Évaluation des conduites addictives chez les personnes entrant en milieu pénitentiaire à partir du programme OPPIDUM du réseau des centres d'évaluation et d'information sur la pharmacodépendance (CEIP) (2010)

FRANÇAIS :
Les modalités de consommation de substances psychoactives consommées durant la semaine précédant l'incarcération de sujets vus en milieu carcéral ont été étudiées à partir de l'enquête observation des produits psychotropes illicites ou détournés de leur usage médicamenteux (OPPIDUM) entre 2003 et 2006 puis comparées à celles des sujets pharmacodépendants ou sous traitement de substitution de la dépendance aux opiacés (TSO) vus dans d'autres structures sanitaires. Sur l'ensemble des quatre années 2003 à 2006, 13 008 sujets ont été inclus dans l'étude, parmi eux 893 (7 %) des sujets ont été vus par des structures carcérales. Les sujets sont, avant leur incarcération, plus jeunes et moins bien insérés socialement que les autres sujets vus dans d'autres structures sanitaires ; ils sont plus polyconsommateurs et consomment plus souvent des substances illicites (65 % des sujets), plus de benzodiazépines (BZD), moins de TSO. Les médicaments sont consommés à des posologies plus importantes et sont plus souvent obtenus illégalement. Les caractéristiques de consommation de ces sujets avant leur incarcération ont peu évolué entre 2003 et 2006. Cette étude met en évidence la spécificité des modalités de consommation de substances psychoactives avant l'incarcération des sujets dépendants ou sous traitement de substitution par rapport aux autres sujets fréquentant une structure sanitaire et souligne la nécessité d'adapter la prise en charge sanitaire dès l'entrée en prison. [Résumé d'auteur]
ENGLISH:
Introduction: The data on consumption of psychoactive substances among new prisoners are documented but not detailed with precision. Nevertheless, analyzing the consumption's characteristics of psychoactive products would led to a better caring of subjects at the entry in the prison. The consumption of psychoactive drugs the week before the imprisonments of subjects seen in prison were studied from the Observation of Illegal Drugs and Misuse of Psychotropic Medications (OPPIDUM) program's between 2003 and 2006. These were compared to those of others subjects with an history of abuse/dependence or under an opiate maintenance therapy presented in other structures of care.
Methods: OPPIDUM is an annual cross-sectional national study, repeated each year in October since several years. It is based on the Network of the Centres for Evaluation and Information on Pharmacodependence (CEIP) which recruits, via the medical system (drug users outpatient care centers, psychiatric units, drug-addict units...), subjects presenting a drug dependency or benefiting of an opiate maintenance treatment.
Results: During the four years between (2003 to 2006), 13,008 subjects were included. Seven percent (n = 893) of them were in prison. They are younger and present worse social-economical indicators compared to the others subjects seen in other structures of care. In comparison to other subjects, the prisoners consume more products, more illicit ones and more benzodiazepines like flunitrazepam and clonazepam before their imprisonment. The medicines are consumed with higher doses and are more often obtained illegally (35% vs 14%). These subjects are less often under an opiate maintenance therapy (51% vs 74%). Between 2003 and 2006 the consumption of cocaine, increased from 18% to 28% for the patients before their confinement and from 11% to 21% for the heroine. Nevertheless, the consumption of benzodiazepines have decreased passing from 41% to 25%; and the consumption and of opiate maintenance treatment taken out of a protocol have decreased from 11% to 4%.
Discussion: This study underlines the specificity of the characteristics of consumption of psychotropic drugs before the imprisonment of the subjects with history of abuse/dependence or under an opiate maintenance therapy by report to consumers presented in other structures of care. It outlines the need to optimize the care by a better knowledge of the consumption of psychoactive products. [Author's abstract]