评论
打印
Over the past 20 years more than 800,000 people have died in the United States due do drug overdose.
在过去的二十年里，美国有超过八十万人死于药物服用过量。
Yes, more than all the lives lost in all the wars this country has fought in.
是的，这个数字比美国在参加过的所有战争中牺牲的人数还要高。
The majority of these cases are due to opioid drugs.
其中大多数死因是阿片类药物使用过量。
Sadly, while we're having this very conversation, at least one person will die from a drug overdose,
令人难过的是，在我们交谈的此时此刻，至少就有一个人会死于药物使用过量，
and a child will be born experiencing severe withdrawals due to in utero opioid exposure.
会有一个孩子在出生后因为暴露于子宫内的阿片类物质而出现严重的戒断症状。
Only recently have some pharmaceutical companies been held legally responsible for the opioid crisis.
直到最近，才有一些制药公司被判对阿片类药物危机负有法律责任。
And compared to their multibillion-dollar revenues, the economic penalties they're paying seem minuscule.
但相比于几十亿美元的收入，他们所支付的经济罚款似乎显得微不足道。
So let me as a question: why does addiction and the stigma of addiction make it OK to undervalue human lives?
那么，让我来问一个问题：为什么药物成瘾和成瘾的耻辱使人类的生命如此不堪一击？
Ironically, I'm often asked the opposite question. Why should we care about "addicts?"
讽刺的是，经常有人问我相反的问题。为什么我们要在乎“瘾君子”？
Sometimes I'm even shouted at by people who think that anyone who suffers from a substance use disorder brought it on themselves.
有时候甚至有人会冲我怒吼，他们觉得那些饱受药物滥用之苦的人都是自找的。
They must be weak, they lack any moral compass and therefore don't deserve any help.
他们肯定意志薄弱，缺乏道德判断，所以他们不配得到任何帮助。
But if you know anything about opioid addiction,
但是如果你对阿片类药物成瘾有哪怕一点点了解，
you know that this population does not fit that stereotype -- not that any addiction every really does.
你就知道这种刻板印象是错误的--因为并不是每个成瘾的人都是这样。
These are mothers, fathers and grandmothers.
他们中有母亲、父亲、奶奶。
They're teachers, business leaders, cheerleaders, athletes, nurses and bus drivers.
有老师、商界领袖、啦啦队员、运动员、护士和公车司机。
They're your brother or sister. They represent every fiber in the fabric of our society.
他们是你的兄弟姐妹。他们代表着我们社会结构中的每一根纤维。
Yes, each person came to addiction in a different way,
是的，每个人会以不同的方式上瘾，
but a major cause of the current epidemic is that medical overprescription of opioid drugs for the treatment of chronic pain.
但是导致当前药物滥用的主要原因，在于治疗慢性疼痛的阿片类药物的处方。
And that is one thing that makes this epidemic different.
这是使这种流行病与众不同的原因。
This particular epidemic was caused by doctors' prescriptions.
它是由医生的处方引起的。
The cycle started when pharmaceutical companies convinced physicians that their patients should not feel any pain.
这个循环从制药公司开始，他们说服医生，病人不应该感受到任何疼痛。
Opioid makers claimed that their very potent drugs would not lead to addiction
阿片类药物制造商声称，他们强有效的药物并不会导致成瘾，
unless individuals were certain kinds of people from certain kinds of communities.
除非是来自特定社区的特定类型的人群。
Such disinformation, compounded with clinicians' limited education and public ignorance about addiction, is what created the epidemic.
这种虚假信息，结合临床医生对其有限的了解和公众对成瘾的无知，是造成这场药物滥用危机的原因。
So that's how we got here. Now the question is: how do you treat a national opioid epidemic?
这也是为什么我们走到了今天这一步。现在的问题是：如何解决全国性的阿片类药物滥用问题？
During an epidemic, normally governments, clinicians and scientists are brought together to help the afflicted.
对于一般的流行病，政府、医生、科学家会聚集在一起来帮助患者。
They develop new and even unconventional treatment strategies to rapidly address the condition.
他们开发新的，甚至是非常规的治疗策略来迅速处理这种情况。
That has not been the case for the opioid epidemic. However, the picture is changing.
但是对于阿片类药物，情况则截然不同。好在，情况正在改变。
We're beginning to see more aggressive government actions.
