Tag Archives: drugs

Playing international whack-a-mole…

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In the wake of Americans being killed while, advisedly or not, traveling in Mexico, there are calls to classify the cartels as terrorist organizations. Maybe they are but that’s probably missing the broader point. 

The cartels exist for one reason only – the immense, unquenched demand in the United Sates for their product. That’s it. Full stop.

With a fortune to be made in supplying that demand, going after the cartels is, in my estimation, one big, international game of whack-a-mole. Until we find the silver bullet to crush the demand curve, someone will fill the supply side of the equation. I mean drugs didn’t suddenly stop being a problem when Pablo Escobar was arrested and eventually killed.

We’ve been funding both sides of the War on Drugs since the day the phrase was coined back in the Nixon Administration. Fifty years later, you really have to wonder if decades of government policy have made any substantive difference. 

I hesitate to say we should just stop prosecuting this war. You won’t hear me calling to legalize heroin or meth, but it feels like we should at least admit that continual escalation of the war can be reasonably expected to deliver mixed results at best. 

At my most honest, I’ll tell you that I don’t really give a damn what a grown adult decides to put in their body. Personally, I like caffeine and nicotine. My only real objection to “drugs” as a policy consideration is when those who choose to use them start doing crime to feed the habit or when it leads to people blocking up the sidewalks and using the streets and parks as open-air bathrooms. It’s the same logic by which I don’t especially care how drunk anyone decides to get as long as they don’t get behind the wheel of a car or otherwise endanger others with their choices.

So, sooner or later I’m sure we’ll end up labeling the Mexican cartels “terrorists.” They probably are by any reasonable definition… but I don’t expect the words we use to make any appreciable difference in what’s flowing across the border and into every city, town, and village in America. 

Blaming “Big Pharma”…

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So Johnson & Johnson just got bitch slapped by the State of Oklahoma for creating a pain reliever it turns out has some addictive qualities. A fair portion of the interwebs are cheering this development.

I’m a contrarian, though. There are some fine points that I don’t quite understand. I have questions.

Opioid pain relievers are, obviously, considered pretty good at what they were designed to do. Without deep diving into the science of how and why, my assumption is they were created principally to reduce / manage pain. It occurs to me, a guy with no medical degree or scientific training, that there are a lot of ways to get after that goal other than opioids depending on the severity of the pain in question.

So now, the question is, what, if anything, is available that’s just as effective at revealing pain as a standard opioid? Then, the question becomes, what role do doctors have in determining the most effective treatment? Finally, we get down to brass tacks and ask what responsibility does the general public have in terms of being informed about what these options are and what they are putting into their own bodies?

You see, I don’t blame the drug companies here – at least not to the level of holding them out as the ultimate bad guy. I suspect in developing bigger and better opioids they were simply responding to a demand signal in the marketplace. That is to say that when given an option, people tend to want to reduce the pain associated with medical conditions or procedures as much and as quickly as possible. I don’t blame them. I’m less than heroic under duress. I don’t want to be in pain any more than is strictly necessary. I wouldn’t do well if it came to holding up under torture. What can I say, I’m a man who knows his own limitations.

With that all said, I’m also a guy who makes his own decisions. I’ve been prescribed opioids on a couple of occasions. Fortunately, the level of pain involved was such that I could manage with a few hands full of 800mg ibuprofen and go on about my business. Even though it was readily available, I opted to bypass the higher powered pain killer because I didn’t really need it. A lot of other people would have made different assessments of their own needs under the exact same circumstance. But everything starts with that choice… and then consequences follow.

But, this is America in the 21st century, so we have to have someone to blame for every bad thing that happens. “Big Pharma” is an easy and tempting target when it comes to who caused the opioid problem. It is their product, after all… even if that product only exists because we collectively have demanded a better and faster painkiller. They gave us a hell of a product. Maybe in the future we we should be a bit more thoughtful about what we ask for and noggin through some of the second and third order effects it might have.

Yeah, right. Like that’s going to happen. Never as long as we have a convenient scapegoat to relieve us of the burden of our own responsibilities.

What Annoys Jeff this Week?

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1. I left the house a little later than usual. Where the street I live on dumps out into the local county road parents and their SUVs were stacked up like cord wood. There they sat, engines running, more or less blocking the road, and making sure their little princelings had enough heat while they waited for the school bus. It was just below freezing, not exactly polar explorer weather. Basically a decent coat and a good pair of socks would have been enough to make it tolerable for a few minutes. I can’t help but remember my own childhood where if you didn’t walk to school you at least walked to the bus stop – and that’s back at a time and place where temperatures below freezing weren’t cause for any particular alarm, being part and parcel as they are of the winter weather season. These kids have never been allowed to run through the woods throwing rocks at each other and it shows.

