The report Stimulating and supporting a Black and minority ethnic voice on drug issues1 was published in April 2017 by CityWide Drugs Crisis Campaign, the national network of community activities and organisations involved in responding to drug-related issues. The research aimed ‘to explore possible structures and processes through which to engage with, hear the voice of, and empower Black and minority ethnic communities in relation to issues of drug use’ (p. 5). It was carried out by Niall Crowley, an independent public policy researcher with particular expertise in human rights and equality.

The findings of the report are based on 14 interviews with those working in community-based drug service provision (n=9), and representatives of Black and minority ethnic (BME) organisations (n=5). The author also reviewed two pieces of earlier research that explored the issue of drug use among new communities in Ireland.2,3

Addressing the varying needs of new migrant communities as well as those of BME groups more generally is complex. The report focuses on the needs of new communities and their experience of cultural difference, in particular how this may impact on their experiences of accessing services and influencing policy in the area of drug use. Chapter 4 of the report focuses on ‘difference’, which is explored under the headings of situation, experience, and identity. The author emphasises that:

[It] underpins the need for a specific focus on these communities in policy and a specific place at the table in deliberating on policy. Difference points to specific risk factors, patterns of drug use, service needs, and communication channels that must be accommodated in policy and provision. (p. 15)

A hidden problem

There was general consensus among those interviewed that problematic drug use is an issue among BME groups, including new communities. However, its extent is unknown and its usage perceived to be largely hidden. While the National Drug Treatment Reporting System (NDTRS) of the Health Research Board has used an ethnic identifier for BME groups since 2008, the report suggests that a lack of presentation to appropriate services means that this is not yet a reliable indicator of the true extent of the problem. The report calls for more research so that this assessment can be substantiated.

Barriers to accessing services

Barriers to accessing services for new communities and BME groups are identified, including: 

• A lack of targeted and culturally appropriate services
• A lack of knowledge of services among potential service users
• Language difficulties and, where a translator is used, concerns about confidentiality
• Community shame – the shaming of a person or group within their own community, as well as the risk that a person or group would shame that whole community
• Perceived and experienced racism, discriminatory behaviour and stereotyping among service providers
• Concerns about a person’s legal or immigration status, where this is precarious. This includes concerns that a person would be deported or experience other repercussions if they approach services. This was particularly problematic for asylum seekers and undocumented migrants. 

Second generation

A recurring theme throughout the report was the particular set of challenges faced by second-generation migrants that put them at increased risk of problematic drug use — an issue that has been recognised internationally. The reasons for this included ‘their specific circumstances in the integration process’ (p. 12) and their having ‘specific stresses in grappling with new and old identities’ (p. 13). Furthermore, dealing with racism and seeking peer acceptance within a culture that is different from that of their parents presents challenges. The hierarchical structures that exist within these communities and that influence and protect the young people can break down over time, providing an environment in which drug use may become a problem. There are also particular challenges to delivering prevention within this context. For example, parents feeling ill-equipped to discuss drugs with their children.

Informing policy-makers

The report identifies a number of ways in which policy-makers could be better informed about the issues facing new communities and other BME groups. These include: 

• To document the stories of people from these groups who are involved in problematic drug use. These could be used to identify the range of issues faced in accessing services.
• To encourage the wider use of an ethnic identifier by service users, which would make BME people more visible to policy-makers
• To provide training for cultural competence among policy-makers
• To support research on the topic of drug use among BME groups
• To support processes of ‘mutual education’ between drug service providers and organisations working with BME communities
• To encourage community-based service providers to report on the diversity of their service users within policy fora
• To improve representation of key stakeholders from within BME groups in policy deliberations
• To encourage the inclusion of BME organisations with the Task Forces

New communities and national drug policy

One of CityWide’s aims in commissioning this report was ‘to enable Black and minority ethnic communities to influence the development and implementation of the National Drugs Strategy’ (p. 5). The author notes that by the end of the timeframe of the previous drug strategy (2009—2016), there was ‘little evidence reported of action in relation to new communities on foot of these commitments’ (p. 7), i.e. commitments both to address the treatment and rehabilitation needs of new communities; and to develop engagement with new communities as a group identified as ‘at risk’ in relation to drug use. In the report, Crowley concludes:

Policy and provision in relation to problematic drug use have yet to respond appropriately and adequately to the needs of Black and minority ethnic communities. Institutional structures to underpin this policy and provision have yet to adequately engage the voice of these communities. This has happened in a context where, after a promising start, policy and provision on integration of new communities over the past decade has been limited. (p. 27)

The new national drugs strategy (2017—2025) was launched in July 2017.4 The needs of migrant communities were raised in the public consultation for the new strategy’s development. It is recognised in the strategy that migrant communities ‘may also experience barriers to accessing services or maintaining treatment, for a variety of reasons’ (p. 47).4 One of the actions from the strategy’s action plan (2017—2020) sets out to improve the capacity of services to accommodate the needs of people who use drugs and alcohol from specific communities (including new communities). This can be achieved by: 

• Fostering engagement with representatives of these communities, and/or services working with them, as appropriate.
• Considering the need for specialist referral pathways for specific groups who may not otherwise attend traditional addiction services (i.e. those who engage in chemsex).
• Providing antiracism, cultural competency, and equality training to service providers.
• Ensuring all services engage in ethnic equality monitoring by reporting on the nationality, ethnicity and cultural background of service users for the NDTRS and treat related disclosures with sensitivity.

The Health Service Executive is identified as the lead agency in this work, with the community and voluntary sector as partners. The scope of these actions is similar to those of the previous strategy; and there continues to be no reference to participation by organisations representing new communities in the policy structures of the new strategy.

Following on from the report, CityWide held a round-table event with representatives from community drug service providers, BME organisations, and task forces. The aims of the session were to build cultural competence and knowledge among service providers about the situation, experience and identity of these communities, as well as to develop capacity and commitment among BME organisations to take up issues of problematic drug use in their policy work.5

2  Corr C (2004) Drug use among new communities in Ireland: an exploratory study. Dublin: National Advisory Committee on Drugs / Merchants Quay Ireland. https://www.drugsandalcohol.ie/5897/

3  Kelly C, Fitzpatrick C and Nic Gabhainn S (2009) Substance use in new communities: a way forward. Galway: Western Region Drugs Task Force. https://www.drugsandalcohol.ie/11508/

4  Department of Health (2017) Reducing harm, supporting recovery: a health-led response to drug and alcohol use in Ireland 2017—2025. Dublin: Department of Health. https://www.drugsandalcohol.ie/27603/

5  Personal communication with CityWide.