Interesting to see Dr. Anand Swaminathan quoted - he is a prominent, highly regarded figure in CME/CPD (ongoing education) for ER docs nationally and internationally, with a large Twitter following.
"Canadians pick their own doctors, just like Americans do. And not only that: since it all pays the same, poor Canadians have exactly the same access to the country’s top specialists that rich ones do."
I am a physician, and there has been a "state of emergency" declared in my province due to a fentanyl overdose "epidemic". Although I use this drug routinely, it is incredibly unsafe outside of a clinical setting. Unfortunately, these are not your stereotypical "bad" people that are dying from overdoses, but your average young people who just happen to experiment. It's utterly awful, and I feel for you. I hope this trend (if you can call it that) ends soon.
Yes, groups that society consider to be trash or defective from the get go. Not "those people" who don't "deserve" such things to happen to them. The law enforcement response to opiods versus crack in the 80s shows us how society views these groups, and what the solution is (militarized police for one, "treatment" for another).
Addiction is a complicated problem and labeling the addict as 'bad' is an antipattern. Modern society should be able to approach everyone from a position of dignity and humanity - dehumanizations erodes both parties in an interaction. 'You deserve to die because of your past history' is a brutal, ethically untenable stance.
Then again, considering we have limited resources for dealing with this problem, pretending all users are the same when we damn well know they aren't is probably not the most efficient approach.
I wasn't claiming statistics or individual differences don't exist.
From the point of view of outcomes and efficiency it's better to approach people as individuals and not as statistics, or even worse, statistics with moral binning into good and bad. The logical argument is that humans are complex and it takes a lot of time to gather sufficient data to be correct.
I can dig out references if you like but medical facilities which focus more on individual-to-individal interactions rather than on factory like throughput work better.
Well sure you can cite evidence where treating people as individuals is beneficial and optimal, my dispute was that this is always the optimum approach.
The people who are overdosing from the Fentynal problem are doing so mostly unknowingly. Dealers are "spiking" their heroin with it in an effort to boost sales as when someone OD's from taking heroin, the user community takes that as being a great batch of heroin and the OD being caused by someone who is not very tolerant to heroin. It's a sick and disgusting game that dealers are using. Again it's not the drug and generally not the users who are OD'ing that are bad, it's the sick twisted dealers out to make more dope money!
I didn't read what GP wrote as those "bad" people deserve to die (nobody deserves to die IMHO but that is another subject) but that it is not the hardcore, everyday drug users who die but the average-kid-nextdoor who is experimenting.
experimenting with drugs which, even if they are what you think they are, can be fatal. Especially when mixed (as they often are) with alcohol and other narcotics.
There isn't some special shield around newbie drug users to protect them from consequence. I find the whole concept bizarre, they are well within their rights to experiment but then they own the consequences.
> but your average young people who just happen to experiment
That's exactly how "stereotypical bad" people start out. It's just that fentanyl kills them faster, while other drugs leave them time to self destroy until we no longer have any empathy.
A surprisingly large chunk of the population has tried opioids, a relatively small percentage become the classic druggie. Much like alcohol is common, but only some people have major issues.
The difference is how long the average person can stay a casual user.
Everyone starts out that way. Some stop, some turn into stereotypical bad people. It's a real shame when anyone at the first stage overdoses and dies. Still a shame for the latter group, but they have more culpability for their own death by continuing to do something they know could/will eventually kill them.
Nobody starts of planning to get addicted. And while they certainly should realize that's a risk I'm not sure it ever factors into anything. Much like harsh punishments don't actually deter crime.
Sometimes we take decisions without being fully aware of the consequences (or simple choosing to ignore the consequences), but this doesn't make us less responsible. Nobody drives intoxicated planning to have an accident, for example.
And of course punishments deter crime. Not the crime that happens, obviously, but the crime which is never committed. There would be more rape, theft and murder if there were no consequences at all.
the same way all the high speed accidents happen to people that started driving at the «harmless» speed of 20km/h.
What I want to say is that demonizing marijuana can allow a bad comparison in the form "marijuana did nothing bad to me, all the thing they say about drugs are nonsense, so I can move to other drugs and be ok".
Truth is marijuana is harmless, compared to almost all the other drugs, including alcohol and tobacco.
It is hard to support my parent comment, but it is true: addicts are not good young girls/boys anymore. And if someone 'experiments' with hard drugs like cocaine or heroine, he/she is statistically-definitely addict with all consequences. One doesn't simply stop after first dose, that's why non-medical drug use is illegal.
