The Intersection of Overdoses and Homelessness 

by Emily Neimeyer

Key Insights 

  • Homelessness is on the rise, nationally and locally. 
  • Overdose deaths, especially from synthetic opioids, have increased dramatically in the last 10 years.  
  • The unhoused population are at a high risk for fatal overdoses.  
  • What you can do: carry Narcan, water, and refer to resources available through organizations local to Austin like ECHO Integral Care; share the helpline number-1-800-662-HELP (4357).  
  • What we can do: support policies that create more housing opportunities and easier access to medication for substance use disorders.  

The First Problem: Substance Use and Overdose Deaths 

Over the past two decades, fatal overdoses have surged. The National Institute on Drug Abuse (NIDA) reports a steady rise in fatal drug overdoses from 1999 to 2022, with nearly 108,000 deaths from overdoses in 2022 alone.1 Synthetic opioids have been the leading cause of these fatalities since 2016, and a significant increase was noted in 2020, as illustrated in Figure 1 below.1  

Figure 1.1 

U.S. Overdose Deaths, Select Drugs or Drug Categories, 1999-2022 

While fentanyl has been found primarily in the heroin supply, in recent years, there has been an alarming increase in non-opioids. For example, a study from 2013 to 2023 found significant increases of fentanyl in illicit, non-opioid drug supplies, like cocaine, methamphetamine, and club drugs (MDMA, ketamine, etc.).2 The presence of fentanyl in stimulants and other non-opioid drugs creates an increased threat for those who have limited exposure to depressants like opioids, as they are at higher risk for respiratory depression or overdose.3  

Overdoses are a nationwide crisis, and Texas, particularly Travis County, is significantly affected by this issue. The rate of unintentional fatal drug overdoses in Texas more than doubled from 7.8 deaths per 100,000 people in 2013 to 16.3 deaths per 100,000 people in 2023.4. Additionally, Texas is grappling with the fentanyl crisis, which is impacting the entire country. Between 2019 and 2020, there was a staggering 181% increase in unintentional fatal fentanyl overdoses in Texas, and this trend has continued to rise through 2023.5 This information is illustrated in Figure 2. Furthermore, Travis County reported 14.5 fentanyl-related deaths per 100,000 people in 2023, placing it among the counties with the highest overdose rates in the state.5 

Figure 2.4 

Texas Statewide Unintentional Drug Poisoning Deaths by Fentanyl, 2010-2023 

The Exacerbating Problem: Homelessness 

The United States is currently grappling with an overdose epidemic alongside a housing crisis. In 2024, approximately 771,480 Americans experienced homelessness, whether sheltered (staying in emergency shelters or transitional housing) or unsheltered (sleeping in tents, cars, abandoned buildings, and other unsuitable places).6 This issue is also present locally; in Austin and Travis County, over 1,600 individuals experienced sheltered homelessness, while more than 1,500 were unsheltered on a single night in 2025.7 The problem has worsened in recent years, with the number of people experiencing homelessness increasing from 2019 to 2023.7 Contributing factors include high living costs, low wages, and systemic racism, such as redlining and gentrification. 

The Connection between Overdoses and Homelessness 

Those who are homeless are at an increased risk of overdose.6,8 A study of hospital data across four US states found that unhoused persons were at an increased risk of opioid overdose and opioid-related emergency department visits or hospital admissions.9 It is important to note that many people do not become homeless due to substance use; unhoused persons may begin using drugs as a coping mechanism for the trauma that is associated with losing their home.10 Receiving consistent treatment for substance use and prevention against overdoses is exceptionally challenging for those struggling with homelessness. Unhoused persons are often forced into itinerant lifestyles, in part due to encampment or street sweeps from law enforcement, or even being sent to jail for vagrancy, which disrupts the continuity of care for substance use disorders (SUD).10  

How Do We Fix This?  

