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Trump’s epic drug fail: The case for safe, legal heroin

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President Trump declared that opioids are now a “National Public Health Emergency.” At the same time he demonstrated his ignorance of important facts. That is likely the fault of Chris Christie’s chairmanship of the President’s Commission on Combating Drug Addiction and the Opioid Crisis. Only one of the Commission members, Dr. Bertha Madras, has any subject matter expertise. The other five are elected officials, all of whom have publicly demonstrated allegiance to the idea that the Drug War is the proper way to deal with an epidemic of overdoses.

To say that this is wrong-headed would be the observation of an astute student of the obvious. The War on Drugs was officially declared by Richard Nixon in 1971, but has been going on at least since the Harrison Narcotics Act of 1914. In a century we have experimented with banning one addictive drug, alcohol, only to discover that prohibition does not work. Yet politicians and their lapdogs in the press have slavishly insisted that if we do more of the same, we will eventually get a different result. Albert Einstein famously noted that this is one definition of insanity.

Widely distributing Narcan to drug addicts will probably save some lives when they overdose, but that’s like calling a wrecker to tow you to the tire store when one blows out after all four have been bald for a year. Sometimes you’ll get in safely, but other times you’ll end up injured or dead in an accident.

Dr. Madras is an expert in the cellular biology of addiction, but it is clear from her writings that she is most comfortable with remedies based in formulary controls, claims data surveillance, and education of physicians on reducing opioid risks. This top-down regulatory approach is shared by the congressman, state attorney general, and three governors who fill out the commission. In short, the Commission’s prescription was printed and signed before the Commission ever met. It completely ignores a century of experience in the field.

Opiates 101: A short course

In my 36 years in Anesthesiology, I became intimately familiar with the salient fact that all opiates are essentially the same drug. (See table) All work on the same receptor in the brain. All depress breathing so that in an overdose, the victim completely forgets to breathe until he is completely dead. All cause constipation, nausea, and vomiting. All change how one sees the world, and once your body is used to them, they all cause horrible withdrawal symptoms.

The only material differences between opiates lies in how quickly their effects start, how long they last, and how the drug is administered. In a sense, Remifentanyl is short acting Fentanyl, while Morphine, Heroin, and Dilaudid are delayed release Fentanyl. Oxycodone is essentially an oral form of Morphine. I could go on, but you get the point.

Knowing those facts made it easy for me to administer literally gallons of opiates safely. Had Heroin been legally available, it could have joined Fentanyl, Morphine, and Dilaudid as my front-line drugs for pain. After all, it has the same onset, duration, and side effects as Morphine and Dilaudid, with potency between them.

History 101: Why opium was banned

By now it should be painfully clear that there is no medical reason whatever for Heroin to be banned. It’s a good drug with definite medical utility. And Fentanyl has proven itself to be a very good drug since it was introduced into clinical medicine over fifty years ago. Yet suddenly there are wild cries to eliminate a “public health emergency” from a drug we’ve used safely for decades. Why should this be?

Opium has been used for both intoxicant and medical purposes for as long as we can trace history. It is an extract from a pretty flower that grows wild in many countries. It dulls pain by working more effectively at the endorphin receptor than endorphins, which your brain makes. As long as the strength of the drug is known, it is extremely safe. But do-gooders can’t leave well enough alone. Could it be they see some benefit for themselves?

Opium has been a cash crop for millennia, but by itself isn’t that highly profitable since harvesting and refining it is inexpensive. An addict can easily be supplied for a couple of dollars a day. A supplier needs a large market. Or he can have a smaller market at a higher price.

Our current obsession with the bad habits of others took full flower at the pen of William Randolph Hearst. During the building of the Trans-Continental Railroad, large numbers of Chinese laborers were imported. They took their one day a week off in the nearest shanty town where many smoked opium, got high, and slept it off. Hearst was a blatant racist with the largest megaphone in the country, the Hearst newspapers.

