A recent study conducted in Glasgow, Scotland, as part of a broader randomised controlled trial, brings new insights into the growing global crisis of homelessness and drug-related deaths, worsened by the Covid pandemic.
Over the past decade, there has been a marked rise in the number of people experiencing homelessness globally, with an accompanying public health epidemic of drug-related fatalities. The study conducted between November 2021 and January 2022 interviewed twenty individuals experiencing homelessness who had survived at least one drug overdose within the past six months. The interviews took place in person, either at a drop-in centre for homeless people or emergency accommodations. The findings were published in the British Journal of Social Work.
The participants’ responses suggested that the pervasive availability of illicit drugs during the pandemic, along with the decreased availability of health and social care services, significantly increased their risk of drug use and overdose. The participants also highlighted the additional stress caused by a lack of autonomy and dehumanising experiences, leading to a significant sense of powerlessness.
Advocacy-based services were identified as a crucial support factor, highlighting the importance of dedicated homelessness staff and access to safe environments. However, it was clear that more research is required to develop specific interventions to address these issues, drawing from the perspectives of those with lived experience of health and social care in this context.
The research was conducted as part of the Pharmacist and Third Sector Homeless Outreach Engagement Nonmedical Independent prescribing Rx (PHOENIx) trial, a collaboration between National Health Service independent prescriber pharmacists and third-sector homelessness support workers. PHOENIx proactively outreaches every week to offer support with housing, welfare benefits, and wide-ranging health issues.
From the qualitative interviews, the study identified three major themes: the impact of the COVID-19 pandemic on mental health, housing insecurity, and access to service provision; an increased sense of powerlessness due to multi-agency stressors; and the crucial importance of advocacy-based services.
The findings underscore the necessity of developing adequate and sensitive responses to the intersecting challenges of homelessness and drug overdose risk. A toxic environment marked by the prevalence of illicit drugs, inadequate living conditions, and the constant witnessing of death led to re-traumatisation of many individuals placed in emergency accommodations. The study also highlights the challenges that participants faced in accessing statutory services for substance use and mental health, leading to a sense of discrimination and powerlessness.
Despite these bleak findings, participants universally emphasised the importance of third sector providers in creating and sustaining hope. Safe accommodation and advocacy were integral parts of cultivating recovery capital.
However, the study acknowledges its limitations. The findings are specific to those receiving the PHOENIx intervention, and while women made up 35% of the study participants, future research should further explore the gendered impact of homelessness and drug overdose. Additionally, the study sample was not ethnically diverse, pointing to the need for more research into the perspectives of racially minoritised groups in Scotland at the intersection of homelessness and drug use.
Ultimately, the study calls for urgent action to reassess the use of unsupported emergency accommodation for those at the highest risk of drug-related death and to understand the role of multi-agency stressors in escalating drug use. Importantly, it highlights the value participants placed on the role of third sector advocacy-based services, reaffirming the necessity for appropriate health and psychosocial support that ensures autonomy and choice in practice.
