# Is the opioid death toll a thing in all of western society?



## D_W (21 Jan 2021)

Separate topic - coming out of the Capitol thread. The statistics about alcohol and death are surprising. I looked them up as part of that discussion and generally don't carry around arguments like that. 

Less on the alcohol thing and more on the overdose deaths. The movie industry and other things in the states have always provided us with odd portrayals of addicts vs. alcoholics, for example. If you knew a kid in a bad house with alcoholics (abuse, etc. all rolled into that), it was "that's a shame, but oh well, what can you do about it". If you brought up such things as weed (which I have no interest in and never did, and never tried, but it's fairly benign), you could get the older folks totally fired up. Including the alcoholics. The perception was an odd thing. Alcohol is a gaba agonist from what I understand. Take it away and someone who needs it to remain calm has no ability to control their fear. Gaba agonists tend to be something that you have to taper off of over a long period of time to change your body's regulation (but being no expert on alcohol, I'm guessing the lack of inhibitions and impaired judgement makes tapering pretty difficult to implement). Since I don't get a particular thrill out of it, I wouldn't have any difficulty doing this, but people who do get the thrill ..not the same. 

On to the statistic that came out of the discussion - drug overdoses in the US are at least 10 times higher than firearm homicides that don't involve gang or drug-related crimes (sorry to offend anyone who thinks I should count those - I don't think you'll get them to go away and you have near zero chance of getting caught in them). the remaining number is something like 6000 and some fraction of that again has an avoidable element, but I can't see the data parsed further to find out what's "regular people run amok". So the number could be 20 or 30 times. 

We're also keenly aware now thanks to publishing of information that a lot of the deaths are people who start with a prescription, find something they really like (just as I'm thankful for not having the lightswitch on effect from alcohol, I'm glad that I've never had any short term medication from a surgical procedure, etc, that was particularly thrilling). 

What's the cause of all of the prescribing? The first thing you'll hear from simplified story tellers here in the states is that it's greedy docs and drug companies. I'm sure that's some part of it. Just about everyone who works has some level of greed and likes to grow their business. But what I'm interested to know is the other side of the cause here with the opioids, and that is that our medical association gets fascinated with ideals. Two that stand out to me is if you go through a low row and go to a psychiatrist here (something I had to do due to an adverse reaction to a migraine medication - a simple beta blocker), the psychiatrist will attempt to figure out how to make you happy "all the time" or "almost all of the time". I may be one of the few, but I think this is a dangerous thing to aim for, and said the same. 

On the pain side, the medical society here apparently (relaying what I've heard from physicians) decided that pain was an important treatable issue and that the goal is no pain. This is, again, a pretty dangerous target for the average person. I've never taken an opioid and probably never will, but I understand that some people get the warm fuzzies from them above and beyond pain relief, but even for those in the latter, the dangerous part about the treatment is that there can be pain relief and reasonable functionality. As tolerance builds, it takes more, but the medical directive states that physicians should treat pain as they would any other condition. 

The outcome of this was predictable. 

Is this a universal international thing, or is it only in the united states (as in, I know there are pharma abusers everywhere, but is it as prevalent elsewhere in a per capita basis?). An equivalent basis in the UK by population would be something like 12k deaths per year with some sizable fraction of those being opiate addicts starting with a pain prescription.


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## Woody2Shoes (21 Jan 2021)

I believe that the US particularly suffers from fentanyl misuse. It seems terrifyingly easy to go from a therapeutic dose to a fatal one - particularly when combined with other (prescription or otherwise) drugs and alcohol.









Why fentanyl is deadlier than heroin, in a single photo


Drugs users generally don’t know when their heroin is laced with fentanyl, so it's easy for them to inadvertently take a deadly dose of the substance.




www.statnews.com





I think that drug misuse patterns are different depending on local supply and on local 'fashions' - British middle class folk happy to snort cocaine would probably never inject heroin, for example.

I also think that it is dangerous to consider 'weed' to be relatively benign. In the UK, cannabis is generally much more potent than it used to be - partly because of genetic engineering or selective breeding of plants, and partly because of synthetic additives.


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## Rorschach (21 Jan 2021)

I think it's less of an issue here due to our prescription practices although our rules and (overly cheap) medication does cause a lot of waste.


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## Woody2Shoes (21 Jan 2021)

I think that in the UK there is a considerable over-presription of anti-depressants (which can have pretty nasty effects on mental health). One of the surprising things for a Brit visiting the US is the extent of 'consumer' advertising of drugs on TV etc. "Ask your doctor about XYZ..."


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## Jameshow (21 Jan 2021)

The tide is changing here 

Both antibiotics and opiates usage are being discouraged in many situations. 

Pain clinics and social prescribing are increasing as ways of reducing dependance upon pain killers.

Also the GP system is only legal way to opiates and they aren't on easy repeat prescriptions so the chances of becoming addicted are restricted.

Cheers James


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## D_W (21 Jan 2021)

Woody2Shoes said:


> I think that in the UK there is a considerable over-presription of anti-depressants (which can have pretty nasty effects on mental health). One of the surprising things for a Brit visiting the US is the extent of 'consumer' advertising of drugs on TV etc. "Ask your doctor about XYZ..."



I wonder how much effect those advertisements have here - we disregard them in general. But, I'd imagine they're for hugely profitable drugs (like combination drugs her that cost several multiples of their constituents). I guess the point of them is to hit the people who have whatever condition being described. "tardive dyskinesia" and COPD inhalers are on TV constantly. As are things aimed at older folks and billed straight back to Medicare (mobility things, diabetic supplies, etc). 

I tend to watch the off-channels (not the .1 major network current stuff, but the .2 -.5 channels here tend to have older reruns, which probably explains why I see the stuff above. Lots of over the counter gimmickry, too, like hot and cold belts, various pain relief rubs, etc). 

Agree on the antidepressants. Their efficacy vs. passage of time is something like +15% (resolution of depression, etc). Most other approaches tried independently (exercise/talk) are more effective, but the latter are secondary approaches here and the former initial primary - presumably due to cost. It's cheaper to put someone on a generic antidepressant than it is for the care system to send someone to talk therapy. 

Not glossing over folks who have "bad wiring" who can't get right no matter what, but rather the folks who can by addressing their issues head on.


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## Fitzroy (21 Jan 2021)

My father was a pharmacist and most of the class of medications you mention are heavily controlled, my expectation was that deaths would be low. A quick search shows its in the hundreds not thousands.









Current UK data on opioid misuse


Opioids Aware: Data on opioid misuse




fpm.ac.uk





Fitz.


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## D_W (21 Jan 2021)

The number that I provided was for all drug overdose - no data on opioid overdose (I'd speculate that itself is rare, but overdose after folks end up turning to heroin would be higher). That was 67k for all of the US for all causes. I'd imagine also that some of those overdose deaths are overlap with the suicide totals. The daughter of a neighbor here (these people are older now, the daughter would be in her 60s if she was still alive) overdosed on railroad tracks and was subsequently run over. I guess there's a chance that was accidental, but not likely. It's something the woman said - not remotely close to something I'd ask for additional information on (the mother is now deceased - she was over 90 - unlucky that one child had a drug problem, another is a dry drunk - and a grandchild was later arrested holding up a gas station due to heroin addiction. A really odd illustration as it was once a close family and both grandparents were professionals). 

