| ▲ | lazarus01 a day ago |
| >> Researchers have pondered what could have caused this sudden turnaround, pointing to the end of the covid-19 pandemic or a rise in drug treatment. A new article, published in Science on January 8th, suggests, instead, that a supply shock drove the decrease. The supply shock sounds right. I was volunteering at a state run institution, who had an addiction data science team, at the peak of the opioid crisis. I was developing ml models to predict patient dropout early in a 32 week program. The data and funding for such research was very scarce and it didn't go anywhere. Treatment for opioid use disorder with medication is highly effective for 50% - 90% who respond well to treatment. The problem with the bottom 50% was early dropout, due to the lack of dissemination of proper treatment protocols and stigma attached to medication for treatment (methadone). I stopped following the work, I became too sensitive, it was pretty depressing. The pandemic coupled with the increase in illicit fentanyl was just tragic in what it did to people. I remember reading the DEA research, where the precursor for fentanyl came from china and was manufactured and distributed from mexico. Mexico was also manufacturing high quality meth and displaced most of the meth labs in america, coming with increases in meth overdose during the same period. The fentanyl was so cheap compared to traditional heroin manufacturing. I'm glad the supply seems to have dried up. It was nuts, what was going on a few years ago. |
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| ▲ | cavisne 4 hours ago | parent | next [-] |
| Channel 5 did a good piece on "Tranq" which lets China skip the Mexican part of the supply chain as they can mail the finish product straight to the US. Since the article suggests there must have been a change in china to cause this it seems likely they just moved from fentanyl to tranq. https://www.youtube.com/watch?v=925wmb-4Yr4&t=1623s&pp=ygUPY... |
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| ▲ | _DeadFred_ 4 hours ago | parent [-] | | Lots of people were getting fent analogs straight from China. Which had me wondering. The guys that I knew that ordered/distributed it (ex-marines that had pill addictions after Iraq/Afghanistan) would get different analogs randomly I guess, and would test each batch on themselves. Some were way more sketchy than others, and they ultimate caught a case with a body from a new batch. Could the less deaths be because of the analogs in production at the time? |
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| ▲ | greygoo222 a day ago | parent | prev | next [-] |
| The initial spike in overdose deaths were largely caused by government crackdowns on pharma drugs. |
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| ▲ | monero-xmr 18 hours ago | parent [-] | | You can live with a sustained opioid addiction permanently without major issues. That’s the entire basis of methadone clinics - controlled dispersement of opioids at a level that solves cravings and allows the addict to be functional. It is very sad we don’t allow pharmaceutical grade opioids to be given to addicts in a controlled way, it would eliminate the purity variance that causes overdoses, and prevent the poison mixed in to increase street profits from destroying bodies (tranq, etc) | | |
| ▲ | herbst 14 hours ago | parent | next [-] | | In Switzerland they can get actual, state grown, heroin. Clean heroin is one of the least problematic substances appearantly, less problematic and more "everyday friendly" than Methadon even. And you don't SEE any issues like in the US (or UK) around here at all. | | |
| ▲ | Aurornis 6 hours ago | parent | next [-] | | > Clean heroin is one of the least problematic substances appearantly, less problematic and more "everyday friendly" than Methadon even. Least problematic is too strong of wording. Consistent opioid use will take a large toll on the body and mind. A therapeutic level of dosing could possibly be better than severe chronic pain depending on the situation, but even chronic pain patients have to deal with a range of negatives and side effects that are only tolerable because they’re less bad than their severe chronic pain. Chronic opioid use induces a lot of changes in the body and mind. The initial euphoria isn’t sustainable, as everyone knows, but long term use induces even further changes that predispose users to deeper depression and can even begin to augment pain signals. Opioids are in a class of drugs that are unusually deceptive because users who more or less control their dosing will talk themselves into thinking they can do this forever without real negatives. They can go for years before the cumulative negatives become too obvious to ignore. For addicts deep in cycles of rehab-relapse extremes, going to a maintenance program and achieving stability is definitely better than continuing the cycle indefinitely. However it comes with a high price relative to sobriety. I think it’s important to not downplay the effects of being on opioids for years and years. | |
