'There's No Hope for Any Kind of Decent Life': A Qualitative Study to Explore the Perspectives of People Experiencing Homelessness with a Recent Non-Fatal Overdose in Scotland

The past ten years has seen a marked increase in the numbers of people experiencing homelessness globally and an associated public health epidemic of drug-related deaths. Drawing from qualitative interviews as part of a wider pilot randomised controlled trial (RCT) conducted in Glasgow, Scotland with National Health Service pharmacists and third sector homeless outreach caseworkers, insights from those with living experience of both homelessness and a recent non-fatal drug overdose will be presented. Twenty people experiencing homelessness with at least one drug overdose in the past six months were interviewed in person, in a homelessness drop in centre or in emergency accommodation between November 2021 and January 2022. Findings from our study indicate that participants' drug use and overdose risk were exacerbated during the Covid-19 pandemic due to the pervasive availability of illicit drugs for those placed in emergency accommodation, alongside reduced support and access to health and social care services. Additionally, multi-agency stressors such as a lack of autonomy and dehumanising experiences were reported, leading to a significant sense of powerlessness. Furthermore, the necessity of advocacy-based services as critical aspects of support was identified, with importance placed upon dedicated, homelessness staff and access to safe environments. Interconnected issues of homelessness and drug misuse are complex, impacted by poverty, trauma and inequality. In Scotland, there has been a general upwards trend in drug-related deaths in the last ten years, with the country recording the highest drug-related deaths per capita in Europe. This study reports on face-to-face qualitative interviews that took place between November 2021 and January 2022 with twenty people who were homeless and had experienced a recent non-fatal drug overdose. We discuss the perspectives that participants described as significant in regards to their overdose risk. This included re-traumatising factors such as the Covid-19 pandemic, unsuitable accommodation, difficulty accessing health and social care services and multi-agency stressors. The findings suggest that safe housing and advocacy-based services are critical aspects of support.