---
title: "Encampment sweeps and homelessness outcomes among people who use drugs in Vancouver"
id: "plos-medicine-0-encampment-sweeps-and-persistent-homelessness-among-unhoused-people-who-use"
canonical_url: "https://medichelpline.com/clinical-feed/plos-medicine-0-encampment-sweeps-and-persistent-homelessness-among-unhoused-people-who-use"
content_type: "clinical_feed_article"
specialty: "General"
source_name: "PLOS Medicine"
source_url: "https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005033"
published_at: "2026-09-24T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Encampment sweeps and homelessness outcomes among people who use drugs in Vancouver
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-medicine-0-encampment-sweeps-and-persistent-homelessness-among-unhoused-people-who-use
- **Specialty:** [General](https://medichelpline.com/clinical-feed/general.md)
- **Primary Source:** PLOS Medicine
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005033)
- **Published At:** 2026-09-24T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- This prospective cohort study examined whether municipal **encampment sweeps** (confiscation of belongings and forced displacement) affected transitions out of homelessness among unhoused people who use drugs in Vancouver between 2021 and 2025. - Data came from two harmonized cohorts (VIDUS and ACCESS) with semi-annual interviews of community-recruited participants; analytic sample sizes were 235 for the main analysis (confiscation) and 154 for the secondary analysis (forced displacement between 2023–2025). - Exposure measures were self-reported municipal government–enforced confiscation of personal belongings (Dec 1, 2021–May 31, 2025) and, in a secondary analysis, municipal government–enforced forced displacement (June 1, 2023–May 31, 2025). - The outcome was no longer reporting homelessness in the past 6 months during follow-up (i.e., transitioning from homelessness). - Statistical approach used proportional hazards marginal structural modeling (MSM) to adjust for time-varying confounders including demographics, drug use patterns, health status, and other social/structural exposures. - Among 235 participants, 59 (25.1%) reported confiscation at baseline; 128 (54.5%) stopped reporting homelessness during follow-up (incidence 55.6 per 100 person-years; 95% CI 46.4–66.1). - In the secondary analysis of 154 participants, 50 (32.5%) reported forced displacement at baseline; 62 (40.3%) stopped reporting homelessness during follow-up. - Adjusted results: confiscation of belongings was associated with a lower hazard of transitioning out of homelessness (AHR 0.35; 95% CI 0.13–0.94; p = 0.036). Forced displacement was more strongly associated with reduced transitions out of homelessness (AHR 0.07; 95% CI 0.02–0.20; p < 0.001). - Authors note major limitations: observational design limiting causal inference, potential overestimation of transition rates due to sampling of service-connected participants, and lack of data on the quality of housing placements. - The study concludes that municipal confiscation and forced displacement may undermine pathways to housing and argues for policy approaches prioritizing dignified, affordable housing rather than practices that perpetuate homelessness.
## Clinical Analysis & Structured Key Points
[ Skip to main content ](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005033#main-content) Advertisement * [plos.org](https://plos.org/) * [Create account](https://community.plos.org/registration/new) * [Sign in](https://journals.plos.org/user/secure/login?page=%2Fplosmedicine%2Farticle%3Fid%3D10.1371%2Fjournal.pmed.1005033) * * About * Browse * Publish * [](https://journals.plos.org/plosmedicine/ "PLOS Medicine") * Search [advanced search](https://journals.plos.org/plosmedicine/search) * 0 [Save](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005033#savedHeader) [Total Mendeley and Citeulike bookmarks.](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005033#savedHeader) * 0 [Citation](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005033#citedHeader) [Paper's citation count computed by Dimensions.](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005033#citedHeader) * 43 [View](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005033#viewedHeader) [PLOS views and downloads.](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005033#viewedHeader) * 0 [Share](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005033#discussedHeader) [Sum of Facebook, Twitter, Reddit and Wikipedia activity.](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005033#discussedHeader) Open Access Peer-reviewed Research Article # Encampment sweeps and persistent homelessness among unhoused people who use drugs in Vancouver, Canada: A prospective cohort study * Kanna Hayashi , Roles Conceptualization, Funding acquisition, Methodology, Project administration, Writing – original draft * E-mail: bccsu-kh@bccsu.ubc.ca Affiliations British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0003-3843-2928 ](https://orcid.org/0000-0003-3843-2928 "ORCID Registry") ⨯ * Eric C. Sayre, Roles Data curation, Formal analysis, Writing – review & editing Affiliation British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-4526-278X ](https://orcid.org/0000-0002-4526-278X "ORCID Registry") ⨯ * Jennifer McDermid, Roles Writing – review & editing Affiliations Police Oversight With Evidence and Research, Vancouver, British Columbia, Canada, Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, British Columbia, Canada ⨯ * Samona Marsh, Roles Writing – review & editing Affiliations Police Oversight With Evidence and Research, Vancouver, British Columbia, Canada, Vancouver Area Network of Drug Users, Vancouver, British Columbia, Canada, Coalition of Peers Dismantling the Drug War, Vancouver, British Columbia, Canada, Research 101 and a Manifesto for Ethical Research in the Downtown Eastside, DTES Community Research Ethics Workshop (CREW), University of British Columbia Learning Exchange, Vancouver, British Columbia, Canada ⨯ * Caitlin Shane, Roles Writing – review & editing Affiliation Pivot Legal Society, Vancouver, British Columbia, Canada ⨯ * Michael-John Sheridan Milloy, Roles Funding acquisition, Project administration, Writing – review & editing Affiliations British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0003-3821-6221 ](https://orcid.org/0000-0003-3821-6221 "ORCID Registry") ⨯ * P.O.W.E.R., Affiliation Police Oversight With Evidence and Research, Vancouver, British Columbia, Canada ⨯ * Thomas Kerr Roles Funding acquisition, Project administration, Writing – review & editing Affiliations British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-0870-7153 ](https://orcid.org/0000-0002-0870-7153 "ORCID Registry") ⨯ # Encampment sweeps and persistent homelessness among unhoused people who use drugs in Vancouver, Canada: A prospective cohort study * Kanna Hayashi, * Eric C. Sayre, * Jennifer McDermid, * Samona Marsh, * Caitlin Shane, * Michael-John Sheridan Milloy, * P.O.W.E.R., * Thomas Kerr ![PLOS](https://journals.plos.org/resource/img/logo-plos-full-color.svg) x * Published: September 24, 2026 * * [Article](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005033) * [Authors](https://journals.plos.org/plosmedicine/article/authors?id=10.1371/journal.pmed.1005033) * [Metrics](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005033) * [Comments](https://journals.plos.org/plosmedicine/article/comments?id=10.1371/journal.pmed.1005033) * [Media Coverage](http://plos.altmetric.com/details/doi/10.1371/journal.pmed.1005033) * [Abstract](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005033#abstract0) * [Author summary](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005033#abstract1) * [Introduction](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005033#sec004) * [Methods](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005033#sec005) * [Results](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005033#sec010) * [Discussion](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005033#sec011) * [Supporting information](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005033#sec012) * [Acknowledgments](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005033#ack) * [References](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005033#references) * [Reader Comments](https://journals.plos.org/plosmedicine/article/comments?id=10.1371/journal.pmed.1005033) * [Figures](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005033) ## Abstract ### Background Housing is a key determinant of health. In response to increasingly visible homelessness amid a growing housing crisis, many jurisdictions in North America forcibly displace unhoused people from public spaces, routinely confiscating their personal belongings. While prior research demonstrated various health-related harms associated with these “encampment sweeps,” the impact on housing placements among otherwise unhoused people remains unclear. We sought to estimate the relationship between experiencing encampment sweeps and transitioning from homelessness among unhoused people who use drugs in Vancouver, Canada. ### Methods and findings Data were derived from two harmonized prospective cohort studies of people who use drugs in Vancouver, followed through semi-annual interviews between December 1, 2021 and May 31, 2025. We used proportional hazard marginal structural modeling (MSM) to examine if experiencing municipal government-enforced confiscation of personal belongings was associated with no longer reporting homelessness in the past 6 months during follow-up among unhoused participants after adjusting for a range of potential time-varying confounders including demographic characteristics, drug use patterns, health status and other social/structural exposures. A secondary analysis replaced confiscation of belongings with municipal government-enforced forced displacement that may have not involved confiscation of belongings between June 1, 2023 and May 31, 2025. Among 235 participants, 59 (25.1%) reported confiscation of their belongings at baseline. During follow-up, 128 (54.5%) stopped reporting homelessness, corresponding to an incidence rate of 55.6 (95% confidence interval [CI]: 46.4, 66.1) cases per 100 person-years. In the secondary analysis, 50 (32.5%) of 154 participants reported forced displacement at baseline and 62 (40.3%) stopped reporting homelessness during follow-up. In the proportional hazard MSM, confiscation of belongings (adjusted hazard ratio [AHR]: 0.35; 95% CI [0.13, 0.94]; _p_ = 0.036) and forced displacement (AHR: 0.07; 95% CI [0.02, 0.20]; _p_ ] U01DA021525 to MJSM [ ]) and the Canadian Institutes of Health Research (CIHR) (PJT-196009 to KH [ ]). KH holds the St. Paul’s Hospital Chair in Substance Use Research and is supported in part by the St. Paul’s Foundation [ ]. Police Oversight With Evidence and Research (P.O.W.E.R.) is supported in part by CIHR (PJT-190266 to KH [ ]) and the Social Sciences and Humanities Research Council of Canada (435-2023-0654 to KH [ ]). