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.