Substance Use
The health impacts of displacement: modelling community spread of overdose following homeless encampment sweeps Kumi Smith* Kumi Smith Smith Smith Smith Smith Smith Smith University of Minnesota
Background: People experiencing homelessness (PEH) have extraordinarily elevated risk of opioid overdose compared to the general population. This population sometimes form encampments, or informal, collectively organized living areas that provide safety and opportunities for resource sharing. Much debate centers on the potential impact of forced displacement of PEH by public agencies (e.g. parks, transit, public works) on overdose risk, whether due to stress driven drug use, community fragmentation, and disruption of drug supply.
Methods: The study used a citizen-science approach to collect information on agency-led forced displacements in Minneapolis, Minnesota, in which community members (PEH, service providers) reported displacement events during monthly meetings. This data was validated against city records. Point level data of non-fatal opioid overdose events were obtained from emergency medical services records, and census tract-level social determinants of health (SDOH) were obtained from multiple sources. Endemic-epidemic spatiotemporal regression models were then used to estimate the impact of SDOH on the background rate of non-fatal opioid overdose events (endemic) and the degree to which forced displacements trigger future overdose events (epidemic).
Results: A total of 1431 non-fatal overdoses and 87 displacement events were reported between March 2024 and April 2025 (Fig 1). Exposure to a displacement event had a significant and positive effect on the future risk of overdose. A displacement event that occurred within 400 meters and 3 days of an overdose event increased the risk of a new non-fatal overdose by 1.58 (rate ratio=1.58, 95% CI, 1.09-2.31). Similar spatiotemporal patterns were observed across all other spatiotemporal bandwidths.
Conclusions: Results demonstrate that public agency-led encampment displacements are significantly associated with increased local risk of opioid overdoses after adjusting for community-level SDOH. Alternative strategies, like encampment resolution or specialized displacement service providers, may not only connect PEH to stable housing and services but also mitigate excess overdose. This study further demonstrates the feasibility of community-engaged approaches to involving PEH in research on their well-being.
