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Drug Overdoses Drive Dramatic Hike in LA County Homeless Deaths

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By Jorge Casuso

May 15, 2023 -- The death toll among LA County's homeless jumped from less than 1,300 in 2019 to more than 2,200 in 2021, largely fueled by a dramatic rise in drug overdoses, according to a Public Health report released Friday.

After a 29 percent increase from 658 homeless deaths in 2014 to 1,289 in 2019, the death toll spiked 55 percent in just two years to 2,201, according to the report from LA County's Department of Public Health (DPH).

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"The primary driver of this recent increase was drug overdoses, which comprised 37 percent of all (homeless) deaths in 2020-21 combined," the report said.

"The specific drug most responsible for this increase was fentanyl," Health officials said, adding that its involvement in homeless overdose deaths almost tripled from 2019 to 2021.

While the mortality rate among LA County's homeless population was 3.8 times higher than for the population at large, homeless persons were 38.9 times more likely to die from an overdose.

Of the 4,012 homeless persons who died in 2020 and 2021 combined, 1,488 died of unintentional overdoses from drugs or alcohol or both, according to the report.

Fentanyl "has rapidly replaced other opioids among" homeless men, especial among White men, whose "rate of overdose deaths was almost twice as high" as that of Blacks and Latinos.

Homeless Mortality Rate
Courtesy LA County Department of Public Health

Meanwhile, methamphetamine "has contributed to a higher percentage of female versus male overdose deaths," according to the report.

"Methamphetamine is the drug of choice among unhoused female users because its sleep depriving effects help protect them from the sexual assaults prevalent in life on the street," health officials said.

Coronary heart disease was the second leading cause of death among the homeless, accounting for 564 deaths in 2020 and 2021, followed by traffic collisions.

People experiencing homelessness (PEH) were "20.4 times more likely to die from a transportation-related injury" than was the general population, according to the report.

The high fatality rate "is likely related to the preponderance of pedestrians and cyclists vs. cars among the collisions causing these deaths, along with the proximity of PEH dwellings to major roadways," the report said.

Homicide was the fourth leading cause of death among homeless persons, who were 15.1 times more likely to die from homicide than the population at large, according to the report.

And it was "the second leading cause of death (after overdose) among all age groups under age 50."

COVID -- which was the second leading cause of death in LA County in 2020 and the leading cause in 2021 -- was the fifth leading cause among the homeless, accounting for 223 deaths.

"The unhoused/housed mortality gap was also relatively low for COVID-19 compared to other leading causes of death," Health officials said.

COVID, however, was the second leading cause of death among homeless persons aged 70 and older and the third leading cause among those between 60 and 69.

Suicide was the sixth leading cause of death among the County's homeless, with 121 homeless persons taking their lives in 2020 and 2021. And it was the fourth leading cause of death among those under age 40.

The death toll among the homeless in Santa Monica reflected that of the County. In 2021, 30 homeless persons died among a population of 985 homeless individuals counted in Santa Monica in January 2020 ("Two Homeless Persons a Month Die in Santa Monica," May 4, 2022).

That was a marked increase from the 22 homeless individuals who died in the city of some 93,000 in 2019, according to an analysis of data provided by the LA County Coroner ("Nearly Two Dozen Homeless People Died in Santa Monica Last Year," May 6, 2019).

The city's 3 percent death rate reflects the County rate of 2,201 deaths among the 66,436 homeless individuals counted in 2020. No homeless census was conducted in 2021 due to the coronavirus shutdown.

The leading cause of death in 2021 was overdose, which accounted for 17 deaths, up from 9 in 2019. Thirteen homeless persons suffered from heart conditions that led to their deaths, seven committed suicide, and one was a victim of homicide.

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