Association between homelessness and opioid overdose and opioid-related hospital admissions/emergency department visits

Soc Sci Med. 2019 Dec;242:112585. doi: 10.1016/j.socscimed.2019.112585. Epub 2019 Oct 3.


Background: Although homelessness and opioid overdose are major public health issues in the U.S., evidence is limited as to whether homelessness is associated with an increased risk of opioid overdose.

Objective: To compare opioid-related outcomes between homeless versus housed individuals in low-income communities.

Design, setting, and participants: Cross-sectional analysis of individuals who had at least one ED visit or hospitalization in four states (Florida, Maryland, Massachusetts, and New York) in 2014.

Measurements: Risk of opioid overdose and opioid-related ED visits/hospital admissions were compared between homeless versus low-income housed individuals, adjusting for patient characteristics and hospital-specific fixed effects (effectively comparing homeless versus low-income housed individuals treated at the same hospital). We also examined whether risk of opioid-related outcomes varied by patients' sex and race/ethnicity.

Results: A total of 96,099 homeless and 2,869,230 low-income housed individuals were analyzed. Homeless individuals had significantly higher risk of opioid overdose (adjusted risk, 1.8% for homeless vs. 0.3% for low-income housed individuals; adjusted risk difference [aRD], +1.5%; 95%CI, +1.0% to +2.0%; p < 0.001) and opioid-related ED visit/hospital admission (10.4% vs. 1.5%; aRD, +8.9%; 95%CI, +7.2% to +10.6%; p < 0.001) compared to low-income housed individuals. Non-Hispanic White females had the highest risk among the homeless population, whereas non-Hispanic White males had the highest risk among the low-income housed population.

Limitations: Individuals with no ED visit or hospitalization in 2014 were not included.

Conclusion: Homeless individuals had disproportionately higher adjusted risk of opioid-related outcomes compared to low-income housed individuals treated at the same hospital. Among homeless individuals, non-Hispanic White females incurred the highest risk. These findings highlight the importance of recognizing the homeless population-especially the non-Hispanic White female homeless population-as a high-risk population for opioid overdose.

Keywords: Emergency department; Homeless; Homelessness; Opioid abuse; Opioid overdose.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Correlation of Data
  • Cross-Sectional Studies
  • Drug Overdose / epidemiology
  • Drug Overdose / psychology*
  • Female
  • Florida / epidemiology
  • Humans
  • Ill-Housed Persons / statistics & numerical data*
  • Male
  • Maryland / epidemiology
  • Massachusetts / epidemiology
  • Middle Aged
  • New York / epidemiology
  • Opioid-Related Disorders / complications
  • Opioid-Related Disorders / epidemiology
  • Opioid-Related Disorders / psychology
  • Patient Admission / statistics & numerical data*