[subungual]

This person is right that hospitals, or health care systems in general should be working on this. It's more complicated than simply not helping people who won't help themselves. The difficulty is that no one knows the best, most effective systems or approaches for doing this, and emergency medicine resources are stretched very thin here in the United States. Emergency departments were designed for the stabilization of life threats, but in our modern collapsing medical system, limiting their scope to this falls short of community needs. There are many people whose only contact with the medical system will be the ED, and finding ways to treat and integrate them into more sustainable programs should be a goal. There are promising advancements being made, however, in initiating standard of care treatments in emergency department settings. On the opioid front, we can start suboxone in the ED, which has proven a pretty effective method of stabilizing people and increasing their participation in treatment down the road. (1)

As someone who is working on this, I don't think it's unfair for people who aren't experts in the field to recognize and call out the fact that something should be done differently. The experts agree, and many of us are trying to figure out a better path forward.

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4527523/