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mg extender price in usa

บทความที่เกี่ยวข้อง mg extender price in usa

GolF ก็ว่า... 7 ปีของ MG จากบริษัทที่มีแต่คนดูแคลน กลายเป็นผู้นำด้านเทคโนโลยียานยนต์

และสร้างสีสันให้กับตลาดรถยนต์เมืองไทยมากที่สุด แน่นอนว่าคงไม่มีใครปฏิเสธว่า คำตอบนั้นก็น่าจะเป็นน้องใหม่ลูกครึ่งอังกฤษ-จีนอย่าง MG

ชมจุดเด่นและจุดด้อย 2019 MG Extender รถกระบะพันธุ์ยักษ์ ทำไมยอดขายรั้งท้าย?

2019 MG Extender (เอ็มจี เอ็กซ์เทนเดอร์) เปิดตัวอย่างเป็นทางการในช่วงเดือนสิงหาคม 2562 กลายเป็นผู้เล่นหน้าใหม่ล่าสุดในตลาดรถกระบะเมืองไทยExtender

2021 MG Extender เตรียมตกรุ่นแล้ว Maxus T90 เปิดโฉมไมเนอร์เชนจ์ใหม่ มาไทยเดือนนี้

2021 MG Extender อาจจะมีหน้าตาแบบนี้MG Extender (เอ็มจี เอกซ์เทนเดอร์) รถกระบะรุ่นนี้เปิดตัวในประเทศไทยได้เพียง

เทียบสเปกรถกระบะ 4 ประตู ขุมพลัง 2.0 ลิตร 2019 MG Extender วัดมวย 2019 Ford Ranger

2019 MG Extender (เอ็มจี เอ็กซ์เทนเดอร์) เปิดตัวพร้อมแนวคิดรถกระบะพันธุ์ยักษ์ ด้วยสัดส่วนตัวถังที่มีขนาดใหญ่โตที่สุดรุ่นหนึ่งในระดับเดียวกัน

Review: MG Extender กระบะยักษ์พันธุ์แกร่ง

Extender 2020 มีรุ่นให้เลือกรวมกว่า 9 รุ่น ได้แก่- MG Extender 2.0 Giant Cab C 6MT ราคา 549,000 บาท-

ชมคันจริง 2021 MG Extender ไมเนอร์เชนจ์ครั้งใหญ่ ขายแน่สิ้นเดือนนี้ คาดราคาทะลุล้าน

2021 MG Extender (เอ็มจี เอกซ์เทนเดอร์) มีการปรับโฉมไมเนอร์เชนจ์แล้ว โดยทาง MG ประเทศไทยได้จัดพรีวิวรอบพิเศษ

2021 Great Wall Motor Cannon (Pao) ควรมาไทยหรือเปล่า?

อ่านต่อ: คุณกัสคาดการณ์ : Haval H4 อาจมาไทยปีนี้ จะมีราคา 689,000 บาทเท่า MG ZS ชมภาพจริงที่นี่ตลาดรถยนต์กระบะในประเทศไทยมีขนาดใหญ่พอที่จะรองรับผู้เล่นหน้าใหม่อีกหรือ

แบงค์บอกต่อ Nissan Almera และ MG HS กับ Extender พร้อมแคมเปญดี ๆ ก่อนสิ้นปีนี้

แบงค์บอกต่อ นำเสนอโปรโมชั่นดี ๆ สำหรับซิตี้คาร์ Nissan Almera (นิสสัน อัลเมร่า) MG HS (เอ็มจี เอชเอส)

2019 New MG Extender กระบะพันธุ์ยักษ์ ทางเลือกใหม่สำหรับคนต้องการความครบครัน

Extender) รถกระบะจากแบรนด์เอ็มจี เปิดตัวไปเมื่อกลางปี 2019 ด้วยรูปร่างบึกบึนใหญ่โต ดูแข็งแกร่ง มีเอกลักษณ์เฉพาะตัว

อ่านก่อนซื้อ! MG EXTENDER มีข้อดีกับข้อเสียอย่างไร

และต้องบอกเลยว่า MG กล้าหาญชาญชัยมากที่นำรถกระบะ MG EXTENDER (เอ็มจี เอกซ์เทนเดอร์) เข้ามาขายในประเทศไทย

ดูเพิ่มเติม

ส่องยอดขายกระบะ 4 ประตูมีนาคม 64 Isuzu D-Max ครองแชมป์ต่อยาวยาว Toyota Hilux ตามมาติด ๆ

MG Extender 437 คันMG Extender (เอ็มจี เอกซ์เทนเดอร์) กระบะยักษ์ ได้รับการปรับเปลี่ยนหน้าตามาใหม่ ด้วยราคาเริ่มต้น

5 รุ่นกระบะแต่ง เอาใจคนสายโม ในงาน Motor Expo 2020

และการตกแต่งที่หลายคนทำก็มีแรงบันดาลใจจากรถแข่งเช่นกัน และรถแข่ง Ford Ranger คันนี้ ก็วิ่งและเลี้ยวได้ดีกว่าที่หลายคนจะคาดเดาแน่นอนครับMG

แบงค์บอกต่อ ซินเจียยู่อี่ซินนี้ฮวดใช้ ซื้อรถแถมทองรับเทศกาลตรุษจีนกับ MG และ BMW

แต่ละบ้านคงออกจะมาทำการไหว้เจ้าและบรรพบุรุษ หลาย ๆ บ้านก็เป็นวันจ่าย และสำหรับบ้านไหนกำลังมองหารถยนต์สักคันจะใช้ เรามีโปรดี ๆ จาก MG

แบงค์บอกต่อ กระบะราคาดีทั้ง Ford และ Mg ส่วนลดเริ่มต้นที่ 200,000 บาท

มีโปรดี ๆ มาบอกต่อกันกับ Ford Ranger กับ Everest และ MG Extender ที่นำรถมาลดราคากันกระหน่ำFord Everest

2020 NEW MG HS PHEV เปิดตัวรุ่นใหม่จะชิงส่วนแบ่งตลาดจาก Honda CR-V ได้หรือไม่?

เมื่อไม่นานมานี้ MG เปิดตัวรถ Compact SUV ทางเลือกใหม่ Plug-in Hybrid ในชื่อ 2020-2021 NEW MG HS PHEV

รถไฮบริด – รถปลั๊กอินไฮบริด – รถพลังไฟฟ้า รถประเภทไหนเหมาะกับเมืองไทยที่สุด?

ไม่ต้องมีความกังวลว่าไฟฟ้าจะหมดลงกลางทาง รถยนต์ปลั๊กอินไฮบริดที่จำหน่ายในเมืองไทย อาทิ BMW X5 xDrive45e Plug-in

2019 New MG Extender  DC 4WD 6AT กับ 4 เหตุผลที่คุณควรซื้อ 

2019 New MG Extender (เอ็มจี เอ็กซ์เทนเดอร์ )DC 4WD 6AT คือรถกระบะน้องใหม่ในตลาดรถกระบะเมืองไทย ที่เปิดตัวด้วยความใหญ่โตของตัวถัง

เปิดตัว MG5 EV และ MG HS Plug-in ก่อนในอังกฤษ ไทยจะตามมาสิ้นปี

และใช้งานได้จริง เพื่อมาเคียงข้างกับ MG ZS EV ให้กับประเทศอังกฤษ คือรถ MG5 EV และ MG HS Plug-in ซึ่งทางเอ็มจีหวังว่าจะช่วยเพิ่มยอดขายให้ได้มากกว่าเดิม

MG สร้างจุดขายใหม่ให้ Extender หวังเจาะเอสเอ็มอีหนุนตลาดโต

MG (เอ็มจี) ผู้นำตลาดเอสยูวีในประเทศไทยในช่วงครึ่งปีแรก เริ่มแผนการสำหรับการผลักดันตลาดอื่น ๆ โดยเล็งไปที่ตลาดรถปิกอัพขนาด

ครั้งแรกในรอบ 2 ปี Isuzu D-Max ยอดขายแซง Toyota Hilux Revo

ใน 4 อันดับสุดท้าย มีรถกระบะค่ายรอง 4 รุ่นด้วยกัน ตั้งแต่ MG Extender (เอ็มจี เอกซ์เทนเดอร์) ซึ่งเป็นรถกระบะค่ายน้องใหม่ที่ชูความใหญ่โตโอ่อ่า

หน้าตาคุ้น ๆ BYD SS Summer ขายแล้วในจีน ในราคาที่ซื้อ MG HS PHEV ได้ 2 คัน

เสริมด้วยล้ออะไหล่ที่ติดตั้งไว้บริเวณประตูท้ายคล้ายกับรถเอสยูวียุคก่อนเหมาะสำหรับการออกไปกางเตนท์แคมป์ปิ้ง เสริมด้วยล้ออะไหล่ที่ด้านท้ายคล้ายกับรถในสมัยก่อนเครื่องยนต์จาก BYDติดตั้งขุมพลัง Plug-in

2021 MG5 ความหวังใหม่ MG ไทย คาดเปิดตัวปลายปีนี้ ด้วยราคาไม่เกิน 7 แสน

ว่า MG5 (เอ็มจี5) ใหม่อาจจะเข้ามาในไทย หรือที่ฮือฮากันใน Facebook ที่มีการปล่อยภาพโทรศัพท์พร้อมตรา MG

2020 MG HS PHEV กับคำถามที่พบบ่อยของระบบปลั้กอินไฮบริด อ่านก่อนคิดจะซื้อ

รถ Plug-In Hybrid ดีกว่ารถทั่วไปอย่างไรข้อดีหลัก ๆ คือ สมรรถนะที่แรงขึ้น จากการทำงานของมอเตอร์ไฟฟ้า ที่เสริมแรงให้กับเครื่องยนต์

Rendered : 2021 MG Extender Gundam Inspired Edition ถ้ากระบะแต่งเป็นหุ่นยนต์ จะเข้ากันมั้ย?

