Opioid‐related overdose deaths among people experiencing homelessness, 2017 to 2021: A population‐based analysis using coroner and health administrative data from Ontario, Canada

Abstract

AbstractAimsTo measure the change in proportion of opioid‐related overdose deaths attributed to people experiencing homelessness and to compare the opioid‐related fatalities between individuals experiencing homelessness and not experiencing homelessness at time of death.Design, setting and participantsPopulation‐based, time‐trend analysis using coroner and health administrative databases from Ontario, Canada from 1 July 2017 and 30 June 2021.MeasurementsQuarterly proportion of opioid‐related overdose deaths attributed to people experiencing homelessness. We also obtained socio‐demographic and health characteristics of decedents, health‐care encounters preceding death, substances directly contributing to death and circumstances surrounding deaths.FindingsA total of 6644 individuals (median age = 40 years, interquartile range = 31–51; 74.1% male) experienced an accidental opioid‐related overdose death, among whom 884 (13.3%) were identified as experiencing homelessness at the time of death. The quarterly proportion of opioid‐related overdose deaths attributed to people experiencing homelessness increased from 7.2% (26/359) in July–September 2017 to 16.8% (97/578) by April–June 2021 (trend test P < 0.01). Compared with housed decedents, those experiencing homelessness were younger (61.3 versus 53.1% aged 25–44), had higher prevalence of mental health or substance use disorders (77.1 versus 67.1%) and more often visited hospitals (32.1 versus 24.5%) and emergency departments (82.6 versus 68.5%) in the year prior to death. Fentanyl and its analogues more often directly contributed to death among people experiencing homelessness (94.0 versus 81.4%), as did stimulants (67.4 versus 51.6%); in contrast, methadone was less often present (7.8 versus 12.4%). Individuals experiencing homelessness were more often in the presence of a bystander during the acute toxicity event that led to death (55.8 versus 49.7%); and where another individual was present, more often had a resuscitation attempted (61.7 versus 55.1%) or naloxone administered (41.2 versus 28.9%).ConclusionsPeople experiencing homelessness account for an increasing proportion of fatal opioid‐related overdoses in Ontario, Canada, reaching nearly one in six such deaths in 2021.