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PaperclipPerfector  2mo ago (text post)   20471 thread views

Culture War Roundup for the week of February 14, 2024

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This will probably get some play and is a bit of a different topic. Former CEO of YouTube CEO Susan Wojcicicki son died of a drug freshman year of college at Cal.

https://www.nbcnews.com/news/us-news/former-youtube-ceos-son-found-dead-uc-berkeley-rcna139355

The obvious implications is he took something laced with fentanyl. Culture war wise concerns about fentanyl are red coded though issues with fentanyl seem apparent in both red and blue states and people.

Overall I feel like this issue has lost its place in the news cycle. A quick google overdose deaths topped 112k in 2023 an all-time record. I am seeing a current U.S. population of 334 million. So to put this in perspective 112k multiplied by an average lifespan of 80 years is like 9 million deaths. Or close to 3% of US population at current rates will die by a drug overdose. I think I can fairly say it’s a huge issue even if you disagree with how I’m calculating the average persons risks of OD at around 3% in their lifetime.

Quick analysis of the kid he looks in shape for a 19 year old and was majoring in math so he’s the dream of any parent. Odd thing is he was found unresponsive at 4:23 pm on a Tuesday. That is going to be weird and details will come out as that time frame is more of an addict death. Versus I expected a weekend OD and he did some fentanyl laced coke/Molly during the weekend.

From people I’ve talked to opioids are amazing. I do not know if I’ve ever done them. They have to be if people do them. I’ve done molly/coke/mushrooms in the past. The big thing to me is I’m paranoid I’m doing something laced now and have largely cut out doing anything now.

The midtwit take is that dealers either sell both and cross contaminate or lace other drugs to get people addicted. Personally opinion and perhaps a difference without a difference is it’s probably lacing just so people say it’s the good shit.

Sorry for their loss.

Culture war issues

  1. Plays into the immigration debate of not controlling the border

  2. Blue states seem to be adopting a let it happen and treat but it doesn’t seem to be working

  3. War on drug topics. I don’t think the old war on drugs ever dealt with the death rate we have now but war on drugs doesn’t seem stupid when it’s a 3% population level lifetime death rate which is far higher than COVID and killing people with high life expectancy

  4. Other policy considerations. Some would say things like legalize drugs to kill fentanyl and people get “safe” drugs. Some conservative arguments that something’s should just be illegal. Opioids probably are fantastic but the death rate for someone who tries opioids seems extremely high.

My numeracy tells me this is a big problem and I believe an order of magnitude bigger problem than COVID. I don’t think it’s quite as hard coded in culture wars.

I’m paranoid I’m doing something laced now and have largely cut out doing anything now.

There are safety precautions when taking something that didn't come from a pharmacy:

  1. Fentanyl test strips
  2. Reagent test to make sure you got the expected substance
  3. Never use alone and have Narcan on hand. That way if you have an adverse reaction someone can call the paramedics in time.

dealers either sell both and cross contaminate or lace other drugs to get people addicted.

The dealer's incentive is to get people addicted to something that will get the user coming back frequently to buy more. Fentanyl is cheaper by weight than many other drugs and doesn't last very long before it puts the user into withdrawals and causes them to seek out more.

If a first-time user comes in for drug X and then get addicted to fentanyl the dealer then has a daily recurring revenue stream.

In this case a potential pipeline is that the deceased user started with a party drug in the past, but it was laced with fentanyl and he then became addicted. Like you say it is hard to imagine what other drug he would have been intending to use on a weekday afternoon that would have been laced.

some would say things like legalize drugs to kill fentanyl and people get “safe” drugs

The DEA scheduling system is absurd. They should make some of the safer ones legal (especially psychedelics) so that:

  1. People are getting a pure substance
  2. People can create safe environments to use the legal drugs in (because if the drug is legal then you can legally have medical and support staff in the environment).
  3. Takes money away from the drug dealers (who are selling impure/laced product) and creates tax revenue (which can be used on support services to get people to quit more dangerous drugs).

The trouble with legalization is that if it’s perfectly legal for just anyone to have it, it’s going to be in homes. This increases the chances of kids getting it and tryin* it at younger ages. The first alcohol most kids take is often taken from the refrigerator at home where dad keeps it around. If hard drugs become legal, the same thing happens for those drugs, kids try whatever the grownups buy and have around the house.

This is already an issue with prescription drugs that are far more addictive and dangerous than psychedelics. This risk could be further mitigated by diversion control requirements like: the newly legal drugs must be stored in a locked location that only adults have access to, a log must kept anytime the drug is consumed/sold/gifted.

If a parent allowed kids to consume the drugs then they could face harsh penalties under the existing laws regarding providing controlled substances to a minor.

It’s illegal to let kids drink at home. That hasn’t stopped them from drinking. In fact drinking parties are so common that they’re practically a rite of passage for teenagers. It’s not going to be easy to catch something like that, and even if you did, figuring out if the kid got if from mom, dad, older sibling, by himself with a fake ID, or from a friend isn’t easy.

The principal you're implicitly espousing here is that if something is too dangerous for children to have access to, adults shouldn't be permitted access to it either. That is not at all compatible with a free society.

I’m not saying never ever, however I think it’s an important consideration because it will very likely happen. And especially for more dangerous or addictive drugs, I think it’s prudent to at least ask the question about the harm done by the drug being available to younger children.

A twelve year old trying pot is not really that big of a deal. The addiction is more psychological than physical, the LD50 is pretty high, and beyond the general dangers associated with smoking anything, it doesn’t cause much harm to the body.

Something like Cocaine or Heroin I think would be worse in all of those ways. Both are pretty physically addictive, have a fairly low LD50, and cause damage to the body. I can’t see a case to be made that the risk of a child of 12 trying crack is outweighed by the benefits of having crack be legal in the US. I’m sure there’s a steel man somewhere, but it seems a pretty high bar.

There's no need for a steelman, the principle itself is invalid.

I think it’s prudent to at least ask the question about the harm done by the drug being available to younger children.

That's stealing a base. You're asking about the harm done by the drug being available to adults on the assumption that if the drug is available to adults, it will also be available to children. Which is at least qualitatively true. But it's also true of knives, guns, poisons, matches and accelerants, fireworks, classified information (right Hunter?), cars, sex toys, etc. Proposing to keep drugs illegal on the grounds that if adults can have it a child can get it is an isolated demand to child-proof the world.

Like you say it is hard to imagine what other drug he would have been intending to use on a weekday afternoon that would have been laced.

I definitely knew people who did coke on weekday afternoons in college, presumably cost wasn’t an issue for him.

Also, I thought fentanyl test strips are often ineffective for eg laced coke because it could be just a tiny fraction of the powder that’s fentanyl, so the strip could come back fine even if the drug isn’t?

I definitely knew people who did coke on weekday afternoons in college, presumably cost wasn’t an issue for him.

But coke is usually a social drug and he was found alone. If he wanted a stimulant to use alone I assume he had access to prescription Adderall or Ritalin. I don't have personal experience on this subject so this is just speculative guesswork.

Also, I thought fentanyl test strips are often ineffective for eg laced coke because it could be just a tiny fraction of the powder that’s fentanyl, so the strip could come back fine even if the drug isn’t?

That is true that there is a detection limit on test strips. You could just test a larger sample, but then you'd have to turn the coke/water mixture back to coke or take it sublingually.

The culture in public schools seems to have changed a lot in the 1-2 decades since I've been there, but surely they still tell kids, "drugs are bad, mkay"? I have a similar reaction to this as I do when people talk about the "suicide epidemic". There is a very simple solution, don't kill yourself.

Why would kids listen to a teacher and not the famous, status-signaling rapper than shows up on their YouTube feed glamorizing drugs? One of them is presenting a way to money and power, the other one is giving them homework.

Indeed, YouTube complicity in the opiate crisis is why I consider this death the least bad possible opiate death. While still a tragedy, it couldn’t have happened to a more deserving parent. I only wish that all parents of opiate victims worked in the music industry.

