Insights into migration paths, drug use, and harm reduction among Nepalese People Who Use Drugs in Lisbon, Portugal

Background 
This study aims to address the experiences of Nepalese People Who Use Drugs (PWUD) at the intersection of migration, drug use, and access to health and social services, including harm reduction. With an increase in migration from South Asia to Lisbon, it has become crucial to develop strategies to engage this community. 
 
Methods 
Employing an exploratory case study design, the research conducted semi-structured interviews with Nepalese PWUD attending a harm reduction centre in Lisbon. These interviews, carried out between August and September 2022, sought to understand their socio-demographic profiles, migration processes, access to services, and drug use. Subsequently, a focus group session in March 2023 addressed the challenges encountered in the migration pathway, upon arrival in Lisbon, and explored differences in drug use experiences between Nepal and Portugal. 
 
Results 
Our results indicated that participants encountered challenges in integration and experienced poor living conditions. They struggled to access housing, jobs, and health and social services. In terms of drug use, there were clear differences between Nepal and Portugal in drug availability, services, and level of repression. In Nepal, drug use was perceived as riskier due to high drug potency and a lack of assistance in case of overdose. Nepal has strict laws, leading to long-term imprisonment for drug possession. On the other hand, participants highlighted the positive impact of harm reduction in the Portuguese context, exemplified by the provision of drug consumption rooms, which contrasted with their previous experiences.  
 
Conclusions 
The study highlights that, despite Nepalese PWUD having knowledge of formal processes and available services in Portugal, they encountered barriers and discrimination hindering their integration. In this context, harm reduction not only addressed drug use but also served as a gateway to accessing essential services, empowering the Nepalese PWUD community. The research process itself facilitated a closer connection between staff and service users, resulting in the introduction of new on-site services.