in modifications to the US Department of Health and Human Services and International Antiviral Society-USA HIV treatment guidelines to recommend LA-ART among people with HIV with viremia and adherence challenges. These comparison data further bolster changes to HIV treatment guidelines,' the study authors wrote. SOURCE: The study was led by Matthew A. Spinelli, MD, MAS, University of California, San Francisco. It was published online on March 6, 2025, in JAMA. LIMITATIONS: The study had a cross-sectional design. Some participants had limited follow-up. Finally, it was conducted at a single center. DISCLOSURES: This study was supported by the National Institutes of Health/National Institute of Allergy and Infectious Diseases. No relevant conflicts of interest were disclosed by the authors. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
