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Is the typical pipeline homeless-to-opioid? I’m asking because as a teenager I lived in motels and homeless with pill-mill turned heroin addict parents and my

Is the typical pipeline homeless-to-opioid? I’m asking because as a teenager I lived in motels and homeless with pill-mill turned heroin addict parents and my anecdotal experiences with the broader transient public suggest a downward spiral involving substances first.

red-iron-pine 3y ago
more opioid to homeless. Uncle Bob gets hurt, can't work for a while, and gets put on Percocet, but that's to expensive and has limitations. Eventually he gets on other pills, and then a neighbor mentions he sells pills sometimes, and can get other stuff. Few years later Bob can't take pills, can't afford them, but can snag bags of H. That's stable for a second but eventually it screws his life up more, and he's homeless. A lot of young folks end up there cuz their home life was bad and it was easy to party / forget abuse at home, and just end up stuck.
FireBeyond 3y ago
I'd hesitate to say 'typical'. I think your use of the word 'spiral' is entirely appropriate because it becomes this revolving descent. Casual substance use becomes substance abuse becomes poverty becomes ... and similarly mental health becomes poverty becomes self-medication via substance use and abuse.
seanmcdirmid 3y ago
A lot of it is substance abuse first, a lot of it isn't. Homeless advocates don't want to emphasize the former cases, however, since it drains empathy faster than just assuming everyone is in the latter category (although it doesn't really matter, empathy is drained quickly in either case). The same debate rages over between groups of people who wind up unhoused locally vs those who arrive already unhoused (you get more empathy for the former and less for the latter, both categories are significantly non-empty).
brian_cunnie 3y ago
> suggest a downward spiral involving substances first. Anecdotally, as a person in San Francisco who's been in recovery 23 years, all the people I know who were once homeless became homeless because they were abusing drugs and alcohol. Sometimes mental illness was at play, too. There's a strong selection bias in my sample set — they're all alcoholics/addicts (thankfully in recovery, thankfully housed).
doctorpangloss 3y ago
I can't find a firm answer to the question "Among the homeless, what fraction have opioid use disorder; a history that contains a legitimate medical visit connected to the prescription of opioids; and no history of substance abuse prior to that visit?" We'd need a Danish style medical records system to answer queries like that, or you can study it with VA data. Opioid use disorder is crazy common, nearly 5% of Americans (https://www.nih.gov/news-events/rates-nonmedical-prescription-opioid-use-opioid-use-disorder-double-10-years); https://www.nih.gov/news-events/rates-nonmedical-prescriptio... but also 9% of the population uses cannabis (https://www.cdc.gov/drugoverdose/deaths/index.html https://www.cdc.gov/drugoverdose/deaths/index.html). It's unclear how many overdose deaths happen to homeless people every year generally, and you can conclude that since homelessness is rare, so too will be "homeless given overdose death." However, the flip side - overdose death as a fraction of all deaths given homeless - can be 17% in one study (https://drugfree.org/drug-and-alcohol-news/more-homeless-die-from-drug-overdoses-than-from-aids/ https://drugfree.org/drug-and-alcohol-news/more-homeless-die...). So overall, I think you're right. Opioid disorder is so much more common than homelessness generally, homelessness is not going to possibly explain opioid use disorder in the general case. Of course it can interfere with treatment. However, when so many people use cannabis, and I haven't even investigated alcohol, the right idea is that substance abuse is so prevalent in America, you'd need more serious interventions earlier on. The issue that can be acted by just medical professionals, which is the prescription of painkillers due to legitimate medical visits that lead to substance abuse, I think there is action on this but I'm not sure what it is.
mc32 3y ago
That’s my experience as well. The path all the homeless and couch surfers I’ve known was drug abuse and dependence leading to loss of job then eventual homelessness due to not paying rent, roommates getting fed up, or parents getting fed up. I know that some homeless are different and became homeless first and then became addicted to substances, but I have not known them. As another poster, Sean, points out most homeless advocates are loath to admit to this for obvious reasons.

red-iron-pine 3y ago

more opioid to homeless. Uncle Bob gets hurt, can't work for a while, and gets put on Percocet, but that's to expensive and has limitations. Eventually he gets on other pills, and then a neighbor mentions he sells pills sometimes, and can get other stuff. Few years later Bob can't take pills, can't afford them, but can snag bags of H. That's stable for a second but eventually it screws his life up more, and he's homeless. A lot of young folks end up there cuz their home life was bad and it was easy to party / forget abuse at home, and just end up stuck.

FireBeyond 3y ago

I'd hesitate to say 'typical'. I think your use of the word 'spiral' is entirely appropriate because it becomes this revolving descent. Casual substance use becomes substance abuse becomes poverty becomes ... and similarly mental health becomes poverty becomes self-medication via substance use and abuse.

seanmcdirmid 3y ago

A lot of it is substance abuse first, a lot of it isn't. Homeless advocates don't want to emphasize the former cases, however, since it drains empathy faster than just assuming everyone is in the latter category (although it doesn't really matter, empathy is drained quickly in either case). The same debate rages over between groups of people who wind up unhoused locally vs those who arrive already unhoused (you get more empathy for the former and less for the latter, both categories are significantly non-empty).

brian_cunnie 3y ago

> suggest a downward spiral involving substances first. Anecdotally, as a person in San Francisco who's been in recovery 23 years, all the people I know who were once homeless became homeless because they were abusing drugs and alcohol. Sometimes mental illness was at play, too. There's a strong selection bias in my sample set — they're all alcoholics/addicts (thankfully in recovery, thankfully housed).

doctorpangloss 3y ago

I can't find a firm answer to the question "Among the homeless, what fraction have opioid use disorder; a history that contains a legitimate medical visit connected to the prescription of opioids; and no history of substance abuse prior to that visit?" We'd need a Danish style medical records system to answer queries like that, or you can study it with VA data. Opioid use disorder is crazy common, nearly 5% of Americans (https://www.nih.gov/news-events/rates-nonmedical-prescription-opioid-use-opioid-use-disorder-double-10-years); https://www.nih.gov/news-events/rates-nonmedical-prescriptio... but also 9% of the population uses cannabis (https://www.cdc.gov/drugoverdose/deaths/index.html https://www.cdc.gov/drugoverdose/deaths/index.html). It's unclear how many overdose deaths happen to homeless people every year generally, and you can conclude that since homelessness is rare, so too will be "homeless given overdose death." However, the flip side - overdose death as a fraction of all deaths given homeless - can be 17% in one study (https://drugfree.org/drug-and-alcohol-news/more-homeless-die-from-drug-overdoses-than-from-aids/ https://drugfree.org/drug-and-alcohol-news/more-homeless-die...). So overall, I think you're right. Opioid disorder is so much more common than homelessness generally, homelessness is not going to possibly explain opioid use disorder in the general case. Of course it can interfere with treatment. However, when so many people use cannabis, and I haven't even investigated alcohol, the right idea is that substance abuse is so prevalent in America, you'd need more serious interventions earlier on. The issue that can be acted by just medical professionals, which is the prescription of painkillers due to legitimate medical visits that lead to substance abuse, I think there is action on this but I'm not sure what it is.

mc32 3y ago

That’s my experience as well. The path all the homeless and couch surfers I’ve known was drug abuse and dependence leading to loss of job then eventual homelessness due to not paying rent, roommates getting fed up, or parents getting fed up. I know that some homeless are different and became homeless first and then became addicted to substances, but I have not known them. As another poster, Sean, points out most homeless advocates are loath to admit to this for obvious reasons.