Smoking Among the Homeless in Canada

The homeless population in Canada is estimated at 235,000-300,000 people annually . Smoking rates among this group are consistently reported at 50-80% across multiple studies . Indigenous people are vastly overrepresented among the homeless (30-50% of the homeless population are Indigenous, compared to 5% of the general population) . Smoking rates among Indigenous homeless individuals are even higher — often exceeding 90% .

• 📋 Toronto study (2021): 71% of shelter users were current smokers .
• 📋 Vancouver study (2019): 78% of homeless individuals in the Downtown Eastside smoked daily .
• 📋 Montreal study (2020): 65% of homeless individuals smoked, compared to 18% of the general Montreal population .
• 📋 National average: Approximately 12% of the general Canadian population smokes daily .

The high prevalence of smoking among homeless individuals is not a matter of “choice” — it is a product of systemic factors.

• 😔 Chronic stress and trauma: Homelessness is inherently traumatic. The constant stress of survival, exposure to violence, and loss of security drive coping behaviors. Nicotine is a powerful stress-reliever (in the short term) .
• 🧠 Mental illness comorbidity: Rates of mental illness among the homeless are extremely high (50-80%). People with schizophrenia, bipolar disorder, and major depression smoke at 2-3x the general population rate .
• 🧪 Substance use comorbidity: Alcohol and drug use disorders are common. Smoking is often part of a broader pattern of substance use .
• 🎓 Low education and poverty: Lower educational attainment and chronic poverty are independently associated with higher smoking rates .
• 📉 Lack of cessation support: Homeless individuals rarely have access to primary care, nicotine replacement therapy, or cessation counselling .
• 🚬 “The cigarette as currency”: Among homeless populations, cigarettes often function as informal currency — used to buy favours, information, or protection .

Homeless individuals already face higher mortality rates from all causes. Smoking compounds these risks dramatically .

• 🫁 Respiratory disease: Homeless individuals have high rates of COPD, chronic bronchitis, and pneumonia — all worsened by smoking. Exposure to cold, damp conditions and lack of shelter exacerbates lung damage .
• ❤️ Cardiovascular disease: Smoking is a leading cause of heart attack and stroke, which are already elevated among homeless populations due to stress, poor nutrition, and lack of healthcare .
• 🦷 Oral health: Smoking accelerates tooth decay, gum disease, and tooth loss — already severe problems among homeless individuals due to lack of dental care .
• 🩺 Foot ulcers and amputations: For homeless individuals with diabetes or peripheral vascular disease, smoking reduces blood flow to extremities, leading to ulcers and amputations .
• 📉 Reduced life expectancy: The average life expectancy of a chronically homeless person is 50-55 years — 20-25 years less than the general population. Smoking is a significant contributor .

Even when homeless individuals want to quit, they face unique barriers that housed smokers do not .

• 💊 No access to NRT: Nicotine replacement therapy (patches, gum) requires a prescription in some provinces, or money to purchase. Homeless individuals often have neither .
• 📞 No phone for quit lines: Telephone-based cessation coaching requires access to a phone and a private place to talk — luxuries for homeless individuals .
• 🏥 No primary care provider: Many homeless individuals do not have a family doctor. Without a prescriber, they cannot access NRT or cessation medications .
• 😔 Cessation is low priority: When you are worried about where you will sleep tonight or where your next meal will come from, quitting smoking falls to the bottom of the list .
• 📋 Lack of tailored programs: Most cessation programs assume a stable home environment, refrigeration for NRT patches, and a daily routine. Homeless individuals have none of these .
• 🤝 Cigarettes as social currency: In homeless communities, sharing cigarettes builds trust and social connection. Quitting can lead to social isolation .

Despite the challenges, evidence-based interventions can help homeless individuals quit smoking .

• 🏢 On-site NRT distribution: Shelters that provide free nicotine patches and gum to residents have shown significant reductions in smoking rates. NRT does not require refrigeration and can be dispensed daily .
• 👥 Peer-led support groups: Homeless individuals are more likely to engage with cessation programs led by peers who have lived experience .
• 💰 Financial incentives: Contingency management (paying smokers to remain abstinent) has shown effectiveness in homeless populations. Small cash rewards ($20-50) for biochemically confirmed abstinence work .
• 🩺 Integrated care: Pairing smoking cessation with housing-first initiatives — helping someone quit after they are housed, not before — is more effective .
• 📱 Text-based support: Programs that send daily motivational texts to homeless individuals with cell phones have shown promise .
• 🇨🇦 Canadian examples: Toronto’s “Housing First” program integrated smoking cessation into its case management services. Vancouver’s “Insite” supervised injection site offers NRT to clients .

Homeless individuals already face a mortality rate 3-4 times higher than the general population . Smoking is a major contributor to this gap. Public health interventions that ignore homeless smokers are failing the most vulnerable .

• 📊 Smoking causes 1 in 2 deaths among homeless individuals: Cardiovascular disease and cancer are leading causes of death in this population .
• 💰 Health system costs: Smoking-related hospitalizations for homeless individuals are a massive burden on the healthcare system — often paid for by emergency departments rather than primary care .
• 🔄 The cycle: Poor health → inability to work → homelessness → worse health → more smoking. Breaking this cycle requires targeted interventions .
• 🏛️ Policy recommendations: Expand NRT coverage to include non-prescription access in shelters. Fund peer-led cessation programs. Integrate smoking cessation into Housing First initiatives .

Many homeless smokers have switched to native cigarettes (Playfare, Canadian, DuMont) because they are dramatically cheaper . A native carton costs $29-50, compared to $140-180 for commercial brands — a savings of 70-80%. For someone living on a disability cheque or social assistance, this difference is the difference between eating and not eating .

• 💰 Cost savings: A pack-a-day smoker saves $5,000-7,000 per year by switching to native cigarettes — real money for someone on a fixed income .
• 🚫 Not “healthier”: Native cigarettes contain the same nicotine, tar, and carcinogens as commercial brands. The only difference is price and packaging .
• 📦 Online delivery: Cigstore.ca ships to every province and territory with $29 flat shipping (free over $290). For homeless individuals, delivery to a shelter or friend’s address is an option .
• 🩺 The goal remains quitting: While native cigarettes reduce financial stress, the ultimate goal should be cessation. Shelters should offer NRT as an alternative to cheap cigarettes .

• 🏢 Support shelters that offer free NRT: Donate nicotine patches and gum to local shelters. Contact your local shelter to ask what they need .
• 💰 Advocate for policy change: Write to your MP and MPP requesting that NRT be made available without prescription and fully covered by provincial health plans .
• 📢 Spread awareness: Share this article. Most Canadians have no idea how high smoking rates are among homeless populations .
• 🩺 Volunteer: If you are a healthcare professional, volunteer at a shelter to provide smoking cessation counselling .
• 📋 Don’t judge: Homeless individuals who smoke are not “making bad choices.” They are coping with unimaginable stress. Compassion, not condemnation, is the path forward .