Most people experiencing homelessness in California are not regular drug users — and for some, substance use begins or worsens after losing housing. Some use drugs to stay awake and safe, coping with the trauma and danger of life without shelter. At the same time, many who want treatment can’t get it. This paper uses data from the California Statewide Study of People Experiencing Homelessness to show a comprehensive, representative look at substance use, overdose risk, and unmet treatment needs among people experiencing homelessness in California.

The United States has fewer labor protections and wage guarantees than most wealthy nations, leaving many workers vulnerable to economic hardship from job loss, reduced hours, or work-related injuries. Based on data from the California Statewide Study of People Experiencing Homelessness (CASPEH), this study shows how income disruptions—through layoffs, unstable gig work, caregiving tied to housing, illness or injury, probation and parole demands, and COVID-19-related impacts—can quickly lead to homelessness when housing costs are high and wages are low.

Californians experiencing homelessness have poor health, struggle to access care, and face high ER and hospitalization rates—despite high rates of insurance. In this cross-sectional, representative study of adults experiencing homelessness in California, we found poor access to health care and high rates of short-term health care utilization that reflected how homelessness is negatively associated with health care access. Predisposing contextual and need factors, including being unsheltered, using illicit drugs, and having functional impairments, were associated with reduced access to care and increased use of short-term care. These findings underscore the necessity for health care and housing interventions that are tailored to the needs of people experiencing homelessness.

Homelessness and behavioral health issues (mental health and substance use) are intertwined. The UCSF Benioff Homelessness & Housing Initiative held a webinar about this complex bidirectional relationship, along with solutions to this crisis. Margot Kushel, MD, Claudine Sipili, Darrell Steinberg, JD, and Stephanie Welch, MSW, discussed findings from the California Statewide Study of People Experiencing Homelessness (CASPEH), highlighted key policy recommendations, and answered audience questions. Marc Dones moderated the webinar.

Latine Californians represent more than one-third of the state's homeless population. Yet their experiences are too often left out of research, policy, and service design. The UCSF Benioff Homelessness and Housing Initiative (BHHI) held a discussion of Toward Equity: Latine Experiences of Homelessness in California, the latest report from the California Statewide Study of People Experiencing Homelessness (CASPEH) series. This webinar highlights key data on how structural anti-Latine racism, housing exclusion, and administrative barriers shape pathways into homelessness, and explores what policy, service, and community leaders can do to close equity gaps.

Most people experiencing homelessness in California do so in unsheltered settings, such as outdoors or in vehicles. This webinar is about the causes and consequences of unsheltered homelessness. Margot Kushel, MD, moderated a conversation with Marc Dones, Ashley Meehan, MPH, and Carter Hewgley, discussing recommendations and solutions for addressing unsheltered homelessness in a way that preserves health, dignity, and civil rights for those experiencing it.