Populations affected by forced displacement experience heightened exposure to risk factors for substance use disorders (SUDs), including trauma, disrupted legal and social protections, and exploitation. Despite this, forcibly displaced people remain under-recognized and under-researched in public health, particularly within addiction science. While data on specialised services for people with migrant backgrounds who use drugs (PMWUDs) in Europe is limited, research on implementing mainstream substance use interventions in humanitarian contexts is slowly expanding. However, existing studies often emphasise descriptive insights over actionable strategies, underscoring the need for evidence on scalable and practical interventions tailored to under-represented populations.
This study applied Syndemic Theory to inform a Delphi exercise aimed at building international consensus on policy and intervention priorities to support displaced people experiencing SUDs. An updated literature review and analysis of mainstream policy responses were translated into actionable recommendations, which were evaluated by an internationally representative panel of experts (n=17) through an explanatory sequential mixed-methods design involving an online survey and follow-up qualitative interviews. The advisory group brought expertise in displacement, addiction science, public health and policy, humanitarian work, and research.
Findings informed the design of a future Delphi study, potential stakeholders for its dissemination, and piloted a novel method for determining consensus that maintains contextual relevance – Contextualised Consensus Scoring (CCS) – which proved effective. Qualitative insights also highlighted how political will and bureaucratic barriers shape expert practice and contribute to perceptions of helplessness among professionals in this field. Two key themes – time and tension – emerged across the analysis, reflecting the dynamism of forced displacement and drug markets, the challenges of decision-making in unstable political climates, and the impact of legal status on service access.
The study highlights the urgent need for cross-sector collaboration and the integration of culturally and linguistically competent approaches into intervention services. Together, these findings underscore the value and necessity of conducting a full Delphi study to strengthen evidence-based responses for forcibly displaced populations affected by SUDs.