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More than 3,000 years ago, a flower began to appear in remedies in Ancient Egyptian medical texts.
三千多年前，有一种花开始出现在古埃及医学文献的药方里。
Across the Mediterranean, the ancient Minoans likely found ways to use the same plant for its high.
而在地中海的对岸，古代的米诺斯人很可能也在用这种植物取得快感。
Both ancient civilizations were on to something -- opium, an extract of the poppy in question, can both induce pleasure and reduce pain.
这两个古代文明都发现了同一样东西：鸦片--这种提炼自罂粟花的物质，既能产生快感，也能减轻疼痛。
Though opium has remained in use ever since, it wasn't until the 19th century that one of its chemical compounds, morphine, was identified and isolated for medical use.
虽然鸦片一直沿用到了现在，但是直到19世纪，它的一种化合物--吗啡才以医疗为目的被鉴定和分离出来。
Morphine, codeine, and other substances made directly from the poppy are called opiates.
吗啡、可待因，以及其他直接从罂粟中提取的物质统称天然阿片剂。
In the 20th century, drug companies created a slew of synthetic substances similar to these opiates, including heroin, hydrocodone, oxycodone, and fentanyl.
在20世纪，制药公司研制了一系列与这些阿片剂相似的合成物质，比如海洛因、氢可酮、羟考酮和芬太尼。
Whether synthetic or derived from opium, these compounds are collectively known as opioids.
无论是合成的还是由鸦片衍生的，这些化合物统称为阿片类药物。
Synthetic or natural, legal or illicit, opioid drugs are very effective painkillers, but they are also highly addictive.
不管是合成的还是天然的、合法的还是非法的，阿片类药物都是很有效的止痛药，但同时也极容易让人上瘾。
In the 1980s and 90s, pharmaceutical companies began to market opioid painkillers aggressively,
20世纪80和90年代，制药公司开始极力营销阿片类止痛药，
actively downplaying their addictive potential to both the medical community and the public.
并故意在医学界和公众面前淡化它们的成瘾潜力。
The number of opioid painkillers prescriptions skyrocketed, and so did cases of opioid addiction, beginning a crisis that continues today.
阿片类止痛药的处方数量直线上升，阿片类药物成瘾的人数也随之猛增，形成了一直延续至今的危机。
To understand why opioids are so addictive, it helps to trace how these drugs affect the human body from the first dose,
要想了解阿片类药物为什么那么容易让人上瘾，首先就要追踪这类药物在各阶段对人体的影响，包括第一次使用时，
through repeated use, to what happens when long-term use stops.
反复使用之后，以及长期用药后又突然停药时会发生什么。
Each of these drugs has slightly different chemistry, but all act on the body's opioid system by binding to opioid receptors in the brain.
各种阿片类药物的化学性质都略有不同，但都会与大脑中的阿片类受体结合，从而作用于人体的“愉悦系统”。
The body's endorphins temper pain signals by binding to these receptors, and opioid drugs bind much more strongly, for longer.
人体内的内啡肽会与这些受体结合，从而削弱疼痛信号，而阿片类药物与受体的结合更强，也更持久。
So opioid drugs can manage much more severe pain than endorphins can.
所以，相比内啡肽，阿片类药物能缓解更加严重的疼痛。
Opioid receptors also influence everything from mood to normal bodily functions.
阿片类受体的影响范围很广，从情绪到人体日常功能都包括在内。
With these functions, too, opioids' binding strength and durability mean their effects are more pronounced and widespread than those of the body's natural signaling molecules.
阿片类药物的结合强度和持久性意味着它们的作用比体内的天然信号分子更明显、更广泛。
When a drug binds to opioid receptors, it triggers the release of dopamine,
药物与阿片类受体的结合会触发多巴胺的分泌，
which is linked to feelings of pleasure and may be responsible for the sense of euphoria that characterizes an opioid high.
多巴胺与愉悦感有关，摄取阿片类药物时标志性的愉悦感可能就是由它引起的。
At the same time, opioids suppress the release of noradrenaline, which influences wakefulness, breathing, digestion, and blood pressure.
