Drugs and Diversity: Ethnic minority groups

Transcription

1 Drugs ad Diversity: Ethic miority groups Learig from the evidece Itroductio This review is part of a wider programme of work udertake by the UKDPC to provide a overview of the differig eeds ad challeges associated with drug use amog diverse miority commuities withi the UK. By brigig together a variety of evidece i oe place we are seekig to ecourage a broader view of the evidece ad its implicatios, as well as promptig debate about how best to respod to the varyig patters of drug use ad associated problems withi differet commuities. The govermet, local parterships, commissioers ad service providers have sought to address the challeges of a rage of diverse groups over the years. This review has ot sought to evaluate the impact these have made but rather to describe what is kow about the curret situatio, to stimulate much-eeded discussio of the issues, highlight gaps ad to idetify ew areas for actio. It was a commo fidig for all the reviews coducted as part of this project that the evidece was limited ad ofte of poor quality usig samples that are ot ecessarily represetative of the populatio. Therefore the fidigs, although the best available, should be iterpreted with cautio. The extet ad ature of drug use ad associated problems 2 Implicatios for policy ad practice 3 Evidece eeds 3 Drug treatmet ad prevetio programmes 4 Implicatios for policy ad practice 5 Evidece eeds 5 Iteractio with the police ad crimial justice system 6 Implicatios for policy ad practice 6 Evidece eeds 6 Also, it is importat to ote that cosiderable diversity withi Black ad miority ethic (BME) commuities is ofte cocealed by the use of geeric termiology coverig a wide rage of geographic origis (ie South Asia may describe populatios from Pakista, Idia, Bagladesh, etc.). Ideed, eve withi groups with the same ethic backgroud there may be differeces associated with other factors such as place of residece withi the UK, geeratioal ad social differeces. This briefig is based o the followig reviews: The Impact of Drugs o Differet Miority Groups: A Review of the UK Literature Part 1:Ethic Miority Groups The Impact of Drugs o Differet Miority Groups: Ethicity ad Drug Treatmet Available at: 1

2 Proportio of 16 to 59 year olds reportig use of drugs i the past year by ethicity (combied dataset 2006/07, 2007/08 & 2008/09 BCS) White Mixed ethicity Idia Pakistai Bagladeshi Black Caribbea Black Africa White Mixed ethicity Idia Pakistai Bagladeshi Black Caribbea Black Africa Ay drug Class A drug % The extet ad ature of drug use ad associated problems I geeral, overall drug use is lower amog miority ethic groups tha amog the White populatio. Reported drug use prevalece is highest amog those from mixed ethic backgroud i a umber of studies, largely as a result of high levels of caabis use. However, whe the youger average age of this group is take ito accout, their drug use levels are similar to those i the White populatio. Lowest overall levels of drug use are reported by people from Asia backgrouds (Idia, Pakistai or Bagladeshi). Caabis is the most commoly used drug across all ethic groups ad age groups. Rates of Class A drug use are higher amog people from White or mixed ethic backgroud tha amog other ethic groups. Poly drug use is most commo amog White groups, compared with other ethic groups. Me are more likely tha wome to use ay illicit drugs i may ethic groups, particularly amog Asia, White ad Chiese/other groups. Black ad mixed race me ad wome have similar levels of use. Natioal ad local records of treatmet services, ad some small scale studies, idicate that the types of drugs that cause idividuals to seek help vary betwee differet commuities: Amog the Asia commuity the most commo reaso for seekig treatmet is problematic use of heroi; Asia drug users also appear to be more likely to use smokig or chasig as their method of admiistratio; those i White commuities are more likely to iject; Drug users from Black groups are most likely to seek treatmet for crack cocaie ad caabis use; Wome make up a bigger proportio of White people i treatmet tha they do of Black people; the proportio of wome amog Asia ethic subgroups (Idia, Pakistai, etc.) is lower still; Almost half of people from White, Mixed ad Black ethic groups report alcohol use prior to eterig treatmet compared with oly about a third of those of Asia backgroud. I some ethic commuities, khat use may be a cultural or social recreatio. Although khat use is legal, cocers have bee raised regardig its potetial egative health impacts. Amog khat usig commuities, me are more likely to be users tha wome. This may be due to: the stigma attached to drug use beig greater for wome; Wome beig more likely to dey their khat use ad use it aloe rather tha i social settigs; Wome also appear more likely to regard their khat use as problematic. Iformatio o reasos for use maily comes from qualitative studies ad discussios with users ad commuity members; it may ot be completely represetative, ad should be iterpreted with cautio. 2

