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Vol. 12, No. 1, 2006
Issue release date: December 2005
Eur Addict Res 2006;12:33–41
(DOI:10.1159/000088581)

Drugs and Social Exclusion in Ten European Cities

March J.C. · Oviedo-Joekes E. · Romero M.
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Abstract

Aim: To describe social characteristics seen among socially excluded drug users in 10 cities from 9 European countries, and identify which social exclusion indicators (i.e. housing, employment, education) are most closely linked to intravenous drug use. Design: Cross-sectional survey. Setting: Interviews were held in social services centers, town halls, streets, squares and other usual meeting points of the target population. Participants: The sample comprises 1,879 participants who have used heroin and/or cocaine and certain derivatives (92.3%) over the last year. Males accounted for 69.7% of the sample, and the mean age was 30.19 years. Participants were recruited in 10 cities: Seville and Granada, Spain; Cologne, Germany; Vienna, Austria; Brussels, Belgium; Athens, Greece; Dublin, Ireland; London, England; Lisbon, Portugal, and Perugia, Italy. Measurements: Structured face-to-face questionnaire, conducted by privileged access interviewers. Results: Cannabis, heroin and cocaine are the most widely used substances. In the total sample, 60.2% injected drugs during the last year, 45.9% reported having hepatitis C; 54.9% have been in prison; 14.2% are homeless; 11.3% have a regular job, and 35.2% are involved in illegal activities. Hierarchical logistic regression analysis (injectors and non-injectors) showed that older participants have a greater likelihood of injecting than younger ones. Social exclusion variables associated with intravenous drug use are incarceration, homelessness, irregular employment, and delinquency. Participants who abandoned or were expelled from a drug treatment program are at greater risk of injecting drugs than participants who have never had treatment, are currently in treatment or have been released. Conclusion: Personal, social, and economic conditions are all linked in a process of social exclusion that compounds problem drug misuse. Given the findings of this study, we believe that there is a clear need for specific programs targeting specific groups, i.e., distinct strategies must be set in place, in line with the profile and needs of the patient in each context.



Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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References

  1. Paugan S: La constitution d’un paradigme; in Paugan S (ed): L’exclusion, l’etat des savoirs. Paris, La Découverte, 1996, pp 7–19.
  2. Lenoir R: Les Exclus, un Français sur dix. Paris, Le Seuil, 1974.
  3. Kanfler J: L’exclusion sociale: Etude de la marginalité dans les sociétés occidentals. Paris, Bureau de Recherches Socials, 1965.
  4. Social Exclusion Unit, 2004.
  5. Morris J: Social exclusion and young disabled people with high levels of support needs. Crit Soc Policy 2001;21:161–183.
  6. Burchardt T, Le Grand J, Piachaud D: Social exclusion in Britain 1991–1995. Soc Policy Admin 1999;33:227–244.
  7. Pringle D, Walsh J: Poor people, poor places: An introduction; in Pringle DG, Walsh J, Hennessy M (eds): Poor People, Poor Places. A Geography of Poverty and Deprivation in Ireland. Dublin, Oak Tree Press, 1999, p 3.
  8. Clayton RR: Transitions in drug use: Risk and protective factors; in Glantz M, Pickens R (eds): Vulnerability to Drug Abuse. Washington, American Psychological Association, 1992, pp 15–51.
  9. Hawkins JD, Catalano RF, Miller JY: Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: Implications for substance abuse prevention. Psychol Bull 1992;112:64–105.
  10. Haden M: Illicit i.v. drugs. A public health approach. Can J Public Health 2002;93:431–434.
  11. Coumans M, Spreen M: Drug use and the role of homelessness in the process of marginalization. Subst Use Misuse 2003;38:311–338.
  12. Galea S, Vlahov D: Social determinants and the health of drug users: Socioeconomic status, homelessness, and incarceration. Public Health Rep 2002;117(suppl 1):S135–S145.
  13. Nice European Council: December 7–9, 2000.
  14. Gallie D, Paugam S: Eurobarometer 56.1: Social Precarity and Social Integration. Brussels, European Commission, Directorate-General Employment, 2002.
  15. European Monitoring Centre for Drugs and Drug Addiction: Annual Report on the State of the Drugs Problem in the European Union, 2000. Luxembourg, Office for Official Publications of the European Communities, 2000.
  16. European Monitoring Centre for Drugs and Drug Addiction: Annual Report on the State of the Drugs Problem in the European Union, 2003. Luxembourg, Office for Official Publications of the European Communities, 2003.
  17. Kuebler D, Hausser D: The Swiss Hidden Population Study: Practical and methodological aspects of data collection by privileged access interviewers. Addiction 1997;92:325–334.
  18. March JC, Oviedo-Joekes E, Romero M, Gomez M, Rodriguez S, Leon MI, et al: The experimental drug prescription program in Andalusia (PEPSA): Procedure for recruiting participants (in Spanish). Gac Sanit 2004;18:245–247.
  19. Broadhead RS, Heckathorn DD, Altice FL, van Hulst Y, Carbone M, Friedland GH, et al: Increasing drug users’ adherence to HIV treatment: Results of a peer-driven intervention feasibility study. Soc Sci Med 2002;55:235–246.
  20. Cottler LB, Compton WM, Ben Abdallah A, Cunningham-Williams R, Abram F, Fichtenbaum C, et al: Peer-delivered interventions reduce HIV risk behaviors among out-of- treatment drug abusers. Public Health Rep 1998;113(suppl 1):31–41.