我们开始看到了更积极的政府行动。
For example, the NIH recently started a new initiative called HEAL.
例如，NIH（国家卫生研究所）最近启动了一项新的计划，HEAL。
HEAL stands for Helping End Addiction Long-term,
全称是Helping End Addiction Long-term（协助结束长期成瘾），
and it's designed to accelerate research for pain management and addiction through funding new treatment strategies.
它旨在通过资助新的治疗策略来加速疼痛治疗和成瘾的研究。
The current treatment strategy for opioid addiction is the use of other opioids such as methadone.
当下对阿片类药物成瘾的治疗手段是使用其它的阿片类药物，比如美沙酮，作为替代品。
These few medications have been used during the past 50 years.
在过去的五十年中，我们一直在使用这类药物。
They're considered substitution therapy -- basically fighting fire with fire.
将其当作替代疗法--基本上是以毒攻毒。
They have saved numerous lives, yet they're not used by many who still need them. Why?
它们已经拯救了无数生命，但还是有很多需要的人用不上。为什么？
These medications are themselves addictive, and therefore come with many governmental regulations.
因为这些药物本事也带有成瘾性，所以一直受到很多政府法规的约束。
Hundreds of thousands of people must be strictly monitored each day.
有数十万人的用药每天都受到严格的监控。
They must find an opioid clinic -- often far from home -- take their meds and then try to make it into work.
他们必须去通常离家很远的一家阿片类药物诊所，服用药物，然后尝试使其发挥作用。
Obviously, that is not the most effective treatment strategy for an epidemic. And it raises obvious questions as well.
很显然，这不是最有效的治疗策略。而且它也带来了显而易见的问题。
For example: why is the treatment of addiction disorders different from other medical disorders?
比如：为什么成瘾症的治疗不同于其它医学疾病？
With most other medical disorders, a nonaddictive, prescribed medication is picked up at the pharmacy.
对于大多数医学疾病，需要在药房购买非成瘾的处方药。
Why do physicians treating their patients with a substance use disorder have limited treatment options?
为什么医生在治疗物质使用障碍的病人时仅有有限的治疗方案？
No one ever says that two to three treatments are enough for cancer, especially when it's not a cure.
没有人说过，对于癌症，两三种治疗方案就够了，特别是针对绝症。
And that brings us to that 200 billion-dollar problem.
这就给我们带来了一个价值两千亿的问题。
Fighting fire with fire is a reasonable strategy, but what about using a different form of fire -- a safer form of fire?
以毒攻毒是一种合理的策略，但是为什么不用一种不同的毒--一种更安全的“毒”？
What about actually developing a nonaddictive treatment derived from another drug?
或者利用其它药物开发出一种不会成瘾的治疗方法？
That has been my journey towards trying to develop a treatment for opioid addiction, and it's taken me in some really surprising directions.
这就是我尝试开发阿片类药物成瘾治疗疗法的旅程，而且它已经带我引入了一些非常令人惊讶的方向。
My journey started with studying cannabis, the drug most people call marijuana.
我的旅程开始于研究大麻，也就是大多数人都知道的一种毒品。
In order to understand how cannabis may connect to combating the opioid epidemic,
为了理解大麻如何与抗击阿片类药物联系起来，
first it helps to understand a little bit about the science behind the drug and the politics.
首先要对药物背后的科学和政策有一些了解。
Cannabis is a complex plant. It's actually made up of over 140 cannabinoids.
大麻是一种复杂的植物，它实际上由140多种大麻素组成。
Cannabinoids are active chemicals from the plant that binds to cannabinoid receptors in our bodies.
大麻素是植物中的活性化学物质，可与人体中的大麻素受体结合。
The potent psychoactive cannabinoid that leads to the reward -- the high -- is THC, which we scientists call tetrahydrocannabinol.
导致精神快感的强效大麻素就是THC，科学家称它为四氢大麻酚。
Pretty simple, right? But the politics is a lot more complicated.
很简单，对吧？但是政策方面就要复杂得多了。
Attitudes towards cannabis and the amount of THC that's considered safe to consume have dramatically changed over the years.
人们对于大麻和可安全食用的THC的剂量的态度在这些年发生了巨大的变化。
In fact, this country's had a roller-coaster relationship with the drug. Cannabis is either highly demonized or glorified.
