Drug-use patterns and consequences observed among socially excluded populations

In the literature and research the following populations are usually considered to be at risk for social exclusion: prisoners, immigrants (100), the homeless, sex workers and vulnerable young people. Bias and methodological limitations in the presented information on drug use and patterns of use among socially excluded groups have to be considered, because of the lack of information sources and comparable data across Europe.

The association between being prisoner and using drugs has been shown to be quite strong (see also ‘Drug use in prison’). A large proportion of prisoners are drug users before being imprisoned, and the reason for their incarceration is often associated with drug use. However, some people follow the opposite course, becoming drug users only after being incarcerated for committing crimes. Studies suggest that between 3 % and 26 % of drug users in European prisons start taking drugs in prison and between 0.4 % and 21 % of incarcerated IDUs first inject while in prison. Drug use within prison is very common: up to 54 % of inmates report using drugs while incarcerated, and up to 34 % report injecting in prison (Stoever, 2001; EMCDDA, 2002a).

The relation between ‘black and minority ethnic groups’ and drug use is less clear, as little information is available. There is no scientific evidence to suggest that drug use is higher among immigrants than in the general population. However, some studies in specific ethnic minority groups have found a higher proportion of problematic drug users among those groups than among the general population, such as among the Ingrian in Finland (1–2 % of whom are estimated to be drug users, especially heroin users), Kurds in Germany, Gypsies in Spain and several ethnic groups in the Netherlands (Vrieling et al., 2000) (Table 19 OL). The reasons for this could be a combination of socially disadvantageous factors, such as poor command of the local language, unemployment and housing problems, poor living conditions and lack of economic resources (National reports, 2002).

As regards patterns of drug use, differences are found among ethnic groups. Use of qat is reported only by Somali populations and black Africans while heroin is smoked by immigrants from Surinam and from Bangladesh. And drug use among Gypsies in Spain appears to start at a younger age (by two to three years) than in the native population (Eland and Rigter, 2001; Reinking et al., 2001; Fundación Secretariado General Gitano, 2002).

Homeless people are also reported to be at risk for drug use. Although comparable data across Europe on the relation between homelessness and drug use are not available, specific studies have been conducted in many countries, and drug use is reported as a frequent problem among the homeless (National reports, 2002). Denmark, France, the Netherlands and the United Kingdom report that up to 80 % of homeless people living in shelters are drug dependent; and prevalence rates are even higher among people living on the streets or in homeless people with other social problems. For example, according to a small study carried out in Ireland, 67 % of homeless ex-prisoners are drug dependent (Hickey, 2002). Among the homeless, heroin is the most commonly used drug, followed by cocaine and polydrug use. Other high-risk behaviours, such as injecting drug use and needle sharing, are also reported to be high among homeless people (101).

Among vulnerable young people, the use of drugs is reported to be frequent; high prevalence is found among children who have experienced family and social problems or problems at school. High prevalence of drug use has been found among the children of drug addicts: rates of lifetime drug use among children whose parents have used drugs in the past year are significantly higher than those found in the ‘non-vulnerable’ group (lifetime prevalence of 37–49 % compared with 29–39 % among children of non-user parents) (102). Several studies report that children who have suffered sexual or physical abuse within the family have a higher risk of using drugs when adults (Liebschutz et al., 2002). In Portugal, young victims of family abuse and violence are reported to be seven times more likely to use heroin than young people in the general population (Lourenço and Carvalho, 2002). In the United Kingdom, ‘young runaways’ (103) appear to be more likely to misuse drugs. Rates of lifetime drug use are two to eight times higher than in young people who have never run away. The drugs most used are crack, heroin and solvents. Problems at school are another risk factor for taking drugs: a high prevalence of drug use is reported in children not attending school (Amossé et al., 2001), among those attending reform schools (40 % of reform school students in Finland were reported to have had an addiction problem at some time, in 16 % of whom this was related to drugs) (Lehto-Salo et al., 2002) and in those with poor educational grades (13.5 % in Norway) (Vestel et al., 1997).

Among sex workers, drug use is often a motive for prostitution, but could also be a consequence (as is the case for other factors associated with drug use). Drug-use patterns vary depending on whether prostitution comes before or after drug addiction. An Italian qualitative study among street prostitutes found that, when sex workers start to use drugs in order to deal with problems related to prostitution, they mainly use alcohol, tranquillisers or other psychoactive medicines; in contrast, when drug addiction is the main reason for prostitution, heroin is the primary drug used (Calderone et al., 2001).

Research findings or data on other socially excluded groups are less readily available; Denmark reports that among patients of psychiatric services 50–60 % are drug addicts, probably because of the widespread availability of drugs and the fact that such patients are familiar with taking psychoactive medicines (National report, 2002).

(100) According to EMCDDA (2002b) immigrants are defined as ‘black and minority ethnic groups’ and include immigrant populations from diverse communities living in EU countries.

(101) The British Home Office reports that in the Unitd Kingdom over one-third of homeless people have injected heroin, and one-fifth have injected crack. In the last month over 10 % are likely to have used someone else’s syringe or passed on their own syringe (Carlen, 1996; Goulden and Sondhi, 2001).

(102) According to a survey conducted in England and Wales in 1998–99 among 4 848 young people (Goulden and Sondhi, 2001).

(103) The Social Exclusion Unit of the British Office of the Deputy Prime Minister defines a ‘young person running away’ as ‘a child or young person under the age of 18 who spends one night or more away from the family home or care without permission, or has been forced to leave by their parents or carers’ (Social Exclusion Unit, 2002).