By David Wagner
Originally published in LAist, May 15, 2023

Service workers are sounding the alarm about skyrocketing drug-related deaths on the streets of L.A. County following a new report that finds the number of unhoused people dying from overdoses doubled between 2019 and 2021.

About 37% of the 2,201 deaths among unhoused people in L.A. County in 2021 were from overdoses, largely driven by methamphetamine and the potent synthetic opioid fentanyl. Between 2020 and 2021, an average of two unhoused people in L.A. suffered fatal overdoses each day.

“It’s a wake-up call,” said John Maceri, CEO of the nonprofit organization The People Concern, which provides advocacy and services for people experiencing homelessness. “For a while Los Angeles was kind of lagging behind the rest of the country in terms of opioid overdoses and fentanyl. But what we’ve seen is just an explosion — a real acceleration in the last couple of years.”

The new public health figures show that for every 100,000 people experiencing homelessness in L.A. County, 579 died from unintentional drug or alcohol overdoses in 2019. By 2021, the mortality rate from overdoses had doubled to 1,189. At last count, about 69,000 people experience homelessness across L.A. County on any given night. The mortality figures were normalized for a population of 100,000.

Drug use can’t be viewed in isolation, doctors say

Dr. Coley King, a street medicine doctor who directs homeless services at Venice Family Clinic, said the numbers saddened but did not surprise him. He said when an unhoused person overdoses, the problem is rarely only about addiction.

“We are addressing this idea of tri-morbidity,” he said. “Our patients who are chronically homeless very often have this convergence of a medical illness, mental health condition and substance dependence.”

King said he spent Friday morning treating a patient who lives with trauma from growing up in the foster care system. King found him on the street suffering from diabetic ketoacidosis, a potentially life-threatening complication from his Type 1 diabetes made worse by methamphetamine dependence that likely exposed him to fentanyl as well.

“He will survive today,” King said. “But he’s at incredible risk to die within the next weeks or next months. And this could be recorded (by the medical examiner’s office) very specifically as a drug overdose, when it’s a complicated issue with multiple things happening at once.”

Does L.A. need safe injection sites?

Deaths from traffic collisions and homicides also rose among people experiencing homelessness in L.A. during that time, but none as rapidly as drug-related deaths.

Service providers say they have seen the spread of fentanyl killing more unhoused people every year, including many who inadvertently take fentanyl when it is mixed into other drugs such as methamphetamine.

“It used to be, to reverse an overdose, it would take maybe one, two, or in an extreme case, maybe three doses of Narcan,” said Maceri with The People Concern. But with stronger doses of fentanyl being mixed into other drugs, he said, “Now, it’s not uncommon to have to use five.”

Maceri said L.A. County health officials have worked to distribute Narcan, a life-saving nasal spray that reverses the effects of opioid overdose, among residents of local tent encampments. But some addicts use drugs alone, out of sight of people who could intervene.

Last year, Gov. Gavin Newsom vetoed a bill that would have allowed Los Angeles, San Francisco and Oakland to create safe injection sites, where drug users could take substances under the supervision of staff trained to intervene in the event of an overdose.

Some advocates for people experiencing homelessness say such sites are needed in L.A. to reverse skyrocketing overdose deaths among the unhoused.

“Ultimately, we want to see people get into care and treatment,” Maceri said. “But until we can make all of those resources readily available in real time, I think we have to operate on a harm reduction approach.”