Effects of encampment sweeps on overdose mortality among people experiencing homelessness in Los Angeles, California

• In Event: The Intersection of Housing Insecurity and Substance Use Disorder—defining the crisis and identifying policy solutions

Abstract

Introduction/Background: Past research has found that community-level increases in homelessness are associated with increases in overdose mortality, underscoring how addressing homelessness can aid in confronting the overdose crisis. To address the growing prevalence of homelessness, however, cities across the U.S. have increasingly gravitated towards policies and practices that criminalize homelessness through bans on public camping and encampment sweeps that involuntarily displace people experiencing homelessness (PEH). Although these policies and practices are often justified in the name of public health, citing concerns about public drug use, infectious disease transmission, sanitation, and crime, such actions present substantial overdose risk to PEH by confiscating medications and other material possessions, disrupting access to treatment and other health and social services, fragmenting social communities, increasing risk of criminal-legal involvement and surveillance.  

Purpose/Research Question: Using geographic variation across council districts in the enforcement of Los Angeles, California’s camping ban (LAMC 41.18), this study aimed to measure the causal effect of encampment sweeps on overdose mortality among PEH.  

Data: This study used a novel panel, constructed at the council district-month-level, that includes (a) locations designated by LA City Council members as enforcement zones that must be free of encampments, (b) encampment sweeps executed by the Department of Sanitation (c) camping ban-related arrests  (d) number of overdose deaths among PEH, based on death certificate data from the County of Los Angeles Medical Examiner’s Office, and (e) total number of people experiencing unsheltered homelessness, estimated during the annual Point-in-Time (PIT) count.  

Research Design and Methods: We conducted an instrumental variable (IV) analysis, where our instrument was the cumulative count of camping ban enforcement zones, measured at the council district-month level, relative to the district’s population of PEH. This effectively measures each council member’s propensity to enact enforcement zones. The IV analysis was modeled in two stages. In stage 1, we predicted the rate of sweeps in a given council district-month as a function of the council district’s rate of enforcement zone designations up until the prior month with district, month, and year fixed effects. In stage 2, we used the instrument-induced changes in sweep rate from stage 1 to estimate the extent to which an increasing frequency of sweeps causes an increased overdose mortality rate among PEH. For our secondary analysis, we repeated this same modeling approach, substituting the rate of sweeps for the rate of camping ban-related arrests. 

Results/Findings: Between October 2021 – December 2024, there were 341 camping ban enforcement zones, 18,497 encampment sweeps, 3,990 camping ban-related arrests, and 2,022 overdose deaths among PEH in the City of Los Angeles, with substantial variation across council districts. Forthcoming results will present estimates of the change in PEH overdose mortality rate per unit increase in sweep rate and, separately, per unit increase in arrest rate. 

Conclusion/Implications: Findings from this research will elucidate health consequences of encampment sweeps among people experiencing homelessness. Policymakers can consider these consequences as they weigh approaches to resolving unsheltered homelessness in their communities.

Author

• Kyle J Moon, Johns Hopkins University
  Presenting Author