2021 MG Extender (2021 เอ็มจี เอกซ์เทนเดอร์) เปิดตัวอย่างเป็นทางการเมื่อเกือบ 2 ปีที่แล้ว แต่ทำยอดขายไม่ดีสมใจอยาก

2021 MG Extender ไมเนอร์เชนจ์ ประกาศราคาสุดเย้ายวน เริ่มต้น 559,000 บาท

2021 MG Extender2021 MG Extender (2021 เอ็มจี เอกซ์เทนเดอร์) รถกระบะโฉมใหม่ได้รับการประกาศราคาจำหน่ายอย่างเป็นทางการแล้ว

เสียงวิจารณ์โลกโซเชียลไม่ระคาย ทำไม MG ทำยอดขายผงาดผู้นำ

ความสำเร็จของรถอเนกประสงค์ค่าย MG ทั้ง MG ZS (เอ็มจี แซดเอส) และ MG HS (เอ็มจี เอชเอส) แสดงให้เห็นว่าค่ายรถยนต์น้องใหม่สามารถโค่นแบรนด์ยักษ์อันเก่าแก่ลงได้หากเดินถูกทางยอดขายสะสมของรถอเนกประสงค์ขนาดซับคอมแพ็กต์อย่าง

Porsche ยอมแบกต้นทุนสูงกว่าเพื่อผลิตในเยอรมนีดีกว่าประทับตรา “Made in China”

แต่ Porsche ยืนยันหนักแน่นว่าจะไม่ย้ายฐานการผลิตออกจากเยอรมนีอย่างแน่นอนแบกต้นทุนสูงกว่าเพื่อตรา Made in

ทำไม Toyota ไม่ขายรถปลั๊กอินไฮบริดในบ้านเรา แม้ประเทศอื่นได้ใช้ต่อเนื่อง?

แต่เมื่อออกนอกเมือง ก็สามารถใช้เครื่องยนต์สันดาปช่วยขับเคลื่อนได้” กิลล์ แพรตต์ หัวหน้าทีมนักวิจัยของ Toyota USA

แบงค์บอกต่อ แคมเปญรถใหม่ Ford Ranger FX4 Max มาพร้อมของแถมฟรีหลายรายการ

2021 Ford ranger FX4 Max (ฟอร์ด เรนเจอร์ เอฟเอกซ์4 แมกซ์) ตัวแต่งใหม่ของ Ford (ฟอร์ด) ประเทศไทย รวมถึง MG

เผยสเปก 2020 MG Gloster รถพีพีวีบนพื้นฐาน Extender โอกาสทำตลาดเมืองไทยมากน้อยแค่ไหน?

หลังจาก 2020 MG Gloster (เอ็มจี กลอสเตอร์) ได้รับการเผยโฉมรุ่นต้นแบบโปรโตไทพ์ในอินเดียไปตั้งแต่เดือนกุมภาพันธ์ที่ผ่านมา

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รีวิว Q&A mg extender price in usa

We are in the midst of an opiod/opiate epidemic, how would you choose to deal with the outcome, and how would try to minimize the damage on society?

