Multnomah County Reports 372 Homeless People Died in 2024

The Multnomah County Health Department on Friday reported at least 372 deaths among homeless people in 2024, down from a peak in 2023 but still high.

The county’s “Domicile Unknown” report shows those who died were relatively young—the average age was 48—and the majority of deaths were ruled accidental. Of the 246 accidental deaths, 214 of them were due to drug overdoses from synthetic opioids and psychostimulants—fentanyl and methamphetamine, respectively.

In other words, well over half of the deaths on the streets were from overdoses. In 71% of reported overdose deaths, both an opioid and a psychostimulant contributed.

Fentanyl overdoses still constitute the vast majority of deaths. About 86% of the deaths from overdoses were fentanyl deaths, which totaled 183 last year. That number is down from its peak in 2023, when the county reported 251 deaths linked to the substance.

Deaths are also down overall from 2023. That year, the county reported 456 deaths, the highest number since it began tracking in 2011. The 18% decrease in deaths from 2023 to 2024 is also the largest decrease reported since the county began tracking deaths in 2011.

At the end of 2024, the county reported 14,000 homeless people residing within county lines.

(It should be noted, however, that before 2022 all death recording information was pulled from the county’s medical examiner; data from that year forward also includes records from hospital and medical care deaths.)

The county report says that the interplay of homelessness and substance abuse is “complex” and cyclical. Unhoused people had a 40-fold increased risk of death from a drug overdose. Those people are more likely to use drugs alone and face barriers to accessing treatment, the report says.

“Housing is a crucial social determinant of health and is associated with numerous inequities,” the report reads. “And while people with substance use disorders may be more likely to face unstable housing situations, the stress and context of homelessness can also worsen substance use.”

The vast majority of homeless people who died were men: 81% versus 19% who were women. About 85% of them were under 65, well under the U.S. average life expectancy of 78, and with the largest concentration being people between 35 and 44 years old. White people made up the majority of the deaths, though the county notes that the number of Black and Indigenous decedents was outsized in relation to the overall population of Multnomah County.

The report also found that 19 people died in traffic, all but three of them on foot or bicycle. Homeless people are 23 times more likely to die in crashes than the average county resident, according to the report. (The rate of unhoused people dying in traffic became a political topic in 2022, when mayoral aide Sam Adams used the numbers to spur the creation of large-scale shelters.)

Apart from accidental deaths, the county reported 88 natural deaths, 13 from suicide, 18 from homicide, and seven from undetermined causes.

The report concludes that many of those deaths could have been preventable had individuals found stable housing.

“Addressing underlying social, economic, environmental and healthcare-related factors, and especially improving access to housing, are necessary to reduce the risk of death among people experiencing homelessness,” it reads.