Hacker News Reader

Comment by gonehome | Hacker News Reader

Arguably SF’s lack of police response enables continued drug abuse and homelessness.

See: https://www.sfchronicle.com/projects/2021/rescuing-jessica-s...

This person has no interest in treatment. They want to do drugs and take advantage of what’s provided to keep doing that.

You can’t fix that with hotels. You either need to require treatment or imprison (paired with arresting dealers).

On the more progressive end, maybe drug clinics that administer drugs to addicts for free onsite (to crash the dealer market while you’re going after them). Eventually you have to force a choice. The do drugs openly while living in a tent on the street can’t be an option.

View on HN

Your thinking here is still focused on symptoms rather than causes.

Most people don't develop debilitating drug addictions without underlying problems. Even most people with drug addictions don't get to a point where they can't hold down a job or have a need to carry out crime to fund it, but of those who do it's worth considering why when e.g. a typical heroin addict can hold down a job and could have funded their addiction for ~$20/day if they had access to clean, medical grade heroin (we know the price, because e.g. the UK NHS buys medical grade heroin for use for post-operative pain management - under the generic name diamorphine).

So there's a long path there from failure to address mental health issues and other social problems, via failure to provide safe, clean supplies and early intervention for those who still get addicted to drugs, failure to regulate healthcare properly (e.g. the prescription oxy -> black market oxy -> heroin recruitment path), and failure to ensure availability of jobs, and lacking welfare options, before worrying about treatment and emergency housing is even in the picture.

Start addressing root causes and a lot of the problems later in that chain would either go away or at least be substantially diminished.

Broken families, abusive childhood environments, terrible influences and friends are among some of those root causes. Check out interviews with Skid Row residents on Youtube if you want to get a good taste of the diversity of reasons for why people end up in those situations. It will be really hard to break the cycle in the US without forcibly separating many, many children from their parents and letting the government raise them in more functioning environments.

Not necessarily, someone could have an awful childhood but with adequate mental health help and support, not fall into addiction and homelessness in adult life. Ideally, yes, we'd eliminate all causes of trauma, but we can also put a _lot_ more effort into mitigating the effects later in life, rather than (subconsciously?) chalking it up to a moral failure in the affected person.

> Your thinking here is still focused on symptoms rather than causes.

We need to clean up the mess and prevent more being added at the same time.

It is not like we can only do either preventive or reactive.

It's aside your point, but you may be thinking of fentanyl rather than diamorphine (street name heroin) with regards to the NHS. The former is often used in NHS hospitals for intraoperative and postoperative pain relief, the latter almost never for anything.

No, I'm thinking of diamorphine. I'm not questioning that fentanyl is also used, but so is diamorphine, and the point was not that it is used a lot, but that it is used enough that we have reliable data on the cost of various doses of it.

Here are some pages covering various uses by the NHS

Most relevant to the point I made, here is a pricing page for diamorphine for the NHS[1].

Use during birth: [2]

"This is an injection of a medicine called pethidine into your thigh or buttock to relieve pain. It can also help you to relax. Sometimes, less commonly, a medicine called diamorphine is used."

Use in NHS Scotland [3]: "Unlicensed intranasal diamorphine has been used in the NHS in Scotland for the treatment of severe pain in children in the emergency setting. The availability of diamorphine hydrochloride nasal spray (Ayendi®) provides a licensed preparation."

Article on recent-ish supply problems[4] due to a problem at one of the manufacturers:

"NHS trusts forced to use ‘expensive’ pre-filled diamorphine syringes to manage ongoing supply issues

Exclusive: Birmingham Women’s and Children’s NHS Foundation Trust has had to source pre-filled diamorphine syringes from other NHS trusts to meet demand."

NICE advice on diamorphine use [5] lists indications and doses for acute pain, chronic pain not currently treated with a strong opioid analgesic, acute pulmonary oedema, myocardial infarction.

NHS patient information (word doc) [6] on the shortage: "Diamorphine is licensed to treat severe pain associated with surgery, heart attack or a terminal illness. It is also used for the relief of shortness of breath in severe heart conditions. In addition, a small number of people in the UK may be receiving diamorphine to manage heroin addiction."

So while I have no idea about the actual volume of use, as you can tell the NHS has suppliers, and NICE has a price list.

[1] https://bnf.nice.org.uk/medicinal-forms/diamorphine-hydrochl...

[2] https://www.nhs.uk/pregnancy/labour-and-birth/what-happens/p...