3 Peer pressure ad ifluece are see as importat reasos why youg people use drugs. Youg people growig up uder the ifluece of wester culture ad treds may seek to distace themselves from traditioal cultural values i order to fit i. BME commuities may be at risk of drug use because they ofte live i disadvataged ad deprived areas, where drug markets thrive. A umber of miority ethic groups, particularly refugees ad asylum seekers, face high levels of uemploymet, isolatio ad social exclusio. Limited opportuities ca lead to frustratio, boredom ad axiety icreasig the likelihood of drug use. Factors suggested as liked to high levels of caabis use withi Black commuities iclude: a perceptio that it is safe ad less harmful tha other drugs; a history of caabis use withi families; for Rastafarias, caabis use is a spiritual act ad part of the culture of the movemet. Amog some BME groups, particularly South Asias ad the Chiese, high levels of stigma are attached to drug use ad directed at both drug users ad their families. This ca lead drug users to hide the extet of their use, ad levels of drug problems beig uderestimated. Evidece eeds Further iformatio is eeded about: the variatio i drug use withi specific ethic commuities to idetify the role ad relative importace of other factors persoal, social, ecoomic, cultural, geographical that may icrease risk of or provide protectio agaist drug use; the differet patters of drug use (types of drugs, mode of admiistratio, legth of use) betwee differet ethic groups ad the cotexts i which drug use occurs; the extet of drug use amog refugees ad asylum seekers; the variatio i drug use withi the White ethic group, for example amog the ew commuities from Easter Europea coutries. Implicatios for policy ad practice Drug use is geerally proportioally greater amogst white commuities tha BME groups; this may chage as youg people become more absorbed ito predomiat atioal culture with the potetial for icreasig drug problems i these commuities. The high rates of use amog mixed race idividuals may be of cocer, as they are likely to be a icreasig group i the future. A more sophisticated uderstadig of ethic differeces i drug use that recogises the differeces withi broad ethic categories is required; at preset cosiderable variability is cocealed withi broad categorisatio which may lead to iappropriate resposes. The extreme social stigma associated with drug use i some ethic groups may lead to uder-estimatio of problems ad ihibit service provisio. 3

4 Drug treatmet ad prevetio programmes There is some evidece about perceived good practice i drug educatio ad iformatio provisio for a rage of BME commuities, but o robust evaluatios of the effectiveess of such programmes. It appears there is limited awareess amog BME commuities of the rage ad value of existig drugs services. Sources of iformatio o services that may be used iclude: GPs; family, frieds or social etworks; religious orgaisatios or leaders; commuity orgaisatios. BME commuities suggested a wide variety of veues for delivery of drug-related iformatio, icludig: schools ad commuity cetres (familiar, commuity-based, well-visited, comfortable ad safe ); youth clubs, colleges ad uiversities; geder-specific veues may be importat for some groups. A variety of writte, oral ad visual media i appropriate laguages will be eeded to provide drug educatio successfully, such as telephoe helplies the aoymity is helpful where stigma is a issue ad iformatio i o-writte formats for groups with a traditio of oral commuicatio or poor literacy levels. BME commuities were agreed that iformatio eeds to be precise ad explicit, particularly regardig drug services, but were split as to whether drug related iformatio should focus o harm reductio messages or emphasise abstiece / illegality. BME commuities have a rage of suggestios regardig the most appropriate people to deliver drug educatio icludig: ex-drug users or drug users i treatmet (from withi commuities); youg peer educators (may be perceived as more credible tha adults); the eed for positive role models to get ivolved i a metorig or buddy capacity; commuity orgaisatio workers with appropriate traiig. While all commuity members eed to receive drug educatio ad iformatio it was felt that there should be a particular focus o youg people, parets ad wome. Implicatios for policy ad practice There is a eed to idetify ways of supportig ad maitaiig cultural resiliece agaist drugs amog successive geeratios i a way that does ot stigmatise users ad families ad ihibit help-seekig. Actio is eeded to reduce the stigma associated with drug use i some BME commuities to make it easier for people affected to obtai help ad achieve ad maitai recovery. Evidece-based harm reductio services ad messages eed to be accessible to all drug users whatever their cultural ad religious backgroud eve though. Lack of iformatio about drugs ad services ihibits treatmet access amog BME groups. GPs, faith-based bodies ad religious leaders could be utilized more to commuicate ad egage with youg people ad families from these groups. Peer educators ad positive role models ca be importat. Social ad cultural media ad etworks ca be used to reiforce or cultivate positive pro-social behaviours rather tha just to iform about harms ad risks. Specialist drug services for specific ethic groups will be usustaiable i may areas. Local parterships ad commissioers eed to assess local eeds ad stimulate iovative solutios to meet the eeds of a growig ethic populatio, some of whom will ievitably develop substace misuse problems. Maistream drug services should review how they are meetig the eeds of ethic commuities. Orgaisatioal ad workforce plaig ad developmet programmes should specifically address issues of diversity icludig meetig the eeds of differet ethic groups. 4

