(In)visible street dwellers: an integrative review of the interface of psychoactive substance use among homeless individuals

Introduction: the objective of this study was to analyze the scientific production regarding the assistance provided by health services at the interface between psychoactive substance use among homeless individuals. Method: an integrative review was conducted using the Virtual Health Library, PubMed, EMBASE, and American Psychological Association. Two independent reviewers selected the studies using software. The analysis was grounded in a theoretical perspective on the approach to psychoactive substance use, methodological procedures, characteristics of the studied population, and findings. The initial search yielded 15 studies that met the predetermined inclusion criteria. Results: Most of these studies incorporated a harm reduction approach by presenting specific strategies or discussing their limitations within health services. The discussion encompassed the utilization of territorial, community-based, and mobile equipment, along with the vulnerabilities associated with the interface between homelessness and psychoactive substance use in accessing health services. Conclusion: existing public policies and health service practices are insufficient to address the multifaceted needs of homeless individuals who use psychoactive substances. Stigma and fragmented care perpetuate exclusion and moral judgment. There is an urgent need for integrated, harm reduction-oriented, and culturally sensitive approaches and further research into intersectional vulnerabilities to improve health outcomes and social inclusion for this population.