Are unhoused individuals more vulnerable to opioid addiction?

Explore the impact of the opioid crisis on the houseless population and the challenges they face in accessing addiction treatment.

Ophelia team
Opioid addiction and houselessness
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Fact checked by
Arthur Robin Williams, MD

Addiction can affect anyone from any walk of life. Certain groups, however, are disproportionately affected by addiction, including individuals experiencing houselessness . Drug addiction amid unhoused individuals presents unique challenges for people dealing with both. 

Studies suggest that those who are experiencing homelessness suffer from substance abuse, making it a difficult addiction to treat. Addressing these issues requires a comprehensive understanding of how houselessness and drug addiction intertwine. 

What is the impact of the opioid crisis on the houseless population?

More than half a million people experienced long-term houselessness in the United States in 2022. Of this group, between 25 to 50% were also dealing with substance use disorder while experiencing houselessness. The COVID-19 pandemic exacerbated both houselessness and drug addiction, leading to a larger population of people in the vulnerable position of both losing their homes and being drug-dependent. 

The opioid crisis, in particular, has had devastating effects on the houseless population. Among those who use opioids, individuals without a steady home are more likely to suffer fatal overdoses and be admitted to the hospital with opioid-related concerns. The use of heroin — a powerful, addictive opioid — has grown significantly over the last decade, as has the misuse of legal opioids. 

In particular, fentanyl has become a major concern. This potent synthetic opioid is so powerful and hard to identify when included in other drugs that it poses significant risks of overdose and death. The houseless population is less likely to have access to resources like fentanyl test strips, leaving them more at risk of the dangers of fentanyl.  

Similar to fentanyl, doctors and researchers have also noted an increased presence of xylazine in street drugs. Xylazine, though not an opioid, has been paired with fentanyl and other opioids and greatly increases the risks of a fentanyl overdose. Intervention efforts specifically geared toward opioids alone may not work on xylazine, further complicating matters. 

Any of these drug additives are especially dangerous because people who use drugs may not know what they’re taking, leading to accidental overdoses. Individuals without homes who have limited access to reliable medical care and addiction treatment are at even greater risk. 

Challenges houseless individuals face accessing addiction treatment

Greater access to comprehensive addiction treatment is key to improving outcomes for those with substance use disorders. Unfortunately, the houseless population often faces even greater barriers to addiction care than the general population. These barriers may delay unhoused individuals from getting the care they need in a timely manner or prevent them from accessing that care entirely. Some of these barriers to addiction treatment include:

  • More immediate concerns, such as housing and food
  • Previous negative experiences with addiction treatment
  • Stigma and perceived prejudice from addiction treatment professionals
  • High costs of traditional addiction treatment
  • Strict appointment times or administrative requirements

Many of these challenges persist even once a houseless individual enters treatment. Those experiencing houselessness are more likely to disengage from addiction treatment programs, which may make it difficult to stay on an opioid treatment path. 

Consider also that LGBTQ+ youth make up a sizable portion of the unhoused population. Over a quarter of LGBTQ+ youth report experiencing houselessness, and the marginalization and stigma they face leave an increased risk of opioid misuse. 

Efforts to address houselessness and drug addiction

Many communities affected by the opioid crisis have made efforts to address the issue for more vulnerable populations, like the houseless. These efforts vary—some communities have focused first on reducing substance misuse while others have first placed emphasis on permanent housing for unhoused individuals. 

New York

Between July 1, 2021 and June 30, 2022, New York City experienced the highest number of deaths among the unhoused population in a year, and overdose was responsible for around half of these fatalities. In light of this, the city has focused on opening and expanding hours at supervised consumption sites or Overdose Prevention Centers (OPCs). These are places individuals can go to use pre-obtained drugs under the supervision of professionals, including medical care providers. 

New York City Mayor Eric Adams has also announced that the city will fund mobile methadone clinics and syringe exchanges to further combat the opioid crisis. Further, the state of New York has allotted over $2 million to provide addiction treatment services at 22 houseless shelters across New York City. Collectively, these efforts should help to address the devastating effects of addiction on the unhoused population in New York. 


Like New York, Pennsylvania has been dealing with epidemics of houselessness and drug addiction. One Philadelphia neighborhood, Kensington, has been hit by the opioid crisis to a devastating degree. To address this crisis, the city created a task force called the Philadelphia Resilience Project and worked to eliminate encampments, bring down criminal activity, and increase access to medications for addiction treatment (MAT). 

The city also has Project HOME, which partners with Philadelphia hospitals to start unhoused individuals on the path to permanent supportive housing after they’re discharged. By 2028, Project HOME will build 150 new beds for unhoused Philadelphia residents dealing with opioid addiction. These efforts will allow the individuals to continue their path to treatment in a supportive housing environment. 

How Ophelia can help 

There’s no single perfect strategy for eliminating houselessness and drug addiction. Various groups, including social services, communities, political leaders, and addiction treatment providers, need to work together to fight these issues effectively. Ophelia’s goal is to make personalized, evidence-based MAT as accessible as possible so that all people—including unhoused individuals with OUD—can get the care they need. 

Schedule a consultation call as a first step to get started.  


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