His hatred for the “coolie” sprang vividly from the headlines, cartoons, and editorials of his papers. Soon the “opium fiend” was a matter of public condemnation, even though the demon created in the printed word never existed, since opium does not lead to aggressive behavior. Shortly Congress passed the Chinese Exclusion Act of 1882, which prevented further Chinese immigration.

This did not end the frenzy. In 1914 Congress passed the Harrison Narcotics Act, again in the complete absence of evidence that individual consumption of narcotics caused harm to those not engaged in its use. Further, many, in the footsteps of the “coolies,” were able to use the intoxicating drug and continue to live a productive life.

When Harry Anslinger became the first Director of the Federal Bureau of Narcotics in 1930, the War on Drugs (by other names) became fully fledged. Never again would the wisdom of the effort to stamp out drug abuse be seriously questioned in the halls of power. Prohibition of one intoxicant, alcohol (1920-1933) was extended to other intoxicants, the opiates. Unlike alcohol which is consumed across wide socioeconomic classes and has been released from constitutional imprisonment, opiates remain the forbidden fruit.

The benefit of prohibition: Risk premium

While it is clear that, in the absence of proper medical indication, opiates are detrimental to well-being, addicts who are maintained on their meds are no threat to society. Many are able to function at a high level. So what benefit arises from prohibition? As James Carville famously said, “It’s the economy, stupid!”

When intoxicants are prohibited, a “risk premium” is created.

A risk premium is the return in excess of the risk-free rate of return an investment is expected to yield; an asset’s risk premium is a form of compensation for investors who tolerate the extra risk, compared to that of a risk-free asset, in a given investment.

– Investopedia

When drugs are legal, there is no legal risk, and the cost to the consumer is the basic economic cost of the steps of production and distribution. As we noted earlier, this is less than the cost of your daily Starbucks latte’. It’s enough for a basic business but simply lacks the margin to support a criminal enterprise.

When drugs are illegal, a market still remains, since a significant portion of the population has wanted intoxicants throughout history. But now there is a notable risk to supplying the demand. So price increases to cover that risk. The curbside pharmacist has to get his supply somewhere. His supplier has the same problem, so the price goes up more. Now the customer has a problem.

If he’s going to empty his wallet to pay for all that risk, he wants a real bang for his buck. After all, he could end up in jail, too! This potency requirement raises the price on the other steps… again. It’s a vicious cycle. What started out as something cheap has become very expensive. And now there is profit for criminal enterprises.

Those enterprises will want to protect their turf from competition, and now we see violent crime start to appear around the drug trade. Customers who become addicted now have to find ways to support their habits, and various other crimes become common. Note that every level of crime was absent in the open trade for opioids. As soon as drugs became criminalized, bigtime crime moved in, because prohibition creates profits for them.

One more problem arises. How does a dealer keep his customers? He has to provide high quality product. This was demonstrated very well in the late 1960’s when Laotian General Ouana Rattikone marketed “999” heroin. It was a very consistent product so that a safe dose could easily be administered. When competitors made more highly refined heroin, he upped his game and produced “Double Uoglobe Brand” heroin. Reliable quality led to large sales.

Rattikone was in a protected area. Your distributor can’t do the same thing without attracting attention. But he can mix his product with other things. If he cuts it with inert materials, he can spread it further, but competitors will attack his poor quality. On the other hand, if he adds something a bit more potent, such as fentanyl, he will give the appearance of a better product.

Unfortunately, this competitive commercial response is now being seen in multiple markets with radically differing amounts of fentanyl. Now each addict is taking on a new risk every time he administers a dose. It may be worthless or it may completely stop his breathing until he is completely dead.

What if we legalized heroin?

Let’s review the chain of events. Prohibition introduces a risk premium, making crime pay. It also prevents the customer from knowing what dose he is getting. Many users will get overdoses, and many will die. Should we be surprised when that is today’s headline?

