Promoting housing stability and preventing overdose deaths among people recently housed: housing plus overdose prevention (HOPE) navigation

The National Institute on Drug Abuse awarded Boston Medical Center Corporation $296,460 under NIDA's Drug Use and Addiction Research Programs (CFDA 93.279) on September 1, 2026, for a research project examining housing stability and overdose prevention among people transitioning from shelter into housing.

The award funds a prospective longitudinal cohort study following individuals as they move out of shelter into housing, with one-year follow-up tracking substance use outcomes (non-fatal overdose, unwitnessed substance use) and housing-related outcomes (housing retention, loneliness, quality of life). The study will assess engagement with substance use treatment services and all-cause mortality, and will explore environmental and supportive housing factors that promote positive substance use and housing outcomes. Boston Medical Center will partner with the Boston Public Health Commission to recruit participants and collect data through direct surveys and interviews, health records access (including vital registration), and homeless services administrative data. The research is framed by the Rhodes Risk Environment Theory and the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework.

Following longitudinal findings, the study will convene a community advisory board composed of people with lived experience of homelessness and substance use alongside service providers working with recently housed populations to inform intervention development.

Work is performed in Roxbury, Massachusetts. The period of performance runs from September 1, 2026, through July 31, 2029.

Abstract

Housing placement is an important public health intervention for people experiencing homelessness (PEH), but the immediate post-housing period confers heightened overdose and other health-related risks, particularly for people who use drugs. Prior scholarship has demonstrated heightened risks of housing eviction and all-cause mortality for PEH who use drugs during this transition from shelter to housing. Some of these risks may be related to loss of connection to overdose prevention resources, substance use treatment services, and social supports. Framed by the rhodes risk environment theory and the exploration, preparation, implementation, and sustainment (EPIS) framework, we will partner with the boston public health commission (BPHC) to recruit a prospective cohort of individuals moving out of shelter into housing and follow them for one year, assessing critical substance use (i.e., non-fatal overdose, unwitnessed substance use) and housing-related outcomes (i.e., housing retention, loneliness, quality of life), as well as other important outcomes including engagement with substance use treatment services, and all-cause mortality (aim 1). Additionally, we will explore factors (e.g., supportive housing elements, proximity to health care and substance use resources) that may promote positive substance use and housing outcomes (aim 2). We will survey and interview participants directly, while also obtaining permission to access health records (including vital registration) and homeless services data to administratively ascertain outcomes in this transient population. Next, guided by findings from the longitudinal cohort, we will convene a community advisory board-composed of people with lived experience of homelessness and substance use as well as people who work with PEH as they transition into housing-to adapt and manualize a housing stability and overdose prevention (HOPE) navigation intervention to improve retention in housing, prevent overdoses, promote engagement in substance use treatment services, and decrease social isolation among recently housed individuals. In a future R01 study, we will assess the efficacy and implementation outcomes (e.g., adoption, cost, fidelity, sustainability) of the HOPE navigation intervention in a hybrid type II randomized controlled trial.