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A new study led by a Georgia State University researcher finds that the opioid epidemic and rural homelessness are exacerbating each other with devastating consequences.
School of Public Health Assistant Professor April Ballard and her colleagues examined data from the Rural Opioid Initiative on more than 3,000 people who use drugs in eight rural areas across 10 states.
They found that 54% of study participants reported experiencing homelessness in the past six months, a figure that suggests Point in Time Counts used to allocate state and federal funding significantly underestimate homeless populations in rural areas. The findings are published in the January edition of the journal Drug and Alcohol Dependence.
“Rural houselessness is very much an issue in the United States, and there are unique challenges that come with it, such as lack of awareness and a lack of resources,” said Ballard, who co-leads GSU’s Center on Health and Homelessness. “When you add the opioid epidemic on top of it, it really exacerbates the problem.”
Ballard explained that the unemployment, financial ruin and loss of family and social networks that often accompany opioid use disorder and injection drug use can precipitate housing instability and homelessness. The uncertain and harsh living conditions experienced by people without stable housing can perpetuate drug use as a coping mechanism. The result can be a self-reinforcing cycle that contributes to poorer health and shorter lifespans.
Ballard and her colleagues found that study subjects with unstable housing were 1.3 times more likely to report being hospitalized for a serious bacterial infection and 1.5 times more likely to overdose than those with stable housing. She explained that a lack of access to clean water to wash the skin and prepare drugs makes infections more likely, and that using drugs alone and furtively can increase the risk of an accidental overdose.
The Rural Opioid Initiative surveyed people about their experiences with homelessness over the past six months, while Point in Time Counts mandated by the federal Department of Housing and Urban Development quantify the number of people experiencing homelessness on a single night in January. Despite this methodological difference, Ballard said her study’s findings suggest that Point in Time Counts significantly underestimate homeless populations in rural areas.
In Kentucky, for example, the researchers counted up to five times as many people experiencing homelessness than Point in Time Counts, even though their sample of people who use drugs constituted less than 1% of the adult population. In three counties that estimated zero people experiencing homelessness using Point in Time Counts, Ballard and her colleagues quantified more than 100 people who use drugs who had experienced homelessness in the past six months.
The dispersed nature of rural areas makes Point in Time Counts difficult, Ballard acknowledged, but the undercounting of people experiencing homelessness can result in fewer federal and state resources reaching vulnerable people and communities.
“Houselessness in rural areas is a major problem,” Ballard said, “but we’re not allocating resources in a way that is proportionate to the problem.”
More information:
April M. Ballard et al, Rural houselessness among people who use drugs in the United States: Results from the National Rural Opioid Initiative, Drug and Alcohol Dependence (2024). DOI: 10.1016/j.drugalcdep.2024.112498
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Study examines links between opioid epidemic and rural homelessness (2025, January 13)
retrieved 18 January 2025
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