Yeah, I know, stow the TLDR comments. I’m not an expert on pharmaceuticals but I do know a thing or two about politics and more than a thing or two about political history. So my take isn’t short because it’s based on facts and I’m not going to state facts here or anywhere else out of context. So this is a long one. You have been warned. They knew opioids were dangerous. Five and a half thousand years ago somewhere in lower Mesopotamia , human beings began to cultivate opium. The Sumerians named it Hul Gil, the "joy plant”, and they shared its properties with the Assyrians . The Assyrians shared it with the Egyptians, and on it spread. The Opium Poppy -- flourishing as it does in hot dry climates – made its way to China via that, 4,500-mile stretch of mountains that extends across central Asia from Turkey through Pakistan and Burma. The very same real estate it inhabits to this day. Opium's properties bordered on the divine. In Crete, the Minoan goddess of narcotics was adorned with a crown of poppies. In Egypt legend told of Isis offering opium to the sun God Ra to relieve the pain of a headache; bookish deity Thoth was said to have invented it. The Graco- Roman god of sleep Hypnos and his necrophile brother Thanatos were often depicted holding the flowers aloft. Across the ancient world, it was used as a symbol of sweet, nocturnal oblivion. Its earthly properties were no less impressive. It was occasionally mixed with hemlock to euthanize the suffering and more often used as an anesthetic to ease the agony of surgery. By the ninth century A.D., the Persian Doctor Abū Bakr Muhammad ibn Zakariyyā al-Rāzī recommended its use for the treatment of melancholy in what must have been one of the earliest examples of mental health advice known to man. There was just one catch. It’s hellishly addictive. Habit Pawning In 2016, in the U.S. alone, one person died from opioid abuse every 14 minutes. That comes to a total of 42,249 deaths a frightening number that even eclipses breast cancer fatalities. Some 11.5 million people misused prescription opioids during that same period and close to a million more-used heroin, (one hundred and seventy thousand of whom were using it for the first time). The total cost to the economy stands at around 504 billion dollars per annum or around $32 per week for every American man, woman, and child. The problem is quintessentially American. Not in the sense that other nations are spared the indignities of opioid abuse. Few places remain untouched. But in terms of sheer scale, America has positioned itself as the homecoming opioid queen. In 2015, U.S. consumption of Oxycodone stood at 194 mg/capita bucking the global mean of 11.4 mg/capita by several magnitudes. The explosion of misuse is no mystery; indeed, it can be traced back to a single metric; ubiquity normalizes that which is otherwise abnormal. Direct-to-consumer pharmaceutical drug advertising became a thing in 1997 when the toothless shill that is the Food and Drug Administration greenlit such marketing. Patients -- we were told -- have a right to know their options. The dangled carrot of ‘choice’ -- that darling watchword of high paid sophists and shit-shoveling marketing folk world over -- was ferried from talking point to talking point and reiterated ad nauseam. Experts nodded, journalists, prevaricated. The FDA caved. Commodity Fetish The drug companies hit the ground running. The first year spend on TV adverts of $664 million was merely an hors-d'oeuvre. According to Kantar , pharma is now the 7th largest ad category in the U.S. in terms of total spending. Said spending hit $6.4 billion last year – a growth of 64% since 2012. Budgets – unmindful of the damage they have wrought -- continue to grow. The number of brands spending at least $50 and $100 million annually has more than doubled since 2012. The Corporate cash injection reaped predictable dividends. Among the top 10 prescription drug brands ranked via 2016 ad investment levels, eight had double-digit growth rates year-over-year and all of them spent over $100 million. The commodification of health became a fetish like any other. Whilst opioids represent a relatively small subset of big pharma ad spending, they knew full well that long-standing taboos can so easily become the new normal if enough money was thrown at them. Got a health condition? There’s an ‘app’, for that; just ask your pharmacist. (As a side note, there is no point in blaming conservatism for the damage that has been wrought. Bill Clinton laid the groundwork as he masqueraded as a conservative pretending to be a progressive who occasionally caved into the Realpolitik machinations of a mischievous GOP. Democratic short-termism was rarely more self-evident than in the 90’s. Clinton abandoned the blue-collar base and laid the groundwork for Trump in a thousand shitty ways. This was just one of them. ) Still, the growth of Big Pharma ad spending was only part of the equation. The root cause of the epidemic lay in a concerted attempt by the pharmaceutical companies to allay the fears of doctors and patients alike. They knew two things. First, that irrespective of how it is packaged, an opiate is an opiate is an opiate and second, that to most people’s minds, that means one thing and one thing only. Addiction. It’s not like we had no prior warning. Royal Blackmail In 1839, Lin Zexu – a Chinese scholar and official of the Qing (Manchu) dynasty , penned a letter to Queen Victoria, a 20-year-old woman recently come to the British throne. He began his ‘letter of advice’, with both an assurance and a warning. Yes, the Emperor of China understood the benefit of trade with so ‘great’ a nation but no, his munificence was not without limit : “If there is profit, then he shares it with the peoples of the world; if there is harm, then he removes it on behalf of the world.” The harm in question was a familiar concern since-- according to Zexu -- mixed in with those engaging in trade with China were those who : “Smuggle opium to seduce the Chinese people and so cause the spread of the poison to all provinces". Such persons he added : “Care to profit themselves, and disregard their harm to others, are not tolerated by the laws of heaven and are unanimously hated by human beings". What right did the United Kingdom have to inflict such indignities upon China? For Zexu knew full well that the smoking of Opium was illegal in Britain and knew too that access was restricted : “Because the harm caused by opium is clearly understood”. Zexu spoke from experience. Tea For Two Britain’s love of tea was – and remains -- a bottomless cave of indiscriminate consumption. The same could not be said for a Chinese obsession with the fruits of English labor. China had little need -- and even less interest in procuring -- British goods. They refused to exchange tea for anything other than silver and silver was the one thing that the British were loath to part with. The opium trade offered a way out. The unfortunate combination of a porous border and widespread demand supercharged the trade. By the 1820s China was importing close to 1000 tons of opium annually despite the fact that the Emperor Jiaqing had banned the substance some twenty years prior. The drug was sold at market in Calcutta to accredited brokers, who transported it to British-owned warehouses in the free trade area of Canton. From here, it was smuggled by Chinese merchants – aided by corrupt customs officers – out of the British zone. But the British monopoly –which began in 1773 – ended in 1820 and as a consequence, the value plummeted. Expressed in Spanish silver dollars, the price of a chest of opium from Patna (Bihar) fell from $2,500 in 1822 to $585 in 1838. The increased demand was also expressed in terms of the area under opium poppy agriculture. In India, for example, cultivation increased from about 36,400 hectares in 1830 to 71,200 hectares in 1840. By 1900 it had peaked at 200,000 hectares. The War For Drugs The effect of plentitude on the price of any given product is well understood but the cultural impact of a product rendered suddenly ubiquitous is always much harder to assess. Certainly in China levels of addiction soared as Britain monopolized and then flooded the market. Family patriarchs ate through savings at a rapid pace and then hawked their worldly possessions. Once denuded of valuables, they forced wives and daughters into prostitution. Two wars were fought by the Chinese to end the trade, the somewhat appropriately titled ‘Opium Wars’. The first of these began in 1839 as a response to Chinese authorities’ seizure of Canton’s opium reserve. The government's assertion of their own sovereignty saw British traders lose some 1,300 mt of the valuable drug; outrage followed. Britain declared war and -- after soundly defeating China's hopelessly outclassed navy -- forced them to cede Hong Kong in lieu of compensation. The second took place in 1856 as the British sought to force China into legalization of the trade. The result – predictably enough – was a second Chinese defeat. In both instances, Opium imports from India rose from some 2,500 mt at the time of the outbreak of the first opium war (1839) to 6,500 mt by 1880. In despair, the Chinese government opted for full legalization, and opium production in China exploded. It peaked in 1906 at a record high of more than 35,000 mt. Legally Bland Lessons should have been learned. Ubiquity – indexed primarily by cost — creates a ‘culture of use’ that results in a never-ending feedback loop. The link between legality and use is a well-understood association. The net effect is always the same; it leads to permissiveness. Today, a drunk passed out on a bench is an object of ridicule at worst. The same man passed out with a needle in his arm is viewed with considerable less mirth. The daily consumption of legal drugs would be described as epidemic were they illicit. Tobacco use remains the single largest preventable cause of death in the United States killing more than 480,000 Americans each year, 41,000 of whom die from exposure to secondhand smoke. Smoking-related illness in the United States costs more than $300 billion a year, including nearly $170 billion in direct medical care and $156 billion in lost productivity. The figures for alcohol abuse are no less sobering. Of course, not all drugs are equal. Some 85% of the U.S. population consumes at least one caffeinated beverage per day. The mean (±SE) daily caffeine intake from all beverages was 165 ± 1 mg for all ages combined. Caffeine is hardly good for us, but it’s not liable to see us fall into prostitution for want of a soy latte. Not even a pumpkin spice one. Studies that have examined the effect of legalized marijuana use suggest that legalization increases overall pot use and dependence for adults 21 and older. The findings suggest that allowing businesses to sell marijuana leads to more access and use, particularly for adults. Whether that’s a good thing or not depends mostly on individual persuasion but the word ‘dependency’, carries with it negative connotations, health risks, and societal cost. Opioids: Opium Redux Not that Opioids are legal. The necessarily brief history explored within this answer focused on the Chinese use of raw opium by way of example only. Synthetic opioids such as Morphine and later Heroin and Fentanyl are many times stronger and as a consequence, far more dangerous both in terms of potential overdose and near-inevitable addiction. And yet, there is one more way to normalize the use of a drug, especially one that has a legitimate medicinal use. Anyone who has ever undergone a serious medical procedure is likely to have been given morphine or even the more potent diamorphine, a drug that those of us lucky enough to die quietly in a bed surrounded by loved ones will be almost certainly be given to ease our passing. Few of us come out the other side of a hospital stay with an eventual Heroin addiction. Because although addiction is complex and the human brain is more so by many magnitudes, one thing is clear: recreational use and the art of self-medication is a very definite factor in the spiral into dependence. Recent studies have even managed to index the euphoria of certain narcotics to specific environmental conditions . One does not simply decide to self-medicate with Heroin though. The decision to normalize opioid use – for a decision it was—came from a pharmaceutical industry who — I have little doubt — saw themselves as crusaders of a sort. The mustache-twirling villain of the popular refrain is often in reality little more than the intersection between loose morals and the desire to make a quick buck. The British did not necessarily want to position themselves as peddlers of misery in China; they sold Opium because it was lucrative. The big pharmaceutical companies were no different. A medicalized society represents near endless opportunity. Even Stranger Danger Still. they knew better than most that their product was dangerous. American medicine cabinets became overstuffed with prescription strength medication and generic names such as Vicodin, Percocet, Oxycontin and so on became as recognizable as any other brands: McDonald's. Snickers. Mickey