At least 456 people experiencing homelessness died in 2023, according to an annual report from the Multnomah County Health Department published Friday.
That’s an increase of more than 100 deaths from the previous year. In 2022, the county’s records included 315 deaths among people who were homeless.
A encampment is seen from the Willamette River in Portland, Ore., on May 29, 2024.
April Ehrlich / OPB
It’s also the highest number of deaths in any year since the county began its analysis in 2011.
The county health department is attributing the surge in deaths to the spread of fentanyl in the drug supply, which it says likely peaked in 2023.
Unintentional overdose deaths in 2023 overall climbed to 282 people, more than double the number of overdoses reported among homeless people in 2022.
Statewide, drug overdoses surged nearly 33% last year.
Fentanyl contributed to 89% of overdose deaths among homeless people in Multnomah County in 2023, according to the report. Methamphetamine was a factor in 81% of the overdose deaths.
County health officials said that’s typical of the so-called “fourth wave” of the opioid crisis, which has been marked by combined use of stimulants and fentanyl.
Surging overdoses and visible distress of people living on the streets in Oregon, and particularly in Portland, have triggered policy change. In 2024, the state ended its experiment with drug decriminalization, which voters approved in 2020. The new law recriminalizing the use of small amounts of drugs went into effect Sept. 1.
Supporters of decriminalization have pointed to research that found the timing of when fentanyl spread through the drug supply in Oregon is the primary reason overdoses have risen sharply in recent years.
Other research concluded at least some of the increase in overdoses can be attributed to decriminalization itself.
Public health staff who prepared the report, which includes just a single year of data, said their analysis didn’t include whether decriminalization was a factor in the number of deaths last year.
“It’s going to take time to analyze changes from Measure 110, to House Bill 4002, to see how those changes and policies have affected mortality patterns,” said Multnomah County Health Officer Dr. Richard Bruno.
Bruno said he believes the county’s efforts to warn people about the dangers of fentanyl, improve access to addiction treatment, and to use the opioid-reversal drug Naloxone to prevent overdoses are gaining traction. Shifts in the drug supply may also be taking place.
Preliminary 2024 data from Multnomah County shows confirmed overdose deaths beginning to drop a little, from an average of 65 deaths a month last year to an average of 58 per month in 2024.
Preliminary statewide data is showing a similar modest decline in overdoses.
The county health department also calculated estimates of how much more likely people who don’t have a stable home are to die of various causes, compared to the general population in the area.
According to their estimates, the risk of death for people who are homeless was eight times higher for all causes of death, 58 times higher for transportation-related deaths, 51 times higher for any drug overdose and 18 times higher for assault and suicide, the health department found.
Those calculations are rough estimates, due to the challenge of accurately counting how many people are homeless each year. The county public health department used the 2023 Point in Time Count tally, counted on Jan 24, 2023, for its estimate of the total population that’s not stably housed, 6,297 people total.
The average age of death was 46, more than 30 years younger than the average U.S. life expectancy the year before.