At any rate, it looks like a comparable total for England and Wales last year was 4400. Overall a much lower rate. 

starting about 5 years ago, controlled substances are now digitally tracked so that people developing tolerances can't string along separate doctors at the same time (which seems to have been a problem that was common and also encouraged by a small number of private practitioners - most of those either in jail now or no longer practicing). Our death rates are declining and I would anticipate they will continue to as you can't easily get absurd stories of Keith Richards type dosages legally. 

There's a casualty in that process, too, I guess, which is immobile people with structural pain (as in, permanent injuries, etc) who will trade a much shortened lifetime for high dosages of pain relief.


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## D_W (21 Jan 2021)

Opioid epidemic in the United States - Wikipedia







en.wikipedia.org
 




This chart would suggest I'm wrong about my suspicion - and this chart fairly well identifies the reason for the uptick. 








Opioid overdose - Wikipedia







en.wikipedia.org





There's a multi-year lag in this data - fortunately the totals have declined in the last couple of years, but not to pre-epidemic levels (which were closer or perhaps below the 4400 figure by per capita rate). 

All of this is foreign to me other than knowing stories like those of my neighbor, but a tradesman here who works on heavy equipment told me that most of the people in his profession are broken down by the time they're 40, and that initially, opioids allowed a lot of them to continue working as normal to a later age (one would have to ask the question how much more irreparable damage they're doing to their bodies if they're covering up pain in the interim, but......he didn't think too much of my idea of planning for something like that going forward. "they're taking these away and making it harder for the working man to get by").


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## Glitch (26 Jan 2021)

Recommended viewing. Great documentary - 'The Pharmacist' on Netflix
Shocking insight into prescription drug abuse in one town in the U.S.

Trailer on YT The Pharmacist trailer


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## Torx (26 Jan 2021)

Chasing the scream is a good read


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## Spectric (26 Jan 2021)

Woody2Shoes said:


> I think that in the UK there is a considerable over-presription of anti-depressants (which can have pretty nasty effects on mental health).


I believe that Tv advertising also has a major impact on mental health, really stupid adverts delibrately aimed at the more vunerable / gullable, they want you to give them all your money under the guise of gambling is fun, trying to sell pointless life insurance policies and then policies that might help pay some of your funeral cost. Does anyone take any of these adverts seriously, they are brain damaging propaganda that in some cases are almost scams.


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## billw (26 Jan 2021)

Woody2Shoes said:


> I think that in the UK there is a considerable over-presription of anti-depressants (which can have pretty nasty effects on mental health). One of the surprising things for a Brit visiting the US is the extent of 'consumer' advertising of drugs on TV etc. "Ask your doctor about XYZ..."



I can assure you that anti-depressants have had anything but a nasty effect on my mental health. Especially when I've forgotten to take them......


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## billw (26 Jan 2021)

Spectric said:


> I believe that Tv advertising also has a major impact on mental health, really stupid adverts delibrately aimed at the more vunerable / gullable, they want you to give them all your money under the guise of gambling is fun, trying to sell pointless life insurance policies and then policies that might help pay some of your funeral cost. Does anyone take any of these adverts seriously, they are brain damaging propaganda that in some cases are almost scams.



Of course people take them seriously, that's why they exist. Funeral plans are the new PPI - the financial sector looks for ways to part people from money in return for worth less stuff. The government will eventually crack down and compensation will be paid, which will be funded by the next dodgy product that crops up.


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## billw (26 Jan 2021)

@D_W I think part of the problem is that everything is profit-driven in the US. It's better to sell something risky and take the chance of being sued than not sell it at all. Do corporations care? Of course not. They'll *say* they do, but they're only remorseful when caught just like any criminal.


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## selectortone (26 Jan 2021)

About ten years ago, while my daughter was living in Canada, she had a nasty fall at speed off her bike. She was in severe pain and was prescribed OxyContin. She told me later that she took one and it made her feel so wierd she threw the rest away. Now, my daughter was a bit of a free spirit back then, and recreational drugs were not exactly unfamiliar to her at that time, so for her to find them too much says a lot. Or perhaps her familiarity warned her off.

This was before the news in the Americas became full of stories of people getting hooked on them, and the great difficulty survivors had getting off them. I remember reading about a well respected lawyer who was prescribed opioids for chronic back pain after an accident and became hooked. It was so painful trying to wean himself off them that in the end his life fell apart and he killed himself. I shudder to think what might have happened if my daughter had stuck with that initial prescription.


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## D_W (26 Jan 2021)

I think it's a two edged sword. Despite the complaining media, the standard of living here is high and the tax burden is relatively low. Corporate efficiency is almost entirely responsible for that. 

In the case of the pain pills, at the outset, everyone probably thought they were gold. You can take them (apparently, I've only taken the codeine as a child mentioned above) late in a working career and keep working. They apparently control post surgery pain well, and for older folks, allow them to relax. 

The trouble is, they're not good for you in the long term. 

I can say at this point that my retirement accounts have about twice or three times as much money in them as I put in them. Without corporations, I wouldn't have it. I don't have the easy answer for it because no heavily socialized country has ever lasted long term. We're running the experiment right now, I guess.


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## D_W (26 Jan 2021)

selectortone said:


> About ten years ago, while my daughter was living in Canada, she had a nasty fall at speed off her bike. She was in severe pain and was prescribed OxyContin. She told me later that she took one and it made her feel so wierd she threw the rest away. Now, my daughter was a bit of a free spirit back then, and recreational drugs were not exactly unfamiliar to her at that time, so for her to find them too much says a lot. Or perhaps her familiarity warned her off.
> 
> This was before the news in the Americas became full of stories of people getting hooked on them, and the great difficulty survivors had getting off them. I remember reading about a well respected lawyer who was prescribed opioids for chronic back pain after an accident and became hooked. It was so painful trying to wean himself off them that in the end his life fell apart and he killed himself. I shudder to think what might have happened if my daughter had stuck with that initial prescription.



I've heard the same about it. Codeine made my stomach hurt so bad that I forgot I had a broken wrist (which never hurt that bad in the first place). I can remember my doctor giving dictation into a device (remember when they did that?) "didn't take prescription - one tough kid!". I wasn't tough, I did what hurt less. 

My dad had a knee replacement a couple of years ago. He had oxycontin or something similar afterwards and when he stopped taking it, all he said was that he could feel things in his knee that he didn't with it. I asked him if he felt like he was having withdrawals (nope!). 

It seems a lot like alcohol. I could never become an alcoholic because drinking much isn't enjoyable. Same with cigarettes. I hear other people describe how great both are and am thankful I wasn't wired to like them. 

I understand that for most people, opiates are a week or ten days of intense withdrawals to get off of. 
I think the benzodiazepenes (just like alcohol) are much harder to kick, but heard once from a guy who went from opioids to heroin as his money went low that he fears all the time if he ever has heroin in front of him, he'll do it again. He's fully employed and hasn't done any of it for years, but it sticks with him. 

Maybe the biggest danger here is something that works really well (alcohol seems to be the old school medication of choice for people trying to get away from their own mind, for example), don't know. Caffeine is the only thing I have no desire to kick. Glad I'm not Mormon.


