TY - JOUR
T1 - Drug-related deaths among housed and homeless individuals in the UK and the USA
T2 - comparative retrospective cohort study
AU - Roberts, Emmert
AU - Copeland, Caroline
AU - Humphreys, Keith
AU - Shover, Chelsea l.
N1 - Funding Information:
This paper represents independent research supported by E.R.'s Commonwealth Fund Harkness Fellowship in Health Care Policy and Practice. The views presented here are those of the authors and should not be attributed to the Commonwealth Fund nor its directors, officers or staff. K.H. was supported by a Senior Research Career Scientist Award from the Veterans Affairs Health Services Research and Development Service. C.L.S. was supported by grants from the National Institute on Drug Abuse (K01DA050771, R01DA057630). The funders had no contribution to the study design; the collection, analysis and interpretation of data; the writing of the report; and the decision to submit the article for publication.
Publisher Copyright:
Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists.
PY - 2023/9/4
Y1 - 2023/9/4
N2 - Background The UK and USA currently report their highest number of drug-related deaths since records began, with higher rates among individuals experiencing homelessness. Aims Given that overdose prevention in homeless populations may require unique strategies, we evaluated whether substances implicated in death differed between (a) housed decedents and those experiencing homelessness and (b) between US and UK homeless populations. Method We conducted an internationally comparative retrospective cohort study utilising multilevel multinomial regression modelling of coronial/medical examiner-verified drug-related deaths from 1 January 2012 to 31 December 2021. UK data were available for England, Wales and Northern Ireland; US data were collated from eight county jurisdictions. Data were available on decedent age, sex, ethnicity, housing status and substances implicated in death. Results Homeless individuals accounted for 16.3% of US decedents versus 3.4% in the UK. Opioids were implicated in 66.3 and 50.4% of all studied drug-related deaths in the UK and the USA respectively. UK homeless decedents had a significantly increased risk of having only opioids implicated in death compared with only non-opioids implicated (relative risk ratio RRR = 1.87, 95% CI 1.76-1.98, P < 0.001); conversely, US homeless decedents had a significantly decreased risk (RRR = 0.37, 95% CI 0.29-0.48, P < 0.001). Methamphetamine was implicated in two-thirds (66.7%) of deaths among US homeless decedents compared with 0.4% in the UK. Conclusions Both the rate and type of drug-related deaths differ significantly between homeless and housed populations in the UK and USA. The two countries also differ in drugs implicated in death. Targeted programmes for country-specific implicated drug profiles appear warranted.
AB - Background The UK and USA currently report their highest number of drug-related deaths since records began, with higher rates among individuals experiencing homelessness. Aims Given that overdose prevention in homeless populations may require unique strategies, we evaluated whether substances implicated in death differed between (a) housed decedents and those experiencing homelessness and (b) between US and UK homeless populations. Method We conducted an internationally comparative retrospective cohort study utilising multilevel multinomial regression modelling of coronial/medical examiner-verified drug-related deaths from 1 January 2012 to 31 December 2021. UK data were available for England, Wales and Northern Ireland; US data were collated from eight county jurisdictions. Data were available on decedent age, sex, ethnicity, housing status and substances implicated in death. Results Homeless individuals accounted for 16.3% of US decedents versus 3.4% in the UK. Opioids were implicated in 66.3 and 50.4% of all studied drug-related deaths in the UK and the USA respectively. UK homeless decedents had a significantly increased risk of having only opioids implicated in death compared with only non-opioids implicated (relative risk ratio RRR = 1.87, 95% CI 1.76-1.98, P < 0.001); conversely, US homeless decedents had a significantly decreased risk (RRR = 0.37, 95% CI 0.29-0.48, P < 0.001). Methamphetamine was implicated in two-thirds (66.7%) of deaths among US homeless decedents compared with 0.4% in the UK. Conclusions Both the rate and type of drug-related deaths differ significantly between homeless and housed populations in the UK and USA. The two countries also differ in drugs implicated in death. Targeted programmes for country-specific implicated drug profiles appear warranted.
UR - http://www.scopus.com/inward/record.url?scp=85170662965&partnerID=8YFLogxK
U2 - 10.1192/bjp.2023.111
DO - 10.1192/bjp.2023.111
M3 - Article
SN - 0007-1250
SP - 1
EP - 7
JO - British Journal of Psychiatry
JF - British Journal of Psychiatry
ER -