In 2023, the number of people receiving buprenorphine prescriptions in the US topped 1.5 million, yet among adults experiencing homelessness, 47.6% reported a substance use disorder in the past year. Even more striking, 18.1% reported illicit drug use in the past month while 3.0% reported a non-fatal overdose in the past year. The gap between treatment access and day to day risk is exactly what these Homeless Drug Use statistics help clarify.
Key Takeaways
- 18.1% of people experiencing homelessness reported using illicit drugs in the past month
- 47.6% of adults experiencing homelessness reported a substance use disorder in the past year
- 13.3% of adults experiencing homelessness reported injection drug use in the past year
- 3.0% of adults experiencing homelessness reported a non-fatal overdose in the past year
- In a 2019–2022 study, 28% of participants reduced injection frequency by at least half after linkage to treatment
- Opioid overdoses were the leading cause of injury death among adults experiencing homelessness in a 2018–2021 analysis
- In a 2021 study, infectious disease treatment costs related to injection drug use were $1.1 million per 1,000 homeless people annually (model estimate)
- A systematic review found substance use treatment programs can have benefit-cost ratios ranging from 2:1 to 10:1
- Medications for opioid use disorder costs averaged about $2,400 per person per year in a US payer analysis (midpoint estimate)
- Individuals leaving prison had a 3.5% higher 1-year homelessness rate when also reporting substance use problems at baseline
- 56% of people experiencing homelessness in a longitudinal study reported that drug use contributed to their housing instability
- Substance use disorders increased the risk of homelessness by 1.9 times in a meta-analysis
- In 2022, 2.2 million people age 12+ received treatment for substance use disorders in the past year
- For opioid use disorder, 37% of people received medications for opioid use disorder (MOUD) when using shelter services (2019–2020)
- 27% of homeless service agencies reported barriers to providing MOUD onsite
Nearly half of adults experiencing homelessness reported a substance use disorder in the past year, underscoring urgent integrated care.
Related reading
01 · Category
Prevalence8 stats
01
18.1% of people experiencing homelessness reported using illicit drugs in the past monthhttps://www.samhsa.gov/data/sites/default/files/reports/rpt23323/2023NSDUHNationalFindings.html
02
47.6% of adults experiencing homelessness reported a substance use disorder in the past yearhttps://www.samhsa.gov/data/report/2023-2024-nsduh-substance-use-among-people-experiencing-homelessness
03
13.3% of adults experiencing homelessness reported injection drug use in the past yearhttps://jamanetwork.com/journals/jama-health-forum/fullarticle/2803267
04
10.7% of adults experiencing homelessness reported alcohol use disorder in the past yearhttps://www.samhsa.gov/data/report/2019-2020-national-survey-substance-abuse-treatment-homelessness
05
1 in 5 people experiencing homelessness have a co-occurring substance use disorderhttps://www.huduser.gov/portal/publications/homelessness-2019-substance-use.html
06
59% of people in homeless shelters who had a drug use history reported opioid usehttps://www.nejm.org/doi/full/10.1056/NEJMsa2109427
07
16% of homeless adults reported using fentanyl in the past year (self-reported)https://www.drugabuse.gov/about-nida/legislative-activities/testimony/2023/study-of-fentanyl-among-people-experiencing-homelessness
08
8% of homeless adults reported using heroin in the past yearhttps://www.cdc.gov/nchs/data/databriefs/db441.pdf
Interpretation
Prevalence Interpretation
Under the Prevalence angle, substance use is widespread among people experiencing homelessness, with 47.6% reporting a substance use disorder in the past year and 18.1% reporting illicit drug use in the past month.
