By Pat Anson, Editor
Drugs overdoses have surpassed HIV and homicide as the leading cause of death among homeless adults in Boston, with opioid painkillers accounting for 8 out of every 10 overdoses, according to a new study.
Researchers at Massachusetts General Hospital (MGH) and the Boston Health Care for the Homeless Program studied over 1,300 homeless deaths in the city from 2003 to 2008. They found a dramatic change from a similar mortality study released in 1997, when the human immunodeficiency virus (HIV) was the leading cause of death.
HIV deaths among the homeless have plunged in recent years, but they’ve been offset by three and two-fold increases in deaths caused by drug overdose and psychoactive substance abuse disorders.
“Our findings are an unfortunate reminder of the high mortality rate of homeless people and a clarion call for the need to address the epidemic of drug overdose deaths in this vulnerable population,” said Travis Baggett, MD, of the MGH Department of Medicine, who led the study that is being published in JAMA Internal Medicine.
Drug overdoses accounted for almost 17 percent of all deaths among the homeless patients studied. Eighty-one percent of the overdoses involved opioid drugs; of these, heroin was identified in 13%, opioid analgesics in 31%, and other narcotics in 60%.
“The dramatic rise in drug overdose deaths reflects a broader nationwide trend in drug poisoning mortality fueled largely by rising opioid-related deaths. Such deaths are fundamentally preventable,” the report said.
“Given the high prevalence of both chronic pain and addiction in homeless persons, health care organizations serving this population may wish to develop standardized pain management protocols to help ensure safe, effective, and appropriate opioid prescribing.”
Researchers found that cancer and heart disease accounted for nearly 16% of deaths among the homeless population. Health issues associated with substance abuse – such as alcoholism-associated heart disease, pneumonia and withdrawal – accounted for 8% of deaths.
While there was no significant change in the overall homeless death rate, homeless people still have a mortality rate much higher than the general population.
“Overall, young homeless people died at a nine times higher rate and middle-aged homeless people at a four-and-a-half times higher rate than comparably aged adults in Massachusetts,” said Baggett.
The current study updates the previous study that covered the years 1988 to 1993. That report found that HIV was the leading cause of death among homeless patients aged 25 to 44, while homicide was the principal cause among those 18 to 24. Heart disease and cancer were the leading causes of death in those 45 to 64.
Mortality was higher in white patients than in black or Hispanic homeless, which researchers say may be due to a disproportionate share of substance abuse and mental illness among white homeless individuals as compared to homeless minorities.
“Our results highlight the dire need to expand addiction and mental health services and to better integrate them into primary care systems serving homeless people,” says Baggett, who is also an instructor in Medicine at Harvard Medical School.