People facing homelessness deal with extraordinary obstacles in accessing substance use treatment and harm reduction services through consistent access to appropriate and affordable healthcare. Offering non-traditional overdose prevention services tailored to the needs of people experiencing homelessness is crucial to supporting their recovery.11 Solutions with research evidence include mobile syringe exchange and addiction medication services in common congregation areas, coupled with affordable housing with onsite wrap-around substance use services.11 Public health policies that couple these two critical areas of support, more supportive housing and easier access to medication for substance use disorders, can support reductions in rates of homelessness and overdoses.  

What Can You Do?  

The best thing a person can do is to carry Narcan (also known as naloxone). Narcan is capable of reversing an opioid overdose within minutes and is safe to use even if opioids aren’t present in a person’s system.12 You can go to https://naloxonetexas.com/ and find free naloxone distributors near you. The Substance Abuse and Mental Health Services Administration (SAMHSA) also has a free, national helpline that provides treatment referrals; you can call at 1-800-662-HELP (4357). The National Coalition for the Homeless offers ways to support those facing homelessness. This includes using intentional language about the unhoused population (“unhoused” vs “homeless” person), creating “survival kits,” or just not looking away from unhoused people; small actions like these can help those experiencing homelessness feel seen and respected. You can find the whole list here: https://nationalhomeless.org/get-involved/.  

References:  

1. Abuse NI on D. Drug Overdose Deaths: Facts and Figures | National Institute on Drug Abuse (NIDA).; 2024. Accessed April 7, 2025. https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates 

2. Lim TY, Dong H, Stringfellow E, et al. Temporal and spatial trends of fentanyl co-occurrence in the illicit drug supply in the United States: a serial cross-sectional analysis. Lancet Reg Health – Am. 2024;39:100898. doi:10.1016/j.lana.2024.100898 

3. Jones CM, Bekheet F, Park JN, Alexander GC. The Evolving Overdose Epidemic: Synthetic Opioids and Rising Stimulant-Related Harms. Epidemiol Rev. 2020;42(1):154-166. doi:10.1093/epirev/mxaa011 

4. Texas Health Data – Drug-Related Deaths. Accessed April 7, 2025. https://healthdata.dshs.texas.gov/dashboard/drugs-and-alcohol/all-drugs/drug-related-deaths#data-source 

5. Texas Health Data – Fentanyl Trends. Accessed April 7, 2025. https://healthdata.dshs.texas.gov/dashboard/drugs-and-alcohol/all-drugs/fentanyl-trends 

6. Bradford WD, Lozano-Rojas F. Higher Rates Of Homelessness Are Associated With Increases In Mortality From Accidental Drug And Alcohol Poisonings. Health Aff (Millwood). 2024;43(2):242-249. doi:10.1377/hlthaff.2023.00951 

7. At a Glance. ECHO. Accessed April 7, 2025. https://www.austinecho.org/about-echo/homelessness-in-austin/ 

8. Yamamoto A, Needleman J, Gelberg L, Kominski G, Shoptaw S, Tsugawa Y. Association between Homelessness and Opioid Overdose and Opioid-related Hospital Admissions/Emergency Department Visits. Soc Sci Med 1982. 2019;242:112585. doi:10.1016/j.socscimed.2019.112585 

9. de Sousa T, Andrichik A, Prestera E, Rush K, Tano C, Wheeler M. The 2023 Annual Homelessness Assessment Report (AHAR to Congress) Part 1: Point-In-Time Estimates of Homelessness, December 2023. U.S. Department Of Housing And Urban Development Office Of Community Planning And Development; 2023. 

10. Doran KM, Fockele CE, Maguire M. Overdose and Homelessness—Why We Need to Talk About Housing. JAMA Netw Open. 2022;5(1):e2142685. doi:10.1001/jamanetworkopen.2021.42685 

11. Fine DR, Dickins KA, Adams LD, et al. Drug Overdose Mortality Among People Experiencing Homelessness, 2003 to 2018. JAMA Netw Open. 2022;5(1):e2142676. doi:10.1001/jamanetworkopen.2021.42676 

12. NARCAN® Nasal Spray. Accessed April 23, 2025. https://narcan.com/en/