PORTLAND, Ore. (AP) — A record 193 homeless people died in Oregon’s Multnomah County, home to Portland, in 2021, a 53% increase compared with the previous year, according to a new county report released Wednesday.

Substances contributed to about 60% of those deaths, the report found, mirroring trends seen across the country.

Similar to 2020, methamphetamine was the most common drug noted in the county’s fatalities. But the number of deaths involving fentanyl, and a combination of opioids and meth, saw the biggest increases.

“Polysubstance, meth and fentanyl are the key takeaways,” said county health officer Jennifer Vines, adding that fentanyl use exploded during the pandemic.

“For a long time, we imagined that fentanyl was sort of a drug contaminant that people would kind of stumble upon accidentally, and it would be something that might move through the drug supply,” she said during a news conference. “What we weren’t prepared for was simply the use of fentanyl as a drug that became cheap, that became highly available, and that is so potent and short-acting that people actually develop an addiction and seek out the drug itself.”

Compared with 2020, the number of homeless deaths involving fentanyl jumped more than eightfold, from four to 36. Those stemming from combined opioid and meth use jumped from 27 to 47.

Meth, however, remained the deadliest drug overall. It was involved in 93 deaths — 82% of substance fatalities — continuing the trend from 2020.

County health officials said they have had difficulty responding to the spike in meth use because there is no medication that can reverse a meth overdose, the way that naloxone can reverse an opioid overdose.

“It’s been really hard and really scary,” said Haven Wheelock, program supervisor at Outside In, a Portland-based nonprofit that provides addiction and homelessness services. “For many years, it’s been an uphill battle to have these conversations and to talk about overdose deaths as the public health crisis that it is, and homelessness as the crisis that it is.”

The report relied on the findings of medical examiners, who tend to investigate non-natural deaths including those caused by suspicious or unknown circumstances, such as homicide and suicide, and those caused by injuries and accidents, such as overdoses. For that reason, the deaths in the report are likely an undercount, county health officials said.

The number of homeless people who died by homicide more than doubled from 2020 to reach a new high of 18, accounting for nearly 10% of all homeless deaths. The majority involved guns. The increase tracks with a citywide trend in Portland, which has reported record homicides for the last two years amid a surge in gun violence.

Extreme weather events were another notable factor in homeless deaths, the report found. Four people died during the devastating summer 2021 “heat dome,” and eight people died of hypothermia during the winter months.

Although 2021 was the first full year of the pandemic, only two homeless deaths were identified as being caused by COVID-19. But the report says this figure is likely an undercount, as medical examiners don’t investigate the deaths of people hospitalized for more than 24 hours prior to a natural death. No COVID-19 deaths were identified by medical examiners in 2020.

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