In November 2019, a study on registering ethnicity and migration in the European Treatment Demand Indicator (TDI) registry was published in the Journal of Ethnicity in Substance Abuse.1 According to international evidence, migrants and ethnic minorities (MEM) are a subpopulation who are both disproportionately affected by drug use and disadvantaged in accessing treatment. However, as the study author notes, data on treatment demand of MEM in Europe are currently limited. The study (a) discusses the importance of recording migration and ethnicity in the TDI along with its risks; (b) analyses current treatment trends from the 2014 national TDI reports; and (c) draws on survey responses from 19 national TDI focal points to identify indicators used and to make recommendations for improvement. 

Treatment demand trends among MEM 

• Populations with high prevalence: Twenty national reports specified MEM populations with high prevalence. Eight countries did not single out specific populations, often citing insufficient data. Highlighted in the reports as most vulnerable to problem drug use were (a) non-nationals; (b) Roma populations; and (c) people of Russian ethnicity.
• Drug treatment demand and social correlates: Only 50% of the reports included statistics on drug treatment demand among MEM, predominantly by nationality. However, they were often reported without further details, such as comparisons with the general population or other social correlates. An exception is the Irish report featuring an in-depth analysis of Irish Travellers’ drug treatment demand. Where social correlates for drug use among MEM are reported, homelessness, unemployment, low educational attainment, and being undocumented are most frequently mentioned, albeit without being analysed with TDI data.
• Drug-related crime: Eighteen reports contained figures on MEM populations and drug-related crime. Non-nationals represented a high percentage of those imprisoned for drug-related crime in some countries (e.g. 39% in Finland), but a low percentage in others (e.g. 8% in Greece). Yet trends are difficult to identify due to a lack of uniform, in-depth reporting.
• Health and risk behaviours: Some countries reported an overrepresentation of non-nationals among drug users who tested positive for infectious diseases and those who engaged in high-risk behaviours such as injecting.
• Access: While all 2014 reports mentioned their national strategies to widen treatment access, only four reports (Ireland, United Kingdom (UK), Germany, and Luxembourg) mentioned MEM in the context of accessibility. 

Current TDI migration and ethnicity recording

The TDI Protocol 3.0 (2012) does not require the recording of nationality. While the recording of ethnicity and nationality is legal and General Data Protection Regulation (GDPR)-compliant, 18 member states or more insufficiently regulate the collecting of these sensitive data, contributing to a taboo around their recording. 

The study’s survey, following consultation with member state experts, revealed: 

• Out of 19 respondents, three stated as not recording migration data, or only having data on the total of non-nationals.
• Nationality was most frequently recorded (10 respondents), along with birthplace (6), EU/non-EU status (5), ethnicity (5), nationality at birth (4), parent birthplace/nationality (1), and language (1).
• 15 respondents used two or more indicators.
• All respondents stated that coverage was a problem, regarding service participation in the TDI in general and the lack of individual-level data for some countries.
• The most common method of recording ethnicity and migration was via service providers. Four respondents reported additionally or exclusively allowing open-ended answers.

Recommendation and conclusions

The study concluded that the potential of the TDI dataset to capture treatment demand trends and inform coordinated policymaking currently remains unused for the subpopulations of MEM. Given the international evidence that MEM often show disparities in drug treatment need and access, data on their characteristics and requirements are vital for equal opportunities for the recovery of MEM populations. 

Recommendations by national experts to improve MEM recording included: 

• Requiring reliable ethnicity and migration indicators in the TDI Protocol (n=5): While nationality is currently recorded by 30% of member states, the author argued for adding mother’s birthplace and language-related and self-identified ethnicity indicators to allow for a more complex and self-determined representation of service users’ backgrounds.
• Conducting in-depth intersectional analyses of MEM treatment demand with TDI data (n=2): Migration and ethnicity variables must be examined in context with social correlates (e.g. gender, education, employment, etc.) to avoid one-dimensional and potentially further stigmatising conclusions. Such analyses would enable a more considered representation of the characteristics and causalities of MEM’s treatment demand.
• Using unique identifiers to allow individual-level insights and database linkage (n=3): This could be a TDI-specific, pseudo-anonymised identifier, as national identifiers would not be available to undocumented migrants.

However, while recording ethnicity and migration status has the potential to increase equality, it also bears risks and concerns regarding privacy, self-determination, and potential misuse of such sensitive data to further stigmatise vulnerable subpopulations. Therefore, the author argues for clearly stating in the TDI the purpose of data collection as increasing equality and protecting the rights of data subjects (following the UK’s example). Furthermore, practising informed consent by clearly communicating to service users is important. Eurobarometer results show that this could encourage voluntary disclosure of ethnicity and migration identities and preclude fear of discrimination.2

The Irish TDI register has included questions on ethnicity since 2007 and currently also features questions on main language and country of birth. Along with the UK, Ireland is the only EU country which records ethnicity data with the specified goal of enacting positive measures, illustrating the feasibility of the current study’s recommendations.

1  De Kock C (2019) Migration and ethnicity related indicators in European drug treatment demand (TDI) registries. J Ethn Subst Abuse, 5 Nov: 1–27. doi: 10.1080/15332640.2019.1664962 .

2  Makkonen T (2016) European handbook on equality data: 2016 revision. Luxembourg: Publications Office of the European Union. Available online at: https://ec.europa.eu/newsroom/just/document.cfm?action=display&doc_id=43205