A Novel Index Measure of Housing-Related Risk as a Predictor of Overdose Among Young People Who Inject Drugs and Injection Networks.

For people who inject drugs (PWID), housing instability due to decreasing housing affordability and other factors (e.g., loss of housing due to severed relational ties, evictions due to drug use) results in added pressure on an already vulnerable population. Findings on the relationship between housing instability and overdose risk among PWID have been equivocal, in part due to inconsistent and conceptually incomplete operationalizations of housing instability. We propose a holistic, multi-indicator measure of housing instability and examine its association with drug overdose to improve understanding of its relationship to overdose. The baseline data from a network-based, longitudinal study of young PWID and their networks living in metropolitan Chicago, Illinois was analyzed to examine the relationship between a housing instability index score-consisting of five dichotomous variables assessing housing instability-and lifetime overdose count using negative binomial regression. We found a significant positive association between the housing instability score and lifetime overdose count after adjusting for 9 variables. Our results support the practical utility of a multi-indicator measure of housing instability in predicting overdose and highlight the importance of taking a holistic approach to addressing housing instability when designing interventions.