Harm Reduction Saves Lives: Reducing the Health Consequences Related to Drug Use Among People Experiencing Homelessness

By Lianna Foster-Bey

Heroin, Morphine, Fentanyl, Cocaine, Meth…the list of drugs that people overdose on is a long one. Concerted efforts have been ongoing for over a decade to address this crisis. Despite this, the data remains stark. Sadly, although not surprisingly, overdose deaths during the COVID-19 pandemic (from January 2020 through January 2021) exceeded 90,000.  That is nearly a 30 percent increase in drug overdose deaths from the prior twelve-month period. While deaths due to drug overdose were already a significant public health issue, the pandemic has clearly compounded the issue. The numbers are important to fully grasp the scope, but more important is to address contributing factors to the overdose crisis and to the recent surge in deaths.

Since the start of the pandemic, I have been thinking about the service gaps and shutdowns that the pandemic triggered and how they have affected people experiencing homelessness and people who use drugs. At the height of the pandemic, when numerous service providers closed their doors, I saw this gap firsthand. For example, a long-time patient who had been experiencing homelessness and attended Alcoholic Anonymous meetings regularly prior to the pandemic; due to church closures, could no longer attend meetings. This fact, combined with his social isolation and housing instability led to the worsening of his already precarious situation.
The pandemic caused other disruptions in care.  I spent hours assisting patients in locating treatment centers for their substance use disorders (SUD) that were open and taking new patients. In addition, I was seeing and caring for numerous patients with major health issues related to substance use, everything from abscesses to infective endocarditis to communicable diseases (such as HIV, hepatitis B / C, STIs) to withdrawal to overdose. These experiences, both in the hospital and during Street Medicine Detroit outreach, showed the overlap between marginalized groups – such as people experiencing homelessness, persons who use drugs, and folks with mental illness.

This overlap and interaction between homelessness, Substance Use Disorder (SUD), and mental illness is the reason my Albert Schweitzer Fellowship project is focused on preventing some of the aforementioned health outcomes (i.e. abscesses, infective endocarditis, communicable diseases, overdoses) through the distribution of harm reduction kits. I am also providing a space for open and non-judgmental conversations to learn about barriers to treatment for SUD and providing connections to SUD treatment services when requested. Using drugs should not, and does not need to, indefinitely lead to the contraction of infectious disease, being frequently burdened with painful abscesses, or overdosing. Harm reduction reduces these risks. Sometimes, it is a matter of taking a humanistic approach and allowing a person who uses drugs to make safer choices until they can successfully treat the substance use itself.

For my project, I am serving persons who use drugs and are also experiencing homelessness in Detroit and the surrounding areas. I have partnered with Street Medicine Detroit, a student-led free clinic and non-profit organization in Detroit that provides person-centered medical care to people experiencing homelessness. For the remaining months of my project, I am excited to continue to work alongside people experiencing homelessness, those who serve them, and local harm reduction organizations to provide support to and improve the health of persons who use drugs.

 The United Nations established August 19th as World Humanitarian Day. Albert Schweitzer Fellows at Authority Health have written posts documenting their project experiences to commemorate the occasion.