A new article published in the Journal of the American Medical Association predicts that continual involuntary displacement — commonly known as sweeps — could account for a large portion of deaths and illness among unsheltered people who inject drugs.
Based on previous studies showing that sweeps decrease the likelihood of people seeking substance abuse treatment and heighten the prevalence of more risky behaviors such as needle sharing, researchers modeled that up to 24.4 percent of deaths over a 10-year period across 23 U.S. cities may be attributable to sweeps. In Seattle, the model predicts that repeated involuntary displacement is associated with more than 19 percent of predicted deaths among people who inject drugs.
The paper’s lead analyst, Samantha Nall — a research assistant at the University of Colorado Anschutz Medical Campus — said the reason the authors looked at the specific subset of unsheltered people who inject drugs is because there was population-level health data available via the Centers for Disease Control and Prevention’s National HIV Behavioral Surveillance System, which gathers information on people who are at higher risk of contracting the disease.
According to Nall, the study was based on a computer simulation rather than observed health outcomes.
“If you imagine sitting down in a computer, and it’s like a Sim-like simulation,” Nall said. “So you’re going to create this group of people: you’re gonna put in age ranges, you’re gonna put in sex distribution, you’re also going to put in their injection frequency — so no injection, low injection frequency or high injection frequency. And then you’re also going to put in their injection behaviors, so needle sharing as well as skin cleaning.”
“Each week, they have a probability of getting something; we call this a ‘sequelae.’ And we defined that as having an overdose, getting a skin and soft tissue infection or getting a case of infective endocarditis, which is an infection of the heart valve or the aorta,” she said.
In addition to increased mortality, the model also found a substantial increase in non-fatal overdoses. An unsheltered person in Seattle who injects drugs was predicted to experience 2.5 times more overdoses over a 10-year period with continual involuntary displacement.
According to the Substance Abuse and Mental Health Services Administration, more than 30 percent of unsheltered people have a substance use disorder.
Nall said that the study had limitations, including the focus only on people who inject drugs and not other drugs that are smoked, which have become more popular in recent years. In its 2022 overdose death report, Public Health – Seattle & King County found that fentanyl, which is commonly smoked but can also be injected or ingested, was involved in 70 percent of overdose deaths, compared to less than 10 percent prior to 2018.
Nall anticipated that, if there was a model for fentanyl and other non-injectable drugs, researchers would find similar results to her study.
“Because we focused on injecting opioids, I can’t really speak on non-injectable drugs,” Nall said. “But in my personal opinion, I think that sweeps or involuntary displacement is not beneficial in any regard, just because there are other options we have. We should be connecting people to services, and when you sweep people away, you may be taking them away from their services that they do have access to, or the community that they’ve built. So I think the results would be similar. I’m not sure about overdose rates or anything specific like that. But I do think the sweeps are detrimental to the health of this population overall.”
Research into the health impacts of sweeps has been relatively sparse due to difficulties in the collection of data. However, studies such as the one Nall co-authored could begin to validate what advocates have been saying for many years: Sweeps exacerbate the negative consequences of homelessness and its adverse health impacts.
Between 2012 and 2021, 1,429 people experiencing homelessness died in King County. The median age of people who died was 51.
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Guy Oron is the staff reporter for Real Change. Find them on Twitter, @GuyOron.
Read more of the Apr. 26-May 2, 2023 issue.