Health and Economic Outcomes of Addressing Encampments of Individuals Using Opioids
A Housing First approach was projected to be costly but has the potential to improve the health of individuals experiencing homelessness and high-risk opioid use.
Lead author Hana Zwick, a research data analyst at the Syndemics Lab, and colleagues published a new simulation modeling study in JAMA Network Open to understand the public health and economic outcomes of strategies that arrest, disperse, or house people who live in encampments and experience high-risk opioid use compared to the encampment status quo.
Cities across the U.S. frequently disperse or arrest unhoused individuals who live in public areas or encampments, a population who have a high prevalence of opioid use disorder (OUD). This enforcement, known as encampment sweeps, harms the affected individuals by disrupting critical community connections and outreach services.
Strategies that house individuals with OUD and offer treatment with medications for OUD (MOUDs) can provide a supportive pathway for this population. However, there is limited data on whether housing that requires, rather than offers, MOUD engagement clinically improves the health outcomes of unhoused people with OUD.
Using the Researching Effective Strategies to Prevent Opioid Death (RESPOND) model, this study projects the full costs of encampment response strategies and rates of fatal overdoses experienced by a simulated cohort of 400 adults living in Massachusetts. The costs were informed by Medicaid reimbursement schedules and literature reviews and calculated from the perspective of the government payer, and included healthcare, carceral, housing, and sweep costs. The study excluded costs from the perspective of the surrounding community and the individuals in the encampment.
Key Findings
Simulation findings demonstrate that sweeps harm the health of people with OUD experiencing homelessness and are more costly than leaving the encampments undisturbed.
- The status quo strategy, which did not disrupt encampments, projected 50 deaths per 1,000 person-years and 2,990 person-weeks spent taking MOUD. The total cost was nearly $6.6 million.
- The sweep strategy, which dismantled encampments, increased mortality and spending compared to the status quo strategy. The model projected 53 deaths per 1,000 person-years and 1,694 person-weeks spent taking MOUD. The total cost was nearly $6.8 million.
- The strategy that offers housing with an MOUD requirement showed a comparable mortality rate with the status quo strategy, but increased spending and duration with MOUD. The model projected 51 deaths per 1,000 person-years and 3,050 person-weeks spent taking MOUD. The total cost was nearly $7.3 million.
- The strategy that offers housing without the MOUD requirement was costly but had the lowest mortality rate compared to other strategies. The model projected 49 deaths per 1,000 person-years and 5,014 person-weeks spent taking MOUD. The total cost was approximately $8.8 million.
This work highlights the life-or-death consequences of policy design for people experiencing homelessness and high-risk opioid use. Evidence-based, compassionate approaches like Housing First aren't just ethically sound—they’re more effective.
Hana Zwick, MS, Lead author and research data analyst at Boston Medical Center.
Access to safe and stable housing has been described as one of the four major dimensions of recovery from substance use disorder, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). However, authors note that housing strategies with the MOUD requirement can only be effective if more than 25% of unhoused individuals in the encampment choose to move into these housing units. While the study simulated the cohort, care delivery, and care utilization in Massachusetts only, the authors believe that other major cities can anticipate comparable results and come to understand that sweeps are not a sustainable response to address homelessness. Instead, the resources used to conduct a sweep may be reallocated to health and housing services.
The study, “Health and Economic Outcomes of Addressing Encampments of Individuals Using Opioids,” was published in JAMA Network Open on June 27, 2025.