December 27, 20245 min readPeople Living in Las Vegass Tunnels Urged to Get Medical TreatmentStreet medicine providers and homeless outreach workers who travel into Las Vegass drainage tunnels have noticed an uptick in the number of people living underground, and it can be difficult to persuade them to come aboveground for medicine and treatmentBy Angela Hart & KFF Health News Unhoused men walk out of a flood control tunnel under the city of Las Vegas near the Rio Hotel and Casino on June 26, 2009. It is thought that 1,200 to 1,500 people now shelter inside the hundreds of miles of storm drains that crisscross the Las Vegas Valley. Brian Vander Brug/Los Angeles Times via Getty ImagesLAS VEGAS Case manager Bryon Johnson flashed a light into a dark tunnel beneath the glitz of the Las Vegas Strip on a recent fall afternoon. He stepped into an opening in a concrete ditch littered with trash and discarded clothing to search an underground world for his homeless clients.Beneath the Caesars Palace hotel and casino, Johnson found one of them stretched out on a plywood bed. Jay Flanders, 49, had sores across his back, up his arms, and into his fingers. The homeless man acknowledged occasional meth use and mental health concerns. He couldnt recall exactly how long hed lived underground, but it had been several years.Why dont you come inside, asked Johnson, trying to persuade Flanders to leave the tunnels. Come get treatment.On supporting science journalismIf you're enjoying this article, consider supporting our award-winning journalism by subscribing. By purchasing a subscription you are helping to ensure the future of impactful stories about the discoveries and ideas shaping our world today.Its Johnsons job to coax homeless people out of drainage tunnels that stretch beneath Las Vegas, a perilous grid where people hide from law enforcement and shelter from extreme weather but risk being swept away by floodwaters. Drugs and alcohol are prevalent. Johnson tells clients they have a better shot at recovery above ground, where they can get medical care to treat chronic illnesses, such as diabetes, depression, and heart disease, and start drug and alcohol treatment programs.Street medicine providers and homeless outreach workers who travel into the tunnels said they have noticed an uptick in the number of people living underground as housing costs have skyrocketed and local officials have adopted a zero-tolerance approach to homelessness. Caseworkers are also confronting a level of drug addiction thats making it harder to get people, many suffering from mental illness and health conditions, to come aboveground for care.Its meth. Its fentanyl. Its opioids. Were seeing it more and more, said Rob Banghart, vice president of community integration for the nonprofit homeless outreach organization Shine a Light, who lived in the tunnels for 2 of the five years he was homeless, often using drugs.Now sober for more than six years, Banghart recalled the tunnels providing a respite. In that state of mind, I said to myself, Its got a roof; its out of the sun. Its a little twisted, but it was a community.Outreach workers say more people are retreating underground. Though dark and damp, the tunnels provide cover from the harsh desert sun, warmth when temperatures drop, and privacy from societys judgment above ground.Constructed in the 1990s and measuring some 600 miles, the tunnels provide flood control for the city and outlying communities. Homeless outreach workers said 1,200 to 1,500 people live in them. Many have constructed elaborate shelters, often out of plywood and scraps of metal or brick below the casinos that define the Strip.Tunnel living is not limited to Nevada. Across Californias Central Valley and its southern deserts, people unable to afford housing are retreating into caves and earthen tunnels, often dug into flood control berms, riverbanks, or along drainage canals, where people can escape the heat and law enforcement. In San Antonio, homeless people have constructed tunnel encampments, and in New York, homeless people have long retreated into subterranean existence in tunnels and defunct train corridors.In Las Vegas, some tunnel dwellers said they hide to avoid constant encampment sweeps, which have increased nationally since the U.S. Supreme Court this year ruled that local authorities have a right to enforce sleeping or camping bans in public spaces, even when no shelter or housing is available.Others said they go down to escape the unbearable weather. Triple digits are common in the summer; this year, Las Vegas climbed as high as 120 degrees. And the tunnels provide protection when temperatures drop into the 30s in the winter. It even snows there.Street medicine providers are also trying to persuade homeless people to leave the tunnels to receive care. In addition to more drug and alcohol use, they have seen new problems with wounds and skin disorders associated with the street drug known as tranq, slang for the animal tranquilizer xylazine, which is often mixed with fentanyl or meth.Tranq causes deep skin infections that, left untreated, can lead to bone infections and require amputation.Flanders, the homeless man in the tunnels, had several of these skin sores, which he referred to as spider bites a euphemism for the deep skin wounds caused by tranq. He estimated he has been to the emergency room at least 10 times this year, several times requiring hospitalization.One time I was there for six days; I almost lost a finger, Flanders said, holding up the index finger that had been warped from a deep infection, as he started to tear up. Despite the risks, Flanders said, he still felt safer living in the tunnels than aboveground.Las Vegas population boom has contributed to rising housing costs. The market rent for southern Nevada rose 20% from 2022 to 2023, according to a Clark County homelessness report higher than the national average.As more people get displaced, more retreat underground. And often, outreach workers say, its not just locals who cant afford the rising cost of living who wind up homeless, but also out-of-towners. Some come to make it in the citys booming entertainment industry, while others become homeless after losing it all at the casinos.People come here on vacation to gamble or try and make it, and they lose everything, said Johnson, who works for Shine a Light, one of two organizations in Las Vegas that provide substantial outreach, housing referrals, and drug treatment services for homeless people in the tunnels.The housing market is insane; rents keep going up. A lot of people wind up down here, said Johnson, who lived in the tunnels until he got sober with help from Shine a Light. People just get stuck.Still, Nevadas scorching heat and rains and monsoons pose a major threat to those living in the tunnels, though its unclear exactly how deadly life in them can be.But Louis Lacey, homeless response director for the nonprofit Help of Southern Nevada, said homeless people living belowground put their lives at risk, often in the monsoon season when the tunnels flood. His organization coordinates with the city of Las Vegas and Clark County to get as many people as possible into shelters before the start of the rainy season, which typically runs from June to September.We go into the tunnels to make sure people who want to get out are out, but not everyone leaves, often because they dont want to leave their belongings, he said. People die every year.KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFFan independent source of health policy research, polling, and journalism. 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