5 Drug treatmet ad prevetio programmes cotiued Diversioary activities (ecouragig positive leisure activities) for youg people may make them less vulerable to drug use. BME groups also recommed addressig kow risk factors associated with drug use: uemploymet, social exclusio, ustable housig arragemets/ homelessess, difficulties i accessig educatio ad health services ad racism ad discrimiatio. The lack of kowledge about services ad a reluctace to seek help due to stigma may mea BME groups are uderrepreseted i services. A perceived lack of uderstadig of their culture ad, occasioally, racism withi services were also reported as barriers to treatmet. However, for those i treatmet the experieces amog differet groups appear similar. Data from the Natioal Drug Treatmet Moitorig System (NDTMS) shows o sigificat variatio by ethic group for a rage of measures. For example: Waitig times for the first itervetio amog cliets commecig a ew treatmet jourey does ot vary much by ethic group; betwee 93% ad 95% of cliets waited less tha 3 weeks; The proportio of idividuals who were retaied i treatmet for 12 weeks or completed treatmet withi 12 weeks was similar across ethic groups ragig from 81% of those of Mixed ethic backgroud to 85% of those i the Other ethicity groupig. The 2007 user satisfactio survey showed geerally good levels of satisfactio with services. Asia service users reported lower levels of overall satisfactio ad, although ot statistically sigificat, were less positive about the impact of treatmet, the extet to which they were treated with respect ad the level of support received. Evidece eeds Further iformatio is eeded about: the extet ad ature of drug iformatio, educatio ad other prevetio itervetios available to differet BME commuities; which programmes are effective i prevetig drug use amog these commuities; models of good practice relatig to prevetio, educatio ad iformatio provisio relatig to specific illegal drug types ad khat; how kowledge ad awareess about drugs relates to patters of drug use withi BME commuities. 5

6 Iteractio with the police ad crimial justice system (CJS) BME groups experiece disproportioate levels of stop & search ad a higher percetage of these are for drug offeces compared to White groups, despite their lower levels of drug use. Tesios aroud disproportioate policig of Romai gypsies, Irish travellers ad showme have also bee reported. Over-represetatio of BME groups i policig of caabis ad other drugs may stem partly from the high proportio of BME groups livig i areas of social disadvatage ad high crime. The over-represetatio of BME groups is less marked whe arrests for drug offeces are cosidered. However, people from BME groups are more likely to be seteced to priso tha people from the white ethic group ad higher proportios of people i priso from BME groups are there for drug offeces. Ethic liks, cultural homogeeity ad family ties are importat to some street-level ad middle-level drugs markets ad may be associated with other illicit, profit-makig activities. Liks with the coutry or area of origi may be used by BME groups for the traffickig of drugs sold i the UK: heroi is mostly obtaied from Afghaista, Pakista ad Turkey, by South Asia ad Turkish groups; sythetic drugs are obtaied by White suppliers of British, Dutch ad Belgia origis. The media has bee criticised for its disproportioate represetatio ad sesatioalisig of BME ivolvemet i drug markets. Ivolvemet i drug markets by people from BME commuities appears to be rarely udertake to fiace a persoal drug habit, but more ofte to fud educatio, repay loas or debts, or afford desiger clothes, cars ad accessories. Drug markets ad the ivolvemet of some idividuals i dealig ca affect BME commuities i may ways; through drug-related crime, family breakdow, public safety, damage to the reputatio of the commuity, ad the spread of drug use withi the commuity. Implicatios for policy ad practice The potetial damage to commuity relatios from the disproportioate experiece of stop & search is well-established; give the sesitivity of the issue, a robust evaluated trial, to compare the impacts of ceasig to use it i certai localities, should be cosidered. The itroductio of police ad crime commissioers could afford the opportuity to put the use of stop ad search tactics i certai areas uder the local microscope i order to judge their efficacy ad value. Where there is cocer about local drug markets with a BME dimesio, iovative approaches to get low-level ad o-violet dealers ito dealer exit programmes should be tested ad evaluated, as has bee doe i the Uited States. The importace of providig treatmet programmes as backup whe local drug market eforcemet operatios occur is ow well established; for ethic miority groups the provisio of broader diversioary activities ad educatioal iputs may be more relevat, especially for youg people. There are growig calls to cotrol khat. However, baig the plat may lead users to switch to more harmful substaces. Evidece eeds There is a eed for iformatio o: the effectiveess ad value for moey of stop ad search for drugs compared with alterative policig methods such as itelligece-led ad eighbourhood policig; what works for divertig low-level dealers from ethic miority groups from drug crime; how to build resiliece agaist drugs amog differet ethic commuities; atioal studies to provide a clearer picture of drug market activities across all ethic groups, icludig the majority White populatio. Fudig for this review was provided by the Home Office. The backgroud reviews for this briefig were udertake for the UK Drug Policy Commissio by the Office of Public Maagemet ad additioal data was supplied by the Natioal Treatmet Agecy for Substace Misuse. The UK Drug Policy Commissio is a idepedet, o-aliged ad time limited charitable body set up with fudig from the Esmée Fairbair Foudatio to ehace political ad public uderstadig of the effectiveess of policies aimed at dealig with the harms caused by illegal drugs. 6 UK Drug Policy Commissio (UKDPC), July ISBN The full versio of this briefig, ad the accomayig full reports, are available at