INTRODUCTION:
People who use crack cocaine experience severe health inequities shaped by homelessness, migration status, criminalization, and stigma (1). Despite a strong health system in Geneva, conventional service design of appointment-access, abstinence penalties and fragmented care reinforces social exclusion for drug users (2)(3). How do health systems contribute to exclusion, and how can they be reimagined to advance equity, inclusion, and sustainability for people who use crack cocaine, for whom no pharmacological treatment exists?

METHODS:
An integrated hospital, community, and social services approach reduces care fragmentation. A multidisciplinary team, funded by Canton of Geneva, consists of two medical doctors, pair-aidant.e.s (former drug users who accompany), addiction nurses trained in motivational approaches, and social workers provide a holistic pyschosocial approach using 'maraudes' on street and open-clinics. Implementation is tracked using mixed indicators: access (users, repeat visits), engagement (continuity of care, outreach-to-clinic links), social inclusion (participation in boxing, art sessions, hairdressing, and cultural outings), and system navigation (successful referrals, reduced care fragmentation).

RESULTS:
The RUE clinic’s inclusive model, characterized by unconditional access, cultural and physical activities (boxing, art sessions, hairdressing services, and cultural outings), and integrated social support has increased sustained engagement amongst highly-marginalized individuals who use crack cocaine or in precarious situations in Geneva. The clinics achieved sustained engagement among individuals traditionally excluded from care, evidenced by repeat attendance, participation in activities, uptake of social support. Health interventions of using sport and creative activities as interventions, supports identity reconstruction beyond drug use, social connection, and stabilization in the absence of medication-based treatment. Outcomes include improved coordination and reduced emergency care visits. Sustainability metrics indicate favorable cost-efficiency, high staff retention, and institutional integration.

CONCLUSIONS:
Inclusive, relationship-based models transform traditional healthcare into public health outcomes. In Geneva, public health response to increasing crack cocaine use require shifting from risk-management to equity-driven, integrated care.