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Excellent, if grim reporting.

But Oregon is much, much worse. I spent 35 years as a prosecutor (in Eugene, Bend, Newport, and Astoria), the last 25 years as the elected DA in Astoria. When the DC-based Drug Policy Alliance single-handedly bankrolled Measure 110 on the 2020 ballot, Oregon functionally legalized ALL DRUGS.

The lie, told in a tsunami of clever and deceptive campaign ads, was that sending hapless addicts to prison was cruel and useless, and that Oregon needed to divert the vast sums being spent in the WAR ON DRUGS into treatment.

Except that Oregon's sentencing guidelines have blocked judges from sending someone convicted even 15 times for Possession of heroin or meth to any sentence longer than 30 days, and in reality capped that at 10 days. That had been the law since 1989. Oregon had the second lowest number of inmates in for drug crimes, only Vermont had lower rates. But in reality no judge sentenced a mere addict to ANY jail for at least two decades, instead opting for drug court. Then in 2017 the Democratic-dominated legislature reduced all drug possession crimes to misdemeanors, effectively defunding any court-ordered supervision.

When the vast majority of voters were told they could have the most "progressive drug laws" (M 110) in America, most bought the lie. Possession of 39 tablets of OxyContin is now a Class E Infraction, meaning it is less serious than having mud on your license plate. The courts "suggest" judges levy a $25 fine, assuming first that any police officer even bothers to cite the drug user, and even less likely that the addict makes a voluntary court appearance (no warrant can issue for even repeated failures to appear and the repeat addict's driver's license CANNOT be suspended). Drug citations, already at a tiny fraction of what they were just 5 years ago can now be counted on one hand in some counties. The theory was that junkies would opt to call a "hotline" to avoid paying fines. Thus far a grand total of 51 people have called, and a total of 8 have actually sought treatment.

Since the possession of a gram or two of meth or heroin is functionally legal, police no longer have probable cause for any crime, and cannot even ASK to search further, and certainly cannot seek a search warrant. Although fentanyl isn't included in the newly-legalized drugs, it almost always presents as bogus 30 mg. Oxycodone tablets, so without testing onsite, officers have no method and less incentive to investigate further.

Oregon now can claim the WORST overdoes rate in the nation, and also the least treatment options for addicts.

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Interesting comment. One question - I just looked up overdose death rates by state - https://www.cdc.gov/nchs/pressroom/sosmap/drug_poisoning_mortality/drug_poisoning.htm

Oregon doesn’t seem to have anything like the worst. More like pretty low by comparison with other states. Is there something I’m missing?

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Avoid the CDC and look at impartial data and you’ll see Oregon is in fact DEAD WORST in lack of treatment and per capita overdoses.

Here are three very different Oregon media reports on how bad Oregon (the state where I’ve been a lawyer for 40 years) is failing:

https://www.kgw.com/article/news/health/oregon-addiction-crisis/283-b917ac02-9e13-441a-bd59-ae2e45bb128d

https://www.foxnews.com/us/portland-drug-decriminalization-effort-tragedy

https://oregoncapitalchronicle.com/2022/02/07/oregon-has-worst-drug-addiction-problem-in-the-nation-report-shows/

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I read the three news stories you linked. None of them claimed Oregon had the worst overdose rates in the nation. They made a variety of claims but not that.

If you think the CDC has faulty data then maybe you can provide a data source to back up your original claim.

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If you read the articles, it’s clear that Oregon‘s nonexistent response to rampant heroin, methamphetamine and fentanyl addiction, is a spectacular failure. I provided three totally different new sources including Fox News, KGW the NBC affiliate in Portland, and a new hyper local news source.

Speaking from both my personal and lived experience dealing with people with severe addictions and those who die from overdoses, and speaking to the people on the front lines of trying to respond to this catastrophe, it sounds like you simply don’t wanna believe this is true, no matter what evidence is provided.

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Jul 27, 2022Liked by Leighton Woodhouse

California needs a massive investment in psychiatric bed infrastructure. Even if we tighten the civil commitment laws, we simply don't have the treatment beds.

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This is a good article, but I really want to know more about each individual's life circumstances--pre-conception onwards--before I shake my head sadly entirely at the "system" Rashid Rashid blames for his child's death.

I'm old enough to remember and decry the mass closings of public mental institutions after the genius ACLU fought so hard against their horrors that severely ill people were dumped on the street to enjoy their individual liberties.

But any of us who've read anything at all of history knows that incarceration for madness is a favored tool of totalitarian systems and their bastard spawn too.