[3] https://pharmaceutical-journal.com/article/news/nhs-trusts-f...

[4] https://www.scottishmedicines.org.uk/medicines-advice/diamor...

[5] https://bnf.nice.org.uk/drug/diamorphine-hydrochloride.html#...

[6] https://www.england.nhs.uk/south/wp-content/uploads/sites/6/...

Well I stand corrected. I've only seen it prescribed under a home office license for treatment of addiction in a single case. Many of your examples seem to relate to paediatrics and maternity care which perhaps explains my ignorance as I work outside these areas.

Root cause prevent - my friend who got hooked ok coke & lost everything for getting caught on the job site would’ve been better off if that coke dealer had been busted before my friend bought coke. Or if my friend’s middle-class parents had disciplined him more. Or maybe if he had a more ridged sports program in college that helped athletes avoid the perils of college parties Vs cutting him.

Arresting dealers / busting drug rings is one of the few policing activities that directly leads to MORE crime.

What happens when you bust a drug ring and arrest some big players? You immediately create a power vacuum, which leads to a turf war where other players (in the gang or between gangs) start jockeying for power, spreading their mayhem across the area.

The only solution here is legalization, treatment, and general social welfare.

Only if you keep the market alive.

Arrest the dealers and administer the drug to addicts for free at clinics? I think that would be an interesting approach.

I'm not a policy expert. I used to agree with you, but I think part of the issue is trivial access to drugs (see the tenderloin). It's harder for addicts to quit when it's very easy to get the drug (whether that's via dealers or legalization) and the city helps to enable you (hotel shelters, etc.) I understand the good intent and compassion, but a lot of bad policy on the left starts with good intent and ends with unanticipated bad consequences. Cities with arguably crueler enforcement don't have these issues (San Mateo). SF attracts addicts because they know it's lax and drug access is easy. Pair that with NIMBY housing policy and it's very hard to get housed and off of drugs.

I'd argue the SF approach to this has been a failure, London Breed's recent speech on the topic is something I agree with. The equilibrium we're trapped in is bad. We need to force a choice and that choice is likely either treatment or prison.

> I'd argue the SF approach to this

I mean, it's a national crisis. It's easy to point the zits on my face but the problem is in what I eat.

So legalize and the gang bangers go away? Nice!

No. I said "The only solution here is legalization, treatment, and general social welfare."

That last one is what makes the gang bangers go away, but it's a long process.

>maybe drug clinics that administer drugs to addicts for free onsite

That is an interesting idea. All kinds of ethical issues for handing out free heroin, but why not take all the confiscated drugs, test them for safety and hand them out for free at clinics with some damage-reduction safe guards like daily per-person limits, offer rehab and mental health services, etc? Turn addicts into informants without even trying, because if they rat out dealers, the dope is free. I doubt users have the long-term awareness to see that it eventually reduce supply.

Heroin itself is much less damaging to your body than more popular drugs like tobacco or alcohol.

Making it harder for addicts to get heroin or a replacement will only increase the energy they will spend on getting it. This makes it nearly impossible to get to a better place in their life. It is mostly getting the drug that has a negative effect on holding down a job, not the drug itself.

It’s much more damaging to the mind and ability to have a functional life.

My sister was a functional alcoholic for 25 years. When she started heroine, everything changed, and she overdosed within 2.

There's a group of people that like to pretend heroin is less harmful despite all the evidence to the contrary. I'm not sure if they're users rationalizing their own use or what, but it's an odd thing I've noticed.

Alcohol is really bad for your mind. I don't think there is sufficient evidence, that heroin is worse than alcohol for your brain.

She couldn't have been a functional alcoholic for 25 year if alcohol were an illegal substance.

There are plenty of people who have a normal life on methadone or heroin if it is provided to them.

As already stated, if you are an addict, getting the substance is the highest priority. Making it harder to get just makes them use more of their resources to get them.

> is worse than alcohol for your brain

It depends on the definition of "worse". If cell death over time, then maybe alcohol is worse. If it's how much a recreational/entertaining dose disturbs the workings of the mind, the operation/rational/ability to live a normal life, which is the purpose of the mind, then I would say heroin is worse.

I would assume the amount of dopamine a drug releases is directly related to its ability to disrupt someones life.

> Arguably SF’s lack of police response enables continued drug abuse and homelessness.

You want to arrest people for being homeless?

Reply on news.ycombinator.com