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. **Competing interests:** We have read the journal’s policy and the authors of this manuscript have the following competing interests. KH serves as an unpaid expert witness in litigation related to daytime sheltering. JM and SM are part of Police Oversight With Evidence and Research (P.O.W.E.R.). P.O.W.E.R. is a 19-member community-directed research group working to fill the gap between official police data and the lived experiences of people impacted by criminalization, with an ultimate goal of contributing to a reduction and elimination of law enforcement violence. The membership of P.O.W.E.R. is largely comprised of people with lived expertise of substance use and housing instability. The majority of P.O.W.E.R. members are also members of the Vancouver Area Network of Drug Users (VANDU) and Western Aboriginal Harm Reduction Society (WAHRS), which are community-based organizations that advocate for health and well-being of people who use drugs. P.O.W.E.R. is officially a community-based participatory action research project funded by the Canadian Institutes of Health Research (CIHR; PJT-190266) and the Social Sciences and Humanities Research Council (SSHRC; 435-2023-0654) (PI of both grants: KH). CIHR and SSHRC did not play any role in the design, implementation, or dissemination of the current study. Additionally, JM is a social worker who supports people with housing instability to access housing services. JM was not paid to work on the current manuscript as social worker. SM is additionally a member of the VANDU Board and the Coalition of Peers Dismantling the Drug War (CPDDW). Similar to VANDU, CPDDW is another community-based organization that advocates for the health and well-being of people who use drugs. SM was not paid by any of these organizations to work on the current manuscript. In summary, JM, SM, and P.O.W.E.R. provided valuable and substantial contributions to the analyses, interpretation, and discussion of data based on their lived/living experiences of the impacts of encampment sweeps. Their contributions served to strengthen the current study but did not undermine the scientific rigour of the study in any way. CS is a staff lawyer with Pivot Legal Society, a nonprofit and nonpartisan legal advocacy organization that seeks to address the root causes of poverty and social exclusion, and also collaborates with the P.O.W.E.R. project. While CS participated in the current study as part of her employment at Pivot, CS’ knowledge and insight into the human rights implications of encampment sweeps informed and strengthened the analyses, interpretation and discussion of data but did not interfere with the scientific rigour of the current study in any way. ECS, TK, and MJSM have nothing to declare. **Abbreviations:** ACCESS, AIDS Care Cohort to evaluate Exposure to Survival Services; AHR, adjusted hazard ratio; CI, confidence interval; CREW, Community Research Ethics Workshop; HIV, Human Immunodeficiency Virus; IQR, interquartile range; MSM, marginal structural modeling; NYC, New York City; PROMIS, Patient-Reported Outcomes Measurement Information System; SD, standard deviation; SROs, single-room occupancy hotels; US, United States; VIDUS, Vancouver Injection Drug Users Study ## Introduction Housing is a key determinant of health and is modifiable by public health and other policy interventions [[1](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005033#pmed.1005033.ref001)]. Despite such policy opportunity, regions across the United States (US) and Canada have faced a worsening housing crisis in recent years. While there is no universal definition of homelessness, the United Nations and other international and national organizations tend to conceptualize it along a continuum of situations characterized by a lack of stable, safe and adequate housing, ranging from living in public spaces or in places not intended for human habitation (i.e., unsheltered homelessness) to residing in emergency shelters, other temporary accommodations or housing that fails to meet public health and safety standards (i.e., sheltered homelessness) [[2](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005033#pmed.1005033.ref002),[3](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005033#pmed.1005033.ref003)]. Between 2023 and 2024, the US had an 18% increase in the number of people experiencing homelessness (including sheltered and unsheltered) [[4](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005033#pmed.1005033.ref004)]. In the Greater Vancouver region in Canada, the number of individuals experiencing homelessness incre
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