Drug use amongst Black and minority ethnic communities1 in the European Union2 and Norway
Jane Fountain, University of Central Lancashire Jon Bashford, University of Central Lancashire, Susan Underwood, University of Central Lancashire Jagjit Khurana, University of Central Lancashire Moira Winters, University of Central Lancashire, Chloé Carpentier, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Kamlesh Patel, University of Central Lancashire
Abstract In several European 'Union countries, drug use amongst Black and minority ethnic communities is largely unacknowledged, ignored, unrecognized, or hidden by some policy-makers, drug researchers, drug service planners and commissioners, and by some members of some Black and minority ethnic communities themselves. This article presents evidence to support this statement and suggests ways forward to ensure th the knowledge base on drug use amongst these communities is increased, and g services are accessible to all who need them. Examples of good practice in eng ing members of Black and minority ethnic communities in research and with drug services are provided.
Keywords Black, drug services, drug use, European Union, hidden populations, minority ethnic communities
The aim of a study funded by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) was to examine drug use amongst Black and minority ethnic communities in the European Union (EU) and Norway, in order to give an overview of the situation and its consequences and correlates; to identify key points relevant to policy-makers; and to suggest further work to fill information grips (Fountain et al., 2002). This article summarizes the results of the study.
The methods used for this project are discussed in detail in Patel et al. (in press) and summarized here. Much of the knowledge base on drug use amongst Black and minority ethnic communities across the EU is undocumented. To overcome this significant barrier to collating the available data and to begin to acquire a picture of the situation across 16 countries, key messages were extracted from EMCDDA's previous attempt to explore this issue (Khan et al., 2000) and used to devise a questionnaire for each country. Respondents were asked how accurate they thought a series of statements were, and to add any other information they had from, for example, academic journal papers, research reports, the media, websites, and personal experience. Details of pertinent documents and contact details of other potential informants were also requested. To maximize the response rate, each questionnaire was translated into the main language(s) of the country it concerned.
Informants to the study were not restricted to drug researchers and drug service providers. The REITOX National Focal Points3 in each EU country were asked to complete the questionnaire (the role of a National Focal Point involves coordinating its national information centres to meet EMCDDA's requirements for a set of core data, annual national reports on the drug situation in each Member State, and a national information network). In addition, a diverse range of others involved in aspects of the health and welfare of Black and minority ethnic communities were contacted, including Black and minority ethnic community organizations, teachers, general health and social services, the police, regional and local government services, and youth services: as discussed by Patel et al. (in press), previous work on this issue by the Centre for Ethnicity and Health has shown that, because so little is known about drug use amongst Black and minority ethnic populations, initial investigations should not rely only on those working in the drugs field in some capacity (as service providers or as researchers, for example).
By the end of the study, questionnaires had been sent to 1 122 potential informants. The overall response rate was at least 28.7 per cent (322) or 1 in 3.5 (in some cases, questionnaires were sent to several members of the same organization, but there was just one response on behalf of the organization). The response rate between countries varied considerably, from 12.5 per cent in the Netherlands to 71.1 per cent in Finland. Three-quarters of respondents (239) completed the questionnaire and/or provided information in another form, and a total of 302 further contact details of organizations or individuals were received. Thirty-nine per cent (125) of responses came from those not directly working on drug-related issues, but who came into contact with Black and minority ethnic communities in another capacity. The valuable data from these respondents revealed the success of the strategy of seeking information from a range of disciplines such as social/health/community/youth services, the media, the prison service, government departments, and Black and minority ethnic community organizations.
The data were collated as profiles for each of the 16 participating countries. A thematic analysis was then performed according to the themes that most consistently arose and that are pertinent to the drug use and related issues of Black and minority ethnic communities at local, national, and EU-wide levels. These themes — which comprise the structure of this article — are therefore firmly grounded in the data received from informants during this study, and consisted of acknowledgement of drug use amongst Black and minority ethnic communities, ethnic monitoring, prevalence of drug use, risk factors for problematic drug use, drug-using patterns, drug distribution, myths, scapegoats and stereotypes, barriers to drug service access, and the research and policy-making agendas.
