Boston’s Homeless Overdosing More

Drug overdose overtakes HIV in all cause mortality among Boston homeless population

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) Medicine may have advanced since the 1980s, but death rates among the homeless in one of the United States' biggest cities remains the same. Drug overdoses have become the greatest concern.

A recent study analyzed death rates for the homeless population in Boston, MA from 1988 to 2008. The study’s results found death rates have remained consistent overall. The drop in deaths from HIV-related illness was offset by an increase in drug overdoses and psychoactive substance use disorder-related deaths.

"Seek treatment for substance abuse."

Travis Baggett, MD, MPH, board certified Internal Medicine physician at Massachusetts General Hospital in Boston, led a team to investigate types of deaths in the homeless population in Boston over the past 15 years.

For the study, 28,033 adults 18 years and older who had visited the Boston Health Care for the Homeless Program between 2003 and 2008 were cross checked with death certificates.

Death rates in the adult homeless population in Boston between 1988 and 1993 were also assessed and compared to those from 2003 to 2008 for changes.

Overall, 1,302 deaths were found. The major causes of death were drug overdose (219 cases), cancer (206 cases) and heart disease (203 cases). Death rates were higher in white homeless compared to non-white homeless.

Drug overdose was responsible for the deaths of one-third of homeless adults under the age of 45. In 81 percent of the drug overdose deaths, opioids were the drugs responsible.

Researchers compared the Boston homeless deaths to those reported by the state of Massachusetts. For homeless between the ages of 25 and 44, death rates were nine times higher in Boston. For homeless between the ages of 45 and 64, death rates were four and a half times higher.

Compared to Boston homeless deaths from 1988 to 1993, human immunodeficiency virus (HIV) associated deaths had dropped. But there was a three-fold increase in deaths by drug overdose and a two-fold increase in deaths by psychoactive substance use disorders.

A drug overdose is a single instance where the body cannot handle the amount of drugs in the system at that time. Psychoactive substance use disorders encompass the use and abuse of any and all legal and illegal substances including alcohol, drugs and over-the-counter medications. Long-term use and abuse of drugs and alcohol can tear down the body and the brain.

The authors concluded, “The all-cause mortality rate among homeless adults in Boston remains high and unchanged since 1988 to 1993, despite a major interim expansion in clinical services. Drug overdose has replaced HIV as the emerging epidemic.”

The authors recommended, “Interventions to reduce mortality in this population should include behavioral health integration into primary medical care, public health initiatives to prevent and reverse drug overdose, and social policy measures to end homelessness.”

Death rates have not noticeably changed in the Boston homeless population since 1988. The types of death have shifted from communicable disease to drug overdose.

This study was published in January in JAMA Internal Medicine.

Reviewed by: 
Review Date: 
January 15, 2013
Last Updated:
January 18, 2013