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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

by tlogan 2y ago

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?

mordae 2y ago
[flagged]
- jraby3 2y ago
  You are online way too much. Come see the world say hi to some people. The US isn't a death cult it's just more heavily influenced by propaganda than most smaller countries.
presentation 2y ago
The latter
martinald 2y ago
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).
- starspangled 2y ago
  > 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?
  - hector126 2y ago
    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.
    - starspangled 2y ago
      > 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. 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.
habosa 2y ago
Please try to speak only for yourself, not all SF residents. I’ve lived here for a decade, in 6 different neighborhoods (including 6th street). I now live near Golden Gate Park where this article is mostly set. I found it inspiring, not insulting.
- archagon 2y ago
  Ditto. (Except I live in the Mission.)
johnnyanmac 2y ago
I can't speak for SF, but LA had judges recently come down very hard on housing organizations for having basicslly zero data on where 20 billion dollars went. The judge forced actual audits and homelessness is actually slightly improving as of late 2024. I would nlt he shocked if similar issues are happening in SF. at best very inefficient spending on minor factors, at medium they may be "fixing homelessness" by paying for more security than actual homes (this was one of the LA factors). Or at the damndest it's hurt outright Embezzlement.
Nifty3929 2y ago
The problem is that money cannot solve homelessness, because you cannot live in it or eat it or be treated by it. It's just money - numbers in a computer. Things that might help would be housing, food or treatments. But those real-world things are often very hard to come by, and often encumbered by the very people who profess to want to help. For example, maybe building more homes would help - but developers are often hamstrung in their ability to do so - and often by exactly the same people that want to fund homeless programs. So what happens when we give people a lot of money to "solve" a problem, but then prevent them from taking the actions that might help? Well, they still will always find a way to "use" the money (I'm not necessarily implying fraud here), but the results will never materialize. What this looks like in practice is funding studies, working groups, paper-pushing bureaucracies, etc. So the money is gone, any we don't have anything to show for it.

by tlogan 2y ago

mordae 2y ago

[flagged]

jraby3 2y ago
You are online way too much. Come see the world say hi to some people. The US isn't a death cult it's just more heavily influenced by propaganda than most smaller countries.

presentation 2y ago

The latter

martinald 2y ago

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).

starspangled 2y ago
> 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?
- hector126 2y ago
  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.
  - starspangled 2y ago
    > 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. 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.

habosa 2y ago

Please try to speak only for yourself, not all SF residents. I’ve lived here for a decade, in 6 different neighborhoods (including 6th street). I now live near Golden Gate Park where this article is mostly set. I found it inspiring, not insulting.

archagon 2y ago
Ditto. (Except I live in the Mission.)

johnnyanmac 2y ago

I can't speak for SF, but LA had judges recently come down very hard on housing organizations for having basicslly zero data on where 20 billion dollars went. The judge forced actual audits and homelessness is actually slightly improving as of late 2024. I would nlt he shocked if similar issues are happening in SF. at best very inefficient spending on minor factors, at medium they may be "fixing homelessness" by paying for more security than actual homes (this was one of the LA factors). Or at the damndest it's hurt outright Embezzlement.

Nifty3929 2y ago

The problem is that money cannot solve homelessness, because you cannot live in it or eat it or be treated by it. It's just money - numbers in a computer. Things that might help would be housing, food or treatments. But those real-world things are often very hard to come by, and often encumbered by the very people who profess to want to help. For example, maybe building more homes would help - but developers are often hamstrung in their ability to do so - and often by exactly the same people that want to fund homeless programs. So what happens when we give people a lot of money to "solve" a problem, but then prevent them from taking the actions that might help? Well, they still will always find a way to "use" the money (I'm not necessarily implying fraud here), but the results will never materialize. What this looks like in practice is funding studies, working groups, paper-pushing bureaucracies, etc. So the money is gone, any we don't have anything to show for it.