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In Response to Homeless Mortality: Harm Reduction Policies Must Be Implemented Immediately

Immediate steps to minimize drug-related homeless mortality include syringe exchange, and distribution of naloxone and fentanyl testing strips.

By: Tim Houchen
January 21, 2021 —


“This alarming increase in homeless deaths, particularly those from drug overdoses, requires immediate action…. As we work hard to secure housing for those experiencing homelessness, we have a civic and moral obligation to prevent unnecessary suffering and death.

Dr. Barbara Ferrer, Director
L.A, County Public Health Department


In the aftermath of a year that has wreaked havoc on so many people, it’s far too easy to remember our own personal struggles and inconveniences without thinking about others who struggled and suffered far more than ourselves.

Every community has been impacted in one way or another while in the grips of the current world-wide pandemic, but no community has been impacted more than the community of persons living without permanent, healthy, safe and secure places to call home.

2020 was exceptionally harsh on persons experiencing homelessness on the streets. From my own experience of homelessness I can tell you that one can get accustomed to the harsh realities of living on the streets as long as one has the will to survive.

The hard truth is, you can wish to live all you want, but there is no guarantee on the street. It’s very easy to lose your life out there and in so many cases lives are just taken at the snap-of-the finger with no questions asked. 2020 was exceptionally cruel to homeless persons in this manner of taking lives.

This month Los Angeles County published its second annual report on homeless mortality. It would be nice if this type of data were made available to advocates in Orange County, but it’s not. So, we look to L.A. to try to find answers to why so many persons experiencing homelessness died in 2020?

The data from L.A. County shows that COVID-19 did not directly impact people experiencing homelessness as much as the county’s general population, overdose deaths — especially those involving fentanyl — increased among the homeless during the pandemic.

The leading cause of deaths among homeless people has been drug overdoses since 2017, and between 2016 and 2019, the overdose rate rose 84%, according to officials. For the combined years of 2017 to 2019, the risk of drug overdose was 36 times higher for people experiencing homelessness than for the general population.

White homeless people had the highest rates of overdoses during that period, but the overdose death rate among Black and Latino people experiencing homelessness rose substantially, officials said.

The other four leading causes of death among homeless people are coronary heart disease, traffic injuries, homicide and suicide, according to officials, who said they are between four and 17 times more likely to die from those four causes than the general public is.

HOMELESS PERSPECTIVE has dedicated the month of January to the topic: “Homelessness and the opioid Epidemic.” Each Saturday night at 8:00 PM we broadcast our LIVE WEEKLY UPDATE program and each week we have interviewed special guests with some kind of expertise in opioid addictions.

Click on the video above to see the HOMELESS PERSPECTIVE LIVE WEEKLY UPDATE for January 17, 2021.

This past week we spoke with a Haven Wheelock from Portland, Oregon (see video above for interview) who is director of a syringe exchange program for a nonprofit, Outside-In. One of the services they offer homeless clients with substance abuse issues is the fentanyl testing strips that can determine the presence of fentanyl in any street drug. It is a program that has saved many lives in Portland.

I first became aware of the fentanyl testing program while working on a documentary in Portland during the summer of 2018. At the time it didn’t really strike me as something that would go over well in Orange County, but after these record numbers of homeless deaths in 2020, and knowing that many of the deaths were from overdose and fentanyl was contributing to these deaths. It only took me a few minutes to call Portland and find out more information about the fentanyl testing strips program.

I had never heard of such a program in California, not to say one does not exist, but you would think that their would be more discussion about this program as a possible way of saving lives. It’s not expensive, one strip costs about $1.00. The strips are not dangerous and they don’t threaten public safety in any way. If a strip turned up on a playground, there might not be an outcry from the public, at least not the same as if a syringe were found discarded in a playground. That’s a problem.

So, this past week I have gone on record as suggesting that fentanyl testing strips should immediately be deployed to give homeless persons struggling with opioid addictions the opportunity to find out if the drugs they purchased on the street are laced with an often lethal substance called fentanyl that can be 50 to 100 times more powerful than morphine or heroin. I am also endorsing the expansion of programs that distribute naloxone and improve access to both of these for persons experiencing homelessness and struggling with opioid addiction.

Now, let’s go back to the L.A. County homeless mortality report. I read some of the information in that report last week. In an article today it reads, “The Public Health Department is taking immediate steps to minimize drug-related mortality among homeless people including: expanding harm reduction services to include syringe exchange programs, and distribution of naloxone and fentanyl test strips. Increasing access to supportive housing for homeless people with substance use disorder, etc, etc.

What is Harm Reduction?

If you refer to the video above, there is a really good description of what harm reduction is. Otherwise, here is a definition from the National Alliance to end homelessness website:

A set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm Reduction is also a movement for social justice built upon the belief in, and respect for, the rights of people who use drugs.

Harm Reduction can further be defined as “a set of policies, programs, and practices that aim to reduce the harms associated with the use of psychoactive drugs in people unable or unwilling to stop. The defining features are the focus on the prevention of harm, rather than on the prevention of drug use itself, and the focus and respect for people who continue to use drugs.”

Harm Reduction does not conflict whatsoever with the Housing First model.

I believe that in times of crisis, and these times are certainly critical, hard decisions must be made to protect and preserve the lives of the people that are most vulnerable in our society and who are are the least likely to protect and preserve themselves.

There is not a lot of time to spend discussing the fentanyl testing and the naloxone kits that when administered can reverse the effects of opioids while overdosing. Every day that passes, more will die if we don’t take these immediate steps and provide better access to these life-saving tools.

The L.A. County Department of Public Health and I, Tim Houchen, agree that immediate steps must be taken to save lives of persons experiencing homelessness and struggling with opioid addictions.


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