A sharp increase in homeless deaths from spring 2020 was caused by drug overdoses involving fentanyl, concluded a report released Thursday by the Los Angeles County Department of Public Health.
During the first seven months of 2020, 926 homeless people died in LA County, an increase of 26% over the same period in 2019.
Although COVID-19 has become the second leading cause of death in the general population of Los Angeles, it has remained a minor factor in homeless deaths, after heart disease, transport accidents and homicide – which lagged far behind overdoses of drugs.
“Despite the relatively minor direct impact of COVID-19 … the first seven months of 2020 saw an alarming increase in overdose deaths in this population,” said the report, conducted by the county’s Health Impact Assessment Center. “This increase was driven in large part by the more frequent involvement of fentanyl.”
“Overdose is an absolute plague in the homeless community,” said Darren Willett, director of harm reduction at Homeless Healthcare Los Angeles, in a briefing on the report.
The increase in deaths apparently stabilized somewhat at the end of the year. The preliminary estimate by the LA County Medical Examiner-Coroner Department of 1,383 homeless deaths in 2020 would be an annual increase of about 9%.
The county’s second annual report on homeless mortality found that drug overdoses were responsible for just under 30% of homeless deaths in 2020, by far the leading cause.
Methamphetamine, determined to be involved in nearly two-thirds of those deaths, remained the dominant contributor. But the presence of the powerful synthetic opioid fentanyl in the mix of drugs commonly found in a person’s body has more than doubled, to 41%.
The report listed recommendations for reducing fatalities, including greater reach on the streets, more temporary housing, chronic disease management, greater distribution of the naloxone antidote, a dramatic increase in residential beds for the treatment of substance use disorder and increasing diversion opportunities from prison to substance use treatment. .
During the briefing, service providers emphasized “harm reduction” – the use of naloxone, syringe exchange programs and sanctioned drug use locations – as the most effective responses.
“One of the main reasons people are dying from overdoses is that they are using it alone,” said Willett. “They don’t have people to ask for help, to reverse the overdose.”
According to Willett, of the skid row residents who responded to a community needs assessment and said they inject drugs, 92% used it alone last year and 60% of them said they use it alone daily.
“This hiding in the shadows, hiding in tents, hiding in alleys is undoubtedly the result of crime and social deprivation from the drug war,” he said.
Of the respondents, only 30% said they have already been to a shelter. That percentage would likely increase if shelters allowed the use of drugs, the research found.
“Changing a factor – if you could use drugs, would you have access to them? – 80% said yes, ”said Willett.
Willett said he was not in favor of allowing widespread use of drugs in shelters, but defended the existence of some specific shelters for drug users.
Soshanna Scholar of the County Diversion and Reentry Office said that since January, the agency has distributed 50,000 doses of naloxone to inmates leaving prisons to handle death rates up to 136% higher than the general population among those involved in the system. of justice.
She credited the program with 3,000 overdose reversals.
The report, which covers 2019 and 2020, did not attempt to calculate a death rate for last year due to the lack of up-to-date information on the number of homeless people.
The authors said they would explore the possibility that COVID-19 had an indirect effect on the increase in homeless deaths, but that they did not have enough information to draw conclusions.
The annual count, carried out last January, showed a 13% increase in people living on the streets or in shelters in 2019. The dramatic job loss resulting from the COVID-19 pandemic must have left more people homeless, but there is no way to stop it. quantify that.
The increase in the number of homeless people in the past year has had a counterintuitive effect of slowing down a multi-year increase in the homelessness mortality rate, despite the number of homeless deaths increasing sharply.
The overall death rate – that is, the number of people dying out of every 100,000 – increased only slightly in 2019, after more dramatic increases in previous years, the report said.
Overall, homeless people were three times more likely to die from any cause than the entire population. The probability of dying was 36 times higher due to drug or alcohol overdose, four times higher due to heart disease, 17 times higher due to transport-related injuries, 15 times higher due to homicide and eight times higher due to suicide.
Drug overdose was not associated with youth. The highest rates and the sharpest increase in 2019 occurred among people aged 55 to 61, followed by those aged 62 or older.
The death rate from drug overdose was higher for whites, but remained stable in 2019, while rates for blacks increased 45% and for Latinos 17%.
“It appears that the continued rise in overdose mortality rates in 2019, especially between Black and Latinx [persons experiencing homelessness], was largely driven by the increased involvement of fentanyl in overdose deaths in these racial / ethnic groups, ”said the report.
The overdose rate among homeless women was only slightly lower than for men, a notable difference from the general population, in which men are twice as likely to be fatal overdose as women.