The thematic analysis revealed that there is much variation between countries, not only in policy and practice surrounding the drug use of, and responses to, Black and minority ethnic communities, but also in the knowledge base. Because of these variations, no attempt was made to collate and compare the data to provide a picture of the drug use of a specific Black and minority ethnic group across the whole of the EU, nor to compare drug use between specific Black and minority ethnic groups and with the rest of the population. Such an exercise at this early stage of building a knowledge base would generate an extremely distorted picture of the situation.
Acknowledgement of drug use amongst Black and minority ethnic communities
It is clear from some of the responses received by this study that, in several EU countries, drug use amongst Black and minority ethnic communities is largely unacknowledged, ignored, unrecognized, or hidden by some policy-makers, drug researchers, drug service planners and commissioners, and by some members of some Black and minority ethnic communities themselves. The study revealed many examples to illustrate this. For instance, policy-makers in Germany, the Netherlands, Spain, and Sweden appear reluctant to address drug use amongst Black and minority ethnic communities. With a few exceptions, such as research amongst Gypsies in Spain and South Asians in the UK, the study was characterized by a lack of detailed investigation into drug use amongst Black and minority ethnic communities and the surrounding issues.
A variety of reasons were given by informants for this neglect, including the avoidance of further stigmatization of these communities, and fears of accusations of racism by exposing drug use amongst them. This finding is underlined by some of those involved in the drugs field in Austria and Belgium being reluctant (and, in a few cases, refusing) to participate in this study because of fears of increasing racism, nationalism, and stigmatization of Black and minority ethnic communities. Other major reasons given for the lack of research were the lack of access to the communities in question, and language barriers.
Some Black and minority ethnic communities hide drug use within themselves to avoid the stigma associated with drug use by their community and a fear of being further marginalized. Some Black and minority ethnic families and/or communities reject drug users amongst themselves completely. This was reported to occur in the Turkish community in Austria, Finland, and the Netherlands; the Gypsy/Roma community in Finland and Spain; and amongst some Black and minority ethnic communities in the UK, especially South Asians. In the UK, another method of hiding drug use within the South Asian communities is for the drug user's family to either attempt an enforced 'home detoxification' or to send the drug user 'home' to Bangladesh, India, or Pakistan in the hope that they will 'recover'. However, due to the availability and cheapness of drugs in these countries, some return with a greater dependence.
Although there is some form of ethnic monitoring of drug service clients and drug survey participants in the majority of EU countries, there is no consistent data collection and analysis of ethnicity. Ethnic monitoring is an extremely sensitive issue, especially when drug use is being monitored, and there was a great deal of variation in the approach to this from the countries participating in this study. Khan et al. (2000) discuss the situation across the EU in some detail, particularly in relation to the differences in how categories are devised, how ethnic monitoring is implemented, and how the results are subsequently used. Although the study's questionnaire did not specifically ask about this topic, it was raised by some informants from every country, particularly in terms of the lack of relevant research results according to ethnicity. Results showed that:
- In Austria and Portugal, ethnic monitoring is not conducted except, it appears, by the criminal justice system.
- In Austria, crime statistics do not show ethnicity, but nationality, and some Black and minority ethnic populations, such as Roma/Sinti therefore appear as 'Austrians' or another nationality.
- Nationality is also used to categorize populations in Belgium, Ireland (although Travellers are recorded as such), and Sweden.
- In Greece, the only officially recognized Black and minority ethnic group is the 'Muslim minority' comprising largely of Turkish people, but also Pomaki and Gypsies.
- Under French legislation, ethnic monitoring cannot be conducted in France.
- Ethnic monitoring does not appear to be conducted in Germany.
- Some ethnic monitoring of drug service users is conducted in Denmark, Finland, Italy, Luxembourg, the Netherlands and Norway, and is widespread in the UK.
- Ethnic monitoring of drug service clients, hospital admissions relating to drug use, and drug overdose deaths was due to begin in Spain in 2003.
Prevalence of drug use amongst Black and minority ethnic communities
Successive annual reports from EMCDDA on the state of the drugs problem in the European Union show that, although prevalence data are relatively robust for cannabis, the use of which is relatively common and not highly stigmatized, 'prevalence data are less reliable for more hidden patterns of use, such as heroin injection' (EMCDDA, 2000: 11). As discussed above, drug use amongst some Black and minority ethnic communities is especially 'hidden' because of the lack of acknowledgement of this phenomenon and research into it. It follows that the prevalence of drug use amongst these communities is even more difficult to assess. It was clear from EMCDDA's previous work on this issue (Khan et al., 2000) that it is not possible to obtain prevalence rates of the drug use amongst Black and minority ethnic communities across the EU, and the project discussed here confirmed this.
