Multnomah County's yearly report on people found dead while homeless in 2018 was released this morning.

The total number of homeless people found dead this year was 92—nearly twice the total who did in 2011, when the county began tracking the statistic.

Officials say that more homeless people probably died but that a portion of those deaths went unreported for various reasons. Of those reported, 29 percent of the deaths were associated with methamphetamines, and 31 percent of deaths were associated with opioid use.

The yearly report is a joint effort by the county Health Department and Street Roots that began in 2012.

"This report is always a heartrending reminder of our collective failure to act in time for so many people with severe and chronic disabling conditions," said Multnomah County Board Chair Deborah Kafoury. "But it is also part of our growing roadmap to a better future."

The report is called "Domicile Unknown," and it "is 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," according to a statement by the county.

Nearly half the deaths this year were caused or partly caused by drug or alcohol use.

"Drugs and alcohol played a role in 49 deaths. Among those, methamphetamine was found in 27 individuals," the statement from the county reads. Fifteen of the deceased were found to have had both opioids and methamphetamines in their systems. That's is a 50 percent increase from last year.

Though recent state legislation enabled naloxone to be much more widely available—the drug that reverses opioid overdoses—there is no such drug for reversing methamphetamine overdoses.

Dr. Andy Mendenhall, the Chief Medical Officer for Central City Concern, says methamphetamines cause a variety of health problems that can lead to death.

"Stroke, heart attack, arrhythmia. And that's in addition to any of the traumas that result from becoming acutely psychotic," said Mendenhall. "Once you're under the influence of methamphetamines, you are no longer of sound mind."

Mendenhall added that if the state wants to be successful in quelling deaths caused in part by methamphetamine use, it has to shift the criminal justice focus from "punishment towards prevention" and needs to refocus its resources and attention to providing more recovery housing.

There was also a significant spike in homicides, from four in 2017 to ten in 2018.

"This is about how substance use disorder is a healthcare issue, and how people medicate against homelessness—trying to stay awake or trying to go to sleep—and medicate through struggles of trauma," said Kaia Sand, Executive Director of Street Roots. "This is about the grip of despair and the relentlessness of violence."

Oregon has long come under scrutiny for providing relatively few mental health services compared to other states, and has routinely come up near the dregs of states with the most drug and alcohol-related issues. Several years ago, the National Survey on Drug Use and Health showed that Oregon was the state with the second  highest rate of methamphetamine use.

Last year, Gov. Kate Brown declared a public health emergency for alcohol and substance abuse. But as WW reported last week, Brown may delay plans to address the emergency for  another 18 months.