Strengthening Local Responses to Opioid Misuse Among Individuals Experiencing Homelessness

February 1, 2017

The United States is witnessing an unprecedented opioid crisis that is touching many segments of the population, from rural and suburban to urban communities and across socio-economic lines. According to the Centers for Disease Control and Prevention, opioid overdose deaths increased by 14% between 2013 and 2014, the most recent years that the data has been analyzed. In 2014 alone, 28,647 drug overdose deaths involved opioids.

The high prevalence of substance use disorders among individuals experiencing homelessness has been well-documented, and the specific impact of the opioid crisis on this population is an issue of increased concern and focus in communities across the country. A groundbreaking study in Boston found that drug overdoses — 81% of those from opioids — are the leading cause of death among individuals experiencing homelessness in the city. Individuals experiencing homelessness in the study were nine times more likely to die from an overdose than those who were stably housed.

While the challenge of serving people experiencing or at risk of homelessness who misuse opioids is not new for health care and homelessness service providers, there are many new federal resources being deployed to address the issue, particularly through grants available to states as a result of the 21 st Century Cures Act.

The Department of Health and Human Services (HHS) has worked to expand the use of evidence-based practices that are effective in reversing overdoses, treating opioid use disorders, and preventing future overdoses. HHS has prioritized action in three key areas to help those struggling with substance use disorders and to save lives of those impacted:

  1. Providing training and educational resources, including updated prescriber guidelines, to assist health professionals in making informed prescribing decisions and address the over-prescribing of opioids.
  2. Increasing use, development, and distribution of naloxone, a life-saving medication used to prevent opioid overdose, to help reduce the number of deaths associated with prescription opioid and heroin overdose.
  3. Expanding the use of medication-assisted treatment, a comprehensive way to address the needs of individuals that combines the use of medication with counseling and behavioral therapies to treat substance use disorders.

In addition to HHS’s cross-cutting work on this issue, the Office of the Surgeon General recently released a groundbreaking report, Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health ,  which outlines not only the scope of alcohol and drug use and addiction and the clinical aspect of these addictions, but also the opportunities to leverage prevention, intervention, and recovery  programs to turn the trends around. The best practices and lessons learned that are covered here are critical for communities seeking to serve individuals experiencing homelessness who misuse opioids.

To support communities as they develop or enhance responses to the opioid crisis among people experiencing or at risk of homelessness, USICH has compiled these and other key resources, programs, and evidence-based practices into a simple guide focused on five key strategies :

  1. Assess the Prevalence of OUDs and Opioid Misuse Among Individuals Experiencing Homelessness
  2. Develop and Implement Overdose Prevention and Response Strategies
  3. Strengthen Partnerships between Housing and Health Care Providers to Provide Tailored Assistance
  4. Improve Access to Medication-Assisted Treatment
  5. Remove Barriers to Housing

It is critical that local, state, and national leaders work together to ensure that these services and treatments are incorporated into their local responses to homelessness. Paired with stable, permanent housing using a Housing First approach, treatment and care for opioid misuse can be transformational for these individuals and families and their communities.

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