Mouse. Xanax, you name it. Drug companies that don’t name the drug in question aren’t even required to list its potential side effects such as with the mesmerizing Lunesta commercials that showcase : An entire nation… on drugs as butterflies, indicated with thousands of illuminated specks, glow across a map of the United States as a voice softly coos, 'Join us'. Ermm, no thanks, I’m British. And yet, even though side effects are required by law to be explained to the consumer, medical professionals themselves are expected to use only their best judgment when prescribing. And their best judgment is often clouded by the pharmaceutical representatives who in turn rely on data provided by their own employers. The FDA approves medication, yes, but it doesn’t conduct its own studies. It can’t afford to. No prizes for guessing who can. The Integral Accident The question then is whether or not Big Pharma knew that the product they were peddling was harmful. There is a concept in political science known as the integral accident. An invention – any invention—brings with it unintended consequences. The Wright brothers invented the airplane and in doing so also invented the plane crash. Dick move Wilbur. But hardly malicious. Because they weren’t trying to sell a product with a faulty steering mechanism. They built the best vehicle they could and made clear via the example of gravity that a certain amount of jeopardy was included in its remit. Crashes happened; they did not insult anyone's intelligence by insisting that they had no prior knowledge of the damage falling from the sky might cause. Such was the tactic of the big tobacco companies who scoffed at links between smoking and cancer by utilizing tactics that fossil fuel lobbyists now employ to deny anthropogenic climate change. Jeffery Wigand’s damning deposition in a Mississippi courtroom that eventually led to the tobacco industry’s $246 billion litigation settlement is a case in point. His name – forever to be associated with whistleblowing –is a stark reminder of the depths to which corporations are willing to sink in the pursuit of profit. That they also sought to make their product more addictive and to market nicotine to an ever-younger audience is really just one of those accidents of history. A posteriori ‘fuck you’, to ordinary people whose lives were cut short by merchants of poison. They learned nothing from their time spent blinking back faux tears in the spotlight of corporate mass-murder. When the golden goose of cancer sticks was quietly euthanized via government efforts to curtail tobacco use they simply shifted focus towards peddling death to developing nations. Meanwhile, the pharmaceutical companies targeted the vulnerabilities of doctors who were simply looking for ways to ease the pain of their patients. Hard-working, well-meaning practitioners were inundated with : “Research that showed the drugs were safe and effective for short-term pain, such as after surgery, as well as cancer and end-of-life pain”. Which then led without rigorous research, to their application to a: “Much larger population with long-term pain, such as low back pain and fibromyalgia”. The Big Lie Down It was as the LA Times later reported the ‘Big Lie’ noting that OxyContin -- America’s bestselling painkiller, and one that has brought in over $31 billion in revenue for its manufacturer Purdue Pharma – was administered as the result of faulty data adding that : “The Federal Food and Drug Administration approved OxyContin based on evidence that the two-pills-per-day regimen worked for half or more of the patients in a test group. But sealed court records and internal company documents… showed that the company knew that the relief wore off for many patients well before 12 hours.” A chemical cousin of Heroin, excruciating symptoms of withdrawal, coupled with an intense craving for the drug was the inevitable result. In the face of mounting evidence, Purdue advised that Doctors stick to the dosing schedule but prescribe higher-strength pills. The result was ever more profound pain relief, tempered by the fact that cravings, pain, and withdrawal would still occur before the 12-hour cycle was up. And yet it was the 12-hour cycle that was the drugs single unique selling point. Without it, Oxy offers little advantage over less expensive painkillers. Some patients burned through supplies that were supposed to last months in a matter of weeks. Adding to the problem was the fact that the very presence of such strong narcotics was an inevitable temptation. A few pills were stolen from the medicine cabinet here and there could lead to an addiction that spiraled out of control with frightening rapidity. A black market in prescription pills sprang up almost overnight. Those not caught in the grips of dependence soon found that pills sold for $20 a pop. The numbers of people arrested for selling on prescription medications increased at an alarming rate. Pharmer’s Market Convincing medical practitioners who saw opioids as best reserved for the relief of the terminally ill did not come cheap. Purdue alone spent $207 million. Sales representatives were sent out in force to push the message. The drug was safe, the addiction problem had been solved. Opioids – doctors were told – were reliable and effective treatments of some of the most common pains known to man; muscle strain, abdominal issues, swollen joints and problems with the back. They were relentless. Indeed, according to the LA Times : “Sales reps showered prescribers with clocks and fishing hats embossed with Q12h. The company invited doctors to dinner seminars and flew them to weekend junkets at resort hotels, where they were encouraged to prescribe OxyContin and promote it to colleagues back home.” It worked of course. Marketing spends that approach the quarter billion mark usually do. That quarter of a billion brought in many billions more. Other drug companies desperate for cash cows of their own fast-tracked versions of opioid hell that had been wallowing around in corporate bilge tanks for years. By 2010, according to a Johns Hopkins University, 1 in 5 trips to see a Doctor in matters relating to pain resulted in narcotic painkiller prescriptions. The eventual criminal investigation of Purdue saw three top executives plead guilty to fraud for downplaying OxyContin’s risk of addiction. Purdue and the executives were ordered to pay a grand total of $635 million. A little more than a half-billion dollar fine for creating a problem that costs half a trillion per annum. It was akin to fining a billionaire arsonist $1000 for burning down the Amazon rainforest. Election Fever By the time the 2016 election rolled around, it was clear that government responses were proving to be woefully inadequate. Then-candidate Donald Trump promised to tackle the crisis and indeed, won big in those areas where prescription abuse rates were highest. But less than a year on and even his own voters were split over the way he was handling the epidemic. In a Gallop poll, only 38% indicated that his public health emergency order has been sufficient; 36% said that it was insufficient to the task of combating the crisis. Coupled with subsequent revelations that President Trump’s personal attorney took money from Swiss drug giant Novartis -- a major player in the opioid market and the recent subject of an investigation over allegations of corruption and bribery – and Trump’s promises of action began to look ever more dilute. Indeed, executives from Novartis were forced to hand over documents detailing the payment of bribes to thousands of doctors in exchange for them boosting prescription numbers. Meanwhile back in March, Reuters was reporting that at least one U.S. lawmaker had had enough. Democratic Senator Claire McCaskill’s call for an investigation was motivated at least in part by the unequivocal fact that : "This epidemic is the direct result of a calculated sales and marketing strategy major opioid manufacturers have allegedly pursued over the past 20 years to expand their market share." Because – you know – they knew it was dangerous. Mother’s Little Helper The actions of Purdue and others are no different from those of Big Tobacco. Actually, scratch that. They are worse. The smoking gun has been found. The documents released by the LA. Times demonstrate the promotion of sloppy, inconclusive clinical trials. They illustrate a deliberate attempt to propagandize pharmaceutical benefits. And worse, they show a willingness to obfuscate the one basic flaw in the premise of treating pain with substances that are basically heroin. Few people in the pharmaceutical industry can wallow in protestations of innocence. Knowing – as they most assuredly must know – the history of past abuses they were culpable. The monstrously addictive Diazepam -- better known as Valium -- was introduced in 1963 and marketed in much the same way as latter opioids would be. Between 1969 and 1982, Valium was the most prescribed drug in the U.S. Sales peaked in 1978 with more than 2.3 billion pills sold. In 2011 treatment facility admissions for Valium or Valium like tranquilizers stood at 58,953. The number of people in America that have used Valium during their lifetime for non-medical reasons alone stands close to 24 million. Fines registering in the tens of millions for Big Pharma drug pushing is no punishment at all. Trump’s public health disorder proclamations have laughable quantities of money attached to them. Just as one cannot turn the ocean brown by adding a thimble of iodine, cash-starved initiatives promising to tackle the crisis are doomed to abject failure. The problem is just too big. Following Suit What to do then? Companies like Purdue would do well to not only read up on Lin Zexu ’s warning but to pay more heed than Queen Victoria ever did. They should also foot the bill for the cleanup operation. The cheque they are going to have to write is going to be truly horrendous to their bottom line. The prospect of criminal prosecutions should also be investigated. And therein lies a potential silver lining. Since the damage that was done outweighs the profits made by many magnitudes they might be faced with the prospect of negative equity. Only by rendering their work ultimately profitless will such companies take pause. On May 15th, attorneys general in six states filed lawsuits on Tuesday against the maker of OxyContin and other pain medicines, for pushing what the Texas Attorney General Ken Paxton described as : “Misleading marketing tactics that are fueling the nation's opioid epidemic.” Fueling. Not fueled. Because yes, they are still at it. The suit claims : "Misrepresentation or failing to disclose the risk of addiction of opioids. Misrepresenting the notion that there is no “ceiling dose” of their opioid drugs. The false representation that doctors and patients could increase opioid doses indefinitely without risk. This was coupled with unsubstantiated representations about pseudoaddiction. The states also took issue the idea that signs of addiction in patients signaled a need to up the dosage. And lastly that Purdue made false claims that their abuse-deterrent formulation of OxyContin reduced the drug's risks". In 2007, Purdue Pharma admitted : “No wrongdoing when it paid $19.5 million to settle lawsuits with 26 states and the District of Columbia after being accused of aggressively marketing OxyContin to doctors while downplaying the risk of addiction”. This time neither the absolving of guilt nor the paltry sums of money are sufficient. Because they knew opioids were dangerous. But not even that will be enough. America is a wonderful country and it is entitled to its own culture but the idea that business is the business of America has to stop. It’s great to see a healthy economy but 4% growth figures require context. There’s profit to be made in deregulation. It’s easier to make money in a country without labor laws, easier to make a buck if you’re allowed to let someone else deal with toxic by-products. Fast food, pharmaceuticals, tobacco you name it, they all have advertising money to burn and without specific restrictions burn it they shall. It is to Congress that America should look. Yes, vested interests will argue their case and yes, media networks will bemoan the loss of revenue but those challenges have to be offset by the potential harm to society. We no longer allow advertisers to promote smoking in the way they once did. The USA is the most medicalized society in the world and perhaps they aren’t aware that in most places companies are not allowed to advertise prescription medicine in any way shape or form. The reasoning is simple. Brand awareness is not necessarily a good thing when it comes to human health. Adverts are the product of propaganda and listing side effects does little to offset that fact. It’s time America followed suit with the rest of the developed world. For general musings or indeed if you want to contact me / yell at me or ask for my phone number, you can contact me via Twitter. If you just want to enjoy my accent— I host a regular podcast called the Sanfu Revue where I discuss having forced myself to watch terrible movies so that you don’t have to.

