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Staggering increase in opioid-related deaths among people experiencing homelessness, new study finds


London, ON, October 17, 2023 – People experiencing homelessness accounted for an increasing proportion of fatal opioid-related deaths in Ontario, Canada, reaching one in six such deaths by 2021, according to new research from ICES, Western University and Lawson Health Research Institute.

In one of the first reports to track the continuous increase in opioid-related mortality in the province among people experiencing homelessness, researchers found that the quarterly proportion of opioid-related overdose deaths among unhoused individuals increased from 7.2% (26 deaths) in the period of July to September 2017 to 16.8% (97 deaths) by April to June 2021.

“On average, that’s one homeless individual losing their life to an opioid overdose every day, one year into the COVID-19 pandemic,” says lead author Richard Booth, adjunct scientist at ICES, associate professor and Arthur Labatt Family Research Chair in Nursing at Western University and affiliate scientist at Lawson. “Unhoused people are overrepresented among opioid-related deaths, and the situation has reached a critical point following the challenges of the COVID-19 pandemic.”

The study was published in the journal Addiction and analyzed linked coroner and health record data. Over the four-year study period, 6,644 individuals (average age of 40 and 74% male) had an accidental death due to an opioid-related overdose and the investigating coroner identified 884 (13%) as experiencing homelessness at the time of death.

Study findings show:

  • People experiencing homelessness accounted for one in 14 opioid-related overdose deaths in 2017 and one in six deaths in 2021; however, this statistic doubled to one in three deaths when considering individuals who had experienced homelessness in the year prior to their death.
  • While opioid overdose deaths in the province increased two-fold over the four-year timeframe, deaths among the unhoused saw a nearly four-fold increase.
  • Unhoused individuals who died were often younger (61.3% versus 53.1%, between 25 and 44 years), resided in major urban centres, and were more likely to have recently accessed healthcare services for mental health or substance use disorders, compared to housed individuals who died.
  • At the time of the overdose, individuals experiencing homelessness were more often in the presence of a bystander and were more likely to have a resuscitation attempt or naloxone administered.

“Lack of housing can influence people’s patterns of substance use, which can introduce considerable risk for people accessing Ontario’s highly potent, unpredictable illicit drug supply,” says Tara Gomes, a senior scientist at ICES and the Li Ka Shing Knowledge Institute of St. Michael’s Hospital. “Access to low-barrier housing should be a central strategy paired with improved accessibility to treatment and harm reduction services tailored to the needs of people experiencing homelessness.”

One limitation of the study was the method of classifying an individual’s housing status, which can be challenging to assess at the time of death. It’s possible that some individuals were experiencing ‘hidden homelessness,’ when is when people live with inadequate housing or avoid using homelessness supports and services.

Nevertheless, this is one of the first population-based studies to track the increasing proportion of deaths from opioid-related overdoses in the population of Ontarians experiencing homelessness. The findings underscore the urgency of the situation, and the need for effective policy and interventions to address the opioid epidemic, which coincides with a severe housing shortage in Ontario.

The authors would like to thank the Office of the Chief Coroner for Ontario for their support in accessing these data, and the Public Health Agency of Canada’s funding support through Homelessness Counts.

The study, “Opioid-related overdose deaths among people experiencing homelessness, 2017 to 2021: a population-based analysis using coroner and health administrative data from Ontario, Canada” was published in Addiction.

Authors: Booth R, Shariff S, Carter B, Hwang S, Orkin A, Forchuk C, Gomes T.

ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on X, formerly Twitter: @ICESOntario

Western University delivers an academic experience second to none. Since 1878, The Western Experience has combined academic excellence with life-long opportunities for intellectual, social and cultural growth in order to better serve our communities. Our research excellence expands knowledge and drives discovery with real-world application. Western attracts individuals with a broad worldview, seeking to study, influence and lead in the international community. 


Lawson Health Research Institute is one of Canada’s top hospital-based research institutes, tackling the most pressing challenges in healthcare. As the research institute of London Health Sciences Centre and St. Joseph’s Healthcare London, our innovation happens where care is delivered. Lawson research teams are at the leading-edge of science with the goal of improving health and the delivery of care for patients. Working in partnership with Western University, our researchers are encouraged to pursue their curiosity, collaborate often and share their discoveries widely. Research conducted through Lawson makes a difference in the lives of patients, families and communities around the world.


Misty Pratt
Senior Communications Associate, ICES
[email protected] 613-882-7065

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