When four people died outdoors in a single weekend last month amid freezing temperatures, Denver officials suspected it wasn’t the frigid weather that killed them.

It was drug overdoses.

The preliminary tests for the string of deaths that occurred Nov. 25 and Nov. 26 later suggested as much, according to the city’s health department. Officials also suspected that another outdoor death Nov. 28 resulted from a drug overdose.

The five deaths — if drug overdose, indeed, was the culprit — illustrated a tragic reality in Denver: Hundreds of homeless people are dying each year from fatal overdoses.

Indeed, so far this year, 477 people have died from drug overdoses in Denver, according to the city’s Office of the Medical Examiner. There is a month left in the year, and statistics may experience a lag of several weeks.

Homeless people have made up 181 of those deaths or about 38%.

“We’re in the worst overdose crisis we’ve ever been in,” said Lisa Raville, executive director at Harm Reduction Action Center.

Homelessness and fentanyl, a fatal combination

Out of the 477 overdose deaths in Denver this year, 315 resulted from ingesting fentanyl, the drug that is fueling the spiraling overdose crisis in Colorado and across the United States.

First synthesized 60 years ago as a safe surgical anesthetic, fentanyl is still used today for its intended purpose. But because it’s cheap and easy to make, it has displaced heroin as the drug of choice for cartels and for drug users.

Fentanyl is far stronger than its plantbased cousin at a fraction of the dose and cost. Its high is more fleeting, its dosage more variable, its demand more consuming.

And it is hammering Denver’s homeless population.

Of the 453 overdose deaths last year, half of the total — 226 — were homeless people.

“Since 2021, it’s been at a constant rate,” said Tristan Sanders, director of community and behavioral health at the city’s health department, referring to overdoses. “It really just reflects fentanyl being in Denver, which is not a new thing, but has been something we’ve been looking at for a long time.”

Activists in Denver said the high number of homeless overdose deaths result from isolation.

“It’s much more visible, more noticeable,” said Cathy Alderman, a spokesperson for the Colorado Coalition for the Homeless. “People are outside using substances instead of in a home. So, many of these individuals are isolated. They’re not using with somebody who can administer Narcan and pull them back from an overdose.”

“When people are in an encampment together, then they’re able to save each other’s lives. When they’re put out on the outskirts and are using alone, they’re at a higher chance of overdosing,” Raville said.

While activists blamed “isolation” as the culprit for overdose deaths, a homeless person said abusing drugs in a group setting doesn’t help, either.

Kelsey, who has been living at a homeless shelter in Denver for three months, said the lack of outside intervention exacerbates the problem.

“Our law system says that people can go to jail and then go to these facilities

“When you take someone who is addicted to fentanyl, and you put them into a 300-square-foot room alone ... that is actually an extremely dangerous situation to put someone struggling with addiction in.” Tom Wolf, Foundation for Drug Policy Solutions

and transitional housing. Or homeless people can go to shelters,” she said. “All they’re finding at these places is other people that have gone through the same thing.”

Kelsey’s point? People in congregate settings find others who also abuse drugs, and they end up abusing together. And dying together.

“It sounds great, but people are going to sit there and have the same mindset or want something to cope with,” she said.

Kelsey, who declined to provide her last name, has seen numerous overdoses in the women’s shelter she currently resides in.

“There’s probably about three a night, if employees catch it,” she said.

When asked what the solution is to lowering drug use, Kelsey said she is unsure.

It’s a complex issue whose solutions remain elusive, even among officials and advocates.

Housing first or treatment first?

“Housing is absolutely the answer,” said Alderman, whose group recently lost a $6.4 million, three-year homelessness contract with Denver. “Housing, appropriate services and getting people to address their substance abuse issues and engage in recovery. We recognize that can take a long time, though.”

Sanders from Denver’s health department agreed with the approach: “There’s a lot of evidence about a housing-first model. You’re not going to be able to address somebody’s substance-use issue, you’re not going to be able to address somebody’s mental health issue, unless they are housed because of the volatility in their living situation.”

“Housing first” is the concept that homeless people must first have access to a safe place to live as the priority before addressing their underlying needs. It’s the animating philosophy permeating Denver Mayor Mike Johnston’s administration.

His first major action as mayor was to declare an emergency and vow to house 1,000 homeless residents by the end of the year.

The main difference between “housing first” and “treatment first,” for example, is that, in the former, treatment is not a pre-condition to obtain housing.

Others counter that a “housing first” approach will not work.

Tom Wolf, who once roamed the

streets of San Francisco as a homeless person and who now serves as director of West Coast initiatives for the Foundation For Drug Policy Solutions, argued that mental illness and drug addiction should be addressed first, and not necessarily housing.

To Wolf, the root cause of homelessness is drug addiction and mental health, and it’s where taxpayer dollars should go to.

“There is an addiction crisis amongst the homeless community,” Wolf said, adding it’s “irrefutable.”

“On paper, ‘ housing first’ sounds like a great idea. And if implemented to perfection, it could work. And I mean perfection — it has to be the perfect scenario,” Wolf said, adding the problem is that any implementation of any strategy would be far from perfect.

