Challenges and support needs among persons with a migration background who use drugs in four metropolitan cities

Background

Persons with a Migration background Who Use Drugs (PMWUD) and live in vulnerable situations (e.g. refugees, undocumented migrants) are very prone to the risks and harms associated with substance use and to poor quality of life. The aim of the study was to better understand the needs and challenges they face as well as the responses to this phenomenon in four selected capital cities: Amsterdam, Athens, Berlin and Paris. These cities are confronted with growing numbers of PMWUD that face various forms of ill health and encounter limited access to essential harm reduction and health care services. 

Methods

Using a Community-Based Participatory Research (CBPR) approach, we administered 98 semi-structured interviews with PMWUD (20-30 interviews per city). CBPR is a participatory research method that involves all partners in the research process equitably and works with the unique strengths that each partner brings. A team of trained academic staff, local researchers (practitioners working in harm reduction services) and community researchers (peers with a migration background) collaborated closely to collect the research data. Study participants were recruited by means of purposeful sampling, using a combination of community gatekeepers, venues-based sampling and snowball sampling. Interviews lasted approximately 30-40 minutes and focused on migration background and status, living situation, substance use, physical and mental health, support needs, use of services and encounters with criminal justice and law enforcement. Interview data were transcribed verbatim from the original interview language, translated to English and analyzed thematically by the academic researchers. 

Results

Across the four cities, PMWUD were living in precarious situations of homelessness, which was mentioned as the main reason for continued substance use, a constant source of distress and a barrier towards legal documents. Basic needs like hygiene and food were mostly fulfilled. PMWUD frequently made use of OAT in all cities, except Athens. While many participants struggled with mental health problems, the extent to which psychological support was available and experienced as helpful varied. Although the majority of participants faced legal barriers toward health care and support services, having an asylum or refugee status/a permanent or temporary residence status significantly decreased these barriers. 

Conclusions

By complicating the opportunities for PMWUD to build up a meaningful life and future, vicious circles of drug dependence, homelessness, unemployment, financial hardship and crime are perpetuated. An integrated and holistic approach is needed that adequately addresses the complex, interrelated and cumulative needs of PMWUD. Experts and practitioners in the four cities unanimously plead for more resources, not only to provide basic needs of housing and emergency health care, but also to increase opportunities for work, mental health support and recovery.