美国国家公共电台 NPR--Controversial harm reduction strategies appear to slow drug deaths

Controversial harm reduction strategies appear to slow drug deaths

Transcript¹

U.S. public health experts are studying Canada's harm reduction programs which include supervised injection sites and legally prescribed drugs that people with addiction² can use to get high.

RACHEL MARTIN, HOST:

Record numbers of people are dying from drug overdoses in this country. And some public health experts say it's time to radically⁴ rethink how we help people living with drug addiction. There's a growing focus on something called harm reduction, where the goal is keeping people alive even while they are still using drugs to get high. A lot of the most cutting-edge and controversial programs like this are being tested in Canada. NPR addiction correspondent Brian Mann has been looking into this and joins me now. Good morning, Brian.

BRIAN MANN, BYLINE⁵: Good morning, Rachel.

MARTIN: So you spent time researching these programs happening in Canada. What did you find?

MANN: Yeah, it's interesting. Canada has really emerged as the laboratory for harm reduction ideas, some of them pretty radical³ by U.S. standards, addiction care experts here in the U.S. watching this closely. A growing number of Canadian doctors, for example, are actually prescribing powerful opioids and stimulants⁶ that people can use to shoot up to get high. This is an approach called safer supply that aims to keep people from using street drugs that are now laced with powerful and often deadly chemicals. The doctors writing these prescriptions⁷ say their patients are experiencing fewer overdoses.

MARTIN: So I want to get back to what - the consequences of that. But for a second, let's talk about how we treat people with addiction here in the U.S. I mean, drug deaths keep rising, as we noted⁸. Why isn't our current strategy keeping more people alive?

MANN: Yeah. Addiction care has gotten better in the U.S. - better therapies, better medications. But getting that kind of quality treatment is still super hard in most of the country. It's also really expensive. And what we've seen with research is that there are tens of millions of people in the U.S. who use drugs every year, and many of them just aren't ready or able to quit. And, again, because those street drugs now are so toxic⁹, a devastating¹⁰ number of people are dying. I spoke¹¹ about this with Dr. Rahul Gupta, who heads the White House Office of National Drug Control Policy.

RAHUL GUPTA: We have an American perishing every five minutes around the clock, and that's unacceptable. There's a lot of progress that is being made, but we know that there's so much more we need to do, making sure that we can save lives first with harm reduction approaches such as naloxone.

MANN: And you heard him there, Rachel, mention harm reduction and naloxone. And the U.S. has been slowly adopting some of these strategies, distributing this drug naloxone that helps reverse opioid overdoses; some communities providing clean needles to help limit the spread of diseases like HIV and hepatitis. All of this used to be really controversial. And even today, some forms of harm reduction are still illegal in parts of the U.S. But we are seeing kind of a slow-motion shift.

MARTIN: So explain more about what Canadians are doing on harm reduction that the U.S. is not doing.

MANN: Yeah. Over the last three years, government-approved clinics have opened all across Canada where people can come in and use street drugs under medical supervision¹². So if they overdose, they can get immediate¹³ help from a nurse or a provider of care. And, again, as we mentioned before, a lot more Canadian doctors with government permission are prescribing medications people can use to get high. I spoke to a guy named Jamie Myers who picks up his opioids from a pharmacist every week in Ottawa.

JAMIE MYERS: Well, I'm working on getting off fentanyl through the safe supply program, hopefully getting back to being a member of society, you know, having a regular job and being a normal person, regular person.

MANN: And Myers told me he thinks this program is saving his life. The Canadian government, too, has concluded that these approaches are effective, that they are helping¹⁴ reduce fatal overdoses.

MARTIN: Although I can imagine some people raising ethical¹⁵ concerns over this, right? I mean, it means doctors and pharmacists are helping people keep using drugs, turning medical workers into, like, drug dealers¹⁶.

MANN: Yeah. That is a phrase that gets used. You know, it's explosive for politician and still very controversial ethically¹⁷ among people in the medical community. Some critics say harm reduction enables or encourages drug use. One problem with these cutting-edge programs is that they're still so new, Rachel, that there's not a lot of great research showing whether the benefits outweigh¹⁸ the risks. And there are skeptics like Keith Humphreys, who's an addiction researcher at Stanford University.

KEITH HUMPHREYS: When you start distributing opioids in the community, including to people to stop overdose, they will, in some cases, sell them and initiate¹⁹ new people onto drugs. And those people will overdose. If you just say, we're just going to supply these drugs, like, what is the end game?

MANN: So Humphreys thinks it's better and ultimately safer to keep focusing health care dollars on more traditional treatments aimed at ending addiction, not these programs that help people use drugs more safely.

MARTIN: I mean, you've talked to doctors and social workers who actually offer this kind of harm reduction. What do they say about those concerns?

MANN: Yeah, you know, they acknowledge harm reduction can be messy. Working with people tangled²⁰ up deep in addiction, it's messy. And it means working in an ethical gray zone. But they also point out the opioid epidemic²¹ has evolved into something far more dangerous. They say no one ever recovers - has no chance to recover from drug addiction if they're dead. I spoke about this with Chad Bouthillier, who himself used to be addicted²² to cocaine²³ and fentanyl. Now he works with patients in one of those supervised drug injection sites in Ottawa.

