ImportanceAt least 500 000 people in the US experience homelessness nightly. More than 30% of people experiencing homelessness also have a substance use disorder. Involuntary displacement is a common practice in responding to unsheltered people experiencing homelessness. Understanding the health implications of displacement (eg, “sweeps,” “clearings,” “cleanups”) is important, especially as they relate to key substance use disorder outcomes.ObjectiveTo estimate the long-term health effects of involuntary displacement of people experiencing homelessness who inject drugs in 23 US cities.Design, Setting, and ParticipantsA closed cohort microsimulation model that simulates the natural history of injection drug use and health outcomes among people experiencing homelessness who inject drugs in 23 US cities. The model was populated with city-level data from the Centers for Disease Control and Prevention’s National HIV Behavioral Surveillance system and published data to make representative cohorts of people experiencing homelessness who inject drugs in those cities.Main Outcomes and MeasuresProjected outcomes included overdose mortality, serious injection–related infections and mortality related to serious injection–related infections, hospitalizations, initiations of medications for opioid use disorder, and life-years lived over a 10-year period for 2 scenarios: “no displacement” and “continual involuntary displacement.” The population-attributable fraction of continual displacement to mortality was estimated among this population.ResultsModels estimated between 974 and 2175 additional overdose deaths per 10 000 people experiencing homelessness at 10 years in scenarios in which people experiencing homelessness who inject drugs were continually involuntarily displaced compared with no displacement. Between 611 and 1360 additional people experiencing homelessness who inject drugs per 10 000 people were estimated to be hospitalized with continual involuntary displacement, and there will be an estimated 3140 to 8812 fewer initiations of medications for opioid use disorder per 10 000 people. Continual involuntary displacement may contribute to between 15.6% and 24.4% of additional deaths among unsheltered people experiencing homelessness who inject drugs over a 10-year period.Conclusion and RelevanceInvoluntary displacement of people experiencing homelessness may substantially increase drug-related morbidity and mortality. These findings have implications for the practice of involuntary displacement, as well as policies such as access to housing and supportive services, that could mitigate these harms.
This is a report on archaeological work in two of Scotland's less well-known medieval burghs of Kelso and Peebles. The excavations at Wester Kelso/Floors Castle established that the original medieval burgh of Kelso or Wester Kelso was much further west than previously believed, being situated well inside the present Castle policies. That early settlement at Wester Kelso appears to have been abandoned in the 14th or 15th centuries, at the same time that the royal burgh of Roxburgh was deserted, probably as a result of the English occupation of Roxburgh Castle. The other settlement of Easter Kelso, near the abbey, survived and expanded northwards from the abbey along Roxburgh Street. The finding of a possible building terrace in Phase 1 at 13–19 Roxburgh Street indicates that settlement along the southern end of that street could date to as early as the 13th or 14th centuries. Combining the archaeological, cartographic and documentary evidence, it seems clear that 'Easter' Kelso, now Kelso, had expanded from the market area around the abbey northwards towards the Floors estate by the early 18th century.
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