Throughout the EU, Black and minority ethnic drug users are under-represented in drug treatment statistics and over-represented in drug law offence statistics, yet in some countries, these data comprise the bulk of the recorded knowledge base on drug use amongst Black and minority ethnic communities. Much of the information on the drug use of these populations received from Denmark, Ireland, Italy, Luxembourg and Sweden consisted of data from drug treatment statistics. From Austria, Denmark and Spain, drug law offence statistics were a major source of informants' knowledge. Such data alone can give an extremely distorted picture of the prevalence of drug use and of drug-using patterns, as obviously they do not take into account those drug users who do not use drug services or come to the attention of the criminal justice system.
Examples of how drug service and crime statistics exaggerate or understate the involvement of Black and minority ethnic communities in drug use (and/or distribution) include data on Black Africans in Austria, who are highly visible because of their skin colour, and are associated with drugs by both the police and the general public, a perception fuelled by adverse media reports (Eisenbach-Stangl, 2002). The consequence is that this group is over-represented in reports of drug crimes to the police and in statistics on recorded drug offences.
Risk factors for problematic drug use
The focus of EMCDDA's previous work on Black and minority ethnic communities (Khan et al., 2000) was social exclusion — a term used as shorthand for the consequences when people or areas suffer from a combination of linked problems such as unemployment, poor skills, low incomes, poor housing, high crime environments, bad health and family breakdown. Khan et al. (2000) explored the relationship between Black and minority ethnic communities, social exclusion, and drug use in depth, concluding that:
Although the use and abuse of drugs is not restricted to any one sector of society, its high prevalence and associated social problems are particularly marked in areas and localities marked by social exclusion. Minority [ethnic] drug users could therefore be said to be facing a position of double jeopardy: they carry the stigmata of racial exclusion and of drug use. (Khan et al., 2000: 9)
Black and minority ethnic communities are vulnerable to problematic drug use in the same way as socially excluded, white indigenous populations, and this applies particularly to the younger generations of some communities. It was pointed out by informants from most of the countries that participated in the study that drug use was more prevalent amongst the younger generations of Black and minority ethnic communities than amongst the older generations, and many informants linked this with social exclusion. This phenomenon was noted amongst:
- Turkish people and Central and Eastern Europeans in Austria
- Moroccans, Greeks, Italians, Portuguese, Spaniards and Turkish people in Belgium
- People from the former Yugoslavia and Turkey in Denmark
- Ingrians in Finland
- Tzigane/Gypsies/Roma in France
- Turkish people in Germany
- Travellers in Ireland
- Moroccans and Antillians in the Netherlands
- Black and minority ethnic communities who frequent the drug-using street scene in the Centre of Oslo, Norway
- Black Africans in Portugal, especially those from Cape Verde
- Gypsies and some Africans in Spain
- Pakistanis, Bangladeshis, and Black Caribbeans in the UK
There are several factors exclusive to Black and minority ethnic communities that may make them vulnerable to problematic drug use. Some migrants have suffered trauma because of wars in their home countries. This was noted amongst drug users from Central and Eastern Europe now living in Austria and Denmark; in Denmark amongst Pakistanis and people from the Middle East; and in the Netherlands amongst some (unspecified) Black and minority ethnic communities.
The immigration experience may not have lived up to expectations, which was noted as a risk factor for problematic drug use amongst people from the former Yugoslavia in Denmark, and North Africans in Spain.
Some members of some Black and minority ethnic communities were using drugs before they emigrated to an EU country and continued to do so once they arrived, although the substances used may change as the drug-using patterns of the indigenous population are adopted. Examples include Russians in Germany who used heroin in Russia and continued to do so after they left; Iranians who used opium in Iran but have changed to injecting heroin in Germany; Maghrebians (Black Africans from Algeria, Morocco and Tunisia), who used cannabis only in North Africa, but changed to heroin in Italy; and North Africans in Spain, some of whom smoked cannabis in their home countries, but who began to smoke heroin and snort cocaine in Spain. There were reports from the UK that although some asylum seekers arrived in the UK with an established drug problem, drug use amongst others did not start until after arrival.
