A militant initiative and the beginnings of "harm reduction"
In 1982, a group of doctors from the Municipal Health centre of Ivry-sur-Seine (Val-de-Marne, France), which included Elliot Imbert and Marie-Christine Charansonnet, created a free of charge and anonymous consultation intended for people who inject drugs. Soon after, in 1986, free HIV screening tests were proposed and 60% of them were found to be positive.
At that time, ten people who inject drugs per day became contaminated with the AIDS virus, and even more contracted that of hepatitis C.
It was urgent to stop the sharing of syringes and to make them available to people who inject drugs. A significant obstacle was removed by the "Barzach decree" of 13 May 1987, which legalised the sale of syringes in pharmacies. Before this, they could only be supplied to persons over 18 having a medical prescription.
Despite this, harmful practices continued.
The work to be done was tremendous: discovering these clandestine practices, understanding them, locating them in often precarious environments. A large number of associations cooperated to work on this issue.
Elliot Imbert and Marie-Christine Charansonnet in 1996
1992
The creation of Apothicom
Elliot Imbert and Marie-Christine Charansonnet at the Ivry-sur-Seine Health centre
Around the Ivry-sur-Seine Health centre, doctors teamed up with drug users and founded the Association for the prevention, pharmacovigilance and communication (Apothicom) in 1992.
Alongside HIV community-hospital networks and the militant associations AIDES and ASUD, its founders observed that the equipment commonly used was what could be called household objects. These are diverted from their initial purpose: spoons or drink cans to prepare the mixture, the wrong type of syringes, cigarette filters or wads of cottonwool, lemon or vinegar for dissolving the substances and tap water, even non-potable water. Moreover, these objects are widely shared. Techniques are transmitted empirically between peers and in the clandestinity related to drug use. All these are practices which contribute to infectious contaminations.
At this time the Apothicom team rapidly becomes convinced that no action against the hazardous behaviour will be effective without proposing new and safe single-use sterile tools. As these do not exist in France, they must be invented and manufactured. Their design must be specifically for drug injection, and accessible to as many people as possible.
A taboo for the pharmaceutical industry. No company wants to embark upon the manufacture and marketing of articles intended for illicit practices.
The period 1990-2000
The invention of tools for injection
With the support of a few partners, Doctor Elliot Imbert develops the first Steribox® injection kit, containing syringes, ampoules of sterile water, alcohol swabs and condoms. This kit is made available throughout France in 1994 and financed by the State in 1996, which is still the case today.
The next step is to design and manufacture specific tools for the key stages of preparing the mixture to be injected and its filtration.
By analysing the practices, the team understands that the preparation container volume must be small to limit the preparation to a single injection and composed of an inert material which can be heated.
Collaboration with industrials results in the launch of the Stericup in 1997. It is a sterile preparation container accompanied by a high-density cotton filter, more effective than makeshift filters.
In 1999, thanks to the support of the health authorities, the Stericup is included in the Steribox kit.
Automation of Sterifilt production
Apothicom then undertakes to design a 10 µm membrane filter in order to limit venous damage linked to the injection. This filter eliminates dangerous particles more effectively: cutting agents from street drugs, medication excipients. It adapts to all syringes, including crimped needle syringes.
After several R&D stages the first Sterifilt was created; it has been distributed since 2004.
The manufacturing processes for the new tools are gradually established, thanks to large investments in the development of production machinery.
2008
Growth of the activity and creation of Apothicom Distribution
Conditioning of equipment before sterilisation
Large-scale studies show that viral transmissions are decreasing thanks to the massive distribution of suitable equipment, a proof that users protect themselves when given the means.
Harm reduction programmes in other countries express interest in the equipment designed in France by Apothicom. Many foreign health authorities perform assessments and call on Apothicom's know-how. In view of the growth of the association's activities, the company Apothicom Distribution was created in 2008.
Apothicom's expertise facilitates its collaboration with many different types of structures: syringe exchange programs and other associative structures, governmental and non-governmental organisations, medical equipment distributors, in Europe and internationally.
It has then enlarges its range of products to offer equipment to complement syringe exchange programs: needles, syringes or tourniquets enrich its catalogue.
The period 2010-2020
New innovative tools
Field work opens the way to constant innovations which make it possible to provide new tools to users.
For example, the injection of medicines, a practice that has been on the rise for around fifteen years, has indicated the need to develop larger volume containers to facilitate preparation.
This is how the Maxicup was developed, a preparation container with a volume twice that of the Stericup. A handle was attached to Stericup and Maxicup in 2019, producing a more stable container.
The injection of medicines also requires the use of more resistant filters, which resist clogging. Apothicom Distribution therefore started the development of two new membrane filters:
• Sterifilt FAST, in 2020, for a faster filtration, in particular of medicines,
• Sterifilt+, in 2021, which eliminates bacteria due to its 0.22 µm membrane.
The single-use, sterile containers and filters are medical devices in Europe.
Today, Apothicom's tools are distributed in syringe exchange programmes and drug consumption rooms in over 20 countries.
Apothicom presents Sterifilt+ during a conference on harm reduction, in 2022
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.