与此同时，阿片类药物会抑制去甲肾上腺素的分泌，从而影响清醒度、呼吸、消化和血压。
A therapeutic dose decreases noradrenaline enough to cause side effects like constipation.
治疗剂量的阿片类药物会导致去甲肾上腺素水平减少，从而引发一些副作用，比如便秘。
At higher doses opioids can decrease heart and breathing rates to dangerous levels, causing loss of consciousness and even death.
更高剂量的阿片类药物则会让心跳和呼吸频率下降到危险水平，令人失去意识，甚至死亡。
Over time, the body starts to develop a tolerance for opioids.
随着时间的推移，人体开始对阿片类药物产生耐药性。
It may decrease its number of opioid receptors, or the receptors may become less responsive.
体内的阿片类受体数量可能会减少，或者受体的反应会变弱。
To experience the same release of dopamine and resulting mood effects as before,
要想体验与以往等同的多巴胺分泌和相应的情绪作用，
people have to take larger and larger doses -- a cycle that leads to physical dependence and addiction.
人们就必须服用越来越大的剂量，而这一循环会导致身体产生药物依赖性和成瘾。
As people take more opioids to compensate for tolerance, noradrenaline levels become lower and lower, to a point that could impact basic bodily functions.
随着人们摄取更多阿片类药物以补偿耐药性的作用，去甲肾上腺素的水平就会逐渐降低，直到开始影响人体的基本功能。
The body compensates by increasing its number of noradrenaline receptors so it can detect much smaller amounts of noradrenaline.
为了对抗这种变化，人体会增加去甲肾上腺素受体的数量，以便能侦测到更低浓度的去甲肾上腺素。
This increased sensitivity to noradrenaline allows the body to continue functioning normally -- in fact, it becomes dependent on opioids to maintain the new balance.
这种对去甲肾上腺素敏感度的增加，让人体得以继续正常运作；事实上，人体变得必须依赖阿片类药物才能维持这种新的平衡。
When someone who is physically dependent on opioids stops taking them abruptly, that balance is disrupted.
当一个对阿片产生生理依赖的人突然停止服用阿片类药物时，这一平衡就会被破坏。
Noradrenaline levels can increase within a day of ceasing opioid use.
去甲肾上腺素水平能在停止服用阿片类药物的一天之内增加。
But the body takes much longer to get rid of all the extra noradrenaline receptors it made.
但是人体需要更长的时间才能除掉体内生成的额外的去甲肾上腺素受体。
That means there's a period of time when the body is too sensitive to noradrenaline.
这意味着，人体会有一段时间对去甲肾上腺素过于敏感。
This oversensitivity causes withdrawal symptoms, including muscle aches, stomach pains, fever, and vomiting.
从而导致戒断症状的产生，比如肌肉酸痛、腹痛、发烧和呕吐。
Though temporary, opioid withdrawal can be incredibly debilitating.
阿片类药物戒断症状虽然短暂，却能让人极度衰弱。
In serious cases, someone in withdrawal can be violently ill for days or even weeks.
严重的情况下，戒断症状患者可能会重病一场，持续几天，甚至几周。
People who are addicted to opioids aren't necessarily using the drugs to get high anymore, but rather to avoid being sick.
对阿片类药物上瘾的人服药不再是为了寻求快感，而是为了避免生病。
Many risk losing wages or even jobs while in withdrawal, or may not have anyone to take care of them during withdrawal.
很多人一旦陷入戒断症状，可能会面临减薪，甚至丢掉工作，或者在发生戒断症状时没人照顾。
If someone goes back to using opioids later, they can be at particularly high risk for overdose,
如果他们以后重新开始服用阿片类药物，他们用药过量的风险将会大幅提高，
because what would have been a standard dose while their tolerance was high, can now be lethal.
因为他们在高度耐药时服用的“标准”剂量，现在有可能会致命。
Since 1980, accidental deaths from opioid overdose have grown exponentially in the United States, and opioid addictions have also exploded around the world.
