Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jun 2;8(6):e2517095.
doi: 10.1001/jamanetworkopen.2025.17095.

Health and Economic Outcomes of Addressing Encampments of Individuals Using Opioids

Hana Zwick  1 , Ryan O'Dea  1 , Joshua A Barocas  2 , Juliet Miko Flam-Ross  3 , Avik Chatterjee  4   5 , Alexander Y Walley  4   5 , Rebecca Arden Harris  6 , Bruce R Schackman  7 , Laura F White  8 , Stavroula A Chrysanthopoulou  9 , Sabrina A Assoumou  1   4 , Sean M Murphy  8 , Jake R Morgan  4 , Dimitri Baptiste  1 , Matthew Carroll  1 , Benjamin Paul Linas  1   4
Affiliations

Health and Economic Outcomes of Addressing Encampments of Individuals Using Opioids

Hana Zwick et al. JAMA Netw Open. .

Abstract

Importance: Many US communities face a crisis of people experiencing unsheltered homelessness often intertwined with opioid use. Jurisdictions seek policy options for managing unsanctioned encampments of this population, but their various outcomes are unclear.

Objective: To evaluate policy options and their health and economic outcomes for an encampment of people experiencing homelessness and opioid use disorder (OUD).

Design, setting, and participants: This decision analytical model study conducted a closed-cohort state-transition simulation using the Researching Effective Strategies to Prevent Opioid Death (RESPOND) model from October 2021 to October 2022. The study was based primarily on data from Massachusetts and simulated an urban encampment with a population experiencing homelessness and high-risk opioid use. Data analysis was performed from December 2022 to October 2024.

Exposure: The following encampment management strategies were modeled: (1) status quo (no sweep); (2) sweep, a sudden disruption of all residents, followed by no additional resources; (3) housing with medication for opioid use disorder (MOUD) requirement; or (4) housing without MOUD requirement.

Main outcomes and measures: The primary outcomes were overdose and all-cause mortality per 1000 person-years, weeks spent in housing and taking MOUD, and economic cost from a modified government payer perspective. Sensitivity analyses were conducted by varying uncertain parameters.

Results: The simulated cohort included 400 adults (mean [SD] age, 48 [17] years; 232 males [58.0%]). Under the status quo strategy, there were 50.4 (95% uncertainty interval [UI], 48.9-52.2) deaths per 1000 person-years, 15.5 (95% UI, 14.0-17.2) deaths from overdose per 1000 person-years, and 2990 (95% UI, 2897-3081) person-weeks spent taking MOUD for a total cost of $6 583 000 (95% UI, $6 502 000-$6 660 000). A sweep strategy resulted in 53.1 (95% UI, 51.3-55.2) deaths per 1000 person-years, 16.4 (95% UI, 18.2-20.2) deaths from overdose per 1000 person-years, and 1694 (95% UI, 1625-1764) person-weeks spent taking MOUD at a total cost of $6 820 000 (95% UI, $6 736 000-$6 899 000). The housing with medication requirement strategy resulted in 51.2 (95% UI, 49.4-53.0) deaths per 1000 person-years, 16.3 (95% UI, 14.6-18.1) deaths from overdose per 1000 person-years, and 3050 (95% UI, 3025-3075) person-weeks spent taking MOUD and in housing, for a total cost of $7 264 000 (95% UI, $7 188 000-$7 336 000). A housing without MOUD requirement strategy resulted in 49.2 (95% UI, 47.6-51.1) deaths per 1000 person-years, 14.3 (95% UI, 12.7-16.2) deaths from overdose per 1000 person-years, and 5014 (95% UI, 4942-5085) person-weeks spent taking MOUD and 14 511 (95% UI, 14 461-14 562) person-weeks spent in housing, for a total cost of $8 822 000 (95% UI, $8 774 000-$8 868 000).

Conclusions and relevance: In this decision analytical model study of approaches to homeless encampments involving individuals with OUD, sweeps increased mortality and spending. Housing without MOUD requirement was the most costly strategy but saved more lives.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Ms Zwick reported receiving grants from the National Institutes of Health (NIH) during the conduct of the study. Dr Chatterjee reported receiving grants from the National Institute on Drug Abuse (NIDA) during the conduct of the study. Dr White reported receiving grants from the NIH during the conduct of the study. Dr Assoumou reported receiving grants from the NIDA/NIH during the conduct of the study. Dr Murphy reported serving on the Indivior advisory board panel outside the submitted work. Mr Baptiste reported receiving grants from the NIDA/NIH during the conduct of the study and outside the submitted work. Mr Carroll reported receiving grants from the NIH during the conduct of the study and outside the submitted work. Dr Linas reported receiving grants from the NIDA/NIH during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Researching Effective Strategies to Prevent Opioid Death (RESPOND) Model
MOUD indicates medication for opioid use disorder.
Figure 2.
Figure 2.. Cost of Strategies by Category at 1-Year Time Horizon
MOUD indicates medication for opioid use disorder.
Figure 3.
Figure 3.. Fatal Overdoses by Strategy and Housing Overdose Multiplier Applied to Both Housing Strategies
MOUD indicates medication for opioid use disorder.
See this image and copyright information in PMC

References

    1. Baggett TP. The CareZONE mobile outreach initiative: pilot evaluation, 01/16/2018 - 11/16/2018. January 31, 2019. Accessed December 10, 2021. https://www.kraftcommunityhealth.org/wp-content/uploads/2020/04/CareZONE...
    1. National Alliance to End Homelessness. State of homelessness: 2023. edition. Accessed October 2, 2023. https://endhomelessness.org/wp-content/uploads/2024/10/StateOfHomelessne...
    1. Barocas JA, Nall SK, Axelrath S, et al. ; NHBS Study Group . Population-level health effects of involuntary displacement of people experiencing unsheltered homelessness who inject drugs in US Cities. JAMA. 2023;329(17):1478-1486. doi: 10.1001/jama.2023.4800 - DOI - PMC - PubMed
    1. Dwyer D. Debate erupted in the South End over the city’s approach to the opioid crisis: here’s what you need to know. August 9, 2019. Accessed December 27, 2022. https://www.boston.com/news/local-news/2019/08/09/operation-clean-sweep-...
    1. Padmanabhan P, Jurecka C, Nall SK, Goldshear JL, Barocas JA. Association of involuntary displacement of people experiencing homelessness and crime in Denver, CO: a spatiotemporal analysis. J Urban Health. 2025;102(1):8-18. doi: 10.1007/s11524-024-00924-1 - DOI - PMC - PubMed

Publication types

Substances