“Gonnae please help me, it’s something that ah injected misel wi. Gonnae help me, am scared am gonnae die tonigh.” What aspects of support are perceived as most significant in order to prevent drug overdose in people who experience homelessness?

Problem
People experiencing homelessness (PEH) often have problem poly-drug use which leads to fatal/non-fatal drug overdoses. Scotland has the highest rate of drug related deaths as compared to the rest of the UK and the European Union and Glasgow has the highest rate within Scotland; PEH account for over half of those dying from drug overdose. Harm reduction and innovative means of delivering substitute prescribing have dominated the landscape of service response and policy within the NHS in Scotland but innovative approaches are needed to buck current trends on overdoses in PEH.

Approach
The PHOENIx intervention (NHS Pharmacist and third sector homeless worker are an outreach service in Glasgow city centre offering weekly help with health and social care problems that matter most to PEH) is under evaluation in a pilot randomised controlled trial funded by the Drug Deaths Task Force. An embedded qualitative evaluation aims to explore patients’ perspectives of their drug use and overdoses, including aspects of support perceived as most significant in order to prevent subsequent drug overdose. Participants shared their perceptions of the existing pathway for health and social care follow up post drug overdose and experience of the PHOENIx intervention. Qualitative face-to-face semi-structured interviews with a purposive sample of 20 recruited participants in the intervention group were carried out. Thirteen (65%) of those interviewed were male. The sample had a mean age of 44.8 (30-58) years. Thematic analysis captured unanticipated insights and explored patients’ perceptions of drug use and support.

Findings
Participants described several components as significant in relation to their perspectives of drug use and support required to prevent drug overdose. Six main themes were identified using thematic analysis: (1) histories of abuse and trauma; (2) unsuitable accommodation; (3) ‘escaping’ by self-medicating; (4) ‘hope’ in recovery; (5) stigma and dehumanising treatment; (6) health and care management.

Consequences
This research provides crucial insight from people experiencing homelessness who use drugs, about how they struggle to survive and will be used to shape a new approach to addressing the underlying health and social care needs of people at highest risk of non-fatal and fatal overdoses.