Low-threshold residential care for people experiencing homelessness and drug use in Barcelona

Issue/problem

People experiencing homelessness and problematic drug use present complex health and social needs. Traditional services often fail to provide continuous, low-threshold support. Residential harm reduction models may offer an effective response, but evidence on their characteristics and outcomes remains limited.

Description

The CRI Galena is a 45-bed residential centre in Barcelona for adults experiencing homelessness and problematic drug use. It provides comprehensive support within a harm reduction and gender-sensitive framework, allowing supervised consumption of drugs, including alcohol. The centre includes long-term residential beds (50% for women) and short-stay crisis beds, including gender-based violence emergency placements and 72-hour crisis care. It aims to promote stability, reduce harm and facilitate social inclusion. This study describes service use during 2025 (119 residents: 52.1% women, 33.6% men and 14.3% non-binary individuals) and explores sociodemographic profiles and health characteristics.

Results

Most residents were referred from harm reduction services within the drug care network. The mean age ranged from 37 years in non-binary individuals, 42 in women and 48 in men, with 45% Spanish nationals. Cocaine (43.7%) and methamphetamine (35.3%) were the main substances of use, with differences by gender and residential modality. Inhalation was the most common route. High vulnerability was observed, including 83.2% living in street situations prior to admission, 38.7% with dual diagnosis and 27.7% reporting HIV. Mean length of stay was 148 days, longer in residential beds and shorter in crisis units.

Lessons

The CRI Galena model shows that low-threshold residential harm reduction services reach highly vulnerable populations with complex needs. Gender-sensitive and flexible approaches are key. Further evaluation of effectiveness and cost-effectiveness is needed, although evidence supports the relevance of these services.

Key messages

• Residential harm reduction services are essential to address complex needs among people who use drugs and experience homelessness.

• The CRI Galena model shows the relevance of gender-sensitive, low-threshold residential care for people experiencing homelessness and drug use.