Hacker News Reader

Comment by narrator | Hacker News Reader

So how do you solve the heroin junky passing out/projectile vomiting/falling asleep/dying/leaving needles around/defecating everywhere but the toilet with the door locked problem?

On the streets of San Francisco I have seen several passed out heroin junkies lying flat on their back right there on the sidewalk, needles nearby, perhaps passed out or worse with some sort of projectile body effluent leaking out of them or trailing behind them. This is probably an average day at Starbucks for a non-discriminatory bathroom in a high addict area.

View on HN

> So how do you solve the heroin junky passing out/projectile vomiting/falling asleep/dying/leaving needles around/defecating everywhere but the toilet with the door locked problem?

Universal healthcare, harm reduction and rehab services, comprehensive welfare, affordable housing and a sufficient number of properly trained and resourced social workers.

No country has ever solved their junky problem even with those things.

To some degree, we have to get used to junkies existing in jurisdictions that aren't inclined to lock them up. However, we can't spend our way out of the problem. San Francisco spends ~$40k/yr/homeless [0] , if that's not enough to solve the problem, then it's just too great. We cannot throw money away on problems created by cities that abet $4k/mo rents for one-bedrooms.

Throwing money at the problem isn't the same thing as investing in effective policies. How many of the above policies mentioned are actually, keyword actually, implemented in SF?

In my opinion, that is a huge problem with the US in general, such as prisons "rehabilitation": high cost per prisoner and very low amounts of actual rehabilitation.

Substance addiction is a problem in the US in general in that we'd love to have less of it.

Junkies shooting up in public, homeless people shitting on the sidewalk, etc, etc is a problem confined to a handful of cities on the west coast.

The substance abusers don't want less of it, thats why they do it to begin with.

Address the causes that lead people into homelessness and addiction and you end up with less of it. That isn't conjecture, its fact, proven by dozens of disparate cultures and countries adopting or rescinding preventative measures with statistically traceable results proving positive correlation.

Where did I say anything about what substance abusers want? For what it's worth many of them want to get clean but can't pull it off because that's how addiction works.

My point was that substance abuse is (relatively) evenly distributed geographically and pretty much every city and state has more of it than they'd like. Homelessness to the point where it is a significant impact on the day to day lives of the non-homeless is a west coast problem (I've never had to step over human feces in DC, NY or Boston). I'm not saying anything about causes, effects or correlations.

You said "what we want" and one of the important things to remember when having a discussion about macrosocial policy like reducing drug abuse or homelessness is that it is exceedingly rare for everyone to be in agreement.

When confronting homelessness, remember that landlords, aristocrats, and even upper middle income working class all don't want to actually improve the homeless situation. To them its a cost center, and they save more money exporting their homeless by force than trying to actually get them housed and healthy. The policies currently in place out west and across the country, in relation to not just homelessness but all "problems" in society are all intentional. Its key to remember that, because recognizing the hostile actors in resistance to societal improvement is often half the battle in knowing how to make meaningful change.

Homelessness and drug abuse are both symptomatic of livelihood instability, as can be proven by how European nations demonstrated marked reductions in both as more policies are enacted to keep people from falling into extreme poverty. But neither is simple enough to distill to being the consequence of one decision or policy - the frequency of homelessness is influenced by many factors, including... 1) The livability of the area exposed to the elements (homeless in Seattle and Boston are often lower not because of good social policy but because its life threatening in the winter). 2) Local policy relating to the homeless. Mostly due to the age of many of the cities there are more well established non-profits, charities, and churches operating to assist the homeless in the East than the West. 3) Housing prices, obviously, are a huge factor. Its much easier to be livelihood insecure when your rent is a larger and larger chunk of your income. This is why, despite often rampant poverty in the South, homelessness isn't nearly as endemic because property is much cheaper in Nowhere Kentucky than it is in the Bay Area.

> Junkies shooting up in public, homeless people shitting on the sidewalk, etc, etc is a problem confined to a handful of cities on the west coast.

This just isn't true. At all. This is a problem in cities all over the country. Some cities hide it away, but homelessness and the other problems that come with drug addiction exist all across this country.

I live in Portland so I'm well aware of the effects from a large homeless population, but I try to travel as often as I can and I make it a point to get out of tourist areas as much as possible, usually to concerts or something. I can tell you first hand, within the last 2 years Philadelphia seems to have the same issues, DC definitely has the same problems, Boston, NY, Chicago, Austin, and Denver all have visible homeless.

