Health risk associated with residential relocation among people who inject drugs in Los Angeles and San Francisco, CA: a cross sectional study

Abstract

Background Given the housing instability and frequent residential relocation (both volitional and hegemonic) of people who inject drugs, we sought to determine whether residential relocation (defined as sleeping in a different place in the past 30 days) is associated with health outcomes in a sample of people who inject drugs (PWID). Methods We recruited 601 PWID using targeted sampling and interviewed them between 2016 and 2018 in San Francisco and Los Angeles, CA about housing, drug use practices, and service utilization. We then developed multivariable regression models to investigate how residential relocation is associated with violence, health outcomes, and social service access. We analyzed our data between June 2018 and October 2019. Results Participants who relocated in the past 30 days had lower odds of being in substance use treatment (Adjusted Odds Ratio [AOR] = 0.62, 95% Confidence Interval [CI] = 0.42, 0.89) and higher odds of nonfatal overdose (AOR = 2.50, CI = 1.28, 4.90), receptive syringe sharing (AOR = 2.26, CI = 1.18, 4.32), severe food insecurity (AOR = 1.69, CI = 1.14, 2.50), having belongings stolen (AOR = 2.14, CI = 1.42, 3.21), experiencing physical assault (AOR = 1.58, CI = 1.03, 2.43), arrest (AOR = 1.64, CI = 1.02, 2.65), and jail (AOR = 1.90, CI = 1.16, 3.13) in the past 6 months when compared to those who did not relocate. Conclusions PWID who have relocated in the past 30 days have higher odds of experiencing violence and life- threatening adverse outcomes, and policies that disrupt living circumstances of PWID should be ended in favor of those that support housing stability.

Population-Level Health Effects of Involuntary Displacement of People Experiencing Unsheltered Homelessness Who Inject Drugs in US Cities

“…Empirical data collected from people experiencing homelessness who inject drugs in 2 cities in which data were available (Los Angeles and San Francisco, California) were used to estimate the changes to model parameters to reflect the association of outcomes with displacement (eTable 3 in Supplement 1). For example, people who reported being forcibly displaced in the past 30 days had an adjusted odds ratio (aOR) of 2.50 (95% CI, 1.28-4.90) for nonfatal overdose compared with people who had not been displaced in the past 30 days. This aOR was then applied as a multiplier to the base case overdose probabilities.…”

“…First, for each city, scenarios were modeled in which 1 of the 3 displacement parameters-overdose risk, syringe sharing probability, or MOUD-was unchanged with displacement, while the other 2 were affected by displacement. Additionally, for each city, a 3-way deterministic sensitivity analysis was performed using the upper and lower bounds of the 95% CIs from the study by Chiang et al 9 on the aORs that were used for the primary analysis. All 3 parameters were varied simultaneously for a "worstcase" and a "best-case" scenario.…”

“…Involuntary displacement may disproportionately impact people experiencing homelessness who use nonprescribed drugs because it can affect access to sterile injection equipment, naloxone, and medications for opioid use disorder (MOUD) . Decreased access to support services and life-saving medications may increase overdose risk and death . This modeling study aimed to better understand the potential long-term health effects of involuntary displacement among unsheltered people experiencing homelessness who inject drugs in 23 US cities.…”

“…7,8 Decreased access to support services and lifesaving medications may increase overdose risk and death. 9 This modeling study aimed to better understand the potential longterm health effects of involuntary displacement among unsheltered people experiencing homelessness who inject drugs in 23 US cities.…”

A Novel Index Measure of Housing-related Risk as a Predictor of Overdose among Young People Who Inject Drugs and Injection Networks

“…As a result, PWID who begin to experience housing instability often remain in a state of long-term, cyclical homelessness (12). Theoretically, housing instability can increase stress, depression, and anxiety, all of which are associated with increased risk for overdose (13)(14)(15)(16)(17)(18)(19)(20)(21). Housing instability is also directly associated with increased risk of overdose in some (5,9,14,(22)(23)(24)(25)(26)(27), but not all studies (28-30), perhaps partly due to the inconsistent conceptualizations of housing instability across studies.…”