The issue is that supportive housing is not exactly supportive. In fair few programs eveb refer to addiction. Absolutely the prescription for #surviving# is that people have housing, food medical care.
The statistics don't match up. In some cities the deaths are in supportive housing. Furthermore death cannot be the only criteria. Meth and indeed fentanyl is now creating a generation of addicts/alcoholics who arw contending with major chronic illnesses. The poor who are indeed the most visibly addicted are having strokes earlier (those strokes don't get the necessary treatment because of their chaotic lives) Thereafter meth addicts thereafter hsve major heart issues. Those issues don't present in ways that traditionally heart problems did. They have accelerated problems with diabetes
There is no strategy in getting people off the street into a virtual trap house. That is in effect moving abject chaos from one area to the next. The strategy of offering peoole housing devoid of any acknowledgement they are profound addicted is indeed promoting chaos. Many of the peoole acting out on the streets are in fact #housed# Their #no strings# housing doesn't include any clause about participating in case management let alone even an acknowledgement how they got there.
Stop gap survival measures is not a treatment it is a receipe for a disastrous supportive housing environment that serves no one.
Are you aware of any good companies or nonprofits trying to create a program where addicts would be in a rehabilitation setting that they cannot leave? I read the Least of Us, absolutely beautiful and creative story telling. I know from that about the jails starting a program.
I am a lawyer who’s worked for the state mental hospital on occasion. I also have a long personal history of witnessing one brother overdose and die in 2003 and another brother devolve into addiction over decades into the throws of meth & fentanyl addiction leaving a wake of destruction along the way. I’m not sure which is worse.
Seeing that behavior though provides anecdotal evidence that you’ve seen, the brain lacks rational decision making when in the throws of addiction. Meth rendered him to seem schizophrenic. It appears to me that society needs to place addicts in something more like a forced mental health hospital setting.
Is any entity working toward that or something similar?
Travis -- appreciate the comment, sorry to hear about your brothers. yes, years of reporting on this have convinced me that the true harm reduction is getting people off the street where they cannot leave -- anything else is preparing for a death sentence -- given the two drugs you mention. Apart from Kenton County, I'd check w the jail in Columbus OH. they built a new jail, opened a couple years ago, that seemed prepared for something like this as well. other than that, I'm not aware of any, but it's a big country and there's much out there....if you hear of anything, please let me know...
Thanks for the quick response. I’ll let you know if I find anything. Your book offered a good deal of catharsis and understanding. For my brother who’s still around, it was spot on in so many ways.
you know I'm about to begin several pieces on meth. any chance you or your brother might want to talk about it? if so, i'm at samquinones7 at yahoo.com
I read Dreamland awhile back, and now I’m a grants and evaluation specialist whose efforts support disability employment and some rural homelessness prevention/resolution programs in a small city/region in Minnesota.
You are saying exactly what I think liberal, educated America needs to hear about homelessness and addiction. There is a pervasive belief on the left that people lose their jobs and then within a week or a month end up on the street. They think longterm homelessness is just a state of being, and not something that totally changes people and their ability to function.
When I tell them that people living on the streets typically ended up that way because they have un-treated or under-treated mental illness and/or substance abuse, they get so defensive. They all want to neatly blame “capitalism” (in a similar way conservatives want to blame “laziness”), but it’s way more complicated. Pretty much once someone is on the street, their bodies and brains are so damaged from that experience (and the effects of longterm undermanaged serious mental illness and/or substance abuse) that they need lifelong supports to recover, which is called permanent supportive housing. PSH works, is humane, but is labor-intensive and expensive.
All homeless people deserve this investment. I believe it is our moral responsibility as a society to support their rehabilitation after the disabling experience of homelessness.
But, it isn’t the money problem leftist often think it is. My agency has some of the best housing outcomes in the state bexause, as a disability services agency, we provide intensive case management and 1:1 supports in the housing search. We send people to mental health supports and through vocational services. Other less effective agencies don’t provide case management, only cash. For most people, cash is not enough.
People don’t become homeless because they lost their jobs and rent is too high. These are reasons that lead to an episode of homelessness, but not the inciting reason. Homelessness is a disability problem. It’s not enough mental healthcare resources for young adults (18-30), including vocational services meant for people with disabilities. It’s a disability system that’s too stingy, especially for people with mild intellectual disabilities with mental illness. It’s not enough MH resources in treatment modalities that center functioning.
Calling attention to the disabling effects of homeless and drug use is taboo but necessary. Thank you!!
