Official websites use. Share sensitive information only on official, secure websites. The use, distribution or reproduction in other forums is permitted, provided the original author s and the copyright owner s are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Objectives: To record the prevalence and risk factors of substance use amongst homeless persons during the COVID pandemic.
Factors associated with substance use were explored using generalised logistic regression models. The use of both substances positively associated with each other, although risk factors varied depending on the substance.
Whilst the rate of tobacco use was relatively stable between Spring and , alcohol use was more common in Conclusion: These findings highlight a high prevalence of substance use amongst homeless persons. People experiencing homelessness face specific challenges in the context of the pandemic, alongside greater vulnerability to illness and low healthcare access, therefore the need to improve prevention and support services for substance abuse within this population is vital.
Evidence suggests that the COVID pandemic has significantly impacted rates of substance use in the general population [ 1 β 4 ]. However, these changes are complex and ongoing. On the one hand, environmental stress is a known risk factor for substance use disorders [ 5 ], with increases in alcohol and tobacco consumption recorded during natural disasters [ 6 , 7 ] terrorist incidents [ 8 , 9 ] and humanitarian conflicts [ 10 , 11 ].
The stress of the COVID pandemic, alongside associated increases in social isolation [ 12 ], may have therefore contributed to increasing rates of substance use [ 13 ]. COVID preventative measures, such as lockdowns, staff shortages and reduced opening hours, were also predicted to disrupt access to support and drug services [ 14 β 16 ]. Nevertheless, the pandemic is likely to have decreased drug availability, due to reduced drug trafficking and market shortages [ 17 ], alongside reducing opportunities for consumption, with users themselves having less freedom of movement, disrupted income and fewer social interactions.