| ▲ | Tom1380 13 hours ago | parent | prev | next [-] | | I live in Zurich. I spent 5 minutes waiting at a bus stop in Langstrasse and I was offered cocaine and marijuana by a thug | | |
| ▲ | comice 12 hours ago | parent | next [-] | | The comment was about heroin. Were you offered heroin? Is cocaine and marijuana available from the government too? If not, what relevance is your comment? Was this the first and only time you were waiting at a bus stop in Switzerland? If so, perhaps a notable story, if not then we'll need more information to conclude how bad this thug problem really is in Switzerland. | | |
| ▲ | zhdc1 11 hours ago | parent | next [-] | | Langstrasse is as close to a red-light district as you'll find in Zurich. It's gotten a lot better over the last couple of years, but stating that you were offered drugs there is like being offended that you walked past a casino in Vegas. | |
| ▲ | johnisgood 6 hours ago | parent | prev [-] | | The problem is definitely with adultered products. Never accept anything from a random "thug". |
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| ▲ | herbst 13 hours ago | parent | prev | next [-] | | Sounds like you have easy options for some common drugs. Not a bad thing perse and sounds like they didn't offer any opioids | | |
| ▲ | fennecbutt 11 hours ago | parent [-] | | Lmao as a kiwi living in UK it's definitely a bad thing. Can't go on a night out in London without half dozen dudes trying to sell you coke. Same dudes who are waiting in alleys waiting to mug people when they get the chance. If you ever see >1 person just standing around and not walking somewhere in London early in the morning just stay the fuck away from them. And if they start heading your way, run. | | |
| ▲ | herbst 10 hours ago | parent | next [-] | | I know how annoying this can be, especially in some countries this behaviour is often directly associated with criminality. Here in Switzerland dealers are often (not always) just that, they make enough to not bother with anything else. They don't look like "dirty" junkies, they don't bother stealing from tourists, they basically don't look for any extra attention when the business is rolling anyway. | | |
| ▲ | seanmcdirmid 5 hours ago | parent | next [-] | | Survival bias: the police would come down on them on hard if they were scene as disrupting social order. They have to not look dirty to survive, Swiss police are no joke. | |
| ▲ | scotty79 9 hours ago | parent | prev [-] | | When I was in Amsterdam people were offering hard drugs on the street but "no, thank you" was perfectly sufficient response | | |
| ▲ | herbst an hour ago | parent [-] | | This. Same in Switzerland. Feels different in for example Prague, Vienna, ... |
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| ▲ | alimw 4 hours ago | parent | prev [-] | | You've only told us that you're scared of being mugged by dealers! That doesn't even count as anecdotal evidence that it's likely. |
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| ▲ | zhdc1 11 hours ago | parent | prev | next [-] | | "waiting at a bus stop in Langstrasse" -> what were you expecting? | | | |
| ▲ | kakacik 4 hours ago | parent | prev | next [-] | | Is it too long, too little or what? Red light districts, official or not are the place to get drugs in european towns. Langstrasse is basically an official place for that, at least the most official Zurich has. | |
| ▲ | Etheryte 10 hours ago | parent | prev [-] | | If you think cocaine and marijuana are comparable/interchangeable with heroin, you might want to educate yourself on the topic a bit more before trying to make a quip. |
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| ▲ | monero-xmr 14 hours ago | parent | prev [-] | | Imagine you are sitting in a room. Your child is in front of you. A scary man sits next to them. The man says: “Your child is a drug addict. They are addicted to opioids. I am the devil, without any care in the world other than making money. The choice is yours. Would you rather they inject clean heroin made by a pharmaceutical company in your country, or banish them forever as street addicts slavishly doing what it takes to score their fix?” When facing the devil I’m voting for my tax dollars to give them clean heroin made by my country. That is what every parent wants when faced with an addicted child | | |
| ▲ | lolive 12 hours ago | parent | next [-] | | I switched from my Twitter addiction to a Bluesky addiction. Still scrolling to death, but now my opinion is mine again.
#dontDoGrok | |
| ▲ | znpy 12 hours ago | parent | prev [-] | | That’s a fake dichotomy btw, a sadly very common logical fallacy. You (wrongly) assume there’s no way out of an addiction, for example. | | |
| ▲ | acessoproibido 12 hours ago | parent | next [-] | | Its definitely easier to beat addiction if you aren't living on the street, selling everything you have and are injecting one of the most horrible shit substances but instead you are using a clean, safe alternative that is provided by the state together with prevention programs (which is usually the model for this) - how is it a false dichotomy? Or are you someone who assumes you just need to "use willpower" and "stop" being an addict?
