The city of San Francisco took her dog away (twice) and declared her place a health hazard for a while, but ultimately it never forced her to get treatment and is tacitly approving of her heroin use. She hasn't paid her property taxes in years and the police come out about once a month, but the US has no ASBO laws so it's catch and release in hippie dippie SF.

She's got the money for the dope, and heroin don't care.

PS> She got the dog back both times.

But to the OP's point, if heroin was sold at clinics or pharmacies there'd be an opportunity for nurses and pharmacists to intervene and offer alternatives before a person's a full blown addict. Even if it's just, "Hey, you're hitting it a bit hard lately, maybe try this meetup group instead."

She's wasting her life away, but also endangering others' (as well as her dog's). Her dog was taken away most recently because she was out on a weeklong bender and left the dog locked inside the house. After a few days of wailing and notices, animal control finally went in and rescued the dog. This being San Francisco, of course she got the dog back after claiming she went on vacation and just forgot about the dog.

That said, there was feces and urine piled up in the apartment for that week, and a few weeks after. She also had a stopped up toilet that backed up raw sewage into her apartment for "several weeks" according to the health dept. She was literally walking around on waste soaked carpets for weeks...and didn't care. Because heroin don't care.

She would also freak out and randomly dial 911 while high and insist that there were people in her apartment that were trying to kill her.

I, mean, I could go on for days writing up the crazy stuff she does while high. Her family wants nothing to do with her. She owns her place, has a pile of money, doesn't pay any real estate taxes, is a "frequent flier" for the police and fire department, but all of this is just A-OK, right San Francisco?

Honestly, I could care less about her life at this point. I'm just worried about the dog. It never gets walked and lives in literal squalor.

Definitely keep complaining to animal control about the dog, and report illegal activity, but other than that it sounds like you should mind your own business.

Local councils also have some other powers for their Community Protection Officers.

That's part of why I think the funnel approach is going to yield better results: when someone's hooked, they are in deep trouble, and with far-reaching impacts.

My musing is that federal agencies are the right choice for this: they can ignore local pressure groups and focus on the global optimum.

So you what do you propose as a solution for this (likely unrepresentative) anecdote? Lock her up?

Until people realise that this is a rational and sensical decision there won't be any solutions for these problems and these cases.

The US drug "treatment" / "rehab" industry is notoriously awful and is dominated by pseudo-religious ideologues obsessed with abstinence (to the point that "cult" is often an accurate, non-hyperbolic term) and whose practices are not based on any medical evidence of what reduces deaths. It's a fucked up industry that loves to use degradation, isolation, and humiliation on its "patients", loves to make people withdraw suddenly from their drug use and force them to endure the withdrawal symptoms, and isn't even particularly good at helping people not die from heroin/opioid use.

Given the current state of the rehab industry, and given how ineffective the "treatments" it offers are, it can alas be a rational decision to avoid it.

here's some reading that is relevant: https://www.theatlantic.com/magazine/archive/2015/04/the-irr... http://theinfluence.org/the-rehab-industry-badly-needs-to-cl... http://www.salon.com/2012/08/28/do_12_step_programs_lead_to_... http://projects.huffingtonpost.com/dying-to-be-free-heroin-t...

Unless the US adopts some sort of ASBO laws, there's not much you can do about forced treatment for someone who doesn't choose treatment.

Also, you could substitute heroin here with any other equally damaging substance like alcohol and the situation wouldn't change.

I encourage everyone to read https://en.m.wikipedia.org/wiki/Anti-social_behaviour_order which has a list of things the government was allowed to punish you for, including "rudeness" and "xenophobia". The most recent ASBO legislation is https://en.m.wikipedia.org/wiki/Anti-Social_Behaviour,_Crime... which I am not familiar with.

Keep that ASBO trash on the other side of the pond.

I prefer my government to absorb the cost of human despair rather than bill for it. Don't write policy based on outliers.

You are very good at using language. The reality is that government doesn't 'absorb' anything. Other people, some of whom can't afford to, pay for it.

No taxes, no currency, no economy to speak of (see: anywhere without a functioning government).

I don't get how some on the internet live and breathe in a government-sponsored property and currency regime and rail against the government part of it, but want to keep the property and currency.

Government turns around and spends those dollars in the economy. They are reallocated, not removed.

Desk jobs and fast food? As long as we have public healthcare I reserve the right to smack that bag of chips out of your chubby fingers. /end of rant

Then just systematically lock all addicts up and ship them off to freshly constructed prisons in Alaska.

Here if they check into detox, even if you are direct family you can't visit them or bring them anything because detox will deny they are there. You can't ask detox to call when they are released so you can pick them up and they don't end up released back on the streets.

Another problem is the waiting times for treatment. Real treatment is a long commitment sometimes living for years in a halfway house being supported by other peers to remain sober. An addict should be able to check into treatment and immediately commit themselves instead of waiting for months for a spot to open.

Lack of any facility for police to just dump out of control users and have them treated by doctors and addiction specialists is another issue. Often there are mentally ill with secondary addictions or other problems, and the police don't know what to do with them and money is wasted having them ferry around doctors to look at these addicts in jails or playing catch and release after a weekend in jail. A one stop sober shop and treatment option is always requested by police here but it never materializes.

Of course all of this costs money nobody will get elected with this spending platform on junkies until the synthetic opiates problem is so large the political will exists to do this.

All the addicts I've talked to including 2 of my friends who had a bad addiction for a few years, they all ended up addicts by becoming successful and partying to celebrate it. Anybody who lives in Vancouver if you go to VANDU and listen to one of their meetings sometime this is the same story you will hear: I was successful, I started drinking and partying, I used drugs to help regulate my sleep, or to get sober (cocaine sobers you up) or stay awake to function, I ended up an addict and lost everything here I am living in the dumpster or flop hotel being enabled by other addicts because I stole from every family member/friend and burned all those bridges.

Of that group that stays in treatment, more than half got jobs (almost all without our help, although we're starting to help now). Focusing on rebuilding your life while on Suboxone, while having access to mental health professionals (doctors, counselors, therapists) is working.

Open 6 months, we're growing fast and hope to help everyone we can. Only one in our city who accepts insurance without a waiting list, and we do that exclusively (no self pay).

It's good you have immediate treatment they still can't figure that out here, the "Rapid Access Addiction Clinic" in that story is unfortunately not accessible to all addicts and has temporary funding.

I don't need to own the entire system with this stuff, but it's very hard to set up (unfortunately). Hoping more people wake up and are able to do similar things. And we're going to keep expanding access to treatment.

We only accept medicaid (for the poor in the US), who otherwise wouldn't have access to free treatment. They pay $300-500 per month for Suboxone at cash clinics, but typically don't get as much behavioral health treatment.