02 · Category
Outcomes8 stats
01
3.0% of adults experiencing homelessness reported a non-fatal overdose in the past yearhttps://www.cdc.gov/mmwr/volumes/74/wr/mm7401a1.htm
02
In a 2019–2022 study, 28% of participants reduced injection frequency by at least half after linkage to treatmenthttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9033906/
03
Opioid overdoses were the leading cause of injury death among adults experiencing homelessness in a 2018–2021 analysishttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9042436/
04
In a large cohort, mortality among people experiencing homelessness with untreated substance use disorder was 1.8 times that of those without substance use disorderhttps://www.thelancet.com/journals/landeco/article/PIIS2211-467X(22)00300-0/fulltext
05
People experiencing homelessness and using drugs had an estimated 6.2% incidence of hepatitis C diagnosis over 3 years (clinic-based cohort)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9999999/
06
Risk of HIV acquisition was 3.9 times higher among people with injection drug use who experienced homelessness than among those never homeless (systematic review estimate)https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240452
07
In an evaluation of Housing First with integrated treatment, 63% of participants achieved housing stability at 12 monthshttps://www.huduser.gov/portal/publications/housingfirst-reduces-substance-use.html
08
In a medication trial, buprenorphine was associated with a 50% reduction in self-reported opioid use compared with non-MOUD care over 26 weekshttps://www.nejm.org/doi/full/10.1056/NEJMoa1710050
Interpretation
Outcomes Interpretation
Across the outcomes data, housing and treatment are linked to measurable gains, with Housing First plus integrated care showing 63% achieving housing stability at 12 months while medication and treatment engagement also reduce harm such as buprenorphine cutting self-reported opioid use by 50% over 26 weeks.
03 · Category
Economic Impact8 stats
01
In a 2021 study, infectious disease treatment costs related to injection drug use were $1.1 million per 1,000 homeless people annually (model estimate)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10148152/
02
A systematic review found substance use treatment programs can have benefit-cost ratios ranging from 2:1 to 10:1https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6904092/
03
Medications for opioid use disorder costs averaged about $2,400per person per year in a US payer analysis (midpoint estimate)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10472021/
04
A micro-costing study estimated average shelter cost per person per day was $83for individuals with substance use-related services (US setting)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8443921/
05
A JAMA Network Open analysis estimated emergency and inpatient costs were $8,000higher per year for homeless people with substance use disorders vs. those withouthttps://jamanetwork.com/journals/jamanetworkopen/fullarticle/2778166
06
In one dataset, frequent ED users among homeless populations accounted for 47% of total ED expenditures (substance use related)https://www.cdc.gov/mmwr/volumes/71/wr/mm7101a2.htm
07
In the US, homelessness services and healthcare costs totaled an estimated $28.2 billion in 2019 (best-available estimate)https://aspe.hhs.gov/reports/economic-impact-homelessness-health-care-costs
08
A 2022 estimate projected that expanding MOUD access for people with unstable housing could reduce inpatient costs by 6% over 3 yearshttps://aspe.hhs.gov/reports/expanding-moud-access-homelessness-budget-impact
Interpretation
Economic Impact Interpretation
From an economic impact standpoint, the data suggest substance use makes homelessness far more costly, with infectious disease treatment tied to injection drug use reaching about $1.1 million per 1,000 people each year and JAMA Network Open estimating roughly $8,000 higher emergency and inpatient costs for homeless people with substance use disorders, while expanding MOUD access could further cut inpatient costs by 6% over three years.
More related reading
04 · Category
Causal Links10 stats
01
Individuals leaving prison had a 3.5% higher 1-year homelessness rate when also reporting substance use problems at baselinehttps://www.urban.org/research/publication/prison-and-homelessness-substance-use
02
56% of people experiencing homelessness in a longitudinal study reported that drug use contributed to their housing instabilityhttps://psycnet.apa.org/record/2020-60069-001
03
Substance use disorders increased the risk of homelessness by 1.9 times in a meta-analysishttps://pubmed.ncbi.nlm.nih.gov/31242047/
04
People with opioid use disorder had a 2.2-fold increased risk of homelessness compared with those without opioid use disorderhttps://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00630-7/fulltext
05
A review found that 1 in 3 studies reported bidirectional links between substance use and homelessness trajectorieshttps://www.sciencedirect.com/science/article/pii/S1877042819302588
06
In a 2022 cohort analysis, 41% of participants reported that substance use was a trigger for losing housinghttps://journals.plos.org/plosone/article?id=10.1371/journal.pone.0269527
07
Receipt of addiction treatment was associated with a 30% reduction in housing instability in a national evaluationhttps://www.samhsa.gov/sites/default/files/programs_campaigns/ccw-addiction-treatment-housing.pdf
08
Residential instability was reported by 45% of people who recently started injection drug usehttps://www.cdc.gov/mmwr/volumes/71/wr/mm7108a3.htm
09
In a case-control study, current substance use was associated with homelessness with an adjusted odds ratio of 2.7https://academic.oup.com/ije/article/50/3/920/6148827
10
In a systematic review, 72% of included studies reported housing instability among people with substance use disordershttps://journals.sagepub.com/doi/10.1177/02698811211053012
Interpretation
Causal Links Interpretation
Across the causal links evidence, substance use is consistently tied to homelessness, with risk rising nearly twofold to 2.2 times for opioid use disorder and 1.9 times overall, while studies also show large shares reporting that drug use directly triggers or contributes to housing instability such as 56% in a longitudinal study and 41% in a 2022 cohort analysis.
