Injury and Violence Prevention
- Injury and Violence Prevention Home
- Data Projects
- MIDAS: Minnesota Interactive Data Access System
MNDOSA Report: Homelessness and Substance Misuse in Northeast Minnesota (2017-2021)
Fatal and nonfatal drug overdose rates in Minnesota have been steadily rising, and drug overdose is a common cause of death among people experiencing homelessness1. In 2019, at least 1 in 262 Minnesotans experienced homelessness, with Minnesotans of color disproportionately affected2. Effective overdose prevention strategies rely on accurate data on risk factors, and tailored approaches that address each population’s challenges and resiliencies.
Therefore, the Minnesota Department of Health developed the Minnesota Drug Overdose and Substance Use Surveillance Activity (MNDOSA) to understand substance use and drug overdose patterns in close to real-time. MNDOSA is a public health surveillance activity that collects data on victims of overdose or substance misuse and tests clinical samples to confirm what substances were involved. This MNDOSA report describes emergency department visits attributable to substance misuse and drug overdose in persons experiencing homelessness, highlighting the connections between stable housing, health, and overdose prevention across the state3.
This webpage summarizes the key findings from the full-length Homelessness and Substance Misuse Reported through the Minnesota Drug Overdose and Substance Use Surveillance Activity (MNDOSA) report (PDF). To learn more, you may also view a two-page Substance Use and Homelessness in Northeast MN fact sheet (PDF) or the MNDOSA project webpage.
Data from five Essentia Health emergency departments in Northeast Minnesota* show that, of 459 patient visits for substance use or overdose between November 2017 and October 2021, 29% of patients (134) were experiencing homelessness. The impact of structural inequities and systemic racism on health and housing is seen in the disproportionately high number of unhoused Black and American Indian patients; 39% of American Indian patients and 55% of Black patients studied by MNDOSA were experiencing homelessness.
The major insight revealed by the analysis of this data is that unhoused patients who misuse substances are more likely to be referred to further treatment, but they are also more likely to decline it. The reasons patients declined additional treatment are unclear, but existing treatment options may have strict abstinence only requirements, may not be culturally responsive, or may necessitate leaving community supports behind, which could make patients’ decisions to engage in such treatment more difficult.
* Data come from five Essentia Health sites in Northeast Minnesota, with results focused on demographic data, risk factors, substances involved, and follow-up treatment. The five participating sites whose data contributed to this report are: Essentia Health – St. Mary’s Medical Center (Duluth), Essentia Health – Virginia, Essentia Health – Deer River, Essentia Health – Sandstone, and Essentia Health – Northern Pines (Aurora).
Patients experiencing homelessness being treated for overdose or substance use often had other life experiences impacting their health.
- 87% of patients experiencing homelessness had a history of at least one mental health disorder.
- 25% of patients experiencing homelessness had a history of justice involvement.
Among patients with substance use concerns, patients experiencing homelessness faced greater barriers to being healthy, compared to housed patients.
- 90% of patients experiencing homelessness required hospitalization for their symptoms related to substance use and/or separate concerns like untreated medical conditions.
- 43% of patients experiencing homelessness had attempted and/or completed chemical dependency treatment in the past, compared to 24% of patients not experiencing homelessness. This suggests that there may not be appropriate treatment options available and that there are barriers to finding housing after completing treatment.
Substances were more often detected through toxicology testing than were reported by patients or clinician observations of symptoms, indicating that many patients did not know what substances they had used.
- 67% of patients experiencing homelessness believed they had used amphetamine or showed signs of amphetamine use, while 83% had amphetamine detected through toxicology.
25% of patients experiencing homelessness believed they had used an opioid or showed signs of opioid use, while 48% had an opioid detected through toxicology testing.
Further study is needed to understand factors that promote access and reduce barriers to treatment in Minnesota’s unhoused population.
The Minnesota Department of Health (MDH) developed the Minnesota Drug Overdose and Substance Use Surveillance Activity to understand substance misuse and drug overdose patterns in close to real-time. MNDOSA illuminates the types of substances being used in Minnesota, helps identify clusters of substance misuse/overdose, and can inform clinicians, community partners and the public about substance use trends to guide prevention efforts. Six participating sites in Northeast Minnesota and the Metro area report patients treated in the emergency departments as a result of substance misuse. Demographic information and data on what substance(s) the patient may have taken, based on patient report and clinician observation of symptoms, is collected by MNDOSA. When sites see patients with severe or unusual symptoms of substance misuse (e.g., the patient was hospitalized, was part of an overdose cluster, or had symptoms not typically caused by the substance used) or where the patient died, MNDOSA collects further narrative information and data on linkage to care after discharge, if available. Participating sites can also send clinical samples for toxicology testing to the MDH Public Health Laboratory to identify the substances involved. MNDOSA uses a high-resolution testing method that can identify nearly 1,000 substances. Findings from MNDOSA contextualize statewide trends on fatal and nonfatal drug overdose and offer insight into circumstances of substance misuse/drug overdose, as well as the substances involved.
- Bauer LK, Brody JK, León C, Baggett TP. Characteristics of Homeless Adults Who Died of Drug Overdose: A Retrospective Record Review. J Health Care Poor Underserved. 2016;27(2):846-859. doi:10.1353/hpu.2016.0075
- Minnesota Homeless Management Information Systems. (Accessed August 2, 2022). Stats on Homelessness in MN.
- Shelton E, Pittman B, Nelson-Dusek S, Gerrard M. (2020). Homelessness in Minnesota: Detailed Findings from the 2018 Minnesota Homeless Study (PDF). Wilder Research.