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Most unhoused opioid users in SF are happy to remain homeless. Their base income is north of $12k tax free a year (SNAP and their SF homeless grant); one woman

Most unhoused opioid users in SF are happy to remain homeless. Their base income is north of $12k tax free a year (SNAP and their SF homeless grant); one woman I’ve been trying to help for over two years makes north of $30k annually, tax free, with zero expenses other than fentanyl and food. Very few are willing to trade the amenable weather and lack of any behavioral restrictions for the (frankly quite minimal) requirements that come with temporary shelter, let alone those associated with a SRO or permanent long term housing.

api 3y ago
Sounds like I am missing the most obvious thing: they literally pay people to be homeless. It sounds like once you are in that lifestyle the incentive is very much to stay there. So no wonder. Of course the high cost of real housing doesn’t help. Makes it that much harder to get truly out of poverty. It also makes a life off the street look unattainable. It’s telling a mentally ill addict there is no hope for them to truly get off the street unless they can somehow produce an engineering degree or gain equivalent experience.
- atdrummond 3y ago
  Yes - and I think worse than that, they don’t pay people to get better. So they create a very real financial cliff for anyone who is determined to make a lifestyle change.
  - lotsofpulp 3y ago
    What is the probability of being able to get better once addicted to strong opioids, regardless of incentive? Is it possible the brain’s chemistry gets irreversibly broken at some point?
    - atdrummond 3y ago
      It is difficult but possible. I have used opioids since the mid-2000s. I am on a low enough dose today that it treats my cancer/Crohns pain but I feel no noticeable psychological effects. I can and do easily taper off multiple times a year for tolerance resets. Further, every year a number of people in my programme finally taper off methadone for good; the relapse rate is in the low single digits. This is similarly the case for patients in Switzerland’s heroin assisted treatment programme. (I live in Estonia and am on their methadone equivalent.)

api 3y ago

Sounds like I am missing the most obvious thing: they literally pay people to be homeless. It sounds like once you are in that lifestyle the incentive is very much to stay there. So no wonder. Of course the high cost of real housing doesn’t help. Makes it that much harder to get truly out of poverty. It also makes a life off the street look unattainable. It’s telling a mentally ill addict there is no hope for them to truly get off the street unless they can somehow produce an engineering degree or gain equivalent experience.

atdrummond 3y ago
Yes - and I think worse than that, they don’t pay people to get better. So they create a very real financial cliff for anyone who is determined to make a lifestyle change.
- lotsofpulp 3y ago
  What is the probability of being able to get better once addicted to strong opioids, regardless of incentive? Is it possible the brain’s chemistry gets irreversibly broken at some point?
  - atdrummond 3y ago
    It is difficult but possible. I have used opioids since the mid-2000s. I am on a low enough dose today that it treats my cancer/Crohns pain but I feel no noticeable psychological effects. I can and do easily taper off multiple times a year for tolerance resets. Further, every year a number of people in my programme finally taper off methadone for good; the relapse rate is in the low single digits. This is similarly the case for patients in Switzerland’s heroin assisted treatment programme. (I live in Estonia and am on their methadone equivalent.)