Is precariousness the blind spot of prevention and treatment of the use of psychoactive substances?

Abstract

Background and aims: Prevalence of the use of psychoactive substances is high in precarious populations. Yet the influence of precariousness on the trajectory of drug users (DUs) has rarely been studied. For the first time, we conducted such a study with a representative group of DUs.Methods: We combined a recruitment through a respondent driven sampling (RDS) with a 250 items questionnaire. The answers of our sample of 327 UDs were studied according to a precariousness score (PS).Results: The prevalence of precariousness ranged from low PS 48.9 %, average PS 30.9 % to high PS 20.2 %. Access to health services at the time of our survey concerned 61.8 % of DUs. Its prevalence was lower among DUs with the highest precariousness score (Low PS 72.5 %, Average PS 61.4 %, High PS 36.4 %) with an Odds ratio of 5.01 (CI95% 2.52-9.97; p<0.0001) between low and high PS for a continuous follow-up. A higher dropout rate was also observed among the highest PS (p<0.0001).Despite differences in their socio-economic characteristics, DUs represented a homogeneous community with respect to their use of drugs. The more precarious DUs were younger, had an earlier age of initiation of injection, of experimentation of cannabis, alcohol, heroin as well as diverted opioid substitution treatments (OST). They had a more frequent and durable use of alcohol. Precariousness was also associated with lower educational levels, less contacts with one’s parents, less search for information on the Internet for drugs and GPs for health and more housing and social rights as plans for the future.Conclusion: In France, despite the fact that specialized care is free of charge, the lower access to for the most precarious DUs and their higher drop-out rates suggest that it is not adapted to their demand, which is more oriented towards socio-economic problems than towards drug use or harm reduction. This observation is all the more important as it concerns the youngest users. Our data suggest that precariousness influences the course of drug addiction from its onset. Lack of consideration of this population limits the ability to develop effective health policies.