{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T04:52:19Z","timestamp":1789447939440,"version":"build-2803163510"},"reference-count":30,"publisher":"Royal College of Psychiatrists","issue":"6","license":[{"start":{"date-parts":[[2023,9,4]],"date-time":"2023-09-04T00:00:00Z","timestamp":1693785600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000905","name":"Commonwealth Fund","doi-asserted-by":"publisher","award":["Harkness Fellowship in Healthcare Policy and Pract"],"award-info":[{"award-number":["Harkness Fellowship in Healthcare Policy and Pract"]}],"id":[{"id":"10.13039\/100000905","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Br J Psychiatry"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:sec id=\"S0007125023001113_sec_a1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The UK and USA currently report their highest number of drug-related deaths since records began, with higher rates among individuals experiencing homelessness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0007125023001113_sec_a2\">\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Given that overdose prevention in homeless populations may require unique strategies, we evaluated whether substances implicated in death differed between (a) housed decedents and those experiencing homelessness and (b) between US and UK homeless populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0007125023001113_sec_a3\" sec-type=\"methods\">\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>We conducted an internationally comparative retrospective cohort study utilising multilevel multinomial regression modelling of coronial\/medical examiner-verified drug-related deaths from 1 January 2012 to 31 December 2021. UK data were available for England, Wales and Northern Ireland; US data were collated from eight county jurisdictions. Data were available on decedent age, sex, ethnicity, housing status and substances implicated in death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0007125023001113_sec_a4\" sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Homeless individuals accounted for 16.3% of US decedents versus 3.4% in the UK. Opioids were implicated in 66.3 and 50.4% of all studied drug-related deaths in the UK and the USA respectively. UK homeless decedents had a significantly increased risk of having only opioids implicated in death compared with only non-opioids implicated (relative risk ratio RRR = 1.87, 95% CI 1.76\u20131.98,\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.001); conversely, US homeless decedents had a significantly decreased risk (RRR = 0.37, 95% CI 0.29\u20130.48,\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.001). Methamphetamine was implicated in two-thirds (66.7%) of deaths among US homeless decedents compared with 0.4% in the UK.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0007125023001113_sec_a5\" sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Both the rate and type of drug-related deaths differ significantly between homeless and housed populations in the UK and USA. The two countries also differ in drugs implicated in death. Targeted programmes for country-specific implicated drug profiles appear warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1192\/bjp.2023.111","type":"journal-article","created":{"date-parts":[[2023,9,4]],"date-time":"2023-09-04T06:50:32Z","timestamp":1693810232000},"page":"562-568","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":10,"title":["Drug-related deaths among housed and homeless individuals in the UK and the USA: comparative retrospective cohort study"],"prefix":"10.1192","volume":"223","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4152-5570","authenticated-orcid":false,"given":"Emmert","family":"Roberts","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4462-1402","authenticated-orcid":false,"given":"Caroline","family":"Copeland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith","family":"Humphreys","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chelsea L.","family":"Shover","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"170","published-online":{"date-parts":[[2023,9,4]]},"reference":[{"key":"S0007125023001113_ref29","volume-title":"ETHOS \u2013 European Typology on Homelessness and Housing Exclusion","year":"2005"},{"key":"S0007125023001113_ref19","doi-asserted-by":"publisher","DOI":"10.1007\/BF00117832"},{"key":"S0007125023001113_ref12","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-147-8-200710160-00010"},{"key":"S0007125023001113_ref22","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2016.12.001"},{"key":"S0007125023001113_ref17","unstructured":"17 Crown Prosecution Service. Coroners. CPS, 2022 (https:\/\/www.cps.gov.uk\/legal-guidance\/coroners)."