Adapting to changing risk environments: examining overdose risk and socio-spatial patterns of unstably housed people who use drugs during converging public health crises

Abstract

Background

The COVID-19 pandemic exacerbated the US overdose crisis and disproportionately impacted unstably housed people who use drugs. Measures to address the pandemic within the context of crisis produced differential effects, particularly among people who use drugs. Examining how unstably housed people who use drugs adapted to shifting risk environments is imperative to responding to future crises.

Methods

Rapid ethnographic data was collected from June 2020 to April 2021 in Rhode Island. Data include in-depth interviews with 39 unstably housed people who use drugs and approximately 50 hours of fieldwork.

Findings

COVID-related service disruptions and policing of public space (e.g. city curfews) reinforced participants’ marginality and increased surveillance. This heightened visibility disrupted participants’ socio-spatial patterns as they were regularly relocated and faced increased risk of arrest due to public drug use and housing instability. Participants regularly weighed overdose risk reduction against COVID-19 exposure and risk of arrest, which increased harm.

Conclusion

Findings demonstrate how COVID-related public health measures intersected with participants’ socio-spatial and drug use patterns in ways that increased overdose risk. Drawing on health equity approaches when responding to crisis situations is critical to address intersecting inequities faced by unstably housed people who use drugs.

Keywords:

• Covid-19
• overdose
• housing instability
• surveillance
• drug use
• qualitative research

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work took place on the traditional lands of the Narragansett peoples. We want to extend our thanks to all participants and outreach workers who contributed to this work, along with project staff. This project was funded by the Rhode Island Department of Health. ABC is also supported by the National Institute of General Medical Sciences of the NIH [P20GM125507] and the National Institute on Drug Abuse of the NIH through the CJRT training program [R25DA037190]. The statements, opinions, and conclusions within this article are those of the authors only and do not represent official positions or policy of the funding organizations.