A groundbreaking study conducted by UC San Francisco's Benioff Homeless and Housing Initiative has revealed complex relationships between substance use and homelessness, while dispelling common misconceptions about drug use among unhoused populations.
The research, published in JAMA, found that contrary to widespread beliefs, only 37% of homeless individuals regularly use illicit drugs, with 25% reporting never having used drugs at all. However, the study confirmed that drug use rates are substantially higher among homeless populations compared to the general public.
The study, which surveyed 3,200 people and conducted 365 in-depth interviews, uncovered that over 65% of respondents had regularly used drugs at some point, with 27% initiating use after becoming homeless. Notably, 35% reported decreased drug use after losing housing, often motivated by concerns like maintaining child custody.
A striking finding highlighted severe gaps in addiction treatment access. One in five respondents actively seeking treatment were unable to obtain it, with only 7% of those with lifetime drug use receiving care. Many described frustrating experiences of being waitlisted or turned away from treatment facilities.
"You shouldn't scrounge to save money to go somewhere and be told you'll be put on a waiting list. That should not happen, but it does," noted Dr. Margot Kushel, the study's lead author and Benioff director.
Methamphetamine emerged as the most commonly used substance among homeless individuals, with many reporting using it to stay alert and cope with trauma, assault fears, and depression. While opioid use was lower at 10%, the risk of overdose remained high - nearly 20% of respondents had experienced an overdose in their lifetime.
The research recommends expanding access to residential treatment programs, increasing street-level resources like methadone, and ensuring treatment paths lead to stable housing rather than returning people to homelessness after relapses.
This comprehensive study represents the largest representative sample of homelessness since the 1990s, offering valuable insights to shape more effective interventions and support services for unhoused populations struggling with substance use.