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Comment by seanmcdirmid | Hacker News Reader

Fentanyl is also responsible for a lot of this current cap, at least from my perspective in a big west coast city. It seems like all unhoused neighbors are on it, but of course that could just be selection bias (the ones you notice are having fent crises).

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There are a few things.

The longer you are unhoused, the more that you are in a chronic state of danger. Opioids turn that stress response off for a moment and simultaneously make it harder to get out of the situation that caused the problem.

The Opioid addicts don't care about being seen in a way that the invisible homeless do.

The people whose mental health crises are exacerbated by being homeless are more likely to be visible because they have no reserves left. And Fentanyl is a good way to ignore that mental health crisis for a moment.

I get that. But that’s probably not all of the cases, maybe a few. A lot of them had a support network and simply burned their bridges with them via drug use, and now they are in the streets. But we should definitely prioritize helping the non drug addicted homeless population, get them off the streets as fast as possible, since once they get into fent, helping them is a magnitude harder! And that’s why we should prioritize sober housing. Yes, it’s sad, but once they get addicted to fent, they are probably not recovering from that, so let’s throw our resources at not letting that happen, rather than burning them on people that are very very hard to help.

Ironically, getting the addicts off the street also helps, and the "housing" is more important than "sober." If you can get them stable, they may have a chance.

The drug addiction happens because of the trauma in a vast majority of cases. Poor decisions may compound, but trauma causes rational decisions that also have the negative consequences that compound.

It doesn’t really help. They get off the streets into a mini home for example, or maybe a spot in a RV park, or hotel room. But the city pays $10k/month for that, since housing an addict requires a lot more maintenance and services than housing someone sober, and that’s not even treating their addiction. The costs are unsustainable, the treatment isn’t available or they dont want to go (it’s not jail, they can’t be forced to go to treatment).

And again, treatment doesn’t even work most of the time, especially if the patient is unwilling. We are just throwing away our money here when we could focus it on the non-addicted homeless instead, get them housed, and prevent them from getting addicted to drugs. Sober housing helps these people a lot, and could prevent the problem from getting worse, because once they start doing drugs, it’s pretty much over.

Last time I saw, that 10k/month was actually less expensive than leaving them on the street.

https://endhomelessness.org/wp-content/uploads/2017/06/Cost-...

Yes, although not cheaper than prison (only applicable for those that commit felonies and then get a slap on the wrist instead of prison time, but we have plenty of that).

There's causation between homelessness and fentanyl use. Being homeless is absolutely hellish in this country; if your life has fallen apart that you're truly living on the street then there's little support and a lot of danger. Opioids might be one of the only options for you to actually feel happy when the rest of your life is terrible and you've run out of options.

It certainly happens that people get addicted to opioids and then their lives fall apart as a result of addiction but it's important to consider how despair itself can lead to addiction.

It really doesn’t matter in either case. Once they are addicted to fent, they probably aren’t coming back from it. So instead of throwing all our resources at drug addiction, we could instead throw it at getting newly unhoused off the street into safe and secure housing. If housing is their only need, that is a much easier problem than forcing an addict into treatment that probably won’t work.

Fully agree; keep people off the street and get them off the street as fast as possible; and build a culture where deaths of despair are less likely to happen.

In discussing this issue with the EMT and paramedic students I teach, absolutely this.

"If your life had descended to a point where you had to go to the bathroom in an alley and use scrap paper to wipe, or were eating your lunch that you fetched from a trash can on the street in the rain, there's a good chance you would use opioids to numb the pain of that existence, too."

And once you start using some of the most powerfully addictive substances we know, it's not about "flaws of character" or anything else, now you've messed with brain chemistry, in some cases, permanently.

You bring up a great point about selection bias. The "homeless" you see are the ones with the drug/mental illness problems. When I was in college 2 of my friends were homeless. One slept in his car, the other slept in an office building. I would have never known if they hadn't told me.

Ya, we really shouldn’t forget about them. As an 18 year old, I slept in my car for a few days before so I can totally empathize.

It is really sad that we have equated drug addiction with homelessness. We should really treat them as separate problems, since one is much easier to solve with social resources than the other.

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