I assure you its not so easy with opiates. | | |
| ▲ | dostick 12 hours ago | parent [-] | | [flagged] | | |
| ▲ | spacecadet 11 hours ago | parent | next [-] | | Defined as addiction... You ever struggle with one, loose a loved one to it? Comment comes off stupid. | | |
| ▲ | threethirtytwo 9 hours ago | parent [-] | | Interesting fact: Hordes of American soldiers were doing heroin in the Vietnam war. When they came back to America we were expecting a massive addiction epidemic. It never happened. Overall, all the soldiers who came back lost the addiction. Little known phenomenon about addiction that can’t be fully explained yet. What you say is true, but the person you responded to, what he says has an aspect of the truth as well. Look into it. | | |
| ▲ | BigTTYGothGF 5 hours ago | parent [-] | | > all the soldiers who came back lost the addiction This does not seem to be born out by the historical record. > https://department.va.gov/history/featured-stories/borne-in-... > Despite initial fears, high substance abuse rates during the war did not entirely translate to enduring addiction issues post-war. A year after returning home, only 10% of Service members initially detected as drug positive reported using opiates after detoxification, and just 7% reported re-addiction > VA initially found itself unprepared for the sudden increase in drug cases. Please note the "entirely" and "7%". Also:
> https://academic.oup.com/aje/article-abstract/99/4/235/13845...
> Rather than giving up drugs altogether, many had shifted from heroin to amphetamines or barbiturates. | | |
| ▲ | threethirtytwo 4 hours ago | parent [-] | | https://www.npr.org/sections/health-shots/2012/01/02/1444317... You’re wrong, and the “historical record” you’re citing is actually the same record the NPR piece is summarizing. What that NPR piece is pointing at is the Lee Robins follow up result that became famous precisely because it violated the folk story of heroin addiction being inevitably chronic. A later review of Robins’ findings summarizes it bluntly: In Vietnam, high heroin use and dependence. After return, only about 10% tried heroin, and only about 1% became re addicted in the first year. Now compare that to the VA history page you linked as a “gotcha.” It says the same thing in slightly different numbers: One year after return, 10% reported opiate use, and 7% reported re addiction. So no, “not entirely” and “7%” are not a refutation. They are the punchline. You can argue about whether it is 1% or 7%, depending on definitions and measurement, but the qualitative point survives trivially: it was nowhere near the relapse pattern people expected for heroin addiction, which is why NPR is telling the story in the first place. Your OUP line about some vets shifting to other drugs is also not the contradiction you think it is. “Some people continued using substances” does not falsify “heroin dependence largely remitted when the environment changed.” Those are different claims. If anything, substitution strengthens the “context and cues matter” thesis, because it implies the Vietnam setting was uniquely good at sustaining heroin use, not that heroin had permanently rewired everyone’s brain. Also, “VA was unprepared” is about bureaucracy, not epidemiology. The VA being behind the curve tells you the system wasn’t ready for the volume of cases showing up at the door, not that “everyone stayed addicted forever.” If you want to be precise, the correct statement is: Most soldiers who were using heroin in Vietnam did not remain heroin addicted after returning home, and relapse was low relative to expectations, which is exactly why this became a canonical example in the first place. |
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| ▲ | 11 hours ago | parent | prev | next [-] | | [deleted] | |
| ▲ | fennecbutt 11 hours ago | parent | prev [-] | | Lmao. You are so wrong. Addiction is the human brain wanting those sweet molecules to hit binding sites. But you know, make it poetic or something. Suppose that's how religion still manages to thrive. | | |
| ▲ | Saline9515 3 hours ago | parent [-] | | There is also very often a psychological aspect, which explains why some addicts are able to stop "cold turkey" if the psychological/contextual aspect of their addiction changes. |
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| ▲ | imtringued 11 hours ago | parent | prev | next [-] | | Usually the fastest and most effective way out of an addiction is medication assisted treatment, which means having a doctor control your dosage with a clean supply of the drug or a less addictive substitute that targets the same receptors. | |
| ▲ | solumunus 6 hours ago | parent | prev [-] | | They never made such an assumption. |
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| ▲ | specproc 15 hours ago | parent | prev | next [-] | | Methadone is available in the UK, on the NHS. I know at least one person who has been on it for decades. https://www.nhs.uk/medicines/methadone/ | |
| ▲ | mmooss 8 hours ago | parent | prev | next [-] | | > You can live with a sustained opioid addiction permanently without major issues. To me that seems to say cause of the opiod crisis doesn't exist, which probably isn't what you mean. But what do you mean? | | |
| ▲ | monero-xmr 8 hours ago | parent [-] | | The problem is not the opioids themselves as a chemical. They are tolerated well and have minimal side effects. The main issue is that street opioids are of uncertain purity, and cut with toxic chemicals. This causes overdoses when a batch is too strong, and various health issues from the harsh toxins. A properly managed opioid addiction can be permanent. For a decade millions of Americans were addicted to opioids (OxyContin, Vicodin, etc.) prescribed by doctors. When the state cracked down they were forced to go on the street to get their medicine, which is when the opioid crisis exploded | | |