The link between drug use and social exclusion is well-established (Lloyd and Griffiths, 1998; HAS, 2001) and the evidence collected by the study does not indicate that the drug-using patterns of Black and minority ethnic communities are substantially different from those of socially excluded, white, indigenous populations. However, there are some cultural variations in the types of substances used, and include, particularly, the use of qat (or khat), that appears to be restricted to members of the Somali community in Denmark, Finland, Italy, Norway and Sweden.Qat use has also been reported amongst Somalis in the UK, and also amongst people from the Middle East and Ethiopia. In the Netherlands, too, qat is used not only in the Somali community, but also amongst other Black Africans and people from the Middle East. Other reports of culturally-specific drug use are pharmaceutical morphine and homemade opium preparations such as 'kompot' amongst older Russians newly-arrived in Spain, and opium amongst Iranians in Germany and communities from the Middle East in the Netherlands.
Ethnic monitoring of drug service clients and research participants would provide one indicator of patterns of problematic drug use amongst Black and minority ethnic populations, but, as noted above, is not conducted in all EU countries, and, where it is, requires many improvements for results to provide a reliable indicator. A further illustration of the need for improvement comes from an informant of this study who is involved in the European Addiction Severity Index (EuropASI) project, which measures the dependency of clients in drug treatment from participating European countries. This project could, theoretically, provide valuable data about Black and minority ethnic drug users in treatment in the EU. However, the informant reported that, although EuropASI screening includes detailed questions regarding land of birth, parents' land of birth, etc., these questions are not asked as often of Black and minority ethnic communities as they are of the rest of the population because of 'language problems'. The informant concluded that there are, therefore, too few relevant EuropASI data to detect drug-using patterns for Black and minority ethnic communities in general, or for specific groups amongst them.
The lack of research into the drug use of Black and minority ethnic communities in the EU is reflected in the lack of consensus about their drug-using patterns compared with the rest of the population. The results from the study suggest that, in some countries, the 'whiter' or more assimilated into the host country the Black and minority ethnic community is, the more likely it is thought that their drug use is the same as that of the white indigenous population. This was noted about, for example, northern European Union nationals in Belgium, and in Sweden, about the 'fully-integrated' South Americans and also the South Asians who were adopted by Swedish families in the 1970s and 1980s. It was also suggested that drug use would increase amongst younger members of Black and minority ethnic communities in Ireland as they became more assimilated, as has occurred amongst some Black and minority ethnic communities in the UK, and that 'giving up their Turkish traditions' has led to drug use amongst young Turkish people in Austria. Contrary to this, however, was the suggestion from the Netherlands that lack of integration into Dutch society was a risk factor for drug use by, for example, young Moroccan and Antillian males.
This study did not aim to address drug distribution by members of Black and minority ethnic communities in any detail. However, an aspect of social exclusion raised by informants was economic survival via involvement in the distribution of drugs. This was noted amongst, for example, Black Africans in Austria, Antillians in the Netherlands, Cape Verdeans in Portugal, and Pakistanis and Bangladeshis in the UK. Those employing this method of income generation are vulnerable to drug use, and their conspicuous wealth in impoverished communities makes selling drugs an attractive proposition to others. Another example of the link between poverty and drug distribution is that some Black Africans living in poverty in Africa were reported to have been recruited in their home countries to sell drugs in Austria and to smuggle drugs into Ireland.
Whilst some informants suggested that involvement in drug distribution by members of some Black and minority ethnic communities precedes problematic drug use, others maintained that drug use amongst these sellers was low.