If adrenochrome gave you immortality, would you take it?

You can also look here: Child Adrenochrome: Globalist Cabal's Immortality Drug of Choice - The Shad Olson Show Although this site has the source of adrenochrome wrong; they say it is a precursor to adrenalin, not the oxidation of adrenaline — which is correct. First, let’s examine the premise: adrenochrome gives immortality. I don’t see any scientific papers on that. It seems to be a conspiracy theory. Instead, I see papers detailing the harmful effects of adrenochrome. I suppose the conspiracy theorists would say those papers are there as part of a cover-up so that adrenochrome can be limited to the “elite”. However, if the “elite” are taking it, they have to have some idea that it works, and that would require scientific studies. But really, adrenochrome would not be that difficult or expensive to synthesize. In fact, I can buy 25 mg of adrenochrome for $55! Adrenochrome A5752 So the idea that adrenochrome has to be harvested from young children is pure bunk. I’m sure mass production would lower the price. Why would the “elite” object to everyone living longer? For that matter, why wouldn’t the drug companies want to make all that extra money by selling adrenochrome to everyone? Call it $50 per year per 200 million adults in the USA. That is $10 billion per year! What drug company is going to let anyone tell them they can’t earn that? It appear that adrenochrome is linked to schizophrenia. The adrenochrome hypothesis of schizophrenia revisited The derivative carbazochrome is a hemostatic agent. So, no evidence it extends life. Evidence that it causes schizophrenia. No documented benefit, documented risk. Why in the world would I take it?

Should the USA put price controls on medications like some other countries do?