What the hell?

You're going to have to elaborate on "Youtube complicity." I'm struggling to imagine what policy they implemented that made you hate their former CEO more than, I dunno, the dealer. The manufacturer. Whatever rapper you have in mind.

It’s quite simple: YouTube allows drug glamorization culture and music videos to be watched by young people. For vulnerable young people, there is a straight line from idolizing a rapper to doing the drugs of said rapper. See: Lil Peep (1 billion+ views, mostly teenagers). Some of these rappers are a walking advertisement for drug use. When you’re then at a party listening to their music and there’s drugs available, you are more likely to participate in taking drugs.

dealer, manufacturer

— are not engaged in a sophisticated emotional manipulation campaign to get adolescents to find drugs cool.

I think this is all too far. Notably, crime-glorifying rap was around well before YouTube was able to become a star-maker. I don't think YouTube not being around would have made that much difference for rapping about fent charting on radio or whatever.

But I don’t think that absolves them of their crime, because as per my OP, I think all of the players involved are complicit and not only YouTube. If our culture wanted they could make this music require an 18+ identification card for consumption, but there’s too much money to be made and they don’t care about the consequences of their actions.

If our culture wanted they could make this music require an 18+ identification card for consumption

I mean, we kinda tried, though it perhaps wasn't overly strict and the high-contrast label they slapped onto those albums arguably only made them more desirable. Our culture is not set up for this.

I don’t see how allowing a certain type of content is comparable to making that content, let alone making the stuff which the content is about.

That’s the same reasoning which leads to colleges banning public speakers.

Colleges are environments specifically designed for intellectual inquiry among adults. And even then, a speaker whose entire shtick is “drugs are good and fun” should probably be prevented from speaking without serious warnings and counter arguments. YouTube is an environment for young peoples’ entertainment, which is very much unlike a college. The content is algorithmically fed to young people, and YouTube profits off of it. As a parent doesn’t escape jail by saying they only allowed their children to drink alcohol, a content server should not escape guilt and shame by saying they only allowed impressionable young people to watch music videos glamorizing opiate use.

Notably, YouTube bans holocaust denialism, which is a less bad thing than the promotion of opiates.

Guilt and shame isn’t equivalent to jail time. Algorithmic service isn’t the same as actually providing drugs. Which, at least in freedom land, isn’t actually illegal, not from a parent to his or her child. Not that youtube provides a parental or even collegiate level of authority over viewers!

Frankly, the analogy is completely incoherent.

We could imagine a scenario where a parent serves their child a reasonable amount of alcohol in their presence. But clearly, in this context, “a parent allowing their child to drink alcohol” isn’t referring to that. This is a discussion on illicit drug use, so a reasonable reader would interpret that in its intended meaning, as an illicit act. But I can be more detailed, if that’s important:

As a parent doesn’t escape jail by saying they only allowed their children to drink too much alcohol when they were not around

There we go.

Guilt and shame isn’t equivalent to jail time

But what do they have in common? They are considered the just responses to an infraction. Our society deemed it an infraction to allow children to drink alcohol illegally, and parents aren’t excused by claiming they merely permitted it and merely had the alcohol out in the open for easy access. Now, at least among many people, showing young people a glamorous depiction of drug use by their idol is considered shameful. The YouTube CEO is not excused from shame by merely permitting it and merely having it in the open for easy access.

So the analogy is comparing the relevant commonality of the two cases. Analogies are by their nature simplifications to save time. But your analogy re: college didn’t work because the expectations of freedom of speech on a college campus are distinct from the expectations on an app used by young people and children, from which the CEO derives profit per view.

Algorithmic service isn’t the same as actually providing drugs

Is it the same as providing a desirable lifestyle of drug use? Why or why not?

How would you react if someone went up to a teen and showed them really cool depictions of drugs? That would be pretty shameful, right? YouTube does this knowingly using middle men.

Does YouTube allow the “promotion of opiates”? From their website:

the following content isn't allowed on YouTube: Hard drug use or creation: Hard drug use or creation, selling or facilitating the sale of hard or soft drugs, facilitating the sale of regulated pharmaceuticals without a prescription, or showing how to use steroids in non-educational content.

I think videos explicitly encouraging illegal opiate use are probably banned on YouTube given they likely involve the use of hard drugs.

Does YouTube allow the “promotion of opiates”?

Yes. From their website: https://youtube.com/watch?v=mRTV-j87wOo

Yea I do them drugs, I don't give a fuck What u think

I don't eat food but I take blues

You can hear more of his lyricism in works such as Overdose, Benz Truck, and Giving Girls Cocaine. All on YouTube. He is not the only rapper who glamorizes opiates.

videos explicitly encouraging illegal opiate use are probably banned

Not if they encourage the drug through catchy lyrics and interesting music videos designed to be memorable to adolescents.

There's a lot that Susan gets flack for, chief among them being the CEO of YouTube during its TV-ification.

Second least bad, surely. It could've been a Sackler.

I have a similar reaction to this as I do when people talk about the "suicide epidemic". There is a very simple solution, don't kill yourself.

You sound like you have a complete disconnect from other people's experiences and suffering, while also believing in free will.

Is this sarcastic? Do you genuinely not understand that many people live lives of despair and feel they have no hope of things ever getting better?

Most people don't want to OD from drugs or commit suicide. They do because their lives are purposeless, hopeless, and devoid of meaning.

"They do because their lives are purposeless, hopeless, and devoid of meaning."

Y'know, most people would say that people kill themselves because they feel their lives are purposeless, hopeless, and devoid of meaning.

Or alternately, because they think doing some drugs would be fun or cool, and pick up a habit.

I doubt the Stanford freshman son of the CEO of YouTube had nothing to live for.

Why doubt that? Just because he had status and wealth doesn't mean he had anything he cared about deep inside. Our culture is corrosive to purpose and meaning, I'd think wealthy scions would be more susceptible to a lack of meaning in some ways since so much is handed to them.

"Purpose" and "meaning" seem to be used here to refer to some sort of internal phenomenon which could probably be produced by the right drugs.

Oh I’m not disputing that the rich can be suicidal at all, just that if he was, it probably wasn’t because of a lack of opportunity in his life.

Yeah, I think we're talking past each other a bit. Opportunity =/= purpose and meaning. If anything a massive amount of opportunity can drain purpose and meaning, as you get slammed with the paradox of choice.

Whenever Richard Cory went down town, We people on the pavement looked at him: He was a gentleman from sole to crown, Clean favored, and imperially slim.

Maybe this is an obvious reference for the Anglophones, but why not just post the poem in its entirety?

You actually misspelled Cal with Stanford. Which is sort of curious because even though I’ve heard Stanford is no fun now her son would have seem connected enough to get into Stanford with a mere mortals test scores. I would assume 99% of people who get into Stanford and Cal go to Stanford.

Yes, I read somewhere it’s typically considered easier for extremely well-connected Silicon Valley individuals to get kids into Stanford than Berkeley, private colleges having more flexibility. Seems he was probably pretty smart then.

Material success is not known to prevent suicidal ideation. Humans require a purpose greater than “make widget, do drugs and women”.

Yeah if anything, it's probably living too much that got him.

I tried estimating this another way -- 32.1 crude death rate from drug overdoses in the 12 months ending 1Q2023 (last data available) divided by 944.1 crude death rate from all causes in the same period. The result is 3.4%, so your estimate checks out. Assuming nothing changes, of course.

Among other things, as with COVID, one change will be killing off those likely to be addicted. As the easily addicted die faster than they are born, we'll start to run out.

I would be not so sure. I listened to some podcast where they had good data which supported a dysgenic effect thesis which boiled down to the fact, that getting pregnant is in modern times just another one of larger cluster of female risky behaviors ranging from having many sexual partners, having unprotected sex, being more prone to substance abuse etc. Remember, all it takes for evolution is for people to reproduce. It is "perfectly okay" from evolutionary perspective to have mother of three overdosing in her early twenties only for her offspring taken care for by welfare state to likely face similar fate.