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## billw (26 Jan 2021)

D_W said:


> I can say at this point that my retirement accounts have about twice or three times as much money in them as I put in them. Without corporations, I wouldn't have it. I don't have the easy answer for it because no heavily socialized country has ever lasted long term. We're running the experiment right now, I guess.



Most of Europe is heavily socialist compared to you. I don't see any failed states here. Your opening statement says a lot - Americans need perpetual growth to fund their retirement accounts, whereas many European states have social funds that provide for old age. I wonder what will happen in the US when big corporations run out of global expansion possibilities? Or the Chinese beat them to it? Economic liberalisation occurred because it was in the US national interest to push their domestic corporations outside their own market to facilitate the need for perpetual growth. What happens when you run out of countries to suck into the system? Pray for the return of Atlantis? Colonise Mars?


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## Stevem (26 Jan 2021)

Wandering a bit off - topic : think USA will do what we in UK and some of our neighbours are doing - that is encouraging population growth (consumers) by any means (hence our immigration 'issues').
Closer to topic: I've seen two work colleagues that smoked marijuana (weed/blow) heavily over 20 years. Both lives ruined, it's unknown to me what happened to their kids/family. TBF , I've seen more lads ruined by alcohol. Sad.


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## Phil Pascoe (26 Jan 2021)

billw said:


> Americans need perpetual growth to fund their retirement accounts, whereas many European states have social funds that provide for old age.



How do you imagine the "social funds" work without perpetual growth?


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## Trainee neophyte (26 Jan 2021)

billw said:


> Most of Europe is heavily socialist compared to you. I don't see any failed states here.


Umm...Greece probably takes the podium position, but remember the PIIGS? Just because someone said they were fixed, it doesn't mean that anything actually _was_ fixed. The borrowing is now stupendous, and can not be repaid. Not that it ever is repaid, because the fiat money system demands ever increasing debt, because debt _is_ money. If you repay debt, you destroy money, which is bad.

Inflation is our future, unless it all goes wrong. Currently no western country can finance its debt unless interest rates stay at zero. Once the currencies have been debased sufficiently, the debt becomes trivial and interest rates can increase again. Until then, expect zombie economic conditions, and galloping inflation, even if the official metrics deny all knowledge.


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## Jelly (26 Jan 2021)

D_W said:


> Agree on the antidepressants. Their efficacy vs. passage of time is something like +15% (resolution of depression, etc). Most other approaches tried independently (exercise/talk) are more effective, but the latter are secondary approaches here and the former initial primary - presumably due to cost. It's cheaper to put someone on a generic antidepressant than it is for the care system to send someone to talk therapy.
> 
> Not glossing over folks who have "bad wiring" who can't get right no matter what, but rather the folks who can by addressing their issues head on.



The NICE guidance on treatment of depressive illnesses is entirely in agreement with that sentiment:

_"1.4.4.1 - Do not use antidepressants routinely to treat persistent subthreshold depressive symptoms or mild depression because the risk–benefit ratio is poor"_​
The evidence seems to suggest that in most cases where they're warranted, antidepressants work best as an intervention to get people into the right frame of mind to make best use of "Talking Therapies" which are then much more effective than they would be alone (whilst anti-depressants alone are not nearly as effective)

I think the issue the UK suffers from in this regard, is that we historically haven't taken mental health seriously enough, so there simply aren't enough trained therapists, psychologists and/or psychiatrists available within both the public and private systems (because the NHS will buy capacity from private where public is unavailable); so it falls on primary care physicians to bridge a waiting lists of 12-18 month or more with patients who are slowly having their depressive symptoms get worse until the GP finally puts them on anti-depressants because it will at least stabilise things whilst they're waiting.

The disparity between the quality of and access to mental health services (regardless of whether you're talking about "free at the point of need" or private) compared to physical health remains pretty dire.


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## doctor Bob (26 Jan 2021)

Stevem said:


> TBF , I've seen more lads ruined by alcohol. Sad.



Indeed, secret addiction of society.


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## billw (26 Jan 2021)

Phil Pascoe said:


> How do you imagine the "social funds" work without perpetual growth?



Social funds are funded by real money, private ones by share prices and the timely buying and selling thereof. Public pensions come from tax revenues and/or borrowing, not from whatever the market feels like valuing a company at on a particular day. The government isn't reliant on market valuations to pay pensions.


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## billw (26 Jan 2021)

Jelly said:


> The disparity between the quality of and access to mental health services (regardless of whether you're talking about "free at the point of need" or private) compared to physical health remains pretty dire.



The chance of being seen by someone is slim at best, and even when it's available it's a long wait to go through a limited program (often 6 to 12 weeks) which is more of a tick box exercise than a genuine attempt to deal with the individual issue. 

"Anxiety? Sure, CBT will cure you....." Nah, it really won't. It's just a way of palming people off because of chronic underfunding.


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## Phil Pascoe (26 Jan 2021)

billw said:


> . Public pensions come from tax revenues and/or borrowing...




and as the need for more money grows year on year that depends upon others making more money ............ growth.


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## billw (26 Jan 2021)

Phil Pascoe said:


> and as the need for more money grows year on year that depends upon others making more money ............ growth.



Tangible growth that requires real money to be paid over in tax, not the folly of the stock market.


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## D_W (26 Jan 2021)

billw said:


> Most of Europe is heavily socialist compared to you. I don't see any failed states here. Your opening statement says a lot - Americans need perpetual growth to fund their retirement accounts, whereas many European states have social funds that provide for old age. I wonder what will happen in the US when big corporations run out of global expansion possibilities? Or the Chinese beat them to it? Economic liberalisation occurred because it was in the US national interest to push their domestic corporations outside their own market to facilitate the need for perpetual growth. What happens when you run out of countries to suck into the system? Pray for the return of Atlantis? Colonise Mars?



We need real economic growth, that's all. my point with asset appreciation is that it only occurs at rates above underlying economic growth if efficiency is found. Most of the things that we enjoy (in terms of disposable income, etc) are not the result of allocating resources, they're the result of private enterprise. 

As far as socialism goes, we are highly socialist in the United States, too. We had this discussion recently. Our entitlements paid each year are greater than most economies. Folks who are indigent and children of irresponsible parents become wards of the states, and even the irresponsible parents generally do if they are willing to seek assistance (the case now is that assistance will seek them). 

A society that's more socialist in nature without subject states to draw from typically results in lower productivity, but an overall uniformity that a state like the US doesn't have. You have to choose what you want. When I say we're running the experiment now, I mean that we don't have very many states that are as socialist as they are now with more than a few decades of life. That's not very long.


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## Trainee neophyte (26 Jan 2021)

Sort of on topic: 'They broke my mental shackles': could magic mushrooms be the answer to depression?

Magic mushrooms are illegal, but may be a huge help with depression.


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## D_W (26 Jan 2021)

billw said:


> I wonder what will happen in the US when big corporations run out of global expansion possibilities? O



This message came about 15 years ago. "the economy is out of gas. there's no way to keep things up. The future looks bleak.". 

And we have a completely different cash rich high demand sector that didn't exist in any similar format at the time - amazon, facebook, netflix, gogle, apple, etc. As much as people said for a long time that there's no real staple to their services and no real long term potential, I doubt there's much chance that they'll go away now. Make fun of them if you want for doing things like running web ads ,but they make more money with web ads than someone did making plastic containers. 

