Supporting Housing as a Cost-Effective Solution for Homelessness and Opioid Crisis

Recent research highlights that providing supportive housing to individuals experiencing homelessness and opioid use disorder (OUD) is a highly effective and economical strategy to address both issues. Conducted by Stanford University researchers, the study underscores the importance of the 'housing first' approach, which offers housing along with supportive services without imposing sobriety or treatment requirements upfront.

Homelessness and opioid overdose deaths are pressing public health challenges in the United States. Overdose deaths are amplified by the widespread availability of dangerous substances like fentanyl. Senior study author Margaret Brandeau emphasizes that individuals living on the streets are less likely to successfully engage in treatment or manage health issues, making supportive housing a critical intervention.

The researchers developed a detailed mathematical model to simulate the health and economic outcomes of 1,000 unhoused individuals with OUD. This model compared the 'status quo' scenario—where individuals remain unhoused—to a 'housing first' intervention, which provides stable housing, healthcare, and support services without requiring prior treatment.

Building on existing models of opioid recovery, they incorporated additional factors such as health outcomes and treatment trajectories, basing their equations on extensive research literature. The model revealed that over five years, the supportive housing approach reduced the death toll among these individuals from 191 to 140, also significantly improving quality-adjusted life years (QALYs), adding an average of 3.59 years of healthy life per person.

Cost analysis showed that the intervention would amount to about $96,000 per individual over their lifetime, with each additional healthy year costing approximately $26,200—considered highly cost-effective by health economic standards. This investment not only saves lives but also reduces healthcare costs by increasing the likelihood of treatment engagement and abstinence.

Rao and Brandeau’s findings support expanding supportive housing initiatives as a means to curb overdose deaths, promote treatment, and foster social stability. The researchers plan to collaborate with local authorities, such as those in Santa Clara County, to inform policy decisions and implement similar strategies in other regions, including Toronto, where homelessness and opioid addictions are also problematic.

This study exemplifies how engineering expertise and sophisticated modeling can be leveraged to tackle societal issues like homelessness and substance abuse, demonstrating that targeted investments in housing can yield substantial health, economic, and social benefits.