"Now that I'm here, I actually have the stability and the time to really think about stuff like that": Perspectives on medications for opioid use disorder in low-threshold harm reduction housing.

Sweeping of encampments is one policy approach to the growing visibility of homelessness and substance use in U.S. cities but is associated with increased overdose deaths. In 2022, to mitigate the impacts of a sweep, the City of Boston created seven harm reduction housing (HRH) sites to accommodate displaced individuals. HRH sites offered on-site or off-site medications for opioid use disorder (MOUD). As part of a broader parent study, we recruited 28 residents from HRH sites previously enrolled in a survey for semi-structured interviews, exploring their experiences with housing, the current HRH site, substance use, service access, overdose, MOUD, and more. We engaged in an inductive thematic analysis of the MOUD interview data. Four themes emerged from thematic analysis: (1) HRH sites afforded participants on-site access and linkages that facilitated MOUD initiation and retention; (2) when off-site, location, transportation and accessibility issues limited MOUD access; (3) MOUD prescribing policies at HRH sites were uniquely low-threshold; and (4) HRH-related MOUD engagement shaped health-related outcomes. Participants reported that HRH facilitated ease of access and delivery of MOUD both on and off site, raised considerations about how MOUD is accessed through HRH, and described how MOUD through HRH changed their substance use behaviors, health, and quality of life. Government entities that opt to clear encampments as a policy approach to address homelessness and substance use should also implement HRH interventions that facilitate MOUD access in conjunction. Such an approach would mitigate known harms associated with sweeps.