HONOLULU - For many homeless residents, death is just part of life on the streets.

"Four of my friends have died on the streets from alcohol abuse," homeless resident Joey Rebman said. 

According to data from the Medical Examiner's office, over the past five years acute alcohol intoxication resulted in the death of 19 homeless residents. 

That is a small portion of the 372 people who died during that period. 

"We have a humanitarian crisis when people are dying needlessly on our streets," Honolulu Housing Director Marc Alexander said. 

The Medical Examiner's office says 'needlessly' because some residents refuse to accept health care or won't clean up their poor hygiene which can eventually result in life-threatening conditions.

"Maybe I'm a diabetic and get an infection on my foot, but if that is not treated then it can seed my blood and that is what sepsis is and mortality rates go up," Dr. Christopher Happy, Honolulu Medical Examiner. 

As Honolulu's Medical Examiner Dr. Happy closely looks at the causes of death in every autopsy. 

"By far the drug we find people acutely intox with is meth, but we also see the chronic long-term effects of meth abuse," Dr. Happy said. 

86 deaths were related to meth use. According to Dr. Happy they also likely contributed to many of the 89 deaths related to cardiovascular issues. 

Because meth causes the heart to rapidly beat, it puts a strain on the bodies of users and abusers.

Other drugs also caused deaths but weren't anywhere close to numbers caused by meth.

About the same amount of homeless residents were killed in homicides, nearly two dozen took their own life during that time.

Even more died from falls, car accidents, or injuries.

"My other friends the old timers they drink, drink, drink, next thing you know they in the water, next thing you know they drowning," homeless resident Smallboy said. 

16 people drowned over the past 5 years, just under the number of deaths that were undetermined.

"A number of the undetermined are people who end up in the water, we just don't know how or why they end up in the water," Dr. Happy said. 

The average age for homeless residents dying on the streets is 52 years old, nearly decades less than Hawaii's average life expectancy of 81.  

"I don't worry about death, I worry about how I am going to live," Rebman said. 

This deadly problem for Hawaii's homeless only seems to be growing. 

"As we've seen the number of homeless population increase, we've seen the number of homeless deaths increase," Alexander said. 

The full breakdown is below:

Causes of death for Oahu's homeless

In 2014, 72 homeless died. 

Alcohol: 7

Sepsis: 2

Homicide: 3

Undetermined: 6

Heart Disease: 18

Meth: 10

Lung-related/Pneumonia: 4

Suicide: 3

Drowning: 4

Drugs/Morphine: 5

Accidents: 6

Brain-related causes: 0

Other: 4

--

In 2015, 63 homeless died. 

Alcohol: 4

Sepsis: 1

Homicide: 2

Undetermined: 3

Heart Disease: 11

Meth: 19

Lung-related/Pneumonia: 2

Suicide: 5

Drowning: 7

Drugs/Morphine: 1

Accidents: 6

Brain-related causes: 1

Other: 2

--

In 2016, 78 homeless died. 

Alcohol: 3

Sepsis: 3

Homicide: 1

Undetermined: 4

Heart Disease: 15

Meth: 17

Lung-related/Pneumonia: 4

Suicide: 8

Drowning: 3

Drugs/Morphine: 4

Accidents: 3

Brain-related causes: 3

Other: 11

--

In 2017, 70 homeless died. 

Alcohol: 2

Sepsis: 4

Homicide: 4

Undetermined: 2

Heart Disease: 20

Meth: 12

Lung-related/Pneumonia: 3

Suicide: 3

Drowning: 2

Drugs/Morphine: 4

Accidents: 7

Brain-related causes: 5

Other: 7

--

In 2018, 89 homeless died. 

Alcohol: 3

Sepsis: 5

Homicide: 3

Undetermined: 3

Heart Disease: 25

Meth: 28

Lung-related/Pneumonia: 2

Suicide: 4

Drowning: 0

Drugs/Morphine: 0

Accidents: 11

Brain-related causes: 1

Other: 5

--

Cause of death totals over the five-year period 2014-2018:

Alcohol: 19

Sepsis: 10

Homicide: 13 

Undetermined: 18

Heart Disease: 89

Meth: 86

Lung-related/Pneumonia: 15

Drowning: 16

Drugs/Morphine: 14

Accidents: 33

Brain-related causes: 10

--

While Hawaii’s homeless are very visible, what has been hidden, until now, is the large numbers of deaths on our streets.

What's even more shocking is the young average age at which people are dying.

Chronic drug & alcohol use as well as very poor health care are some of the main reasons so many homeless residents are dying.

Details on the exclusive report on KITV4 Island News at 5, 6 & 10 p.m.