Suppose we legalized drugs? Apologists for prohibition claim we’ll see more addiction and more deaths. Instead “we need more detox and rehab programs.” Should we be surprised that this approach is promoted by people who profit from those programs?

Fortunately, we have laboratories that show what works. One of them is called Portugal. There, heroin was made legal in 2001. Sixteen years have shown that overdose deaths have almost vanished.

Addicts are maintained on steady doses of drugs they get for free from clinics. The total cost is less than that latte’ we mentioned earlier. And, curiously, addicts are slowly weaning themselves off of opioids in an average of ten years.

Imagine that! When they don’t have to resort to crime, addicts are able to maintain relatively normal lives and then act in their own self-interest. And no funds are diverted to unnecessary detox and rehab programs. And, by the way, no funds are spent on expensive drug interdiction efforts. No undercover cops infiltrate drug rings, because there aren’t any.

Suppose the United States was to do this? Our expensive rehab programs would go away, allowing money to be spent where it can actually do some good. But more important, the profit that fuels the Mexican drug cartels would dry up. We wouldn’t have Border Patrol agents running up against heavily armed drug gang members. There will be no need to prosecute the next El Chapo, because he won’t get rich enough to matter or to export his crime to the US.

What’s not to like?

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Conservatism

Dr Wen was pushed out of Planned Parenthood because she’s not a wartime leader

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Dr Wen was pushed out of Planned Parenthood because shes not a wartime leader

Some leaders are meant to bring people together. Others are made to get from one point in an organization’s development to the next stage. On occasion, an organization needs to go to war, and that’s what Planned Parenthood believes it needs to do right now. Their former president, Dr. Leana Wen, believes she is a combination of the first two types of leader – bringing people together and transitioning Planned Parenthood. She believes this is why she was pushed out the door by the board.

They want to go to war and Wen is not a wartime leader.

This may sound like a bad thing for pro-life organizations as their top nemesis is clearly positioning to be more of a political organization willing to play dirty and force the issue of abortion on as many people as possible. But an astute examination of the way things are today reveals one truth: America is polarized, so it’s better to go to fight ideology versus ideology rather than attack an organization trying to build bridges.

It may have been difficult for Wen to truly coax moderate pro-lifers, liberty-minded ant-government folks, and people on the fence on the abortion issue, but she was laying the groundwork for such things. This is why I’m glad to see her go. I know the threat of a proper radical progressive who hates pro-lifers to the core is worrisome to some, including our top pro-life writer. But the writing is on the wall: war is on. Planned Parenthood is looking for a battle-hardened fighter to shame people in Alabama, scare people in Georgia, and celebrate progressives in New York. They want someone who will push the feminine healthcare aspect of Planned Parenthood to the backburner and focus solely on advancing pro-abortion laws and planting more abortion clinics around the country.

We’re not just fighting for the lives of preborn babies, though that is plenty of incentive to fight. But we’re also fighting for the soul of the nation. For the pro-life, conservative, and Judeo-Christian worldviews to regain prominence in America, it’s important that we stake our claim to unambiguous differences between our beliefs and their’s. Some will tell me we need more unity, but the only unity that’s possible in today’s polarized society is if the left gets their way and enough on the right accept it. The left will not accept our perspectives. Therefore, we must force the issue. We must get into an ideological war. Most importantly, we need to put our truths up against their best lies.

The best lies they tell are that abortion is a right, pre-born babies aren’t people, and killing the “lump of cells” in the mother is somehow considered healthcare.

In an article posted today by the NY Times, Wen explains why she was ousted and gives hints about the direction Planned Parenthood wants to go without her:

With high-quality, affordable health care out of reach for so many, Planned Parenthood has a duty to maximize its reach. I began efforts to increase care for women before, during and after pregnancies, and to enhance critically-needed services like mental health and addiction treatment.

