Housing and displacement as risk factors for negative health outcomes among people who inject drugs in Los Angeles, CA, and Denver, CO, USA

Abstract

Background The United States is currently experiencing a housing and homelessness crisis. In response, many cities have adopted policies of displacement that move unhoused people from place to place. Recent research indicates that these policies may have negative health impacts on unhoused people who use drugs. We sought to examine health risks associated with forced displacement among unhoused people who inject drugs (PWID). Methods We interviewed a community-recruited sample of opioid-using PWID in Los Angeles, CA and Denver, CO between April 2021 and November 2022 (N = 472) about their demographic/socioeconomic characteristics, drug use patterns, housing status, forced displacement including items discarded during displacements, and health risks. We constructed binomial generalized linear regression to examine the risk ratio of non-fatal overdose, and syringe and cooker/cotton sharing between four groups of participants: housed, unhoused and not displaced, unhoused and moved, and unhoused and displaced in the last three months. Results In the last 3 months, 52% of participants were unhoused and displaced by the government. Among those who were displaced, median number of forced displacements was 3 with 69% reporting loss of syringes, 56% loss of naloxone, and 22% loss of buprenorphine medicine. In multivariable models, adjusted risk ratios for unhoused and displaced participants were higher for nonfatal overdose (ARR = 3.84, 95% CI: 1.60-9.20), cooker/cotton sharing (ARR = 2.46, 95% CI: 1.40-4.33), and syringe sharing (ARR = 2.76, 95% CI: 1.04-7.29) as compared to housed participants. Conclusions Unhoused and displaced PWID experience elevated health risks. Ending the use of forced displacement of unhoused PWID is essential to reducing health risk in this population.