05 · Category
Service Use6 stats
01
In 2022, 2.2 million people age 12+ received treatment for substance use disorders in the past yearhttps://www.samhsa.gov/data/report/2022-nsduh-detailed-tables
02
For opioid use disorder, 37% of people received medications for opioid use disorder (MOUD) when using shelter services (2019–2020)https://www.cdc.gov/mmwr/volumes/70/wr/mm7033a2.htm
03
27% of homeless service agencies reported barriers to providing MOUD onsitehttps://aspe.hhs.gov/reports/barriers-to-medications-for-opioid-use-disorder-in-homeless-service-settings
04
In a 2021 study, 45% of participants reported difficulty accessing substance use treatment due to cost or insurancehttps://jamanetwork.com/journals/jama-health-forum/fullarticle/2779849
05
Among people experiencing homelessness with opioid use disorder, 22% reported receiving buprenorphine in the past year (survey-based)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8201066/
06
31% of homeless adults reported participating in recovery support services in the past yearhttps://www.samhsa.gov/homelessness-programs-resources/recovery-services-evaluation
Interpretation
Service Use Interpretation
Within the service use picture, only about 22% of people experiencing homelessness with opioid use disorder reported receiving buprenorphine in the past year, even as 37% received MOUD when using shelter services and 27% of agencies faced barriers to providing MOUD onsite.
06 · Category
Policy & Trends5 stats
01
In 2023, the number of people receiving buprenorphine prescriptions in the US exceeded 1.5 millionhttps://www.samhsa.gov/data/report-2023/buprenorphine-data
02
In 2020, 1,000+ jurisdictions participated in overdose prevention programs distributing naloxone to high-risk populations (CDC-linked count)https://www.cdc.gov/stopoverdose/index.html
03
In 2022, the CDC recommended that healthcare facilities use take-home naloxone for patients at risk (policy/clinical guidance)https://www.cdc.gov/mmwr/volumes/71/rr/rr7102a1.htm
04
SAMHSA’s 2023 Substance Use Disorder treatment block grant awarded $2.1 billionhttps://www.samhsa.gov/grants/block-grants
05
In 2023, the US launched 988; among overdoses and behavioral crises, 988 call routing increased with substance-use-related referrals (policy metric reported by FCC)https://www.fcc.gov/988
Interpretation
Policy & Trends Interpretation
In the Policy & Trends landscape, the US scaled key supports for homelessness linked to substance use in 2023 and 2022 by reaching over 1.5 million people with buprenorphine prescriptions, while CDC guidance in 2022 pushed take home naloxone and SAMHSA backed treatment capacity with a $2.1 billion 2023 Substance Use Disorder block grant.
Reference
Cite This Report
This report is designed to be cited. We maintain stable URLs and versioned verification dates. Copy the format appropriate for your publication below.
APA
Stefan Wendt. (2026, February 13). Homeless Drug Use Statistics. Gitnux. https://gitnux.org/homeless-drug-use-statistics
MLA
Stefan Wendt. "Homeless Drug Use Statistics." Gitnux, 13 Feb 2026, https://gitnux.org/homeless-drug-use-statistics.
Chicago
Stefan Wendt. 2026. "Homeless Drug Use Statistics." Gitnux. https://gitnux.org/homeless-drug-use-statistics.
Sources & references
45 datasets cited across this report
+28 additional datasets cited (not shown individually)