This weekly roundup thread is intended for all culture war posts. 'Culture war' is vaguely defined, but it basically means controversial issues that fall along set tribal lines. Arguments over culture war issues generate a lot of heat and little light, and few deeply entrenched people ever change their minds. This thread is for voicing opinions and analyzing the state of the discussion while trying to optimize for light over heat.
Optimistically, we think that engaging with people you disagree with is worth your time, and so is being nice! Pessimistically, there are many dynamics that can lead discussions on Culture War topics to become unproductive. There's a human tendency to divide along tribal lines, praising your ingroup and vilifying your outgroup - and if you think you find it easy to criticize your ingroup, then it may be that your outgroup is not who you think it is. Extremists with opposing positions can feed off each other, highlighting each other's worst points to justify their own angry rhetoric, which becomes in turn a new example of bad behavior for the other side to highlight.
We would like to avoid these negative dynamics. Accordingly, we ask that you do not use this thread for waging the Culture War. Examples of waging the Culture War:
-
Shaming.
-
Attempting to 'build consensus' or enforce ideological conformity.
-
Making sweeping generalizations to vilify a group you dislike.
-
Recruiting for a cause.
-
Posting links that could be summarized as 'Boo outgroup!' Basically, if your content is 'Can you believe what Those People did this week?' then you should either refrain from posting, or do some very patient work to contextualize and/or steel-man the relevant viewpoint.
In general, you should argue to understand, not to win. This thread is not territory to be claimed by one group or another; indeed, the aim is to have many different viewpoints represented here. Thus, we also ask that you follow some guidelines:
-
Speak plainly. Avoid sarcasm and mockery. When disagreeing with someone, state your objections explicitly.
-
Be as precise and charitable as you can. Don't paraphrase unflatteringly.
-
Don't imply that someone said something they did not say, even if you think it follows from what they said.
-
Write like everyone is reading and you want them to be included in the discussion.
On an ad hoc basis, the mods will try to compile a list of the best posts/comments from the previous week, posted in Quality Contribution threads and archived at /r/TheThread. You may nominate a comment for this list by clicking on 'report' at the bottom of the post and typing 'Actually a quality contribution' as the report reason.
Jump in the discussion.
No email address required.
Notes -
One example. Fundamentally, the claim is that Purdue/FDA believed that, with non-abusive use, extended release was less likely to result in addiction. This is probably true for some value of true (interesting discussion to be had about RCTs, selection effects, ideal/typical use/abuse, with connections to things like obesity/alcoholism/etc.), which then led to physicians being much more nonchalant about prescribing them. Thus, the pipeline was born, and there have been plenty of profiles of 'kingpins' running straw patient networks to siphon as many pills as they could into the streets. (The Sacklers didn't need to personally set up networks of doctors/patients.) This entire chain worked together to accomplish the important final outcome: more pills on the streets.
Given the beliefs about this pipeline, its mechanism of operation, and its final outcome, one can pretty much take the entire proposition to be, "This is a way to get pharma-quality opioids onto the streets." It's a work-around, yes. But any utilitarian consequentialist, who also believes the preliminaries about making pharma-quality opioids, should think that this work-around is an absolute utilitarian Good (TM). They could agree to quibbles on many edges, but they should absolutely endorse the project as a whole.
But really, we can divorce ourselves from any specifics. Let's just assume a hypothetical world, and it's purely questions about the pipeline that are in play. It's like the Underground Railroad, but for pharmaceutical opioids. Sure, it's not the abolitionists' ideal world; it's a kludgy work-around, but it gets more pharmaceutical opioids into the streets (gets more slaves away from slavery). Different abolitionists might quibble with different details, but at least somebody would be willing to stand up and say, "Getting slaves out of slavery is a Good, and if we could get more slaves out of slavery via the Underground Railroad, it would be Better." Similarly, somebody should be willing to say, "Getting pharmaceutical opioids into the streets is Good, and if we could get more pharmaceutical opioids into the streets, it would be Better." Would you agree with that?
Yes, there were people running straw patient networks and unethical doctors to prescribe to them. But the Sacklers weren't doing this; not personally and not through proxies; it was a side-effect. This was not, so far as I can tell, a goal of theirs, and that would be required to satisfy your idea that drug legalizers should somehow lionize the Sacklers.
Your AMA Journal of Ethics column, BTW, is crap. It claims "patients became dependent on the prescription drugs and moved on to cheaper and readily available illicit drugs, including heroin and fentanyl." with a footnote that makes no such claims. May as well cite Porter and Jick.
I would agree that pharmaceutical-quality opiods displacing low-quality opiods on the streets would be a good thing. Pharmaceutical-quality opioids adding to low-quality opiods would be a bad thing. (I think recreational drug use is most often a bad idea, though I do not think it should be illegal). We can see that when pharmaceutical-quality opiod supplies dry up, low-quality opiods substitute for them, but I think strictly speaking there has not been strong evidence for the reverse; I would expect it to happen under true legalization but for it to be caused by the entry of high-quality suppliers into existing black markets seems less certain.
I don't know what you mean by this. I don't think this is a knob we can tune, even in our hypothetical model. In our hypothetical model, we can basically just turn up/down the quantity of pharmaceutical opioids that make it to the street. We can't really determine whether they displace low-quality opioids or add to them. The market would decide this, right? Unless you're saying that the project of pumping more pharmaceutical opioids into the streets is only Good if it's combined with some other form of crackdown on low-quality opioids?
I think the fundamental claim underlying a lot of positions is that if we just turned the knob of increasing pharmaceutical opioids on the street, then the market will totally, definitely, automatically treat them as a substitute, and they will displace low-quality opioids. This is like, the basic claim that allows people to continue on a chain of reasoning that legalization -> pharmaceutical opioids become widely available -> substitution of pharmaceutical opioids for low-quality opioids -> unmitigated win. I think if you're saying that this chain of reasoning just doesn't hold, because we just have no idea whether they'll substitute or add, then I would view that as being a pretty generic argument against the type of drug legalization reasoning that I've been saying all along doesn't go through. Like, it would appear that we actually agree?
I expect that a drug user given the choice between, at equal price per dose, pharmaceutical opiods and shit put together in Mexican lab with random Chinese ingredients and cut with God-knows-what, would choose pharmaceutical opiods. However, I would not expect a black market to reliably give that choice. Black markets tend to have a major problem with fraud.
I think that is not actually the claim of those who want legalization, and does not follow from the claims of those who want legalization.
Has there been a whole lot of fake Oxy pills? I imagine it would be a bit challenging to make high-quality counterfeits. I imagine there would probably be some fraud around the edges; hell, people can go on Amazon today, a totally white-looking market, and order regular products from China that turn out to be fraudulent. But my sense is that if we truly turned up the dial on dumping pharmaceutical opioids into the streets, then the prices would plummet, and we'd only have small amounts of fraud around the edges (why go to great lengths to make counterfeits when supply is plentiful and prices are cheap?). Why wouldn't that be the case?
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link