2. ISIS brides. The last few weeks have been thick with reports of women and girls who ran off from western civilization for the fun and adventure of becoming ISIS brides. Now, with the dream of an Islamic caliphate collapsing around their ears, they come out of the woodwork claiming to have learned the error of their ways. Here they come crawling “home” after years of providing aid and comfort to the enemy. I’m not a scholar of international law nor does my heart bleed for their reaping the results of traitorous decisions. They wanted the wonder of life in the belly of the beast, the best thing that we can do now is let them have it.

3. Fentanyl. I keep seeing news stories wherein a drug ring has been busted in possession of enough  Fentanyl to kill 375,000,000 people. Look, I know we can’t really aerosolize the stuff and indiscriminately launch it from a mortar tube, but maybe we hold back on making these arrests for a hot second. I mean, look, people are basically awful so with enough of this floating around in the underground economy it seems to me the problem with those who habitually associate with a culture of heavy drug use could significantly reduce the demand side of the market by simply dropping dead. If a subset of the population is committed to continuing  to inject a substance they know full well may kill them more or less instantly, I don’t feel any moral force compelling me to intervene between them and and their apparent desired end state. I’d rather spend a much reduced budget on saving the small minority whose exposure to fentanyl or other high powered narcotics is accidental or that happens in the line of duty. Don’t tell me I never see the bright side, damnit.

In recognition of Big Pharma…

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I’m not going to lie here, I was a bit skeptical when I was given a link that promised a “significant rebate” on one of the more expensive meds that are currently keeping me alive. Sure it was all nice and official and came to me by way of bitching at my doctor about the ridiculous cost of this new pill, but the claims of being rebated almost 95% of my out of pocket expenses seemed outlandish and unrealistic.

After getting my second check back from the nice folks at Merck, though, I had to admit to being pleasantly surprised. Sure, they make they process convoluted and require a fair deal of bureaucracy, but in the end what would otherwise be an obnoxious monthly expense ends up costing a total of $5.00 out of pocket. I’m just going to ignore for the time being the small fortune I’m sure to be costing Blue Cross for all this, of course. I just think of myself as an insurance industry loss leader. They an feel free to use me as an example of someone who’s wildly pleased with their products and services.

As much as I like to bitch and complain, I think it’s worth doling out credit where and when it’s due. From my perch, kudos to Big Pharma for the solid work at delivering new and effective medication and for having a means and method to help offset costs for he end user. Well done.

Choice, vice, and the Protestant ethic for the 21st century…

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Note: The following is loosely based on a recent conversation and nicely sums up what’s probably at the core of my life philosophy. It has been sanitized for your protection, or ribbed for your pleasure, or whatever…

Look, if you want to kill yourself, have at it. You want to whore yourself out? Go forth and do great things. Want to chase that high six times a day? You do you, kiddo. Want to escape from the world and go live in the woods or under a bridge somewhere? Help yourself. I don’t have any business telling you how to live – or rather it isn’t my business right up until how you want to live starts having an out-sized impact on those around you who are just trying to live their lives too.

You see, the thing is, I don’t really care about what are commonly called “vice” crimes. Drugs, gambling, prostitution – the old classics. As long as everyone involved is a consenting adult, why the hell do I care what they choose to do with or to themselves? Experience tells me that trying to save someone from themselves is almost the textbook definition of a losing proposition. I’m fully prepared to let people go on drinking and drugging and whoring and gambling to their heart’s content if that’s what they want to do.

Here’s the catch. When their decisions start interfering with other people who are just out in the world trying to do their own thing, I’m perfectly willing to see society crash down on them like the clenched fist of any angry god. When they start killing and thieving and generally making civilized life impossible for others, my level of sympathy with their “plight” drops to damned near zero.

When the drunk climbs behind the wheel or the addict breaks into a home or the gambler starts embezzling from their employer, I cheerfully advocate a policy of zero tolerance and swift, harsh retribution. In life you make your choices and the consequences should naturally follow. It’s not my job to shelter you from those consequences. It’s not society’s job to pick up the tab and bail people out because they’ve made shit decisions.

Some people call me misanthropic. They’re not wrong. Based on a lifetime of observation, I like to think my general misanthropy comes from a place of reason. Couple that with a firm belief in self-determination across all circumstances, and well, there’s a pretty high risk of sounding like an asshole. Of course just because you sound like an asshole doesn’t mean you’re wrong.
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I feel like I’m on to something here. Do the work. Be responsible for yourself. Basic guidelines for life not spent as a complete and utter drain on society. Maybe I’ve stumbled upon the Modified Protestant Ethic for the 21st Century.

