October 16, 2019

Their families are haunted by misplaced guilt, wondering what else they might have done. They still look for their loved ones at a bus stop or on the street. And they see them in the people still struggling with homelessness and addiction.

A memorial at Street Roots to those who have passed away

“It’s caused us to think about this horrible housing crisis in Portland, the street people who have become, for a lot of people, a sort of plague on the city,” said Mark Chism, whose son Tyler was stabbed and killed a year ago this month. “But the deal is, they’re real people.”

During the 2018 calendar year, at least 92 people died in Multnomah County while experiencing homelessness, according to an analysis by a team of researchers at the Multnomah County Health Department. Those who died ranged in age from 20 to 77. 

Consider:

  • Drugs or alcohol caused or contributed to more than half of the deaths in 2018. 

  • Methamphetamines were a leading cause and contributor of deaths associated with drugs or alcohol, contributing to 29 percent of all deaths.

  • Thirteen people were found deceased in a car, RV or camper in which they were living. 

  • Ten people died in homicides; guns were used in 6 of those killings.

  • Hypothermia caused or contributed to the death of two people

“Many people without shelter have a disabling medical, mental and substance use issue that contributes to their situation and makes it difficult to deal with when they are just trying to survive,” said Chair Deborah Kafoury. “There is no health condition that homelessness won’t make worse, and no condition that safe and stable housing won’t help treat.”

These findings are part of the 2018 Domicile Unknown report, a project of the Health Department in partnership with Street Roots, and sponsored by Chair Deborah Kafoury. The project began in 2012 as a way to inform policy and funding decisions on housing, health and homelessness — and to call attention to the lives our community is losing, and the stories behind them.

Since the Health Department and Medical Examiner’s office began tracking deaths among people who were homeless, at least 530 people have died on the streets. The number of deaths is almost certainly higher than what’s counted in this analysis, which only captures those in whom homelessness can be confirmed.

“It’s been a fairly steady drumbeat of preventable deaths among young and midlife people. In a way, it’s the monotonous nature that’s important,” said Tri-County Health Officer Dr. Paul Lewis. “This allows us to refocus our energy. It shows that many of these deaths are preventable, but prevention is hard to implement if people are unhoused.”

Tri-County Health Officer Dr. Paul Lewis at the release of the 2018 Domicile Unknown report.

About 20 percent of people died in a hospital bed, and nearly that many died in a motel, hotel or someone else’s home. About half were found dead outside — in or near tents, in cars, RVs or campers, or in the Willamette or Columbia rivers. About equal numbers of those who died while homeless in 2018 passed during the cooler months, October through March and the warmer months April to September. Two people died of hypothermia, both during the colder months from October through March.

Ten people were killed, including Dallas Boyd, a 29-year-old woman, who was strangled in a van, and Tyler Chism, a young man who was stabbed early one morning in Old Town Chinatown. That’s more than double the four homicide deaths in 2017.

“We’ve long said that homeless folks are much more likely to be the victims of crime than the perpetrators of crime,” said Megan Husting, executive director of the National Coalition for the Homeless. “It’s a common misconception that there are crazy people on the streets are making our lives dangerous. When you’re homeless, you are in an extremely vulnerable position.”

Drugs and alcohol played a role in 49 deaths. Among those, methamphetamine was found in 27 individuals. This is the second consecutive year that deaths from stimulants have increased among people experiencing homelessness. 

Opioids — mostly heroin — were found in 15 individuals, about 31 percent, a slight drop from the previous year. Among those found with opioids or methamphetamine in their system, 15 people were found to have died from a combination of both, a 50 percent increase from the previous year.

Dr. Andy Mendenhall, Central City Concern's Chief Medical Officer, said meth is cheaper and purer than ever. Unlike opioids, it kills in myriad ways. And there is no drug to reverse an overdose or ease the effects of withdrawal. Death from opioids occurs when a person stops breathing, but the drug naloxone, given soon after, can revive someone by waking them up. In part because of opioid deaths documented by Medical Examiner investigations Multnomah County championed state legislation that’s made naloxone widely available in the community.

“But when we’re talking about methamphetamines, you see death from a variety of causes,” Mendenhall said. “Stroke, heart attack, arrhythmia. And that’s in addition to any of the traumas that result from becoming acutely psychotic. Once you’re under the influence of methamphetamines, you are no longer of sound mind.”

Looking out over the Columbia River, where a man was found dead.

Under methamphetamines, dopamine levels surge to 50 to 100 times normal, prompting the brain to produce less natural dopamine. So when a person stops using the drug, they might feel depressed or hopeless for weeks, if not months, until their natural dopamine levels recover.

“We have to understand this is a chronic brain disease. There’s not a cure, but people can manage the symptoms,” Mendenhall said. “if we‘re going to help people be successful in the face of a more potent and less expensive drug, we really need to be committed to making an investment in supportive recovery housing, expanding access to treatment, and realigning our criminal justice system away from punishment and towards prevention and treatment.”

Street Roots Executive Director Kaia Sand said housing is intrinsically tied to healthcare and recovery, allowing a place to heal, safely store medications, and sooth the soul — strum a guitar and hang family photos. 

“This is about how hearts suffer too much until they stop, how bodies are torn up by violence and immune systems are ravaged by exhaustion,” Sands wrote in the report. “Rather than push for people on the streets to disappear, we need to really see them, and support them with our actions. It is about loving people that much.”