Encampment sweeps and persistent homelessness among unhoused people who use drugs in Vancouver, Canada: A prospective cohort study

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.