A jarring new report finds a sharp and significant increase in unhoused people dying in Los Angeles County — up 70% between just 2019 and 2021, according to county health officials.
That number of deaths marks a new record high and the first time L.A. County has had more than 2,000 people experiencing homelessness die in a single year.
“There's a tragedy happening in L.A., and it's happening on a daily basis,” said Will Nicholas, director of the Center for Health Impact Evaluation at the L.A. County Department of Public Health. “This is the first time that we've broken the 2,000 mark, so I hope people take notice. Hopefully this is not a new normal."
One key thing to know: COVID-19 is not the the main issue driving the rise in deaths for those experiencing homelessness, it's not even in the top three.
Here's what we know about deaths of unhoused people in recent years, according to statistics released by the L.A. County Department of Public Health:
Mortality increased among both people experiencing homelessness and the general county population during the first two years of the pandemic. But the increase was greater among people experiencing homelessness, so the gap between the housed and unhoused groups — already large — widened more.
The proliferation of fentanyl, a dangerously potent synthetic opioid, and surges in homicides and road traffic fatalities all took a tremendous toll on unhoused Angelenos. Those factors contributed to a 55% increase in the crude mortality rate for people experiencing homelessness in just two years, from 2,056 per 100,000 in 2019 to 3,183 per 100,000 in 2021.
The report relied on data from the 2022 homeless count and from medical examiners who tend to investigate non-natural deaths, such as deaths caused by suspicious circumstances including overdoses, homicides and suicides.
Drug overdose remains the leading cause of death among people experiencing homelessness, as it has since 2019. Overdoses account for 37% of all deaths in 2020 and 2021 combined. That’s about two deaths per day.
On average over the last couple years, two people every day are dying of overdose on the street... It’s a shocking number and it is preventable.
“More people experiencing homelessness died of overdoses in 2020 and 2021 than in the six previous years combined,” said Nicholas. “On average over the last couple years, two people every day are dying of overdose on the street [in L.A. County],” Nicholas said. “It’s a shocking number and it is preventable.”
Methamphetamine remains the most common drug in fatalities. But the number of deaths involving fentanyl and a mixture of both drugs also jumped.
In 2021, 71% of fentanyl deaths among people experiencing homelessness also involved methamphetamine.
The report authors note the data did not allow them to determine if people who died of overdoses involving fentanyl purposefully took it in combination with another drug or took it because it was added to another drug without their knowledge.
“The issue with fentanyl is that it's being found everywhere now. It's being found in illicit drugs, it's being found in counterfeit pills. The individuals who are being exposed are very broad now, it’s not just people experiencing homelessness,” said Dr. Gary Tsai, division director of the Substance Abuse Prevention and Control with L.A. County Public Health.
Tsai is a physician who treats people experiencing homelessness and has seen the devastating effects of fentanyl first hand.
“We're seeing more people actively seeking out fentanyl. Once the body builds up tolerance, the higher potency is going to be something that the individual is going to need, otherwise, they may feel like they're going into withdrawal, which does not feel good. I think that's the problem,” he said.
In a striking observation, the report authors cited anecdotal reports from female users who favor methamphetamine “because its sleep depriving effects help protect them from the sexual assaults prevalent in life on the street,” which may explain why methamphetamine contributed to a higher percentage of female versus male overdose deaths.
Coronary heart disease was the second leading cause of death among people experiencing homelessness. Coronary heart disease deaths accounted for 14% of all deaths among persons experiencing homelessness in 2020 and 2021 combined — about 5 deaths per week on average.
“Coronary heart disease is the leading cause of death in the general population, so it’s not surprising,” said Nicholas. “People on the streets are also aging and they tend to die of coronary heart disease, younger.”
The third leading cause of death was traffic injuries. The number of people experiencing homelessness who died from traffic injuries increased by 47% from 2019 to 2021. Traffic deaths account for 8% of all deaths of people experiencing homelessness in 2020 and 2021 combined —about 3 deaths per week on average.
The homicide rate increased by 49% in 2021 compared to the previous year. Homicides were the fourth leading cause of death in 2020 and 2021—about 2 deaths per week on average.
COVID-19 also took a serious toll on the homeless population. There were 789 outbreaks detected at homeless shelters in 2020 and in 2021.
“People experiencing homelessness died of COVID at almost twice the rate of the general population,” Nicholas said. “It’s not that COVID was not an issue, it certainly was. It's just that it's dwarfed by some of the other causes of death."
Nicholas said Public Health’s team of people focused specifically on identifying and controlling COVID outbreaks in homeless shelters and among people experiencing homelessness may have played a part in preventing that gap from widening.
The report calls for more housing and greater access to the opioid overdose reversal medication Naloxone.
“You can't really treat somebody's mental, physical, or behavioral health issues until they have a home,” Nicholas said.
