A recent study by Stanford University researchers has found that providing housing without requiring prior drug treatment can lead to significant public health improvements and cost savings. The research, published in JAMA Network Open, addresses the dual challenges of homelessness and opioid use disorder in the United States.
The study’s senior author, Margaret Brandeau, emphasized the difficulty of treating opioid use disorder for those living on the streets. “If you’re living on the streets, you’re not going to be successfully treated for your opioid use disorder or for your other health conditions,” she stated.
The research team, including Isabelle Rao from the University of Toronto, focused on a “housing first” approach. This strategy contrasts with a “treatment first” policy that requires individuals to seek treatment before receiving housing—a method that has faced obstacles according to Brandeau. “It’s really, really hard for people on the street to get into treatment and to stay in treatment,” she explained.
Rao and Brandeau developed a mathematical model simulating outcomes for 1,000 unhoused individuals with opioid use disorder. The model compared two scenarios: one where individuals remained unhoused and another where they received housing and supportive services without a requirement for sobriety or treatment.
Their findings revealed that over five years, an average of 191 out of 1,000 people died under the status quo scenario compared to 140 deaths with supportive housing intervention. The intervention also added an average of 3.59 quality-adjusted life years per person at a cost of $26,200 per year gained—a figure deemed highly cost-effective by health economics standards.
Rao highlighted additional benefits: “Housed people have a higher likelihood of getting into treatment…and that is going to save costs on the health care system.” She noted that their model did not account for criminal justice costs related to homelessness, which would further enhance cost-effectiveness.
The researchers plan collaboration with Santa Clara County officials to inform local policies and intend outreach efforts in Toronto as well.
Brandeau underscored how engineering expertise can address societal issues beyond traditional applications: “We really want our work to make a difference. And homelessness is a significant humanitarian crisis in our country.”
This research was funded by the National Institute on Drug Abuse.
For more information, contact Jill Wu at jillwu@stanford.edu.
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