Background <p>People who use drugs (PWUD) interact with hospital and emergency departments at higher rates than the general population. PWUD have unique needs when receiving hospital-based care and often face challenges receiving care in hospital-based environments. Programs such as Hospital at Home provide the opportunity to deliver hospital-level care outside of traditional hospital-based environments through the use of in-person outreach and virtual care, however have traditionally faced challenges providing this care to people actively using substances and to those who are unhoused or unsafely housed.</p> Case presentation <p>In Vancouver, Canada a novel partnership was formed between Hospital at Home and a community-based, harm reduction site in order to provide hospital-level care for PWUD who are unhoused or precariously housed. Baseline demographic data as well as substance use disorder diagnoses, admitting diagnoses and admission outcome were collected. During the first 3 months of the program, 17 patients were admitted, with 94% (<i>n</i> = 16) of patients admitted for an infectious disease. There was a high preponderance of opioid use disorder (<i>n</i> = 15, 88%) and stimulant use disorder (<i>n</i> = 14, 82%). There was 1 patient-initiated discharge and 2 patients required transfer back to hospital to receive a higher level of care. All other patients completed treatment and were discharged to community. Median length of stay was 31 days (standard deviation 26 days).</p> Conclusions <p>Early program findings suggest that providing hospital-level of care in a community based harm reduction setting may be an acceptable alternative to traditional hospital admission in appropriately selected patients who use drugs.</p>