Housing and harm reduction: what is the role of harm reduction in addressing homelessness?
Abstract
Homelessness and drug use often overlap and the harms of substance use are exacerbated by homelessness. Responding to the twin problems of homelessness and substance use is an important aspect of strategies to end homelessness. The introduction and development of ten year plans to end homelessness in North America heralds a new era of systemic responses to homelessness. Central to many of these plans is the adoption of 'Housing First' as a policy response. Housing First focuses directly on housing people regardless of current patterns of substance use. As such, harm reduction is a key principle of Housing First. In this paper, we examine Housing First as an example of the integration of housing and harm reduction and then put forth a community level policy framework to further promote the integration of harm reduction as part of a response to homelessness. Drawing on Rhodes' risk environment framework and current evidence of Housing First and harm reduction, we describe four key policy areas for action: (1) social inclusion policies; (2) adequate and appropriate supply of housing; (3) on demand harm reduction services and supports and (4) systemic and organizational infrastructure. We conclude by identifying areas for future research.
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Partnerships with harm reduction programs may also promote social inclusion and community integration for Housing First tenants who use drugs.
“In addition to benefits related to safer drug use, partnerships with harm reduction programs may also promote social inclusion and community integration for Housing First tenants who use drugs (Kerman et al., 2020b; Pauly et al., 2013).”
From Harm reduction outcomes and practices in Housing First: A mixed-methods systematic review (2021) · cites this paper as Pauly et al., 2013
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- Authors
- Pauly, B. (., Reist, D., Belle-Isle, L., & Schactman, C.
- Affiliations
- Canadian Institute for Substance Use Research (CA)
- Venue
- International Journal of Drug Policy
- Publisher
- Elsevier BV
- Published
- 2013-07
- Volume
- 24
- Issue
- 4
- Pages
- 284-290
- ISSN
- 0955-3959 (ISSN-L)
- OpenAlex
- W2025319606
- Cited by
- 113
- References
- 89
- Citations by year
- 2026: 12 · 2025: 15 · 2024: 12 · 2023: 5 · 2022: 8 · 2021: 16 · 2020: 10 · 2019: 7 · 2018: 5 · 2017: 9 · 2016: 6 · 2015: 3 · 2014: 4 · 2013: 1
- FWCI
- 8.45
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Drug Policy (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Mental Health Commission
- Topics
- Health Sciences › Health Professions › General Health Professions › Homelessness and Social Issues
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- homelessness, harm reduction, Housing First, substance use, social inclusion policy, housing supply, harm reduction services, organizational infrastructure
- MeSH terms
- Ill-Housed Persons, Housing, Humans, North America, Public Policy, Substance-Related Disorders, Harm Reduction
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