Substance Use
Non-fatal overdose and naloxone possession prevalence among adults experiencing homeless; Results from the California Statewide Study of People Experiencing Homelessness Ryan D. Assaf* Ryan D. Assaf Meghan D. Morris Margot Kushel
Overdose is the leading cause of death among people experiencing homelessness (PEH), but little is known about non-fatal overdose and overdose prevention efforts in this population. There are over 181,000 PEH nightly in California, representing 28% of those experiencing homelessness and half of those experiencing unsheltered homelessness in the US. Using cross-sectional data from a representative sample of PEH in California, we estimated non-fatal overdose and naloxone possession prevalence, overall and by substance use behaviors. We weighted participant (n=3,200) responses to represent the statewide adult PEH population and calculated weighted distributions for prevalence estimates. The median age was 46 years (IQR 35.9, 55.8), two-thirds were cisgender men (67.3%) with similar distributions of White (27.9%), Latinx (26.4%), and Black and African American (26.3%). Lifetime and recent (during current homelessness episode) non-fatal overdose prevalence was 19.6% and 10.0%, respectively (Figure 1); of those with lifetime non-fatal overdose, half (52.4%) experienced a non-fatal overdose during their current episode of homelessness. Of those with a recent non-fatal overdose experience, 34.6% reported any meth/amphetamine and opioid use in the last 6 months, 21.4% reported any meth use only, and 15.7% reported any meth, opioids, and cocaine/crack cocaine use; 35.1% of those with a recent non-fatal overdose reported injecting substances in the last 6 months. One-quarter (24.9%) possessed naloxone; 43.4% of those with lifetime non-fatal overdose possessed naloxone, 56.7% of those with a recent non-fatal overdose did, and 20.3% who never had a non-fatal overdose did. Non-fatal overdose is prevalent among PEH and concentrated in those who used more than one illicit substance, who used meth only, and who did not inject drugs. There is a need to increase overdose prevention in PEH. Increasing naloxone possession could reduce the risk of fatal overdose.
