Disheveled men with sleeping bags stage protests at City Hall, camp on prime downtown real estate and gather every evening on one of the city's most prominent bridges.
But when a homeless person dies, sometimes in a horrific manner, the event passes with little notice.
On Friday, the state Medical Examiner released a review of 47 homeless people who lost their lives on the streets of Portland last year. The report did not put a name or a face on those who died, but provided a snapshot of what caused their lives to be cut short.
"These were not happy deaths," said Dr. Paul Lewis, the deputy health officer for the three-county Portland metropolitan area and the author of the report.
The review is the first of its kind in Oregon, and is similar to a report King County, Wash., has been releasing since 2004.
Of the 47 deaths reported in Portland, 28 of were deemed accidental - 21 from drug overdoses, mostly heroin, and the rest from trauma, such as a fall or getting hit by a car. Another six deaths were attributed to prolonged alcohol use. There were also four suicides and two homicides.
The report underestimates the number of deaths because the fatalities are only those that fall under the jurisdiction of the medical examiner, Lewis said. A homeless person who died in a hospital would likely not be included.
Much like the number of deaths, the number of people living without a home is imprecise. The most recent one-night count - conducted by volunteers in 2011 - found 5,059 homeless in Portland and 22,116 statewide.
Multnomah County Commissioner Deborah Kafoury said the high cost of housing is pushing more people to the streets and they don't get needed help for mental and physical problems, along with treatment for addictions.
"This is not what a strong, healthy community looks like," Kafoury said.
The majority of the dead were white men and 68 percent fell between the ages of 30 and 59. Twenty-seven deaths occurred during the fall and winter, but the cold was not the primary cause in any.
The review was requested by Street Roots, a Portland newspaper devoted to and sold by the homeless.
Charles Yost, 57, who has hawked Street Roots, said he was homeless for 12 years before getting a roof nine months ago. He expected the number of deaths to be higher, saying he has witnessed many ambulances picking up street people over the years.
"It's no playground out there," he said.