But the team that I brought in, experts in public health and health policy, faced daily internal opposition from those who saw my goalsas mission creep. There was even more criticism as we worked to change the perception that Planned Parenthood was just a progressive political entity to show that it was first and foremost a mainstream health care organization.

Perhaps the greatest area of tension was over our work to be inclusive of those with nuanced views about abortion. I reached out to people who wrestle with abortion’s moral complexities, but who will speak out against government interference in personal medical decisions. I engaged those who identify as being pro-life, but who support safe, legal abortion access because they don’t want women to die from back-alley abortions. I even worked with people who oppose abortion but support Planned Parenthood because of the preventive services we provide — we share the desire to reduce the need for abortion through sex education and birth control.

The Planned Parenthood of the near future is one that doesn’t worry about reproductive health or the safety of babies. They simply want more abortions. There’s an evil at the heart of the organization that is actually darker than we’ve seen in the past, if that can be imagined. We need to fight this darkness, and Wen was in the way trying to make Planned Parenthood inclusive and acceptable. That went against their new goal. They want the issue forced.

Our truths are able to shine brightest when the opposition is at its darkest. A kindler, gentler, inclusive agenda isn’t as dark as Planned Parenthood’s desired goal of advancing as many abortions as possible. I’m glad to see Wen removed.

We are currently forming the American Conservative Movement. If you are interested in learning more, we will be sending out information in a few weeks.

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Democrats

The real reason Kamala Harris and others keep dodging on Medicare-for-All funding

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The real reason Kamala Harris and others keep dodging on Medicare-for-All funding

Arguably the first major “dumb” moment for Alexandria Ocasio-Cortez was when she replied to a question about paying the $32 trillion price tag associated with Medicare-for-All. She said, “You just pay for it.”

Conservatives were laughing at the response while many Independents and even some Democrats were scratching their collective heads. But she meant exactly what we said. Let’s put a pin in that for a moment and move on to an interview Kamala Harris did with CNN.

Even the Democrat-friendly CNN reporter couldn’t help but press Harris about how she plans to pay for Medicare-for-All without raising taxes on the middle class. Bernie Sanders has acknowledged he’d have to raise taxes to pay for Medicare-for-All. What strange math does Harris know that Sanders does not? Is it simply artful dodging of the question over and over again as the Senator kept calling it an “investment”? Is she just pandering, knowing darn well she’ll have to raise taxes on everyone in order to fund socialized medicine but pretending like she won’t? Or is she being absolutely serious?

I’m going with that. She’s saying what she means. In essence, she’s saying what AOC said. Harris is just going to have the U.S. government pay for it even if tax dollars won’t cover it.

At this point one might be thinking that both Harris and Ocasio-Cortez are delusional. If that were the case, I wouldn’t be too worried. But they’re not delusional, at least not to the point that they don’t really know what they’re insinuating by saying the government is going to “invest” in Medicare-for-All and we’re just going to pay for it. There’s only one way to do this without drastic tax increases. It’s called Modern Monetary Theory and AOC has been on board with the disastrous concept since before she was elected. Now, it seems Harris is going to invoke the same methodology to pay for her version of Medicare-for-All and whatever else she has up her sleeve.

In essence, Modern Monetary Theory erases the fear of budget deficits and skyrocketing national debt by printing money. And more money. And again. Rinse. Repeat.

It’s the precursor for hyperinflation, though its proponents claim otherwise. They’ll tell you we’re already running trillion dollar deficits and nothing bad is happening, so why not keep going? Why not run five trillion dollar deficits? Or more? The government and the Fed have the power to keep printing as much money as they want, and as long as the U.S. Dollar is the world reserve currency, there’s really no way for hyperinflation to set in.

But it will. There’s no possible way to avoid it once the world takes note because they’ll instantly seek other avenues to replace the Dollar. That includes OPEC and the designation of the petrodollar being shifted. Nobody wants to rely on a currency that is being devalued by its own government. They’ll bail. And when they do, hyperinflation will set in.

