This article first appeared on The Daily Yonder and is republished here under a Creative Commons license.
Opioid abuse and rural homelessness create a spiral for some rural residents, a new study has found.
For the study, researchers with the Rural Opioid Initiative at Georgia State University interviewed more than 3,000 people in rural communities across 10 states who had used drugs. Of those, more than half (54%) said they had experienced homelessness in the last six months.
April Ballard, assistant professor at the Georgia State University School of Public Health, said the research suggests that the number of rural homeless is significantly larger than federal data suggests.
“Houselessness is an issue in rural areas, but it's not talked about,” Ballard said in an interview with the Daily Yonder. “That's largely because it looks very different than in urban areas. It can look like couch surfing, or moving from place to place. It's hard to count in the same way that we do in urban areas.”
The U.S. Department of Housing and Urban Development requires a nationwide “Point in Time Count” of people experiencing homelessness on a single night in January. On that day, groups of volunteers spread out to count and talk to homeless people in a community. However, Ballard said, because of the nature of rural homelessness, getting an accurate count is difficult.
“In an urban area, there are groups of people that get together and they walk around the city and they talk to people (to get the homeless count),” she said. “That can be challenging, obviously, for urban areas that are really spread out or not walkable. But in rural areas, obviously, you're not going to go climb mountains and go in the backwoods to count people. That's just not feasible.”
Rural people without housing may live in different situations — with relatives, or in tents, or in cars, Ballard said — instead of living in shelters or on the street. That makes finding and identifying them difficult at best. And there is a greater prevalence of homelessness because of the nature of rural community economics, she said.
“In some rural areas there are fewer economic opportunities and more economic disparities,” she said. “There's insufficient public housing infrastructure and a limited acknowledgement of rural houselessness, which means that less money and resources go toward it.”
In one case, the researchers counted up to five times as many people experiencing homelessness in Kentucky than the “point in time” counts had identified. In three counties, the research found, the “point in time” counts estimated there were no people who were homeless, while Ballard and her group found more than 100 people in those same counties who said they had used drugs and experienced homelessness in the previous six months.
Mary Frances Kenion, vice president of training and technical assistance with the National Alliance to End Homelessness, agrees that homelessness in rural communities is undercounted.
“Every year, communities conduct an annual ‘point in time count, which is comparable to what we see in the Census —where folks go out knocking door to door to count people,” she said in an interview with the Daily Yonder. “But how do you count people that don't have a door to answer?”
Rural homelessness, she said, stems not only from lower economic opportunities and a lack of affordable housing, but a lack of support services as well.
“We see a lack of service providers that are really responsible for a whole range of services to the community,” she said. “We do not seem to see the same concentration of service providers that you would see in, say, metropolitan Atlanta or Washington, D.C., or New York City.”
Ballard said her team’s research also indicated that there is a link between opioid use and rural homelessness, each one feeding off of the other.
“Obviously, it's very clear that the opioid epidemic, as well as other sorts of drugs, has just been wreaking havoc on rural America for a while now. And I would say that houselessness has been an issue in rural areas, but it's not talked about,” she said. “These two things, I think have been happening in parallel, and as the opioid epidemic has dramatically increased, it [has led] to that kind of cycle.”
The social losses that accompany opioid use disorder, Ballard said — such as unemployment, financial ruin, and the loss of family and social networks — can lead to housing instability and homelessness. In turn, the harsh living conditions presented by homelessness can perpetuate drug use as a coping mechanism. Together the two can create a self-reinforcing cycle that contributes to poorer health and shorter lifespans.
Homelessness can also inhibit treatment and medical care, Ballard said. People without stable housing were 1.3 times more likely to report being hospitalized for serious bacterial infection and 1.5 times more likely to overdose, the study found. Ballard said the lack of access to clean water contributed to a higher infection rate, while the prevalence of homeless people to use drugs alone increased the risk of accidental overdoses.
Although the two often overlap, Kenion cautioned against equating homelessness with drug addiction.
“I would be really careful about drawing parallels to the narrative that sometimes takes over that the majority of people experiencing homelessness are addicted to opioids or other substances, because that's not supported by the data,” she said.
Rather, many homeless people across the country have experienced financial hardships — even one unexpected expense —that spiraled out of control and forced them from their homes, she said.
“Not a lot of people realize how folks are just often one crisis away from experiencing housing instability and homelessness, but that is felt more acutely in rural communities,” she said. “If you look at the overall snapshot, rural homelessness has actually increased by 17% between the beginning of the Covid-19 pandemic and 2023. And 42% of people experiencing homelessness in rural areas are in unsheltered situations, with women and families with children being far more likely to be unsheltered outdoors.”
Both Ballard and Kenion agree that accurately counting the homeless in rural communities in necessary in order to ensure they have the services they need to get back on their feet.
Additionally, Ballard said, having an accurate count can help ensure the rural homeless who have drug abuse issues can get the help that they need.
“I feel like without that awareness, we are not allocating resources to this,” Ballard said. “From a policy standpoint, it's incredibly important for us to be capturing accurate information and accurate estimates, so that we're actually dedicating the right amount of resources to communities. If we are trying to stop deaths related to drug use as well as other epidemics related to HIV and hepatitis C, and we're not considering housing status, efforts to mitigate that are not going to be as effective or as efficient.”