| ▲ | Veliladon 7 hours ago | parent | next [-] | | And we learned zero from the change after shutting down the Purdues. The electorate just wants to see drug users punished, not treated. Even though treating cheaper, more humane, and has way better outcomes. | |
| ▲ | gruez 7 hours ago | parent | prev [-] | | >When the state cracked down they were forced to go on the street to get their medicine, which is when the opioid crisis exploded. What's the data corroborating this theory? |
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| ▲ | brewcejener 6 hours ago | parent | prev [-] | | [dead] |
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| ▲ | 20after4 a day ago | parent | prev | next [-] |
| I think that many methadone clinics are operating very unethically, to the point I would call it fraudulent. Certainly it's cruel to the patients. They essentially set up the patient to be a lifetime methadone addict. This may be an improvement over getting your fix on the street but it's still addiction dependence and it's expensive (profitable!). I'm unsure if it's just a few or a large fraction of them that operate this way. Maybe my data point is a unique outlier but here's what I saw: I had a friend who was going through the program in Springfield Missouri, approximately 10 years ago, and the clinic literally increased his dose every week or two. They also had strict controls to make sure the patients actually take the full dose (because otherwise they might sell some of it on the street). So they were left with just 2 options, either drop out of the program and find their fix elsewhere, or accept a gradually increasing dose of methadone, forever. It's a sick program that is set up to make sure patients gradually descend deeper into addiction while they rake in huge profits. It's not really any different from what the drug dealers on the street are doing except that it's even more exploitative and dishonest. The doctors had zero plan for weaning people off of the methadone and some people had been on the program for years, with correspondingly huge doses doled out to them every time they came in. This was 10 years ago, at the time it cost something like $50 per visit, paid by the patient or possibly medicaid. Edited slightly for clarity. |
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| ▲ | deepsun a day ago | parent | next [-] | | Well, addiction or not, the main question is what medics call "quality of life" -- whether a patient can life their life to the full potential. There are millions of people addicted to caffeine, the most popular psychoactive substance in the world, but as it usually doesn't prevent them to live their life and "be a productive member of society", no one cares of treating caffeine addiction, save for religious societies. My point is -- is methadone addiction "better" than fentanyl in that regard? If yes, than that's ok. | | |
| ▲ | 20after4 a day ago | parent | next [-] | | My complaint was about the forced increasing of dosage. They literally would not allow the patient to wean off of it. So yes, it might be an improvement over the shit on the street but it's diabolical that they force patients to continually increase their dose rather than gradually decreasing it. I have no idea if this is common or just this one shady clinic but my data point of 1 still stands. If there is one, then given that this would be very profitable, it's highly likely that there are other clinics with similarly unethical policies. | | |
| ▲ | patmorgan23 8 hours ago | parent | next [-] | | > They literally would not allow the patient to wean off of it If true that clinic needs to be reported. Patients have a right to taper down and exit treatment. When a patient enters treatment at an OTP (Methadone clinic) they start with a small initial dose that is increased over the initial 30-60 days of treatment. Some clinics do this somewhat aggressively because they are trying to get the patient up to a "protective" dose. Methadone blocks the 'euphoric' effects of other opioids and protects patients who may still be taking other substance outside of their prescribed treatment program from overdose. Getting to a protective dose faster ends up saving patients lives. So that maybe why the clinic was firm about trying to increase you friends dose. OTPs are also required to offer counseling, the idea being methodone is used to address the physical aspects of addiction, and counseling is use to address the psychological/emotional side of addiction. Help patients build coping skills, figuring out what their triggers are, and find ways to stay out of those situations, etc. Some patients are instrested in that and eventually getting off of Methadone, some aren't. Some clinics provide really great counseling, some don't. The "dose and go" clinics are definitely a problem in the industry. https://www.samhsa.gov/substance-use/treatment/options/metha... | | |
| ▲ | vladvasiliu 6 hours ago | parent [-] | | > Methadone blocks the 'euphoric' effects of other opioids and protects patients who may still be taking other substance outside of their prescribed treatment program from overdose. Getting to a protective dose faster ends up saving patients lives. How does this work? Naively, I'd expect addicts to up the dose of the "other substances" if they can't reach their high. Or does methadone outright "block" the other substances' effects? | | |