The vast majority of overdose deaths are between 25-54, and the highest rates are between 35-54. In the same way that Covid didn't necessarily improve the overall health of the population, but it killed off so many immune-compromised or aged people that if we got a new similar disease it would have a lower death rate because the dead wood has cleared out. Eventually we're going to be killing off addicts faster than we are producing new ones, even if the overall rate of addicts doesn't change.

Eventually we're going to be killing off addicts faster than we are producing new ones, even if the overall rate of addicts doesn't change.

Why? If addicts reproduce faster than the rest of the population before they die due to OD, and if addiction is heritable, then we will in fact not be killing the addicts off faster than we are producing new ones. That is my argument: susceptibility to addiction is related to overall susceptibility to impulsive behavior including things like having unprotected sex, forgetting to take pills and other risky behavior related to fertility.

A quick google overdose deaths topped 112k in 2023 an all-time record.

[...]

I believe an order of magnitude bigger problem than COVID.

Trying to put some actual numbers to this:

According to the NYT COVID data page, weekly COVID deaths in the past year have ranged from 490 (July 2-8) to 2,462 (Jan 7-13) or 0.9%-3.6% of all deaths. Of course, this is deaths from acute COVID, actual COVID deaths is somewhat higher than the official numbers, but hard to get good data on how much higher, so let's stick to these numbers. Also, going back further the numbers are a lot higher and less regular, I'm assuming the past year is a much better approximation of what to expect going forward than including any older data. (Also, I'm not seeing an official 2023 death count... looking I found this 2022 report published in May 2023 so it's probably just too early for finalized 2023 numbers.)

112k/52 = average 2,153 deaths/week from overdose deaths, doesn't seem hugely different from number of COVID deaths, although since overdose doses are mostly young and COVID deaths are mostly old, measuring in QALYs would likely paint a different picture... although if you're measuring QALYs, not trying to measure the impact of post-COVID conditions seems unfair, and I'm not sure how that would affect the conclusion.

There's also the obvious issue that COVID is practically unavoidable, although there's ways to reduce the impact (vaccination, antivirals, not getting old being healthier), while avoiding an overdose is straight forward: Don't Do Drugs(tm). Or, at least, that's the oversimplification in the popular conception of the two.

Yes when I say OD are an order of magnitude (or close to that) bigger issue it was adjusting for life expectancy loss.

Yeah, it's bad.

If you have a 3% chance of dying of an OD, and the average OD death shaves 50 years off a person's life, then easily 10% of life expectancy reduction is due to overdoses.

Someone might object that, when a junky finally ODs, society has not actually lost that much. Which is somewhat true. But that's only because of how much was already lost when a healthy person was gradually turned into a junky in the first place.

Let's consider the millions of people who are harmed (but not outright killed) by drug addiction. In terms of QALYs lost, drugs are one of the worst perils our society faces, possibly up there with heart disease and obesity.

A new war on drugs would save the equivalent of millions of lives.

A new war on drugs would save the equivalent of millions of lives.

If, really big if, it is effective.

Comparing the badness of various problems to COVID isn't a meaningful basis for a response because the response to COVID wasn't driven by how bad it is.

It's tempting though, isn't it?

"We spent 10 trillion for zero (or possibly negative) value during Covid. Surely we can spend 10 billion on my issue".

Also works for Afghanistan/Iraq wars.

I want to take this in another direction. - 'The universal empathy for the remaining life of a parent who has lost a child at a young age.' Susan is a billionaire with power, access and status. Everything you wish for, she has. And I am certain that she would give it all away to bring her son back.

Events like this hold up a familiar but often ignored mirror to the face of young people like me. My parents are still around. I will have kids one day. I have the one thing Susan has lost: time and agency.

Or close to 3% of US population at current rates will die by a drug overdose

No matter how much money I earn, it takes 1 not-so unlikely event to unilaterally turn me into a hollow husk of a person. Whether that be a permanent disability due to a car accident, death of child/spouse or slightly misplaced tap on my head.

From a utilitarian perspective, I am better off minimizing the changes chances of a unilaterally disastrous event, than trying to get billions. Because the money only matters if these disastrous events don't happen. I could live an unimpressive life where my kids live tiil a ripe old age, and I bet Susan would trade my life for hers any day. The negative utility of losing a child is THAT high.

Have kids, help them not kill themselves and you're already living a life that's the envy of many billionaires.

After a 24 hrs existential crises resulting from having the mirror held to my face, I shove it into the closet of 'things to think of when I have time.' I wake up, 2 continents away from family, 1 continent away from my partner, and innocently continue grinding it out in hopes of making a couple of millions in silicon valley at the expense of my 20s and 30s. Some people never learn. Hopefully, I won't stay this way for too long.

Even on this anonymous no-name forum, I feel the urge to say I'd never wish such a tragedy on anyone. I wish she finds the support and space needed to get through this difficult time.

Susan is a billionaire with power, access and status. Everything you wish for, she has. And I am certain that she would give it all away to bring her son back.

Have kids, help them not kill themselves and you're already living a life that's the envy of many billionaires.

I think you are typical minding someone who is not typical minded. There were dozens, if not hundreds of things Susan could have done differently in how she waged the culture war in her position of chief censor of one of the largest media platforms in the world to prevent this from happening. Not just for her own family, but prevent it from happening for hundred or thousands of other families. She did not. I do not expect her to change her behavior.

We'll see. Maybe I'm wrong. Maybe Youtube will adopt as capricious and neurotic a censorship regime against drugs as they have against guns, Republicans, COVID "misinformation", claims of election denial, etc. But somehow I doubt it. I sincerely doubt it.

I really quite doubt your culture war complaints against her (valid as they are) have anything to do with her freshman son probably accidentally taking some drugs laced with fentanyl. I also doubt if she was previously a YouTube drug warrior that would have saved her son's life.

There were dozens, if not hundreds of things Susan could have done differently in how she waged the culture war in her position of chief censor of one of the largest media platforms in the world to prevent this from happening.

You can't change human nature. Young guy (so risk taker), college age, smart (so thinks he has it all figured out and won't end up like the dumb addicts) and wants some fun. Drugs are no big deal, the whole war on drugs thing is right wing conservative Republican freakout. Plenty of people do drugs and have no problems. Heck, his parents generation, so there's a good chance his parents did too, did drugs in their time and they're successful, economically productive citizens. All his friends and the people he's hanging out with are trying different things. It's just fun, he's not going to become an addict.

You can tell your kids till you're blue in the face "don't do thing" but you can never guarantee it will catch, never mind if you're poor or a billionaire thought leader.

Drugs are no big deal, the whole war on drugs thing is right wing conservative Republican freakout

designed to tyrannize innocent BIPOC, of course.

See Portland moving to re-criminalise drug possession. My oh my, who could ever have foreseen that only nice, respectable, non-criminal, non-junkie drug users who confined it to the weekend for recreational fun, didn't need to steal or rob to feed a habit, and were perfectly rational about their drug use would not be the only ones using drugs under the scheme of de-criminalisation? Who could have imagined that making it easier to have and use drugs would mean the types who shoot up in public, beg, steal, and act like feral dog packs would also be out and about taking advantage of this? Such a shocking surprise, why did nobody warn them about it? No, it's all the fault of those right-wing conservative Republicans this utopia never materialised!

Maybe Youtube will adopt as capricious and neurotic a censorship regime[...]

Indeed, this is what I suspect. Wojcicicki and Troper (yes, the kid had a father) will indeed try to do something, but they'll do it by flailing in ways that wouldn't have helped their kid, that probably won't help anyone else's kid, and will do general harm.

Apocryphally the billionaire Bill Ackman who was recently also behind ousting of Claudine Gay from Harvard may have gotten redpilled by his own daughter who is apparently very into Western Marxism and overall Social Justice, at least according to what she - a History Teacher - follows on LinkedIn.