What I find strange is how every city tends to believe their city is unique with homeless, like they don't realize this is a problem across the entire country. Go to any of those city's subreddits and search "homeless" and you'll see how they've all deluded themselves into believing their city is somehow unique and magically the only place in the country with a homeless problem. It's bonkers. This is a massive problem across the entire country. I suspect small towns across the rust belt probably have their own problems, especially considering how their meth and opiate addictions on a per capita level are significantly higher than even major cities.

I've lived and worked in Boston and DC. You see the occasional person panhandling in certain places. There's some homeless on the public transit systems. Never once have I had to step over shit. Never once have I seen a homeless person bother anyone else. Never once have I had to step over feces. I didn't say these cities were special. I just said the west coast has it far worse. I have been to SF. The scale and nature of the homelessness is categorically different.

I literally saw a homeless woman take a shit on the sidewalk in DC at 14&P (around 2008).

> San Francisco spends ~$40k/yr/homeless [0]

Did you forget the citation for this? If so, I'd appreciate it.

Not the OP, but probably from here: https://projects.sfchronicle.com/sf-homeless/2018-state-of-h...

$300M / year is spent and there are 7,500 homeless in SF.

I believe a good chunk of the money is spent on housing formerly homeless though.

This is correct. Helsinki is full of public, free toilets in very good condition and I never had such issues.

There are two dead comments that are both just straightforward criticisms of this. I don't get it. The question is basically, "How do we keep bathrooms tidy?" and the answer is massive spending programs. Criticism of this sentiment is verboten. What the hell?

As to the subject, gas stations and fast food restaurants, etc, have always been effectively public bathrooms all through the US. Maybe San Francisco is an exception that people here confuse with a rule.

  Criticism of this sentiment is verboten. What the hell?

People who live in SF imagine your city with tidy bathrooms, then follow this tree:

(1): Does the city have homeless and drug addicts? If yes, go to (2). If no, go to (3).

(2): And where are the bathrooms? If 'in private businesses' go to (4). If public toilets, go to (5).

(4): The private businesses chase off the homeless, who shit in the street. SAN FRANCISCO IS HERE.

(5): They're probably going to have people passing out in them, then.

(3): OK, so where have the homeless drug addicts gone? If they've been cured, go to (6). If you've sent them to another city, go to (7)

(6): Now you've probably got a massive spending program. THIS IS WHERE THE PEOPLE YOU'RE TALKING TO ARE

(7): Eh, you aren't the first. THIS IS UNLIKELY TO EARN YOU UPVOTES ONLINE. It might earn you re-election if you get elected then do it by stealth though.

If you've got a solution that avoids every pitfall I'm sure people would be eager to hear it - but if your explanation skips over some of the problems, that's less helpful.

> Does the city have homeless and drug addicts? If yes, go to (2). If no, go to (3).

Why did you put the two together though? There are many drug addicts whose life circumstances are very different, and they are leading a successful life with their addiction, because addiction does not necessarily cause such psychosocial harm.

"Homeless drug addicts" would be more accurate, which you are using later on though. :P But then again, many homeless people defecate publicly despite having the option not to, AND are not drug addicts.

I guess when people refer to drug addicts, they are referring to people displaying a certain set of behaviors that we usually see from homeless or poor people, because they are less likely to be able to hide their addictions and whatnot, mostly because it affects them negatively more, and the consequences are more obvious. I also believe it is not actually due to drug addiction alone. Do not forget that there is a reason for why they started using drugs. It could have been merely because they ended up on the streets, and for totally unrelated reasons.

https://global.oup.com/academic/product/addiction-and-choice...

The book explains it better than I ever could. It is very likely that I phrased myself incorrectly, the first two sections of this book should clear it all up. Cheers.

This is what I am talking about (posted it here to avoid confusion):

Relatedly, different life circumstances may protect people more or less well against impaired functioning (for a review, see Martin et al. 2014). For example, it is well known that addiction is associated with low socio-economic status alongside other mental health problems (Compton et al. 2007; Heyman 2009). But, in so far as addiction is diagnosed via negative consequences, wealth, alongside other forms of privilege, may offer a protective factor (cf. Matthews 2014; Schmidt et al. 2010). For example, a wealthy mother who drinks heavily but can afford a live-in nanny to ensure her children are adequately cared for is able to meet more of her role-related responsibilities than a poor woman who drinks equal amounts but whose children go hungry and miss school. The consequences are more serious by shared social standards in the latter case than the former, and so too, as a result, is the likelihood of a diagnosis.