I’m somewhat in between both Habib and Anthony Zarrella on this one, but we all agree that price controls in terms of government coming in to say “This is now the price of Zantac” is a Generally Bad Thing™. There are a few considerations here that I think have gone unrecognized. (1) Government often develops a lot of these products. The National Institutes of Health, a government agency, does a lot of the early research on many medicines. The pharma companies do surprisingly less R&D than they would like us all to believe. Many of the early breakthroughs that lead to marketable drugs come out of the NIH initially. Pharma companies typically come in to figure out how to mass produce these medications. Same with certain medical devices. The Epi-Pen that has recently skyrocketed in cost by more than 4,000% was not developed by Mylan, the company that owns the patent. The auto-injector mechanism that the Epi-Pen uses was developed by the military for Vietnam. The government later doled out the patent to the private company, who has been making bank on it ever since. That needs to change. When these things are publicly developed, the underlying medication should be immediately categorized as a generic and allowed to be produced by any company capable of it. The pharma companies can still patent their particular process, but if it’s publicly developed, no longer should they get an exclusive right to grab it and sell it via monopoly at premiums. (2) Free market principles only work to a limited extent when there is inelastic demand. Free markets are when you could buy a lamp for $45 at one store, and a similar lamp at another competing store for $35, and you as a consumer make a choice about which lamp you want or whether to purchase a lamp at all. Free markets work great when it comes to wants. You can decide whether you want one of those two lamps or none at all, and if the price goes down, it might affect your buying choice. That incentivizes sellers of products to competitively price their products to entice buyers, and the circle of capitalism continues down the Great Material Continuum. All of this is based on finding just the right amount of greed you can get away with. What’s that, latinum? I need more of you? Well, if you say so! Too much greed, and you lose profit because you lose customers. Too little greed, and you lose profit because you price your margins too low. The demand is elastic, because the price and quality of the product can stretch and contract that demand, so it’s just a matter of tinkering around in the market to figure out the best place along the return curve. Free markets are not great when dealing with needs, like “we’re the only ones who sell this thing you need to live, and you either pay us what we demand or you die.” I’ll uh… just leave the rest of my latinum here for you, then. This is called “inelastic demand.” This is why food prices are significantly higher at grocery stores in really rural areas where they might be the only store for 40 miles. You need food to live, and your options are to drive a really, really long way to go get them, or not eat. So, the store prices in that inelastic demand up to the tipping point where people will drive that 40 miles. Drugs are an even more inelastic demand, because you might have to go to an entirely different country to go get that lower price. Fine, if you can afford it, but most Americans don’t have a budget to take a trip to New Zealand every year. Those who control the supply know that the curve on that demand will never go down no matter what they do, and so there isn’t incentive to balance the price out because there is never such a thing as too much greed here. Which leads to smarmy little shits like this fucker: Pictured here: the very goddamned reason that Adam Smith wrote The Theory of Moral Sentiment in addition to The Wealth of Nations. When people like this human colostomy bag control the entire marketplace for something with inelastic demand, there is no check on the greed to hold it down. And the results speak for themselves. (3) Patents granting exclusive rights to an inventor are interventions in a free market in and of themselves. Drug patents grant an exclusive right to manufacture and sell a drug for a set period of time. Currently in the United States, that period is twenty years. Really, it’s more like 12–15 because it takes a while from the time the drug is patented to when it gets through FDA approval, which they are constantly lobbying to relax restrictions and speed that up. Patents, on their face, are a great idea. You invent something useful to the human race (or even some sort of trinkety crap that people just plain want for the sake of it,) and you should have the rights to profit from that for a time. That incentivizes people to make useful products. That’s the whole purpose of a patent. This works great for inventions that are just wants with elastic demand, like computers and robots and the symmetrical all-wheel-drive system and 8.7 inches of ground clearance of the Subaru Outback™ that allows you to traverse snowy and icy roads with confidence, while remaining in the comfort of a spacious cabin with heated power-adjustable seats (available with the All-Weather Package). They are inherently a grant of a monopoly on a concept or product to an individual. A truly free market means that there is a level playing field between all competitors, and those competitors need to figure out how to price themselves or innovate their product to compete. Monopolies destroy this level playing field. So, you can’t have your cake and eat it at the same time here. If you’re going to grant patents, the market is no longer an entirely free market. You are inherently advantaging one market participant for a desired outcome. (4) How patents are managed can either stifle innovation or drive it. Now, I don’t have a problem with appropriate interventions in the marketplace to ensure a level playing field. I’m something of a classical liberal in this sense; I don’t oppose free market capitalism, but appropriate interventions to smooth out the rougher results is a net positive for everyone. Managed well, patents are an intervention that does drive innovation. When not managed well, they actually hinder innovation, because if a bunch of people need this thing to survive and you’re the only one allowed to make it, what’s the incentive to do something else? None. You have the fish on the line permanently. There is nowhere else for them to go. They will pay whatever you charge, because they have to. You’ll stagnate and sit on that exact patented drug to treat that particular issue forever, because there is no reason to change. If the other drug manufacturers can make the same medicine faster, better, cheaper, purer, then there is an incentive to keep innovating and developing better products and processes. The difference between the two is how broad the patent is and what it protects. Let’s even put this into the context of elastic wants. If someone were to patent the entire concept of the portable computer and have exclusive rights to all production of portable computers, it would seriously stifle innovation in portable computing. Let’s say we have a company called Orange. They hold the patent on all “mobile computing devices.” They might come out with progressive, incremental upgrades to keep people buying new devices and disposing of old ones, but since nobody else can make “mobile computing devices,” there is no incentive to create disruptive technologies. People won’t stop buying them if no new innovation occurs. Let me just pull out my new tablet computer here… latest model, very fast. Now, let’s say Orange doesn’t have a patent on “mobile computing devices,” but rather a patent on a particular feature that makes their mobile computing device really cool, like a fingerprint scanner that makes it so that only authorized people can unlock the device. That drives people to their product, because it’s now better than other products. Even if it’s more expensive, people might be willing to pay for the better product. And it drives other competitors to come up with equally cool innovations to attract consumers over to their product instead. This is the difference between patenting the chemical composition of a drug and instead patenting a smaller piece of it, such as a certain manufacturing process, or putting it in a liquid capsule instead of a tablet. If a different manufacturer is able to innovate a breakthrough process that makes the same drug cheaper, awesome. That’s good for all of us. And they are now incentivized to do that. That way, the consumer gets a choice of a range of products that all effectively do the same thing, but some do it better or differently, and they get to decide which is best. This creates competition in the marketplace for those choices, and that drives innovation, while still, and this is important, granting a patented right to certain innovations. This incentivizes innovation, not stifles it. (5) Drug companies are patenting combinations of generic drugs or using “evergreening” to extend their patents. My wife is pregnant right now, and has a bad cold. That rules out most cough medicines for her, and she is miserable in the process. Mostly, she needs to get some sleep. So, I headed off to the store with a list from the doctor of pregnancy-safe drugs in hand. Benadryl for the congestion. Unisom to help her sleep. I start looking at the active ingredients. Diphenhyrdramine, 25 milligrams for the Benadryl. Diphenhyrdramine, 25 mg for the Unisom. Hey… wait a minute… The difference is two bucks, and the pills are different colors. Some inactive ingredients are a little changed. I look up what those do, thinking maybe they change the release times. Nope. Literally, it just changes the color of the pill. Since the Benadryl we’d been using wasn’t doing as much to help her sleep (though it was improving her congestion,) I went over to the pharmacist with another sleep aid that wasn’t specifically on the doctor’s list, but several Google results said was safe, doxylamine succinate, and asked if it was okay. He told me it was probably fine, since it was being used with thiamine (vitamin B6) to treat morning sickness. Both are generic, extremely common drugs that cost maybe $5 USD for 48 tablets at retail prices. Then the pharmacist shook his head and told me something that stunned me: the company that sells that drug (the combined doxylamine succinate and thiamine) is selling it for over a thousand dollars a month. This is, at the cheapest, a $990 markup, or roughly 10,000%. Actual picture of a pharmaceutical CEO at a presentation showing that this shit can be patented and what the profit margins could be. And when that patent starts to get close to running out, you know what they can do? Slightly change one of the inactive ingredients and renew the patent. This is called “evergreening,” and it’s a way to keep extending a patent beyond its normal life. Basically, they’re manipulating an otherwise potentially fair free market tool to continue to gain an unfair advantage in the marketplace. Now, these combo drugs can still be purchased separately and just taken separately and cheaply. But seriously: there is no reason why a patent should be granted on just combining the two together. None. That is not an innovation. I could see it maybe if there was some sort of revolutionary new binding agent that keeps the two from causing problems with each other, but it’s just two drugs that can be taken together in one pill instead of two. These things need to be outlawed. (6) Completely unregulated free markets literally kill people for profit. This isn’t just a wild assertion with no basis in reality. It is the very reason we have a Food and Drug Administration. Around the turn of the 20th century, the drug market was a free-for-all. There was zero government intervention. Nobody required things to be safe, or tested, or have supportable marketing claims. It was the golden age of the businessman, laissez faire. Do you know what was put in those drugs? The relatively safe things had cocaine, morphine, and methamphetamines in them. “Whatcha puttin’ in this time, Jim?” “Splash of gasoline, gives it a bit of spice on the finish.” Popular cures included in their list of ingredients, and I shit you not, turpentine, kerosene, and radium. You know it’s working because of that blood coming out of your colon, taking the toxins and germs with it! Milk producers in the days before pasteurization used to actually cut down milk with things ranging from pond water mixed with chalk or plaster dust to toxic dyes, and would often add preservatives, including formaldehyde to it to keep it from spoiling. In the early 1900’s, a chemist working under Theodore Roosevelt was so committed to proving that these things were dangerous and needed to be banned that he put together the “Poison Squad,” a team of volunteer employees who agreed to eat meals with a 50/50 shot of having various drugs laced into them. They kept careful notes and research to prove that many of these things were actually poison. Hey, boss? My tea kinda tastes like arsenic… This ultimately led to the Pure Food and Drug Act of 1906, the first significant consumer protection reform in U.S. history and which created the Food and Drug Administration to keep people safe. Importing drugs from other countries sounds like a great idea. And it can be: if they have some regulations to keep things safe. That can easily be done with import regulations. You can sell it in the United States if you can manufacture it to these standards. And the burden is on you to show the government that you are. Not only is safety a concern, but the conditions of the places that might be making a product for a cheaper price should be at least something we consider if we’re going to import drugs. I’m only ten, but this looks about like the right ingredient ratios to me for making some sweet, sweet methadone to sell in ‘Murica. Another day, another fifteen cents in the bank! Cheaper does not always equal better or safe. And sometimes government sticking its nose in keeps us all alive. (7) Bargaining power It’s very difficult to bargain individually against a large corporation. Try going into, say, your local neighborhood Target, and try to negotiate down the price of something. Not likely to happen, right? Maybe they’ll drudge up some coupon or something. But more likely, if you want a significant discount, you’ll be escorted off the premises. It’s a little different if everyone works together. And that’s how single payor health care would work. Not by, as many Republicans pitch a fit about, taking over the means of care itself, but taking over who pays for it so that it’s one unified bargaining unit against things like the medication providers. I’ll let John Green explain : In the United States, we do not negotiate as aggressively as other countries do with healthcare providers and drug manufacturers and medical device makers. So like in the UK, the government goes out to all the people who make artificial hips and says, “One of you is going to get to make a crap ton of fake hips for everybody who is covered by the NHS here in the United Kingdom. But you better make sure your fake hips safe, and you better make sure that they’re cheap, because otherwise, we’re going to give our business to some other company.” And then all the fake hip companies are motivated to offer really low prices because it’s a huge contract. Like, imagine if your company got to put hips inside of everyone in England and Scotland and Wales and Northern Ireland. (I guess not everyone, just the people who need hips.) But in the U.S., we don’t have any of that centralized negotiation, so we don’t have as much leverage. We do have Medicare, which covers about a third of the country right now. But for some stupid, inexplicable reason, it is actually forbidden from negotiating with pharmaceutical companies. It can negotiate on other things and, funny enough, always gets the lowest prices when it does. Ultimately, we should not put price controls on medications in the sense of actually regulating the prices themselves through legislation or agency rulemaking. What would be far more effective is Medicare-for-all, a single payor system that covers every United States citizen, which can negotiate with care providers and drug manufacturers to get the best prices for its people. Addendum: I’ll issue my standard disclaimer here, because this one is probably likely to attract some folks of a particular stripe. I welcome rational debate on the merits with credible sources. But coming on here and calling me names, pissing and moaning about how biased I am, etcetera and so forth, will result in a swift trip out the airlock. I’m done with warnings. If you have to consider whether or not you’re over the line, the answer is most likely yes. Debate responsibly.

Why do some vapers use strengths greater than 20 mg?

