Multnomah County reports 193 homeless deaths in 2021

PORTLAND, Ore. (KGW) — At least 193 people died while experiencing homelessness in Multnomah County in 2021, the highest total since the county health department began analyzing medical examiner deaths in 2011 for its annual Domicile Unknown report.

The 193 deaths documented in the latest report, released Wednesday, represent a sharp increase from the 126 homeless deaths reported in 2020, although the overall proportion of homeless deaths remained constant at about 10% of all deaths investigated by the medical examiner.

The county produces the report in partnership with the nonprofit Street Roots, examining the characteristics and causes of homeless deaths that are investigated by the medical examiner.

Overdoses and substance abuse were the most prominent contributors to the 2021 death toll, according to the report. Methamphetamines played a role in 93 of the deaths, including 82% of the deaths involving substances.

Fentanyl was involved in 36 deaths, a huge jump from four deaths in 2020 and an average of one or two deaths per year for the previous three years.

That trend will likely worsen, the county reported, based on the fact that the Multnomah County Sheriff’s Office reported a nearly twentyfold increase in the number of individual fentanyl pills sized in 2022 compared to the year before.

“Never have I seen the drug supply shift in such a short amount of time,” Haven Wheelock, program supervisor of the Drug Users Health Services at Outside In, said in a statement.

Another striking figure is the number of homicide deaths: 18, up from eight in 2020. That increase tracks with an 83% increase in overall homicides documented by the Portland Police Bureau in the same year.

Eight of the deaths were suicides, the report found, doubling the number reported in 2020.

Severe weather was also a frequent cause of death; four people died of overheating during the June 2021 heat dome event, and hypothermia during the winter months played a role in another eight deaths. The hypothermia deaths were often in combination with substance use.

“This is a widespread and deadly suffering,” Kaia Sand, executive director of Street Roots, wrote in the report’s introduction. “People slip into hallucinations that mask their daily suffering. Without access to foundational needs like housing, some escape into their own burning hallucinations. Others take amphetamines to stay awake, ever more vigilant to grim survival, watchful against violence, against the rats that roam the night sidewalks. Some stay awake to piece together an income harder to come by in daylight, collecting bags of clanking cans to redeem at bottle exchanges. It’s a life that’s based not only on survival, but surviving that survival: people reach for ways to endure.”

The average of men who died while experiencing homelessness in 2021 was 48 years old, and the average age for women was 46 — roughly three decades younger than the average U.S. life expectancy, the county noted in a news release Wednesday.

Only two of the deaths were due to complications from COVID-19, the county said, along with a third death for which it was a contributing factor, but the pandemic drove many people into homelessness, the county noted.

“It’s impossible to capture all of the rippling effects of the COVID-19 pandemic on people’s lives, but there is no question that 2021 was another extraordinarily difficult year,” Multnomah County health officer Dr. Jennifer Vines said in a statement.

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