Supportive Housing: A Cost-Effective Solution to Combat Homelessness and Opioid Addiction

Recent research has revealed that supportive housing can serve as a highly effective and economically viable strategy for addressing the intertwined issues of homelessness and opioid use disorder in the United States. This study, published in the JAMA Network Open, underscores the importance of providing stable housing and supportive services without prerequisites for drug treatment.

With the alarming rise in opioid-related overdoses--exacerbated by the emergence of potent substances like fentanyl--homeless individuals face dire health risks. The leading cause of death among this population is overdose, highlighting the urgent need for effective interventions. Researchers from Stanford University emphasize that individuals living on the streets are unlikely to receive proper treatment for opioid use disorder and other health issues.

The study focused on the 'housing first' model, which prioritizes stable housing for individuals struggling with substance use issues. This approach contrasts with the 'treatment first' model, which mandates individuals to pursue treatment before they can access housing. According to the study's findings, the latter approach has been met with significant challenges, as it is often difficult for homeless individuals to engage in and maintain treatment.

To evaluate the impact of supportive housing, researchers constructed a mathematical model simulating the health and treatment outcomes for 1,000 unhoused individuals with opioid use disorder. In the control scenario, individuals remained homeless, whereas in the 'housing first' scenario, they received housing, healthcare, and support services without any sobriety requirements.

The model accounted for historical data on opioid treatment and recovery, incorporating the ups and downs that individuals experience during recovery. The research demonstrated that stable housing significantly increases the likelihood of individuals seeking and successfully completing treatment for opioid use.

To quantify the costs and benefits associated with supportive housing, the researchers conducted extensive simulations. Their analysis found that over a five-year period, 191 individuals in the control group died, while the supportive housing intervention resulted in 140 deaths. Furthermore, the study quantified the improvement in quality-adjusted life years (QALYs) associated with the 'housing first' model, which added an average of 3.59 QALYs per individual.

When considering the financial implications, the total cost of the supportive housing intervention was approximately $96,000 per person over their lifetime. This translates to an added cost of $26,200 for each additional quality-adjusted life year gained. Such a cost is deemed highly advantageous in health economics, indicating that the investment in supportive housing yields significant health benefits for marginalized populations.

The research also emphasizes that stable housing enhances the probability of individuals receiving treatment, thereby reducing overall healthcare costs associated with addiction and homelessness. Additionally, the study did not factor in potential savings related to criminal justice expenses, suggesting that the economic benefits of the housing intervention could be even more substantial.

Looking ahead, the researchers intend to collaborate with officials in Santa Clara County to inform and shape policies addressing homelessness. Plans are also in place to extend outreach efforts to Toronto, where opioid use and homelessness present significant challenges.

This research highlights the potential for engineering methodologies to address pressing societal issues, reinforcing the notion that innovative modeling can lead to impactful solutions in public health.