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In July 2017, O'Brien relocated to San Salvador in Central America to teach literature at an English-language preparatory school and to write a sequel to Beneath the Neon about survivor dwellers of the storm drains. In an article about O'Brien, the Las Vegas Review Journal described his move out of the country as the "man who shined light on Las Vegas' tunnel dwellers (is) moving on."

In January 2016, O'Brien raised more than $13,000 in 24 hours through Crowdrise for O'Brien's nonprofit group Shine a Light to benefit homeless people living in tunnels beneath the Las Vegas Strip.

After three tunnel dwellers died in June 2016 in a flash flood, O'Brien and a homeless man called "Jazz" appeared on NPR's southern Nevada affiliate KNPR to talk about the flood, in which Jazz's longtime girlfriend Sharon drowned. O'Brien's nonprofit, Shine a Light, helped one of the flood victim's families with expenses surrounding the death.

In March 2015, digital network Seeker profiled O'Brien on the air as he explored the tunnels and interacted with residents.

On September 3–4, 2013, O'Brien appeared on the Dr. Phil Show in a two-part series after O'Brien escorted professional locator Troy Dunn into the underground flood channels of Las Vegas. There, they found a homeless mother, Cyndi, who'd been separated from her four daughters for several years. The second episode of the show, Cyndi appeared with Dr. Phil and reunited with her daughters in the studio. At the end of the show, Dr. Phil offered Cyndi and her husband, Rick, rehab and family-counseling services, which they accepted. Dr. Phil discussed O'Brien's book, Beneath the Neon.

O'Brien is founder of Shine a Light, a community project that provides housing, drug counseling, and other services to homeless people living in the drains. In a January 2011 article, the Atlanta Journal-Constitution described O'Brien's work in the tunnels "turned into a 4½-year obsession for O'Brien, where he wound up documenting a population he suspects no one except a handful of police officers knew existed." CBS News correspondent Seth Doane, who went underneath the Las Vegas Strip with O'Brien in the summer of 2010, wrote that "O'Brien's interest has turned into advocacy" in his efforts to help the homeless.

American Public Media's "The Story" segment covered O'Brien's efforts to help homeless people when they interviewed O'Brien and featured a homeless man in April 2011.

In November 2011, O'Brien was given the Nevada Writers Hall of Fame Silver Pen Award, sponsored by the Friends of the University of Nevada, Reno Libraries. Established in 1996, the Silver Pen recognizes writers who are in mid-career but have already shown substantial achievement. After the announcement of the award, The Nevada Review featured O'Brien in a Q&A article.

O'Brien's second book, My Week at the Blue Angel: And Other Stories from the Storm Drains, Strip Clubs, and Trailer Parks of Las Vegas, released November 15, 2010, is a collection of creative-nonfiction stories set in off-the-beaten-path Vegas, including a seedy motel on East Fremont Street that's known for prostitution, street drug dealing and violence, and the case of Jessie Foster, an international endangered missing Canadian woman lured to Las Vegas who disappeared 10 months later. Jessie is thought to be the victim of human trafficking.

O'Brien received two Artists Fellowship grants awarded by the Nevada Arts Council for 2010 and 2007 for his nonfiction book projects.

His research about and interviews from inside the underground flood channels are detailed in his book Beneath the Neon: Life and Death in the Tunnels of Las Vegas, released in June 2007. This book has been reviewed or written about by more than 100 media outlets, including Publishers Weekly, Kirkus Reviews, Wired, Der Spiegel, Le Monde, and the Atlanta Journal-Constitution. Nightline, "The CBS Evening News with Katie Couric", Al Jazeera, CNN, NPR, the BBC, the Associated Press, and other national and international media outlets have done stories about the tunnels and the tunnel-dwellers.

He has won several first-place awards in the Nevada Press Association's Better Newspaper Contest, including Journalist of Merit (given to journalists with less than five years of experience to encourage them to stay in the business) in 2002 and Outstanding Journalist (a top individual award) in 2006.

He was a staff writer, news editor and managing editor of the alternative weekly Las Vegas CityLife from 2000 to 2008. While at the paper, he co-wrote two cover stories about exploring the underground flood channels of Las Vegas after reading about Timmy "TJ" Weber, who was suspected (and later convicted) of murdering his girlfriend and her son, raping her daughter and attempting to kill another son. Weber used the drains to evade the police. O'Brien discovered hundreds of homeless people living in the storm drains.

O'Brien, who grew up in the Atlanta, Georgia, area, graduated in 1988 from Decatur High School, where he was a point guard on the basketball team, and from the University of West Georgia in 1995. He taught English at the University of Nevada, Las Vegas, from where he earned a MFA in creative writing.

Matthew O'Brien (born in 1970) is an American author, journalist and teacher best known for penning the nonfiction book Beneath the Neon about homeless people living underground in the Las Vegas Valley. He lived in Las Vegas from 1997 to 2017.