自从1980年以来，阿片类药物过量导致的意外死亡案例在美国已呈现指数性增长，而世界各地的阿片类药物成瘾人数也在爆发性增加。
While opioid painkiller prescriptions are becoming more closely regulated, cases of overdose and addiction are still increasing, especially among younger people.
虽然阿片类止痛药的处方已经得到了更严密的监管，但是过度用药和成瘾的案例数量仍在持续攀升，特别是在年轻人中。
Many of the early cases of addiction were middle-aged people who became addicted to painkillers they had been prescribed, or received from friends and family members with prescriptions.
很多早期染上药瘾的人是中年人，让他们上瘾的是开给他们的止痛药，或是家人朋友给他们的处方药。
Today, young people are often introduced to prescription opioid drugs in those ways but move on to heroin or illicit synthetic opioids that are cheaper and easier to come by.
如今，年轻人通常是先通过这些途径接触到阿片类处方药，后来却转而吸食海洛因和非法的合成类阿片剂，因为它们更便宜，也更容易入手。
Beyond tighter regulation of opioid painkillers, what can we do to reverse the growing rates of addiction and overdose?
除了更严格地监管阿片类止痛药之外，我们还能用什么方法减缓成瘾和用药过量事件的快速增长呢？
A drug called naloxone is currently our best defense against overdose.
目前，有一种叫做纳洛酮的药物是防止阿片类药物过量的最佳手段。
Naloxone binds to opioid receptors but doesn't activate them.
纳洛酮会与阿片类受体结合，但不会激活受体。
It blocks other opioids from binding to the receptors, and even knocks them off the receptors to reverse an overdose.
它会阻止其他阿片类药物与受体结合，甚至能把它们从受体上撞开，逆转用药过量的情况。
Opioid addiction is rarely a stand-alone illness; frequently, people with opioid dependence are also struggling with a mental health condition.
阿片类药物成瘾鲜少作为患者的唯一病症，很多时候，患有阿片类药物依赖的人同时也在受某种精神疾病的困扰。
There are both inpatient and outpatient programs that combine medication, health services, and psychotherapy.
目前，有些住院和门诊疗程综合了药物、保健服务和心理治疗等疗法。
But many of these programs are very expensive, and the more affordable options can have long waiting lists.
但是，这类项目大都费用昂贵，而相对便宜的项目则呈僧多粥少的局面。
They also often require complete detoxification from opioids before beginning treatment.
而且在开始这类综合治疗之前，患者往往必须先进行彻底的阿片类药物解毒。
Both the withdrawal period and the common months-long stay in a facility can be impossible for people who risk losing jobs and housing in that timeframe.
戒断期和往往长达数个月的住院期，对可能在这段时间内失去工作和住所的人来说是难以承受的。
Opioid maintenance programs aim to address some of these obstacles and eliminate opioid abuse using a combination of medication and behavior therapy.
阿片类维持治疗的目的就是克服这类障碍，并且通过结合药物和行为治疗来消除阿片类药物滥用的问题。
These programs avoid withdrawal symptoms with drugs that bind to opioid receptors but don't have the psychoactive effects of painkillers, heroin, and other commonly abused opioids.
为了避免引发戒断症状，这类疗程使用的药物会与阿片受体结合，但不会像止痛药、海洛因等那样产生精神作用。
Methadone and buprenorphine are the primary opioid maintenance drugs available today,
美沙酮和丁丙诺啡是目前主流的阿片类维持药物，
but doctors need a special waiver to prescribe them -- even though no specific training or certification is required to prescribe opioid painkillers.
但是医生必须申请特别许可才能开出这类药物，尽管开出阿片类止痛药不需要接受特定训练或获得认证。
Buprenorphine can be so scarce that there's even a growing black market for it.
丁丙诺啡非常稀缺，甚至出现了日渐增长的地下市场。
There's still a long way to go with combating opioid addiction.
想要赢得与阿片类药物成瘾的战斗，我们还有很长的路要走。
