5 Although representing the best available data, such counts underestimate the true extent of homelessness, in part because homelessness is often a transient or episodic state that may not be captured at a single point in time.

At the national point-in-time count of homelessness in January 2020 (before the COVID-19 pandemic), there were more than 580 000 people living in shelters or unsheltered (eg, on the streets or in encampments). The number of people experiencing homelessness, and particularly unsheltered homelessness, has been growing in the US since 2016, after several years of declines. Consequently, many researchers and addiction practitioners may feel they are ill-equipped to address the seemingly insurmountable problem of homelessness. Federal funding favors research on pharmacologic treatments for addiction over research on interventions targeting the social and structural determinants of health, including housing. People experiencing homelessness are marginalized, often literally as witnessed in encampment clearings or sweeps.

4įine et al 1 highlighted the frequently overlooked association between drug overdose death and homelessness. 2 - 4 In Philadelphia, for example, drug overdose has been the leading cause of death among people experiencing homelessness since at least 2011, with the number of such deaths doubling in a 4-year period. 1 Other studies that were conducted elsewhere in the US have reported similar findings. The cohort’s standardized mortality rate from overdose was 12 times higher than that for the adult population of Massachusetts. In their cohort study, Fine et al 1 found that drug overdose mortality among adults experiencing homelessness in Boston increased substantially from 2004 to 2018, with a particularly rapid growth in deaths that involved multiple drugs or synthetic opioids.

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