A new study finds that well under half of unhoused people in California are regular drug users, challenging public perceptions about the extent to which addiction is fueling homelessness.
Only about 37% of the more than 3,200 homeless residents surveyed in the UC San Francisco-led study reported using drugs at least three times a week in the prior six months. Roughly 25% said they had never taken drugs before.
However, the statewide survey also found that nearly two-thirds of respondents reported regularly using drugs at some point in their lives, evidence the drug and homelessness crises are still clearly linked.
About four in 10 respondents said they began using drugs before becoming homeless, while 23% said they only started after losing their housing.
“Our research shows there is an increased risk of becoming homeless if you use drugs; and that homelessness itself increases drug use because people use it as a coping strategy,” said study author Dr. Margot Kushel in a statement.
The findings didn’t come as a surprise to Vivian Wan, chief executive of Abode Services, one of the Bay Area’s largest homeless service providers. She said that while homeless people using drugs in encampments and on city streets are the most visible to the public, there are even more waking up in their cars each morning before heading to work or going unnoticed on their laptops at Starbucks.
“When you actually see someone on a sidewalk or at a BART station who may be actively using drugs, that sticks in people’s minds,” Wan said. “Largely, homeless people are invisible.”
Researchers who conducted the survey, taken over 12 months in 2021 and 2022, noted that respondents may have underreported their drug use. To get honest responses, researchers worked with community outreach teams to build trust and administered the survey anonymously.
Last year, California’s homeless population rose 3% to more than 187,000, while homelessness in the Bay Area increased 6% to an estimated 38,891 people. Across both the Bay Area and the state, about two-thirds of homeless residents live in encampments, vehicles or other places not meant for habitation, while the rest stay in shelters or transitional housing.
Experts agree that homelessness will persist across the state until California can alleviate its staggering shortage of affordably priced housing. Wan said a stable home is especially important for people with addiction so they can focus on recovery rather than worrying about their safety or where to find their next meal.
“The crisis of living outside, it’s hard to concentrate on anything else but survival,” she said.
The study found that just 7% of respondents were in treatment at the time of the survey. About 21% said they wanted drug treatment but were unable to find it.
Across the state, communities are now phasing in new reforms to expand access to treatment or compel people into rehab programs. Last March, California voters narrowly approved a $6.4 billion bond measure estimated to add 10,000 behavioral health beds and supportive housing units combined in the coming years.
Another potentially unexpected finding in the study: The most common drugs used by homeless people aren’t opioids but methamphetamines.
One-third of respondents said they regularly used methamphetamines, while just 10% reported regular opioid use. Homeless people living without shelter may use meth to help them stay alert on the street, the researchers said.
About 20% said they had overdosed on drugs at least once in their lifetime, with 10% overdosing while they were homeless.
Since the start of last year, overall overdose deaths in California and across the country have been on a steep decline, a remarkable reversal following an explosion of drug fatalities during the pandemic.
Experts have speculated the drop could be due to a combination of factors: expanded treatment and intervention efforts, recent crackdowns on the illicit opioid trade and less lethal pills on the street — or simply because the overdose epidemic has passed its inevitable peak.
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