An estimated 250 people died while homeless in Scotland last year, according to the latest figures.
It comes after the numbers hit a high of 256 in 2020 after consistently increasing over the previous three years.
Almost 100 more people died on the streets in 2021 than five years ago. National Records of Scotland said this was a similar level to last year but remaind higher than 2017, when it first collected the data.
Housing secretary Shona Robison described the figures as “heart-breaking reading”.
There were two deaths where the underlying cause was Covid-19, but most were the results of drug-misuse.
Midlothian, Glasgow City, and the City of Edinburgh had the highest rates of homeless deaths within Scotland, while Na h-Eileanan Siar, Orkney Islands, Perth and Kinross, and Stirling council areas recorded none.
81% of those who died were male and 60% were aged under 45.
Head of vital events at National Records Scotland, Julie Ramsay, said: “Drug-misuse deaths of people experiencing homelessness fell in the past year for the first time, from 151 to 127, but it was still the cause of over half of all deaths for people experiencing homelessness in 2021.
“As in previous years, the death rate of males is much higher than that of females. 81% of deaths in 2021 were male and 19% were female. The age profile of females was younger, with 72% of those who died being under the age of 45.”
Suicide accounted for 9% of deaths, while 7% were related to alcohol, according to NRS.
In the report, NRS explained that as homeless deaths “are difficult to count” the method it used “tries to account for and estimate how many we might have missed”.
Of the 250 deaths that occurred last year, 222 were identified from death registration records, with an additional 28 deaths estimated using statistical modelling.
Robison said: “Behind every statistic is a human story and this year’s report provides heart-breaking reading.
“We know that experience of multiple forms of extreme disadvantage, including homelessness, poor mental health and opioid dependence, is linked to higher rates of ill health and premature death.
“We are committed to doing all we can to address disadvantage and prevent homelessness from happening in the first place.”
The housing secretary continued: “That is why we are introducing new homelessness prevention duties in the forthcoming Housing Bill and why we continue to support local authorities to develop housing first programmes.”
She added: “While it is positive to see a fall in the number of drug-related deaths compared to 2020, the numbers remain worryingly high.
“One focus of the national mission on drug deaths is to strengthen partnerships between health and homelessness services to improve outcomes for people experiencing homelessness and multiple complex needs, including substance use.”