Esben Houborg

People who use drugs and experience homelessness face disproportionate health and social harms and are often embedded in street-based drug markets. In welfare states, supported housing—including homeless shelters—is one strategy to address their needs. Yet such services typically prohibit drug use and supply, creating barriers for some potential clients. At times, however, homeless shelters allow certain drug-related practices, generating drug environments in which the boundaries between institutional and street spaces blur. Drawing on ethnographic fieldwork (2022–2023) in a homeless shelter located in a social service hub in a large Danish city, and on interviews with 20 shelter users (5 women, 15 men) and 15 professionals (frontline staff, management, and local police), this article examines how onsite drug-market activity is regulated by residents and staff. Using boundary practices as the primary analytical lens and situating the analysis within scholarship on pragmatic care and risk/enabling environments, we trace everyday negotiations over what is acceptable inside the shelter space and what belongs outside. These boundary practices shape and are shaped by the shelter drug environment, revealing how institutional and material factors, social relationships, and tensions between care and control intersect in regulating onsite drug-market activities. We show that residents and staff sustain a fragile order that partially tolerates small-scale supply while excluding disruptive actors and elements. This arrangement carries risks, yet it also produces protections distinct from the street. We argue that the pragmatic regulation of this partly accepted drug market can be understood as a form of harm reduction related to the supply side: it mitigates risks and social harms associated with street-based markets while enabling pragmatic care and security resources. We contribute to debates on how the supply side, integral to drug environments, can be addressed pragmatically within institutional harm-reduction settings serving marginalized people who use drugs.

Background: Denmark and Sweden have similar welfare systems, but different drug policies. Denmark has historically a more liberal and more harm reduction-oriented drug policy than Sweden. On this background, we present a study of risks and use of formal and informal resources among structurally vulnerable people who use drugs in Copenhagen in Denmark and Malmö in Sweden. Methods: The study reports from research projects in each city that investigated the everyday lives and risks- and enabling environments of structurally vulnerable people who use drugs. Both projects involved the same survey. Participants were recruited at treatment and low-threshold services in Copenhagen ( n = 243) and Malmö ( n = 231). Results: The participants in the two cities used many different resources provided by the welfare system, but participants from Copenhagen made more use of available harm reduction services. The participants from Malmö used drugs in more risky settings and relied more on other people who use drugs for resources and had more concerns regarding overdoses and other drug-related harms and about being arrested by the police. Conclusions: In both cities, the Nordic welfare state plays a large role in providing resources, but drug policy can influence access to harm reduction resources and the experience of criminalization. These differences can play a role in shaping the local risk environments, although the patterns identified should be interpreted with caution given the exploratory nature of the study. More comparative research is needed to explore how drug policy shape risk environments.

Harm reduction is an important public health factor for people who use drugs. It is recommended by United Nations agencies and implemented in many countries around the world. In this article, we present a study of local harm reduction policies in Denmark. Historically, harm reduction has developed at the local level due to local stakeholders’ concerns about the health of people who use drugs. Therefore, it is a key site for studying harm reduction policies. In Denmark, harm reduction policy implementation is delegated to 98 municipalities. National legislation obliges municipalities to implement some harm reduction services and makes it optional for them to implement others. The latter services include heroin-assisted treatment (HAT) and drug consumption rooms (DCRs). In this article, we present a study of local harm reduction policy processes in relation to implementation of HAT and DCRs—or not—in three municipalities in Denmark based on document analysis and qualitative interviews with local stakeholders. One municipality had implemented a DCR, one has implemented HAT, and one had implemented neither. Analytically we apply Kingdon's multiple streams approach to policy analysis and Stone's ideas about moral and emotional engagement in policy processes. We show how local problem constructions and justifications influence the implementation of harm reduction services, and that moral engagement with core policy values like equity in such processes. We conclude that the Danish harm reduction model, which at the same time makes it optional for municipalities to implement certain harm reduction services and gives them a monopoly on implementing them, creates geographical differences in access to harm reduction services in Denmark. To characterize harm reduction in Denmark on the basis of national policy and legislation would therefore be a misrepresentation, local differences need to be taken into account.

The development of drug policy in Denmark has moved from a relatively liberal position to a stricter policy. The 2020s is marked by both criminalization and harm reduction and the development can be characterized as following a dual track where people with a problematic drug use are being cared for.

This article presents results from a study of clients’ experiences of attending an opioid substitution treatment clinic in Copenhagen, Denmark. The study is part of a research project about the everyday lives of marginalized people who use drugs in Copenhagen, their risk environments, and their access to formal and informal resources. Thirty-eight clients participated in structured interviews, covering topics concerning drug use, income, housing, social relations, violence, and use of health and social services. A risk environment/enabling environment framework was developed to analyze the data. The study highlights the importance of including the drug scene that surrounds the clinic to understand the clinic as both an enabling, constraining, and risky environment affecting the clients’ everyday lives, their safety, health, and well-being. The study shows that the clinic gives the clients access to different material, social and affective resources, but that access to resources often involves different trade-offs. For the clients, such trade-offs include balancing enabling and risky aspects of interaction with other clients or accepting constraints to get access to substitution medicine. Some clients accept such trade-offs, others do not and choose to find other ways to get resources, exposing themselves to potential harm. By paying particular attention to these trade-offs, this study provides a nuanced picture of the clinic’s dual role in both being a source of stability and a place that many clients associate with feeling worried and insecure.