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Illegal drug use is deeply entangled with homelessness, increasing the risk of losing a home, and can occur or worsen when people find themselves on the streets, new research has found. However, we also found that the majority of people living on the streets are not drug users.
Published in the medical journal JAMA by the Benioff Homeless and Housing Initiative in UC San Francisco, the study provides a complex statistical picture of topics bewildered by conflicting narratives. To the public’s perception that drug use is inherent to homeless camps, service providers and supporters see an exaggerated response to open drug use on the streets, denounced the majority of homeless people who are not using drugs.
Benioff’s research supports several elements of both perspectives. Contrary to popular perception, only about 37% of homeless people used illegal drugs regularly, so 25% said they had never used drugs. However, drug use is much more common among homeless people than among the general population. Only 65% reported being used regularly at some point in their lives, with 27% starting after becoming homeless.
Another twist: 35% said their drug use decreased after becoming homeless. Some parents were worried about losing custody of their children. Others “we’ve just reached that point,” said Margot Kuschel, the lead author and director of Benioff.
The findings underscored the need for better treatment options, Kushel said. Many people told interviewers who have already cut back and are hoping to help them cut more.
“One of the most moving findings was that one in five people were actively seeking treatment and they couldn’t get it,” Kushel said in an interview.
In a thorough interview, Kushel explained their frustration, saying that respondents are “appearing where they show up and telling them to call.”
Only 7% of people who use it for life said they were receiving treatment.
“It’s difficult to get treatment,” Kushel said. “We shouldn’t. We shouldn’t be told we’re going somewhere and we’re going to be on the waiting list. That shouldn’t happen, but it does.”
Housing is the solution, Kushel said, but until it is fully available, more resources will need to be brought onto the streets, such as methadone and other medications to treat opioid addiction.
Kushel also encourages increased access to treatment in the home, as long as it could lead to housing, and those who recur with treatment – “a part of the natural history of substance use disorders, which are very common,” will not be reverted to homelessness.
The use of illicit substances and access to treatment among adults experiencing homelessness is one of a series of reports based on a 2023 statewide study of people experiencing homelessness. The largest representative sample of homelessness since the 1990s consisted of 3,200 surveys and 365 in-depth interviews.
Previous Benioff reports based on the survey cover intimate partner violence and pathways to homelessness.
Unlike 1990s surveys that included only those using homeless services, Benioff canvas both shelters and camps, changing patterns of homelessness, and higher rates of sheltering, and drug preferences in the general population have shifted from cocaine to methamphetamine and fentanyl.
A new report found methamphetamine is the most used drug on the streets.
“People are telling us that it helps them survive,” Kushel said. “It awakens them and makes them alert, they use it.
Only about 10% of respondents said they regularly use opioids, with most mixed with methamphetamine. However, intermittent use, or even unconscious use due to contamination, increases the risk of death. Just under 20% experienced lifetime overdoses and 10% of current episodes of homelessness.
About a quarter reported suffering from naloxone, a drug that reverses opioid overdose, but Kushel said it should be in the hands of all opioid users and everyone around them.
“What we’ve heard from a lot of people is, ‘we saw an overdose’,” she said. “We don’t often wait for the first responder.”
Despite the high lifetime use of cocaine, only 3% said they are currently using it, despite being 58%.
“Like a lot of things we talk about in medicine, some things get worse, some get better, some stay the same,” Kushel said.
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