Myths, scapegoats and stereotypes
In a discussion of research to examine the nature of drug use amongst Black and minority ethnic communities in the UK, Patel lists a series of statements collected from a range of South Asian communities, including from religious leaders and workers in statutory and non-governmental organizations in the drugs field. These include: 'Asian people don't use drugs,' 'Religion prohibits drug taking — therefore it is not a problem,' 'It [drug use] is a white western disease,' and 'Our strong religious and cultural values stop us from this behaviour.' Patel comments that
These statements clearly highlight the dilemma facing agencies, researchers and drug workers in the UK, operating as a series of myths that have acted as barriers to the development and delivery of drug services for Asian minority ethnic groups. (Patel, 2000: 127)
The results of this study reveal that myths, scapegoats and stereotypes are not exclusive to the UK. For example, the knowledge base on the involvement of members of Black and minority ethnic communities in drug distribution is largely influenced by, and dependent upon, statistics from the criminal justice system, which, as noted above, can reflect a bias against Black and minority ethnic communities; media reports (which are often extremely biased); and impressions gained from the visibility of drug users and sellers on the street because of their skin colour, noted in Austria and Italy in relation to Black Africans. However, Eisenbach-Stangl (2002) usefully unpacks the criminal statistics in Austria to show that there is little support for the 'Black skin, black market' stereotype of Black Africans as heroin dealers.
Other examples of what may be stereotypical assumptions that are based on crime statistics include that Albanians in Greece are responsible for the increase in the rise of heroin and cannabis use, especially amongst adolescents, because they sell these drugs cheaply; and that Antillians in the Netherlands are heavily involved in transporting drugs as 'mules' or 'bodypackers'.
Some Black and minority ethnic communities in the EU are described as 'close- knit' and it is said that it is therefore 'difficult' for drug services to work with them because they 'do not allow interference from outside'. This was applied to the Turkish population in Belgium and to Moluccans in the Netherlands, for instance. However, as noted in relation to the Turkish community in Belgium, these perceptions can be equally interpreted as non-Turkish-speaking drug workers being unable to communicate with the Turkish community and drug services' lack of culturally-appropriate responses.
It is also believed that 'strong social bonds' protect Black and minority ethnic communities from drug use. This was reported in relation to Black and minority ethnic communities in general in Austria, and to Turkish people in Germany.
Another common belief is that religion protects some Black and minority ethnic communities from drug use. This was suggested in relation to Iraqis in Finland, and is illustrated by the quotations collected by Patel (2000), above, in reference to South Asians in the UK.
The lack of research into the drug use of Black and minority ethnic communities throughout the EU means that, currently, many myths, scapegoats and stereotypes can neither be confirmed nor demolished. Even where research that has demolished a myth (such as female Gypsies in Spain and South Asians in the UK do not use drugs), it persists, and was reported as 'fact' to the study.
Barriers to drug service access
Barriers to health and other services are a significant element of social exclusion, and were explicitly or implicitly discussed by informants from almost every country in relation to the under-representation of Black and minority ethnic communities as drug service clients. This contributes to the so-called 'hidden' nature of drug use amongst some of these communities.
Members of Black and minority ethnic communities face many barriers to drug treatment, education, and prevention services. Major barriers are a lack of cultural sensitivity by the service, a distrust of confidentiality, communication problems because of language, a lack of awareness of drugs and drug services, the stigma surrounding drug use within their community, and the failure of drug services to target Black and minority ethnic drug users. These issues are thoroughly discussed in studies from the UK (Fountain et al., 2003, in press; Sangster et al., 2002) and the Netherlands (Broers and Eland, 2000; Van Wamel and Eland, 2001).
A solution to break down the barriers listed above is to target services at specific communities. In France, however, this is constitutionally forbidden, because the country's approach to race discrimination 'can be characterised as enshrining a principle of equality, non-recognition of 'minorities', and, most of the time, prioritising rights and freedoms above nationality' (Khan et al., 2000: 51). Portugal has a similar approach, whilst in some other EU countries (such as Germany, Spain and Sweden) the issue of cultural diversity appears not to be addressed in relation to the provision of drug services. Nevertheless, there are examples of both large and small initiatives in the EU that are attempting to engage with Black and minority ethnic communities, including in those countries where targeted drug services are officially either not allowed or not encouraged. To illustrate the wide range of initiatives and the issues they are tackling, six examples are given below. Others can be found in Khan et al., 2000; AC Company, 1999 and 2001; and on the Exchange on Drug Demand Reduction Action (EDDRA) database. It is noticeable that an essential element of many of the examples of successful targeted drug services reported to the study is the involvement of the relevant Black and minority ethnic community in the planning and delivery of the service in question:
• The Arazzi Prevention Project was initiated as a response to the concern over drug use and criminality amongst adolescent Moroccan boys in the Netherlands, and because it is commonly assumed that their parents lack knowledge about drugs and drug services. Although a decrease of drug- related problems amongst these boys is a long-term target, the first step was the development and implementation of a series of education courses initiated in co-operation with Moroccan community organizations. The courses aimed to enhance discussions about drugs and crime amongst Moroccan families in specific Amsterdam neighbourhoods, and to inform parents about drug services. An evaluation of the project revealed that its importance was stressed by almost all the parents, especially because it was initiated by Moroccan community organizations and targeted parents. More than 80 per cent of those who attended the courses thought that there should be more discussion about drugs and crime in their community, whereas only 47 per cent of non-participants agreed with this. Participants strongly expressed that the courses should continue, but that organizing these in co-operation with Moroccan community organizations had to be a prerequisite.
