Population-Level Health Effects of Involuntary Displacement of People Experiencing Unsheltered Homelessness Who Inject Drugs in US Cities
Authors: Barocas Joshua A. , Nall Samantha K. , Axelrath Sarah , Pladsen Courtney , Boyer Alaina , Kral Alex H. , Meehan Ashley A. , Savinkina Alexandra , Peery David , Bien Michael , Agnew-Brune Christine , Goldshear Jesse , Chiang Joey , Linas Benjamin P. , Gonsalves Gregg , Bluthenthal Ricky N. , Mosites Emily ,   NHBS Study Group, Wortley Pascale , Todd Jeff , Melton David , Flynn Colin , German Danielle , Klevens Monina , Doherty Rose , O'Cleirigh Conall , Jimenez Antonio , Clyde Thomas , Poe Jonathon , Vaaler Margaret , Deng Jie , Al-Tayyib Alia , Shodell Danielle , Higgins Emily , Griffin Vivian , Sanger Corrine , Khuwaja Salma , Lopez Zaida , Padgett Paige , Kwa Sey Ekow , Ma Yingbo , Santacruz Hugo , Brantley Meredith , Mathews Christopher , Marr Jack , Spencer Emma , Nixon Willie , Forrest David , Anderson Bridget , Tate Ashley , Abrego Meaghan , Robinson William T. , Barak Narquis , Beckford Jeremy M. , Braunstein Sarah , Rivera Alexis , Carrillo Sidney , Ibrahim Abdel R. , Wogayehu Afework , Moraga Luis , Brady Kathleen A. , Shinefeld Jennifer , Nnumolu Chrysanthus , Menza Timothy W. , Orellana E. Roberto , Bhattari Amisha , Flynn Anna , Chambers Onika , Ramos Marisa , McFarland Will , Lin Jessica , Miller Desmond , Miranda De Leon Sandra , Rolon-Colon Yadira , Martinez Maria P. , Jaenicke Tom , Glick Saral , Kienzle Jennifer , Smith Brandie , Reid Toyah , Opoku Jenevieve , Kuo Irene , Adams Monica , Baugher Amy , Broz Dita , Burnett Janet , Chambers Susan , Chapin-Bardales Johanna , Denning Paul , Finlayson Teresa , Handanagic Senad , Hickey Terence , Kanny Dafna , Lee Kathryn , Lewis Rashunda , Morris Elana , Olansky Evelyn , Robbins Taylor , Sionean Catlainn , Smith Amanda , Teplinskaya Anna , Trujillo Kindsay , Wejnert Cyprian , Whiteman Ari , Xia Mingjing 
Published: April 2023

Importance

At least 500 000 people in the US experience homelessness nightly. More than 30% of people experiencing homelessness also have a substance use disorder. Involuntary displacement is a common practice in responding to unsheltered people experiencing homelessness. Understanding the health implications of displacement (eg, “sweeps,” “clearings,” “cleanups”) is important, especially as they relate to key substance use disorder outcomes.

Objective

To estimate the long-term health effects of involuntary displacement of people experiencing homelessness who inject drugs in 23 US cities.

Design, Setting, and Participants

A closed cohort microsimulation model that simulates the natural history of injection drug use and health outcomes among people experiencing homelessness who inject drugs in 23 US cities. The model was populated with city-level data from the Centers for Disease Control and Prevention’s National HIV Behavioral Surveillance system and published data to make representative cohorts of people experiencing homelessness who inject drugs in those cities.

Main Outcomes and Measures

Projected outcomes included overdose mortality, serious injection–related infections and mortality related to serious injection–related infections, hospitalizations, initiations of medications for opioid use disorder, and life-years lived over a 10-year period for 2 scenarios: “no displacement” and “continual involuntary displacement.” The population-attributable fraction of continual displacement to mortality was estimated among this population.

Results

Models estimated between 974 and 2175 additional overdose deaths per 10 000 people experiencing homelessness at 10 years in scenarios in which people experiencing homelessness who inject drugs were continually involuntarily displaced compared with no displacement. Between 611 and 1360 additional people experiencing homelessness who inject drugs per 10 000 people were estimated to be hospitalized with continual involuntary displacement, and there will be an estimated 3140 to 8812 fewer initiations of medications for opioid use disorder per 10 000 people. Continual involuntary displacement may contribute to between 15.6% and 24.4% of additional deaths among unsheltered people experiencing homelessness who inject drugs over a 10-year period.

Conclusion and Relevance

Involuntary displacement of people experiencing homelessness may substantially increase drug-related morbidity and mortality. These findings have implications for the practice of involuntary displacement, as well as policies such as access to housing and supportive services, that could mitigate these harms.