Comment by pnathan | Hacker News Reader

Comment by pnathan | Hacker News Reader

This is a yellow journalism headline. Hearst would be proud.

As I've remarked before, the war on drugs and getting tough on crime is not working out too well for us, so it's time to change our plan.

I don't advocate off the shelf heroin or any of the cluster of ideas that suggest that. I do advocate focusing on the funnel that leads to addiction, homelessness, and death. Part of that is significantly amping up mental healthcare spending; part of that is having legally controlled drugs available in pharmacies for reasonable prices; part of that is supporting better schools (giving a window into a better world, and a way to climb through); part of that is supporting jobs programs. All of those relate in one way or another to the problem, some years and years earlier in the funnel.

No one is born choosing to be an addict in their later life; a series of choices and pressures put them there. The pressures from society can be changed, which shapes the set of choices visible.

I live next door to a rich heroin junkie. She has no job. What's left of her family has basically cut her off. She can afford all of the care in the world, but chooses heroin over treatment instead. Why? Heroin don't care.

The city of San Francisco took her dog away (twice) and declared her place a health hazard for a while, but ultimately it never forced her to get treatment and is tacitly approving of her heroin use. She hasn't paid her property taxes in years and the police come out about once a month, but the US has no ASBO laws so it's catch and release in hippie dippie SF.

She's got the money for the dope, and heroin don't care.

PS> She got the dog back both times.

>She's got the money for the dope, and heroin don't care.

So you what do you propose as a solution for this (likely unrepresentative) anecdote? Lock her up?

I don't have a solution, but my point was that not all addicts are victims. For some, it's a conscious decision about choosing heroin over life (insert Trainspotting ending here).

Unless the US adopts some sort of ASBO laws, there's not much you can do about forced treatment for someone who doesn't choose treatment.

Also, you could substitute heroin here with any other equally damaging substance like alcohol and the situation wouldn't change.

> Also, you could substitute heroin here with any other equally damaging substance

Desk jobs and fast food? As long as we have public healthcare I reserve the right to smack that bag of chips out of your chubby fingers. /end of rant

Even if ASBO laws were effective, I'd rather have a few drug abusers than ASBO laws. I don't want the government to be able to use force against people for being "anti-social", however that happens to be defined or interpreted. I've seen some ridiculous cases of punishment for "anti-social behavior" out of the UK, including what essentially amounts to outlawing particular unsavory political beliefs.

I encourage everyone to read https://en.m.wikipedia.org/wiki/Anti-social_behaviour_order which has a list of things the government was allowed to punish you for, including "rudeness" and "xenophobia". The most recent ASBO legislation is https://en.m.wikipedia.org/wiki/Anti-Social_Behaviour,_Crime... which I am not familiar with.

This is the problem with the HackerNews libertarian streak. You're in favor of legalized drugs, prostitution, etc. But no one wants their daughter to grow up and be a crackwhore.

I'd rather take the risk that my daughter would grow up to be a crack whore than leave anti-drug busybodies the kind of power they've managed to accrue.

How about we just let addicts be addicts while we figure the rest out. That's certainly better than today's situation where we make extra sure we ruin their lives to, ya know, protect them from themselves.

Because that has worked historically.

The problem is they create a wake of destruction in their path of addiction.

The cost of a free society.

Keep that ASBO trash on the other side of the pond.

How about charging them for their public costs? If you get rescued by helicopter because you went skiing out of bounds at a resort and got lost, don't they send you a bill? How about that for people with money who abuse the system while abusing other things?

Like how the Japanese will send a bill to the family of someone who commits suicide on a train line?

I prefer my government to absorb the cost of human despair rather than bill for it. Don't write policy based on outliers.

Sending the bill to the family is dumb but there's sense in sending the person responsible for damages bills. I think we already mostly do that though, they just don't always pay the bill.

> absorb

You are very good at using language. The reality is that government doesn't 'absorb' anything. Other people, some of whom can't afford to, pay for it.

All economics are redistribution, it's simply the details that change with the methods. It is unrealistic to want a world where each person pays exactly for what they consume or are liable for.

