Housing saves lives and money for drug users first

According to a Stanford University study, housing is provided to homeless people without requiring them to get cleaning first and saving money.

The study published on JAMA Network Open found that Housing First plans to reduce deaths by 27% in five years, while a healthy living age of just $26,800 per year, the threshold most economists consider cost-effective.

These findings are a vulnerable population with homelessness and overdose crises across the country, especially fentanyl making street drugs increasingly deadly.

Two competitive philosophies

The study explores the basic debate in homelessness policy: Do cities require people to be awake before they accept housing, or provide housing first and then talk about addiction later? The “treatment-first” approach has dominated policy for decades, but researchers want to test whether instant housing may produce better results.

“It’s really hard for people on the street to get treatment and keep it treated,” Margaret Bran, a senior author of the study and Stanford University engineering professor, doesn’t explain. “The treatment-first approach isn’t particularly useful in many populations.”

Using mathematical modeling, the researchers simulated the results for 1,000 people who were addicted to homeless people. In the status quo program, participants remain on the street. In the housing intervention, they immediately obtained permanent housing with health care and support services without the attached conditions.

The result of saving lives

The difference is obvious. Over the past five years, 191 people died in homeless organizations, while 140 people in the housing group, reducing 51 deaths. Housing interventions prevent excessive death and death from other causes associated with street life.

Key results of housing priority programs:

• Total deaths fell by 27% in five years
• Reduce drug overdose by 11%
• 35% reduction in other reasons
• 3.6 additional healthy years in their lifetime

“The people who are accommodated have a higher likelihood of entering treatment, which means they are more likely to be.” Housing also significantly reduces exposure to violence, weather and health risks, making homeless people so deadly.

Economic benefits

Apart from saving lives, housing first plan is economically justified. The intervention costs $96,000 per person over their lifetime, including $20,900 per year for housing as well as health care and support services. But these costs are partially offset by reduced emergency medical visits, hospitalizations and other medical expenses.

The cost of $26,800 per quality-adjusted lifetime year is much lower than the $100,000 threshold most health economists use to define cost-effective interventions. Even doubled the cost of increasing housing will result in the program receiving less than $70,000 a year.

The analysis does not include criminal justice savings, which will make housing plans look better economically. Previous research shows that homeless people spend only $5,000 to $15,000 per year on prison costs.

Real-world applications

The researchers applied their model to San Jose, California, which has about 6,340 homeless residents. All of them will spend $113.8 million a year, but generate $72.6 million in healthcare savings as well as additional criminal justice savings – keeping net costs below the list price.

However, this analysis assumes that housing already exists. Nationwide, the cost of building new affordable housing is $150,000 to $1 million per unit, representing a large upfront investment that challenges cash-strapped cities.

The timing of this study is important, as overdoses have become the leading cause of death for homeless people, and fentanyl makes street medication dangerous than previous generations of opioids.

Policy Impact

The study supports housing-first policies that have received federal support but face local resistance. Critics are worried about promoting drug use, but Stanford models show that fear is misplaced — and in fact, people have better treatment outcomes than forced to choose between sobriety and shelter.

“Engineers have been working hard to make things better,” Brandeau reflects. “We really want our work to make a difference. Homelessness is a major humanitarian crisis in our country.”

The study provides quantitative support for the quantum that advocates have long debated: Stable housing solves the foundations people need to address addiction, mental health issues, and other challenges. For policy makers weighing investments in expensive housing, research shows that these dollars are not only for people to live in—they can save lives while reducing long-term costs for taxpayers.

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