Abstract: Le rapport Défi addictions vise à diffuser une conception intégrée de la politique des addictions abordée sous la perspective de la santé publique. Fondé sur des considérations relevant de la politique sanitaire, il préconise d’élargir le domaine d’application de la politique des addictions en Suisse, mais également d’en modifier l’orientation stratégique. Dans ce but, il énonce dix lignes directrices qui doivent contribuer au développement d’une politique cohérente vis-à-vis de la consommation problématique de tous les types de substances psychoactives et des comportements à potentiel addictif.

Abstract: The General report of activities is an annual publication providing a detailed progress report of the EMCDDA’s activities over a 12-month period. It catalogues the Centre’s achievements in each area of its annual work programme. The report is a useful information source for all those seeking comprehensive information on the Centre and its work.

Abstract: Objective To systematically review cohort studies of mortality among people who inject drugs, examine mortality rates and causes of death in this group, and identify participant- and study-level variables associated with a higher risk of death. Methods Tailored search strings were used to search EMBASE, Medline and PsycINFO. The grey literature was identified through online grey literature databases. Experts were consulted to obtain additional studies and data. Random effects meta-analyses were performed to estimate pooled crude mortality rates (CMRs) and standardized mortality ratios (SMRs). Findings Sixty-seven cohorts of people who inject drugs were identified, 14 of them from low- and middle-income countries. The pooled CMR was 2.35 deaths per 100 person–years (95% confidence interval, CI: 2.12–2.58). SMRs were reported for 32 cohorts; the pooled SMR was 14.68 (95% CI: 13.01–16.35). Comparison of CMRs and the calculation of CMR ratios revealed mortality to be higher in low- and middle-income country cohorts, males and people who injected drugs that were positive for human immunodeficiency virus (HIV). It was also higher during off-treatment periods. Drug overdose and acquired immunodeficiency syndrome (AIDS) were the primary causes of death across cohorts. Conclusion Compared with the general population, people who inject drugs have an elevated risk of death, although mortality rates vary across different settings. Any comprehensive approach to improving health outcomes in this group must include efforts to reduce HIV infection as well as other causes of death, particularly drug overdose.