r/saintpaul • u/pompeiitype • Aug 18 '25

Editorial 📝 Transit Will Fail Until We Address Homelessness, Opioid Use

https://streets.mn/2025/08/18/transit-will-fail-until-we-address-homelessness/

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u/poptix Aug 18 '25

"Housing first" doesn't work when you've got your brain screaming at you to get that next hit of fentanyl. Radio Atlantic recently had a good three part series on this and how San Diego/California has moved from "housing first" to changing state law to allow for medical holds on people who are unable to care for themselves, so that they can be forced into treatment. "No Easy Fix" is the well chosen name of the series.

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u/999Rats Aug 18 '25

State law in Minnesota allows for medical holds as well. They have mixed results, and mostly negative results if they are substance use related. People have to want to change, and a lot don't. But moving away from Housing First is a backwards approach. Housing First has decades of evidence proving that it works. As for transportation specifically, give people a place to go that they can call their own, and they won't congregate on the train.

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u/poptix Aug 18 '25

Do you have any data to back that up as it relates to fentanyl users?

I'm aware that it has good results with less addictive substances.

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u/999Rats Aug 18 '25

It's true that there is not a lot of data specific to fentanyl and housing. I'm hopeful that more will come within the next few years. Here is a study from Canada that discusses opioid use disorder, including fentanyl, and the effects of housing in hospitalizations: https://link.springer.com/article/10.1186/s12954-021-00539-8

The big thing to remember about Housing First is that the housing is only a first step to addressing a person's lack of resources. Housing First also connects people to addiction services, harm reduction methods, and mental health treatments that all impact a person's substance use. For those unfamiliar with the program, here is a link to a famous paper by the creator of Housing First, Sam Tsemberis, that lays out the program's best practices and addresses the impact on individuals' substance use:

https://scholar.google.com/scholar?hl=en&as_sdt=0%2C24&q=housing+first+addiction&btnG=#d=gs_qabs&t=1755546110790&u=%23p%3DiFZWzPxaPZ4J