The implication that individual differences in conceptions of how to live and life circumstances can affect the likelihood of a diagnosis may give pause. Indeed, Martin et al. (2014) have proposed that the negative consequences of use should be considered ancillary rather than core features of addiction for this very reason, namely, that they introduce significant individual and context specificity. However once we acknowledge that drug use in itself is not indicative of any form of disorder, but rather offers instrumental means to fulfilling valuable ends, the idea that negative consequences are fundamental to the pathological nature of addiction becomes evident.

I would think most of addicts are relatively poor people, therefore should be eligible for medicaid, which covers healthcare, detox and rehab services.

Boils down to housing and social workers then?

In big european cities many fast food places have weird blue lighting in the toilets; apparently it makes it hard for junkies to find their veins or something.

That's pretty common in America too

The Portland loo features this too, it's only on a night.

Wet houses are something that's been proposed in San Francisco. IMO they would be a good start.

This is a San Francisco problem. In most of the world such a sight would be very rare.

A Vancouver BC problem, too. Really, it's a problem with any city that has better support for disadvantaged populations (homeless, drug addicts) than the country it exists within—because those populations will flock to it in order to receive that support, and thus put a far larger support burden on city/NGO resources than you'd expect given the population.

I don't know about Canada, but the US is the only place where "Greyhound therapy" is a thing, and no it's not homeless playing with dogs. Basically, cities just ship their homeless/mentally-ill to another city via Greyhound bus lines. Some cities get the short-end of the stick more than others.

I discovered it first hand taking a bus from Philadelphia to Pittsburgh.

https://en.wikipedia.org/wiki/Greyhound_therapy

That practice is from sending people back to their hometown or last known good address. Cities have limited resources to they kick the can back to its origin. It’s obviously not any kind of solution but it stems from limited resources and wanting to spend it on locals rather than drifters, so to speak.

Greyhond therapy is a thing in Canada as well, although I've never heard that exact phrase before. https://www.cbc.ca/news/canada/british-columbia/homeless-sas...

In the case of Vancouver, I went to elementary school a block away from East Hastings. The benefit of the way they do it there is that those elements stay on E. Hastings for the most part, and aren't out causing discomfort for the rest of the city. I recall there being functioning public washrooms there from when I lived there as a kid.

San Francisco half-asses the social services, they just give out clean needles without considering how to dispose of them. Successful cities provide safe injection sites and supplement them with harm reduction strategies.

The streets of Portland aren't quite as bad as those of San Francisco, but there are plenty of heroin addicts in the Northwest. This particular article doesn't seem to state it directly, but those poor souls are exactly what this public toilet was designed to be resilient to.

https://portlandloo.com/faq/

The only time I've seen something similar to what you describe was on my trip in New York. And I've been to about 20 countries across 4 continents.

It's an American homegrown problem with too much focus on capitalism.

edit: You can downvote this, but it doesn't make it untrue nor irrelevant to the point. If you have basically no people living on the streets, you also avoid this problem. I'm still shocked from seeing homeless (nearly) die in the cold in New York.

With a better social systems it's maybe not fully solvable, but reducible to a point where it's no longer an apparent problem in every day live. It does work, many countries in the world do it, also in major cities.

> It's an American homegrown problem with too much focus on capitalism.

Capitalism does not preclude charity.

It could be argued that it precludes state-funded social programs, but the US has a very large number of those already, so it follows that Capitalism (as implemented here) is not the cause of this problem.

Regardless of what I or anyone else thinks about the necessity and morality of those programs, they do exist, and they are ineffective. The question is "Why are the ineffective?"

Most European countries also allow involuntary psychiatric treatment and admission, while the US does not.

If you started forcibly hospitalizing the mentally ill homeless in SF you would "solve" the issue pretty quickly, but that goes against some core American values.

The US used to be like this, and changed somewhere in the 1980s. It wasn't because of "core American values", it was because of the removal of funding.

There was widespread abuse and the expense kept going up, laws were passed that curtailed involuntary commitment (based on civil rights, not expense), and we are left with what we have today.

1. decriminalization of drugs use

2. public healthcare

3. state-funded homeless shelters

And then not only you don't have a problem with all these undesirables messing up your public toilets - you also don't have a significant part of your society wasting their lives.

Oh but that would literally be communism, right. Carry on, then.

1. Drug use was not a crime few decades bug. Smoking is not a crime today. It tried before. It doesn't work. 2. Public healthcare is working well if you are not interested in result. It tried before. It doesn't work. 3. Nobody will pay ever penny to care about zero cost homes. It tried before. It doesn't work.