Spot on Nicole. There is a huge step between someone who lost a job and has to couch surf for a while and someone living in the woods on the outskirt of town. And you are right about the mental and physical toll that homelessness has on people. I can take two 40 year old people -- one in a stable envoirnment and the other homeless and you would swear there was a 20 year difference.
Nicole - Well, you're certain welcome! thank you for the very insightful, detailed comment, coming from your experience working in this world for so long. I've often thought every town needs to provide a few (small number - 6-10) of addiction/mental health beds, which need to be in the same complex, very intensively supervised by medical personnel for people who are civilly committed, thus can't leave when the drugs demand they do so. If every town has to have this, then no town can duck the responsibility. it's expensive, but hardly more expensive than people living in encampments, under overpasses, with all the costs associated with them. Someone once said, "but you can't scale it." To which I reply, good. the problem is always political -- no one wants huge numbers of beds for addicts, the mental ill, and the homeless. Anyway, that's my thinking as I dream how we work our way out of this.
We would rather pass out band-aids. Meaningful rehab is too expensive. Streets full of addicts are probably even more expensive, but the cost is spread around and invisible, and people don't know they're paying it.
I think, too, that problems on the street presented by fentanyl and meth are quite daunting -- they are so potent, so prevalent, and lead to such seemingly intractable mental and physical conditions. People are out of their minds, have been allowed to waste away on the street, in tents, amid piles of trash, and there's no easy place to put them now....but it needs to start....the tents and trash might be one place.
Part of the problem is just finding a rehab that's open never mind all the rehabs where the only thing the Administrstion cares about is money. I only have information about three of them across the country that I can trust
You said kindly what I have said many, many times about narcan and subsequent MAT without actual treatment being primary in helping people make changes they need to stay sober. I always said that these enabling activists are just prolonging the torture. Many people I treated abused narcan as much as they did their opioids; and you are correct about the injured addict brain. The belief of using narcan as a way to “get back” from an OD (addicts always believe they can get higher and will never die; addict logic dictates that narcan will provide that opportunity). I’m a big fan of giving people a chance to truly get sober. So let’s remember the limits of MAT and narcan, useful as they can be.
Thanks for the coverage of opioids over the past 11 years. With all the attention to the users and pharmaceutical companies making these addictive drugs, one item that I feel has not been given enough attention are the drug stores filling prescriptions. They must have at some point recognized the sheer volume of prescriptions for opioids and no doubt they were happy for the money involved. Have you ever talked to CVS, Walgreens, or other corporate drug store companies about this issue?
This reminds me so much of living in the San Fernando valley during the 70’s and 80’s and friends were getting quaaludes from shifty doctors writing scrip all day for the money. Didn’t’ pharmacies recognize the uptick on “disco drugs” or were they just happy pocketing some easy money?
Thanks for bringing up the limits of Narcan. It is indeed a Band-Aid, which is better than letting patients expire when overdosed, but not a long-term solution.
There’s another aspect or two to overdose which I might add. When patients are overdosed, but not in respiratory arrest, they will lie in the same position for hours. Their body weight pressure on the muscle underneath them (an arm, a leg, the gluteus, muscle, etc.) will often kill the muscle and sometimes later the Patient.
The morbidity associated with loss of a limb or the muscles of walking is devastating. The depression and regret at the loss often propels further use until death.
The necrotic muscle sometimes poisons the kidney with the myoglobin released and patients can end up on dialysis as well.
The part of the brain, most susceptible to hypoxia is not the judgment center, but rather the motor cortex. At the far end of the arterial beds in the brain is an area always on the verge of hypoxia. This watershed area is the part most commonly damaged in hypoxic injury, such as is found in overdose.
One more observation, the decline in overdose may not in fact be attributable to Narcan. There was a rise in alcoholism and drug use during the lockdowns. That bubble has receded and the acute on chronic overdose statistics have reverted back to normal. “Normal,” unfortunately is 80,000 deaths a year it seems.
Interdiction is having a big effect with seized fentanyl plummeting since the southern border was secured this year. Admissions are up in treatment centers as supply tightens.
all of this is quite interesting and on point. I was just talking recently with someone who mentioned the overdosing and lying on a body part that then is disabled to some degree. hadn’t thought of that.
More on the interdiction of fentanyl in later posting.
The issue is that supportive housing is not exactly supportive. In fair few programs eveb refer to addiction. Absolutely the prescription for #surviving# is that people have housing, food medical care.