This is depressingly true. So much activism is centered on "root causes" which often expresses itself as trying to isolate people from the consequences of their actions. And it only makes things worse and worse. Doing the wrong thing is much worse than doing nothing.

I hope I'm wrong and she comes out hard for criminalizing drugs again and locking dealers in prison. But I doubt it.

criminalizing drugs again and locking dealers in prison

Good news: they are currently illegal to possess and dealers get locked up. That's true almost everywhere in the US, Portland and Seattle excluded.

I'm still a believer in the desirability of liberty, if too blackpilled to be an actual libertarian, so I can't endorse that. Fentanyl and other opioids and most stimulants remain criminal, so I don't know what you mean by "criminalizing drugs again"; certainly I doubt he died from pot. The drug warrior approach might have saved him from death, though perhaps he'd have preferred it to the life in prison or drug rehab drug warriors would offer. If his death was indeed due to adulterated drugs or just drugs of unusual purity, then the libertarian approach might have saved him as well.

In many places in the United States, it is the policy of the police not to arrest anyone for drug possession, and even drug dealing is tolerated. For example, you can consume and sell drugs with impunity in my hometown of Seattle. This is what is meant by "decriminalization". Recriminalization simply means that existing laws are enforced again.

Recriminalization certainly doesn't mean that a young person would be thrown in prison for life for possessing a small amount of drugs. That is an absurd strawman.

‘If you get caught doing drugs, your life is over, and we WILL catch you if you try doing drugs,’ sounds like exactly what’s needed to fix the opiates epidemic.

You like shrooms, LSD, cannabis, ok, I don’t approve but we can argue about legalisation or appropriate penalties. But for anything harder, don’t do them, don’t associate with people who do them. It cannot possibly be that hard.

Q.E.D.

(and also this )

More comments

Recriminalization certainly doesn't mean that a young person would be thrown in prison for life for possessing a small amount of drugs. That is an absurd strawman.

The charge gets upgraded to possession with intent to distribute, for all but the most trivial amount of drugs. Maybe you can plea-bargain it down, but if the prosecutor is in a law and order mood that week (re-election coming up?), no. You don't get life for that but you do get prison time unless there's a diversion program (rehab). The conviction disqualifies you from most white collar jobs, but fortunately still qualifies you for the kind of marginal labor you can do to make just enough to get a fix until you get tossed into jail again.

This is just so far away from the world I'm living in.

In my city, people who have committed literally dozens of violent crimes are being released same day only to commit more offenses. Meanwhile, more than 1 in every 2000 people in my county died of a drug overdose last year, and drug use is practiced openly.

I am honestly starting to even doubt how many of the abuses of the War on Drugs even happened. Whenever I hear a story about "he dindu nothin', just some weed", you dig deeper and find a criminal with a rap sheet a mile long, and so they stick him with some trumped up drug charge. A bad thing? Possibly. But its a far cry from the paranoid fantasy that smoking a reefer could land you in prison for life.

The number of people in U.S. jails for drug possession approaches zero.

Let's not let more than 100,000 people die each year, and millions more become addicted because we're worried about very rare police or prosecutorial abuse. And if they really wanted to get you, they could get you for something else anyway.

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Your claim is that her son wouldn't have OD'd if drug content was banned from YouTube?

I mean, maybe? The King is never played by the actor playing the King, but by all the other actors around him. Lots of people say that drugs are bad, but look at how online communities treat drug content compared to how they treat content that they think is actually bad. /r/drugs still exists. /r/coontown and associates were nuked 10 years ago. Lots of social information here.

Reddit allows many gun subs even though most progressive elites hate guns. I think the difference versus racist subreddits is that advertisers don’t mind depictions or discussion of drug use (after all, AMC had ads on Breaking Bad) but don’t want to be next to racism.

And, of course, /r/drugs is probably one of the best deterrents against drug use on the internet. Scrolling down even the current main page there is horrific story after horrific story.

You're not wrong. They should quit the crappy 'drugs bad' PSA and show stuff from that subreddit instead.

Coke made my cock soft ended up having lesbian sex

The time I accidentally banged an old Asian woman

Tripping on LSD when a luxury sex doll arrives and things start getting weird.

i magnetized my dick on meth

My best friend just died

/r/drugs still exists, but the question is if drugs would still exist if /r/drugs did not.

From people I’ve talked to opioids are amazing... They have to be if people do them.

Maybe I'm an outlier (or I was taking an insufficient dose as described in Drug users use a lot of drugs), but Opioids weren't that great unless I was in pain.

My experience made me much more sympathetic to the idea that the "opioid epidemic" is an appropriate reaction to the chronic pain epidemic (particularly among blue collar workers with physically-demanding jobs. Who would've thought.)

I haven't run into any obviously drug seeking patients myself in India, the people getting morphine or fentanyl prescriptions climb the pain ladder at the same rate anyone else does.

I was prescribed tramadol once, for severe sudden back pain and costal tenderness (?acute pancreatitis but the the enzymes came back normal), and it was a warm glow, but I never felt the urge to get more once the course was over. It did at least help with the agony, when the strongest NSAIDs didn't. The maximum I took daily was equivalent to about 10 mg of morphine, oral.

I suspect it's a lot of people trying to cure SLS (Shit Life Syndrome), and well, if you can't fix your problems you might as well not notice them.

My friend was given fentanyl at a hospital for pain relief after an injury and had completely the opposite reaction. He said it felt so good he would almost certainly have tried to get more if he’d known how. Even now, he said, when something good happens part of him is thinking, ‘Okay, but fentanyl was so much better’.

This was a young, happy man with the world at his feet. The reaction was purely physical. I think @JulianRota is right, there must be an individual difference in response.

there must be an individual difference in response.

From my subjective experience, an individual difference is everything when it comes down to psychoactive substances. People tend to differ much more neurologically then physically, which is unpleasant truth for many. But we cannot see this on the first sight, so this thought rarely comes through our minds. For my part, I get almost no pleasure or kick from drinking alcohol. And I come from heavily-drinking culture, so this is a huge social burden. I have drunk hundreds times and most of the time I get instantly sleepy and then heavily depressed. And I know people who are extremely aggressive and psychotic when drunk, so the response is indeed deeply varied.

FWIW, I was given IV morphine before surgery for a broken arm as a kid and still remember how amazing it made me feel. They could've marched a firing squad in there with my death warrant and I wouldn't have cared in the slightest.

OTOH, from a very small sample size it appears that I'm allergic to hydrocodone. I got some of those after having wisdom teeth yanked out and they just made me feel sick and unpleasantly intoxicated.

If there is a current epidemic of chronic pain, it's come in tandem with a broader shift away from physically demanding jobs and non-work activity.

My experience was similar. Sure, being zombie and staring at the wall doing nothing was better than being in infernal pain but I sure as hell prefer not being a zombie given the choice. I can’t think of a single actually pleasant thing about the experience.

I've heard from people in the medical industry that the effect of prescription opioids is roughly split in thirds - about a third get basically no effect at all or strictly bad effects, another third get effective pain relief but no desire to do more once the pain is gone, and the final third feel dangerous addictive desires in addition to pain relief and are prone to addiction and all the resulting issues if other factors in their life line up right/wrong.

Meanwhile, it seems really weird that there is suddenly a "chronic pain epidemic". Why should there be such a thing now? Humans have been doing lots of strenuous manual labor for all of recorded history - especially before the industrial revolution. Have we all suddenly got worse somehow? Is it maybe related to signs that the modern diet is mostly terrible?

and the final third feel dangerous addictive desires in addition to pain relief and are prone to addiction and all the resulting issues if other factors in their life line up right/wrong.

This may roughly correspond to estimates that 27% of Chinese males were addicted to opium as aftermath of opium wars and wide availability of the drug. To be honest, I do not get the whole idea of how decriminalization of drugs will be so fantastic with these and other natural experiments during 19th century. There was a reason why newly discovered drugs got banned in the first place.

It's probably not everything, but it doesn't help that we've gotten a lot fatter and older on average.