    External Resources

  21. Romero M, Zunzunegui MV, Perea E, Gornemann I, Fernandez A: The consistent use of condoms among intravenous drug users and their regular partners (in Spanish). Gac Sanit 1999;13:96–101.
  22. Friedman SR: Going beyond Education to Mobilizing Subcultural Change. National Committee on AIDS Control Encouraging Peer Support for Risk Reduction among Injecting Drug Users. Amsterdam, NCAB, 1993.
  23. WHO Collaborative Study Group: An international comparative study of HIV prevalence and risk behaviour among drug injectors in 13 cities. Bull Narc 1993;45:19–45.

    External Resources

  24. Estebanez PE, Russell NK, Aguilar MD, Beland F, Zunzunegui MV: Women, drugs and HIV/AIDS: Results of a multicentre European study. Int J Epidemiol 2000;29:734–743.
  25. SPSS for windows. Chicago, SPSS, 2002.
  26. Anthony JC, Petronis KR: Early onset drug use and risk of later drug problems. Drug Alcohol Depend 1995;40:9–15.
  27. De la Fuente L, Barrio G, Vicente J, Bravo MJ, Lardelli P: Intravenous administration among heroin users having treatment in Spain. Int J Epidemiol 1994;23:805–811.
  28. Galai N, Safaeian M, Vlahov D, Bolotin A, Celentano DD: Longitudinal patterns of drug injection behavior in the ALIVE Study cohort, 1988–2000: Description and determinants. Am J Epidemiol 2003;158:695–704.
  29. Neaigus A, Miller M, Friedman SR, Hagen DL, Sifaneck SJ, Ildefonso G, et al: Potential risk factors for the transition to injecting among non-injecting heroin users: A comparison of former injectors and never injectors. Addiction 2001;96:847–860.
  30. Strang J, Griffiths P, Powis B, Gossop M: Heroin chasers and heroin injectors: Differences observed in a community sample in London, UK. Am J Addict 1999;8:148–160.
  31. MacDonald R, Marsh J: Crossing the Rubicon: Youth transitions, poverty, drugs and social exclusion. Int J Drug Policy 2002;13:27–38.
  32. Vangeest JB, Johnson TP: Substance abuse and homelessness: Direct or indirect effects? Ann Epidemiol 2002;12:455–461.
  33. Strehlow AJ, Amos-Jones T: The homeless as a vulnerable population. Nurs Clin North Am 1999;34:261–274.
  34. Neale J, Kennedy C: Good practice towards homeless drug users: Research evidence from Scotland. Health Soc Care Community 2002;10:196–205.
  35. Winkleby MA: Comparison of risk factors for ill health in a sample of homeless and nonhomeless poor. Public Health Rep 1990;105:404–410.
  36. Klee H, Morris J: Factors that characterize street injectors. Addiction 1995;90:837–841.
  37. Johnson TP, Freels SA, Parsons JA, Vangeest JB: Substance abuse and homelessness: Social selection or social adaptation? Addiction 1997;92:437–445.
  38. Fiellin DA, O’Connor PG, Chawarski M, Schottenfeld RS: Processes of care during a randomized trial of office-based treatment of opioid dependence in primary care. Am J Addict 2004;13(suppl 1):S67–S78.