> And if someone 'experiments' with hard drugs like cocaine or heroine, he/she is statistically-definitely addict with all consequences. One doesn't simply stop after first dose, that's why non-medical drug use is illegal.
This is definitively wrong. They do not meet the medical criteria for substance use or substance dependence. Nor is it statistically probable that a person eventually will, given that they have taken the drug at least once.
I've taken cocaine exactly one time in my life. That being said, I would never touch meth, heroin or crack even once.
People will do drugs, I accept that. I just want them to know the actual risks of what they are doing. I can't stop adults choosing to take drugs but maybe I can remind a few people to be a lot more careful and to be less trusting of their suppliers.
Can't downvote so responding instead: this is the kind of harmful misinformation that stigmatizes even responsible drug use and makes it less safe for all. Please educate yourself and reform your beliefs on the matter, and stop spreading it.
Also do you realize what you're saying to the author of the root comment? Shame on you.
Can you please provide a link to addicts-per-'those who used cocaine/heroine' ratio? I can't find exact numbers supporting common medical knowledge (e.g. 1/5 for cocaine).
> And if someone 'experiments' with hard drugs like cocaine or heroine, he/she is statistically-definitely addict with all consequences. One doesn't simply stop after first dose, that's why non-medical drug use is illegal.
Even though I'd also like to see such a link, I'd argue that because you're the one making a rather strong (purportedly factual) statement, it's up to you to provide evidence for it.
Don't get me wrong: I don't have a strong conviction on this matter. I really do want to see some evidence to inform my own point of view.
That said, the vast majority of my friends have used cocaine, as have I. Most of them multiple times. None of them have a problem with cocaine.
I'd never encourage someone to experiment with cocaine or heroin because it can be quite dangerous. But misinformation is potentially even more dangerous.
Same in my case. I tried LSD, cocaine, MDMA and DXM, and each of these only once in my life. I saw no point in doing any of them again, and I had no problem whatsoever refraining myself from it.
I'm a physician. Unfortunately, most of our overdoses in North America are from prescribed opiates. They are very addictive, and despite best efforts to control and monitor dosing and schedules, these opiates are often either purposefully overdosed (suicide attempts), diverted, or accidentally ingested. My worst memory in pediatrics was a 7 year old who was brain-dead after ingesting only one (!!!) tablet of her grandfather's high-strength Oxy prescription that she thought was Tylenol.
Opiates are bad news, and physicians unfortunately were duped into prescribing way too much for the last ~15 years.
> Unfortunately, most of our overdoses in North America are from prescribed opiates.
A more relevant metric would be number of overdoses per number of total doses, no?
If there are 50x more prescription opiate users than heroin users and 10x more prescription overdoses than heroin ones that still implies heroin is more dangerous.
I don't follow your logic. A 7 year old swallows drain cleaner, so we should ban drain cleaner? A shame that happened, but irrelevant to the discussion.
You think that by banning opiates no one will get opiates? The methadone clinic two blocks from my apartment, and the people who panhandle around it and the subway station, and the needles I walk past when I cut through the tennis court, do not show the government's laws are solving the problem. As a physician you may see the emotional side, but logically I would love to hear your solutions to the problem.
The point of laws is not to make an undesirable behaviors disappear. The point of laws is to discourage undesirable behaviors, and, hopefully, reduce their incidence. There are still thieves and murderers and rapists and pedophiles out there. Yet we don't just throw our hands in despair and claim that we should just remove all laws off the books because some people break the law. True, some people will get opiates even if opiates are banned. However, overall fewer people will get opiates, and overall fewer opiates will be sold.
Logically, I would love to hear your solution to the problem...
The problem with thieving and murdering is generally considered to be the one presented by the people who's property or lives are unwillingly taken from them.
Yes, my logic is simple: stop trying to ban victimless crimes like drug use. A grown adult wants to inject himself with heroin? Let him. By banning the drug you create a black market, and all of the crimes that entails. The USA tried to ban alcohol, and the bootleggers won. Take all of the money we put into the war on drugs and redirect it to treatment, and tax the shit out of the drugs to pay for our schools.
Banning stealing, rape, and child pornography is nothing like banning drugs. Completely, totally, 100% unrelated and by trying to loop all of them together you disregard logic and sane, rational arguments.
The best I can explain it, drugs are like rewiring your brain to need something, like food, water, air, sexual reproduction, etc.
