The decree on “shooting rooms” has been published, it remains to put them in place
It was a long-awaited decree. Olivier Véran published in Official Journal of February 23 the decree “of January 26, 2022 approving the national specifications relating to “addiction care” stops” (HSA). Behind this term hide the famous Lower Risk Consumption Rooms (SCMR) – which the HSAs replace –, better known by the name, quite improper moreover, of “shooting rooms”. Concretely, this decree which details quite precisely the methods of implementation of the HSA, opens the way to their establishment everywhere in France where it can be useful, and in particular in the Paris region, thanks to the fact that the institutional actors agree .
For the Addiction Federation, “this is very good news: the lower-risk consumption devices, of which all the studies have activated the usefulness and relevance, will be able to continue and develop”, indicates – her in a statement. Same echo on the side of Anne Sourys, deputy mayor of Paris in charge of Health: “This is good news, the HSA will be able to be mentioned”.
In the preamble, the decree recalls that “the final results of the evaluation of the two existing rooms [à Paris et Strasbourg] highlight positive effects on the health of the people concerned, an acceptable cost-effectiveness ratio for society as well as an absence of deterioration of public peace”. This justifies the extension of the experiment. Moreover, the two pioneering SCMRs which were to operate until March 2022 have been extended until December 31, 2025.
Avoid the risk of overdose
These new HSAs, renamed with the “aim of strengthening the dimension of access to a health course of these devices” must fulfill several objectives: “Contribute to reducing, among active users, the risks of overdose, infections and ‘other complications of drug use’ and ‘bringing drug users into […] on a health journey. The order is very careful to specify, to reassure the taxpayer, that HSAs save public funds. The evaluation of the two SCMR figures “the medical costs ceased at 11 million euros for the two rooms”.
Concerning their possible location, the decree indicates that “the implementation of HSA experiments is designated […] reception and support centers for risk reduction for drug users (CAARUD) and addiction treatment, support and prevention centers (CSAPA)”. What’s more, these HSAs will have to be placed “close to places of consumption in order to be close to users and reduce public nuisances where they are most tangible”. This reduces the mesh even if Anne Souyris warns that “we are not going to implant HSAs wherever possible. We will have to carry out a diagnosis with the actors in the field to find out where the installers are”.
Working together is no mean feat
Even before the establishment of an HSA, a steering committee must be set up which is managed jointly by “the mayor of the municipality where the HSA is deployed, the general manager of the ARS, the prefect of the territorially competent department and the prosecutor “. In the Parisian case, the HSAs will therefore be jointly managed by Anne Hidalgo and the prefect of Ile-de-France, whose relations are not always very cordial on the issue of crack. Moreover, Anne Souyris hopes “that the prefect will ensure that we meet quickly, in particular with the actors in the field, to discuss the HSA”.
If the elected Parisian is satisfied with the publication of the decree, she regrets that there is nothing on accommodation, which hinders the logic of the care pathway. “This must be articulated with the HSA and we must do as in Strasbourg where there is accommodation on the upper floors of the SCMR”. For its part, Addiction Federation, specifies that these HSA “can only develop their role in close connection with the care devices”.