Wolf and Raville agreed that isolation for a person who is addicted to drugs is deadly.

Wolf, who visited Denver a few months ago, noted that the overwhelming majority of overdoses at one point in San Francisco occurred at fixed addresses and deaths happened within “supportive” housing units.

“When you take someone who is addicted to fentanyl, and you put them into a 300-square-foot room alone ... that is actually an extremely dangerous situation to put someone struggling with addiction in,” Wolf said. “They are all alone with their drugs. Too often, they overdose and they die alone.”

Wolf, in effect, argued that Johnston would be creating the same conditions as he has seen in his hometown of San Francisco in Denver’s “micro-communities,” which, as envisioned, would provide individual housing units and communal centers for services.

‘Safe injection’ sites

While experts and advocates disagree on which overarching approach is best for tackling homelessness and drug addiction, they, along with local government officials, agreed that naloxone and fentanyl testing strips would help prevent deaths.

Denver’s health department provides free naloxone and fentanyl testing strips to anyone directly via its website.

Sanders, the officer from the city’s health agency, said any civilian having naloxone can make a big difference.

“We come across people all the time in the community that are in need. Carrying naloxone and doing the brief training on our website on how to administer it is critical,” he said.

“Everyone needs to carry naloxone.

But, we also need to have real conversations,” Raville said. “If someone is overdosing, I would rather them be with me and my staff than a 17-year-old barista or someone waiting for the bus.”

Raville was alluding to facilities where people can use illegal drugs under the supervision of medical professionals — places that advocates call “safe injection sites” or “overdose prevention centers.”

The idea has repeatedly failed to gain traction at the state Capitol, where lawmakers must authorize it.

Some 14 countries currently offer such sites. New York City opened its first site in 2021, and Rhode Island became the first state to authorize its use in the same year.

In Colorado, the Denver City Council passed an ordinance authorizing such a center in 2018, but the city can’t establish it unless a state law expressly allows municipalities to do so.

Both Alderman and Raville argued that such sites would offer a significant foothold in the battle against overdoses among homeless people.

“People are already doing drugs outside, in parks and in business bathrooms. We want to reduce drug usage just like everybody else. It would be safer to do it at use sites,” Raville said. “We have safe use sites all over the city already. They’re called your residence. But if you don’t have a place to live, you’re using outside and in alleys and business bathrooms.”

“The chaos of homelessness itself makes them feel like the only way to survive is to self-medicate,” Alderman added. “You give them a safe place to be and use their substances. You make sure they’re using clean needles, and during that process, you’re building a relationship of trust with somebody.”

Sanders said Denver hasn’t discussed

“safe injection sites” and suggested that officials would first evaluate the data and evidence coming out of cities that have tried the experiment before reviving the idea. Notably, Denver would want to “understand the efficacy of the sites.”

Several Democratic leaders already said they’re against the idea.

During his campaign for mayor, Johnston said he doesn’t think such centers are the “right step for Denver right now.”

And just this October, a spokesperson said Gov. Jared Polis “has been clear with Coloradans and the legislature that he is opposed to these drug use sites.”

“He looks forward to continuing to work with the legislature to get people help for substance use disorders, end the scourge of fentanyl, and crack down on drug dealers in support of making Colorado one of the 10 safest states,” the governor’s spokesperson said. “There is also great uncertainty nationally about the role of the federal government and how they would enforce against these sites that are already operating in other states.”

The governor’s office was responding to a decision by an interim legislative committee tasked with working on Colorado’s opioid crisis to reject the proposal to set up the “safe injection sites.” The committee did so out of concerns about a possible veto from Polis.

Critics of such taxpayer-funded injection sites have argued they enable drug abuse without addressing the causes of addiction. They would also decrease property values and increase crime in the areas where they’re established, critics said.

“I am grateful to the Senate for putting an end to this poorly thought out bill before it created more Colorado opioid tragedies in our state,” House Minority Leader Mike Lynch, R-Wellington, said earlier this year, when the Democrat-controlled legislature killed legislation to establish such sites.

Referring to the legislation, Lynch said it would have “misused tax dollars to facilitate the use of illicit drugs and extended the nightmare for those struggling with drug addiction.”

The drug stigma

Brooke Perez, founder of KK Fearless, a nonprofit organization out of northern Colorado that holds annual concerts and uses the funds to put musical equipment in treatment facilities, said eradicating the stigma of drug abuse is the most important part of fighting addiction.

She lost both her brother and sister, both talented musicians, to drug overdoses within two years.

“We can help by talking about it. By offering support,” Perez said. “When I was going through this with my sister and brother, we had a tough-love approach. It didn’t work.”

“Just being there and offering resources and treatment facilities, that’s the biggest help,” she said.

The drug-related overdoses in Denver year to date already surpassed 2021 numbers, the high mark for overdose deaths in the city.

That year, the city hit a record-high of 472 dead people due to drugs, a dramatic jump from 2019’s 225 overdose deaths.

In 2019, 58 of the fatal overdoses resulted from ingesting fentanyl.

Only 34 were homeless people.