There will never be a permanent solution to the problems inherent in any society run by human beings.

And it's not helpful, of course, to note that reducing the dreadful toll of mental illness begins in the grandparents' generation. Healthy well-nourished people not deficient in essential nutrients at the time they conceive children confers a huge advantage from the start in the hope of having reasonably stable and resilient offspring.

Of course we need many more excellent detox services and supportive housing facilities. But you could build a million and you won't solve the problem of people so intractably ill that no solution lasts for long.

And services that switch addicts from one life-long dependency to another i.e. methadone and suboxone maintenance programs--keep addicts attached to that life forever, with the same associates so toxic for them to mix with in the first place.

There's a very sad truth here. People unwilling to fight for their own lives can't be helped by others. The percentage of addicts suffering from diagnosable severe conditions such as schizophrenia need to be institutionalized, because they haven't the ability to fight for themselves. The others can't be allowed to suck up all the energy and money and good intentions in the world that cannot save them from themselves.

(deleted duplicate of this comment)

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Jul 27, 2022Liked by Leighton Woodhouse

Hey, but on the bright side you guys have a bullet train between Bakersfield and Salinas, or maybe will have someday.

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What a gut wrenching tale, I’m curious though - Exactly how much of Adam’s plight is Adam himself responsible for?

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Adam's father would be the first to say that Adam shared a great deal of the responsibility for his own situation, and that his family shared some of that responsibility, too. But mental illness is mental illness and addiction is addiction: it's the nature of both afflictions that you lose control of your actions and your executive function. So the language of personal responsibility necessarily only goes so far. This is a problem not just for individuals and their relatives — many of whose lives have already become completely taken over by the effort to save their loved ones, and who physically couldn't possibly do more than they're already doing — but for all of us, because the problem is so pervasive that it's taking over our cities and changing the very nature of public life in California. I've spoken to enough of these parents to understand that this could happen to any of us; even kids who have no pre-existing mental health issues can become addicts almost overnight as the consequence of a single bad decision, so potent are the drugs on the street today.

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You wax poetically about parents and relatives who “couldn’t possibly do more than they’re already doing” …. Does that include Adam’s father, who drops his addict son off, right where he cops - and hands him $30?

I know you said the $30 was for food, but anyone who actually believes that has no concept of the addict mind, and therefore has zero credibility when proposing solutions.

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I admire you for your fortitude in pursuing this work Leighton. I've got family and friends' families that have been ruined by this. In all of the cases I'm familiar with, it was with drugs obtained illegally. And knowing what I do of myself, one wrong decision in this area and I would be in their shoes.

However, we've already had asylums and they were not popular. We (Americans) live in a country where a "Give Me Liberty or Give Me Death" flag still waves in thousands of places, I don't see how any government organization can realistically expect to adopt a policy of mandatory hospitalization of people deemed dangerous to themselves.

Should it happen? I think yes.

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How many addicts are schitzophrenic though? How many stop taking their meds while non-psychotic? I'm sorry if I am being harsh, but as someone with a trauma background and mental illness I am so sick of people using this as an excuse. For severely pyschotic people they cannot take responsibility. I get it. But how many are in this category and how many are psychotic because of the drug they are taking?

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It's a mix. But whoever you pin the responsibility on, it's still not going to change without intervention. I'm less concerned about the moral dimension than the question of what we can do about it, because wishing people took more personal responsibility isn't going to do to anything to turn back the tide of addiction that's destroying our cities.

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I used to think that way but until we put more responsibility back on the addict we won’t turn the tide. This expectation that they won’t take any responsibility keeps us stuck in the enabling. Don’t wish. Expect and formulate policy around that. The community does it’s part and so does the addict. The ones that don’t want to be saved won’t. Maybe we do need more moralizing. Maybe at one time there wasn’t enough compassion and it was needed but I think it’s safe to say the pendulum has swung waaaay the other way and maybe needs to re-center.

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I agree but that's what recovery is. It's the path to abstinence in which you slowly reduce your dependency while building back up your executive function, your self-respect, and your ability to look after yourself. It's literally the process of overcoming addiction by summoning your inner fortitude. Enabling is what SF does now: pass out needles and foil and provide safe consumption sites in the name of "harm reduction," with no intention whatsoever to push anyone toward sobriety.

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One hundred percent. Adam's story is sad and too frequent, but this was completely on Adam. It was a suicide, perhaps years in the making. I'm sure the parents are both not surprised and devastated.

California could add 10,000 hospital beds and 1,000 dedicated psychiatrists to them, and people would still die from their life choices. Instant escape from reality is too easy to find on a lot of streets and without drastically more severe penalties, the risks of dealing are well worth the financial rewards.