If you go without eating for a day or two, your brain really drives you to find something to eat. Same thing happens with some drugs - within varying degrees.
When I tried to give up smoking cigarettes hundreds of times, my body really felt like it was dying by not having the nicotine around. I eventually got passed it. I haven't had one in 8 years.
The drug laws do nothing more than make addicts bad people. It makes it harder for them to get jobs when they get busted. These guys were just trying to survive - their brains rewired to do that.
They really need to get rid of the drug war. Take that $50 billion a year and spend it on mental health/addiction research - instead of killing a bunch of people on the border. Provide some treatment centers. Let people be anonymous when attending. Get the courts and criminal records out of the equation.
I've known some very smart addicts over the years. The tragedy is they get worse and worse - and they have no way out without getting a very negative stigma attached to them. Some end up unable to get jobs. It all because of our laws.
We would be much better off educating our population honestly on drugs (think of how dishonest the refer madness propaganda was). Keep the drugs available, in clean, reliable doses. Help people addicted get off the drugs. Learn about the cycle. This is much better than the system we have now.
These are some great points. In particular, we need to reduce the stigma on addicts, especially those that [try to] recover. Mind you, reducing the stigma is hard, because the stigma doesn't come from a void, or from laws, it comes from the cumulative experience people have with addicts, which are less than great. In another piece from the same story, http://www.latimes.com/projects/la-me-oxycontin-everett/, read on Brandon Smith, who ended up spending all his savings and belongings on drugs, ultimately resorting to robberies. Personally, the first addict I ever met ended up stealing my winter jacket within 3 month of working in the same building, in the middle of a heavy winter. Robbing and stealing are not great ways to build sympathy or trust.
I happen to share the experience to shrugging off nicotine addiction. It was very easy to get hooked [peer pressure played a role], and surprisingly hard to get rid of. In my case, took a few weeks of fighting my body with reason. From what I hear, opioid addiction is stronger, thus I'm having a really really hard time believing that having over-the-counter opioids that anyone can "try a few times" is going to be anything but a major disaster.
The best strategy for most people is to never use opioids. Simply not worth the risk of ruining one's life for a very short time gratification. Given the reality of rebellious teenagers / young adults, I'd much rather have no easy legal path for opioids. Sorry, no opioids in a supermarket locker that you can get by just showing your driver license. On the flip side, I believe we should still crack down hard on dealers, to keep pressure on the supply side.
Which leaves us with the people caught in the opioid trap. While we already fund addiction research, see https://www.drugabuse.gov/international/research-funding-lan..., we probably could do more. We already have rehab clinics where at least some form of palliative care is to be found, though we should seek to make rehab and rehab clinics a better experience. Whether that includes availability of drugs, I frankly haven't seen any relevant research indicating that's a good idea, and I see some evidence [prescription abuse, see the original article] that it is rather dangerous.
That's where Ansible + Capistrano can work together nicely.
No need to change your application or deviate significantly from a "vanilla" Ubuntu install - just add your nginx, Passenger configs to Ansible, build the server, and then deploy with Capistrano.
I'm a Canadian citizen who just finished the process of sponsoring my Australian wife for permanent residency in Canada.
What you've written isn't true unless there's some extenuating circumstances you're not disclosing. My wife was automatically eligible for PR, and in fact it was much easier than the reciprocal process (me applying for PR in Australia). It took about $2000 all up, and took about 8 months in total. Easy!
Seriously??? My friend's wife even had to go back to the US to give birth because she couldn't get health care! I wonder if it has changed. That would be great news!
This looks really well done. Any chance that it could emulate the functionality of wkhtmltopdf in the browser (a.k.a. CSS styling, structure from HTML)?
I would say pretty low wkhtmltopdf like PhantomJS uses Webkit to layout HTML then converts that layout to PDF, HTML layout including CSS and javascript execution is a heavy lift, this library only scratches the surface of what would be needed to cover wkhtmltopdf.
First you would need a pure js web browser, the closest thing currently being zombie I think. If you didn't care about running on the server then you could take advantage of the browser the lib is running in to get the current computed layout from the active dom and transform into the PDF layout, still a big job but the heavy lift is done by the browser. Telerik does this in their Kendo lib, where they render a active dom element to thier abstracted vector graphics model, then have PDF, SVG and Canvas renders for that: http://docs.telerik.com/kendo-ui/framework/drawing/drawing-d...
That's exactly what I was going to say. I finally put 2FA on my Dropbox account a while ago. Scanned the QR code in Authy, and everything worked just ifne.