Pain doesn't have to be physical. Psychological pain is a thing and it is just as real a sensation as physical pain. See e.g. phantom pain which is pain experienced by an individual in a limb that has long since been amputated. Phantom pain is a very real thing we've known about for centuries so it's not some new fad or whatever.

What happens when a limb is cut off? Necessarily, the nerves that come from the central nervous system have to be cut somewhere as well. So now you have some unnatural nerve ends dangling around in your stump, which may still attempt to send signals to the brain. And since these signals are fundamentally nonsensical, they can be interpreted as almost anything - and in doubt, the brain often interprets unusual signals as simple pain.

Worse yet, even if a theoretically perfect surgeon does such a great job that these nerve ends do not send any signals whatsoever, our brain is actually wired to expect them. So now it's trying to interpret the lack of signals, which, in doubt, ....

I'm actually not against your main point - I think that modern life often does not fulfill our natural urges and fails to offer adequate alternatives, and that this can lead to depression, chronic pain and similar issues. But IMO phantom pain is quite physical in nature.

Because the pain isn't physical, it's mental/emotional/spiritual. Look up biopsychosocial concepts of pain, or for a more classic take, Healing Back Pain by John Sarno.

As someone who has experienced chronic pain for almost a decade, I can confirm that physical issues are not the cause of my pain at least. I've become convinced that the vast majority of chronic injury and pain is not a mechanical issue either.

Meanwhile, it seems really weird that there is suddenly a "chronic pain epidemic". Why should there be such a thing now? Humans have been doing lots of strenuous manual labor for all of recorded history - especially before the industrial revolution.

Tissue damage is only one part of pain.

https://www.painscience.com/articles/pain-is-weird.php

There could be other factors that might explain a higher rate of pain today.

Looks like an interesting article, thanks! I will read later. But that, and TheDag's point would imply that any "chronic pain epidemic" is just a broader symptom of, I guess I don't really know what to call it, the broad cultural sickness we have in the West and America right now, and treating with opiates is clumsy duct-tape over the real problem that mostly won't help much.

Yeah, there's something going on besides chronic pain. Opioids are also prescribed for acute pain (e.g. after an operation) despite the fact that acetaminophen and nsaids are similarly effective. When my wife got her wisdom tooth removed, the surgeon prescribed oxycodone a week before the surgery even happened. It's crazy.

I guess I'm somewhat lucky in not having many issues with serious or chronic pain. I did get my wisdom teeth removed, and I don't think I was prescribed or took anything particularly strong for that, but I don't recall very clearly. I had to get a root canal a few years ago, and I do remember that hurting pretty badly the next day. I had been prescribed Tylenol with Codeine, which I took and worked pretty well at dulling the pain, but left me pretty zonked out. Definitely not something I had any interest in taking if I wasn't in serious pain. I think I only took that for 1 or 2 days, and the pain was mild enough after that that I didn't bother.

Humans have been doing lots of strenuous manual labor for all of recorded history - especially before the industrial revolution.

And in pain much of the time. Especially as they aged. The term "backbreaking labor" isn't new.

Eh maybe. But then still, why an opioid epidemic now? Opium and derivatives have also been around for a very long time. Is it just that much more appealing in pill form and prescribed by your doctor than in smokeable or snortable form?

It is prescribed by a doctor, imparting legitimacy. And in pill form you can pop a couple in a quiet moment to yourself anywhere, something you can't do with a syringe or opium pipe. And the pharmaceutical companies only figured out in the fifties and sixties how to mass produce doses that would leave people mostly functional while still taking their pain away. Before that those drugs were prohibitively expensive and so people just drank themselves to death.

There certainly was an opium epidemic in the 19th century US, but most addicts were middle class or wealthy, predominantly women; the poor could afford neither the drug nor the doctor to introduce it to them (you could buy it over the counter, but the poor then were very poor indeed), and it was primarily injected by said physician. There was a population of civil war veteran addicts too. It was estimated that 0.5% of the population were opium addicts, a much larger percentage presumably used opioids occasionally. Apparently there are about 2.1 million opioid addicts in the US (estimated number with ‘opioid misuse disorder’) today, which is approximately 0.6% of the population. This doesn’t seem like a huge difference.

Opium smoking only became a major issue at the very end of the 19th century, and was primarily a feature of Chinatown opium dens which were necessarily not fully geographically distributed across the whole country but concentrated in major cities. As soon as opium addiction became recognized as a major problem in the 1890s it was restricted and then banned pretty quickly, physicians were shamed for prescribing it (both within and beyond the profession) and so it was never even introduced to many working and underclass communities. There were also horror stories from Western travellers in China describing the opioid epidemic there (eg half of all young men wasting away in the opium dens of major Chinese cities) such that politicians acted relatively quickly.

Today opioids are much easier to produce synthetically, much easier to sell (eg on the dark web) and ship, global trade offers far more places to hide large volume illicit imports, and a decline in communal identity means that social pressure (around almost everything) is less than it was in 1890.

So I don't really dispute any of that, but it feels like this conversation is getting a little shifted or circular, I suppose as a consequence of it being with so many people. What I'm really arguing against is ulyssessword's point that "the 'opioid epidemic' is an appropriate reaction to the chronic pain epidemic". I find it pretty hard to buy into, humans have been doing manual labor for millennia, opium has been around for millennia at varying levels of availability, but only now somehow is blue-collar manual labor so strenuous that using opiates to dull the pain is an appropriate response.

It seems more likely to me to be something like the point that sarker and TheDag are making, that the pain is actually a symptom of broader cultural disease, not a natural consequence of manual labor.

Uh, I'm pretty sure that the laboring classes who had access to a lot of drugs have proceeded to do a lot of drugs for all of recorded history. "They drink way too much" is a pretty universal blue collar stereotype, because that's a nearly universally available drug that's priced at blue-collar affordable levels in most societies.

Opium may have existed in 1890, but it wasn't widely available in the US the way it often is now. Booze was the drug of choice for construction workers and miners suffering from nonstop pain; when we decided it was a medical issue doctors of course can't say "have you considered needing some AA?" and so prescribed oxycodone instead. I suspect that the issue will fade with the normalization of medical marijuana.

I think it’s much more available now and at much greater purity. If you have a script, you can pop into any pharmacy and have 100 pills in minutes. You don’t even need to get out of the car. Unless you lived in a big city, you probably had a harder time getting patent medicines simply because it required a trip to those cities, and it came as a bottle of a couple of ounces mixed with all kinds of stuff. Modern medical insurance covers a lot of the cost of modern opioid drugs where the older patent medicines were comparatively expensive. Cheap easy pills that you can get in large quantities without leaving your car are probably going to be a bigger addiction risk than something that’s expensive and sold in small quantities.

Opioids definitely do affect different people differently. I've had them prescribed once to take after a surgery. I took one dose immediately after the surgery and decided I'd rather no pain medication at all than a second dose. (Pretty sure I took ibuprofen, not nothing.) I've discussed this with others and gather this isn't an entirely uncommon reaction, although certainly far from a majority opinion.

My experience was extremely similar. When I got my wisdom teeth removed, they gave me a massive bottle of vicodin. Dozens of doses, apparently intended to be taken daily for months. I took two doses: one several hours after the surgery once the initial anesthesia wore off, and then another two days after the surgery when the pain became very acute. The rest of the pills in that bottle went untouched.

It occurred to me how easy it would have been, and how profitable, to sell the rest of the pills. Although I’ve never used the “Dark Web”, nor do I have any familiarity with the sorts of websites or venues people use to buy and sell drugs, I can’t imagine it would have been difficult to figure out. And, sadly, there is at least one member of my family who would have taken them off my hands if I’d offered. I also did not want to throw them away in my dumpster, for fear of attracting a swarm of local homeless. I ended up returning the bottle of pills to the surgery center, over their objections, and told them to figure out what to do with it.