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| ▲ | antonvs 21 hours ago | parent | prev | next [-] | | To answer my own question: what you described sounds like part of the standard recommended protocol, and it seems likely your friend misunderstood or misrepresented that. I'll explain with liberal quotes from the document linked below. Dosages start out low to avoid risk to the patient, because "the most common reason for death or non-fatal overdose from methadone treatment is overly aggressive prescribing/dose-titration during the first two weeks of treatment." Because of this, "methadone induction and titration MUST be approached slowly and cautiously. It may take several weeks to address opioid withdrawal
effectively. It is important to be upfront with patients about this requirement and to discuss ways to cope with ongoing withdrawal and cravings, to maintain engagement in treatment." The dose increase is described in the following paragraph: "...methadone can be initiated without the prerequisite presence of opioid withdrawal. This may be preferential for some patients. The patient’s dose should be titrated with a “start low and go slow” approach, based on regular clinical assessment, until initial dose stability is reached – see specific recommendations below. A stable dose is achieved when opioid withdrawal is eliminated or adequately suppressed for 24 hours to allow patients to further engage in ongoing medical and psychosocial treatment. The ultimate goal is to work toward clinical stability." In other words, for patients who are continuing to take other opioids, the methadone dose is increased over time to make it easier for the patient to reduce that other intake. Dosage is based on interviews with the patient. Addicts are very good at subconsciously coming up with rationales for remaining addicted. It's much more likely that your friend found himself in that trap, than that he was going to an unethical clinic trying to keep him addicted "forever". That would be a major violation of the law and breach of medical ethics, and would be likely to come to the attention of regulators if it was a recurring pattern. https://cpsm.mb.ca/assets/PrescribingPracticesProgram/Recomm... | |
| ▲ | antonvs 21 hours ago | parent | prev [-] | | Was there some stated rationale for the dose increase? | | |
| ▲ | 20after4 20 hours ago | parent | next [-] | | It's possible my friend wasn't telling me the whole story or just misunderstood the program. I don't think he was actually trying to stay addicted though because after a few weeks on methadone (with increasing doses and doctors telling him that he would always be an addict for life) he decided to take the more extreme route of getting clean by quitting cold turkey. He moved to a different state and cut ties with every possible source he had to acquire the drugs. | | |
| ▲ | XorNot 19 hours ago | parent | next [-] | | Did it work? Is he clean? | | | |
| ▲ | idiotsecant 14 hours ago | parent | prev | next [-] | | And yet, you're comfortable accusing the people trying to cure addicts of some diabolical plot to ensnare them into permeant addiction in order to make money off them forever. Maybe next time you'll think before you propagate nonsense. | |
| ▲ | antonvs 17 hours ago | parent | prev [-] | | This is certainly possible, but it sounds more like what AA tells its clients. Doctors are less likely to say things like this, because it can have consequences for them. Going cold turkey like you're saying he did is fine if (1) it doesn't kill you and (2) you're able to do it. For many people, it's just not very practical. I don't think it's a good idea to demonize medical professionals for doing their jobs to the best of their abilities in the face of enormous challenges. That's the kind of thing that the conspiracy theorist and anti-science Robert F. Kennedy Jr. does, and it's not helping the US in any way at all. |
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| ▲ | 20after4 21 hours ago | parent | prev [-] | | Not that I'm aware of, it seemed rather arbitrary. The people who had been going to that clinic for a while all had massive doses, almost to a ridiculous degree. My perception was that it was to keep them hopelessly addicted. I was only peripherally involved as it was my friend who was the patient. He was very fortunate to have family with influence in the Mormon church - his family had the church send some local missionaries to help him - and they genuinely did help him escape that terrible situation. |
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| ▲ | lazarus01 a day ago | parent | prev | next [-] | | Agreed. Methadone is effective because it comes with lower respiratory fatigue. If you have a nasty addiction, methadone is the gold standard for treatment. It's really all that's available to ween people down. There are other medications for maintenance like buprenorphine and naltrexone. But you can't take those if you're in the throws of heavy addiction, you can die. | |
| ▲ | herbst 14 hours ago | parent | prev | next [-] | | In Switzerland there is state grown heroin because it should be even less quality of life inferencing than most other alternatives. They do this for a long while now and it works, most people have jobs and you couldn't tell they get daily heroin in the best quality you could imagine (for free) | |
| ▲ | vixen99 14 hours ago | parent | prev | next [-] | | And no one bothers much about these either: 'A Neglected Link Between the Psychoactive Effects of Dietary Ingredients and Consciousness-Altering Drugs.'
