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Drug overdose deaths are 12 times higher in people experiencing homelessness. Synthetic opioid and polysubstance use are increasing causes of mortality, necessitating expanded prevention and treatment access.

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Area of Science:

  • Public Health
  • Epidemiology
  • Addiction Medicine

Background:

  • Drug overdose deaths are disproportionately high among individuals experiencing homelessness.
  • Understanding the specific patterns and substances involved in overdose deaths within this population is crucial for targeted interventions.

Purpose of the Study:

  • To examine drug overdose mortality patterns in a homeless population in Boston compared to the general Massachusetts adult population.
  • To analyze the types of drugs involved in overdose deaths over a 16-year period.

Main Methods:

  • A cohort study of adults (aged 18+) receiving care at Boston Health Care for the Homeless Program (BHCHP) from 2003-2017.
  • Linking BHCHP records with Massachusetts Department of Public Health death records to ascertain overdose deaths and implicated substances.
  • Analysis of data from December 2020 to June 2021.

Main Results:

  • The drug overdose mortality rate in the homeless cohort was 278.9 per 100,000 person-years, 12 times higher than the general adult population.
  • Opioids were implicated in 91.0% of overdose deaths; synthetic opioid mortality significantly increased, while opioid-only deaths decreased.
  • Opioid-involved polysubstance overdose deaths rose substantially, with cocaine-plus-opioid being the most common combination, particularly among Black individuals.

Conclusions:

  • Drug overdose is a leading cause of death (1 in 4) among people experiencing homelessness in this cohort.
  • The rise in synthetic opioid and polysubstance involvement highlights the urgent need for enhanced prevention and treatment strategies.
  • Addressing polysubstance use is critical for reducing mortality in this vulnerable population.