The Opioid Crisis and Homelessness: How Addiction Leads to the Streets

The Scale of the Crisis

The opioid epidemic has killed over one million Americans since 1999. But death is only the most visible consequence. For every person who dies, many more lose their housing, their families, their careers. The numbers are staggering:

• • Over 100,000 drug overdose deaths in 2023, the majority involving opioids
• • Approximately 2.7 million Americans have opioid use disorder
• • 26% of homeless adults have drug use disorders according to SAMHSA
• • Fentanyl is now involved in over 70% of overdose deaths

Opioid addiction does not discriminate by class or education. Middle-class men who owned homes, held professional jobs, and coached their kids' sports teams have ended up on the streets because of these drugs. The pathway from prescription to homelessness can be frighteningly fast.

How Opioid Addiction Leads to Homelessness

The progression typically follows a predictable pattern:

Stage 1: Legitimate Use

Most opioid addiction begins with legitimate pain management. A construction worker injures his back. A warehouse employee has surgery. A truck driver is in an accident. Doctors prescribe opioids because they work—they effectively manage pain. No one intends to become addicted.

Stage 2: Tolerance and Dependence

The body adapts. The same dose no longer provides the same relief. Taking more becomes necessary. Physical dependence develops—missing a dose causes withdrawal symptoms: sweating, nausea, muscle pain, anxiety. The drug is no longer about feeling good. It is about avoiding feeling terrible.

Stage 3: Behavioral Changes

As addiction takes hold, behavior shifts:

• • Doctor shopping to get more prescriptions
• • Buying pills from friends, then dealers
• • Spending money meant for bills on drugs
• • Calling in sick to work
• • Lying to family about use
• • Isolation from friends and activities

Stage 4: Consequences Accumulate

The consequences start piling up:

• • Job loss due to performance, attendance, or failed drug tests
• • Relationship breakdown as trust erodes
• • Financial devastation as income stops and drug costs continue
• • Legal problems from possession, theft, or driving impaired
• • Health deterioration

Stage 5: Housing Loss

Without income, rent goes unpaid. Without family support, there is no safety net. Eviction comes. Friends and family who might have helped have been burned too many times. The transition to heroin or fentanyl—cheaper than pills—often happens around this time. Life on the street begins.

Why Men Are Particularly Vulnerable

Men are more likely than women to become addicted to opioids and to experience homelessness as a result. Several factors contribute:

• • Higher rates of workplace injury: Men dominate dangerous industries where injuries requiring pain management are common
• • Reluctance to seek help: Masculine norms discourage admitting vulnerability or asking for treatment
• • Weaker social networks: Men often have fewer close relationships to intervene early
• • Higher risk tolerance: More willingness to try street drugs when prescriptions run out
• • Fewer family services: Women with children can access more support programs

The result is that men overdose at nearly three times the rate of women and make up the majority of homeless individuals with substance use disorders.

The Fentanyl Factor

The opioid crisis has evolved. What began with prescription pills has transformed into a fentanyl epidemic that is far more deadly:

• • Fentanyl is 50-100 times more potent than morphine
• • It is now mixed into virtually all street opioids and increasingly into other drugs
• • Dosing is unpredictable, making every use potentially lethal
• • It is cheap to produce, flooding the market

For people experiencing homelessness, fentanyl presents particular dangers:

• • Using alone is more dangerous, but people without housing often have no choice
• • Access to naloxone (Narcan) may be limited
• • Emergency response times are longer when someone is found on the street
• • Withdrawal symptoms make it nearly impossible to navigate services

The Cycle Continues on the Streets

Once homeless, recovery becomes much harder. Homelessness and addiction reinforce each other in a vicious cycle:

• • Drugs provide escape: Street life is traumatic, and substances offer temporary relief from cold, hunger, fear, and despair
• • Drugs are available: Street-level drug markets often exist in the same areas where homeless people concentrate
• • Treatment barriers: Without an address, phone, or transportation, accessing treatment is extremely difficult
• • Shelter rules: Many shelters exclude people who are actively using
• • Social networks: Connections on the street are often with other users

Breaking this cycle requires addressing both homelessness and addiction simultaneously. Treating one without the other rarely works.

What Effective Intervention Looks Like

Addressing opioid-related homelessness requires integrated approaches:

Medication-Assisted Treatment (MAT)

Evidence strongly supports medications like buprenorphine (Suboxone), methadone, and naltrexone for opioid use disorder. These medications:

• • Reduce cravings and withdrawal symptoms
• • Block the effects of other opioids
• • Reduce overdose risk dramatically
• • Allow people to stabilize and engage in other services

MAT is not substituting one drug for another. It is evidence-based medical treatment for a chronic condition. Programs that reject MAT on philosophical grounds have worse outcomes.

Housing First

Requiring sobriety before housing sounds logical but does not work for most people with severe addiction. Housing First approaches:

• • Provide stable housing without preconditions
• • Offer treatment services but do not require them
• • Recognize that recovery is easier from a stable base
• • Have better housing retention outcomes

Harm Reduction

Harm reduction keeps people alive long enough to recover:

• • Naloxone distribution so overdoses can be reversed
• • Fentanyl test strips to detect contaminated drugs
• • Safe use education
• • Connections to treatment without judgment

Long-Term Support

Opioid addiction is a chronic condition. Short-term interventions fail because:

• • Brain chemistry takes years to normalize
• • Relapse risk remains elevated for years
• • Life rebuilding takes time
• • Support networks need to be rebuilt

Effective programs measure success in years, not weeks. Expecting permanent change from 28-day treatment is unrealistic.

Recovery Is Possible

Despite the severity of opioid addiction, recovery happens every day. Research shows that:

• • Most people with opioid use disorder eventually recover
• • Multiple treatment attempts are normal, not failure
• • MAT dramatically improves outcomes
• • Stable housing significantly increases recovery rates
• • Peer support from others in recovery is powerful

The men who seem most hopeless can recover. We have seen it. The contractor who lost everything to oxycodone now runs his own business. The warehouse worker who was homeless for three years now mentors others in recovery. Change is possible with the right support over sufficient time.

Our Approach at The Steady Ground

Many of the men we serve struggle with opioid addiction. Our program integrates:

• • Comprehensive assessment through the Stronghold Assessment to understand each man's situation
• • Support for medication-assisted treatment when appropriate
• • Stable housing that does not require sobriety as a precondition
• • Mental health services addressing underlying trauma
• • Peer support from men in recovery
• • Long-term program measured in years, not weeks
• • Job training and employment for sustainable income
• • Faith integration for those who want spiritual support

We do not believe addiction is a moral failure. We believe it is a treatable condition that, with proper support, people can recover from. Every man deserves that chance.