Injection drug use trajectories among migrant populations: a narrative review

– Melo JS, Mittal ML, Horyniak D, Strathdee S, Werb D

Importance of this Study

This review aims to characterize the risk factors for injection drug use initiation associated with migration and describe how these might be addressed through interventions.

Key Concepts

Inter-Urban (IU): People who mobilize within the same metropolitan context, experiencing different risk environments across neighborhoods and local districts.

Internal/Domestic (ID): People who may migrate longer distances between noncontiguous communities but do so through within-country migration streams across regional boundaries.

International (Intl): People who cross international borders and, in this review, are explored in the context of well-established migration routes and interim mass migration events.

How This Study Was Conducted

Based on previous literature, we divide migration streams into three classes: intra-urban, internal, and international. We synthesized existing literature on migration and drug use to characterize how mobility and migration drive the initiation of injection drug use and the transmission of hepatitis and HIV. We employed a risk environment framework and focused on the San Diego-Tijuana border region as the most dynamic example of these phenomena.

Public Health Implications

  • Policies that exacerbate risk environments for Policies that worsen risk environments for migrants may contribute to the expansion of epidemics of injection-driven blood-borne disease.

  • Successful interventions in border regions may need to be tailored to migrant populations and distinguish between the vulnerabilities experienced by different migration classes and border settings.

What This Study Found

Socioeconomic Differences IU ID Intl

Cultural differences in arrival communities

Discrimination and marginalization

Exposure to new drug use norms

Integration challenges

Isolation and disrupted social ties

Stressors of undocumented status

Structural Dimensions

IU ID Intl

Barriers to healthcare or harm reduction

Constrained rights





Disrupted drug supply

Exposure to new drug and migration policy



Poverty and unemployment

Substandard housing and homelessness

Key Findings

  • Populationmixingbetweenmigrantsand receiving communities and the consequent transmission of social norms about injection drug use create risk environments for injection drug use initiation.

  • These risk environments are the result of local policy environments, injection drug use norms in receiving communities, migration-related stressors, social dislocation, and infringement on the rights of undocumented migrants.

A global, evidence-based approach on drug use.


© 2019 PRIMER