You ask about nicotine strengths, and nicotine's potential for dependence: two interrelated issues. Which to address first? Dependence, I think, because vaping is a consequence of smoking. .............................. Part 1 - Pure nicotine's lack of any dependence potential Nicotine most certainly has potential for dependence when delivered in a tobacco vehicle, and smoking qualifies (ticks all the boxes) for being described as addictive (meaning: a dependence with significant risk elevation). That does not mean that smoked nicotine is addictive for everyone, or that smoking is addictive for everyone: they are addictive on average, meaning that most people will experience symptoms of dependence on smoking, if they smoke enough, for long enough. Arguments about all the numbers are a side issue. Pure nicotine has no potential for dependence [1], no matter how much of it is delivered or how it is delivered. It has to be potentiated and synergised (have its dependence potential created, and then multiplied) by tobacco, and especially by cigarette smoking, in order to show any dependence potential. We can say this with confidence now - at Q2 2016 - because of two important factors and some significant pieces of evidence: The number of clinical trials (around 10 identified so far, but there are reports of several more) where large quantities of pure nicotine were administered daily (in some cases the equivalent of 15 cigarettes), to never-smokers, for long periods of time (up to 6 months), without any subject ever displaying any sign of dependence [2]. No person has ever been clinically demonstrated as showing any sign of dependence on nicotine without first being a consumer of tobacco. There is an enormous sum of money ready and waiting for any researcher who can show that pure nicotine has any potential for dependence; and an equally large sum for any researcher who can show that pure nicotine consumed in electronic vaporisers has any potential for dependence. The sums amount, at the very least, to $10 million in each case [3]. Either of these would be very easy indeed to show, if any such potential existed. Thirdly, because of certain factors that are now much clearer: nicotine is a normal part of the diet, and everyone tests positive for it [4]; and because of the very strong connection between non-smoker status and some diseases (neurodegenerative disease, auto-immune disease) [5], a significant push is being created by some pharmaceutical firms to identify new ways of presenting or formulating nicotine (as that is assumed to be the prophylactic agent) for treating diseases such as Parkinson's, that can hopefully be patented: at least one researcher has a full-time job administering large quantities of pure nicotine to never-smokers suffering from various medical conditions, to seek new therapies [6]. There is absolutely no problem whatsoever getting ethics panel approval for clinical trials where large quantities of pure nicotine are administered to never-users of tobacco for months at a time. Indeed, such approvals are routine: everyone involved knows it is harmless in all respects, and simply a megadose nutritional exercise. In the past it was often stated that it would be difficult (or even impossible) to get approval for studies where nicotine is administered to never-smokers. This is incorrect as we now know it has been achieved frequently. Today, CTs and RCTs where never-users of tobacco are given large amounts of pure nicotine for months are routine. They are ongoing, all of the time. No example exists of any such trial ever finding any subject who showed any sign of reinforcement or any other marker for dependence (reinforcement, withdrawal syndrome, continuation of use after the CT). As the leading authority says (see Notes), "Pure nicotine's potential for dependence is about zero". All the red herrings There are a whole bunch of confusers and confounders in this area, together with a rich mine of prior positions and ridiculous policy statements that cannot be contradicted for fear of embarrassing the senior figures who made them. It basically means that, for the establishment view of nicotine to be challenged, there would have to be the equivalent of a nuclear explosion in the area. This is not a bad analogy because it is quite common that change cannot come until all the old fossils who protect the status quo are gone. I will just illustrate one of them: the 'speed of delivery' fallacy. 1) If a material is strongly dependence-forming (and frequently of the class that can be described as addictive: substances that cause addiction, tolerance, and harm), then the speed it is delivered is often a factor in its dependence potential. For example, if you can inject it, its effects are faster, stronger and more dependence-forming than if you eat it. 2) If a material has no dependence potential at all, and no subject of any CT has ever displayed any tendency to dependence, in any form, no matter how much is administered to them, or however it is administered, or for how long: then delivering it at the speed of light won't make it any more 'addictive'. That's all. To suggest otherwise is rubbish, claptrap, and wibble. Above all, very foolish, as it demonstrates the speaker has no real knowledge of the subject. Why make definitive statements about something your knowledge of is demonstrably weak? Here are the reasons why the above is true for nicotine: Smoking is said 'to supply nicotine to the brain' in 8 seconds or so - faster even than injecting it. As I am not a psychopharmacologist nor a highly expert clinical researcher experienced in brain imaging, I will take that as read. Let's agree, as it makes things simpler. I can supply you with an electronic vaporiser and nicotine refill combination that will make your head spin in 12 seconds from inhalation, and knock a naive subject to the floor [7]. If this is not fast enough for you, please suggest how much faster I need to make it that you will agree that a 'speed of delivery' condition has been complied with. It is absolutely certain and beyond any doubt whatsoever that the California Lie Factory will have spent millions and employed the world's most expert clinical trial fraudsters to work on exactly this aspect of vaping, to try and show some sign of potential for dependence on vaping or vaping-delivered nicotine. This is the Holy Grail of the ANTZ [11] and their funders: their top priority. They will have tried high nicotine strengths, super high power, and the fastest and most efficient delivery methods possible, to try and get just one naive subject to show any sign of dependence on pure nicotine, and especially in electronic vaporisers. If the world's most skilled medical research liars cannot find a single subject who shows the smallest sign of dependence, with millions of dollars and any resources or expertise needed thrown at the problem to find something: then you can guarantee that nothing can be found or even dressed up as a 'find'. It can't be done, no matter at what speed of delivery, and that's that. If it could be done, they would have done it. I hope this clarifies the issue. ............................ Part 2 - Nicotine dependence after smoking Smoking causes addiction in many cases; and also causes dependence on nicotine, in many cases. Nicotine dependence cannot be clinically demonstrated without tobacco consumption. Tobacco and tobacco smoke contain 9,600 separate compounds identified to date [8]. Some act as nicotine optimisers, several act as potentiators for nicotine, and others act as synergens that multiply its effect. In other words, tobacco smoke is a potent mix of chemicals that multiply nicotine's potential for dependence by many times. We don't know by how many times because nicotine has no potential for dependence outside of delivery in tobacco. It would be speculative to describe this multiplication of power as an increase of several hundreds or even thousands of times - but that is the effect in practice. The chief culprits are believed to be the MAOIs harman and norharman, but this could be an over-simplification. Because of the clearly vast multiplication of dependence potential (an increase from zero to 'a lot' is, um, exponential), it seems likely that several materials are involved. Suggestions are the nicotine modifiers that present it optimally; the MAOIs; all the other tobacco alkaloids, with anatabine said to be a good candidate; some naturally-occurring aldehydes; and the pyrolytic aldehydes created by combustion. That probably isn't a complete list - it's complicated. We are just talking about nicotine potentiation here, and nothing else. Smoking addiction is a complex phenomenon, with multiple psychological and chemical dependency factors. After smoking, many people are still dependent on nicotine (not 'addicted') [9]. This dependence is persistent, but usually reduces over time. It does not matter whether nicotine is still consumed or not, because the dependence is only caused by smoking and it is not affected by any activity or consumption that is not smoking. It is routine for vapers to gradually reduce their nicotine consumption, in order to avoid symptoms of overdose. They commonly start out as new vapers with a strong need for nicotine at comparatively high doses; the requirement reduces over time; and it does not matter if they vape high nicotine, low nicotine, or no nicotine. Nicotine dependence results from smoking, is only related to smoking, reduces as smoking history recedes in time, and neither ongoing consumption nor no consumption at all are relevant. If this is an interest area for you, you will have also noticed that - QED - nicotine does not create tolerance. A tolerance to the material is created by smoking. Outside of smoking, nicotine use cannot create tolerance, and an ex-smoker - even if s/he consumes *pure* nicotine as in vaping - will find their tolerance to it reducing. Smoking creates tolerance effects (for smoking, and for nicotine), but nicotine by itself does not. Tolerance is generally regarded as a marker for addictive substances. Nicotine itself exhibits none, outside of tobacco use. (This is actually another of those red herrings, and could have been placed up in that slot above - but one red herring is enough for some poor academics, for whom we must show some sympathy and, well, tolerance.) The academia problem The basic problem here is that most academics who talk about nicotine have little or no practical experience with it or knowledge of experienced consumers outside of smokers. It is a little like making a statement on the flora of Borneo without ever having been there and having simply read an article about it in a fifty year old magazine. The effects of nicotine are not like theoretical particle physics, where speculative statements can be made without fear of contradiction because nobody knows the answers; potentially, millions of people are able to refute some of the more outlandish things said about nicotine. On the other hand, it is hard to blame these academics as, in practice, nicotine research has been virtually prohibited for a long time, by funding limitation and reputational negatives. Now that the pharmaceutical industry needs nicotine-based therapies for a wide range of conditions, and millions of pure nicotine consumers report their experiences, we are beginning to see some progress. With luck this will soon result in the sweeping away of many outdated beliefs. On the other hand, since a significant amount of (corrupt) legislation is based on the argument that nicotine is both dangerous and addictive, perhaps progress will be rather slow in this area. Or, perhaps we will see a two-tier approach to nicotine: academics will consider it as harmless as for example vitamin A (which is fatal with a large overdose) and with no potential for dependence; and legislators will continue to treat it as dangerous and addictive, for pecuniary reasons. The beginnings of this can already be seen, since ethics panels routinely approve clinical trials where large quantities of nicotine are administered daily to never-smokers for extended periods, and they simply would not do this if there were any risks of any kind - they don’t approve CTs for cocaine - and legislators use the most ridiculous language when constructing laws to limit access to nicotine products, making statements that are impossible to support. It seems that a two-track approach to nicotine is profitable, and in the end, that’s what counts. ............................ Part 3 - How vaping split into two distinct types A Long Time Ago, in a distant land, people vaped at low power. Then along came sub-ohmers and cloud-chasers, who wanted huge clouds and the high power that enables such displays, and vaping changed. Well, it's not quite like that. The place was here (wherever you might be), and the low-power vapers are still here. They buy and use different hardware and different refills from the high-power vapers. It would be something of an over-simplification to characterise one group as old pensioners, and the other as young men with extensive beards and girls with tats, but it's an easy distinction to make - and who doesn't love easy, and labels; and when you can combine them it's just supreme... The low-power vapers So now, in case #1, we have one group of vapers who generally vape somewhere around 10 watts, use the indirect inhalation technique (mouth to lung, or M2L) [10], produce and inhale comparatively small clouds of vapour (by today's standards), and as a consequence may need fairly high strengths of nicotine. On average they consume 3ml or 4ml of refill liquid a day - some, half of that. It is a very cheap and low-impact version of vaping, and trying to come up with some kind of vector for morbidity is rather difficult. To associate mortality with this vaping mode requires an admirable level of zealotry. For these vapers, 18mg is average, a little lower at 12mg or higher at 24mg common, 6mg or 30mg often seen, and 3mg or zero at one end or 36mg at the other less common but still seen. Occasionally, people may use 45mg (ex- heavy smokers, most likely), and I have met people who vape at 60mg (6% nicotine strength). It seems more noticeable with these low-power vapers that the initial nicotine strength needed to successfully quit smoking is clearly higher; this is probably just a feature of the numbers themselves (the nicotine strengths used with low power) being higher. For these people, fixing the maximum strength at 20mg is obviously going to be problematic for a significant proportion of them, especially the new vapers. They only inhale small amounts of vapour, and therefore need more nicotine in it, especially after recent smoking cessation. I am not going to comment on the possible outcomes from this situation. The high-power vapers And in case #2, we have another group of vapers who vape around 40 watts and up - 25 watts is sometimes seen, 80 watts is not uncommon, and hardware is available that delivers 200 watts. They use the direct inhalation method (direct to lung or D2L), produce monster clouds of vapour, and need little nicotine as a consequence. The consumption volume in this mode can reach 20 or 30 ml per day (about ten times the amount low-power vapers consume), occasionally higher. The average, stabilised nicotine strength needed is 6mg or for some, 3mg. Meaning that, after time has elapsed since smoking cessation, the requirement for nicotine has stabilised down to around 6mg (it may reduce further over time). These D2L vapers laugh at any nicotine strength restrictions, because they produce such enormous volumes of vapour that strength needs to be dialed back radically, compared to the M2L vapers who are significantly affected by the legislation. I don't want to try and estimate the numbers or proportions of low-power vs high-power vapers; or the scale of the black market that is now guaranteed in both the EU and the USA. That does not belong here. At the time the EU tried to strangle vaping by restricting nicotine refill strengths, only low-power vaping existed in the mainstream; and restricting the refill strength ensured, then, that smokers attempting to switch to vaping would fail and relapse to smoking. However, technical advances and fashion movements sidestepped the EU, and high-power vaping now means 6mg is enough for the average vaper, and 12mg is more than enough. You can be a stupid person and outmanoeuvred by events. You can be a corrupt official and be outmanoeuvred by events. But it takes a special kind of extremely stupid, corrupt, lying, large-scale desk murderer such as an EU official to be stupid and corrupt enough to have been outmanoeuvred already. No doubt they will fix it, though, as their paymasters at pharma and tobacco own the law, and will never permit the world's biggest gravy train to be threatened. Notes [1] We refer to a consumption or other compulsive habit that has no measurable harm as dependence (such as compulsive birdwatching, as practised by 'twitchers') or has no harm that can be measured, or that is accepted by society as 'harmless' (even though that is impossible) such as coffee drinking. Dependence is an 'addictive' activity that has no significant harm associated with it, or is accepted as having no significance in today's world. Addiction is a compulsion with a significant elevation of risk; a habit that harms, on average. Compulsive gambling, and heroin use, are in this class: various types of significant harm are likely, on average. The terms addiction and dependence are therefore philosophical and not in any way scientific. This is one reason why there are multiple definitions of them (especially addiction). This does not matter as what is being discussed is a cultural / societal value judgement, not a scientific definition. For example, here is one definition of abuse: you consume more of it than I do. Smoking is certainly in the addiction class as it provably leads to serious morbidity and subsequent mortality, for many smokers. On the other hand, it appears that all of the record-holders for oldest person in the world have been smokers, and some of them may have smoked for around 100 years. An interesting combination of factors which seriously annoys some people - but life is not simple. [2] You can find the references on my website, if you google 'ecigarette politics'. [3] Some researchers who produced a fraudulent study that claimed ecig vapour contains large quantities of formaldehyde subsequently received $3.5 million for their next project, another mindless attack on vaping. In contrast, demonstrating that vaping is 'addictive' is the Holy Grail of the California Lie Factory, and there will be enormous sums available for anyone who can help. Unfortunately for these cunning millionaires, they haven't been able to show it, despite the fact that if it were at all possible it would be very, very easy to show. [4] None of the large-scale clinical studies of nicotine in the population, which tested hundreds of people, ever found a single person who did not test positive for nicotine (even, of course, when many would have had no contact with smokers or ETS). [Please see the refs on my website.] [5] More than 40 clinical studies show that smoking protects against Parkinson's disease. The Director of Research at the Parkinson's Institute said, "There is a huge literature that says smoking protects against Parkinson's". The same thing, on a lesser scale, applies to multiple conditions in the areas of neurodegenerative disease, auto-immune disease, and cognitive function disorders (and to a lesser extent skin disease: the nicotine group has significant prophylactic and treatment functions in the areas of brain chemistry disorders and skin disorders). The simplest way of putting this is that we are discussing nutrients here, and of nicotine, nicotinic acid, and nicotinamide - the materials under discussion - one is classified as vitamin B3. The others probably await more enlightened times. Therefore, there is a research drive to find ways of either confirming that nicotine is the sole active agent in smoking that protects against neurodegenerative disease and similar conditions, or to identify the additional factors, and to find therapies based on nicotine that can be patented. Keep in mind that such research does have some risks, when taken to its logical conclusion: a combination of materials that replicates the active compounds in tobacco smoke that are suspected of protecting against Parkinson’s (for example) and presumably best treating it. At some point, the dependence potential of tobacco smoke might also be replicated. Thus, nicotine may successfully treat Parkinson’s symptoms in some patients, and a combination of - say - nicotine, MAOIs, anatabine and multiple aldehydes might work better and work for more patients; but it might turn out to be dependence-creating, just like tobacco smoke. [6] Dr Paul Newhouse of Vanderbilt appears to do little else. He is the world's leading authority on nicotine therapies and nicotine administration to never-smokers. He has administered more pure nicotine, in larger doses, for longer periods, to more never-smokers, in more clinical trials, than anyone else in the world. In the course of his research he has discovered two interesting facts: - Pure nicotine's potential for dependence is about zero. - Long-term nicotine consumption lowers the blood pressure. Since he is by a long chalk the leading authority, and knows more about it than anyone else, perhaps people should listen to what he says. [7] 'Naive' in medical terms means a subject unexposed to the operative agent. In this case, we mean a never-smoker /never-user of tobacco and a never-vaper. (Of course, we are all exposed daily to nicotine in the diet - or should be, for good health - but here the meaning is 'in large amounts'). [8] Rodgman, Perfetti 2013. [9] I am unable to locate even a single example of research that shows nicotine-induced harm (not smoking-related harm, of course) in the average human. If you can help me resolve this issue, I will consequently modify my language and stop referring to nicotine as harmless. If something is a normal part of the diet, and has no evidence for harm, then it is probably best to refer to it as harmless, just as all nutrients are. Abuse and huge overdoses are irrelevant - many nutrients will kill very effectively with sufficiently-large overdoses: vitamin A, vitamin D and iron, for example. The dose is quite important, as with most things (there is a joke in there for scientists). [10] There are two basic ways to inhale from an electronic vaporiser (EV if you like). Others methods such as the cigar method are not covered here. The basic method, using low power, is to suck vapour into the mouth, hold it there for a second, then inhale the vapour. You can probably see that the total vapour volume inhaled cannot be greater than the buccal volume (space in the mouth). This is called M2L vaping, aka mouth-to-lung. It requires high nicotine strength since there is a restricted volume of vapour. The high-power D2L method is to inhale direct to the lungs, using the diaphragm to suck in a full lung volume of vapour (if desired). It requires low nicotine strength due to the great volume of vapour. [11] ANTZ = anti nicotine and tobacco zealots. ——————— Q: “Why do some vapers use strengths greater than 20 mg?” “The EU has banned strengths greater than 20 mg which accounts for approximately a quarter of sales. Could pure nicotine actually be addictive?”

