PORTLAND, Ore. (KOIN) – Multnomah County released its 2023 Domicile Unknown report on Friday, showing a surge in deaths among homeless people and that most of those deaths are related to substance use.

The annual report -- which reviews deaths among the county's homeless population -- found at least 456 people facing homelessness died in 2023, which is not only an increase from the more than 315 deaths reported in 2022 but also marks the highest number of homeless deaths since Multnomah County started publishing the reports.

Among the 456 people experiencing homelessness who died in 2023, more than half of those deaths (251) were linked to fentanyl. However, health officials believe the report shows a peak in the fentanyl crisis and are hopeful for the future.

Substance use

According to the Multnomah County Health Department, the report echoes national trends as fentanyl-related deaths reached a record high in 2023.

Of the 456 deaths reported in 2023, more than half (251) were linked to fentanyl – which is also triple the number reported in 2022, the report said. Overall, overdose deaths climbed to 282 people, more than double the 123 overdose deaths reported in 2022.

“The devastating toll fentanyl is taking on our community is starkly apparent in this report and it is heartbreaking,” said Multnomah County Chair Jessica Vega Pederson. “This is a moment for our community to grieve alongside more than 450 families who lost loved ones in 2023 and to continue providing and fighting for more behavioral health, supportive housing and other resources to respond.” 

According to Multnomah County Health Officer Dr. Richard Bruno, the 2023 numbers show the toll fentanyl has had in the community, which has "begun to lessen in 2024, following a local and state emergency declaration to address the crisis and other national changes.”

“The data in this report are from 2023, which appears to be the peak of the fentanyl crisis in Multnomah County,” Bruno added. “As we are seeing fentanyl overdose deaths decreasing in 2024, we are hopeful that future reports will hold much lower numbers.”

“For me, this report hits close to the heart,” Bruno said. “Many of the people outlined in this report were patients I cared for in clinic and I knew their stories well. These were people who fought incredible odds, facing barriers and adversity in healthcare and housing systems. Many struggled with an untreated substance use disorder or mental health problem, or suffered violent abuse or traffic fatality. In every case, we as a society could have done better to help people get the care and stability they needed.”

The largest proportion of deaths (316) was accidental or unintentional, with 89% of those deaths tied to drug overdoses, according to the report. Officials said most people had multiple drugs in their system with fentanyl present in 89% of cases and methamphetamines present in 81%.

Traffic-related deaths

Traffic-related deaths made up the second-largest number of accidental deaths in the report, with 22 people dying from crashes. This is also similar to a national trend of pedestrian deaths reported by the United States Department of Transportation showing those deaths have increased every year for the last five years.

Homicide and self-harm

According to the report,14 people were killed by someone else while experiencing homelessness in 2023, which is a decrease from a record 24 homicides in 2022. Additionally, 26 people died by suicide, which has increased from the 17 people reported in 2022.

Moving forward

Concluding the report, the Multnomah County Health Department pointed to several reasons contributing to the homeless crisis and called for policies to address the underlying issues.

"There are multiple intersecting causes leading to homelessness, including lack of affordable housing, racial injustice, lack of social support systems, substance use, mental health challenges, major trauma and a lack of access to healthcare, both physical and behavioral," the report said.

"Drug overdoses, traffic injuries and suicides were major contributors to mortality among [people experiencing homelessness] in 2023. Interventions to reduce mortality rates among PEH must address these areas. In addition, housing, as well as the social, economic and environmental factors that underlie the causes of excess deaths among people experiencing homelessness, must be considered to develop policies that can save lives and prevent premature death."