Susanna James - First Prize

I interviewed homeless people about their experiences of the drug supply during COVID-19. A thematic analysis was conducted on the interview transcript, which revealed five themes relating to the drug supply: availability of drugs, presence of dealers, quality of drugs, finances, and personal experiences. I found that there were mixed reports regarding the drug supply, with half of the participants reporting reductions in the drug supply and the other half reporting minimal changes to the drug supply. Some participants reported difficulty generating income for drugs, through begging, due to the lockdown measures. This meant for some participants, drugs were more difficult to access, even if drugs were in the locality. Participants also reported a reduced presence of drug dealers over the course of the pandemic, which inevitably made it more difficult to purchase drugs. One of the most interesting findings was that participants relied on their Opiate Substitute Treatments (safer alternatives to street drugs, such as heroin) more as a result of the pandemic. This suggests that a reduced supply of drugs, or increased difficulty in accessing drugs has meant that homeless people who use drugs are relying on drug services to a greater extent. This highlights the importance of these services and suggests that policy makers should capitalise this opportunity to improve the lives of homeless drug users by investing in harm reduction services for homeless people.

Research idea and originality
Given the recency of the pandemic, minimal research has been conducted exploring the drug supply during COVID-19. Whilst there are reports on the availability of drugs in different countries, and there is some literature about the experiences of drug users, there is no research to date on the experiences of homeless people who use drugs. This information is important because homeless people are a particularly vulnerable population: 78% of homeless people report having a physical health condition and 44% have a mental health diagnosis, contrasting with 37% and 23% respectively of the general population (Crisis, 2020).

Deaths among the homeless are on the rise in the UK, many of which are drug-related (Office for National Statistics, 2020). Research suggests that when drug supplies reduce, drug users’ tolerance to drugs reduces. This suggests that, if supply returns to normal, drug users may be more vulnerable to drug overdoses, a common cause of death amongst the homeless. It is important to address this issue, not only to help individuals but also to reduce the strain on the NHS, which is particularly stretched because of the pandemic. This research therefore informs third sector services and policy makers about the needs of homeless drug users, and the urgent need for increased provisions to prevent drug related deaths post COVID-19.

Well defined social challenge addressed by the research
Homeless people have been a difficult population to access for a long time. The findings from this study suggest that homeless people are seeking the help of services more, due a reduced ability to access drugs, and are relying more heavily on the treatment provided by drug services. This research thus reveals an opportunity for service providers and policy makers to engage homeless drug users and invest in harm reductions services. In turn, the concerning number of drug related deaths could be reduced, and homeless people could be invested into a greater extent. This research therefore demonstrates how policy makers can take advantage of drug shortages and difficulties accessing illicit drugs caused by lockdown restrictions.

Indication of how the research findings can be transferred to policy/business/third sector practices
The findings of this research can be implemented by policy makers and drug services through greater investment in harm reduction services, such as needle exchanges, with a particular focus on the homeless. Drug services could encourage people seeking Opiate Substitution Treatment, due to their reduced ability to access illicit drugs, to use the needle exchange. Here, services could provide harm reduction advice, for example by encouraging people not to share needles and to use in a clean environment.

Services should also use the increased engagement of homeless drug users as an opportunity to immunise homeless people from blood borne viruses, which are commonly spread through sharing injecting equipment used for drugs. Finally, policy makers could consider establishing more medically supervised injecting centres to reduce the spread of blood borne viruses, in turn reducing the rates of drug related deaths.