To assume that "we're just out of potential down the road" assumes that we have a basket of things now and it won't change. This isn't very historically accurate, or we'd be riding horses and playing in banjo bands using tar buckets to lube the wheels on our wagons. 

Anyone here doing bobbin lace?


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## billw (26 Jan 2021)

Trainee neophyte said:


> Sort of on topic: 'They broke my mental shackles': could magic mushrooms be the answer to depression?
> 
> Magic mushrooms are illegal, but may be a huge help with depression.



I'm pretty sure being on a permanent trip isn't going to help with everyday functioning.

_“It removes any barriers and allows you to process what you need to in an almost seductive way. You are inevitably and irresistibly drawn into it.” _

Sooooo.....it's addictive and haluciogenic. Awesome mix. Citalopram is positively boring in comparison.


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## D_W (26 Jan 2021)

billw said:


> Tangible growth that requires real money to be paid over in tax, not the folly of the stock market.



This is a dopey comment - where do you think stock appreciation goes? It's claimed as real income, quite often the high flyers are short term gains paid at a high tax rate, and the same market appreciation funds pension benefits and retirement which....

....is received as regular income, spent in the open economy to make more income, and each level generates tax revenue.


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## doctor Bob (26 Jan 2021)

Trainee neophyte said:


> Sort of on topic: 'They broke my mental shackles': could magic mushrooms be the answer to depression?
> 
> Magic mushrooms are illegal, but may be a huge help with depression.



I remember as a young lad sharing a house with mates, partying the night before and getting up for work with a mouth like the bottom of a parrot cage. As I left there was a cold cup of black tea on the side and I just necked it down, 20 minutes later I felt like I was having a physcotic episode, very very scary at the time but just couldn't stop laughing. Good stuff those MM's if you know whats coming bloody terrifying if you dont.


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## Trainee neophyte (26 Jan 2021)

Someone once suggested to me that our current service economy works on the basis that if I cut your hair, and you mow my lawn, we will all miraculously be wealthier for ever and ever.

Hard to see how that works in the long term. Perhaps magic mushrooms might help.


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## Nigel Burden (26 Jan 2021)

doctor Bob said:


> I remember as a young lad sharing a house with mates, partying the night before and getting up for work with a mouth like the bottom of a parrot cage. As I left there was a cold cup of black tea on the side and I just necked it down, 20 minutes later I felt like I was having a physcotic episode, very very scary at the time but just couldn't stop laughing. Good stuff those MM's if you know whats coming bloody terrifying if you dont.



I remember reading about the effects of magic mushrooms a few years ago. Apparently it is possible to have flash backs up to three months after the initial ingestion. The danger being that the effects will then echo you current mood, not the high that you were intending when you originally took them.

Nigel.


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## D_W (26 Jan 2021)

billw said:


> "Anxiety? Sure, CBT will cure you....." Nah, it really won't. It's just a way of palming people off because of chronic underfunding.



CBT is more effective than medication in anything other than the immediate term....It's probably something every single person could stand to work through on a regular basis. It's (CBT based therapy) much more expensive here, too, than generic scripts.


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## Phil Pascoe (26 Jan 2021)

I wonder how people addicted to opiates/opioids cope with the awful constipation that goes with it. For many months I was on pregabalin, nortriptyline, tramadol, gabapentin, codeine, dihydrocodeine and morphine, bith liquid and slow release. Often any perm of four or five at a time. I was glad to get off them, I had the cold sweats and shakes for a few days but came away unscathed - possibly because I never felt anything from the morphine, even when taking too much. I never felt anything when they gave me fentanyl either, which is just as well, maybe. My pill count at one time for a couple of weeks was forty three a day.


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## RobinBHM (26 Jan 2021)

A burglar broke in and stole my anti depressants.

All I can say is: "I hope it makes him happy"


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## Jelly (26 Jan 2021)

D_W said:


> CBT is more effective than medication in anything other than the immediate term....It's probably something every single person could stand to work through on a regular basis. It's (CBT based therapy) much more expensive here, too, than generic scripts.



One of the big issues with effectively treating depression is that some people don't respond at all to certain types of talking therapy, and some are wholly unresponsive to all talking therapies.

CBT is widely available at least, but it's a postcode lottery in the UK as to whether you'll get regular 1-1 sessions focused on your needs, or wait a year to get a few generic group sessions as part of a strictly time limited process which may help if they suit you.

Access to alternative types of talking therapies is even more patchy, and it's not even a case of going private, there's whole areas where those therapies simply aren't available full stop.



Irrespective of local healthcare arrangements, I feel particularly for people the world over with severe refractory depression which is unresponsive to talking therapy and SSRI/SSNI anti-depressants as they're left with the choice between:

Old-school (very powerful) anti-depressants with weird impacts on their ability to maintain appropriate emotional responses, awful side effects and potential for lethally dangerous drug/food interaction.
Electro-convulsive therapy every couple of months, which is substantially less unpleasant now than it was when it was invented, but still has a side effect of upto a few days of short-term amnesia and confusion.
Feel so awful they can barely (or can't) function.


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## D_W (26 Jan 2021)

Yes, not downplaying that there are some resistant to one approach while others may work, and some who need more than one at a time or that none work for at all. 

One on one therapy is standard here. Groups are something we only see on TV or in movies. If you have an issue and you want to go the talk therapy route, you can usually find someone in a matter of days.


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## Jelly (26 Jan 2021)

D_W said:


> Yes, not downplaying that there are some resistant to one approach while others may work, and some who need more than one at a time or that none work for at all.
> 
> One on one therapy is standard here. Groups are something we only see on TV or in movies. If you have an issue and you want to go the talk therapy route, you can usually find someone in a matter of days.



That was more of a general commentary than aimed at yourself.

It's nuts that the UK can get acute care for physical ailments to a standard about as good as any other western country (I don't hold with glorifying the NHS, whilst it's well above average worldwide, it only really leads the world in value for money) but mental health coverage is at best inadequate and at worst dismal depending where you live.

I suspect it's because it was something of a tabboo until recently, which meant it was easier politically to cut or freeze budgets in an area no-one talked about; which highlights the one real failing of the NHS for me, that it's been allowed to become a political football where funding decisions can become wholly detached from the realities of service delivery.


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## John Brown (26 Jan 2021)

TN wrote: 

"Someone once suggested to me that our current service economy works on the basis that if I cut your hair, and you mow my lawn, we will all miraculously be wealthier for ever and ever.

Hard to see how that works in the long term. Perhaps magic mushrooms might help."





I thought that was the Thatcher principle. Get rid of all industry and rely on being a "service" provider economy. Which probably works out OK when the global economy is booming, but not so well at other times.


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## D_W (26 Jan 2021)

There's been a lot of groundwork laid here to get rid of the idea that "mental illness is just ___"

(someone just being unreasonable)

(someone who just needs to go out and take a walk) 

(someone who just needs to perk up)

(someone who is just being a burden on other people). 

