Social exclusion, integration barriers, and drug-related risk behaviours among immigrants in Europe: a systematic scoping review.

Background: Europe has witnessed a significant increase in immigration over the last 20 years, which has been associated with complex public health issues. The immigrants, such as refugees, asylum seekers, and economic migrants, are exposed to various social exclusion processes and integration barriers that may increase their vulnerability to drug-related risk behaviours. Although there is increasing awareness of this problem, there is a dearth of research synthesising the interplay of social exclusion, integration barriers and substance use among immigrant groups in European settings. Purpose: The present systematic scoping review sought to identify and map the forms of social exclusion and integration barriers experienced by immigrants in Europe in relation to substance use service access. Methods: The systematic scoping review was completed as per the Joanna Briggs Institute (JBI) methodology and was reported following PRISMA-ScR guidelines. The searches were conducted in EBSCOhost databases, MEDLINE, Scopus, and Web of Science to find peer-reviewed qualitative and mixed-method studies published in English between 2015 and 2025. These studies were eligible provided that they had investigated the association between social exclusion or integration barriers and drug-related risk behaviours among immigrant populations residing in Europe. Results: Five out of 412 citations initially retrieved were included in the study. All the studies employed qualitative or mixed-methods designs and were carried out in Norway, Belgium, Germany and across four metropolitan cities in Europe. The included studies predominantly sampled immigrants already in contact with treatment or healthcare services and/or those experiencing homelessness or precarious housing. The synthesised results indicated that these specific immigrant subgroups experience a variety of interrelated barriers that comprise language challenges, stigma and cultural taboos surrounding substance use, discrimination and racism, lack of awareness of existing services, precarious legal and socioeconomic conditions, and inadequate culturally competent care. These barriers were experienced at an individual, community, and systemic level and seemed to contribute to social exclusion and vulnerability to substance use and harm. Conclusion: The findings suggest that social exclusion and integration barriers are closely associated with access to and experiences with substance use services among specific subgroups of immigrants in Europe. The results highlight the necessity to have culturally sensitive, low-threshold, and linguistically accessible substance use services. Policymakers, service providers, and researchers need to embrace intersectional and participatory strategies to address the structural determinants that may contribute to health inequities among immigrants.