},{"key":"S0007125023001113_ref8","unstructured":"8 Centres for Disease Control and Prevention. Drug Overdose Deaths (Provisional). CDC, 2023 (https:\/\/www.cdc.gov\/nchs\/nvss\/vsrr\/drug-overdose-data.htm)."},{"key":"S0007125023001113_ref30","doi-asserted-by":"publisher","DOI":"10.7249\/MG829"},{"key":"S0007125023001113_ref18","doi-asserted-by":"publisher","DOI":"10.1002\/sim.1522"},{"key":"S0007125023001113_ref1","unstructured":"1 Office for National Statistics. Deaths Related to Drug Poisoning in England and Wales: 2021 Registrations. ONS, 2021 (https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/birthsdeathsandmarriages\/deaths\/bulletins\/deathsrelatedtodrugpoisoninginenglandandwales\/previousReleases)."},{"key":"S0007125023001113_ref7","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2018.08.029"},{"key":"S0007125023001113_ref26","unstructured":"26 National Alliance to End Homelessness. State of Homelessness: 2022 Edition. National Alliance to End Homelessness, 2022 (https:\/\/endhomelessness.org\/wp-content\/uploads\/2023\/05\/StateOfHomelessness_2022.pdf)."},{"key":"S0007125023001113_ref20","unstructured":"20 Canette, I. Using gsem to combine estimation results. STATA Blog 2014; 14 Aug (https:\/\/blog.stata.com\/2014\/08\/18\/using-gsem-to-combine-estimation-results\/)."},{"key":"S0007125023001113_ref16","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.14135"},{"key":"S0007125023001113_ref2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)02252-2"},{"key":"S0007125023001113_ref9","doi-asserted-by":"publisher","DOI":"10.1353\/hpu.2016.0075"},{"key":"S0007125023001113_ref5","doi-asserted-by":"publisher","DOI":"10.4324\/9781315586052"},{"key":"S0007125023001113_ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2020.108314"},{"key":"S0007125023001113_ref15","doi-asserted-by":"publisher","DOI":"10.1111\/add.15468"},{"key":"S0007125023001113_ref11","doi-asserted-by":"publisher","DOI":"10.1177\/003335491513000411"},{"key":"S0007125023001113_ref27","unstructured":"27 Department for Levelling Up, Housing and Communities, Ministry of Housing, Communities and Local Government. Homelessness Statistics. GOV.UK. Available from: https:\/\/www.gov.uk\/government\/collections\/homelessness-statistics"},{"key":"S0007125023001113_ref4","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2022.103818"},{"key":"S0007125023001113_ref23","doi-asserted-by":"publisher","DOI":"10.1080\/10401230802177656"},{"key":"S0007125023001113_ref28","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.1997.tb03375.x"},{"key":"S0007125023001113_ref14","doi-asserted-by":"publisher","DOI":"10.1080\/10530789.2022.2069408"},{"key":"S0007125023001113_ref3","unstructured":"3 Advisory Council on the Misuse of Drugs. Drug-related Harms in Homeless Populations and How they Can be Reduced. ACMD, 2019 (https:\/\/www.gov.uk\/government\/publications\/acmd-report-drug-related-harms-in-homeless-populations)."},{"key":"S0007125023001113_ref24","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2010.06.007"},{"key":"S0007125023001113_ref25","volume-title":"The Rent is Too Damn High: What To Do about It and Why It Matters More Than You Think","author":"Yglesias","year":"2012"},{"key":"S0007125023001113_ref6","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2022.109274"},{"key":"S0007125023001113_ref10","doi-asserted-by":"publisher","DOI":"10.1097\/PAF.0000000000000550"},{"key":"S0007125023001113_ref21","volume-title":"Pan-London Homeless Hotel Drug and Alcohol Support Service. Lessons Learned","author":"Gardner","year":"2020"}],"container-title":["The British Journal of Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0007125023001113","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,27]],"date-time":"2024-09-27T08:25:23Z","timestamp":1727425523000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0007125023001113\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,4]]},"references-count":30,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2023,12]]}},"alternative-id":["S0007125023001113"],"URL":"https:\/\/doi.org\/10.1192\/bjp.2023.111","relation":{},"ISSN":["0007-1250","1472-1465"],"issn-type":[{"value":"0007-1250","type":"print"},{"value":"1472-1465","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,4]]},"assertion":[{"value":"Copyright \u00a9 The Author(s), 2023. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}