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Abstract

Background: Most deaths associated with North America’s overdose crisis occur in housing environments, largely when individuals are using drugs alone. In Vancouver, Canada overdose deaths are disproportionately concentrated in single room occupancy (SRO) housing in the Downtown Eastside. Many SROs have implemented housing-based overdose prevention interventions in response to high overdose rates. However, challenges adapting these approaches to address the contextual dynamics in SROs and rising overdose deaths suggest a need to better understand how overdose vulnerability is produced and negotiated in relation to place. This dissertation uses qualitative methods to examine how the social, structural, and physical contexts of SRO housing shape overdose risks for structurally vulnerable people who use drugs (PWUD) in the Downtown Eastside. Methods: This dissertation draws on qualitative and community-based research conducted with PWUD living in SRO housing in Vancouver’s Downtown Eastside between October 2022 and September 2023. Data include 30 in-depth interviews and photovoice activities with a subsample of nine participants. Analysis drew on the intersectional risk environment and complementary theories (e.g., emotional geographies, necropolitics) to explore the social, structural, and physical forces shaping overdose vulnerability for people living in SROs. Results: Findings highlight how overdose risks are produced in response to the social, structural, and physical contexts of SROs. Surveillance and control strategies endemic to SRO housing carried an implicit threat of punishment that drove people to use drug alone. Further, the social-structural dynamics (e.g., surveillance and control, violence, theft) and poor physical conditions (e.g., pests, mould) of SROs reinforced the normalized stigmatization and social suffering of structurally vulnerable PWUD in ways that underscored overdose risks and undermined engagement with novel harm reduction interventions such as safer supply. Findings illustrate how certain indicators of overdose vulnerability (e.g., social isolation, using alone, increased drug use) are experienced as calculated and rational responses to the wider environmental contexts in SROs. Conclusion: This dissertation focuses attention on how overdose vulnerability and other health and social harms are produced in relation to the life-constraining conditions of SRO housing, rather than individual behavioural choices, and emphasizes the critical role of housing policy in shaping drug-related outcomes.