Unsheltered people experiencing homelessness (PEH) in the U.S. face high rates of illegal drug use and overdose, influenced by their marginalized status. A study in Baltimore City explored how these individuals perceive and navigate their drug use environments, which include public, semi-public, and private spaces. Participants were recruited from the AIDS Linked to Intravenous Experience (ALIVE) Study, with data collected from nine interviews.

The study found that public spaces, like streets, are accessible but often involve risks due to policing. Semi-public spaces, such as library restrooms, offer limited privacy, while private spaces, like residences, provide a safer environment for drug use. Participants described using various strategies to find privacy in public areas, which sometimes compromised their safety. Accessing private spaces often required engaging in an informal economy of sharing drugs and resources.

Participants expressed a need for a supervised facility where drug use can occur safely and privately. The findings suggest a need for targeted resources and interventions focusing on harm reduction to improve safety for unsheltered PEH who use drugs, emphasizing a multi-level approach to address both environmental and individual factors.