The impact of homelessness and the opioid crisis on San Francisco streets
cnn.com
cnn.com
There needs to be proper leadership that understands how people live and work to build a city that can cater to everyone outside of the upper/middle class at major companies.
I think many in government knew this was going on, and becoming an increasing issue/epidemic in recent years, but until the public becomes outraged and is willing to support a big shift in policy and budget, what they can do is limited. It might be some of the people in government that we should feel most sorry for - they've been witnessing it for years and voicing concern, but few in the public will listen or do anything about it.
Perhaps I'm being too generous, but I see government and big institutions as behaving very much like computers, with much less intelligence and autonomy than the general public might think.
Government officials are constituents too and they should be able to figure this out even without any public feedback. This is their job. Ignorance and apathy have no place there and they would be fired in any other industry for this kind of incompetence. Unfortunately they're also in charge of any rules around accountability.
It may be worth considering how all the issues you so correctly and wisely identify have been addressed in the place that seems to continue to exemplify the worst of the crisis. Perhaps they're all addressed improperly or inefficiently. Perhaps trying to address the issues is simply too new to have had any impact at all. Perhaps the solutions are so successful that they've drawn people from elsewhere in need of help, making the crisis falsely appear to be ongoing. Perhaps the critical services you point to are insufficient somehow.
What are your thoughts on explaining this apparent conundrum? I'd very much love to hear! I want to understand.
I still hold my point that the public may get "outraged" or whine about the problem, but they won't act or vote in alignment with that outrage until it actually impacts them. The homeless/opioid epidemic finally crossed that threshold and so they did. But that just proves my point that it's the public that must act/vote and see themselves as the responsible party, and not wait for the government to solve everything.
The reality is fine-grained democratic voting on every issue does not scale to today's world. People do not have the time, attention, education and understanding to vote properly on everything, and when you add in personal biases, lack of risk management, short-term outlooks, majority power, and special interests; things break down completely.
Many of these things which could improve civic life do not really need a voting process. It's not a system for the people (not anymore) but stays around because it removes accountability and provides regulatory capture for the few who profit. Of course, as you say, the very people who do not take action are the ones that need to take action for this to get better. I do not have an answer for that.
Tell it to Switzerland. The most recent referendum included such important issues as "should the government offer subsidies to farmers who leave the horns on their cows".
Having lived in Switzerland a while, direct democracy may not be perfect but it definitely works. It might not work in America but it works.
Switzerland is also around 8M people which is smaller than some cities in bigger countries so it barely qualifies for the scale argument.
A large part of it is likely the vast isolation they see from the actual issues. More skin in the game would greatly change things if they actually had to face these problems themselves instead of just answering public feedback with empty platitudes.
We need to REPORT the ISSUE with the city - use the "311" phone number to report people behaving suspiciously or who obviously need support. This generates METRICS.
Then, the CITY can use the metrics to justify ACTION. Politicians can feel "safe" by responsibly spending $$ beaucoup bucks $$ without fear of voter reprisal come election-time.
The PEOPLE can use the metrics to justify SOCIAL CHANGE. Why does the US face this problem? Is it because of our "pull yourself up by your bootstraps" mentality? How can the US adopt a holistic social approach, to accept and respond healthily to the fact that some people have harder times than others? There needs to be a change in attitudes.
But who are we kidding, it is not. A huge portion of them are too mentally ill to take proper care of them selves; A huge portion prefers the freedom and the drugs and another portion needs forced drug treatment.
But all we ever hear is more money is needed, never what that money should be spent on. Because we both know it won't be spend on more cops to arrest people who shit in public, to keep those arrested for drugs from the places they previously frequented, or to raize illegal homeless camps.
At the same time the citizens need to establish more holistic expectations around what their society is all about.
Materialism, identity defined by an individuals job, tribalism all help and hurt. I think we're missing a kind of consideration / a kind of subsystem in our societal system, resulting in the "unsolvable" situation we find ourselves in now. With a different perspective I think we could find new solutions.
This kind of selfish mentality needs to go away.
Culturally I'm thinking about something which might not be what you were asking about -- the responsibility of the society to care for its disadvantaged or "ill fitting" citizens. US does have some programs to help but it's also famously still crushing large groups of its population.
I don't know what the solution would be.
Drugs are already completely legal for the underclass - basically, any and all petty crimes are. Our judges dismiss the citations (~65K in one case!), our juries acquit them, our DA refuses to prosecute them, and our cops don't bother at all anymore.