https://www.frontiersin.org/journals/psychiatry/articles/10.... | |
| ▲ | kakacik 4 hours ago | parent | prev | next [-] | | Dude, caffeine ain't no heroin. I drink 2-3 coffees a day and skipping this (ie traveling on vacation, easily for a week or two) does 0 to my body, mind or sleep. I just don't feel the effect at all, I drink it purely for the taste. There is no human in this world who could say something similar about heroin. | |
| ▲ | scotty79 9 hours ago | parent | prev [-] | | > no one cares of treating caffeine addiction If people were aware in how many ways caffeine messes up a lot of people there would be. Exhaustion, migranes, anxieties, twitching, insomnia, mental issues to name a few. Most never attributed to caffeine but mysteriously going away after a person manges to kick the habit. |
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| ▲ | SkyPuncher 5 hours ago | parent | prev [-] | | Your argument seems to be missing the fact that methadone clinics are serving people with an existing addiction. They didn’t create that addiction, but they can fill the desire created by that addiction in a safe manner. The ideal situation is the client leverages methadone into a recovery/remission from addiction - but that can be incredibly hard for them to do. | | |
| ▲ | Lord-Jobo 5 hours ago | parent [-] | | If someone is addicted to ice cream, and the most effective treatment is to replace that addiction with spinach(scientifically supported), would anyone have this problem? I doubt it. People’s knee jerk reaction to any kind of “”””drug enabling”””” treatment is infuriating.
I know multiple people personally who have had their life saved by methadone. Yes that makes me biased but it also justifies the bias (alongside the many medical professionals advocating for it) |
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| ▲ | AndrewKemendo a day ago | parent | prev [-] |
| Even still today there is no reliable place to source black tar or China White or any of the traditional opium derivatives without having a fentanyl cut. |
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| ▲ | t-3 a day ago | parent [-] | | Isn't this more because the supply of poppy was cut off when the US pulled out of Afghanistan? Users want the good stuff, dealers buy the cheap and available stuff and pretend it's real. | | |
| ▲ | metalman 14 hours ago | parent [-] | | poppy/opium/heroin production has shifted to myanmar, but there has been less production, and the synthetics are much cheaper ,so that reduces profitability for poppy
Afganistan, have set up addiction centers, where addicts are put, but it's cold turkey.
Opium poppy production is bieng eradicated
in Afganistan ,and penaltiys for drug smugglers and dealers will escalate, but a quick search shows the increadable synicism of the western press who are spinning it as "hardship for Afganinstans farmers" | | |
| ▲ | lukan 14 hours ago | parent [-] | | "hardship for Afganinstans farmers" Isn't it hardship when people with guns come to you and burn your fields? | | |
| ▲ | t-3 5 hours ago | parent | next [-] | | Oh, woe is me, the government burned down my illegal drug manufacturing operation! Where is the justice?! | |
| ▲ | HPsquared 11 hours ago | parent | prev | next [-] | | I wonder how this compares to the common western situation of livestock culls. Presumably there is compensation in some cases and not in others (poppy cultivation being illegal). I suppose it's at opposite ends of a scale. | |
| ▲ | metalman 13 hours ago | parent | prev [-] | | ok, lets talk about Palestine ,if thats what you want. |
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