Drug overdoses, especially heroin and painkillers, have surpassed AIDS has the number one cause of death among homeless adults in the USA.

The new findings came from a five-year study of homeless people who received treatment from the Boston Health Care for the Homeless Program (BHCHP). The study was conducted by a group of researchers from Massachusetts General Hospital (MGH) and BHCHP, and will be published in JAMA Internal Medicine.

The study found that drug overdose was the number one cause of death among homeless adults from 2003 to 2008 in Boston, and was responsible for one-third of deaths of those adults between the ages of 25 and 44. The authors note these findings can be applied to homeless populations across the United States.

Travis Baggett, MD, MPH, of the MGH Department of Medicine and BHCHP, who led the study said:

“Our findings are an unfortunate reminder of the high mortality rate of homeless people and a clarion call for the need to address the epidemic of drug overdose deaths in this vulnerable population. Overall, young homeless people died at a nine times higher rate and middle-aged homeless people at a four-and-a-half times higher rate than comparably aged adults in Massachusetts.”

This study follows a previous one that reported the number one cause of death among BHCHP patients aged 25 to 44 was HIV during the years of 1988 to 1993, while homicide was the main cause of death for those aged 18 to 24, and heart disease for those aged 45 to 64.

The current study updated the previous data by examining available information on over 28,000 adults who got care from BHCHP during the years 2003 to 2008.

Results showed that of those people who passed away, 17 percent died from drug overdoses and 6 percent died from complications due to AIDS.

This outcome is a total reversal of the previous data which reported a 6 percent death rate from overdoses and 18 percent due to ADIS. Following drug overdose, the second and third principal causes of death in the current study were cancer and heart disease, making up for 16 percent of the deaths.

Other health issues such as alcoholism-related heart disease, pneumonia and withdrawal made up for eight percent of deaths.

The reduction seen in AIDS-associated deaths shows that there has been an overall fall in infection rates and better care and services for patients since the last study.

Results of this study also showed that homeless people are much more likely to die than their counterparts in the regular population, with those homeless people between the ages of 25 and 44 being nine times more at risk for death, and individuals between the ages of 45 and 64 being four and a half more times more likely to pass away.

The current study has only explored a small piece of approximately 2.3 million to 3.5 million Americans who experience homelessness at some point and time each year, according to the Urban Institute.

The drugs used amongst the homeless vary by region. Opiate pain-killers and heroin are more common along the coasts while, methamphetamine is seen more in the middle of the country.

Prescription painkiller misuse is more frequent in Boston because of high concentration of doctors and hospitals, making it easier to have access to these drugs, according to the National Coalition for the Homeless.

The authors point out that the all-cause mortality rate among the homeless population in Boston is still high and has not changed since 1988 to 1993. Drug overdose has taken the place of HIV has a potential epidemic. The authors recommend the following actions to address these issues:

  • public health initiatives to prevent and reverse drug overdose
  • social policy measures to end homelessness
  • behavioral health integration into primary medical care

Baggett, who is also an instructor in Medicine at Harvard Medical School concluded:

“Our results highlight the dire need to expand addiction and mental health services and to better integrate them into primary care systems serving homeless people. They also suggest that, while health care services like BHCHP can help improve the health of homeless people, they probably are not enough. Making a major impact on mortality for these patients will also require addressing the social factors that contribute to homelessness in the first place.”

Written by Kelly Fitzgerald