What Annoys Jeff this Week?

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1. No paper towels. I’m all for environmental responsibility where it makes sense. I recycle. I’m replacing all the light bulbs in my house with LEDs. The new water heater I installed is ridiculously efficient (and has the price tag to match). Some things, though, are beyond the pale. I know that keeping old fashioned paper towels in your public restrooms is a hassle. They’re expensive, they end up all over the floor, and they become bags and bags of trash to be disposed of… even knowing that, I just don’t care. All I want to do after taking a wiz is wash my hands and be able to dry them. The underpowered, barely functional “hot air dryer” just doesn’t cut it since I don’t have 43 minutes to thoroughly dry my hands each time I used the facilities. Public restrooms are an unfortunate necessity. I don’t expect them to be gold plated but for the love of Pete, I’d like to be able to dry my hands.

2. The demand side. Given my predisposition towards fairly conservative economic principles I can safely be called something of a supply sider. Watching the US Coast Guard show off the nearly half billion dollars wort of cocaine and heroin interdicted last month, though, I’m not sure the who “drug thing” is something that we can fight principally from the supply side. As long as there’s a demand, the suppliers are going to find a means and method of supplying that demand – at an increasingly high cost on both sides. I’m not enough of a libertarian to think that flat out legalization of everything is a good idea, but it increasingly strikes me that to get after the issue with drugs means going after it on the demand side. Pouring increasingly large amounts of money into chasing the supply would seem to only garner continuingly middling results. I have no idea what the answer to the demand side is – treatment, sure, that will work in some cases. Start letting the addicts drop dead, or what I like to cheerily think of as letting Darwin have his due? OK, maybe it’s hard medicine but perhaps best in the long run if it means that subset of the population is no longer thieving and whoring and begging, which might help alleviate the impression that every city and small town in the country is well along the process of turning into a filth ridden hell hole.

3. The NFL. Stories are popping up on a number of news sites about the ratings hit the NFL has taken this year. Some sources are blaming the weather, others the rise of “activist” players. As someone who hasn’t watched a professional football game from start to finish since the late 1990s, I don’t really have a dog in the fight, but I can make a few observations. First and foremost, the NFL is a ratings driver. It’s not in danger of going out of business any time soon. With that said, the league would be well served to remember that despite the outward appearance of a nation of fierce team loyalists, the product they offer is entertainment and it’s subject to the same market forces that influence every other competitor out there trying to put their hands on viewer’s wallets. There has probably never been a time when there are more and better entertainment options available to the average American consumer than we have today. The fact that a game run by billionaires, played by millionaires, and marketed to the great swath of Americans who think of themselves as middle class is losing some of its grip on the market shouldn’t in any way be surprising. A good first step in bringing fans back into the fold would seem to be to making sure the paid performers don’t offend their viewers by dragging politics into what would otherwise be a nice mindless Sunday’s entertainment. Don’t put a stick in the eye of the people who you want to hand over enormous sums of money feels like it should be Rule #1.

Training my life away…

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I’m not a procrastinator by nature. I tend to want to jump in and get shit done just as soon as possible. The grand exception to this rule is the laundry list of online annual mandatory training opportunities that Uncle has decided are important. Many of them don’t change from year to year. The old ones never drop off and new ones are always being added by some good idea fairy lurking in the depths of the five sided lunatic asylum on the banks of the Potomac.

For as long as I can remember, I’ve put off doing this online training hell right up until the last possible minute. Usually that means sequestering myself for a few days before the end of the year to click through everything just before the end of the fiscal year and clear my name off the training officer’s naughty list.

I’m trying to turn over a new leaf and using part of my telework days to plow through these interminable classes two at a time. I don’t have a rhyme or reason for which ones I take other than working the list from top to bottom… but today turned out to be “drug and alcohol awareness day” at the online training farm.

After two hours of checking this particular box, I’m left to wonder how these dumbass training requirements don’t send us all down the path of reckless drug and alcohol use.

What Annoys Jeff this Week?

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1. Coat blowing. I dearly love my ever-loyal, if somewhat ditzy, chocolate labrador. She is the operative definition of a kind and loving soul. But honest to whatever God there is in heaven if she doesn’t stop blowing her winter coat soon I’m going to lose what small slivers of sanity I have managed to hang on to lo these many years. It’s like the whole bleeding house is covered in a fine, slightly fluffy film of dog.

