title: Changing patterns of first injection across key periods of the French Harm Reduction Policy: PrimInject, a cross sectional analysis.
abstract: BACKGROUND
  Monitoring of emerging modes of drug consumption in France has identified new patterns of injection among youths with diverse social backgrounds, which may explain the persistence of high rates of hepatitis C virus infection. The circumstances surrounding the first injection have been poorly documented in the group of heavy drug users and in the context of the French opioid substitution treatment (OST) policy that provides expanded access to high-dosage buprenorphine (BHD) METHODS: An Internet survey (Priminject) was conducted from October 2010 to March 2011 with French drug users. Four time periods were compared based on critical dates throughout the implementation of the Harm Reduction Policy in France.
  
  
  RESULTS
  Compared with drug users who injected for the first time prior to 1995, the aspects of drug use for users who recently injected for the first time were as follows: (1) experimentation with miscellaneous drugs before the first injection; (2) an older age at the time of first injection; (3) heroin as the drug of choice for an individual's first injection, notwithstanding the increased usage of stimulant drugs; (4) BHD did not appear to be a pathway to injection; and (5) an increased number of users who injected their first time alone, without the help or presence of another individual.
  
  
  CONCLUSIONS
  The PrimInject study showed that there is a group of injection drug users that is larger than the group of injection drug users observed in previous studies; therefore, it is necessary to diversify programs to reach the entire spectrum of high-risk users.
authors.affiliation: French National Institute of Prevention and Health Education, Scientific Affairs Department, 42 boulevard de la Libération, 93203 Saint-Denis cedex, France. Electronic address: anne.guichard@inpes.sante.fr.
authors.forename: Anne
authors.initials: A
authors.lastname: Guichard
authors.forename: Romain
authors.initials: R
authors.lastname: Guignard
authors.forename: David
authors.initials: D
authors.lastname: Michels
authors.forename: François
authors.initials: F
authors.lastname: Beck
authors.forename: Pierre
authors.initials: P
authors.lastname: Arwidson
authors.forename: France
authors.initials: F
authors.lastname: Lert
authors.forename: Elise
authors.initials: E
authors.lastname: Roy
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D055030:Drug Users / Q000523:psychology*; D005260:Female; D005602:France; D040261:Harm Reduction; D006291:Health Policy / Q000639:trends*; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000523:psychology*; D013997:Time Factors
keywords: Buprenorphine; Drugs uses; First injection episode; France; Injection drug users; Internet study