Rich people get to use drugs all the time without even any worry of arrest.
https://www.buzzfeednews.com/article/jimdalrympleii/public-d... https://www.nytimes.com/2018/08/18/health/san-francisco-opio...
The issue with the legalization approach is lack of intervention infrastructure to help them.
it's not hard to figure out that whatever you're doing in the US is not working. I've been to SF and just walking past Tenderloin is not a preety sight.
- https://www.independent.co.uk/news/world/europe/portugal-dec... - https://news.vice.com/en_us/article/59eqqk/ungass-portugal-w...
In the general Portugal population, since the decriminalization, cannabis use is increased, heroin use decreased (thought much less than it decreased among the youth, which means that it likely increased in older groups), cocaine use is increased, amphetamine use is basically the same, LSD use is increased, ecstasy use is increased, and hallucinogenic mushroom use is increased.
If drug decriminalization in Portugal led to increased total drug use, and increased heroin use among people over 35, why exactly you believe that doing the same in the US would solve any problems here?
Increased use could be explained by increased availability that is independent of legality (eg: better smuggling routes or larger synthetic batches).
Anyways, reduced opiate use and increased use of the other drugs mentioned generally sounds like a win to me.
I’d also consider more widespread recreational use by previous non-users. I’m not sure if that’s a problem for the lower-dependence risk drugs mentioned.
Also note that it's significantly reduced opiate use among youth (15-34 y.o.): total opiate use only went down a little, which means that it likely has increased among people over 35.
Point is, even if overall drug problems decreased in Portugal (which is not clear to me at all, since total drug use increased), evidence that it's the decriminalization that helped, is flimsy at best.
Gee, I wonder if this is the reason why people say drugs are terrible?
I don't think any solution short of the government/pharmacies selling/giving clean drugs to people with addictions (As long as they are actively attending counselling programs, that aren't one-size-fits-all 12-step nonsense) is going to work.
[1] Also, a hospital bed to detox in is free, but good luck getting your shit together after you go through withdrawal.
I have never been through a 12-step process but I know a few people who have done it for alcohol and it works for them (I know, survivorship bias etc.)
The evidence base for 12 step programmes isn't great.
Unfortunately the US has a load of wilderness-retreat style camps using some half-assed version of a 12 step program. They're very good at getting people's money and attention, but pretty poor at sucessful treatment.
Beth Macey has a good book about the Opioid Crisis and some of it is alarming.
https://www.amazon.com/Dopesick-Dealers-Doctors-Company-Addi...
For some people, it's fixing whatever drove them to a situation where shooting heroin into their arm is a better decision then not shooting heroin their your arm.
For other people, it's switching a dependency on a street drug to a dependency on a prescription drug.
Telling people that they have zero agency in their lives, and that only Jesus can magically cure them - definitely works for some people, but not for everyone.
AA has a success rate of, depending on which study you cite, between 5% and 25%, over doing nothing.
There is no significant provided housing in the city and it's causing the problem to get much worse - decriminalizing drugs has helped quite a bit with street safety though.
Also, 'All the homeless people moving to Vancouver' is a problem, but only a part of it. Most of the non-locals are from small dying towns in the BC interior. They aren't really suited, financially, to dealing with the social problems[1] that result - yet Vancouver would rather close its eyes, and pretend that they don't exist.
Even so, if we sent everyone who isn't originally from Vancouver back to the towns they came from, there would still be a catastrophe of homelessness, overdose deaths, etc.
[1] Yes, it would be much cheaper to provide housing for homeless persons, within their communities, instead of in the most expensive city in Canada. Sadly, nobody in Victoria seems to be keen on fixing this, on a province-wide level. The Liberals didn't care, and the NDP care, but aren't doing anything.
Intuitively it seems to me like the opposite would be better, if you could not get heroin you couldn’t get addicted to it. But my minimal understanding is it’s too easy to make for enforcement to be practical.
https://www.theguardian.com/news/2017/dec/05/portugals-radic...
Of course, this is in a controlled fashion, and doesn't require legalization.
Why not just put porta potties -- on a temporary basis -- on street corners in the worst areas?
It seems such a stupidly obvious quick fix for half the problem that I feel I'm missing something.
It would surely be cheaper than paying clean up teams? More humane for the homeless? Healthier for local residents?
Additionally most businesses will no allow homeless to use their facilities out of fear. Even if most would be respectful, it only takes one person to disrupt or destroy a restroom and cost business owners thousands of dollars.
