A devastating surge in drug overdoses drove up deaths among unhoused people in Los Angeles County in recent years, along with the rising toll of traffic collisions and homicides, according to a public health department report released Friday.
The death rate increased 55% among people experiencing homelessness in L.A. County between 2019 and 2021, a markedly sharper increase than in the years before the COVID-19 pandemic, public health officials found.
More than 2,200 unhoused people died across the county in 2021 — the first time the agency has reported an annual toll exceeding 2,000, said Will Nicholas, director of the Center for Health Impact Evaluation at the L.A. County Department of Public Health.
“It’s becoming more deadly or dangerous to be homeless,” Nicholas said. “The call to action is that getting people housed is more important than ever.”
The leading cause of death was drug overdoses, which made up more than a third of deaths among homeless people in L.A. County in 2020 and 2021 combined, the report found.
Deadly overdoses often involved more than one drug, but the surging rate of overdose deaths appears to be tied to the explosive rise of fentanyl, public health officials said. The powerful synthetic opioid was implicated in 58% of deadly overdoses among unhoused people in L.A. County in 2021 — nearly three times the percentage that had involved fentanyl in 2019.
Methamphetamine, in turn, was involved in nearly 77% of the overdose deaths. That figure, which had risen in recent years, was slightly higher among unhoused women than unhoused men, possibly because some women use meth to try to stay awake and avoid sexual assault on the street, the county report noted.
Nicholas said that people who overdosed solely from meth tended to be “considerably older,” making them more vulnerable to health risks from stimulant use.
Both meth and fentanyl have been mingled with other drugs to deadly effect. More than 40% of overdose deaths among homeless people involved both fentanyl and methamphetamine in 2021, the county report found. Fentanyl deaths “almost always involved other drugs as well,” but the public health department said it could not determine from the data whether people were using fentanyl on purpose or unknowingly.
Fentanyl overdoses have skyrocketed in general in L.A. County, but the overdose crisis has hit unhoused people especially hard. Homeless people in the county were nearly 39 times more likely to die of drug overdoses than the general population, the report found.
The numbers underscore “the urgency of the overdose crisis, which is the worst in history” both locally and nationally, “as well as the fact that this is significantly impacting some of the most vulnerable members of our society,” said Dr. Gary Tsai, director of the substance abuse prevention and control division in the public health department.
Tsai said that the crisis has been particularly pronounced for unhoused people because of their higher rates of substance use disorder and mental health conditions, which increase the likelihood of drug use.
And “people who are homeless are disconnected,” Tsai added. “People oftentimes will turn to drugs for some form of connection, or because of how disconnected they are from things that are important in life.”
What makes that even riskier, he said, is that many unhoused people are isolated, and using drugs alone ramps up their risk of dying from an overdose, because there is no one there to intervene or call for help.
The public health department calculated mortality rates per 100,000 people by comparing annual deaths among unhoused people to the total unhoused population in the county. To accurately compare mortality rates between different groups of homeless people, it adjusted for age differences in their populations.
Among the unhoused population in L.A. County, the rates of overdose deaths have been highest — and continued to climb — among white people and those in their 50s and 60s. Homeless men are also dying of overdose at higher rates than women, the county report found.
The second-leading cause of death among people experiencing homelessness was coronary heart disease, which made up 14% of deaths among unhoused people in L.A. County in the years 2020 and 2021, followed by traffic injuries, which accounted for 8% of deaths. The fourth-leading killer of homeless people was homicide, the rate of which saw an unnerving increase of 49% between 2020 and 2021.
All in all, homeless people were dying at nearly four times the rate of the L.A. County general population during the combined years of 2020 and 2021, when adjusted for age and gender differences in the population.
That gap had widened since before the pandemic, partly due to a growing disparity in traffic-related deaths between housed and unhoused people, the report found. COVID-19 also killed homeless people at a higher rate than housed people in L.A. County.
To save lives, the L.A. County Public Health Department argued that many changes are needed, including ramping up the distribution of naloxone, commonly known under the brand name Narcan; improving access to medications such as methadone and buprenorphine that help people shake off addiction; expanding mobile clinics for unsheltered people; and moving forward with supervised sites where people can consume drugs so that trained staff can intervene and stop overdoses.
Last year, Gov. Gavin Newsom vetoed a state bill to launch such supervised sites in Los Angeles, San Francisco and Oakland, although the governor said he remained open to the idea if local officials returned to the California Legislature with “comprehensive plans.”
Tsai said that in L.A. County, discussions are underway with law enforcement and other local officials “to explore if we have sufficient alignment locally to implement the program.”
“We have tools to try to address the overdose” crisis, Tsai said. “Clearly we need to be doing more.”
Emily Alpert Reyes
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