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Leighton's point in this and a number of other essays is the solution is known, it just takes the political will to implement it (which sadly requires a mechanism to compel adults to accept treatment). That will is not just lacking in California, but is subject to ideological barriers.

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Sorry - what's the solution ? I *really* feel for the person who killed himself and his family, but I'm not clear on the solution.

Looking at the industry that pours $ at the problem in CA, and has no different outcomes, call me skeptical that 'political will' will sort it.

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Jul 27, 2022·edited Jul 27, 2022Author

The solution in my opinion is what Michael Shellenberger has called for: the creation of "Cal Psych," a centralized, statewide mental health and addiction care agency *with the power to mandate treatment.* Every street addict eventually gets arrested for the crimes they have to conduct to fuel their habits. Incarcerating users is not the answer, but the threat of prison time can be used as leverage to divert addicts into treatment. That's what Cal Psych would offer: detox, long term rehab, group therapy, job training and even job placement, over the course of years, in a locked facility far from the cities with their open air drug markets.

It would be very expensive, but not as expensive as the loss of our cities to chaos and madness.

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Im a Cali resident and also lived for 5yrs most recently in that open-air insane asylum called Venice Beach, so I have some little bit of personal knowledge.

First, I just want to acknowledge and thank you for your sanity and compassion; your work and your dedication to actually helping suffering people is excellent and commendable.

That being said, I just cannot possibly trust any new grandiose social schemes in Cali, at least not with its current leadership class and one-party rule.

I lived in Venice when the Prop HHH $1.2 billion bond tax was approved and that was about 6 years ago and what has it accomplished? A few thousand apartments being built all for around $700k (!), with so many lawyers developers bureaucrats etc skimming the loot and the homeless issue only growing worse by the day.

Really, how much more in taxes should we pay and how much more money should be spent to rescue the most broken members of society? (And how many of these people are drawn here in the first place bc of the weather, social tolerance and generous social services?)

We have turned our state into a magnet for the country's most damaged dropouts and fuckups, and until a critical mass of citizens demand that some of these carrots be replaced by sticks, the problem will only get worse.

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No sir, the solution is not, and never is, more government.

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Well the market certainly isn't fixing it.

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Jul 27, 2022·edited Jul 27, 2022Liked by Leighton Woodhouse

The solution is mandatory treatment. Successful programs in other states are usually part of the penal system; that is, the participants are compelled to participate. They have saved many lives.

The reason why there is no political will is, who gives a shit about drug addicts? Almost no one. There are a lot more exciting issues anyone running for public office will want to highlight before proposing a costly and prickly (from a civil liberties standpoint) solution for drug addiction. Like trans bathrooms, for or against, really meaty Stuff That Matters.

Regarding the mountains of cash poured into California's homeless industry, again, I think Leighton's earlier essays cover that: it's part of the problem. The clients of the homeless and social services industry are not the drug addicts and homeless people they profess to serve, but the employees and contractors gobbling up all that sweet sweet social spending.

that has to change as well.

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What is it specifically in California that other states don’t seem to have these problems to such an extreme extent. I do know Prop 47 made it easier to commit theft and shoplifting to fund drug addiction. What else makes California an outlier?

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An ideological reluctance to compel sick people to accept help is the main problem in places like San Francisco.

In LA no one in local government gives a shit because it does not affect them.

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Just as it is w people and how our worst qualities can be rooted in our best qualities (and vice versa), the best (or at least most commendable) Cali qualities are what's responsible (in part) for our current social disaster.

Firstly, there's the climate and all this constant sun and natural beauty, which makes everyone want to come here, whether they can afford it or not, whether they know anyone here, whether they have any plan in place once they arrive. Cali is and has always been a magnet for the dropouts, outcasts, runaways and castaways of the rest of the country. And, if your luck runs out when you're thousands of miles away from any support system, you often end up on the street or living in your car.

Then there is just an enormous laissez-faire tolerance here (unlike any other place I've ever lived), which i think is partially rooted in the fact that Cali is still a brand-new outpost of Western Civ and most of us are from elsewhere and so there is no deeper rooted tradition to either shield, control or protect us (for better or worse).

Really the prototypical SoCal person is The Dude from The Big Lebowski: I'm cool, you're cool, you do your thing, I'll do mine, let's all get along and never pass judgment, I just wanna get high and hang out, and if there's any social dysfunction it's the fault of that eternal amorphous scapegoat, The Man.