There are a lot of obvious things to bring up when someone says "where was all of this mental illness when I was a kid - we didn't have it"

(yeah, when someone medicated with alcohol and was just straight up nasty because of their life long fear of things we didn't ever come to find out....we just pointed our finger at them being irresponsible. Who needs to solve a problem when you can just blame someone else?).


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## D_W (26 Jan 2021)

John Brown said:


> TN wrote:
> 
> "Someone once suggested to me that our current service economy works on the basis that if I cut your hair, and you mow my lawn, we will all miraculously be wealthier for ever and ever.
> 
> ...



It works if you can own the manufacturing company and get someone in another country to make things for you and you skim off the top. Like an imperial economy. My point about the socialist track is if you don't mind economic production, soon you sink in weak currency because the rest of the world doesn't put much value on what you produce. 

The reality of the united states is that we are highly socialized, but not automatically at every level and we cater to the bits that generate economic value as we're tied into it from end to end. All of the local, state, etc. governments with pension and health care funds need the investment earnings just like anyone else. That means as taxpayers we need it. The rest of the world is waiting to eat your lunch if they can, and no matter what anyone says about quality this or that or principle, when quality is perceived as equal, buyers go for lower cost. I doubt the GDP per capita in the US was greater than britain 100 years ago. 

the 2020 estimate is 63k for the US and 39K for britain. What happened? There's no way we work 60% more.


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## Jelly (27 Jan 2021)

D_W said:


> the 2020 estimate is 63k for the US and 39K for britain. What happened? There's no way we work 60% more.


Off the top of my head...

Low Productivity resulting from amongst other things:​
Decades of underinvestment in infrastructure
An even greater willingness to tolerate our biggest blue-chip companies being gutted by corporate raiders and sold off piecemeal to make a one-off fast buck (should that be quid?), than the US (which also did a fair bit of that for a time) ever had.
Privatising large nationalised concerns and then rapidly selling them to their (publicly owned) foreign competitors who proceeded to do the majority of the high value, high skill work required to run the business in their home nation.

Compared to US and European models, our "Austerity" approach to dealing with the 2008 crash has proved ineffective, resulting in a recovery about 20-30% slower than the global average.​

Oh and we've done a couple of things which have undermined global confidence in the UK resulting in rapid devaluations of the pound; but have never put forward any coherent strategy (despite having a whole government department for "Industrial Strategy") to use that devaluation to improve our dire balance of trade position by revitalising the manufacturing sector to boost our exports...​​_Which was pretty much the only thing we could have done to make up for that sudden decrease in ($US Terms) GDP which was not linked to a change in anything tangible, just the impact of negative market sentiments about decisions the UK made._​


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## TRITON (27 Jan 2021)

Last time i was laid up with a slipped disc, in truth lying on the floor for 4 days solid did it no good at all, got taken into hospital and was put on oramorph which was explained to me at the time I was only going to get it for 3 days due to it's addictiveness. In the UK, the 'First do no harm' applies to this level of drug, and they prefer you not to end up with more problems than you came in with.
That point aside, I guess it's dependent on how much pain you are in.
The elderly get opioids usually in the form of codeine based painkillers in long term format.

The US is very different, but I guess we all know that.


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## Phil Pascoe (27 Jan 2021)

... oramorph which was explained to me at the time I was only going to get it for 3 days due to it's addictiveness ...

I took it for several months. Three or four nights of discomfort when I dropped it.


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## evildrome (27 Jan 2021)

Trainee neophyte said:


> Someone once suggested to me that our current service economy works on the basis that if I cut your hair, and you mow my lawn, we will all miraculously be wealthier for ever and ever.
> 
> Hard to see how that works in the long term. Perhaps magic mushrooms might help.



That's how all economies work. Exchange of labour. 

I might exchange 3 hours of my labour for 1 hour of the dentists labour & we use currency as the medium of exchange.

Goods are just (labour+commodities), so goods are also an exchange of labour. 

This cycle does create wealth, "for ever and ever". This is how economies work.


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## gregmcateer (27 Jan 2021)

Interesting to see economy discussions. I do try to understand it all, but am a bit of a slow-mo, esp as maths is my weakest suit. So this is handy so far, as it doesn't feel too political, more economic theory. (Even though DW started off the thread as an discussion on addiction!).

Some time ago, I read a book called, I think, The Simpol Solution - about international state cooperation. I can't remember the detailed discussion, but it did seem to be the beginnings of finding a way forward for nations to work together.
(Grabbing hard hat ready for this to be shot down )


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## D_W (27 Jan 2021)

That kind of thing is great if you ignore that it involves humans who are motivated by incentives. 

Most of our progress comes from people who are either selfish or self-fascinated. It doesn't come from idealistic ideas (unless labor is forced) where what people get is based on their efforts. 

Below that there is a layer of folks who want to be guaranteed a certain amount of return for their efforts without being responsible for the efforts being viable or useful to others, and below that yet are folks who just want a guarantee that they can get more than they put in. 

You can't change human nature, but you can take incentives away and slow overall progress. If you want to solve problems, rather than creating cooperation/collusion, you have to offer incentives (either for ego or money) to solve the problems to draw in people who are competitive risk takers. 

Elon Musk is a perfect example of this. What comes out of his efforts and competitive drive? The first really viable electric car, and now pilers on following him - most of those large capital backed who would've done no such thing if he hadn't showed the market to be there. Space flight? Same thing - monstrously cheaper and more efficient than anyone else because he's incentivized to do what he's doing and take risks. Believe that he would do the same thing regardless? I doubt it - he just moved from a state that interferes in his business to one that doesn't. He'd just switch countries, and there would quickly be a non-cooperative country that would attract all of those ventures - it would be easy if there was non-competitive cooperation among all other states - a haven would appear. We can now send hardware and people to space cheaper even than any of the chinese firms can do it. The chinese firms have the advantage of cheap labor and state backing, but they have the stick behind them, not the carrot in front.


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## evildrome (27 Jan 2021)

" He'd just switch countries"

Why doesn't he go to South Sudan? 

Exactly zero government interference. No government at all in fact.

Why don't all these fantastic self made men all move to South Sudan where they can be completely free of Gummint interference?


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## D_W (27 Jan 2021)

If I thought your question was serious, I'd address it. Give a list of things you'd want if your primary concern was absolute fastest, most efficient, etc. innovation and business development and execution.


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## Trainee neophyte (27 Jan 2021)

Elon Musk is a fine example of government picking winners. Nancy Pelosi Buys Tesla Calls, Stands To Benefit From New Biden EV Plan

One day we could go back to trying a free market capitalism system, but for the moment, corporatocracy is what we get.

Anyway - back on topic. Drugs. Another sweeping statement: it is my experience that people tend to take the party drugs when times are good, and self - medicate when times are are bad. Recessions boost opiate addictions. There's probably a study on it. (There are lots, and some of them even support my thesis). Assuming that I am correct, coronavirus and associated economic chaos should create many extra addicts over the next few years. If we move to a universal basic income, will this relieve the need for drugs, or will it create an endless underclass of self-medicating jobless poor? Interesting times ahead.

When I was a wippersnapper we only had Heroin to worry about. Fentanyl is even more exciting, and even cheaper, I understand. Not my thing, so I'm only going by Daily Mail and Guardian hyperbole.


