A single shoe, articles of clothing, and pieces of cardboard are found behind Livingstone’s Restaurant and Pub in Fresno’s Tower district on Thursday, Sep. 8, 2022. Unhoused individuals often gather in the shade near dumpsters behind the restaurant. Credit: Melissa Montalvo / Fresno Bee / Fresnoland

What's at stake?

Fresno County officials say true heat-related deaths are extremely rare among the unhoused, since there tend to be other health and drug issues that are determining factors. But homeless advocates say heat likely plays a role and blame on individuals experiencing substance use disorders.

Two homeless individuals died on the streets of Fresno during the triple-digit heat wave the first week of September.

The Fresno County Coroner’s Office, however, said both deaths were likely prompted by drug use rather than the high temperatures.

“We see cases like this…year-round, regardless of the heat,” Tony Botti, spokesperson for the coroner’s office, said in a call with The Bee on Thursday. “True heat-related deaths are extremely rare” since there tend to be other health and drug issues that are determining factors, he said.

Botti confirmed that a homeless man, around 60 years old, died on Sept. 1 in downtown Fresno. That day, temperatures in Fresno soared to 106 degrees, according to the National Weather Service.

The man’s body was found in downtown Fresno, near the corner of Van Ness Avenue and Ventura Street. Botti said the man had a “drug history,” but the cause of death was still unknown.

Another man was found dead behind Livingstone’s Restaurant and Pub in Fresno’s arts and culture Tower District on Sept. 4, a day Fresno experienced a high of 107 degrees.

Botti said the death “appears to be an overdose.”

The coroner’s office is still trying to contact family members of the deceased individuals. The causes of death are still unclear, and a final toxicology report in each case will take an estimated four weeks.

Botti explained that Fresno often sees homeless deaths related to methamphetamine overdoses. “Meth heats the body so much that (it) usually kills the person if they are on it,” Botti said.

According to medical research published in the Journal of Pharmacology & Therapeutics, meth use can induce extreme hyperthermia, a condition in which the body overheats above normal temperature. Lethal drug overdoses are generally associated with extreme hyperthermia.

But ongoing exposure to heat can also be detrimental to the health of the estimated 1,700 unsheltered people in Fresno.

A Fresnoland report published Aug. 31 found that between 77 and 81 people died due to heat-related illness in Fresno from 2006 to 2021, according to data from the California Department of Public Health. Fresnoland interviewed around two dozen unhoused Fresno residents who said the summer heat causes them headaches, dizziness, dehydration, exhaustion, or complications with other health conditions.

Substance use disorders only complicate matters, especially when drugs such as meth increase the core body temperature.

Regardless of the exact cause of death, “trying to survive the streets of Fresno is the most difficult thing,” said Dez Martinez, founder of We Are Not Invisible and chair of the Fresno Homeless Union, during an interview with The Bee on Thursday.

“Especially when it’s over 111 degrees outside and people are in direct sunlight.”

Fresno’s heat and meth conditions meet on the streets

Fresno has long struggled with its meth epidemic, which has garnered national attention in recent years. In the last four years, Fresno County has had over 350 deaths due to meth overdoses, Botti said. There were 58 deaths from meth overdose in 2018; 77 in 2019; 121 in 2020, and 98 in 2021.

But Martinez, the homeless advocate, said it’s hard to ignore the context of these deaths, such as the triple-digit temperatures that homeless individuals endure on the streets, in addition to the ongoing meth epidemic.

“I don’t want people to put it off and say, ‘Oh, well, if they weren’t high,’ or, ‘It’s their fault,’” Martinez said.

“It’s not the individual’s fault when our city and county don’t have the proper resources funded in order to help the individuals that are in direct sunlight and high, that are lost on our streets of Fresno in their addiction, which is a disease,” she said.

Ahmad Bahrami, a division manager for the Fresno County Department of Public Behavioral Health, said the county has “low-barrier to almost zero barrier projects” like The Lodge, which engages unhoused individuals with substance use disorder and mental health challenges if they are not currently in care. Low-barrier shelters are those that have few requirements for people who seek shelter, while zero-barrier shelters are those where no requirements (such as sobriety) are placed on guests.

“While we continue to increase outreach, efforts are often contingent on a participant’s willingness to engage in care,” he said.

But Bahrami said one of the challenges with meth addiction is effective treatment models. “Things like medication assisted treatment (MAT) have been effective for opioid treatment, but there are not similar approaches yet for meth.”

The city of Fresno’s spokesperson couldn’t immediately be reached for comment. However, city-funded shelters have triage services to help residents access treatment for meth addiction, as well as other services.

‘This is everybody’s problem’

Martinez said she has been delivering cold water to unhoused individuals living on the streets during the heat wave. She said while she can’t stop people from doing drugs, she tries to remind them to stay cool.

“I tell them, ‘Please, please drink all this water, stay in the shade on grass,’” she said. “Your body temperature is never gonna lower when you’re sitting on the concrete or dirt.”

She said she hopes to see more attention and resources from the city and county of Fresno for meth detox centers, as well as safe places, such as cooling centers, for homeless individuals experiencing drug disorders.

Martinez said, “This is our problem; this is everybody’s problem.”

How to get help

Residents of Fresno County who are interested in seeking services for substance abuse disorders can call the 24/7 access line at 800-654-3937 or visit recoverfresno.com; information on substance use disorder providers is also available in Spanish and Hmong.

Support our nonprofit journalism.


Your contribution is appreciated.

Melissa is a labor and economic inequality reporter with The Fresno Bee and Fresnoland.