We need to acknowledge that San Francisco has spent billions over decades on homelessness programs, yet the crisis persists, leaving us to ask: Is this truly the best we can do? Are we investing efficiently, or are we simply maintaining a broken system?
For meth, crack, etc there are effectively no pharmacological interventions available. And many (most?) of the street homeless have dual addictions to a stimulant and an opioid, so even if they did manage to switch from fentanyl to buprenorphine they would almost certainly be extremely unstable with their stimulant addiction.
Obviously there are psychological interventions and peer support groups, but these require quite a lot of stability to stick to and get to, which I think is extremely difficult for someone in a very chaotic addiction cycle.
To me, it seems some of the billions that cities spent on social services for homeless should be diverted (or in addition to) to pharmacological research. There is so little funding available for this - I read Prof David Nutt was doing an interesting PET study for kappa opioid response in addiction but ran out of funding. The funding requirements were low-medium hundreds of thousands of dollars and couldn't find it to continue the research.
The current status quo seems a bit like trying to treat TB without antibiotics. The treatment back then was basically similar to current 'rehab' programs - send them to a quiet place and give them care and help. Obviously not a bad thing to do; but once you had antibiotics the prognosis improved by many orders of magnitude almost overnight (and a lot less costly to provide).
Isn't that still treating a symptom, rather than the core problem? If homelessness is caused by drug addiction, what causes drug addiction? Underlying mental health? Lack of opportunity? Government welfare dependence?
One can argue that certain people are more predisposed to enjoy being high, I'm one of those people. When you see incredibly rich and successful people like Jimi Hendrix, Janis Joplin, Chris Farley, and Philip Seymour Hoffman ultimately losing it all to that desire, I feel like it's hard to blame something like lack of opportunity or government welfare dependence.
The "bad" drugs, crack/meth/opioids/etc. make your brain feel a way sober-type people can't really imagine. I don't know what the answer is.
I bet if you gave the average HN user meth or crack every day for three weeks, almost certainly nothing would change except their toilet flushing slightly more frequently!
My point was not about basic mechanism of dependence which sure will happen to anybody. It was about what causes them to seek out and take those things in excess in the first place.
> One can argue that certain people are more predisposed to enjoy being high, I'm one of those people. When you see incredibly rich and successful people like Jimi Hendrix, Janis Joplin, Chris Farley, and Philip Seymour Hoffman ultimately losing it all to that desire, I feel like it's hard to blame something like lack of opportunity or government welfare dependence.
Individual cases and especially these extreme outliers are no good. It's not that one single government policy or social problem is the cause of all drug addiction, but they could contribute to the issue on a population level.