The statistics don't match up. In some cities the deaths are in supportive housing. Furthermore death cannot be the only criteria. Meth and indeed fentanyl is now creating a generation of addicts/alcoholics who arw contending with major chronic illnesses. The poor who are indeed the most visibly addicted are having strokes earlier (those strokes don't get the necessary treatment because of their chaotic lives) Thereafter meth addicts thereafter hsve major heart issues. Those issues don't present in ways that traditionally heart problems did. They have accelerated problems with diabetes
There is no strategy in getting people off the street into a virtual trap house. That is in effect moving abject chaos from one area to the next. The strategy of offering peoole housing devoid of any acknowledgement they are profound addicted is indeed promoting chaos. Many of the peoole acting out on the streets are in fact #housed# Their #no strings# housing doesn't include any clause about participating in case management let alone even an acknowledgement how they got there.
Stop gap survival measures is not a treatment it is a receipe for a disastrous supportive housing environment that serves no one.
always interested to read your perspective.....keep em coming!
Sam,
Are you aware of any good companies or nonprofits trying to create a program where addicts would be in a rehabilitation setting that they cannot leave? I read the Least of Us, absolutely beautiful and creative story telling. I know from that about the jails starting a program.
I am a lawyer who’s worked for the state mental hospital on occasion. I also have a long personal history of witnessing one brother overdose and die in 2003 and another brother devolve into addiction over decades into the throws of meth & fentanyl addiction leaving a wake of destruction along the way. I’m not sure which is worse.
Seeing that behavior though provides anecdotal evidence that you’ve seen, the brain lacks rational decision making when in the throws of addiction. Meth rendered him to seem schizophrenic. It appears to me that society needs to place addicts in something more like a forced mental health hospital setting.
Is any entity working toward that or something similar?
Travis -- appreciate the comment, sorry to hear about your brothers. yes, years of reporting on this have convinced me that the true harm reduction is getting people off the street where they cannot leave -- anything else is preparing for a death sentence -- given the two drugs you mention. Apart from Kenton County, I'd check w the jail in Columbus OH. they built a new jail, opened a couple years ago, that seemed prepared for something like this as well. other than that, I'm not aware of any, but it's a big country and there's much out there....if you hear of anything, please let me know...
Thanks for the quick response. I’ll let you know if I find anything. Your book offered a good deal of catharsis and understanding. For my brother who’s still around, it was spot on in so many ways.
Keep up the good work!
you know I'm about to begin several pieces on meth. any chance you or your brother might want to talk about it? if so, i'm at samquinones7 at yahoo.com
Thanks for challenging my thought process!
:)
I read Dreamland awhile back, and now I’m a grants and evaluation specialist whose efforts support disability employment and some rural homelessness prevention/resolution programs in a small city/region in Minnesota.
You are saying exactly what I think liberal, educated America needs to hear about homelessness and addiction. There is a pervasive belief on the left that people lose their jobs and then within a week or a month end up on the street. They think longterm homelessness is just a state of being, and not something that totally changes people and their ability to function.
When I tell them that people living on the streets typically ended up that way because they have un-treated or under-treated mental illness and/or substance abuse, they get so defensive. They all want to neatly blame “capitalism” (in a similar way conservatives want to blame “laziness”), but it’s way more complicated. Pretty much once someone is on the street, their bodies and brains are so damaged from that experience (and the effects of longterm undermanaged serious mental illness and/or substance abuse) that they need lifelong supports to recover, which is called permanent supportive housing. PSH works, is humane, but is labor-intensive and expensive.
All homeless people deserve this investment. I believe it is our moral responsibility as a society to support their rehabilitation after the disabling experience of homelessness.
But, it isn’t the money problem leftist often think it is. My agency has some of the best housing outcomes in the state bexause, as a disability services agency, we provide intensive case management and 1:1 supports in the housing search. We send people to mental health supports and through vocational services. Other less effective agencies don’t provide case management, only cash. For most people, cash is not enough.
People don’t become homeless because they lost their jobs and rent is too high. These are reasons that lead to an episode of homelessness, but not the inciting reason. Homelessness is a disability problem. It’s not enough mental healthcare resources for young adults (18-30), including vocational services meant for people with disabilities. It’s a disability system that’s too stingy, especially for people with mild intellectual disabilities with mental illness. It’s not enough MH resources in treatment modalities that center functioning.
Calling attention to the disabling effects of homeless and drug use is taboo but necessary. Thank you!!
We need more people like you, my friend.
