Opioid overdose fatalities ranks top among homeless; JAMA

High rates of drug overdose death trends among homeless individuals, while the types of substances implicated in overdose fatalities remain unknown in this community.

A new study found that People experiencing homelessness died from drug overdoses at a rate of one in every four, with synthetic opioid and polysubstance use becoming major contributors to mortality in recent years.

This study was conducted by Danielle R. Fine with the objective to identify trends in drug overdose mortality among a large cohort of homeless persons in Boston compared to the overall adult population of Massachusetts, and to examine the types of substances implicated in overdose fatalities over a 16-year period of observation. The findings of this study were published in the Journal of American Medical Association.

This cohort research looked at persons over the age of 18 who received care at the Boston Health Care for the Homeless Program (BHCHP) between January 1, 2003, and December 31, 2017. Individuals were tracked from the date of their first BHCHP interaction during the research period to death or December 31, 2018. The data was evaluated between December 1, 2020, and June 6, 2021. Drug overdose fatalities and the types of substances involved in each overdose death were determined by matching the BHCHP cohort to death data from the Massachusetts Department of Public Health.

The key findings were:

1. By the conclusion of the research period, 7130 people had died in this cohort of 60 092 homeless adults. A total of 1727 people (24.2%) died as a result of a drug overdose.

2. The drug overdose decedents included 456 females (26.4%), 194 Black (11.2%), 202 Latinx (11.7%), and 1185 White (68.6%) people, with a mean (SD) age of death of 43.7 (10.8) years.

3. The BHCHP cohort had a drug overdose mortality rate of 278.9 fatalities per 100 000 person-years, which was 12 times higher than the Massachusetts adult population. Opioids accounted for 91.0% of all drug overdose deaths.

4. The synthetic opioid mortality rate grew from 21.6 to 327.0 fatalities per 100 000 person-years between 2013 and 2018.

5. Between 2004 and 2018, the opioid-only overdose mortality rate fell from 117.2 to 102.4 deaths per 100,000 people, whereas the opioid-involved polysubstance mortality rate rose from 44.0 to 237.8 deaths per 100,000 people.

6. Throughout the research period, the most prevalent drug combination implicated in opioid-involved polysubstance overdose deaths was cocaine-plus-opioid, with Black people having the greatest proportion of cocaine-plus-opioid involvement in death.

In conclusion, these findings highlight the significance of increasing access to evidence-based opioid overdose prevention strategies and opioid use disorder treatment among people experiencing homelessness, as well as the importance of addressing both intentional and unintentional polysubstance use in this population.

Reference:

Fine DR, Dickins KA, Adams LD, et al. Drug Overdose Mortality Among People Experiencing Homelessness, 2003 to 2018. JAMA Netw Open. 2022;5(1):e2142676. doi:10.1001/jamanetworkopen.2021.42676