    External Resources

  39. Alcabes P, Vlahov D, Anthony JC: Characteristics of intravenous drug users by history of arrest and treatment for drug use. J Nerv Ment Dis 1992;180:48–54.
  40. Koulierakis G, Gnardellis C, Agrafiotis D, Power KG: HIV risk behaviour correlates among injecting drug users in Greek prisons. Addiction 2000;95:1207–1216.
  41. Stohler R, Dursteler-Mac Farland KM, Gramespacher C, Petitjean S, Battegay R, Ladewig D: A comparison of heroin chasers with heroin injectors in Switzerland. Eur Addict Res 2000;6:154–159.
  42. Healey A, Knapp M, Marsden J, Gossop M, Stewart D: Criminal outcomes and costs of treatment services for injecting and non-injecting heroin users: Evidence from a national prospective cohort survey. J Health Serv Res Policy 2003;8:134–141.
  43. Smyth BP, O’Brien M, Barry J: Trends in treated opiate misuse in Dublin: The emergence of chasing the dragon. Addiction 2000;95:1217–1223.
  44. French MT, Zarkin GA, Hubbard RL, Rachal JV: The effects of time in drug abuse treatment and employment on posttreatment drug use and criminal activity. Am J Drug Alcohol Abuse 1993;19:19–33.
  45. Duburcq A, Charpak Y, Blin P, Madec L: Two years follow-up of a heroin users cohort treated with high dosage buprenorphine. Results of the SPESUB study (pharmacoepidemiologic follow-up of general practice Subutex) (in French). Rev Epidemiol Sante Publique 2000;48:363–373.
  46. Gossop M, Griffiths P, Powis B, Williamson S, Strang J: Frequency of non-fatal heroin overdose: Survey of heroin users recruited in non-clinical settings. BMJ 1996;313:402.
  47. Darke S, Ross J: Fatal heroin overdoses resulting from non-injecting routes of administration, NSW, Australia, 1992–1996. Addiction 2000;95:569–573.
  48. Smolka M, Schmidt LG: The influence of heroin dose and route of administration on the severity of the opiate withdrawal syndrome. Addiction 1999;94:1191–1198.
  49. Buchanan J, Young L: The war on drugs – A war on drug users? Drugs: Educ Prev Policy 2000;7:409–422.
  50. van den Brink W, Hendriks VM, Blanken P, Huijsman IA, van Ree JM: Medical co-prescription of heroin: Two randomized controlled trials. Central Committee on the Treatment of Heroin Addicts (CCBH), Netherlands, 2002.
  51. Uchtenhagen A, Dobler-Mikula A, Steffen T, Gutzwiller F, Bläter R, Pfeifer S: Prescription of Narcotics for Heroin Addicts: Main Results of the Swiss National Cohort Study. Basel, Karger, 1999.
  52. German Project of Heroin Assisted Treatment of Opiate Dependent Patients. http://www.heroinstudie.de. Accessed January 2005.


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