Housing First Saves Lives and Money for Drug Users todayheadline

Providing housing to homeless people with opioid addiction—without requiring them to get clean first—prevents deaths and saves money, according to a Stanford University study that challenges conventional approaches to homelessness.

The research, published in JAMA Network Open, found that “housing first” programs reduce deaths by 27% over five years while costing just $26,800 per healthy year of life gained—well below the threshold most economists consider cost-effective.

The findings come as cities nationwide grapple with overlapping crises of homelessness and drug overdoses, particularly as fentanyl has made street drugs increasingly deadly for vulnerable populations.

Two Competing Philosophies

The study examined a fundamental debate in homeless policy: should cities require people to get sober before receiving housing, or provide housing first and address addiction later? The “treatment first” approach has dominated policy for decades, but researchers wanted to test whether immediate housing might produce better outcomes.

“It’s really, really hard for people on the street to get into treatment and to stay in treatment,” explained Margaret Brandeau, the study’s senior author and Coleman F. Fung professor of engineering at Stanford. “The treatment-first approach has not been particularly helpful in many populations.”

Using mathematical modeling, researchers simulated outcomes for 1,000 homeless people with opioid addiction over their lifetimes. In the status quo scenario, participants remained on the streets. In the housing intervention, they received immediate permanent housing with health care and supportive services—no strings attached.

Life-Saving Results

The differences were stark. Over five years, 191 people died in the homeless group compared to 140 in the housed group—a reduction of 51 deaths. The housing intervention prevented both overdose deaths and deaths from other causes linked to life on the streets.

Key outcomes of housing-first programs:

• 27% reduction in total deaths over five years
• 11% decrease in drug overdoses
• 35% reduction in deaths from other causes
• 3.6 additional healthy years per person over their lifetime

“Housed people have a higher likelihood of getting into treatment, which means that they have a higher likelihood of becoming abstinent,” noted Isabelle Rao, the study’s lead author and now an assistant professor at the University of Toronto. Housing also dramatically reduces exposure to the violence, weather, and health risks that make homelessness so deadly.

Economic Benefits

Beyond saving lives, housing first programs proved economically sound. The intervention costs $96,000 per person over their lifetime—including $20,900 annually for housing plus health care and support services. But those costs are partially offset by reduced emergency room visits, hospital stays, and other medical expenses.

The $26,800 cost per quality-adjusted life year falls well below the $100,000 threshold most health economists use to define cost-effective interventions. Even doubling housing costs would keep the program below $70,000 per life year gained.

The analysis didn’t include criminal justice savings, which would make housing programs look even better financially. Previous studies suggest homeless individuals cost taxpayers $5,000 to $15,000 annually in jail expenses alone.

Real-World Applications

The researchers applied their model to San Jose, California, which has about 6,340 homeless residents. Housing all of them would cost $113.8 million annually but generate $72.6 million in health care savings plus additional criminal justice savings—making the net cost much lower than the sticker price.

However, the analysis assumes housing already exists. Building new affordable housing costs $150,000 to $1 million per unit nationwide, representing a massive upfront investment that challenges cash-strapped cities.

The study’s timing is significant as drug overdoses have become the leading cause of death among homeless people, with fentanyl making street drugs exponentially more dangerous than previous generations of opioids.

Policy Implications

The research supports housing-first policies that have gained federal backing but face local resistance. Critics worry about enabling drug use, but the Stanford model suggests that fear is misplaced—housed people actually have better treatment outcomes than those forced to choose between sobriety and shelter.

“Engineers are always trying to make things better,” Brandeau reflected. “We really want our work to make a difference. And homelessness is a significant humanitarian crisis in our country.”

The study provides quantitative backing for what advocates have long argued: that stable housing creates the foundation people need to address addiction, mental health problems, and other challenges. For policymakers weighing expensive housing investments, the research suggests those dollars don’t just house people—they save lives while reducing long-term costs to taxpayers.

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