实际上，国家这类药物的关系也是扑朔迷离。大麻要么或被高度妖魔化，要么就被高度美化。
On the demonized side, cannabis was deemed a Schedule I drug by the DEA -- the Drug Enforcement Agency
在妖魔化方面，大麻被DEA（禁毒署）定为一类管制毒品，
meaning that cannabis is considered to be a drug of the highest abuse potential and to have no medicinal value.
意思是，大麻被认为是滥用可能性最高，且没有任何医疗价值的药物。
Moreover, the Schedule I label led to the mass, biased arrest for the use of cannabis, particularly among young Black and brown men.
此外，一类毒品的标签导致了大量的有偏见的逮捕事件，尤其是针对一些年轻的黑人和棕色人种的逮捕。
However, things are changing. The pendulum is shifting in the opposite direction.
然而，情况正在改变。钟摆在向相反的方向摆动。
Today, cannabis is legal for medical or recreational use in most states.
如今，大麻在大多数州的医疗或娱乐领域都可以合法使用。
And a bill is even being considered in Congress to remove cannabis from the list of schedule drugs.
国会甚至正在考虑一项法案，将大麻从毒品清单中删除。
We've also seen a great increase in cannabis research. Most research studies, including some of my own, focus on THC.
我们也见到了了越来越多关于大麻的研究。大多数研究，包括我的一些内容，都专注于THC。
In fact, our animal research has shown a negative relationship between THC and opioid addiction.
实际上，我们的动物研究表明了THC和阿片类成瘾之间的负相关关系。
However, as I mentioned, the cannabis plant has over 100 cannabinoids. So THC was not the only one to study.
然而，就像我提过的，大麻中含有过百种大麻素，所以不应该只研究THC。
In examining another cannabinoid, cannabidiol -- that is, CBD
在研究其它大麻素过程中，大麻二酚--也就是CBD，
we were actually surprised to see features relevant to alleviating opioid addiction-related behaviors. So there my journey turned to CBD.
让我们惊喜地看到了其与缓解阿片类药物成瘾相关行为有关的功效。所以我的研究转向了CBD。
So what's this CBD that has moved from virtual obscurity only a few years ago to everywhere in society
那么，这个在几年间从默默无闻变得无处不在的CBD究竟是什么，
in your coffee in the morning, your water at lunch and your beer at dinner?
早晨的咖啡，午餐的水和晚餐的啤酒中都有它。
CBD comes from the cannabis plant, but in contrast to THC that has the high, CBD has no addictive properties.
CBD源于大麻植物，但是与致人兴奋的THC不同，CBD没有成瘾性。
We're still trying to figure out how CBD fully works,
我们仍在努力弄清CBD的运作方式，
but it is known that CBD alters chemicals in the brain that regulate emotions and anxiety.
但是众所周知，CBD会改变大脑中调节情绪和焦虑的化学物质。
Interestingly, giving CBD to our animal models that had a history of self-administering heroin, reduced their heroin-seeking behavior.
有趣的是，给具有自主服用海洛因历史的动物服用了CBD后，它们的海洛因寻求行为明显减弱了。
Specifically, CBD reduced heroin-seeking triggered by environmental cues that were previously associated with the drug.
具体而言，CBD是减少了以前与该药物有关的环境因素引发的寻求海洛因的行为。
Let me say that again. CBD reduced heroin-seeking triggered by drug cues.
我再说一次：CBD减少了由毒品引发的寻求海洛因的行为。
This is significant, because craving is often triggered by the memories of the cues previously associated with drug use.
这一发现的重要性非同小可，因为对毒品的渴求通常是由先前与吸毒相关的记忆触发的。
And craving is a matter of life or death daily for people with an opioid use disorder.
而这种渴求对于有物质使用障碍的人就是每天生死攸关的事情。
Simply put, craving can lead to relapse and death from overdose. So reducing craving is an important treatment strategy.
简单地说，对毒品的渴求会导致复吸和用药过量致死。所以，降低毒瘾再犯是一项重要的治疗策略。
Getting results from animal models like this is actually the first critical step in the FDA process for developing new medications.
从类似的动物实验对象身上获得研究结果，实际上是FDA（美国食品药品监督管理局）在开发新药过程中非常关键的第一步。
The next step: human studies.
下一步是：人体研究。
In our first human study, we demonstrated that CBD is safe, even though individuals taking it had also consumed a potent opioid.
