Promising practices to increase drug treatment reach and retention of and accessibility for migrants and ethnic minorities: a review and assessment of practices in Europe

Background: Preliminary research demonstrates that some migrants and ethnic minority (MEM) populations, especially refugees and asylum applicants have limited access to European drug treatment (Blomme et al., 2017). Also, the knowledge about drug treatment services is limited among some MEM (De Kock et al., 2017). Furthermore, MEM populations in Europe are more at risk for depressive symptoms and low socio-economic status (Missine et al. 2012). There is a broad research base about such disparities among MEM compared to non-MEM counterparts and about promising practices to reduce these disparities in Canada, New-Zealand and United States. In Europe however, studies document treatment underrepresentation of some MEM populations but there is little evidence available concerning promising practices to meet the needs of, and overcome such disparities (access, reach, retention) among MEM populations in European drug treatment.

Methods: Resultant of a policy oriented research project funded by the Belgian Science Policy office, the aim of this paper is to identify (1) and asses (2) European promising practices (at the intervention level) aimed at decreasing identified treatment disparities (access, reach, retention) among varying MEM populations in Europe. (1) We identified promising practices by means of four complementary methods: a. purposive literature review of peer-reviewed articles, b. a systematic analysis of all European national focal point reports submitted to EMCDDA between 2014-2017, c) an online survey among all Eurotox national focal points and d) follow-up phone interviews with survey respondents and snowball sampling for additional respondents. Inclusion criteria for promising practices were that interventions be aimed at increasing reach or retention of, or accessibility for (potential) MEM clients. (2) Taking into account the limited implementation of evidence based practices targeting MEM in European drug treatment contexts, the identified interventions are systematically assessed based on the low threshold Grüne Liste quality standards. These quality standards are in line with the European EDPQS standards and include conceptual, implementation and evaluation quality criteria. This means that the identified practices are assessed based on their reference to implementation quality standards (implementation quality), having been evaluated (evaluation quality) and their reference to evidence among the targeted MEM populations (i.e. prevalence, access, reach or retention) as well as evidence concerning intervention effectiveness (conceptual quality).

Results: We systematically discuss (1) the main aims, target populations and blind spots among the identified practices and (2) the implementation, evaluation and conceptual quality and their transferability across nations and varying MEM populations. Furthermore, we focus on the main similarities and differences between the identified interventions across the European member states. Lastly, we look into the prevalence of promising practices aimed at specifically vulnerable MEM populations (intra-European migrants, asylum applicants, refugees, female MEM problem users as well as second, third and fourth generation backgrounds).

Conclusion: We conclude with a reflection on how the identified practices can be enhanced and with highlighting concrete research and intervention needs for better understanding and acting upon MEM disparities in drug treatment in the European context.