Among Veterans Who Experience Homelessness, Non-fatal Overdose is a Relatively Common Problem

BACKGROUND:
Drug overdose accounts for more than 70,000 deaths annually in the United States, and non-fatal overdose accounts for over 500,000 emergency department (ED) visits each year; however, overdose risk varies substantially among individuals and across populations. Overdose is one of the most common causes of death for younger homeless individuals, but the prevalence of non-fatal overdose among the homeless is unknown. Understanding the prevalence of and risk factors for non-fatal overdose among homeless individuals could inform risk mitigation interventions at approximately 300 federally-funded Health Care for the Homeless Programs, and 55 VA patient-centered medical homes tailored for homeless persons (Homeless Patient-Aligned Care Teams or H-PACTs). Investigators in this study administered a survey to Veterans who have experienced homelessness (current or past) and received primary care at one of 26 VA medical centers across the nation. The survey asked 5,766 Veterans if they had experienced an overdose within the past three years that required an ED visit or immediate medical care (and the substances involved in the overdose) – and/or if they had witnessed someone else experience an overdose during the same time period. Investigators also examined self-reported demographics, housing status, and drug or alcohol problems, in addition to health status, comorbidities, current pain, and chronic pain.

FINDINGS:

• Of this study cohort, 7% reported an overdose in the previous three years. Those who reported an overdose were nearly three times as likely to have witnessed an overdose (39% vs. 14%).
• Compared to Veterans without overdose, those reporting an overdose were younger, more likely to be white, more likely to be homeless at the time of the survey, more likely to be taking medication for mental health issues, had greater psychological distress, and were more likely to report an alcohol or drug problem.
• Alcohol was the most common substance reported with overdose, nearly as common as all drugs combined and more than twice as common as opioids.

IMPLICATIONS:

• Improving access to addiction treatment for homeless and recently-housed Veterans, especially for those who have experienced or witnessed overdose, could protect this population. Also, given the prevalence of high emotional distress in persons who experienced overdose, enhanced mental health services could mitigate some risk for individuals residing on the streets, in shelters, or newly in housing.

LIMITATIONS:

• The cross-sectional nature of the survey prevents causal inference. Current homelessness, for example, was associated with overdose, but it is possible that having an overdose or serious addiction contributed to loss of residence.

AUTHOR/FUNDING INFORMATION:
This study was primarily funded by HSR&D. Drs. Riggs, Hoge, DeRussy, and Kertesz are part of the Birmingham VA Medical Center.

Riggs K, Hoge A, DeRussy A, et al., and Kertesz S. Prevalence of and Risk Factors Associated with Non-Fatal Overdose among Veterans Who Have Experienced Homelessness. JAMA Network Open. March 17, 2020;3(3):e201190.