On the one hand, this could be read as a story about how easy it is for people to inadvertently become addicted to opioids; I went in for a minor surgery, was given a huge bottle of pain pills by a trusted medical professional, and told to use them to my heart’s content. I was fortunate in that I did not end up experiencing very much significant recurring pain as a result of my surgery, and therefore was not seriously tempted to use more than what was absolutely necessary. If my surgery had produced significant recurring pain, who’s to say that I would have had the fortitude and self-control to resist burning through that whole bottle of pills?

On the other hand, even if I had done so, I could not plausibly have claimed that it was inadvertent, or that I didn’t understand the risks. Every thinking adult with even a cursory understanding of current events is aware of the gravity of opioid addiction. Now, if there had been something laced into those pills without my knowledge - if I’d thought I was taking immunosuppressants and it turned out they had fentanyl in them - this would obviously be beyond my control. My sense is that people who talk a lot about the “opioid crisis” tend to imply that this type of situation - people taking opioids without realizing it, and becoming addicted - is very common. My naïve sense is that probably the much more common scenario is more similar to my experience, wherein people are given massively unnecessary and inflated doses of pain medication by doctors, and fail to exercise proper self-control over how much of that medication to use.

I know it's a popular narrative that fentanyl is mostly being brought by illegals across our porous border, but it's mostly not true. Most fentanyl, by a wide margin, is smuggled into the US by citizens across ports of entry. This makes obvious logistical sense. A US citizen driving a vehicle across the border is both much less likely to be searched and can transport far more drugs per trip than someone hoofing it with a backpack across miles of desert and river and mountain.

That might be true but I don't see how we could possibly know. What that source says is:

Over 90 percent of fentanyl seizures occur at legal crossing points or interior vehicle checkpoints, not on illegal migration routes, so U.S. citizens (who are subject to less scrutiny) when crossing legally are the best smugglers.

So we seize more at the places where the border is controlled and we don't seize much at the places where it's uncontrolled. This sounds a lot like the guy who only looks for his lost keys under the streetlights.

Believable to me. It’s small in size so you could easily sneak it in. But I have no expertise. It’s a nice narrative for anti-immigration to connect the two.

Looking at the fentanyl deaths per year shows the dramatic spike beginnings in the 2015-2016 timeframe. I wondered what caused this spike, why that particular point in time and why so large? Fentanyl has been around for a long time, first being synthesized in the 50s.

An explanation that sounds plausible: opioid prescription rates have been increasing since at least the 90s, either for legitimate or illegitimate reasons (as alleged in lawsuits against Purdue pharma etc).

Opioid prescriptions peaked in 2010 but by this time we have a large subpop hooked on opiates. when prescriptions are heavily curtailed, addicts still need their fix, so they turn to illegal substitutes. First heroin (heroin ods start to rise in ~2011), and then illegal fentanyl. Fentanyl wins out because it's potency probably makes it cheaper than heroine per "unit high", and likewise it's high potency makes oding easier. not to mention the profliferation of fentanyl analogues which further complicates dosing appropriately.

If true it seems like another, particularly tragic , lesson in unintended consequences, or cruel indifference if you subscribe to the allegations against the pharma companies.

And unfortunately the same features that make it cheap and deadly also make it harder to fight a drug war against it. It is apparently easy to manufacture and total volumes trafficked are relative low, in many cases being trafficked through international mail.

EDIT: Looks like I screwed up the math and chart stuff and it's all kind of weird. CDC says drug overdose is .32% of deaths, but that doesn't jive with their listed number of deaths in 2023, off by an order of magnitude. I'm wondering if deaths have more than one listed cause, or if some set of these numbers are projections or something.

As to why we won't talk about this more: We've talked about the opioid epidemic a lot, which is what this stat is about. 20% of opioid deaths are on prescription meds, and as far as I can tell the large majority of fentanyl users started with prescription opioids and then switched to fentanyl when they could no longer obtain/afford their growing addiction to prescribed meds.

Basically, you can't solve this problem without majorly overhauling the US healthcare system, which is a political quagmire that has been swallowing careers and movements whole for decades (Hillary Clinton started her political life as First Lady pushing for healthcare reform, and it didn't accomplish any more then than it has now).

Sure, you can imagine a world where you lock down the borders enough to stop all imported fentanyl (although the link to immigration is an obvious misdirect, imported drugs tend to come over sea borders and ports not the Mexican land border, and the programs to find caravans of people vs suitcases of drugs are completely different). But we import it because that's cheaper, not because it's the only way... US criminals are well capable of making their own fentanyl to sell if other supply lines close up.

You have to stop demand, which means fixing the prescription opioid epidemic, which means massively overhauling much of how we think about healthcare and the entire healthcare and insurance industries. That's disruptive, expensive, and politically difficult... not to mention opposed to the interests of a lot of rich capitalists. So, good luck on that.

You have misplaced the decimal point. 112000/3500000 = 0.032 which is 3.2%

Hmm yeah. That's weird, I thought it was right because the CDC also says .32%. Don't know where the discrepancy is then, unless it's that deaths can be listed as having more than one cause?

I'm seeing

The age-adjusted rate of overdose deaths increased by 14% from 2020 (28.3 per 100,000) to 2021 (32.4 per 100,000).

but 32.4 per hundred thousand is 0.0324 %.

I think that the issue is that CDC is dividing (overdose deaths this year) by total population, but we are trying to get a feel for the meaning of the number of overdose deaths by doing the calculation

(overdose deaths this year) divided by (total deaths this year)

We are pondering: people are always dying, what proportion of deaths are overdose deaths?

One anticipates that (total population) divided by (total deaths this year) roughly approximates life span, so 70 or 80. But the ratio is more like 100. Err, I'm seeing in other calculations that (total population)/80 over estimates (total deaths this year) by quite a lot. Total population is around 334 million, total deaths for 2021 3.4 million. The ratio is surprisingly (confusingly?) close to 100.

Yeah I think that makes sense.

The US has around 3.5M deaths per year, 112K/3.5M=.32% of all deaths, pretty straightforward.

3.2%

EDIT:

Also, looking at the graph, on first glance it looks like overdose deaths spiked during Covid lockdown, and are already dropping quickly.

Are we looking at the same graph (Figure 1a. 12 Month-ending Provisional Counts of Drug Overdose Deaths: United States)? That apparent downward trend has the note "Underreported due to incomplete data", and the predicted value of deaths is holding steady at 110-112k.

EDIT2: @guesswho (do pings work in edits?)

EDIT: Looks like I screwed up the math and chart stuff and it's all kind of weird. CDC says drug overdose is .32% of deaths, but that doesn't jive with their listed number of deaths in 2023, off by an order of magnitude. I'm wondering if deaths have more than one listed cause, or if some set of these numbers are projections or something.

Still not sure where you're getting .32% from. From their first paragraph, 0.032% (32.4 per 100,000) of people died of overdose deaths (mostly opioid) in 2021. If you round it off to 1/100 people dying each year, it adds up to 3% of deaths.

I'm looking at this graph which runs from 1999 to 2021 and depicts a terrifying rising trend.

I wish someone would explain what’s up with my math and 3% rate. My extrapolation feels right but something not jiving with the lower percent of deaths.

I don’t buy the prescription opioids to fentanyl theory but can’t prove it. Any user I know of (young people) don’t have any reason for pain meds. Even someone I’m thinking of who did prescription meds was also just in the scene and doing both. If anything it would feel like an adderall as a kid to party scene pipeline.

“People who overdose on drugs don’t have long lifespans” - obviously because they died from an overdose. Absent substance abuse a 24 year old drug overdose would have lived to old age. There isn’t an underlying medical condition that would have killed them young absent.

I’m not sure what health care reform has to do with substance abuse. Data I have seen already have Americans doing more prescription drugs so better health insurance/single payer and more money spent on health care wouldn’t seem to shrink the amount of pharmaceuticals American are using. Now if you meant targeted reform like stricter limits on prescribing then it would likely do some good.

PO->fentanyl pipeline I was getting mostly from personal observations plus common sense, but also backed by this paper. Though that paper isn't only about fentanyl so maybe it's not a strict majority for fentanyl itself.

