In recent years, the rise in humanitarian emergencies worldwide has led to an increase in displaced people entering Europe from a wide variety of third countries, including a high number of arrivals from the Middle East (mainly Syria), Afghanistan and Africa over the past decade, but also more recent arrivals from the war in Ukraine. (18) As a result, challenges linked to the mental and physical health of migrant populations (19) have been high on the agenda of host countries (EMCDDA, 2022; EMCDDA, 2017). There have also been concerns stemming from an elevated vulnerability among different groups of migrants and challenges in their access to healthcare in Europe (WHO, 2018; 2019).
In 2020, the European Union Agency for Asylum (EUAA) conducted two studies on mental health concerns among applicants for international protection and on related challenges for asylum and reception professionals in EU+ countries (EUAA, 2020; 2021). The findings indicated that three quarters of respondents working with applicants in asylum and reception facilities regularly encounter applicants with mental health concerns. The signs of mental health concerns most commonly reported by applicants were anxiety and substance use, including the use of illicit drugs and alcohol.
A sizeable minority also observed the misuse of medicines among applicants for international protection (IP). While the migration and substance use nexus in Europe is not new and has indeed been the focus of various studies (Domenig et al., 2007; EMCDDA, 2013; EMCDDA, 2017; Lemmens et al., 2017), increase in migration since 2015 has heightened concerns related to substance use in migrant populations and highlighted the need to develop appropriate responses in host countries and reduce health inequalities linked to migration status (De Kock et al., 2017; Stöver et al., 2018; De Kock et al., 2020).
More specifically, previous studies have explored the nature of substance use and access to healthcare and specialised services among people who use drugs (PWUDs) and who have migration backgrounds (Domenig et al., 2007; EMCDDA, 2013; EMCDDA, 2017; Lemmens et al., 2017). However, there is still limited data and knowledge related to the circumstances and needs of a specific subpopulation of migrants who use drugs, namely refugees and applicants for international protection. Also, the increase in humanitarian crises and the growing displacement of people around the globe highlight the need to close the knowledge gap in order to develop appropriate responses in host countries (De Kock et al., 2017; Stöver et al., 2018; De Kock et al., 2020).