A study published by the Benioff Homeless and Housing Initiative at the University of California San Francisco is challenging public perceptions of substance use among California’s homeless population.

According to the study, which was recently published in the medical journal JAMA, a large majority of people living on the streets in California are not illegal drug users.

UCSF researchers found that contrary to popular perception, only about 37% of homeless people were using illicit drugs regularly, and 25% said they had never even used drugs.

That said, the researchers also confirmed that drug use is far more prevalent among homeless people than in the general population, with 65% reporting that they regularly used drugs at some point in their lives, and 27% reporting that they had started using drugs after becoming homeless.

The nuance continues, with 35% of respondents also saying that their drug use actually decreased after becoming homeless. This response was most common among parents who worried about losing custody of their children, according to the researchers.

What the researchers concluded is that drug use, while not as high as popular belief, is still deeply intertwined with homelessness and is both a risk factor and effect of losing housing. 

“Our research shows there is an increased risk of becoming homeless if you use drugs; and that homelessness itself increases drug use because people use it as a coping strategy,” Margot Kushel, MD, director of the BHHI and senior author of the report, said in a statement.

The report was part of a larger Statewide Study of People Experiencing Homelessness from BHHI, which gathered findings from over 3,200 adults experiencing homelessness. It is the largest representative sample of the homeless population since 1996, according to UCSF. 

While drug use is indeed a widespread issue among homeless communities, the public perception that illicit drug use is endemic to homelessness can be challenged with this new data.

Additionally, researchers found that the most common drugs used among the homeless population aren’t opioids, but rather methamphetamines. And many respondents had a reason for why they turn to these specific substances.

“People, particularly those who are unsheltered, may use meth to help them stay alert in unstable situations,” the researchers said.

“People are telling us that it helps them survive,” Kushel added in an interview with The LA Times. “It keeps them awake and alert. They are using it either because they are traumatized, they have been assaulted, they are afraid or depressed, using it as coping to make it all go away.”

But that doesn’t mean they want to be using the drug. The report’s findings also indicated the need for robust treatment options for homeless people navigating substance use disorders.

A significant percentage of the respondents who are homeless and use drugs regularly said they have tried — but have been unable to — receive treatment.

“One of the most poignant findings was that 1 in 5 told us they are actively seeking treatment and couldn’t get it,” Kushel told The LA Times.

Only 7% of respondents who had any use of drugs in their lifetime said they were receiving treatment. 

“It’s hard to get treatment,” Kushel told The LA Times. “It shouldn’t be. You shouldn’t scrounge to save money to go somewhere and be told you’ll be put on a waiting list. That should not happen, but it does.”

The researchers pointed to housing as the obvious solution to this problem, though more immediate resources like methadone and other medications that treat opioid addiction should be readily available, they added.

“We know how to treat substance use, but it is hard to do that while people are still homeless,” said Ryan Assaf, PhD, MPH, assistant professor in the Division of Health Equity and Society at UCSF and first author of the study.

“We need to reduce barriers to substance use treatment and that includes prioritizing people’s ability to return to housing.”

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Header image by Randy Laybourne on Unsplash