Epidemiology of Substance Use among Forced Migrants: A Global Systematic Review

Abstract

IntroductionForced migration is occurring at unprecedented levels. Forced migrants may be at risk for substance use for reasons including coping with traumatic experiences, co-morbid mental health disorders, acculturation challenges and social and economic inequality. This paper aimed to systematically review the literature examining substance use among forced migrants, and identify priority areas for intervention and future research.MethodsSeven medical, allied health and social science databases were searched from inception to September 2015 in accordance with PRISMA guidelines to identify original peer-reviewed articles describing any findings relating to alcohol and/or illicit drug use among refugees, internally displaced people (IDPs), asylum seekers, people displaced by disasters and deportees. A descriptive synthesis of evidence from quantitative studies was conducted, focusing primarily on studies which used validated measures of substance use. Synthesis of evidence from qualitative studies focused on identifying prominent themes relating to the contexts and consequences of substance use. Critical Appraisal Skills Programme (CASP) checklists were used to assess methodological quality of included studies.ResultsForty-four quantitative (82% cross-sectional), 16 qualitative and three mixed-methods studies were included. Ten studies were rated as high methodological quality (16%), 39 as moderate quality (62%) and 14 as low quality (22%). The majority of research was conducted among refugees, IDPs and asylum seekers (n = 55, 87%), predominantly in high-income settings. The highest-quality prevalence estimates of hazardous/harmful alcohol use ranged from 17%-36% in camp settings and 4%-7% in community settings. Few studies collected validated measures of illicit drug use. Seven studies compared substance use among forced migrants to other migrant or native-born samples. Among eight studies which conducted multivariable analysis, male sex, trauma exposure and symptoms of mental illness were commonly identified correlates of substance use.ConclusionOur understanding of substance use among forced migrants remains limited, particularly regarding persons displaced due to disasters, development and deportation. Despite a growing body of work among refugee-background populations, few studies include refugees in low and middle-income countries, where over 80% of the global refugee population resides. Findings suggest a need to integrate substance use prevention and treatment into services offered to forced migrants, particularly in camp settings. Efforts to develop and evaluate interventions to reduce substance use and related harms are needed.

Identification of health risk behaviours among adolescent refugees resettling in Western Australia

“…The reported prevalence of drug and substance misuse varies greatly among forced migrants, depending on the study population, including origin country and cultural norms 32. In the current study, drug and alcohol use was reported only among males and the overall frequency was low compared with other non-refugee adolescent groups, including those who have experienced abuse/neglect 15.…”

The Global Refugee Crisis: Empirical Evidence and Policy Implications for Improving Public Attitudes and Facilitating Refugee Resettlement

“…() found that the prevalence rates for PTSD and depression were 30.6% and 30.8%, respectively. In addition to PTSD, depression, and anxiety, refugees also experience issues such as dissociation (Carlson & Rosser‐Hogan, ), somatic complaints (van Ommeren et al., ), and elevated rates of substance use (Horyniak, Melo, Farrell, Ojeda, & Strathdee, ).…”

Injection Drug Use Trajectories among Migrant Populations: A Narrative Review

“…This mode of migration is associated with highly constraining risk environments for injection-related harms, given a variety of stressors—including fear of deportation, housing instability, compromised basic human rights, and forced return migration—associated with injection-related risks (Apostolopoulos et al, 2006; Hacker et al, 2011). Reviews of substance use and migrant health literature have concluded that forced migrants, including deported migrants, are particularly vulnerable to initiating problematic substance use (Horyniak et al, 2016a), as forced migration disrupts social networks, which in turn heightens the risk of injection initiation as a coping mechanism (Higgs et al, 2008; Ojeda et al, 2011; Wagner et al, 2011). …”

“…Migrant populations have also been shown to be at risk of initiating injection drug use (IDU) (Folch et al, 2016; Horyniak, Melo, Farrell, Ojeda,& Strathdee, 2016a; Ojeda et al, 2011), especially those populations whose migration pathways traverse drug trafficking regions (Beyrer et al, 2000; Rachlis et al, 2007). Relatedly, dual epidemics of IDU and blood-borne disease have been observed across international borders and drug trafficking routes globally (Beyrer et al, 2000; Rachlis et al, 2007; Strathdee, Magis-Rodriguez, Mays, Jimenez, & Patterson, 2012).…”