More than 300 people experiencing homelessness died in Multnomah County in 2022

At least 315 people died in Multnomah County while experiencing homelessness in 2022, according to a recent report. In 2021, that number was 193. Nearly half of the deaths in the most recent report were found to be accidental — often relating to drug overdoses. The report also shows that people experiencing homelessness were killed in traffic accidents at a rate that is 45 times higher than the overall population. Kaia Sand, executive director of Street Roots, joins us to share details on the report and what led to an increase in deaths since last year.

Note: The following transcript was created by a computer and edited by a volunteer.

Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. Housed and unhoused people die from the same things. It’s just that people living outside, people on the margins of society, people in deep despair and poverty are much more likely to have fatal overdoses from meth or fentanyl, or to be hit by cars or be victims of homicide, or die from suicide, heart disease or COVID-19. These are some of the findings from the latest Domicile Unknown Report that was put out by the county and the newspaper at homeless advocacy organization, Street Roots. The new data is from 2022 and found that at least 315 unhoused people died in Multnomah County. Their average age was 49. That’s about 30 years younger than the current U.S. life expectancy. Kaia Sand is the executive director of Street Roots. She joins us now. Welcome back to the show.

Kaia Sand: Thank you, Dave.

Miller: There’s a lot of data in this new report, but there are also some stories of individual people who died while living on the street. Do you mind telling us just one of their stories?

Sand: Sure. I had the opportunity through the work of this report to meet the brother and sister-in-law of Angela Boyd. She was 47 when she died. She was someone who went to Oregon City High School. She went to U of O and got a journalism degree, so she did work, she was an artist, she worked in print, commercials. And the way her family tells it, she made some kind of turn that they didn’t really understand, her personality changed. She was going through grief. She ended up homeless in the Sellwood neighborhood actually. And how she died was, she was hit by a car, it was a hit and run on Powell Boulevard. Of course, this is devastating for them. She died about the average age of when people die when they’re homeless. This year it’s 49. And as I think about her and a number of the traffic related deaths, I think also about how, even when people don’t die and they’re homeless, often their bodies are whittled away or harmed.

Recently, a Street Roots vendor was hit by a car on that same street, on Powell. And he was just trying to cross, it was hard to cross. He had a lot of belongings and he had two legs broken and an arm, and he survived. But that is part of what happens when people are living in public.

Miller: What else do you think that Angela Boyd’s story illustrates about some of the larger policy issues here?

Sand: Yeah. I think in your opening, what really struck me - because I agree that what we see by doing this report since 2011, is that societal crises, societal challenges are amplified. Right now, we know that traffic fatalities are really high. And I think Sarah Iannarone from Street Trust describes it as a “canary in the coal mine,” right? We know that people on the streets have more than 40 times the likelihood of dying, according to this 2022 report, from traffic fatalities. But it’s the same in a lot of other areas. When homicides are up over all, they’re up even more among unhoused people. So about a quarter of all the people, of all the homicides in 2022, were people who are homeless. Now that might go down because homicides went down in 2023, so it will be really helpful to see that.

Miller: Sticking with the issue of transportation, there is a very helpful graph in the new report that charts mortality risk comparisons to the general population. And it basically shows you, in what I said in my intro, that the risk for death from COVID-19 or suicide or homicide, drugs, they’re all higher for people who are homeless. But the highest, comparatively, the biggest discrepancy in fatality rates among people who are homeless and who are not, is in transportation - 45 times higher than for the general population. What do you think county or city leaders or individual residents can do specifically when it comes to this?

Sand: I know Portland Street Trust did a lot of listening sessions with people in shelters and a lot of the discussion was around infrastructure. Like the description that I gave of a Street Roots vendor on Powell, he didn’t have a crosswalk near him and those are the kinds of things that actually came up. I think we’re also dealing with distracted driving, with impaired driving, with speeding, with heavy vehicles. So all these things that, again, the general population struggles with. When you have people who are homeless - and I don’t just mean living outside [but also] living in shelters, and they often have to walk around all day - they have no space they really can be. They’re in public. They’re just much more susceptible.

Miller: One of the reasons for the increase - something like a 30% increase per year in these deaths over the last three or four years - seems to be drug overdoses. For as much as we talk about fentanyl, methamphetamine was identified as an underlying cause of death in a higher percentage of fatal overdoses. Slightly higher. 81% for methamphetamine for fatal overdoses compared to 74% for fentanyl. What does that tell you?

