Deaths Among Multnomah County Homeless People Soared 45% in 2023 as Fentanyl Took More Lives

Deaths among homeless people in Multnomah County soared 45% in 2023 to a record number as fentanyl took more lives of those living on the street, a report released by the county showed.

At least 456 unhoused people died in the county last year, up from 315 in 2022, and the highest tally since the county began investigating deaths among the homeless population in 2011.

Fentanyl deaths went parabolic in 2023, soaring to 251 from 74 in 2022, 36 in 2021, four in 2020, and two each in 2018 and 2019. Just one person died from fentanyl in 2017, the first year it was detected.

In 2023, the scale at which fentanyl was ravaging Portland became impossible to ignore. That summer, WW examined the potency of “a drug so powerful and unpredictable that observers can watch its victims collapse within feet of obtaining it. Unlike with heroin, every hit can be a potential overdose.” By February 2024, state lawmakers voted to recriminalize hard drugs in Oregon, as fentanyl’s scourge turned voter sentiment against the drug reforms of Measure 110.

One bright spot in an otherwise grim report: Fentanyl is unlikely to take as many lives among the homeless this year, the county said.

Last year “appears to be the peak of the fentanyl crisis,” Multnomah County health officer Dr. Richard Bruno said in a statement. “As we are seeing fentanyl overdose deaths decreasing in 2024, we are hopeful that future reports will hold much lower numbers.”

The majority of homeless people who died in 2023—77%—were people assigned male at birth, the report says, while 23% were people assigned female. The average age of the deceased was 46, compared with an average at death of 76 for Multnomah County’s population overall.

Compared with the population at large, homeless people were 58 times more likely to die from a transportation-related injury, the county said. They were 51 times more likely to die from a drug overdose, 18 times more likely to die by homicide, and 18 times more likely to die from suicide.

The largest number of deaths—316—were deemed accidental. That category includes overdoses, which accounted for about 9 out of 10 accidental deaths in 2023. Traffic fatalities made up the second-largest number of accidental deaths, with 22 people dying from crashes.

Homicide took the lives of 14 homeless people in 2023, down from a record 25 in 2022. An additional 26 people died by suicide, an increase from the 17 suicides reported in 2022.

On average, 38 homeless people died each month. March was the most deadly, at 53, while April was the least lethal, with 29. One person died from cold exposure in January.

The Multnomah County Health Department undertakes the Domicile Unknown Report each year to determine the number, characteristics and causes of deaths among homeless people. The 2023 report examined both the accidental or suspicious deaths investigated by the Multnomah County medical examiner—394 last year—as well as the deaths of 62 people who died at the hospital or under medical care, and whose deaths were tallied from certificates recorded by funeral homes.

Hospital deaths were included after Senate Bill 850 took effect Jan. 1, 2022, establishing mandatory reporting of housing status at death. This report is the second in Multnomah County to include those kinds of deaths. Prior reports could not include that additional data because it was not available at the time.