Gilles Penavayre Head of mission. I've been working in harm reduction for 25 years and have set up many community health projects in France and abroad (in prisons, harm reduction services, drug consumption rooms, TAPAJ, advocay, research,harm reduction training...). ) I also coordinate the ESAR project.

France has only two drug consumption rooms (Paris and Strasbourg) for 67 million people. Despite positive evaluations, the future of these rooms is uncertain, their experimentation ends in September 2025. The decision will be made by a government for whom PWUD are public enemies. Meanwhile, all other projects for drug consumption rooms (Marseille, Lille, and Lyon) have been denied, sometimes by direct order of the Minister of the Interior.

At the same time, stakeholders in harm reduction have observed that drug use is occurring in the toilets of their associations. They have been distributing syringes and crack pipes, which are being used in unsupervised settings, highlighting the need for innovative harm reduction strategies to meet health and social needs.

Facing this situation, these French associations, initiated by Oppelia and coordinated by the Fédération Addiction, have launched the ESAR (Supervision and Support Spaces for Harm Reduction) initiative. More than twenty French harm reduction services have or will launch unsanctioned safe consumption sites for injection, inhalation, smoking, and snorting. The setup of each ESAR will depend on the specific needs of people who use drugs (drug use practices for example) locally and the possibilities of the association (architecture, opening hours…) but will follow common protocols, include required training for workers, and involve co-construction with people who use drugs. Unlike traditional DCRs, ESARs are part of regular harm reduction activities rather than a separate service. The initiative also includes working groups on themes such as ethics, evaluation, and communication.

This initiative allows PWUD to use drugs in a safe space, without waiting for the establishment of official DCRs. We believe that a national network of small drug consumption rooms with a common framework adaptable to local particularities can meet the needs of PWUD and involve them fully in building spaces made for them.