But as the old adage goes, you can lead a horse to water but you cannot make it drink. You can provide the toilets, but you cannot make people use them. Many of these people have mental or drug related problems. So even if you provide a toilet, there is no guarantee they will use it.
Are they just supposed to hold it for 12+ hours overnight?
A better solution would be the German solution: actual pay toilets, where somebody is on premise to ensure cleanliness and that nobody takes drugs there.
The last and most expensive German toilets I have used were about 50 cents a visit, so within pay range of homeless persons. Also, and I can't emphasizes this enough, they were nice, clean and safe.
But America hates pay toilets, so instead there are no toilets.
That's not to take away from this and I hope they can do something for those folks, but it also strikes me as amazing this city in general has the largest focus and not even close to the largest homeless population.
1. https://www.statista.com/chart/6949/the-us-cities-with-the-m...
In LA I suspect that due to the large geographical size, high automobile usage (whereby there's less direct interaction with people) and perhaps more draconian law enforcement, the unsheltered population is slightly less visible.
I think the rest of it might be the contrast. SF is seen as - sees itself as - the shining city on a hill, the city of the future, a place made of innovation and progressiveness. Where kindness and compassion flow like water.
San Francisco · Population 884,363 (2017)
New York · Population 8.54 million (2016)
https://streetlifesolutions.blogspot.com/2018/05/california-...
I know a lot about homelessness. Among other things: I had a class on Homelessness and Public Policy many years ago. More recently, I spent several years homeless. I still blog about it and still talk with homeless individuals regularly.
Your argument doesn't look like a good faith argument to me. It looks like a case of "how to lie with statistics." That makes it difficult to engage with you.
I am using your population numbers and dividing by the numbers in my reference.
The per capita rates are:
SF: 6857/884363 = 0.00775360344
NY: 78676/8540000 = 0.00921264637
The reason I said this is not to lie with statistics, but to show that when normalizing for population the rates are still worse in NY.
It's not hugely worse. So, the reason it's a whole order of magnitude worse in absolute figures is that New York is a whole order of magnitude larger.
There are probably more accurate figures in New York. California has a really high percentage of rough sleepers compared to New York, in part due to mild temps and dry weather. I have participated in a homeless program that did the annual point in time count. There are serious challenges in counting rough sleepers. You probably see a lot more undercounting of street people than of homeless people using the shelter system. So my guess is the real per capita figures are actually pretty close.
San Francisco has a fairly small footprint and good public transit. It has insanely high housing costs. California has underbuilt housing for decades and has serious systemic problems in that regard.
There is evidence that individuals voluntarily choose to relocate to California while homeless, in part due to the weather. There is also evidence that sometimes other states just issue them a bus ticket to California.
The high cost of housing plus lovely weather contribute to California having more chronic, long term homeless. These people wind up typically being the most visibly homeless. The longer you are on the street, the harder it gets to fit in to normal society for various reasons.
The figures I've seen (some linked above) suggest that California overall seems to have a lot more homeless per capita than the rest of the nation. The most destitute homeless tend to gravitate to the bigger cities because that's where soup kitchens et al are found.
That’s just my anecdotal experience, but if true it would explain why the problem in SF gets so much attention.
Seems that I've seen shelter rates brought quite a bit in the last 5 minutes, and I'm currently investigating these differences. I hope homelessness gets solved for every city of course.
ED: also, as your posted link says, "New York can at least claim that 65 percent of its rough sleepers are given sheltered accommodation" - what is that figure for SF?
This is kinda where my mind is taking me with this kind of interesting deviation in exposure.
This is not a SF problem. This is an American problem.
The situation in SF and Seattle (to name two) has a lot to do with how bad the overall housing situation is in those places.
1: https://www.businessinsider.com/homeless-population-usa-stat...
My mother was one of the latter.
The housing situation in many places is bad, it doesn’t mean it will attract homeless people from all over the place.
However, SF brands itself as the city of the future, innovation, and progress. Because it is the epicenter of the worlds technology startup scene.
But this darker aspect of the city contradicts that positive brand. You can’t be the city of progress and innovation if half of your people are subsisting in third world pits of despair. I mean you can try to be, but it doesn’t quite work. Something is wrong.
I think what you describe are mostly business-related things. As an outsider, SF’s brand is about [mostly young] people claiming their opportunity to make a lot of money. None of the branding I see is about improving wellbeing.
If something is wrong, I think it must be more general, perhaps that money and wellbeing aren’t so coupled. But unless SF is totally misrepresenting its brand to me, I’m not seeing any contradiction in its brand.
