Staggering increase in opioid-related deaths among people experiencing homelessness, new study finds

People experiencing homelessness account for an increasing proportion of fatal opioid-related deaths in Ontario, Canada, reaching one in six such deaths by 2021, according to new research from ICES, Western University and Lawson Health Research Institute.

In one of the first reports to track the continuous increase in opioid-related mortality in the province among people experiencing homelessness, researchers found that the quarterly proportion of opioid-related overdose deaths among unhoused individuals increased from 7.2% (26 deaths) in the period of July to September 2017 to 16.8% (97 deaths) by April to June 2021.

"On average, that's one homeless individual losing their life to an opioid overdose every day, one year into the COVID-19 pandemic," says lead author Richard Booth, adjunct scientist at ICES and associate professor and Arthur Labatt Family Research Chair in Nursing at Western University. "Unhoused people are overrepresented among opioid-related deaths, and the situation has reached a critical point following the challenges of the COVID-19 pandemic."

The study, titled "Opioid-related overdose deaths among people experiencing homelessness, 2017 to 2021: a population-based analysis using coroner and health administrative data from Ontario, Canada," was published in the journal Addiction and analyzed linked coroner and health record data. Over the four-year study period, 6,644 individuals (average age of 40 and 74% male) had an accidental death due to an opioid-related overdose and the investigating coroner identified 884 (13%) as experiencing homelessness at the time of death.

Study findings show:

• People experiencing homelessness accounted for one in 14 opioid-related overdose deaths in 2017 and one in six deaths in 2021; however, this statistic doubled to one in three deaths when considering individuals who had experienced homelessness in the year prior to their death.
• While opioid overdose deaths in the province increased two-fold over the four-year timeframe, deaths among the unhoused saw a nearly four-fold increase.
• Unhoused individuals who died were often younger (61.3% versus 53.1%, between 25 and 44 years), resided in major urban centers, and were more likely to have recently accessed health care services for mental health or substance use disorders, compared to housed individuals who died.
• At the time of the overdose, individuals experiencing homelessness were more often in the presence of a bystander and were more likely to have a resuscitation attempt or naloxone administered.

"Lack of housing can influence people's patterns of substance use, which can introduce considerable risk for people accessing Ontario's highly potent, unpredictable illicit drug supply," says Tara Gomes, a senior scientist at ICES and the Li Ka Shing Knowledge Institute of St. Michael's Hospital. "Access to low-barrier housing should be a central strategy paired with improved accessibility to treatment and harm reduction services tailored to the needs of people experiencing homelessness."

One limitation of the study was the method of classifying an individual's housing status, which can be challenging to assess at the time of death. It's possible that some individuals were experiencing "hidden homelessness," which is when people live with inadequate housing or avoid using homelessness supports and services.

Nevertheless, this is one of the first population-based studies to track the increasing proportion of deaths from opioid-related overdoses in the population of Ontarians experiencing homelessness. The findings underscore the urgency of the situation, and the need for effective policy and interventions to address the opioid epidemic, which coincides with a severe housing shortage in Ontario.