When radical progressive politicians give strange responses about how they’re going to pay for their huge projects, take them at their word when they say they’ll just pay for it. They have a plan in mind that’s more dangerous than anything our economy has faced.

We are currently forming the American Conservative Movement. If you are interested in learning more, we will be sending out information in a few weeks.

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Conservatism

A trillion dollar deficit is much more dangerous than the GOP acknowledges

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A trillion dollar deficit is much more dangerous than the GOP acknowledges

Spending. It’s the thing that helped me make my decision to leave the GOP a few years ago as there seemed to be very little difference between them and the Democrats when it came to fiscal responsibility. Where we spend the money is the only big deviation, but both sides of the political aisle have an addiction to spend more than the country has available. In the past, this was dangerous because of the crushing force of national debt that will eventually bring about an economic collapse. Today, the risk is much, much greater and within immediate striking distance.

What a trillion-dollar budget deficit represents today is an avenue through which Modern Monetary Theory could actually be realized in the United States. Those who are familiar with MMT may still be as complacent about it as I was a year ago; “It’ll never happen, not in America.” But as Democrats push Medicare-for-All, the Green New Deal, open borders, state-funded education, reparations, and outright socialism, there’s only one conclusion that any economist or political pundit can come to: If the new thinking of the Democratic Party gets a foothold and initiates some of their plans, then MMT is the only possible way to make it happen.

They don’t even need to initiate all of them. Just one or two will be enough for catastrophe.

In other words, they’re policy proposals are already writing checks the U.S. can’t cash, so every scenario in which a partial implementation of these policies takes place can only happen through MMT. For those who don’t want to read up on it, MMT is essentially the practice of printing the cash to pay the bills. Proponents say it will be different this time from every other failed attempt at MMT because America is responsible enough and too crucial to the world economy for it to cause hyperinflation. Reading the delusional excuses for promoting MMT reveals an uncanny ability to deny reality while simultaneously suppressing common sense. It’s the type of thing that only progressive economic scholars can truly comprehend, and that should terrify you.

By moving the budget deficit into the ten-digit arena, we’ve broken a threshold that gives MMT legs. Whether it’s Alexandria Ocasio-Cortez saying, “You just pay for it,” or Elizabeth Warren constantly saying the rich will be taxed until it’s paid for despite the basic arithmetic that demonstrates this is impossible, they’ll all latch onto the notion that if we can spend a trillion dollars in one year that we don’t have, why can’t we spend two? Ten? Fifty?

On one hand, I want to do whatever it takes to convince Republicans they need to do what they campaign to do: cut spending. It’s not as easy as just pulling the plug on frivolous programs, services, agencies, and whole departments… except that it truly is that easy. It’s not popular. Some say it’s political suicide. But considering it’s never been tried in the modern era (no real cuts have been made to spending in decades), now is the time to be bold and do what’s right for the nation. The rise of the internet in general and social media in particular gives conservatives an outlet through which they can educate the masses about the need to make cuts. It’s something we plan on doing as part of the American Conservative Movement.

But on the other hand, one thing that can’t happen in trying to convince Republicans they’re doing it wrong by allowing them to lose. The Democrats are now more than the lesser of two evils. They’re dangerous. The plans they will implement are existential threats to America. Sadly, many of them know this. The Justice Democrats, who are driving the leftward lurch within the Democratic Party, are shockingly aware of what they’re trying to accomplish. Destroying and rebuilding America in their image is the end goal. That image is not a pretty one, even to the Justice Democrats, but things are rarely pretty when radicals get their hands on it.

Modern Monetary Theory will be implemented if the Democrats get full control. Unfortunately, Republicans aren’t helping fight it as long as they’re pushing such untenable budget deficits. It’s time for a heavy dose of fiscal conservatism.

We are currently forming the American Conservative Movement. If you are interested in learning more, we will be sending out information in a few weeks.

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