2. The other email. Without delving into any specific details, I have an alternate email address that occasionally gets used for work. In part it’s annoying because I can’t access this account from my desk. Fortunately, almost no one ever uses that address so it’s not completely inconvenient. That being said, if you don’t log into the damned thing about once a week, you start getting nasty messages from the Great Email Monitor threatening to cut off your access. Once they do that you’ve got to start from scratch setting up a new account, which could take as long as 247 work days to complete. Since I really do need this account for about one message ever 8-10 weeks it effectively just creates a barely essential pain in the ass that requires me to set up a calendar reminder to schlep next door once a week to log in, look at an empty inbox, and ensure that the account stays active for another week. You’ll forgive me, I hope, for being only slightly vexed (but not at all surprised) by such a patently inefficient process.

3. Acting surprised. A major musician has died under unclear or suspicious circumstances. I’m not sure why anyone would be surprised that a music superstar might have succumbed to the effects of legal and/or illegal medications. It’s not like this is the first time music and drugs march down the same road. It’s the fact that anyone from fans to media pontificators can pretend such events are anything other than “as expected” that’s farcical. A man is dead and that’s sad enough in its own right, but when it’s self-inflicted I have a hard time finding it an outright tragedy.

Darwin’s price…

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My news feed has been flooded for the last couple of weeks with the “news” that a heroin epidemic has broken out. Well, I don’t suppose that’s news really. HBO built a pretty popular television franchise by telling the story of heroin almost a decade and a half ago. It’s not exactly a new problem, even if it has taken on new faces and occupied new territories – territories that were once largely the traditional province of prescription drugs and methamphetamine.

A local county here in Maryland reported twenty heroin overdoses in the first two weeks of February this year. Now hang on to your hats, because what I’m about to say will probably annoy a large number of people and might even cost me a few friends. Still, though, I think it needs saying – if only because the currently popular discussion of mass treatment versus mass incarceration seems to continually miss the target.

Maybe it’s time to just accept that there are a certain subset of people who have accepted death as a risk of what they’re doing. If people want help, by all means give it to them, but if their actions demonstrate clearly that they’ve resolved to die in a ditch no matter how much help is available to them, well, it seems like the problem will sort itself out fairly quickly. At what point is it just stupid to save someone who’ll be on the street knocking over a liquor store or stealing from their former friends and neighbors to fund their next fix as soon as they’re out of the hospital or jail. It might be a kindness to allow Darwin to extract his price sooner rather than later.

Now before someone comes screaming at me that addiction is just like any other treatable disease, let’s remember that even though I’m diabetic I may be killing myself slowly with my dinner options, but I’m not breaking into anyone’s house to steal pie and I’m not out working the corner to raise cash for my next Snickers. It’s not just a difference of semantics.

I know there isn’t a chance in hell of my shell of a plan ever being adopted. For the most part people are entirely too softhearted to allow natural consequence to take its course. The point is, what we’ve been trying clearly isn’t getting the job done, so what’s next?

What Annoys Jeff this Week?

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1. Big Pharma Guy. Despite the public outcry it’s actually not the physical embodiment of Big Pharma that bothers me about someone who ramps up the price of their product from $13 to $750. The dude might be an MBA, but he clearly wasn’t paying attention in the “shaping public opinion” part of class. Sure, it was a douche move, but hey, I’m going to tell you to go out there and charge whatever the market will tolerate for your product. The fact that he’s been so quick to backpedal gives me a pretty strong indication that he didn’t think things through all the way to their logical conclusion. What annoys me more than anything though, is that I’ve never had the foresight to buy the patent on some widget I can make for less than a dollar and turn around and sell to a willing marketplace for thousands of percentage points in mark up.

2. Volkswagen. Someone established tough standards and then someone else found a way to lie in order to beat the standard. That’s how it works. That’s how it’s always worked. While I agree that Volkswagen did a very bad thing, I’m not sure why anyone is reacting with surprise. People, almost as if by nature, look for the loophole that lets them do whatever they wanted to do with the least amount of trouble. In this case, jiggering with the onboard computer was the path of least resistance. A test is only as good as the way it’s validated, or as a wise old Warrant Officer once told me, “You don’t do what the boss don’t check.” If you’re going to insist on having regulations, at least then insist that someone is responsible for making sure the testing mechanism works. I don’t blame Volkswagen for following their own self interest so much as I blame a system that was put in place that let them get away with it for the better part of a decade.

3. Delayed interest. When I’ve been working on something for months, there is no conceivable way I can bring you up to speed on the intricacies of each bit and piece of the puzzle 37 seconds before that particular thing is done. Thirty seven seconds may be an exaggeration, but only a minor one. At some point when I tell you something needs signed it’s going to have to be ok in believing that I know what I’m doing. At least we can put that dirty rumor that we’re trusted professionals to rest now.