And this extreme tolerance is very commendable for the most part, it allows people from all over the planet to come here and live peacefully together, but now we also see the downside: when your block gets taken over by a bum camp, no one steps in and tries to remove it; when your streets fill with deranged junkies, everyone just walks by trying to ignore, because, Hey, who am I to judge? (And there's also the modern complaint everyone I know makes: "The government should do something about that!")

Sorry for the long answer, there is just a lazy hazy blissed-out apathy here in Cali that is hard to explain, and I think the combination of this w the modern Social Justice ethos of performative compassion is what's led us to our bum/junkie crisis.

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Love "performative compassion" will definitely use it.

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I lived in NYC in the 80’s when coke and then crack use was rampant. I buried three friends I can think of. White, urban well educated upper middle class. You just can’t help a junkie. They’re doomed. If they’re rich they can go through 10 or 12 visits to rehab and maybe, just maybe climb out of the hole, but it’s rare. They have to get clean. That can’t happen in jail and it almost never happens through rehab. Lock up the psychiatric patients. Crack down on all street drugs as hard as possible. Close the border. Give traffickers mandatory life sentences. Put addicts into mandatory 60 day cold turkey rehab. If they habitually commit crimes get tough with them. It’s time to think about what’s best for the rest of society. These people are lost. Quit making it easy for them to destroy themselves and by doing so, take the rest of their families and friends down with them.

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"the system"

Huh. His dad bought him his last fix. This isn't the system, it's the inability of his parents to sort whatever problem this poor, disturbed kid, had.

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I'm not sure what more you could reasonably expect his father to do to save his son. He spent years doing everything in his power to intervene. A parent only has a few tools to rely on — namely, love and persuasion — and that's not nearly enough.

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No. The largest tool a parent has is to NOT be an enabler and hold hard lines. Treatment or you get nothing. You advocate for the state doing this yet don't see how the parents are acting just like the current state.

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Love doesn't mean enabling. It can mean exactly what you're describing.

Every parent I talk to is well aware of the risk of enabling and constantly worry about where that line is. Literally every parent has told me they want their kid incarcerated because they'll die on the streets — that's not enabling.

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True, in that case if they are pushing the choice between jail or treatment but the state is not allowing that then they are in a bind. The best you can do then is not give them funds.

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It's a tough one. I used to work at a program called Samaritan Village, in New York, in the 1990s--back then patients would stay in the inpatient program for up to two years. That program wasn't for the mentally ill, just for addicts, but I worked in another program that did take people with schizophrenia. California doesn't seem to have a lot of long term programs. If you have a family member who has drug addiction and serious mental illness, your best bet is probably to move them to New York.

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So, a few things.

First, suddenly expressing suicidal intent as one becomes aware of a plan for discharge is suggestive of a situation called "malingering for shelter." Even if we suppose he was sincere, it's irrelevant to the ultimate outcome, because this gentleman did not commit suicide.

Narcan has a half-life in the body of about 60 minutes. By 2.5 hours later, it is pretty much gone (10-15% of the original dose might remain.) Narcan in the ambulance would have done nothing to prevent an opioid overdose 2.5 hours or more later. It just doesn't work like that.

The half-life of fentanyl is even shorter, incidentally. So either he took a large amount of a longer-acting opioid (doubtful, unless he got Narcan in the ED, or he would not have been able to walk out) or, more likely in these circumstances, he scored more drugs after leaving and overdosed for the second time that day.

Lack of mental health beds is a problem, the lack of detox beds arguably is one as well, but before we conclude that, we have to ask whether detox, or rehab either, are actually doing anything to free people from addiction. And if we find they are (very much an open question) then the follow-up question is: Is there any evidence forcing people into substance abuse programs involuntarily improves their outcomes?

There is one and only one kind of intervention for opioid use disorder that has been proven to work: medication assisted treatment (MAT) with partial opioid agonists (methadone or buprenorphrine.) But MANY detox and/or rehab programs DO NOT incorporate/allow this lifesaving intervention.

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I spent a lot of time looking into some of these details, such as whether it's physically possible that Adam's death was from the first OD (I agree with you, it isn't). I left those forensic questions out of the article though, because they weren't really relevant to the questions I was asking.

I agree that MAT is part of the solution, but it's not *the* solution, it's just a tool. Many rehab programs use it, some as basically a permanent "solution" (I don't think being on methadone for the rest of your life is the best most addicts can hope for), some as a bridge toward sobriety. I don't see it as like the answer we're looking for, though. Like "harm reduction," it's just a useful method to deploy in a much larger recovery system that simply doesn't exist yet.