I imagine you could use a snow shovel and a long push broom to get them into the shovel, but where do you put them afterwards? A garbage bag seems to be a bad idea, as it'd conceal the neon orange warning color of the syringes, while allowing the points to stab and infect anyone who handled the bag. Do you put them directly in a metal garbage can?
Afterwards how do garbage collectors in SF deal with this? Are thick leather gloves and maybe chaps enough to protect people?
https://www.harborfreight.com/30-inch-magnetic-sweeper-with-... (They make a 12" version too)
Or this (stick)? https://www.harborfreight.com/15-lb-capacity-telescoping-mag...
I heard one of those folks excitedly shout "jackpot" as they came across a bunch of needles on the floor the other day! I guess they're getting some pleasure out of cleaning up the neighbourhood at least…
Maybe if the big tech companies set up non-profit housing organization at various price points, it would help. Maybe even at least get the working homeless off the street. After all, a huge percent of bay area corporate expense just flows through employees into rent or mortgage interest.
Also if they are moving within the city and the previous location is rent controlled, then the landlord will likely raise the rent for the next tenant.
[0] https://www.theguardian.com/us-news/ng-interactive/2017/dec/...
[0] HN discussion: https://news.ycombinator.com/item?id=18375280
[1] http://www.sfexaminer.com/sf-reaches-400k-settlement-proposa...
So it does happen, but they don't want to publish it out of fear that it will just legitimize the practice for other cities.
There is no 'opioid crisis', it is a new moral panic fed by hysteria from media and politics. There have always been drug addicts and drug users, and there always will be.
Please look at the trendlines for "heroin deaths" and "synthetic opiod deaths" in the following graph of US CDC data, and note that from the turn of the millennium to 2017, opioid-related deaths in the US have increased more than 10x:
https://www.drugabuse.gov/related-topics/trends-statistics/o...
https://d14rmgtrwzf5a.cloudfront.net/sites/default/files/od2...
Overdoses have increased because of fentanyl being sold falsely as other drugs or mixed with other drugs, and that happens because it's cheaply imported from China by anyone with internet access and the desire to do so. Overdoses are NOT because of a marked increase in use of drug use or addiction, there is always a segment of society that will use drugs, be addicted, and participate in these activities.
We're deep in a moral panic while simultaneously ignoring the real problem (imported fentanyl), thus the complete inefficacy of the ongoing overreactions form society and governments.
It's because they're hooked on opioids. How did they become hooked? They started with legally prescribed opioids. Sometimes those meds were prescribed to them. Sometimes those meds were prescribed to a family member or neighbour and handed on or stolen.
It's because the US is awash with opioids that were legally prescribed. The US massively over-prescribes opioids. That's why the US used over 99% of the world supply of hydrocodone.
Americans are prescribed 6 times more opioids that people in France or Portugal.
Here are some details: http://www.painpolicy.wisc.edu/opioid-consumption-data
And we know Americans start with meds that were legally prescribed because: https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTab...
Look how many people are getting meds for free from friends and family.
Nonetheless, we can try using some data. Here's a massive retrospective cohort study on 500,000(!) patients clearly demonstrating there is an absurdly low risk of addiction from legitimate prescriptions (0.5%):
https://www.ncbi.nlm.nih.gov/pubmed/29343479
Virtually no overdoses are from legal prescriptions, and virtually no addiction is from legal prescriptions. Abundant data and evidence shows this repeatedly.
Now let's go ahead try your hysterical logic with some other issues:
Why do people drink alcohol?
It's because they're hooked on alcohol. How did they become hooked? They started drinking legally available alcohol! Sometimes they bought the alcohol, sometimes a family member or neighbor had the alcohol and it was handed on or stolen!
The US is awash with alcohol!
Or, let's take a legitimate crisis, the obesity epidemic. Why are people so fat? Why do people eat so much?
It's because they're hooked on food! How did they become hooked on food? Because they ate food which is widely available! Maybe they ate food at a restaurant, or at home... maybe it was stolen or given to them!
Look how many people are getting alcohol or food free from friends and family!!
If laws regarding public drug use, loitering, etc. were actually enforced in a meaningful way, I think we'd see some actual improvement.
And surely we could do more work to understand why people fall into this hole, and make societal changes to help those who want to beat their addiction do so more reliably. It’s absolutely misinformed to suggest that addiction isn’t a real problem or that doing anything about it is somehow beyond our control.
Why do people do anything? It's all the same fundamental reason.
Is that what you were getting at?