Spot on Nicole. There is a huge step between someone who lost a job and has to couch surf for a while and someone living in the woods on the outskirt of town. And you are right about the mental and physical toll that homelessness has on people. I can take two 40 year old people -- one in a stable envoirnment and the other homeless and you would swear there was a 20 year difference.
Nicole - Well, you're certain welcome! thank you for the very insightful, detailed comment, coming from your experience working in this world for so long. I've often thought every town needs to provide a few (small number - 6-10) of addiction/mental health beds, which need to be in the same complex, very intensively supervised by medical personnel for people who are civilly committed, thus can't leave when the drugs demand they do so. If every town has to have this, then no town can duck the responsibility. it's expensive, but hardly more expensive than people living in encampments, under overpasses, with all the costs associated with them. Someone once said, "but you can't scale it." To which I reply, good. the problem is always political -- no one wants huge numbers of beds for addicts, the mental ill, and the homeless. Anyway, that's my thinking as I dream how we work our way out of this.
We would rather pass out band-aids. Meaningful rehab is too expensive. Streets full of addicts are probably even more expensive, but the cost is spread around and invisible, and people don't know they're paying it.
I think, too, that problems on the street presented by fentanyl and meth are quite daunting -- they are so potent, so prevalent, and lead to such seemingly intractable mental and physical conditions. People are out of their minds, have been allowed to waste away on the street, in tents, amid piles of trash, and there's no easy place to put them now....but it needs to start....the tents and trash might be one place.
Part of the problem is just finding a rehab that's open never mind all the rehabs where the only thing the Administrstion cares about is money. I only have information about three of them across the country that I can trust
You said kindly what I have said many, many times about narcan and subsequent MAT without actual treatment being primary in helping people make changes they need to stay sober. I always said that these enabling activists are just prolonging the torture. Many people I treated abused narcan as much as they did their opioids; and you are correct about the injured addict brain. The belief of using narcan as a way to “get back” from an OD (addicts always believe they can get higher and will never die; addict logic dictates that narcan will provide that opportunity). I’m a big fan of giving people a chance to truly get sober. So let’s remember the limits of MAT and narcan, useful as they can be.
Thanks for the coverage of opioids over the past 11 years. With all the attention to the users and pharmaceutical companies making these addictive drugs, one item that I feel has not been given enough attention are the drug stores filling prescriptions. They must have at some point recognized the sheer volume of prescriptions for opioids and no doubt they were happy for the money involved. Have you ever talked to CVS, Walgreens, or other corporate drug store companies about this issue?
This reminds me so much of living in the San Fernando valley during the 70’s and 80’s and friends were getting quaaludes from shifty doctors writing scrip all day for the money. Didn’t’ pharmacies recognize the uptick on “disco drugs” or were they just happy pocketing some easy money?
Not per se, but they have had to pony up serious cash for their role in precisely what you describe.....https://www.npr.org/2022/12/13/1142416718/cvs-walgreens-opioid-crisis-settlement
Thanks for bringing up the limits of Narcan. It is indeed a Band-Aid, which is better than letting patients expire when overdosed, but not a long-term solution.
There’s another aspect or two to overdose which I might add. When patients are overdosed, but not in respiratory arrest, they will lie in the same position for hours. Their body weight pressure on the muscle underneath them (an arm, a leg, the gluteus, muscle, etc.) will often kill the muscle and sometimes later the Patient.
The morbidity associated with loss of a limb or the muscles of walking is devastating. The depression and regret at the loss often propels further use until death.
The necrotic muscle sometimes poisons the kidney with the myoglobin released and patients can end up on dialysis as well.
The part of the brain, most susceptible to hypoxia is not the judgment center, but rather the motor cortex. At the far end of the arterial beds in the brain is an area always on the verge of hypoxia. This watershed area is the part most commonly damaged in hypoxic injury, such as is found in overdose.
One more observation, the decline in overdose may not in fact be attributable to Narcan. There was a rise in alcoholism and drug use during the lockdowns. That bubble has receded and the acute on chronic overdose statistics have reverted back to normal. “Normal,” unfortunately is 80,000 deaths a year it seems.
Interdiction is having a big effect with seized fentanyl plummeting since the southern border was secured this year. Admissions are up in treatment centers as supply tightens.
all of this is quite interesting and on point. I was just talking recently with someone who mentioned the overdosing and lying on a body part that then is disabled to some degree. hadn’t thought of that.
More on the interdiction of fentanyl in later posting.
thanks for the thoughtful comment.