Situation of Homelessness and Substance Use in India and the Impact of COVID-19 Pandemic

Availability of safe and comfortable shelter is one of the elementary human needs essential for both an individual’s survival as well as social development. However, even in the 21st century, about one fifth of the world’s population lives in inadequate housing conditions and more than 100 million are estimated to be homeless (United Nations Economic Commission for Europe (UNECE), 2021). Although a global phenomenon, most of the burden of homelessness is observed in densely populated urban areas of developing countries. India, the world’s second most populous country, has a sizeable number of homeless individuals estimated to be about 1.77 million (Census 2011, Government of India). However, some non-governmental organizations estimate the number to be much higher (Housing and Land Rights Network (HLRN), 2016). It is estimated that an additional 68 million people live in urban slums. There has been some improvement in the situation over the last 2 decades. Between 2001 and 2011, share of houseless population declined from 0.19% to 0.15% of the population (Census 2011, Government of India).

A substantial body of work has directed its attention towards understanding the nature and direction of relationship between high prevalence of substance use disorders and homelessness. Studies have identified younger age of onset of substance use, addiction to alcohol and illicit drugs, poly-substance use, poverty and presence of a comorbid psychiatric condition as independent predictors of homelessness among patients with substance use disorders (Fountain et al., 2003; Early, 2004; Johnson and Chamberlain, 2008). Similarly, among homeless individuals, younger age, dropping out of school, long duration of homelessness, having a drug-using peer or sex-partner, negative coping practices, sex work and having comorbid depression have been found to be associated with increased risk of substance use (Lowe & Gibson, 2011; Torchalla et al., 2011; Upshur et al., 2017). These studies also point towards certain common underlying factors such as poverty, poor coping skills, etc. which can increase risk of both substance use and homelessness in a given individual. It appears that substance use and homelessness share a complex bidirectional relationship wherein certain risk factors increase risk for both the conditions while substance use and homelessness themselves increase the likelihood of each other.

Homelessness is a significant social, developmental and health challenge in a rapidly urbanizing country like India. Homeless populations are extremely vulnerable to variety of adverse health conditions particularly substance use disorders and often lack access to quality treatment. During the last 2 years, the COVID-19 pandemic has only worsened this vulnerability due to its disproportionate economic impact on poorer sections within the society. Although, support and relief measures have been directed towards the homeless populations, much more needs to be done to truly mitigate the impact of the pandemic. While the impact of the pandemic on the availability of psychoactive substances is unclear at the moment, there have been changes in the pattern of substance use in the community. These changes in the nature and extent of substance use and treatment access due to the pandemic are poorly understood and need further scientific exploration.