Refugees & drug use in Belgium: A national study on drug-related intervention needs in the reception setting (DrugInt)

Background: An EMCDDA & EUAA (2023) report signals that substance use (SU) related incidents are a growing concern in the EU reception setting. The study reports an observed rise in non-medical use of medications (e.g. opioids, pregabalin, benzodiazepines). It also points out that EU reception professionals need more drug-related knowledge and skills. Although population-level knowledge on prevalence of refugee SU is absent in Belgium, studies do point out that persons without the Belgian nationality are underrepresented in residential SU treatment (SUT). Moreover, language is an exclusion criteria in the majority of Belgian SUT services.

Methods: The Belgian Federal Agency for the Reception of Asylum Applicants funded the DrugInt 1.0 research project (2023) to gain insight in the current situation of SU (and interventions) in the Belgian reception setting. It included 4 research questions:

1.      What is the nature of observed SU among applicants for international protection? 

2.      Which SU related interventions exist in Fedasil reception centres?

3.      To what type of SUT are applicants referred and how is referral and treatment experienced?

4.      What professional training and intervention needs do respondents identify?

An online survey (adapted EU survey) was distributed and completed by 273 respondents, including a representative sample of Fedasil professionals. 49 qualitative interviews were conducted to gain in-depth insight in survey responses.

Results: As in other EU countries, the 3 substances most commonly observed to be used by applicants are tobacco, alcohol and cannabis. The rise of non-medical use of psychotropic medication is equally observed in Belgium. Concerning SU related problems, respondents mainly identify alcohol-related incidents in the centres. At the intervention level, safety-related interventions appear to be prioritised over psycho-social and guidance-oriented interventions. Moreover, the latter are not always evidence-based. In the rare cases that applicants are admitted to residential SUT, it concerns very short admissions to psychiatric wards of general hospitals. Finally, respondents specify that training on types of substances and related interventions and skills in dealing with SU related incidents, are key.

Conclusions: This study formulates 10 recommendations at the level of Fedasil headquarters, reception centres, SUT and at policy level. An infographic and information clip on prevention, early intervention, treatment and harm reduction were developed for staff. The project group will develop a Basic Drug Training for Fedasil staff (DrugInt 2.0) with a specific focus on the identified training needs as well as evidence-based early intervention and prevention.