• In France, the legislation against Black and minority ethnic targeted services has been overcome by Espoir Goutte d'Or (EGO). This drug service is based in the Goutte d'Or district of Paris, a well-known drug-using and dealing area and also home to a large population of Maghrebians, other Black Africans, and Black Caribbeans. Thus, the majority ofEGO's clients are from these communities. The project operates by involving all members of the community in all its activities, and is a focal point and mutual aid network around drug use and HIV/AIDS. EGO offers a range of social and health services — including a needle exchange — and training in community work, AIDS and hepatitis prevention, and the reduction of drug-related harm.
• There is evidence that few Gypsies in Spain attend abstinence-based treatment programmes, preferring treatment with methadone. It was reported to the study that some drug services in Spain are lessening the regulations on treatment with methadone in an effort to attract more Gypsy clients.
• In Rotterdam, 12-15 per cent of 'street junkies' are of North African origin, and most of them are illegal immigrants. This group was considered to be at very high risk of sexually-transmitted diseases, as they are characterized by injecting heroin and prostitution; regarded as very hard for drug services to reach; and drug use and sexual activity is not discussed amongst members of their families and community. Preventive activities amongst this population are sparse, but an experimental peer support project was conducted amongst them. An evaluation shows that, of 35 potential peer supporters (all male), eight were chosen to be trained and, between them, contacted 595 male drug users, three-quarters of whom had never had contact with drug services in Rotterdam. The peer support offered included information about drugs and drug services, and the distribution of sterile injecting equipment.
• In the UK, the Department of Health (DH) funded the Centre for Ethnicity and Health at the University of Central Lancashire €1.8 million to conduct research into the drug use needs of England's Black and minority ethnic communities. This project developed and employed the Centre's community engagement model (Winters and Patel, 2003), in which community organizations researched their own communities with training and support from the Centre for Ethnicity and Health. Although the research reports (Bashford et al., 2003) were an important outcome of this project, of equal importance was the process of building the skills and capacities of the individuals and community organizations involved, and including drug service commissioners and providers in the process (Winters and Patel, 2003: 5):
The project aimed to increase community capacity to raise awareness about drug use issues within the participants' own communities, to assess the needs of the communities, and to articulate that need to those responsible for planning services. Crucially, in doing so, the project also engaged service commissioners and providers with the community members that they serve, in some instances introducing them to communities whose existence they were unaware of, increasing their capacity to address diversity, particularly ethnic diversity, within their services.
This project trained and supported 350 individuals from a range of Black and minority ethnic communities, and they collected data from over 12,000 people from 30 different ethnic and national groups, including over 2000 drug users. Since completion, around one in five of the 350 individuals trained to undertake the needs assessments have gained employment in related fields, none of whom had previous experience in those fields. In recognition of the scale and impact of the Community Engagement process, the DH have provided a further €5.3 million to the Centre for Ethnicity and Health to undertake this process with an additional 120 community organizations over a three-year period.
The way forward: research and policy-making agendas
This section discusses the considerations that should inform research and policy- making agendas at local, national, and EU-wide levels in respect of the drug use of Black and minority ethnic communities and the related service provision.
Denial that drug use is taking place amongst Black and minority ethnic communities must be confronted, including denial by policy-makers and amongst these communities themselves. For example, in a discussion of research of drug use amongst South Asian communities in the UK, Patel (2000: 30) stresses that:
Researchers should be aware that they will encounter official bodies and professionals who will simply deny that Asian young people are as much at risk
[of drug use] as the 'white' population; researchers must be prepared to challenge those who dogmatically repeat these assumptions.
