This weekly roundup thread is intended for all culture war posts. 'Culture war' is vaguely defined, but it basically means controversial issues that fall along set tribal lines. Arguments over culture war issues generate a lot of heat and little light, and few deeply entrenched people ever change their minds. This thread is for voicing opinions and analyzing the state of the discussion while trying to optimize for light over heat.
Optimistically, we think that engaging with people you disagree with is worth your time, and so is being nice! Pessimistically, there are many dynamics that can lead discussions on Culture War topics to become unproductive. There's a human tendency to divide along tribal lines, praising your ingroup and vilifying your outgroup - and if you think you find it easy to criticize your ingroup, then it may be that your outgroup is not who you think it is. Extremists with opposing positions can feed off each other, highlighting each other's worst points to justify their own angry rhetoric, which becomes in turn a new example of bad behavior for the other side to highlight.
We would like to avoid these negative dynamics. Accordingly, we ask that you do not use this thread for waging the Culture War. Examples of waging the Culture War:
-
Shaming.
-
Attempting to 'build consensus' or enforce ideological conformity.
-
Making sweeping generalizations to vilify a group you dislike.
-
Recruiting for a cause.
-
Posting links that could be summarized as 'Boo outgroup!' Basically, if your content is 'Can you believe what Those People did this week?' then you should either refrain from posting, or do some very patient work to contextualize and/or steel-man the relevant viewpoint.
In general, you should argue to understand, not to win. This thread is not territory to be claimed by one group or another; indeed, the aim is to have many different viewpoints represented here. Thus, we also ask that you follow some guidelines:
-
Speak plainly. Avoid sarcasm and mockery. When disagreeing with someone, state your objections explicitly.
-
Be as precise and charitable as you can. Don't paraphrase unflatteringly.
-
Don't imply that someone said something they did not say, even if you think it follows from what they said.
-
Write like everyone is reading and you want them to be included in the discussion.
On an ad hoc basis, the mods will try to compile a list of the best posts/comments from the previous week, posted in Quality Contribution threads and archived at /r/TheThread. You may nominate a comment for this list by clicking on 'report' at the bottom of the post and typing 'Actually a quality contribution' as the report reason.
Jump in the discussion.
No email address required.
Notes -
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.
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.
More options
Context Copy link
More options
Context Copy link
3.2% is correct. His .32% was either a typo or a calculation error.
More options
Context Copy link
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.
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link