Approximately 45% of the New Yorkers experiencing homelessness who sadly died in the past year lost their lives directly to drug overdoses or alcohol misuse. [1]
While the figure alone is bleak, the report also highlights a more positive countertrend that’s easy to miss. That is, overall deaths among this population dropped by nearly a fifth, even as substance use remained the single biggest threat. [1]
What the NYC report found
According to the New York City Department of Health and Mental Hygiene and Department of Social Services/Homeless Services’ 2026 report, 285 of the 634 people experiencing homelessness who died between July 2024 and June 2025 died from drug-related causes or alcohol-related causes–such as drug addiction, overdoses, or alcoholism–representing 45% of all deaths. [1]
The report covers deaths that occurred in temporary shelters, on the street, in the subway system, in abandoned buildings, or in the home of someone the person knew. [1]
Of all deaths, 58% occurred in a hospital, while 22% of deaths among people experiencing unsheltered homelessness occurred outdoors. [1]
| Metric | FY2025 (Jul 2024–Jun 2025) | FY2024 (Jul 2023–Jun 2024) |
|---|---|---|
| Total deaths | 634 | 770 |
| Drug-related deaths | 251 (40%) | 348 (45%) |
| Alcohol-related deaths | 34 (5%) | 34 (4%) |
| Combined drug + alcohol deaths | 285 (45%) | 382 (about 50%) |
| Change in total deaths vs. prior year | -18% | — |
The full FY25 report is available directly from the New York City government here.
Drug-related causes remained the leading category
Drug-related deaths fell sharply, down 28% to 251 from 348 the year before. Yet despite the drop, they still significantly topped every other cause of death. [1] Put another way, someone living without shelter in New York City was more than three times as likely to pass away from drug misuse as from heart disease, the leading overall cause of death for Americans. [2]
The leading causes of death of unhoused residents in NYC, the report highlighted, were: [1]
- Drug-related deaths (40%, 251)
- Heart disease (12%, 78)
- Accidents excluding overdose (9%, 60)
- Alcohol dependence or misuse (5%, 34)
- Cancer (4%, 23)
- Suicide (3%, 18)
- Cold exposure (2%, 15)
- Subway accidents (2%, 15)
- Auto accidents (2%, 14)
- Homicides (2%, 11)
There were also a handful of deaths linked to poisoning by noxious substances, heat exposure, and falls. [1] These were classified separately from accidental drug overdoses, which accounted for the majority of deaths from external causes. [1]
Homeless deaths fell, but substance-related mortality remains a major concern
The 770 deaths of those experiencing homelessness in 2024 were the highest figure recorded since the city began publishing the report in 2005, making this year’s 18% drop especially remarkable. [1]
City officials point to programs like the expanded Opioid Overdose Prevention Program and citywide naloxone (Narcan) administration training as part of what’s driving the improvement. There’s also been a broader Harm Reduction Strategic Plan in place aimed at limiting the damage caused by substance use. [1]
Still, substance use remained responsible for close to half of all homeless deaths in New York City for the second year running. And the New York Post also flagged that since thousands of migrants placed in temporary shelter by other city agencies weren’t matched against death records, the real number of substance-related deaths among people experiencing homelessness is likely higher than what’s reflected in the report. [1]
Why overdose risk is higher among people experiencing homelessness
The gap between homelessness and general-population deaths isn’t new or unique to New York City. A recent analysis of overdose deaths in San Francisco found that people experiencing homelessness passed away due to opioid overdoses at more than 33 times the rate of the general population. [3] This accounted for nearly half of all overdose deaths in the city, despite making up a fraction of its residents.
A separate study that tracked more than 60,000 unhoused individuals in Boston over 15 years found that drug overdose was responsible for one in four deaths. [4]
A nationwide analysis of veterans in the VA healthcare system found that those experiencing homelessness were more than three times more likely to pass away from a drug overdose than veterans living in homes. Overdose rates ran seven to 14 times higher, depending on the drug involved. [5] Synthetic opioids are attributed to having increasingly driven the figures in recent years. [4]
Several overlapping factors help explain the higher risk of overdose among people experiencing homelessness, including:
- Using drugs alone without anyone nearby to call for help.
- Consuming drugs from a supply that’s more likely to contain fentanyl.
- Reduced or inconsistent access to primary care and addiction treatment.
- Co-occurring mental health conditions that often go untreated.
- Housing instability that often cuts people off from routines, storage for medication, and relationships that tend to support recovery.
What this means for prevention
The decline in deaths of those experiencing homelessness in 2025 came during the same period that outreach teams increased naloxone distribution and harm reduction services. These are meaningful signals toward policymakers making important decisions on where to direct limited resources. [1]
But while naloxone access and overdose prevention efforts matter hugely, so does moving people into stable housing and low-barrier substance use disorder treatment to prevent tragedies from occurring.
Programs that focus on finding housing for those experiencing homelessness, along with addiction and mental health care, could be powerful in helping those who might otherwise fall through the cracks around a system built around emergency response rather than prevention.
Other strong prevention methods worth watching include training shelter staff how to recognize and respond to overdoses and providing easier walk-in access to medications like buprenorphine. These are the types of investments harm reduction advocates argue often show up in the numbers a year or two later.
Final thoughts
The New York report shares both sides of the story: a meaningful year-over-year decline in deaths of people experiencing homelessness in the city, as well as a substance use crisis that continues to devastate communities.
Drug and alcohol use remain the leading cause of death among those unhoused in New York, just as they have for most of the past two decades. Real progress means treating that fact as urgent and implementing additional prevention strategies to protect this vulnerable group.
If you or someone you know is struggling with substance use, speak with a licensed provider or the SAMHSA National Helpline (1-800-662-4357), which can help connect you with treatment and support.
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