Referral of European and third country non-national clients in Belgian drug treatment

Background and aim: Significant disparities in the access of health care and drug treatment for migrants and ethnic minorities (MEM) compared to non-MEM counterparts, have been documented comprehensively across the continents (Algria et al. 2008; Budja et al. 2014), but to a much lesser extent in Europe.

Based on a published preliminary treatment demand indicator (TDI) analysis – that documented the underrepresentation of specified MEM group – presented at Lisbon Addiction 2017 (Blomme et al., 2017), we therefore conducted an analysis on secondary TDI data to explore the access to and referral of non-national clients into Belgian drug treatment.

Methodology: This study is based on secondary data of new entry treatment episodes within Belgian drug treatment facilities between 2012 and 2014, collected and processed for TDI-registration by the Belgian Reitox National Focal Point. As we only obtained access to the aggregated datasets, data analysis was largely descriptive in nature. We additionally calculated odds ratio’s (OR) and 95% confidence intervals to examine bivariate associations between referral sources (self-referral, general practitioner, other treatment centre, hospital, other medical and psycho-social services, court) and clients’ nationality. P-values <0,05 were considered statistically relevant.

Results: Between 2012 and 2014, a total number of 54.148 treatment episodes and 32.715 identifiable clients were registered within Belgian drug treatment facilities. Only 7,8% of these treatment episodes comprised of non-national clients, of which 3,1% had an EU-nationality and 4,1% a third country nationality. When examining the data more in detail, we found that that differential presence across the treatment spectrum (from low threshold outpatient to high threshold residential services) persists at the regional levels (Flanders, Wallonia, Brussels), although it is most pronounced in Flanders. Furthermore, non-Belgian clients were consistently more often located in low threshold ambulant services compared to European non-national clients in Flanders and Wallonia, whereas this difference does not hold for the Brussels region.

When looking at the referral sources, self-referral and referral by other drug treatment centres seem to be more common among non-nationals, compared to Belgian clients. More notably however is that, according to the TDI data, the odds of referral from medical-oriented referral sources are significantly higher for Belgians than for non-nationals (OR 1,62, 95% CI 1,25-2,11; OR 1,65, 95% CI 1,35-2,03). Same counts for referral from the Criminal Justice System, although associations are not as strong.

Conclusion: These results confirm differences in service access between non-nationals and Belgians in treatment facilities. However, these results should be dealt with cautiously because registration and methodological issues hampered in-depth analysis. The main limitations concern the analysis of treatment episodes (instead of identifiable clients), limitations with data analysis as we only obtained access to aggregated data and the adequacy of some of the TDI categories (e.g.nationality).