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I certainly don't think MAT is *the* solution, that's not why I bring it up. I bring it up to illustrate that the existing paradigms of addiction treatment are not evidence-based, and so we can't reform the system by simply pouring more money into this failed model. We need, as you say, a much larger recovery system. There is a phenomenon in medicine where things are so ubiquitous people assume they are necessary or in some way useful, like c-collars or strep tests, and if you try to tell people this thing we do a million times a year is not necessary and was never grounded in evidence, people will look at you like you just grew a second head. I would put "detox" and "rehab" in that category. I sincerely don't know that addicts would be any worse off if these things disappeared from the face of the Earth.

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Jul 28, 2022·edited Jul 28, 2022

I've long recognized that there are some people who just cannot function in modern society. And no matter the reason, they are just not going to abide by society's rules and mores. And, to a certain degree, that should be OK. But when we let this situation get out of hand, as we have done here on the west coast, we will have a hard time pulling back from this.

Nothing will make an addict quit except themselves wanting to quit. And if they don't want to quit, they will die, as life on the streets trying to score a high is really difficult, dangerous, and in the end, deadly. So, sadly, the current addicts will take care of themselves. And while that sounds incredibly harsh and wrong, there isn't much you can do for those people. So, the real question becomes: what do we do going forward?

1)make drugs legal, and that means legal at every step of the process and treated just like alcohol. They need to be vetted by the FDA, sold in grocery or liquor stores and that will remove some of the stigma, the street dealers, and help break the back of the cartels. This will help with a lot of low-level crimes such as auto break-ins.

2) provide a way out for those who want it. Whether it is through the church, civic groups, or what, there needs to be a path, preferable multiple paths to help end this pattern for those who so choose.

3)no tolerance for bad behavior. When someone is out on the street doing damage to themselves or others, destroying property, etc., we as a society have to frown on that. And by frown, the social and personal stigmas must be great enough to keep people from returning to that behavior. A week scrubbing public toilets, picking up trash, and things like that to start with will go a long way to making this an intolerable act in public. Much like Driving Drunk, we need to stop enabling bad behavior and really get down to brass tacks.

4) we need to really be a better job of helping those with legitimate psychiatric issues, as the need for self-medication is often the driving force behind many addictions.

I know that having drugs be legalized and sold in stores sounds counterintuitive, but we need to be honest with ourselves and realize that the drug war failed. And with that failure is so much collateral damage and social damage that it is only now possible to see. Having the addicted hide in the shadows removes a lot of people from the cycle of recovery, and as they become involved in petty crime, and quick scores of bad dope they are only going to get worse. But, like a public drunk, this needs to be handled quickly and surely.

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Hard to believe an unconscious body made a round trip to Antioch given the train turns back at Bay Point and you have to walk a few hundred feet to catch a shuttle. Might want to fix that sentence.

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My guess is he actually scored again while getting to the train. That’s what killed him, not the original OD.

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Jul 27, 2022·edited Jul 27, 2022

Is there anything on the addicts to get help here? So they have to wait a few weeks for long term care in a facility so amazing that they are gaining weight and feeling better, so they just leave? Any onus to keep taking their anti-psychotics? At what point does societial obligation end and the individual obligation begin, and is this one-sidedness part of the problem? We introduce Narcan and addicts use it to overdose repeatedly, often in the parking lot of the hosipital that saved them. Most addicts cycle through expensive free treatment multiple times. They have food and care but decline because they can't abuse people while at the shelters. Nobody seems to ask why they took this drug in the first place that everyone knows kills and maims. I have much more sympathy for alcoholics considering booze is ubiquitous in sociey and almost considered a rite of passage to adulthood, but at what point do we have the nerve to state the obvous, "Hey, maybe doing heroin is a bad idea, no matter how bad your life is right now?" Unlike the general consensus I keep hearing that "anybody can become a heroin addict", NO, only people who choose to do heroin can become heroin addicts. It doesn't strike you like lightning.

Mental health needs fixing but most of these poeple stopped taking their prescribed meds, so we know they received some care to begin with. Do we keep readmitting people who are non-compliant, and if so, whose fault is that? Seriously, the worse part was where addicts won't stay in a nice hospital waiting for FREE treatment but cry foul when they relapse.

I'm becoming callus. Let's just start handing out Darwin Awards and be done with this. Play stupid games win stupid prizes.

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Very sad. However, it's easy to blame the hospitals but, in fact, more hospitals are having shortages of nurses and doctors. We need more trained people to work with mentally ill and addicted people.

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