In Houston, Dwindling Homeless Population Dies of Overdoses

On the longest night of the year, December 21, people gather in cities across the country to light candles, say prayers, tell stories or simply list their names, remembering those who died while homeless.

On the occasion of Homeless Remembrance Day, questions are flying. Existential, moral, mourning and unknown questions are mixed with two questions that, in theory, should have clear answers: who is dying and how?

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In 2019, a team of researchers, officials, and homeless advocates from across the country worked together to create a toolkit for cities to answer these questions. Today, a clinical assistant professor on that team, Ben King of the University of Houston, released the first annual report on homeless mortality in the state, showing that in Harris County, even as the homeless population is declining, homeless deaths are rising. In 2022, a Harris County resident died due to homelessness once every 36 hours on average.

Fifteen years ago, when King was living in Austin, he realized that the database used by the local medical examiner’s office wasn’t designed to report such deaths.

So in 2020, when King moved to Houston to work for the University of Houston, he immediately saw an opportunity to create a report because the Harris County Medical Examiner’s Office database reliably reported homeless deaths. That year, the University of Houston formed a 10-year partnership with the medical examiner’s office to create annual homeless mortality reports for Harris County.

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For the first time in the state, there will be annual, systematic analyses of deaths in the homeless community, how people are dying and whether the problem is improving or getting worse. This data has the potential to save lives.

“I hope housing departments will use it to advocate for housing,” King said. “I hope addiction treatment programs will use it to advocate for addiction treatment. The American Heart Association can use it to advocate for heart health in very low-income communities.”

The reports revealed a disturbing fact: While the number of homeless people in Harris County has declined dramatically, the number of deaths has increased. In 2011, about 50 people died while homeless, about the same number as the two years before and after. Since then, the homeless population has declined by more than two-thirds. But the number of people dying while homeless has increased.

In 2022, nearly 250 people died while homeless. While some of this increase may be related to a change in methodology in 2021, the rise began years earlier.

In other words, it becomes much more deadly to live outdoors or in a shelter.

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Before King received the data, he expected his analysis to focus on cardiovascular disease, which is the leading cause of death worldwide and in the United States.

Until recently, this was also the case within Houston’s homeless community. But in recent years, there has been a dramatic increase in overdose deaths. And these overdoses have involved drugs that were not previously a scourge of the homeless community.

Deaths caused by opioids – primarily fentanyl – and methamphetamine increased in 2020, with each implicated in more than 50 deaths in 2022. In previous years, alcohol and cocaine were the most dangerous substances in the community. Neither had been implicated in more than 20 deaths before 2020.

“What hit the East and West coasts more than a decade ago is now hitting Houston,” King said. “And we have an opportunity to be more proactive, but we need to look at where the system is failing to help people experiencing homelessness.”

King hopes awareness of the problem will lead to solutions. In the meantime, he’s looking for ways to use data to improve our understanding of what’s happening today.

For example, one of the first questions people ask is how death rates among the homeless population compare to those of the general population. But because the medical examiner’s office doesn’t see every death, it doesn’t know the death rate for the general population. To answer that question, King asked for what’s called the county’s “death file,” which is maintained by the state and tracks the total number of deaths in the county. (The medical examiner’s office looks at homicides, suicides, accidental deaths, and natural deaths that aren’t observed or whose cause is unknown; King estimates that most homeless deaths are recorded by the medical examiner’s office.)

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There are also questions about how Houston’s homeless response interacts with people before they Regions that receive homeless funding from the U.S. Department of Housing and Urban Development must coordinate the various organizations that work to address homelessness by collecting data on their clients and the services they receive. King has worked for years on integrating this system with health data — his dissertation linked Austin’s Homeless Management Information System to medical records.

In Houston, he could imagine working with the Coalition for the Homeless of Houston and Harris County to understand: How many interactions do people dying of homelessness have with service providers before they die? And how do individuals fare after they receive housing?

“I view housing as a health intervention, so the fact that they’re in two different data silos never made sense to me,” King said. “I’m constantly trying to reassemble them.”

As King worked on his first report on homeless mortality, he found a motivator near campus: Victor, who lived under I-45 on Cullen Boulevard. Victor was very interested in the leading causes of death in the homeless community, as he had lost many friends himself.

He urged King to get this information to agencies that could use it to save lives as soon as possible rather than going through the lengthy peer-review process of publishing it in a journal.

As King prepared to release the pilot report, he passed the underpass. He noticed a constellation of candles and a collection of letters arranged near one of the bicycles Victor had repaired. There was a sign with Victor’s name on it and a note indicating how mourners could contact his mother.