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## D_W (27 Jan 2021)

Free market is long gone. Crony capitalism is in its place, but there are a few like Musk who are looking to innovate and achieve. Comparing money spent on tesla to solyndra and other things that are dead ideas from the start is a no brainer, and our space program (on the spaceX side) is obviously intensely interested in avoiding mistakes and embarrassment far more than they are in achievement or efficiency. 

- Can you make a marketable car with a battery? (at the outset, the criticism was "no, the batteries in a tesla cost more than the car". History at this point). 
- Can you make a car with a 200 mile range on battery? "no, not that is affordable". wrong again
- How much will it cost to replace the battery? who cares - it hits 90% of its capacity long after most other cars are dead
- Can you make space cargo and people hauling profitable and cheaper than it can be done anywhere else? Yes
- Can you land boosters and reuse them? Of course not, that's absurd - nothing can fly backwards and land............ Oops...

Will you get someone like that to establish a business somewhere that graduates from college feel entitled and every level of government wants to have a stake in making company decisions? No.

What if you virtue shame them and tell them to stay and pay twice as much in taxes as they will somewhere else? They might just move away and take their entire headquarters with them. 

We can launch cargo and people to space now cheaper than any chinese or russian company can. Not just better, not just more reliably, cheaper. That's absurd.


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## D_W (27 Jan 2021)

Trainee neophyte said:


> Elon Musk is a fine example of government picking winners. Nancy Pelosi Buys Tesla Calls, Stands To Benefit From New Biden EV Plan
> 
> One day we could go back to trying a free market capitalism system, but for the moment, corporatocracy is what we get.
> 
> ...



From the charts, fentanyl is the rising killer in the US. I don't know the split of folks who get to opioids recreationally vs. script, but there are definitely script users who get cut off and end up homeless from spending their money on the drugs. 

Expect that addicts and deaths will drop here because the supply is monitored now. You can probably bring things in illegally, but the great majority of what was out there before was most likely obtained legally. It's no possible to do that now in huge amounts like it was. 

But that's the US. What it means for the rest of the world, I don't know. 

Our disability system has its share of younger folks who have drug problems and get full public benefits because they're impoverished due to lack of having ever worked in combination with psychological issues that come along with drug problems (chicken or egg thing here in some cases - the order those occur is likely not the same for the entire group). But, enabling someone with income and no responsibility certainly doesn't reduce users in some cohorts. Disability in the US is a legal process - sometimes the legal side matters more than the medical basis.


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## finish_that (28 Jan 2021)

Part of what drives the pain killer epidemic in the USA is the health care system, if you cannot afford the insurance payments , or do not have benefits from your employer you are stuck, so instead of treating your problem with a fix , you keep pushing it away with another type of fix and that is addictive and ruins your life one way or another.


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## Trainee neophyte (28 Jan 2021)

D_W said:


> We can launch cargo and people to space now cheaper than any chinese or russian company can. Not just better, not just more reliably, cheaper. That's absurd.


But is it a "fair" price? All the subsidies and government contracts distort the entire operation, and the endless money printing just means someone, somewhere, will have an unpleasant awakening eventually. It is unlikely to be Elon Musk paying the true cost in the end. Much more likely that every American will pay, instead.


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## Ollie78 (28 Jan 2021)

The American health care system is absolutely insane by any standard, the fact that doctors earn more the more they prescribe is fundamentally unsound, as is TV advertising of strong prescription medication to the public. Imagine if you had adverts saying " feeling a bit sore, does your back ache after work, then try heroin it's brilliant" .

This is off topic a bit but I find the amount of gambling ( online casino and betting shops) adverts on uk TV to be disturbing, they never existed until a few years, people are addicted to gambling and losing everything because of it.

Ollie


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## D_W (28 Jan 2021)

we did find one benefit earlier here -in the US system, unless you hamstring yourself by buying coverage with a huge deductible (such a thing is for folks who don't plan to use coverages), access to providers, mental or physical is pretty much unlimited. This may not be meaningful to some people, but someone seriously in the dumps will find it very useful. 

That said, the drug business here is offputting. We develop them, we pay the most for them, the rest of the world gets them at cut rate pricing. Not a fan. 

But as a nod to your comment about gambling, I've noticed the same - every single sporting event seems to have main adverts for gambling. Is nothing else valuable enough to advertise? Presumably, such a thing is heavily taxed. It used to be completely forbidden here except for stupid schemes like lotteries run by states, and of course, vegas and indian land. But now, the state is advertising gambling apps on TV. but, no matter. It's ethical now because the state licensed casinos are involved and they have a disclaimer with a number to call after your gambling addiction empties your bank account and you're distraught. 

The sale to folks here in my state was that it would lower property taxes, possibly eliminate them. Of course this is a really stupid idea that assumes just the taxes from gambling will equal a thousand or couple of thousand per head. No clue where the tax money went - my property tax bill hasn't changed (it's possible that it's a couple of percent less than it was before, I wouldn't notice - but the promise was of paradise, not pair of percent.


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## D_W (28 Jan 2021)

Trainee neophyte said:


> But is it a "fair" price? All the subsidies and government contracts distort the entire operation, and the endless money printing just means someone, somewhere, will have an unpleasant awakening eventually. It is unlikely to be Elon Musk paying the true cost in the end. Much more likely that every American will pay, instead.



Not sure what you mean by fair. If only nasa did it, lots of folks would say it's fair because it's all government and there's no profit. NASA had a shuttle launch price of $1.6B per mission. That's a lot of money to send some toilet paper and a couple of folks to the space station. SpaceX charges $55MM a seat to transport people. I don't think there's that many seats, so this is inexpensive (so inexpensive that no other space force, for profit or not no matter how low the in country ages, etc. can match it). 

There are other groups here - one is called United Launch Affiliation, etc, or something of that sort. 

What happens with something like this is there's no initial investment unless someone calls it a hobby (like Bezos, but bezos wasn't around in the 1940s and 1950s to develop this stuff - nasa was rewarded for progress back then, not punishing for any chance of error - the latter is a predictable thing once efforts become politicized instead of progress-based). At any rate, Nasa recognizes they can't do anything for any reasonable budget at this point, gives up on a lot of their efforts in terms of launching people, especially, and searches for contractors to control costs. They award less than it costs to do things but their awards attract private money, so the ventures are funded by private and public dollars. If venture capital is lost, it's lost. Too bad, but it's unencumbered by publicly listed monies, etc (as in, you can lose money on a venture without getting sued). 

We had a wholly private system of bridges and roads more than a century ago - it didn't work well. Then we built like crazy, that worked well. Then the government groups filled themselves with red tape instead of results and now we have crumbling infrastructure (which is a good lesson about costing things at the outset - project budgets are a fraction of future costs. If you build something, you'd better want it in the long term, because you can't just back out later). 

We're generally quite delighted with spaceX here - we have a group who isn't going as slow as they can and milking projects as long as they can, but rather they're in growth phase and solving problems as fast as possible and initiating projects that aren't just government awards. We're sending people to space for an eighth or tenth of what it was costing under NASA, which leaves nasa to do other things. The amounts awarded to spaceX will be saved in launching about 20 astronauts. Perhaps sooner because the cargo loads that spaceX takes up may have covered a bunch more already. It's not just people that spaceX can launch more cheaply than china, it's everything of any significance, and they completely changed the outlook in regard to what can be done. Instead of assuming spacecraft are consumable, now everyone will be stuck figuring out how to make them reusable - it's not just a savings in spaceX. 

