Drug and alcohol overdoses continued to be the leading cause of death among Los Angeles County's homeless population in 2023, accounting for 45% of all deaths despite increased distribution of the overdose-reversal medication naloxone, according to a county report released Thursday.
The Los Angeles County Department of Public Health's sixth annual mortality report revealed 2,508 people experiencing homelessness died in 2023, with the mortality rate plateauing for a second consecutive year after a devastating 56% increase from 2019 to 2021.
While the overall homeless mortality rate remained high at 3,326 deaths per 100,000 people, it increased just 1% from 2022 to 2023, following a 2% increase the previous year.
Public Health officials said earlier reporting of a plateau in overdose mortality in 2022 was revised after an unusually high number of unexplained causes of death in their provisional death file for 2022 were belatedly assigned causes (mostly drug-overdoses) after a backlog of medical examiner cases requiring toxicology testing was cleared.
Officials attribute this year’s plateau largely to stabilized drug overdose death rates.
"Despite the continued plateau in drug related overdoses among people experiencing homelessness, we are still facing the worst overdose crisis in history," said Dr. Gary Tsai, director of the Bureau of Substance Abuse Prevention and Control.
The distribution of naloxone tripled from 2021 to 2023, which health officials believe helped stabilize overdose deaths. However, the report emphasized that fentanyl remained present in 70.4% of all overdose deaths, underscoring the continued high risk for unhoused individuals who use drugs.
Coronary heart disease ranked as the second leading cause of death at 14%, with its mortality rate surging 22% from 2022 to 2023 — the largest increase recorded since 2016. The increase affected both males and females and was most pronounced among White and Latino homeless individuals.
Transportation-related injuries remained the third leading cause of death, with rates plateauing but still 50% higher than 2019 levels. On average, a homeless person was killed by a moving vehicle in LA County approximately every other day, with 95% of those deaths among pedestrians and cyclists.
The homicide rate, the fourth leading cause of death, decreased 25% from 213 to 159 deaths per 100,000 people — the first reduction since 2019. The decrease was particularly significant among Black homeless individuals, among whom homicide deaths fell from 8% to 4% of total deaths.
Suicide rates, the fifth leading cause, remained relatively stable, consistently higher among younger homeless individuals and among White and Latino populations.
COVID-19 mortality, which peaked in 2021, continued to decline in 2023.
The report highlighted increased risk of death faced by homeless individuals. In 2023, people experiencing homelessness were 4.5 times more likely to die, an increase from 3.8 times in 2022.
These disparities were even more pronounced among certain demographics. White homeless individuals faced mortality rates seven times higher than White people in the general population. Among Latino homeless individuals, the rate was 4.8 times higher, while Black homeless individuals died at 2.7 times the rate of Black people in the general population.
"Homelessness is deadly. And while this plateau is better than an increase, even one person dying on our streets is one too many," said Los Angeles County Supervisor Janice Hahn. "Getting people out of encampments and into shelters saves lives and we should double down on harm reduction and preventing overdoses."
County officials made several recommendations, including ensuring rapid access to housing and shelter, expanding harm reduction services, improving access to health services, and collaborating with local governments to reduce traffic deaths among homeless residents.
"This report reinforces that shortening the timeframe people experience homelessness is a matter of life or death," said Supervisor Holly J. Mitchell.
Barbara Ferrer, director of the Los Angeles County Department of Public Health, emphasized the need for "focused actions" to reduce mortality disparities and improve health outcomes among the homeless population.
The report used data from the LA County Office of the Medical Examiner, California state death records, and the annual point-in-time homeless count. The next report, covering 2024 data, is expected in early 2026.
