Opioid Abuse and Homelessness: Housing Is a Critical Treatment


My recent change in jobs has allowed me to get a different perspective on healthcare and how opioid abuse hurts those who are homeless and low income more then the average population.  A recent article posted on the NHCHC’s website said the following.

According to the 2016 policy brief released by the Council on medication-assisted treatment, persons experiencing homelessness have even higher rates of substance abuse disorders, poorer health, and higher mortality rates by opioid overdose than national averages

This is probably not surprising but it still should be sobering.  Not only are people suffering homelessness trying to find housing but they are doing so with higher rates of substance abuse issues and mortality rates.  When homelessness is mixed with drug addiction and mental health issues, the chances of getting successfully housed are slim to none.  It is obvious that loose prescribing doctors and expecting patients have driven this problem into the national attention.  The USA as a whole needs to double down on helping those who are homeless or at risk of homelessness especially when opioid abuse is concerned.

The same fact sheet quoted above also brought out how stark this issue is with homeless persons.

Furthermore, opioid overdose is one of the major causes of death among people experiencing homelessness. Individuals experiencing homelessness in the study were nine times more likely to die from an overdose than those who were stably housed. Compared to 61% nationally, 81% of overdose deaths were caused by opioids among those experiencing homelessness (13% heroin, 31% opioid analgesics).


There are clearly barriers to helping homeless addicted persons recover.  There are many programs that are lacking funds or have tight requirements that make it difficult for the person with high barriers to succeed.  The quoted article also brings up the cost of treatment can be an extremely large barrier to improvement.  If the homeless individual with addiction issues has chronic pain, many doctors are now trying other treatments outside of narcotics that might not be as strong.  That can drive the person back to using street drugs.  Like any large issue, there are many challenges and reasons why finding a solution is not simple.

Best Practices:

While the challenges are large, some areas of the country are having some success.  One thing I noticed in Arizona is that the medicaid expansion opened up the doors to treatment and insurance for many who previously had limited options.  Another important development that is really taking hold is housing within the healthcare system.  Health plans are learning that you cannot treat addiction and mental health issues successfully unless a person is housed.  This will be an interesting trend to follow as more states and health plans continue to move towards social determinants of health and use housing as one of the key centerpieces.


It will be interesting to see what happens as more and more healthcare plans get involved in housing.  Should they partner with housing authorities and let them do all of the housing related work?  Leave a comment and let us know what you think?

Quoted Articles and Pieces

Click to access nhchc-opioid-fact-sheet-august-2017.pdf

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