Of course, half of the country hates musk because he's not a virtue signaler.


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## D_W (28 Jan 2021)

well, the dippy rule again. We go from the snide and nasty to the stupid. 









John Kerry Suggests Oil Workers Laid Off Due to Biden Policies Should Make Solar Panels


White House climate czar John Kerry on Wednesday recommended that oil and gas workers should pivot to manufacturing solar panels if their jobs are eliminated as a consequence of the Biden administration’s environmental policies. During a press briefing at the White House on Wednesday, Kerry, who...




www.yahoo.com





(our last president was infatuated with the idea that people in profitable industries could just make solar panels and batteries, despite the fact that without regard to any other costs, nobody can make such things profitably here just paying ongoing costs. Musk and panasonic changed that for batteries - the govco groups managed to waste money and disappear unless there's a few remaining operating only on government contracts....

....however, the platitudes arrive again. Never mind that just failed, we'll magically move oil workers into making something the Chinese make in huge amounts at a low price....again, except the Chinese are even better at it now and are technologically ahead on solar stuff. So, we can offer making things at a price that nobody will buy at using intellectual capital that is below the level of the lowest-cost producers. 

It'll be interesting when the mid-terms come along. 

I wonder if I can convince other independents to make something called the "numbers party" where proposals have to make numerical sense at the start (which is still below the threshhold of guaranteeing success, but at least you could weed out the ideas that are guaranteed failures and prevent idiots from attracting other idiots by proposing them).


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## Trainee neophyte (28 Jan 2021)

D_W said:


> Not sure what you mean by fair


Simply a "fair market price". Because there is so much government involved, plus military - some of which is probably secret - it is nigh on impossible to calculate what the actual market costs for the service is. Therefore, is SpaceX cheaper than all the competition because it is by far the best, most efficient and technologically forward thinking company in the world, or does it just hide it's costs and offer services well below market price for political and monopoly making purposes? 

I don't pretend to have the answer to the question, but the murky Public-Private corporate government synergy makes everything difficult to judge. How do Musk's other ventures benefit from such government largesse? Musk is a bit of a polarising character, but I don't particularly love or hate him. He hasn't impressed me much with his drug taking and tweeting nonsense, (and ignoring of rules which would get lesser mortals imprisoned) but he can certainly get funding for all his projects, so definitely a clever guy. Obviously a believer in Other People's Money.


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## D_W (28 Jan 2021)

SpaceX doesn't hide all of their costs. One of the controversial things occurring here recently is that the other contractors managed to get government money to make infrastructure improvements. Somehow, Space X was left out. In a recent quote, spaceX had a higher bid than one of their competitors because they had to build infrastructure improvements into the contract. Why the bid still didn't go to the other group, I don't know, but suspect it has something to do with the government planning on spacex costing less in the long term to do the same thing. 

The other company complained publicly, neglected to mention the government paid for improvements for them and called out spaceX for including infrastructure costs in the bid that "they weren't billing in their bid". 

As far as why spaceX is chosen in general, though, it's almost certainly for two reasons:
1) they're capable and quick
2) they're overall cheapest

But they won't get all of the contracts as Nasa is looking to spread some risk (Bezos org. is coming along). 

Far more private money is being invested in space than money from Nasa, though - not because it's deemed a good way in the future to get gov. contracts, but rather because the push is on here for private for-profit ventures in the future (commercial satellite spaces, the expectation of high dollar space tourism, etc). 

I would assume spaceX's long-term goals are commercial and not governmental.


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## Amateur (28 Jan 2021)

When I worked in US at a management meeting it was decided to block off four feet in the gents locker room and put a false wall in.
A camera was then put in the false wall.
Two weeks later we were given lists of employees captured on video using drugs or emptying coke cans and filling them with vodka.
The employees were interviews by managers and human resources.
At the time no one was directly fired but offered professional help.


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## D_W (28 Jan 2021)

Amateur said:


> When I worked in US at a management meeting it was decided to block off four feet in the gents locker room and put a false wall in.
> A camera was then put in the false wall.
> Two weeks later we were given lists of employees captured on video using drugs or emptying coke cans and filling them with vodka.
> The employees were interviews by managers and human resources.
> At the time no one was directly fired but offered professional help.



Probably the case elsewhere in the world ,too. Unfortunately, some people are good workers but have substance problems. I heard a sawmill owner once talk about a guy he had who was on meth. The guy was a faller, and he didn't know what to do, but said he would be up an down hills on foot twice as fast as anyone else, and if you were skidding logs, he'd have three more on the ground for every one you took. If he didn't have his stuff, he didn't even show up to work, and eventually the guy decided he was unsafe (it may not have been meth, but rather whatever a stylish amphetamine was around 30 years ago ,but the guy was hooked). 

I have sat in meetings where groups talk about their prescription drug plans as they can see what's getting abused and the insurer will provide them with lists of who. Instead of firing everyone, they try to redesign plans and protocols to prevent it and then work their way down to the managers to get the guys on programs. 

No clue what the treatment success rate is, but in the rougher jobs, you can't just fire everyone who has a problem or there'll be nobody to work. You have to try to help them instead, and though it's popular to think that most employers in the US are sharks looking to fire everyone, they're not looking to crush lives if someone can be helped. 


....

compare that to my first good job. Aristokraft cabinets. No clue what they did for drugs as I took the test and passed (I don't do drugs or anything questionable, never even an afterthought to me). But, they had a policy - assembly work on lines - nobody can be late or everything is held up. if you are late to clock in twice in a quarter, automatic termination. 

I never saw a single person late in the assembly area (about 125 employees) in three full summers between college, and I sure wasn't late either. Lots of older people got to work very early and played cards in the parking lot or shot the breeze as they'd no patience for cutting the time close. Half an hour early on a 15 minute commute wasn't unusual.


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## dannyr (20 Feb 2021)

Back to your question DW:

US news today reports that Opioid and Fentanyl deaths in the US totalled nearly 85000 in the last year -- the level had flattened off as opioid prescription by physicians dipped but now it's rising fast again with illegal fentanyl. I think deaths from Heroin, crack cocaine, crystal meth etc are lower, and not included in the above total.

EDIT Correction: that was a less reliable source -- 2020 Fentanyl/Opiod overdose deaths in USA 61,000, heroin+crack+meth+? overdose deaths 23,000 according to Bloomberg.

The last administration declared war on opioid misuse in its second year of office, but then effectively closed down the department a few months later.

Amongst other groups, very high for ex-military.

In the UK opioid deaths were under 200 last year, with 2000 for heroin and others (not including alcohol or cigarettes). But we have plenty of other problems.

The US seems to have by far the highest death rate from drug overdose for large countries, but it is pretty high in Russia and Iran (Russia also has a huge alcohol death rate).


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## dannyr (20 Feb 2021)

for perspective:

US deaths from Covid now just under 500,000

US deaths in the many years of Vietnam war I believe about 55,000


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## billw (20 Feb 2021)

dannyr said:


> for perspective:
> 
> US deaths from Covid now just under 500,000
> 
> US deaths in the many years of Vietnam war I believe about 55,000



well the Vietnam war benefitted from Donald Trump not being there I suppose.


