EL CAJON, Calif. – The mayor of El Cajon said San Diego’s opioid addiction, homelessness crisis and hepatitis A outbreak are related and it’s only getting worse.

“Almost all homelessness is linked to drugs or alcohol,” said El Cajon mayor Bill Wells.

Wells has a unique perspective running a major city and being an emergency room doctor.

“Ninety-seven percent of people who became addicted to heroin are because they became addicted to pain pills. And sharing needles is a very real way these people are catching Hep A,” Wells said.

People who recently got off the streets and were staying at the East County Transitional Living Center in El Cajon said they have no doubt all those factors have led to San Diego’s health crisis.

“The streets are pretty dirty. I’m not surprised it happened. It’s hard to stay clean out there. No one wants to help you,” said Bryan Smith, who recently got off the streets of El Cajon.

Mother of three children Victoria Valdez has been homeless on and off for a decade and has fought drug and alcohol addiction.

“It’s really scary,” said Valdez. “You don’t think or consider what the other person might have when you’re sharing needles. You don’t consider what might be on the ground when you lay there.”

Valdez is grateful she got off the streets of El Cajon before the hepatitis A crisis hit.

A total of 19 people have died in San Diego as a result of hep A – 13 of them were living on the streets.

Wells and other experts said the first step to solving these issues is to get people off the streets.