The Harms of Involuntary Displacement for Unhoused People Who Use Drugs

Involuntary displacement has been shown to have significant negative effects on homeless individuals who inject drugs. Continual involuntary displacement has been associated with increased drug-related morbidity and mortality, contributing to additional deaths among unsheltered people experiencing homelessness who inject drugs [1]. Homelessness has been linked to relapse into injection drug use among those who have stopped injecting and increased risk behavior among those actively injecting [2]. Among young people who inject drugs, homelessness is associated with adverse psychosocial and health consequences, including the risk of overdosing, psychological distress, limited treatment access, and injection practices that increase the risk of HIV and hepatitis C transmission [3]. Furthermore, chronic homelessness, substandard housing, and housing instability have been associated with increased drug and alcohol use, including injection risk behaviors [5]. Homeless people and people who inject drugs have a higher risk of becoming carriers of methicillin-resistant Staphylococcus aureus (MRSA) due to crowding and poor hygiene [6]. Injecting drugs substantially increases the risk of hepatitis C virus (HCV) infection and is common among the homeless population [7]. Homelessness has been significantly associated with a return to injection drug use [8]. Public injecting has been found to be concentrated among the most vulnerable people who inject drugs, independently associated with homelessness, recent incarceration, high-intensity drug use, and injecting-related risks [9].

In addition to the physical health risks, involuntary displacement and homelessness have been linked to increased psychological distress and societal consequences due to drug use [10]. Studies have shown that involuntary displacement often creates various threats for the community and individuals 11. The portrayal of addiction as involving involuntary behavior in the face of intentional actions has been identified as a challenge for the concept of addiction [12]. Moreover, involuntary displacement and homelessness have been associated with increased stress, habits, and compulsive, overwhelming involuntary drug use [13].

Involuntary displacement and homelessness have a range of negative effects on homeless individuals who inject drugs, including increased drug-related morbidity and mortality, heightened risk of infectious diseases, psychological distress, and societal consequences. These findings underscore the urgent need for comprehensive support and interventions to address the complex challenges faced by this vulnerable population.

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8. Yoo R., Krawczyk N., Johns E., McCormack R., Rotrosen J., Mijanovich T.et al.. Association of substance use characteristics and future homelessness among emergency department patients with drug use or unhealthy alcohol use: results from a linked data longitudinal cohort analysis. Substance Abuse 2022;43(1):1100-1109. https://doi.org/10.1080/08897077.2022.2060445

9. Scheim A., Rachlis B., Bardwell G., & Mitra S.. Public drug injecting in london, ontario: a cross-sectional survey. Cmaj Open 2017;5(2):E290-E294. https://doi.org/10.9778/cmajo.20160163

10. Maria D., Padhye N., Yang Y., Gallardo K., Santos G., Jung J.et al.. Drug use patterns and predictors among homeless youth: results of an ecological momentary assessment. The American Journal of Drug and Alcohol Abuse 2017;44(5):551-560. https://doi.org/10.1080/00952990.2017.1407328

11. Pietkiewicz I., Wójcik M., Popio?ek K., & Bańka A.. Resources and adaptation following involuntary resettlement in the bytom-karb community. Polish Psychological Bulletin 2015;46(1):15-25. https://doi.org/10.1515/ppb-2015-0002

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have reported feeling that the impact of homelessness on their drug use behavior made hepatitis C virus (HCV) acquisition inevitable 4.