The 1980s: the militant approach and the beginnings of "harm redution"
In
1982, a group of GPs from the town health centre of Ivry-sur-Seine (Parisian
region), including Elliot Imbert and Marie-Christine Charansonnet, set up a
free, anonymous consultation service for people who injected drugs (PWID), a
service to which they were denied access at the time.
As early as free HIV screening tests were
offered at the health centre laboratory. 60% of them were positive.
At that time, ten PWID were contaminating themselves with HIV every day,
and even more with hepatitis C.
There was an urgent need to put an end to the
sharing of syringes and to make them available to PWID.
The "Barzach
decree" of 13 May 1987 lifted a major barrier, liberalising the sale of
syringes in pharmacies, which had previously only been allowed to adults with a
prescription.
However, despite this, high-risk practices went on.
There was a great deal of work to be done:
finding out about these clandestine practices, understanding them and situating
them in often-precarious environments. Many associations met up and worked on
this.
1992: Foundation of Apothicom
Around
the Ivry-sur-Seine Health Centre, doctors joined forces with people who use
drugs (PWUD) to found the Association pour la prévention, la
pharmacovigilance et la communication (Association for prevention,
pharmacovigilance and communication) in 1992.
Alongside other militant associations
such as AIDES, its founders noted that the equipment commonly used consisted of
everyday objects that had been diverted from their original purpose: spoons or
cans to prepare the mix, unsuitable syringes, cigarette filters or pieces of
cotton, lemon or vinegar to dissolve the substances and tap water, or even
non-drinking water. These objects were also widely shared ; all of these
practices contributing to infectious contamination.
By preparing the solution and injecting themselves,
PWID substitute for health professionals. The methods are passed on empirically
by peers and going underground in the context of drug use.
Creation of the Steribox®
This team quickly became convinced that it would be
impossible to take effective action on risk behaviours without proposing new supplies
that were safe, sterile and for single use: since these did not exist, they had
to be invented and manufactured. From the outset, they had to be designed specifically
for injecting drug use and made accessible to as many people as possible.
A taboo for the pharmaceutical industry. No laboratory
wanted to get involved in the production and marketing of items intended for an
illicit practice.
With a few partners, Elliot Imbert developed the first
Stéribox® kit, containing syringes, vials of sterile water, alcohol swabs and
condoms. It went on sale in 20 pharmacies in Ivry-sur-Seine in September 1992,
at the price of 2 syringes at the time (5 francs). In 1994, Simone Veil, the
French Health Minister, decided to extend the programme nationwide.
Two years later, the government introduced
financial support for the release of Steribox®, making it accessible to PWID at
a lower cost. This is still the case nowadays.
Invention of dedicated injection supplies
What remained was the design and manufacture of
specific supplies for the key steps of preparing the mix to be injected and
filtering it.
By analysing practices, the team realised that the preparation container
needed to be small enough to limit preparation to a single injection, and made
of a material that could be heated, but thin enough to limit the temptation to
reuse it.
A collaboration with several manufacturers led to the
creation of Stericup® in 1997. It includes a preparation
container, a post-injection dry pad and a high-density cotton filter, which is
more effective than makeshift filters.
In 1999, thanks to the support of the health
authorities, Stericup® was included in the Steribox2®. It will be distributed
in pharmacies and harm reduction programmes in France.
Apothicom then designed a 10-µm membrane filter to
limit vein damage caused by injection. This filter more effectively eliminates
high-risk particles from the mix to be injected (cutting products from street
drugs, excipients from medicines). It fits all syringes, notably those with
fixed needles. Selection of materials and membrane, assembly methods: once
again, it was after several stages of research and development that the first
Sterifilt® was created.
After being tested in real conditions between 2001 and
2003, Sterifilt® started being distributed in France in 2004.
Gradually, the manufacturing processes for the new
tools were established, thanks to major investments in the development of ad
hoc industrial machines.
2008: Activity growth and the establishment of Apothicom Distribution
Large-scale studies have shown that viral transmissions
decrease thanks to the mass distribution of suitable paraphernalia and
information campaigns on good practices, proving that PWID protect themselves
when the means are available.
As the supplies designed in France to equip Stéribox2®
did not exist elsewhere, they were of interest to harm reduction programmes
abroad. Following evaluations carried out by health authorities in many
countries, they called on Apothicom's expertise and its new tools. As the
association's activities grew, the company Apothicom Distribution was founded
in 2008.
Apothicom's design and industrial expertise has led the company to respond
to numerous calls for tender in several countries, in Europe and beyond.
This reflects in the steady growth of its export sales.
The company has also extended its product range to
include complementary supplies for needle exchange programmes: needles,
syringes and tourniquets have all been added to the Apothicom catalogue.
Thanks to its investment in production capacity and
the large volumes distributed worldwide, Apothicom Distribution was able to
create new tools at affordable prices.
2008 - 2020: New innovative supplies
Drug use practices
change, and so do their health consequences.
On-site observations led
to constant innovation, enabling us to provide PWID with new supplies. This is
how the Maxicup® was developed, equipped with a larger
preparation cooker suitable for injecting medicines. Stericup® and
Maxicup® were fitted with an attached handle in 2019, providing the
cooker with greater stability.
• the Sterifilt® FAST, disponible depuis 2020, available since 2020, which enables faster filtration, particularly of
medicines,
• the Sterifilt®+, launched in 2021, which eliminates bacteria thanks to its 0.22 µm
membrane.
The sterile, single-use
tools developed by Apothicom are registered medical devices in Europe.
This was followed by
hand hygiene solutions, with the creation of the Apogel hydro-alcoholic gel
range, and then disinfectant wipes with alcoholic chlorhexidine.
Partnerships
were gradually formed with distributors in several countries. Apothicom's products
are now distributed in needle exchange programmes and drug consumption rooms in
over 20 countries.
2024: Steribox+ and Kit+ in French pharmacies
As the contents of the Steribox2® had not changed
since 1999, it was necessary to update it. Indeed practices have changed over
20 years, particularly with the increase in pharmaceutical drugs injecting.
In 2022, the content of state-funded harm reduction
kits was therefore amended by ministerial decree.
In 2024, the French Ministry of Health selected
the new Steribox®+ and Kit®+ prevention kits manufactured by DELPHARM. They
benefit from State funding to be available at lower cost in pharmacies and
associations. Maxicup®, Sterifilt®+
and disinfectant wipes developed by Apothicom are among the items included in
these kits.
Dedicated to research and training, this endowment fund is a non-profit organisation that operates like a foundation. "Savoir + Risquer -" works in the public
interest in the field of harm reduction, or helps other non-profit
organisations to do so. It conducts scientific studies, experiments and action
research, supports research and innovative injection practices, and produces
guides for professionals and PWID. It provides training on safer injecting for
harm reduction professional workers of needle exchange programmes (Caarud). Part
of Apothicom Distribution's income is allocated to this fund.