Drug use amongst Black and minority ethnic communities must be acknowledged in order that appropriate responses can be developed. Many of these communities are already stigmatized as drug users or dealers, yet refusing to accept that this behaviour may occur amongst them does nothing to decrease the stigmatization, and obstructs consideration of their drug service needs by policy-makers and by service commissioners and providers.
Increasing the knowledge base
Research in specific localities amongst specific Black and minority ethnic communities can and does provide the valuable data that are necessary to inform the development of local drug services, and should be encouraged and expanded. To begin to obtain a comprehensive picture across the EU requires comparable data, however. This would clearly be a difficult undertaking given that Black and minority ethnic communities are not an homogeneous group: there is a large variety of these communities in the EU, and cultural variations between and amongst them. In addition, some risk factors for drug use are specific to some Black and minority ethnic communities. Themes that should be prioritized for future investigations should incorporate both quantitative and qualitative research methods. They are:
• The reasons for the under-representation of Black and minority ethnic communities as drug service clients;
• Whether or not commonly-held beliefs about Black and minority ethnic communities — such as strong social/family bonds and religion are factors that protect against drug use — are accurate and, if so, how these protective factors operate; and
• Whether factors affecting drug-using patterns amongst specific Black and minority ethnic communities, such as selling drugs, access to substances not available in the home country, and trauma suffered before and during migration, are risk factors for problematic drug use.
The research agenda should not neglect those Black and minority ethnic communities newly-arrived in the EU, nor those communities that are dispersed throughout a particular country (a characteristic that, in the UK, has been found to apply particularly to the Chinese population). Those Black and minority ethnic communities that are not officially regarded as such in the countries where they live (such as all communities except the 'Muslim minority' in Greece) should be included in the research agenda.
For progress to be made in the development of drug services, there is a need for the implementation (or improvement) of ethnic monitoring in each of the 16 countries covered by the study reported here. However, it must be stressed that simply collecting these data is pointless unless results are analysed and acted upon.
Consistent, co-ordinated ethnic monitoring by drug researchers and drug service providers, based on a common set of classifications, is a reliable instrument to measure drug service use and, importantly, non-use, by drug users. Analysis of results provide a baseline for improvements to the quality of service provision — including equal access for all drug users and more equitable allocation of resources — and can be used to track changes in drug-using patterns and in the uptake of drug services.
From the UK, where ethnic monitoring is conducted more comprehensively than in other EU countries, Sangster et al. (2002: 59) recommend improvements be facilitated by producing clear guidelines and official classifications, ensuring that the benefits of monitoring are clear to those collecting the data, and encouraging drug service planners and commissioners to make use of the results.
Drug service development
The statistics collected for this study reveal that, with very few exceptions, every Black and minority ethnic group in the EU is under-represented as clients of drug services. Many Black and minority ethnic communities are already socially excluded: failure to consider their drug service needs exacerbates this situation. There is considerable variation in the drug services provided for Black and minority ethnic communities both within and between member states, but across the EU as a whole, drug policy and practice reflect the needs of the white indigenous population.
Although the data collected for this study indicate that, overall, the drug-using
patterns of Black and minority ethnic communities are not different from those of
socially excluded, white, indigenous populations, it does not follow that Black and minority ethnic communities can simply 'slot into' existing drug services. Responses
may have to be different in order that the barriers to drug service access that these communities face can be overcome. This solution gives rise to the debate on whether or not specialist services should be developed for Black and minority ethnic populations. Sangster et al. (2002) discuss this issue, concluding from their research that specialist services have an important complementary role when integrated with generic services.
As an illustration of the specialist versus the generic services debate, Patel et al. (2001) report that in the London borough of Tower Hamlets, no agency, commissioner, nor service provider, contested that there was a serious and deteriorating heroin problem amongst Bengalis in the area. Nevertheless, perceiving a proposed drug service for this population as based on an Islamic model, they were unsure what it could offer, assuming that it would preclude advocating or using medical interventions. When the service was established, these doubts were allayed somewhat as it became clear that the agency saw treatment with methadone not as 'the answer', but rather as sometimes the best solution available, and that
elements of faith were incorporated into the treatment programme in order to achieve cultural sensitivity. After the initial scepticism, other drug agencies in the area began to request joint working with the new agency.
