The UK and USA currently report their highest number of drug-related deaths since records began, with higher rates among individuals experiencing homelessness.

Given that overdose prevention in homeless populations may require unique strategies, we evaluated whether substances implicated in death differed between (a) housed decedents and those experiencing homelessness and (b) between US and UK homeless populations.

We conducted an internationally comparative retrospective cohort study utilising multilevel multinomial regression modelling of coronial/medical examiner-verified drug-related deaths from 1 January 2012 to 31 December 2021. UK data were available for England, Wales and Northern Ireland; US data were collated from eight county jurisdictions. Data were available on decedent age, sex, ethnicity, housing status and substances implicated in death.

Homeless individuals accounted for 16.3% of US decedents versus 3.4% in the UK. Opioids were implicated in 66.3 and 50.4% of all studied drug-related deaths in the UK and the USA respectively. UK homeless decedents had a significantly increased risk of having only opioids implicated in death compared with only non-opioids implicated (relative risk ratio RRR = 1.87, 95% CI 1.76–1.98, P < 0.001); conversely, US homeless decedents had a significantly decreased risk (RRR = 0.37, 95% CI 0.29–0.48, P < 0.001). Methamphetamine was implicated in two-thirds (66.7%) of deaths among US homeless decedents compared with 0.4% in the UK.

Both the rate and type of drug-related deaths differ significantly between homeless and housed populations in the UK and USA. The two countries also differ in drugs implicated in death. Targeted programmes for country-specific implicated drug profiles appear warranted.

英国和美国目前报告的与毒品相关的死亡人数是有记录以来最高的，其中无家可归者的比例更高。

鉴于无家可归人群的过量预防可能需要独特的策略，我们评估了与死亡有关的物质在（a）被安置的死者和无家可归者之间以及（b）美国和英国无家可归者之间是否存在差异。

我们利用多级多项回归模型对 2012 年 1 月 1 日至 2021 年 12 月 31 日经验尸官/法医验证的药物相关死亡进行了一项国际比较回顾性队列研究。美国的数据是从八个县管辖区整理的。已提供有关死者年龄、性别、种族、住房状况和与死亡有关的物质的数据。

美国死者中无家可归者占 16.3%，而英国为 3.4%。在英国和美国，所有研究的药物相关死亡中，阿片类药物分别占 66.3% 和 50.4%。与仅涉及非阿片类药物相比，英国无家可归者死者仅使用阿片类药物导致死亡的风险显着增加（相对风险比 RRR = 1.87，95% CI 1.76–1.98，P < 0.001）。美国无家可归者死亡人数的三分之二 (66.7%) 与甲基苯丙胺有关，而英国这一比例为 0.4%。P < 0.001);相反，美国无家可归者的风险显着降低（RRR = 0.37，95% CI 0.29–0.48，

在英国和美国，无家可归者和有家可归者的毒品相关死亡率和类型都有显着差异。两国在导致死亡的药物方面也存在差异。针对特定国家相关药物概况的有针对性的计划似乎是必要的。