Maybe you are right but I cannot understand or agree with this idea that has taken hold among some on the internet that we should be happy to pay taxes because the government will go and solve problems with that money. Beyond the fact that the government is horrible at allocating resources and using them efficiently, every tax is a dollar being taken from the economy that could have gone to people that produce things of value not what some bureaucrat decided was of value.

every tax is a dollar being taken from the economy

Government turns around and spends those dollars in the economy. They are reallocated, not removed.

Individuals are significantly better at allocating resources than a central authority.

Three arguments in favor of governments and taxes: 1) Taxes are what makes a currency valuable (if you don't believe me, try printing your own money, or using Monopoly money, to pay for something) 2) Governments provide currency (also, see above). Look for the lowest interest rates on financial instruments, and you'll find governments. 3) Governments enforce property rights.

No taxes, no currency, no economy to speak of (see: anywhere without a functioning government).

I don't get how some on the internet live and breathe in a government-sponsored property and currency regime and rail against the government part of it, but want to keep the property and currency.

from OP, > chooses heroin over treatment instead

Until people realise that this is a rational and sensical decision there won't be any solutions for these problems and these cases.

The US drug "treatment" / "rehab" industry is notoriously awful and is dominated by pseudo-religious ideologues obsessed with abstinence (to the point that "cult" is often an accurate, non-hyperbolic term) and whose practices are not based on any medical evidence of what reduces deaths. It's a fucked up industry that loves to use degradation, isolation, and humiliation on its "patients", loves to make people withdraw suddenly from their drug use and force them to endure the withdrawal symptoms, and isn't even particularly good at helping people not die from heroin/opioid use.

Given the current state of the rehab industry, and given how ineffective the "treatments" it offers are, it can alas be a rational decision to avoid it.

here's some reading that is relevant: https://www.theatlantic.com/magazine/archive/2015/04/the-irr... http://theinfluence.org/the-rehab-industry-badly-needs-to-cl... http://www.salon.com/2012/08/28/do_12_step_programs_lead_to_... http://projects.huffingtonpost.com/dying-to-be-free-heroin-t...

So why give them the choice in the first place?

So the rehab industry is shit, and your response is literally "make people go through it anyways"?

Well give them an option. Cold turkey in isolation block in jail or rehab. Guess which they'll pick.

Why not? Make "having taken these drugs in the past and tested positive for them in your system" a crime.

Then just systematically lock all addicts up and ship them off to freshly constructed prisons in Alaska.

Um, Poe's law?

Part of me wonders what the problem is exactly? It doesn't sound like she's hurting anybody, just wasting her life away. But really, that's just my opinion. I think people who watch TV are wasting their life away, too, but it's really not my problem.

But to the OP's point, if heroin was sold at clinics or pharmacies there'd be an opportunity for nurses and pharmacists to intervene and offer alternatives before a person's a full blown addict. Even if it's just, "Hey, you're hitting it a bit hard lately, maybe try this meetup group instead."

Heroin dealers are pretty smart. Even if you have a ton of money, they'll only sell you a bit at a time. They don't want you doing something stupid and messing up their gravy train. At least, that's what I was told by someone who was a former heroin user (I asked him for advice and guidance in this situation).

She's wasting her life away, but also endangering others' (as well as her dog's). Her dog was taken away most recently because she was out on a weeklong bender and left the dog locked inside the house. After a few days of wailing and notices, animal control finally went in and rescued the dog. This being San Francisco, of course she got the dog back after claiming she went on vacation and just forgot about the dog.

That said, there was feces and urine piled up in the apartment for that week, and a few weeks after. She also had a stopped up toilet that backed up raw sewage into her apartment for "several weeks" according to the health dept. She was literally walking around on waste soaked carpets for weeks...and didn't care. Because heroin don't care.

She would also freak out and randomly dial 911 while high and insist that there were people in her apartment that were trying to kill her.

I, mean, I could go on for days writing up the crazy stuff she does while high. Her family wants nothing to do with her. She owns her place, has a pile of money, doesn't pay any real estate taxes, is a "frequent flier" for the police and fire department, but all of this is just A-OK, right San Francisco?

Honestly, I could care less about her life at this point. I'm just worried about the dog. It never gets walked and lives in literal squalor.

So your problem is with the animal abuse and not the heroin addiction? Heroin isn't helping, but for all you know she treats the dog that way when she's sober.

Definitely keep complaining to animal control about the dog, and report illegal activity, but other than that it sounds like you should mind your own business.