在我们首次的人体研究中，我们论证了CBD是安全的，尽管实验的个体也服用了阿片类药物。
Next, to determine efficacy, we conducted clinical trials
接下来，为确定功效，我们进行了临床试验，
and made sure that both the study investigators and the study participants were blind to the CBD or the placebo substances.
并确保研究调查员和研究参与者不知道CBD或者安慰剂物质的存在。
The results from those studies replicated the findings that we had in the animal experiments.
这些研究的结果与动物实验中的发现一致。
So now we know that CBD can reduce craving triggered by environmental cues in human heroin users.
所以现在我们知道了，CBD可以帮助海洛因服用者减少环境因素导致的对毒品的渴求。
What's more, our results demonstrated that CBD reduced anxiety associated with the drug use.
更重要的是，我们的结果论证了CBD减少了毒品使用相关的焦虑。
This is also significant because anxiety is another critical factor that triggers craving.
这项发现有着十分重要的意义，因为焦虑是致瘾的另一个关键因素。
Importantly, CBD also reduced the levels of the stress hormone cortisol
重要的是，当上瘾的人接触毒品时，
that is often elevated when addicted individuals are exposed to drug use.
CBD还降低了通常会升高的应激激素皮质醇水平。
Another intriguing finding was the CBD continued to decrease craving and anxiety even a week following its final use.
另一个有趣的发现是，CBD甚至会在最后一次服用之后的一周持续减低毒品成瘾和焦虑的症状。
This aspect of prolonged efficacy is very beneficial for people taking any medication.
功效延长这一方面对服用任何药物的人们都非常有益。
So the evidence is mounting. CBD does show potential to reduce critical features for opioid addiction such as craving and anxiety.
证据变得越来越多。CBD确实显示出了能减少阿片类药物成瘾关键特征的潜力，像是对毒品的渴求和焦虑。
But we're still not at the end of the road for medication development.
但是我们对药物的开发还没有走到尽头。
The gold standard for medicine established by the FDA is large, clinical trials.
FDA建立的药物黄金标准是要进行大型临床试验。
Recently, I was fortunate enough to be given that rare opportunity
最近，我很幸运地得到了一个难得的机会，
to conduct a large, clinical trial with CBD in people with an opioid use disorder.
可以在阿片类药物使用障碍患者中进行CBD大型临床试验。
And that study is expected to continue for at least another two years.
这项研究还要继续至少两年。
CBD is now being investigated for numerous medical conditions.
针对众多医疗案例下的CBD使用的研究正在进行中。
Also, during the past decade, our society has seen an explosion of CBD.
而且，在过去十年，我们的社会出现了CBD使用的爆炸式增长。
It's being put into drink, food, wellness and skincare products. They're even giving CBD to pets.
它已经被加入了饮料、食物、保健和护肤产品中。他们甚至给宠物提供了CBD。
So is CBD a wonder drug as now touted by many? No.
那么，CBD现在真的成为了被许多人吹捧的神奇药物？并不是。
Does it have potential medicinal benefits? It does.
它有潜在的医学价值吗？有的。
But the only way to get definitive information about CBD's full safety and efficacy is through large, clinical trials.
但是想得到关于CBD安全性和有效性的完整且确定信息的唯一方式是通过大型的临床试验。
So is it possible that we could actually change the game
那么我们是否有可能改变游戏规则，
by taking this very familiar plant and developing a nonaddictive, FDA-approved medication for opioid use disorder? Absolutely.
通过利用这种非常熟悉的植物开发出非成瘾性、且FDA批准的阿片类使用障碍药物？绝对可以。
That is why we're working so hard right now to develop a solution based on CBD.
这也正是我们现在如此努力开发基于CBD的解决方案的原因。
For me, the potential benefits are obvious and also overwhelming.
对于我，这些潜在的好处是显而易见的，也是压倒性的。
It means helping to give families back their mother or father. It means having your child graduate from high school or college.
这意味着它可以帮助爸爸妈妈回归他们的家庭，帮助孩子成功地从高中或大学毕业。
But most of all, it means helping to save many of the hundreds of thousands of lives that will otherwise be lost to opioids in the next decade. Thank you.
但最重要的是，它意味着可以在未来十年拯救那些本会因鸦片类药物而消失的数十万生命。谢谢大家。