For healthcare I can imagine a variety of policies including stricter prescription control, but really I'm thinking about something bigger than that.

I suspect that a lot of things we prescribe long-term pain meds for could be treated with combinations of things like rehabilitative therapy, biofeedback therapy, various surgeries, personal trainers to maintain overall health, etc. And a lot of things that do need pain meds could be prevented from turning into a long-term addiction with close monitoring by a doctor or nurse to test whether patients still need the meds and help them taper off slowly while using exercise/rehabilitation to recover promptly.

(obviously not all chronic pain conditions are like that, but I wouldn't be surprised if 60% of long-term opioid cases could be resolved with something in these genres)

The problem is all of that takes expensive one-on-one care and treatment by a variety of professionals, as well as some type of personal relationship with medical providers where they remember your name and your issues and are forming and executing long-term plans to work through them with you, and all of that is both more expensive than pills and not the way the system wants to be designed. The system is very much geared towards insurance only supporting the cheapest treatment in the short-term, which is normally pills, and in having an atomized care model where you get 15 minutes with your doctor and they follow a checklist to prescribe you something and then your relationship with them is over and you have to start from scratch if you want another appointment.

I really think the opioid epidemic in large part stems from opioids maximizing metrics that the modern healthcare and insurance industries judge themselves by - it 'solves' a ton of problems at a fairly low cost with very little physician time spent and no expensive in-care facilities needed. I think we could improve this and a lot of other medical problems if we weren't so focused on those metrics, but that would require really fundamentally changing the way the whole industry works.

The problem is all of that takes expensive one-on-one care and treatment by a variety of professionals, as well as some type of personal relationship with medical providers where they remember your name and your issues and are forming and executing long-term plans to work through them with you, and all of that is both more expensive than pills and not the way the system wants to be designed.

Not to mention a tremendous amount of personal discipline, faith, and ability to work through pain for years and years. Trust me, as someone who has done PT and put in over ten thousand hours into stretching/exercise to deal with chronic pain, it is brutally difficult. Easily the most challenging thing I've struggled with in my life.

I wish someone would explain what’s up with my math and 3% rate. My extrapolation feels right but something not jiving with the lower percent of deaths.

3.2% is correct. His .32% was either a typo or a calculation error.

Now if you meant targeted reform like stricter limits on prescribing then it would likely do some good.

I think this experiment has already been tried. Opioid prescriptions are the lowest they've been in decades, down 50% from 2010. Curiously, the downward trend in prescriptions coincides with the upward trend in opiate ODs

https://thegarrisonproject.org/wp-content/uploads/2022/02/opioid-prescribing-1400x788.png

https://drugabusestatistics.org/wp-content/uploads/131/opioid-prescriptions-and-opioid-overdose-deaths.png

Wouldn't be surprised if the short-term and long-term trends are different here - cracking down on prescriptions while tons of people are addicted will force them to look for non-prescription opioids which are more dangerous, but in the long run it may reduce the number of people who get addicted in the first place.

as far as I can tell the large majority of fentanyl users started with prescription opioids and then switched to fentanyl when they could no longer obtain/afford their growing addiction to prescribed meds.

This is another drug warrior talking point. It's probably true, but the main study in support of it I have seen (with heroin, not fentanyl) includes a small detail which the drug warriors generally fail to mention: the prescription did not belong to the eventual street drug user.

Yes, this is correct, the media image (as seen in Dopesick and the Netflix version of it) of legal oxy prescription > illegal oxy purchasing [ > heroin ] > fent is extremely unusual. Most oxy prescriptions are to older people who aren’t taking taxis from retirement homes to buy fentanyl on Sunday afternoons in any great numbers.

Purdue and others were right that opioid abuse and the fentanyl epidemic is overwhelmingly because stupid children and family members stole legitimately prescribed opioids from relatives and then, when grandma didn’t get any anymore because she died or recovered from her fall, they search for an illegal equivalent. Then they sell or give various drugs on the way down to their friends or acquaintances, exacerbating the problem.

Every year millions of competent, middle class and above Americans get prescribed opioids for pain management, do their prescribed course and move on with their lives without incident. The Sacklers were just unlucky that a combination of grifting pill mill doctors (among the greediest professions in America) and feckless underclass communities cost them their reputation.

She got what she voted for. In fact, she got what she weaponized her platform to convince everyone to vote for.

I know, I know, she's a Party member in good standing, and these policies were only supposed to sacrifice the proles in the name of progress. She was voting for this to happen to you, not her sweet prince and future Party apparatchik.

This won't change anything. At most it will be taken as a test of faith. That she sacrificed her son for The Party, and progress. At worst it will be directly blamed on red tribe... somehow. Some MAGA extremist got to him. Not unlike how Paul Pelosi's attacker, a drug addled insane criminal in a city where drug addled insane criminals are given completely free reign to do as they please, was smeared as somehow being a product of MAGA America and not SF's abysmal policing and keeping of public order.

Taking glee in the misfortune of others is a bad thing. We should aim to rise above such petty and base pleasures and be sad about the suffering she must now be going through, regardless of her actions and beliefs in the past. At least he was probably in complete bliss when he passed out and so did not suffer. But still it is a sad case of life being severed short and a reminder that one day we too will pass from this world.

I don't say this as someone who is even against people dying from an overdose. It's probably one of the nicest ways to go out too. I can make a strong argument that on net drug overdoses are positive for humanity as a whole (not in this case obviously but when you average out over the kinds of people who overdose the calculus changes significantly). However that does not mean that each and every such death is not a minor tragedy on its own, and we should be sad about this and recognise what the surviving family of the person who just died is having to go through.

In fact in this case the suffering is probably even worse than normal. Consider the fact that Susan Wojcicicki and her partner are probably more empathetically developed than the average person who just lost a family member and you'll realise the suffering they must be going through right now is an experience far worse than that suffered by most people in their situation. I sincerely hope they are able to find peace and wish them the best in this troubled time.

This post has gotten a bunch of reports, and while Susan Wojcicicki is a public figure and we usually relax the rules about being unnecessarily antagonistic to public figures, it seems to me that if you want to dance on someone's grave (in this case, a dumb rich college kid who ODed) you should justify it with a better reason than "She's one of my tribal enemies so Ha! Ha! (insert Simpsons gif)." The OP was about fentanyl and drug policy in general: your response is just culture warring.

What is the program of Republicans to ensure higher quality cocaine that isn’t laced with fentanyl for rich young Americans?

Strict drug laws and closing the border. The latter won’t do anything about this issue but the former can at least plausibly reduce the tendency of rich young people to do drugs.

My inclination is that if anything, strict drug laws make events like this more likely, because even very rich people end up getting drugs from underground sources. who knows where this batch of fentanyl originated? Where if drugs were legal, this kid would probably have gotten top-brand shit.

In Japan, drugs are illegal and almost nobody does drugs. The secret, oddly enough, is getting rid of the underground sources because they’re illegal.

The whole ‘if it’s illegal people will do it without supervision’ business is half people who think it’s fine and probably do it themselves, and half people whose moral codes proscribe actual enforcement of the laws

Unless the secret is, you know, being Japan.

The numbers I’m seeing here are all over the place, but the largest seizures were like 2,000 kg/yr. Meanwhile the US border seizes 82,000 kg/yr of meth alone. This can’t just be lack of enforcement.

Because in Japan nobody is stupid enough to try it, and if they do they don’t have the layers of procedural and legal protection they would in America. Japan has something like a 90% conviction rate.

Obviously there are other factors, most notably land borders, but I think the vast majority of the discrepancy comes from severity of enforcement.

With all these other factors, why do you think severity of enforcement makes the difference?

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I don't feel too strongly about this, obviously there's a whole bunch of factors involved here, but it's not like enforcement cannot result in a dramatic decrease in crimes that need enforcing against (see El Salvador) or lack of enforcement resulting in an increase (see post-BLM murder rate).