In the UK, the way forward has been assisted by the Race Relations (Amendment) Act 2000, which places a general duty on public authorities to promote race equality and challenges all public services to eradicate discrimination and disadvantage. The Act requires public organizations to have clear race equality action plans and creates a clear expectation that these authorities will review their functions and identify steps to be taken to comply with the new provisions. The Race Relations (Amendment) Act 2000 provides the impetus for drug services in the UK to address the shortfalls in the provision of appropriate and accessible services for Black and minority ethnic communities, and can be used as a template for the development of services for these communities in other countries.
Dissemination and evaluation
This study has revealed the many gaps in the knowledge base concerning the drug use of Black and minority ethnic communities in the EU and the related drug service issues. This situation is not helped by the lack of dissemination of the information that is available. Evaluation should be a key component of all drug services for Black and minority ethnic communities. An EU-wide database of relevant research results should be established and include examples of good practice in methods of researching drug use and the related service needs amongst Black and minority ethnic communities. Drug services that demonstrate effective engagement with, and capacity building of, Black and minority ethnic communities should be especially highlighted.
There is a lack of prevalence estimates of drug use amongst Black and minority ethnic communities, they are under-represented in drug services, and there is a lack of recognition that drugs are used by them. This combination means that acknowledgement of drug use amongst these communities is an extremely important stage in the development of responses. The lack of evidence of the prevalence of drug use can be used as a justification not to address it, yet it is only through acknowledging it that debate and further investigation can be initiated. The way will then be paved for responses that will support Black and minority ethnic communities through drugs and drug service education, and awareness-raising activities. Needs assessments can then take place alongside changes within drug services, and, ultimately, evidence of prevalence and drug service uptake and retention can be systematically acquired. This process should be monitored throughout via drug service commissioning systems, to ensure that the needs of the Black and minority ethnic population are being identified and appropriate responses are being implemented.
The current study was only the very first step in constructing an overview of the drug use of Black and minority ethnic communities in the EU. A highly fruitful next step would be to devise just one questionnaire based on a synthesis of the results
from this study and repeat the exercise, increasing the range and diversity of informants, and including strategies that encourage the participation of more Black and minority ethnic communities in the data collection process.
1 We are very conscious that, within the European Union, various terms are used to refer to the many diverse communities living in the member states. We prefer the term Black and minority ethnic groups/communities. This reflects that our concern is not only with those for whom 'Black' is a political term, denoting those who identify around a basis of skin colour distinction or who may face discrimination because of this or their culture: 'Black and minority ethnic' also acknowledges the diversity that exists within these communities, and includes a wider range of those who may not consider their identity to be 'Black', but who nevertheless constitute a distinct ethnic group.
2 This study was conducted in 2002, when the European Union (EU) consisted of 15 countries: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, Sweden, and the United Kingdom. Ten other countries acceded to the EU in May 2004.
3 The European Information Network on Drugs and Drug Addiction (REITOX) consists of one National Focal Point in each of the 15 European Union Member States and in Norway, and one at the European Commission in Brussels.
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The Process. Preston: Centre for Ethnicity and Health, Faculty of Health, University of Central Lancashire.
Jane Fountain is Reader in Ethnicity and Health at the Centre for Ethnicity and Health, University of Central Lancashire. Address: Centre for Ethnicity and Health, University of Central Lancashire, Preston PR1 2HE, UK. Tel: +44 (0)1772 892 780 @uclan.ac.uk
Jon Bashford is Associate Head at the Centre for Ethnicity and Health, University of Central Lancashire, Preston, UK.
Susan Underwood is Senior Lecturer (Research) at the Centre for Ethnicity and Health, University of Central Lancashire, Preston, UK.
Jagjit Khurana is Senior Lecturer (Research) at the Centre for Ethnicity and Health, University of Central Lancashire, Preston, UK_
Moira Winters is Senior Lecturer at the Centre for Ethnicity and Health, University of Central Lancashire, Preston, UK.
Chloé Carpentier is Scientific Project Manager at the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA),Lisboa, Portugal.
Kamlesh Patel is Head of the Centre for Ethnicity and Health, University of Central Lancashire, Preston, UK.