How should we design substance use programs in our shelters to respond to the dynamics of overdose and socio-economic drivers of addiction?

Ashwin Parulkar, Senior Research Specialist

According to the New York City Department of Health and Mental Hygiene, overdose has been the leading cause of death among people experiencing homelessness in the city since 2014.

Our previous newsletter reported initial findings from a HELP USA  study that we conducted in two single adult shelters.  It examined the socio-economic drivers of substance use problems among our clients with an aim to recommend a program of services, rooted in the harm reduction approach (HR), to address substance problems before overdoses occur.

The final report identified two barriers that inhibit the implementation of harm reduction services in HELP USA shelters. First, the absence of a dedicated staff person to coordinate the implementation of a Department of Homeless Services (DHS) HR-based substance use policy requires multiple front-line staff to primarily respond to crises, such as overdoses.

Secondly, the official prohibition of substance use in shelters prevents the establishment of supervised spaces of drug and alcohol use in these facilities, which is an essential component of a comprehensive HR program.

The study offers two recommendations to address these gaps:

  • An HR team should be appointed and provided resources in shelters to provide harm reduction education and outpatient medical assisted treatment services to clients. 
  •  A dialogue with policymakers should begin to advocate for the establishment of supervised spaces of drug and alcohol use in shelters for clients that are connected to harm reduction programs.
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