It’s definitely possible. Which is why I find it a bit premature to say the secret is getting rid of underground sources.

Weirdly I would say rich young people want cocaine to be expensive. If you could buy coke at 7-eleven for the price of a Red Bull it wouldn’t be a status symbol having the coke in the club/after-party but a lower class stimulant.

Anything can be a status symbol if it comes in an expensive, fancy bottle.

"How expensive drugs are" has little to do with how likely the children of billionaires are to experiment. "How likely you are to be arrested and prosecuted for simple possession" has a lot to do with it; we like to think of 18-20somethings as thinking they're invincible, and they certainly have a high tolerance for risk, but upper class kids are actually keenly conscious of living in a zero sum competition to stay at the top of the ladder. I'll bet this kid would never dream of getting a hooker because of the legal risk(which seems like it's probably not that high), despite being young and male and probably wanting some casual sex, because he knew getting prosecuted for solicitation would leave him with a permanent record. Putting drugs in that basket is at least theoretically a thing that strict drug laws can do.

Rich young people still smoke weed though, and that’s cheap now.

I'm reminded of the old clip of an alleged 'jewish Democrat candidate' gleefully contextualizing how many white men are killing themselves.

In ingroup/outgroup terms, if my enemy is dying, I can only shrug my shoulders. Is it by his own hand? Wow, how curious, I can't imagine why he would do that. I can't contextualize his death in a wider context. It's just happening. Probably due to some failure on his part, obviously. There's not wider causal chain at play, no broad narrative to examine. Because if there's one thing I know, it's that my people are innocent, and my enemy is guilty and deserves it.

Now, if a member of my ingroup dies, that's not their fault or mine. There's a wider context, a system, that's at fault. We need to do something!

That's at least the rhetorical implication of noticing this event. Maybe now something will be done since the 'people with power' will take up arms for one of their own dying. In that sense, this is a joyous occasion for the 'have nots'. The more 'elite' children that die, the more their parents are forced to take up the common cause of others who have had to live in with such conditions for much longer. Conditions that people like Susan Wojcicicki had helped create, facilitate and ignore for a long time now. Some might even be waiting for any brave soul to take aim at more direct causal factors, like the Sacklers. Why do they get to exist free of the conditions they inflict on others? Not only that, they get to profit from it.

I think posts like this help illuminate where one stands in the hierarchy of everything. Those with power can place landmines in your environment, and if you or yours step on them you just get to suffer whilst they get to profit. The worst part is that your only recourse as a 'have not' is to hope that someone with power also steps on a landmine so that they just might lead your cause forward. A sort of validation of your suffering. That's it. Patriotism/national identity doesn't play a part, voting doesn't play a part, 'the voices of the many' doesn't play a part. The statistical significance, the economic impact, none of it matters even if it is so often acted like it does matter in so many different contexts. In the modern western democracy these things don't matter at all. The only common cause people can find is suffering. In clear terms: If a powerful jew isn't suffering your problems, you will just have to live with them.

This is not unique to modern western democracy, nor are powerful Jews the only one taking advantage of the hierarchy of everything. You are describing power. Power has not changed in thousands of years.

Power might not change but who benefits from it does, depending on who has it.

Are there any other large-scale problems our society faces where we need a “powerful jew” to personally suffer before we can make progress?

All of them, but it was taken care of two millennia ago according to the Catholic Church.

Ok that’s funny because I didn’t even consider the obvious joke.

That dang Original Sin anyway.

In clear terms: If a powerful jew isn't suffering your problems, you will just have to live with them.

It's interesting that at the beginning of this paragraph you say that something might be done about drugs and by the end you are talking as if something has already been done and those damn Jews just don't care about anything until it affects them.

Luckily, there are so many powerful Jews that odds are high at least one of them is suffering from any given problem we gentiles might face.

White suicide rates are higher than black suicide rates in the US, although the gap is closing fast; black rates have risen by 20% or so in the last 5 years, white rates have iirc declined very slightly. As with birth rates the gap will close. Natives have the highest rate of all, which hasn’t changed.

In general elites, being more likely to live in eg. Manhattan than the median middle-class white suburban American, are more exposed to, say, psychotic violent homeless people hanging around in Central Park or whatever than ‘normal’ people of their race. It’s not a good predictor (the average NYT editor or Dem political advisor takes the subway, they don’t have bodyguards or chauffeurs).

Drug deaths and related "deaths of despair" have been wildly underappreciated for at least a decade. They tend to kill prime age people, and for reference they dwarf US annual losses in Vietnam (the worst year -1968 - was about 17,000; average over 20 years was about 3,000).

Preventable drug deaths have been compounding YoY since at least 1998, when there were about 11,000 "preventable" deaths. About 80% of deaths are due to opiates. Max statewide variation is almost 10X, with Nebraska, South Dakota, Iowa, Texas near the bottom (approx 14 deaths/100k), and West Virginia, Tennessee, Louisiana, Kentucky at the top (about 60 deaths/100k). Cali, NY, Washington, Oregon are middling (about 27 deaths/100k). Large clusters are found in the rust and coal belt. Unsurprisingly, "manufacturing job loss predicts a substantial share of drug and opioid overdose deaths for women and men" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7725949/).

Opioids probably are fantastic

In my experience, there is a threshold for enjoyment depending on the person. I simply didn't find opiates all that interesting (prescription, tincture, inhaled), even at highly inebriating levels. Nevertheless, vs other drugs, the likelihood for life-deranging enjoyment is probably unmatched.

https://injuryfacts.nsc.org/home-and-community/safety-topics/drugoverdoses/data-details/#:~:text=In%202021%2C%2098%2C268%20people%20died,%2C%20homicide%2C%20and%20undetermined%20intents.

https://www.cdc.gov/nchs/pressroom/sosmap/drug_poisoning_mortality/drug_poisoning.htm

I doubt fentanyl will ever be as radioactive as covid because of the element of choice. Nice people feel like they can just not buy fentanyl, so they don’t care as much. Obviously the children angle changes this a bit but I to be a bit harsh I still think it’s basically true that only fuckup teenaged take hard drugs.

Might still get some traction like cigarettes but not fury in the same way. Personally what really infuriates me is cocaine users acting like they have no responsibility for gang violence in London.

Personally what really infuriates me is cocaine users acting like they have no responsibility for gang violence in London.

Stopping the use of cocaine by respectable middle class people in London would be easy, just have the police raid high end clubs, posh pubs in Chelsea and Clapham and a few private parties in affluent neighborhoods and search (and charge) everyone with the drug, and do so persistently every weekend for a year or two and the issue would solve itself. But they prefer to go upstream.

Middle class people know their situation is extremely precarious and would usually be ruined by criminal conviction; that they use cocaine so openly is a testament to the fact that the British police almost never prosecute or even arrest hard drug users unless they’re extremely visible or otherwise annoy them.

Agree completely. I once had someone pretty high up in the Met (London Metropolitan Police) proselytise me for legalising hard drugs. His argument was that they caused too many problems with blackmail.

Obviously he has the right to his opinion but I think it’s a pretty bad look for a senior police officer. I wouldn’t be surprised if he’d been taking something himself.

this issue has lost its place in the news cycle. A quick google overdose deaths topped 112k in 2023

"112k ODs is a statistic"

-Stalin

Additional culture war topic: my understanding is that most fentanyl is exported by China. How might this tie into the "calling it the Wuhan flu is racist/the lab leak hypothesis is racist" narrative?

Precursors are exported by China and then the drug itself is made in Mexico, isn’t it?

I'm pretty sure that tying it into Mexico would be considered racist by most of the same people for whom tying it to China would be considered racist.

You can't even blame China for exporting precursors because precursors have many many different uses. It's like blaming a steel mill for selling someone an ingot they used to forge a sword to behead people with.

clearly we need to secure the border so that we can get quality drugs again!

Cocaine seems to be far too risky in the US now, possibly in much of the world. And even if it’s not laced, there are so many people with undiagnosed heart issues who could easily die from a dose that others would be fine with.

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