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## D_W (21 Feb 2021)

dannyr said:


> Back to your question DW:
> 
> US news today reports that Opioid and Fentanyl deaths in the US totalled nearly 85000 in the last year -- the level had flattened off as opioid prescription by physicians dipped but now it's rising fast again with illegal fentanyl. I think deaths from Heroin, crack cocaine, crystal meth etc are lower, and not included in the above total.
> 
> ...



Yes on the high rate, but as previously shown, it's driven by fentanyl.


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## DennisCA (22 Feb 2021)

The opoid epidemic's not a thing here. Doctors in general are way more cautious about prescribing painkillers at all. In most cases you get extra strength ibuprofen or paracetamol (tylenol) or a combo, I've had three surgeries and once it's all I got home, once I got something opoid based to last a few days. They really don't want people to use a lot of pain killers, or prescribe pain killers for issues, the idea is more to see what causes the pain and try and avert it before going that route, it's the like the last option. It's always seemed to me to be a US thing in particular.


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## D_W (22 Feb 2021)

There are conditions where pain is unavoidable (structural back issues, etc). But the downfall here was the idea that the AMA or something similar got that pain was treatable and we should treat pain like we would treat fever - to eliminate it. That was a stupid idea. 

In the early years of opioids, there were accounts of people coming off of disability and going back to work and too many got swept up in the idea that somehow that was permanent with no consequences.


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## dannyr (5 Apr 2021)

I know this is a workshop forum but it's a an important topic raised by DW -- there's a frightening but inspiring USA adoption story on BBC news right now.

One of scary facts coming out of this was a figure of 1 in 15 babies of all babies are being born to mothers who had taken opioids during pregnancy and the fearsome painful withdrawal the baby has to go through after birth.

And then there are the other medications/drugs often taken at the same time.


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## D_W (5 Apr 2021)

billw said:


> well the Vietnam war benefitted from Donald Trump not being there I suppose.



I get what you're saying (incompetence), but if there's only one thing to give trump credit for here, it's that he ignored mongering from small countries and greatly pulled back our active military conflicts. For that, I am thankful.

He also presided over a system that paid for-profit companies with government money to create the two best vaccines in the world. That caused some controversy here (funding development for companies that would profit after the fact).

I don't, however, miss hearing him talk.


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## Spectric (5 Apr 2021)

And now you have some old geriatric who should be using a zimmer frame to get around and at his time of life should be enjoying retirement. Letting a younger person who has many years of life ahead of him take the reigns would be better for the countries future.


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## D_W (5 Apr 2021)

Spectric said:


> And now you have some old geriatric who should be using a zimmer frame to get around and at his time of life should be enjoying retirement. Letting a younger person who has many years of life ahead of him take the reigns would be better for the countries future.



Trump was our 7th inning stretch as far as taking a break from corporatist globalism from both parties. Biden is our 7th inning stretch from fast paced governing now. It's been relatively pleasant recently as long as we don't get fed the BS about how subsidized globalism is for the average person.


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## baldkev (5 Apr 2021)

I do find it funny that there isnt someone younger given a good run at being president....

Back to space x ( ive just caught up with the thread ) musk is thinking long term... sure, theres the moon and mars, but theres also a big asteroid worth far more than the worlds economy ( in rare metals etc ) and i bet you any money ( if ive got it ) that he is prepping for space mining.... i would.... maybe he'll call the first mining ship red dwarf?


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## TRITON (5 Apr 2021)

baldkev said:


> I do find it funny that there isnt someone younger given a good run at being president....
> 
> Back to space x ( ive just caught up with the thread ) musk is thinking long term... sure, theres the moon and mars, but theres also a big asteroid worth far more than the worlds economy ( in rare metals etc ) and i bet you any money ( if ive got it ) that he is prepping for space mining.... i would.... maybe he'll call the first mining ship red dwarf?


Maybe theyre looking to get closer access to the asteroid belt, which lies on and just beyond Mars


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## dannyr (5 Jul 2021)

Looks like this won't go away.

After clamping down on the drug companies and certain physicians/pharmacies, opioid abuse and death was falling or at least flattening out quite fast in USA, but last year has seen a big rise in numbers again (fentanyl as well as prescription) - especially the death thru overdose..

Seems like the other place with a real problem, and growing fast, is Vancouver area. (Tough, on top of heat deaths and fires this week).

The numbers are still worrying, but far lower, in W Europe, drug abuse/addiction yes, but way fewer deaths..


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## JobandKnock (5 Jul 2021)

Phil Pascoe said:


> I wonder how people addicted to opiates/opioids cope with the awful constipation that goes with it.


You don't have to be addicted to it - I take prescription strength co-codomol for arthritis pain (which maybe indicates that Im a geriatric), and as little as possible most of the time because even a small amount of codeine causes me problems. My approach is chocolate, and every Sunday I have a day off the drugs. I know others who do likewise. Maybe we're all just full of s...


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## Phil Pascoe (5 Jul 2021)

I was in hospital for two months - this was a small hospital to where we were shipped out from the major one when it was decided we were no longer in immediate danger. A chap I was in with had really bad constipation and blood transfusions for anaemia and I asked one day if he'd been told to eat loads of figs and prunes and other fruit. I was surprised when he said no, he hadn't. I ate liquorice, chocolate, figs and prunes by the pound. 
I was way past co codamol - I was on codeine, morphine and slow release morphine (overnight) - they and baby stuff like gabapentin, pregabalin, nortriptyline, tramadol are things of the past. I don't want to go there again . )
Codeine affects people differently - my wife takes one 30 mg? and it knocks her out, I can take three or four and not feel any side effects. I didn't feel anything the one time they gave me fentanyl, I did have a few lousy days when I dropped the morphine, though.


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## JobandKnock (5 Jul 2021)

I don't eat sweets much any more (other than chocolate, which I not fussed about), but i do carry dried apricots around a lot of the time. Similar effect


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## dannyr (19 Nov 2021)

sad news today, USA just passed 100,000 annual death by drug overdose level (not including alcohol). this is a rise of 5x since 2000.

I had 5 lovely younger American cousins of whom 3 are dead, two accidently, one drug related and a fourth had a close brush (alcohol). It certainly wasn't poverty/deprivation/lack of family support in their cases. 

Europe has plenty of problems, but the highest death by drug overdose is Norway with one fifth of the US rate per million, and an average country like say Spain has a rate only one twentieth.

Why?? - serious subject, so sensitive answers, please


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## selectortone (19 Nov 2021)

dannyr said:


> Why?? - serious subject, so sensitive answers, please



Why? Money. Purdue Pharma, the manufacturers of OxyContin, and the Sackler family who own the company, have been called the biggest drug cartel in the world. Unlike the Colombians though, it was all legal.


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## Jake (19 Nov 2021)

The Fentanyl issue in the US is also very much driven by China.


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## Phil Pascoe (19 Nov 2021)

I'd be a bl00dy expensive junkie - I was given fentanyl and asked how it made me feel - I felt nothing at all.


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## Jake (20 Nov 2021)

As I understand it, that's one of the problems with it. Super narrow dosage window between no effect and dead.


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