Drugs and social exclusion in ten European cities.
OBJECTIVE
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.


METHODS
Cross-sectional survey.


METHODS
Interviews were held in social services centers, town halls, streets, squares and other usual meeting points of the target population.


METHODS
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.


METHODS
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.


CONCLUSIONS
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.
March
Joan Carles
JC
Andalusian School of Public Health, Campus Universitario de Cartuja, Granada, Spain.
Oviedo-Joekes
Eugenia
E
Romero
Manuel
M
D000328:Adult; D019970:Cocaine-Related Disorders / Q000453:epidemiology* / Q000523:psychology / Q000534:rehabilitation; D003415:Crime / Q000706:statistics & numerical data; D005060:Europe; D005260:Female; D006306:Health Surveys; D006556:Heroin Dependence / Q000453:epidemiology* / Q000523:psychology / Q000534:rehabilitation; D006703:Ill-Housed Persons / Q000706:statistics & numerical data; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D011330:Prisons / Q000706:statistics & numerical data; D016079:Refusal to Treat / Q000706:statistics & numerical data; D012926:Social Control, Formal; D012934:Social Isolation; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data; D015819:Substance Abuse, Intravenous / Q000453:epidemiology* / Q000523:psychology / Q000534:rehabilitation; D011795:Surveys and Questionnaires; D014478:Unemployment / Q000706:statistics & numerical data; D014505:Urban Population / Q000706:statistics & numerical data*