In the last article, we looked at the opioid pandemic and its relationship to mental health. Today we want to look at one of the demographics, the homeless. Baggett and others (1) in a study involving 28,033 adults seen at Boston Health Care for the Homeless Program (BHCHP) in 2003–2008, discovered that of the 1302 deaths, 219 deaths were due to drug overdose, 1,074 deaths were due to other causes, and nine deaths had no recorded underlying cause (and this was before the opioid pandemic really took hold). The number of overdose deaths was three times higher than that of a study conducted fifteen years earlier.

Bauer and others (2) conducted a review of the 219 adult overdose victims. They identified three factors that seemed to be prevalent: substance abuse, mental health conditions, and chronic pain. The mean age was 41 years, 80% were male, and 68% were white. Opioids were involved in 81% and alcohol in 85% of the cases (12 years ago!). They concluded that opioids were the most commonly implicated substance in overdose deaths and about one-third also involved alcohol intoxication. Mental Health issues were also a major factor in almost all cases, with only 6% receiving specialized mental health services in the three months leading up to their deaths. They concluded that in order to be effective, care services needed to be involved in these three domains. They suggested that clinical settings are needed to identify those at highest risk of drug overdose and they should be equipped with the resources to deliver interventions services.

This seems to me to be a good place to start. We need to be assured that adequate clinical services are being provided where the action is and that is usually in the downtown area. Secondly we can’t leave it up to volunteer community services. Soup kitchens and drop in centers are wonderful and I admire the people who are providing these services but to be effective it is not enough. We cannot leave it up to charity to take care of the needs of these unfortunate people. A government operated clinical health service needs to be located near the site with immediate access to counselling, medical services, adequate housing and food and other essentials. A social worker then needs to be put in charge of the overall program with a caseload of no more that fifteen individuals. Progress has to be monitored daily with adjustments to the program as needed. Links to other community volunteer services can then be explored.

It’s time we stopped crossing the street or looking away when we see a homeless person. We need to see them, really see them, and do what is necessary to get them back on their feet again. For this week’s Poetry with Purpose, I am delighted to give you a poem by Kelly Madden, the winner of the recent NIC Poetry Contest.

I See You All.

Orangutans bend forward,
use leaves as cover
and wait for the
crushing rain to stop
and the ladybug mother,
I just discovered, laid her eggs
in between the spikes
of a thistle; the perfect crib
and the chatter of meerkats,
warning each other there is
a reason to duck in and hide
and the tricky bird, airborne
its name escapes me now—
imitates meerkat danger call
and they duck in and hide
this bird then steals
the meal they had
and of course too, there is the man
the one who is always limping,
rain or shine, I see him
downtown all the time
and the woman, the one with dark hair
who hop-skips when she is high
yes, that one, the one with sores on her face
I see her too, even when she is not there
and the teenager, the one who hangs out
by the bridge in the woods
below the middle school
yes, him, the one who moves like a shadow
where are their meerkats,
now that everything is sideways—
is there a call for them,
urging them back inside?

By Kelly Madden


[1] Baggett, Travis P.;  Hwang, Stephen W.;  O’Connell, James J.;  Porneala, Bianca C.;  Stringfellow, Erin J.;   Orav, E. John;  Singer, Daniel E.; and  Rigotti, Nancy A. . Mortality Among Homeless Adults in Boston: Shifts in Causes of Death Over a 15-year Period.  HHS Public Access. 2013.


[2]  Bauer, Leah K.;   Brody, Jennifer K.;  León, Casey; and  Baggett, Travis P.. Characteristics of Homeless Adults Who Died of Drug Overdose: A Retrospective Record Review. HHS Public Access. 2017.