Health Harms Associated With Forced Displacements Among People Who Use Drugs in San Francisco, California

Forced displacements may increase overdose risk among people who use drugs (PWUD) through disruptions to naloxone, safer drug use supplies, and substance use disorder (SUD) treatment access. We investigated whether forced displacements were associated with nonfatal overdose, naloxone access, and SUD treatment access among PWUD in San Francisco, California.

We conducted a cross-sectional survey of 790 PWUD from September 2024 to September 2025. Participants reported number of forced displacements by police, security guards, or other officials in the past 3 months. Outcomes included past 3-month overdoses, naloxone access, and SUD treatment. We conducted separate multivariable modified Poisson models with robust standard errors for each outcome, adjusting for age, gender, race, housing status, past 3-month opioid use, and interviewer.

In the past 3 months, 70% of participants were forcibly displaced at least once and 36% were displaced 20 or more times. Of those forcibly displaced at least once, 65% had their belongings taken by those displacing them. Eleven percent experienced an overdose; 62% were provided with naloxone; 33% received any SUD treatment, and 18% were currently receiving any treatment. Those forcibly displaced 20+ times had 1.99 times the prevalence of overdose of non-displaced participants (95% confidence interval [CI]: 1.01-3.93). Participants who had their belongings taken had 1.59 times the prevalence of nonfatal overdose of those who did not (95% CI: 1.00-2.53). There was no association between forced displacements and receiving any SUD treatment, but participants who were forcibly displaced 20+ times had a lower prevalence of currently receiving any treatment (adjusted prevalence ratio = 0.44, 95% CI: 0.27-0.72).

Our findings demonstrate forced displacements have significant health harms and negatively affect treatment services. Forced displacement policies should be replaced with public health approaches that prioritize stability, housing, and supportive services.