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Principal Investigator: Kelly Doran
Organization: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
Fiscal Year: 2022
Award: $802,854
Funding agency: National Institute on Drug Abuse
PROJECT SUMMARY
Over 1.4 million people experience homelessness in the U.S. each year. A large body of evidence has
demonstrated the bidirectional relationship between homelessness and substance use (SU), and overdose is
the leading cause of death among people experiencing homelessness. The COVID-19 pandemic has greatly
exacerbated the existing and overlapping crises of homelessness and SU. Localities across the U.S. have
taken drastic steps to mitigate risk of COVID-19 among their homeless populations—including mass
movement of tens of thousands of homeless individuals to hotels—but there has not yet been research on how
these efforts have affected SU. We propose to conduct community-partnered, mixed methods research to
examine SU and related health impacts of a large-scale initiative to place people experiencing homelessness
into commercial hotels during the COVID-19 pandemic. The proposal leverages a natural experiment in New
York City, where 9,500 homeless individuals were moved to hotels during the pandemic. Aim 1 is to explore
how SU behaviors and treatment access changed for people experiencing homelessness who were placed into
hotels during the COVID-19 pandemic, using in-depth interviews with homeless services clients and staff. Aim
2 is to examine effects of hotel placement on SU-related and other health care outcomes using a difference-in-
differences approach with linked homeless services and Medicaid data. Aim 3 is to understand effects of hotel
placement on SU-related outcomes and to identify strengths, gaps, and best practices to inform future efforts,
using merged findings from Aims 1 and 2 as well as a national environmental scan of COVID-19 hotel
strategies relevant to SU disorders. The research will be conducted by a transdisciplinary investigator team in
partnership with the NYC Department of Social Services and Project Renewal, Inc., a nonprofit homeless and
health services provider. The research team will work together with a Stakeholder Advisory Board that includes
individuals with lived experience of homelessness to maximize the practical impact of the research, which has
been designed to inform local and national programmatic and policy interventions. The study will identify
challenges, assets, and innovations with durable lessons for the future that will be critical not only to prepare
for future pandemics, but also to inform future programs and policies to better respond to the overlapping
crises of homelessness and substance use disorder. This research is especially important as the pandemic is
expected to bring with it large increases in homelessness, as well as worsening SU and overdose nationally.
The pandemic has spurred communities to rapidly change how they address homelessness, including by
permanently converting unused hotels for long-term shelter and housing. It is therefore critically important to
understand the benefits and potential unintended consequences—and how to best mitigate them—of such
initiatives. We have a unique, time-limited opportunity to study this topic of large national importance.
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