zlacker

>>NaOH+(OP)
For those who live in San Francisco and witness homelessness and drug addiction across the city, this article feels deeply out of touch and even insulting.

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?

>>tlogan+oJ
The core problem imo is there is simply not good enough treatments for addiction (yet?). For opioid addiction there is methadone and buprenorphine etc. But I suspect these have became even less effective with so much fentanyl around now, requiring much higher doses. But these all really work (simplifying massively) by replacing the addiction with something that is easier to eventually titrate down.

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).

>>martin+yz1
> The core problem imo is there is simply not good enough treatments for addiction (yet?).

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?

>>starsp+VN2
In my experience, having watched friends enter that position, it's drugs which cause drug addiction. Mental health might play a factor, but if I gave the average HN user meth or crack every day for three weeks, their brain chemistry would be almost irreversibly changed and would spend years, if not the rest of their life, wanting more. Same goes for powerful opioids.

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.

>>hector+SV2
Not like people in other countries don't have access to the same drugs. It's not solved 100% anywhere, but the magnitude is very different in say Canada.

End of the day, it's still societal issues that's causing some people to go down this path. Most of the drug addicts have some level of "atypical" upbringing. Maybe abusive childhood, constant foster care, growing up in a bad neighborhood with the wrong influence etc. Seems like we should be focusing on solving those issues, which not only benefits the topic at hand but society and communities in general.