Sand: Methamphetamine, for the history of this report, has always come out a little bit higher and it strikes people. I think one of the things that’s really powerful this year is we also have hospital data. So for instance, methamphetamines, when they impair the heart. Some of that also comes out in the fact that now we know from 66 hospital deaths that are added in, there’s a lot of heart failure that we’re seeing. And again, way before people’s time. By doing this report and staying with it, we know that if you’re homeless, you are going to die on average three decades before the general population. And so even looking at that hospital data, folks are dying still in their fifties, on average, but the average is 49. So yeah, I think methamphetamine is consistently a killer.

But I also think it’s important to see, again, looking at the general trends, fentanyl entered into the Pacific Northwest right around the pandemic. So when this report started, it was heroin that was the opiate that was killing people. And then it was only in 2017 that fentanyl showed up and that was one person who died. Now, if you looked on the East Coast, it was or in the Midwest, it was 2013, probably when you’re seeing it. So four or five years later is when we’re seeing it in the Pacific Northwest.

So I think it’s really important for folks to see that through this data, we know that fentanyl has become just a massive killer of people, but that that’s part of a national trend of a toxic drug supply that is almost predictable in terms of how it’s growing.

Miller: And just to finish those numbers, the ones that are in this report, it was four deaths tracked to fentanyl in 2020 [and] 91 deaths for 2022. Again, that’s the most recent year for which we have data.

We’ve had these annual reports from the county for more than a decade now. Have they led to any concrete changes? Have they led to better policies? Have they led to improvements?

Sand: One area that I think about is even the ways in which extreme weather shelters have adjusted. And that has come out of these reports because we’ve been able to track these reports, look at the seasons, look at hypo[thermia] and hyperthermia. So when we have the heat dome, we know how many people are dying of heat. When we have big freezes, we know how many people are dying of cold. So what happens now, like we have this weekend, when we’re all preparing, we know that actually part of what we’re doing is working to prevent death. And so the report has given us that knowledge.

I would add to that, that it’s larger. [We’re] looking at larger societal problems, we’re actually looking at climate change, right? As we get more extreme weather and forest fires, the folks who are most vulnerable to dying from those things are people who are homeless, whether in shelters or living outside. And so we always have to get ahead of it. And if we’re watching these numbers, we know not only the policy we need to do around homelessness, but we know of larger societal dilemmas.

Miller: The state legislature required funeral directors all across the state to report domicile unknown on death certificates, meaning that medical examiners can’t find a stable address to write that down. That was just in 2022, a statewide law. How significant is this?

Sand: Yeah, it’s really significant. I’m really proud of this report at the Multnomah County level - Israel Bayer of Street Roots and Deborah Kafoury, Paul Lewis, all from the county. They made this happen in late 2010 and this report then inspired the state legislators to do a statewide account. But the thing about the numbers is that [they] are a little less rich, in terms of how we’re able to analyze them. The medical examiner numbers, they are so committed that they actually are doing narratives, they’re going out and interviewing families, [and] they are trying to find ways to create public policy or to be able to give information for public policy.

But yeah, 66 people we know died in hospitals. And I think that’s super important for us to know because people have untreated diabetes when they don’t have hygiene [or] showers. I know [at] Street Roots, we’re adding showers and laundry because when people get infections, that can grow into sepsis. And we see in the data from hospital deaths, people die from sepsis, that overall bodily infection. Heart disease really strikes me and we lost a couple of people in our community in the last couple of months to things like that at really young ages with all of their stress, all their untreated illnesses, all the ways it’s just difficult to have preventative care.

And I would add, going back to fentanyl, fentanyl is this really interesting thing right now because we know it’s coming, it’s separate from Measure 110. This is national knowledge and if people inject versus smoke it, where they’re injecting elsewhere in the country, we will see more problems in the sense that there’s endocarditis, there’s hepatitis. So watching those hospital deaths and seeing the kind of heart related deaths in that way, those can be related to meth. It can be related to infections from injecting…

Miller: Kaia, we’re out of time, but thank you so much for joining us.

Sand: Thank you.

Miller: That’s Kaia Sand, executive director of Street Roots.

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