> It tried before. It doesn't work.

It works in Portugal.

> Public healthcare is working well if you are not interested in result. It tried before. It doesn't work

Public healthcare works in almost every country on Earth, and in most of developed countries it works really well. At least better than that in USA (looking at the life expectancy).

> Nobody will pay ever penny to care about zero cost homes. It tried before. It doesn't work.

They won't have a choice. That's what taxes are for.

> It works in Portugal.

Is number of drug uses reduced? Nope. It risen.

Is criminal drug activity reduced? Nope. It risen.

So, what exactly "works" in Portugal?

> Public healthcare works in almost every country on Earth, and in most of developed countries it works really well. At least better than that in USA (looking at the life expectancy).

If you are not a drug user, your life expectancy is at same level as in Europe.

I have personal experience with public health care. Public healthcare is interested in popping you out of clinic as fast as possible.

For example, I received no treatment for my little pain in the back until I was unable to move. In result, I spent more than year in bed. Private clinic identified my problem _decade_ before, but their results were ignored by government clinic. I was stupid enough to trust government clinic. And so on. I can tell a lot if you want to listen.

> That's what taxes are for.

I want to be homeless then.

> Is number of drug uses reduced? Nope. It risen. > Is criminal drug activity reduced? Nope. It risen.

Sources please.

> So, what exactly "works" in Portugal?

https://en.wikipedia.org/wiki/Drug_policy_of_Portugal#Observ...

- Increased uptake of treatment (roughly 60% increase as of 2012.)[12]

- Reduction in new HIV diagnoses amongst drug users by 17%[19] and a general drop of 90% in drug-related HIV infection

- Reduction in drug related deaths, although this reduction has decreased in later years. The number of drug related deaths is now almost on the same level as before the Drug strategy was implemented.[12][19] However, this may be accounted for by improvement in measurement practices, which includes a doubling of toxicological autopsies now being performed, meaning that more drugs related deaths are likely to be recorded.[20]

- Reported lifetime use of "all illicit drugs" increased from 7.8% to 12%, lifetime use of cannabis increased from 7.6% to 11.7%, cocaine use more than doubled, from 0.9% to 1.9%, ecstasy nearly doubled from 0.7% to 1.3%, and heroin increased from 0.7% to 1.1%[19] It has been proposed[by whom?] that this effect may have been related to the candor of interviewees, who may have been inclined to answer more truthfully due to a reduction in the stigma associated with drug use.[20] However, during the same period, the use of heroin and cannabis also increased in Spain and Italy, where drugs for personal use was decriminalised many years earlier than in Portugal [20][21] while the use of Cannabis and heroin decreased in the rest of Western Europe.[22][23] The increase in drug use observed among adults in Portugal was not greater than that seen in nearby countries that did not change their drug laws.[24]

- Drug use among adolescents (13-15 yrs) and "problematic" users declined.[20]

- Drug-related criminal justice workloads decreased.[20]

- Decreased street value of most illicit drugs, some significantly

- The number of drug related deaths has reduced from 131 in 2001 to 20 in 2008.[25] As of 2012, Portugal's drug death toll sat at 3 per million, in comparison to the EU average of 17.3 per million.

- Homicide rate increased from 1.13 per 100 000 in 2000 to 1.76 in 2007, then decreased to 0.96 in 2015

Seems good to me.

> If you are not a drug user, your life expectancy is at same level as in Europe.

Sources please.

> I have personal experience with public health care.

Anegdotal evidence.

> I want to be homeless then.

Nobody's stopping you.

> Nobody will pay ever penny to care about zero cost homes.

I'm 100% opposed to this sort of thing being state-funded (I'm an AnCap), but I have to disagree with you here. I've personally subsidized housing for people who I've met that I believed were honestly trying to escape homelessness.

Most people's politics aren't as extreme as my own, but the mere existing of private, non-profit homeless shelters falsifies your idea that no one will help pay for zero cost homes.

Subsidized home is not equal to free home.

The homeless problem on the west coast has become much worse in the past decade or so. Drugs have been criminalized, healthcare for the poor has been crappy and state funded homeless shelters have been practically non-existent for far longer than that. I don't think any of those will do any more than make some small dents in the problem.

Maybe costs of living increased compared to low-end salaries in the recent years?

Something had to change, it's not normal to have so many homeless people that it becomes a practical concern.

Reply on news.ycombinator.com