She creates a wake of police calls, fire department dispatches, defenestration on a regular basis, getting her lock drilled out at 3AM because she lost her keys on a bender, etc. Her behavior makes it my business (and everyone else around her).

ASBO laws are retarded. That's why the UK has phased them out.

ASBOs ended in 2015. They were replaced by Criminal Behaviour Orders. https://en.wikipedia.org/wiki/Anti-Social_Behaviour,_Crime_a...

Local councils also have some other powers for their Community Protection Officers.

Yeah, that's not surprising, both on the part of the City and the part of the addict. West Coast cities tend to be pretty schlubby about dealing with those sorts of issues, afaict. Unsure about other parts of the country.

That's part of why I think the funnel approach is going to yield better results: when someone's hooked, they are in deep trouble, and with far-reaching impacts.

My musing is that federal agencies are the right choice for this: they can ignore local pressure groups and focus on the global optimum.

From anecdotes of living beside the biggest open air drug market in Canada for a decade, and from watching my own friend's behavior growing up it seems to me the biggest problem is being unable to do anything when somebody you know or a family member becomes an addict. You can't force them into treatment, you can't even get the police to find them if they disappear into the streets, and the cycle in and out of jail just makes them career addicts as any chance of normal life seems over to them at that point.

Here if they check into detox, even if you are direct family you can't visit them or bring them anything because detox will deny they are there. You can't ask detox to call when they are released so you can pick them up and they don't end up released back on the streets.

Another problem is the waiting times for treatment. Real treatment is a long commitment sometimes living for years in a halfway house being supported by other peers to remain sober. An addict should be able to check into treatment and immediately commit themselves instead of waiting for months for a spot to open.

Lack of any facility for police to just dump out of control users and have them treated by doctors and addiction specialists is another issue. Often there are mentally ill with secondary addictions or other problems, and the police don't know what to do with them and money is wasted having them ferry around doctors to look at these addicts in jails or playing catch and release after a weekend in jail. A one stop sober shop and treatment option is always requested by police here but it never materializes.

Of course all of this costs money nobody will get elected with this spending platform on junkies until the synthetic opiates problem is so large the political will exists to do this.

All the addicts I've talked to including 2 of my friends who had a bad addiction for a few years, they all ended up addicts by becoming successful and partying to celebrate it. Anybody who lives in Vancouver if you go to VANDU and listen to one of their meetings sometime this is the same story you will hear: I was successful, I started drinking and partying, I used drugs to help regulate my sleep, or to get sober (cocaine sobers you up) or stay awake to function, I ended up an addict and lost everything here I am living in the dumpster or flop hotel being enabled by other addicts because I stole from every family member/friend and burned all those bridges.

Started an addiction clinic (outpatient) and I'm pretty convinced it's a great model for large populations. It's not for everyone initially - you may need more attention than weekly/bi-weekly visits to a treatment center, but we've seen more than half remain in treatment.

Of that group that stays in treatment, more than half got jobs (almost all without our help, although we're starting to help now). Focusing on rebuilding your life while on Suboxone, while having access to mental health professionals (doctors, counselors, therapists) is working.

Open 6 months, we're growing fast and hope to help everyone we can. Only one in our city who accepts insurance without a waiting list, and we do that exclusively (no self pay).

They've had success here too with Suboxone but took a long time for regulators to allow it to be prescribed instead preferring methadone which failed as a treatment strategy http://www.theglobeandmail.com/news/british-columbia/a-bc-cl...

It's good you have immediate treatment they still can't figure that out here, the "Rapid Access Addiction Clinic" in that story is unfortunately not accessible to all addicts and has temporary funding.

Methadone is a full opioid agonist, similar to traditional opioids like painkillers and heroin. So the abuse potential is there. And nearly all methadone clinics don't provide additional supports (behavioral health or otherwise). They more or less function as pill mills.

I don't need to own the entire system with this stuff, but it's very hard to set up (unfortunately). Hoping more people wake up and are able to do similar things. And we're going to keep expanding access to treatment.

We only accept medicaid (for the poor in the US), who otherwise wouldn't have access to free treatment. They pay $300-500 per month for Suboxone at cash clinics, but typically don't get as much behavioral health treatment.

Reply on news.ycombinator.com