Encampment sweeps and persistent homelessness among unhoused people who use drugs in Vancouver, Canada: A prospective cohort study
8 affiliations
- 1British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- 2Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- 3Police Oversight With Evidence and Research, Vancouver, British Columbia, Canada
- 4Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, British Columbia, Canada
- 5Vancouver Area Network of Drug Users, Vancouver, British Columbia, Canada
- 6Coalition of Peers Dismantling the Drug War, Vancouver, British Columbia, Canada
- 7Research 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
- 8Pivot Legal Society, Vancouver, British Columbia, Canada
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 < 0.001) were both negatively associated with transitioning from homelessness. Main limitations include potential overestimation of rates of transitioning from homelessness and limited causal inference due to the observational study design. Conclusions: The confiscation of personal belongings and forced displacement might undermine pathways to housing. Our findings underscore the need for policy approaches that prioritize access to dignified and affordable housing rather than practices that perpetuate homelessness. Future research should assess the quality of housing that unhoused people are placed in and examine how it relates to returning to homelessness. Why was this study done?: What did the researchers do and find?: What do these findings mean?: In this prospective cohort study, Kanna Hayashi and colleagues examine whether encampment sweeps, including the confiscation of personal belongings and forced displacement, are associated with transitions out of homelessness among unhoused people who use drugs in Vancouver, Canada. Participants who experienced these interventions were less likely to stop reporting homelessness over time, highlighting concerns that such practices may hinder pathways to stable housing and underscoring the importance of housing-focused policy approaches.
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BibTeX
@article{hayashi2026encampment,
title = {{Encampment sweeps and persistent homelessness among unhoused people who use drugs in Vancouver, Canada: A prospective cohort study}},
author = {Kanna Hayashi and Eric C. Sayre and Jennifer McDermid and Samona Marsh and Caitlin Shane and Michael-John Sheridan Milloy and P.O.W.E.R. and Thomas Kerr},
journal = {PLOS Medicine},
year = {2026},
month = sep,
doi = {10.1371/journal.pmed.1005033},
url = {https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005033},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Encampment sweeps and persistent homelessness among unhoused people who use drugs in Vancouver, Canada: A prospective cohort study
AU - Kanna Hayashi
AU - Eric C. Sayre
AU - Jennifer McDermid
AU - Samona Marsh
AU - Caitlin Shane
AU - Michael-John Sheridan Milloy
AU - P.O.W.E.R.
AU - Thomas Kerr
PY - 2026
DA - 2026/09/24
JO - PLOS Medicine
DO - 10.1371/journal.pmed.1005033
UR - https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005033
AB - 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 < 0.001) were both negatively associated with transitioning from homelessness. Main limitations include potential overestimation of rates of transitioning from homelessness and limited causal inference due to the observational study design. Conclusions: The confiscation of personal belongings and forced displacement might undermine pathways to housing. Our findings underscore the need for policy approaches that prioritize access to dignified and affordable housing rather than practices that perpetuate homelessness. Future research should assess the quality of housing that unhoused people are placed in and examine how it relates to returning to homelessness. Why was this study done?: What did the researchers do and find?: What do these findings mean?: In this prospective cohort study, Kanna Hayashi and colleagues examine whether encampment sweeps, including the confiscation of personal belongings and forced displacement, are associated with transitions out of homelessness among unhoused people who use drugs in Vancouver, Canada. Participants who experienced these interventions were less likely to stop reporting homelessness over time, highlighting concerns that such practices may hinder pathways to stable housing and underscoring the importance of housing-focused policy approaches.
SN - 1549-1676
ER -