What factors fueled the growing opioid crisis that exists in the US right now?

It started with prescription painkillers. Before Oxycontin was approved by the FDA there were other prescription painkillers like morphine, dilaudid, Percocet, Percodan, Vicodin, and Demerol, but they weren’t prescribed as often. Percocet, Percodan, Roxicodone, and Oxycontin are all formulations of oxycodone with slight differences. Vicodin and Zohydro are both formulations of hydrocodone, Percocet is oxycodone mixed with acetaminophen, Percodan was oxycodone mixed with Aspirin, Roxicodone is just oxycodone, and Oxycontin is an extended release formulation of oxycodone. Vicodin is hydrocodone mixed with acetaminophen and Zohydro is an extended release formulation of pure hydrocodone. Hydrocodone is about half as strong as oxycodone, and both oxycodone and hydrocodone have a bioavailability of roughly 80% compared to the roughly 30% that morphine and dilaudid have. Morphine and dilaudid are good for IV use in the hospital, but in pill form they aren’t as effective as oxycodone because they have a lower oral bioavailability, meaning a lower amount of the pill enters the bloodstream when taken orally. Oxycodone and hydrocodone are better for pain management than dilaudid or morphine because a majority of the drug enters the bloodstream. Percocet, Percodan, and Vicodin only come in relatively small doses: 2.5 mg, 5 mg, 7.5 mg, and 10 mg with varying amounts of acetaminophen. In the 90’s there were a lot of people getting sick from taking too much Percocet or Vicodin because acetaminophen is terrible for the liver. This was around the time when the FDA approved Oxycontin so there would be a pure version of oxycodone without the acetaminophen or aspirin that would provide around the clock relief from pain. Oxycontin comes in 10 mg, 20 mg, 30 mg, 40 mg, 60 mg, and 80 mg pills, and when the pill first came out it was easy to tamper with. Like a lot of other extended release pills, it had an outside polymer that could easily be peeled off and the pill itself could be crushed into a powder, either to be injected or snorted. Even for people who didn’t want to shoot or snort it, just chewing the pill would release the entire amount of oxycodone at the same time rather than over a period of 12 hours. Oxycodone is really no more different from heroin than red wine is from white wine. There are slight differences in the 2 drugs, but they work on the same receptors in the brain and produce similar effects. Heroin is used in England in hospitals instead of morphine because it has less side effects under the brand name Diamorphine. Heroin is really nothing different from extra strength morphine, and snorting oxy is basically the same thing as snorting heroin except pure heroin is about twice as strong as oxycodone on a mg for mg basis. In addition to Oxycontin, Opana (Oxymorphone) was also approved by the FDA. It’s not as commonly prescribed as oxycodone because it has a very low bioavailability, but if injected or snorted it’s twice as strong as oxycodone. It also lasts considerably longer than oxycodone. Fentanyl has been around for decades, but use of fentanyl for outpatient pain management is relatively new. Fentanyl generally comes in 3 forms: an injectable version that is used for surgery and in the hospital for Patient Controlled Analgesia (PCA), in a patch that is supposed to provide around the clock pain relief for 2–3 days, and in a lollipop for breakthrough pain. Like any other drug, people started abusing the new painkillers by crushing the pills and snorting/shooting/smoking them or taking the fentanyl gel out of the patches and injecting it. Since insurance was paying for the pills and they used to be relatively easy to get a prescription for, million of Americans started using them. Some people for legitimate pain and some to get high. When Oxycontin was first approved by the FDA, Purdue Pharma knew how addictive it was, but still lied to doctors about it and provided them with incentives to prescribe it. Since Florida is home to such a large number of senior citizens, people would drive there from all over the country and easily find a pain management clinic where they could pay the doctor a certain fee and get 30 day prescriptions of whatever they wanted. Since there is a limit to what a doctor can prescribe without setting off too many red flags with the DEA, typically a person would get a prescription for an extended release painkiller and a painkiller for breakthrough pain, like Oxycontin and Roxicodone. After a few years the number of overdose deaths started to spike, and most of them were from oxycodone because of Oxycontin, so Purdue Pharma, the company that makes Oxycontin changed the pills to make them tamper proof. The new pills do not turn into a powder, they turn into a gel. There’s no way they can be injected or snorted; the only thing people can do is take a high dosage like an 80 mg pill and chew on it for 5–10 minutes until there aren’t any solid pieces left and swallow it. It’s basically the same thing as taking 80 mg of instant release oxycodone or Roxicodone, which became people’s new preference. Roxicodone comes in dosages of 5 mg, 10 mg, 15 mg, 20 mg, and 30 mg and they aren’t tamper proof at all. They can be snorted or injected just like Oxycontn before they changed the formula. The same thing they did to Oxycontin they also did to Opana extended release pills, which made them basically useless to most pill poppers since they had such a low oral bioavailability. Eventually, the DEA started to crack down on doctors prescribing painkillers. They changed Vicodin from a Schedule 3 narcotic to a Schedule 2 narcotic and started to shut down a lot of the pill mills. Even doctors who were prescribing painkillers for a legitimate reason were scared so they cut off patients who weren’t dying of cancer or AIDS, which left a lot of people in a tough position. You could still buy pills off the street, but like any other commodity, supply and demand set the price. The most desired pills were the 30 mg Roxicodone pills and before the DEA crackdown you used to be able to get them for $10-$15 depending on who you knew. After the crackdown the price went up to $20, then $25, then as high as $1/mg. Since heroin and oxycodone are basically the same, and heroin is significantly cheaper, people switched. It varies by state but in NY/NJ you can buy a 20–30 mg packet of heroin that’s about 80% pure for about $5. At that purity and that weight it’s equivalent to roughly 50 mg of oxycodone for 1/10 of the price. The more you buy, the lower the price and the higher the purity. The large number of people who were addicted to oxy or other prescription painkillers just switched to heroin since it was so much cheaper. For people who only snort, it’s not easy to tell if they’re under the influence. Unless they do too much and start to nod out the only way you can really tell is looking at their pupils to see if they’re constricted. Unlike alcohol or some other drugs where people are noticeably high, an experienced opioid user will look normal and act normal as long as they’re taking whatever dose their body has gotten used to. Obviously if the first time a person tries an opioid and they take 30 mg of oxycodone, they’re going to be noticeably high. But for people with a tolerance it’s nearly impossible to tell unless they overdo it. The same way legal goods are made by a certain company, heroin dealers differentiate their heroin from other dealers by putting a stamp on the glassine envelopes they package their heroin in. It might say Nike, Bin Laden, Taliban, Trump Towers, Adidas, etc. and it’s also done in a variety of colors (red, purple, blue). Customers find out which stamp has the most potent heroin and tend to seek it out. Since the occupation of Afghanistan and an overall increase in global commerce, there has been an abundance of heroin in North America; the US and Canada are the biggest market for drugs in the world. People that sell heroin usually don’t sell it pure. Even if they’re selling kilos to other lower level dealers, they still tend to cut it with baby laxative or something neutral so that there’s more powder. Since fentanyl is 50 times stronger than heroin, dealers add small amounts of it to their heroin, mix it up, and their customers realize that it has a stronger effect without necessarily realizing that it’s mixed with fentanyl. If it isn’t mixed right and somebody who shoots heroin goes to inject their regular dose, they’ll overdose, and fentanyl and some of its derivatives are so strong that even Narcan (which if injected pushes all the opioids out of your system) doesn’t work. Fentanyl is a legal medication in the US, but it’s also manufactured illegally in Asia. Since it’s synthetic, it doesn’t require large amounts of poppy plants like you would need to synthesize heroin or oxycodone. It’s extremely high potency is what’s causing the majority of opioid-related deaths in the country and if the failed War on Drugs has taught us anything it’s that the problem will never be defeated on the supply side. There are certain things the government could do to lower the number of deaths. 200 Americans die on average every day from opioid related deaths and that number could be drastically lowered if the government looked at how Europe and Canada have dealt with their opioid problems, but first they have to understand what they’re dealing with. Contrary to the idea that it’s like a bad flu I can say from experience that opioid withdrawals are the worst physical pain I’ve ever been in, worse than the actual surgery. The worst of it lasts for days where you’re delirious with pain, cold, hot, sweaty, shivering, sick, no appetite, anxious, in pain—it’s a nightmare, and even though after a few days it’s not as bad it takes months to get back to normal without taking Suboxone or Methadone. I wouldn’t be surprised if someone going through withdrawals with access to a gun shot themselves. The other thing about withdrawals that makes it harder for people to quit is how you can go from having the absolute shittiest and most painful day of your life to feeling great within 30 seconds. One time someone stole 10 pills from my prescription bottle and that was 2 and a half days worth. I went through withdrawals for one full day and half of another day and picked my prescription up from a 24 hour CVS at midnight. I didn’t usually snort pills but I was feeling so shitty that I took 2 30 mg Roxicodone pills, crushed them up and snorted them. Within 30 seconds all my aches and pains were gone, I had my appetite back, I smoked a cigarette and it didn’t taste like shit, and I felt like a different person. For people who inject opioids the feeling is immediate; as soon as they stick the needle into a vein it takes less than a second for the drug to take effect. For one thing, methadone isn’t just a drug that heroin addicts take to stop using heroin, although that is its most common use. Methadone is also used for pain management and after I had surgery my doctor prescribed it because it lasts nearly 24 hours and can’t be abused like oxycodone or dilaudid. It’s also (IMO) more effective at killing pain than any other painkiller I’ve taken and I’ve taken everything from codeine to fentanyl. Anybody with a prescription can go to their local CVS or Walgreens and get a month supply of methadone pills, except patients on methadone maintenance. The only place they can get methadone is in a methadone clinic and since the problem of opioid addiction has spread to the suburbs it makes sense to bring the solution there. Even if a person has to go to their local pharmacy every day for a witness dose, it makes more sense than sending them to the city where they sell heroin across the street from the clinic. Switching from heroin to methadone (if dosed correctly) alleviates all of the withdrawal symptoms, and withdrawal is the only reason addicts keep on using. If people could go to their doctors, get a prescription for methadone and have it filled in a regular pharmacy instead of a methadone clinic, more people would switch to methadone. Even though a lot of people are against the clinics where people can receive their daily dose of heroin from a nurse under supervision, it would stop them from buying heroin on the street that may be mixed with fentanyl. They don’t even have to use heroin. Any injectable opioid would do the same thing, whether it’s morphine, dilaudid, oxycodone, oxymorphone, or fentanyl. Some countries also prescribe addicts extended release morphine pills to alleviate the withdrawal symptoms. Suboxone is becoming more popular since you can easily get a 30 day prescription for it in the US if you can find a doctor to prescribe it, usually a psychiatrist. It’s less popular among addicts than methadone because it doesn’t produce any euphoria in people with high tolerances, all it does is alleviate the withdrawal symptoms. Methadone is a full opioid agonist like heroin, oxycodone, dilaudid, etc. Suboxone is a partial agonist/partial antagonist, and it blocks the effects of other opioids because it binds to the same opioid receptor in the brain as other opioids. While less popular it’s just as effective and has less side effects, particularly it doesn’t result in respiratory depression so it can be combined with other medications like benzodiazepines like Xanax or Ativan. The pharmaceutical companies started the opioid epidemic, the DEA cracked down on the doctors expecting less people to use pills, but since heroin is almost exactly the same thing as oxycodone the people who were cut off by their doctors switched. Now that fentanyl is becoming more available in the US, more people are dying from heroin mixed with fentanyl. At this point there isn’t much that the government can do to stop people from using, but they can make treatments like methadone more accessible or create clinics where people can get doses of opioids injected by a nurse to keep them out of withdrawals. It won’t stop the problem of addiction but it will lower the number of overall deaths.

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