CHAD BOUTHILLIER: The clients are choosing what success means to them at that moment. If it's coming to get clean gear - success. If it's coming to use while being supervised - success. And they can build on those successes.

MANN: So Bouthillier points out that no one has ever died in Canada's supervised drug consumption sites. And, Rachel, he thinks that alone is a huge win that could be replicated²⁴ all over Canada and all over the United States.

MARTIN: Well, speaking of which, Brian, I'm pretty sure I've read about something like this happening in California, right?

MANN: Yeah, that's right. This summer, California's Legislature actually approved a big pilot program for a new network of supervised drug use clinics that would look kind of like the place I visited there in Ottawa. At the last minute, the state's Democratic governor, Gavin Newsom, vetoed that measure. It was a huge setback²⁵ for harm reduction advocates in the U.S. But the thing that's happening now is as these drug deaths keep rising, there is pressure to try something new.

So we saw two supervised drug consumption clinics open last year in New York City with support from local officials. It's the only program of its type in the U.S. And it's significant that the Justice Department and the Drug Enforcement Administration have so far left that program alone. They're not moving to shut it down. Right now, the Justice Department is also negotiating with a program that wants to open a similar clinic in Philadelphia. If that happens, it could send a very different signal to cities and states that this kind of harm reduction might be worth trying.

MARTIN: NPR addiction correspondent Brian Mann, thank you.

MANN: Thank you.

1 transcript   

n.抄本，誊本，副本，肄业证书

参考例句：

• A transcript of the tapes was presented as evidence in court.一份录音带的文字本作为证据被呈交法庭。
• They wouldn't let me have a transcript of the interview.他们拒绝给我一份采访的文字整理稿。

2 addiction   

n.上瘾入迷，嗜好

参考例句：

• He stole money from his parents to feed his addiction.他从父母那儿偷钱以满足自己的嗜好。
• Areas of drug dealing are hellholes of addiction,poverty and murder.贩卖毒品的地区往往是吸毒上瘾、贫困和发生谋杀的地方。

3 radical   

n.激进份子，原子团，根号；adj.根本的，激进的，彻底的

参考例句：

• The patient got a radical cure in the hospital.病人在医院得到了根治。
• She is radical in her demands.她的要求十分偏激。

4 radically   

ad.根本地，本质地

参考例句：

• I think we may have to rethink our policies fairly radically. 我认为我们可能要对我们的政策进行根本的反思。
• The health service must be radically reformed. 公共医疗卫生服务必须进行彻底改革。

5 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

6 stimulants   

n.兴奋剂( stimulant的名词复数 )；含兴奋剂的饮料；刺激物；激励物

参考例句：

• Coffee and tea are mild stimulants. 咖啡和茶是轻度兴奋剂。
• At lower concentrations they may even be stimulants of cell division. 在浓度较低时，它们甚至能促进细胞分裂。 来自辞典例句

7 prescriptions   

药( prescription的名词复数 )； 处方； 开处方； 计划

参考例句：

• The hospital of traditional Chinese medicine installed a computer to fill prescriptions. 中医医院装上了电子计算机来抓药。
• Her main job was filling the doctor's prescriptions. 她的主要工作就是给大夫开的药方配药。

8 noted   

adj.著名的，知名的

参考例句：

• The local hotel is noted for its good table.当地的那家酒店以餐食精美而著称。
• Jim is noted for arriving late for work.吉姆上班迟到出了名。

9 toxic   

adj.有毒的，因中毒引起的

参考例句：

• The factory had accidentally released a quantity of toxic waste into the sea.这家工厂意外泄漏大量有毒废物到海中。
• There is a risk that toxic chemicals might be blasted into the atmosphere.爆炸后有毒化学物质可能会进入大气层。

10 devastating   

adj.毁灭性的，令人震惊的，强有力的

参考例句：

• It is the most devastating storm in 20 years.这是20年来破坏性最大的风暴。
• Affairs do have a devastating effect on marriages.婚外情确实会对婚姻造成毁灭性的影响。

11 spoke   

n.（车轮的）辐条；轮辐；破坏某人的计划；阻挠某人的行动 v.讲，谈（speak的过去式）；说；演说；从某种观点来说

参考例句：

• They sourced the spoke nuts from our company.他们的轮辐螺帽是从我们公司获得的。
• The spokes of a wheel are the bars that connect the outer ring to the centre.辐条是轮子上连接外圈与中心的条棒。

12 supervision   

n.监督，管理

参考例句：

• The work was done under my supervision.这项工作是在我的监督之下完成的。
• The old man's will was executed under the personal supervision of the lawyer.老人的遗嘱是在律师的亲自监督下执行的。

13 immediate   

adj.立即的；直接的，最接近的；紧靠的

参考例句：

• His immediate neighbours felt it their duty to call.他的近邻认为他们有责任去拜访。
• We declared ourselves for the immediate convocation of the meeting.我们主张立即召开这个会议。

14 helping   

n.食物的一份&adj.帮助人的，辅助的

参考例句：

• The poor children regularly pony up for a second helping of my hamburger. 那些可怜的孩子们总是要求我把我的汉堡包再给他们一份。
• By doing this, they may at times be helping to restore competition. 这样一来, 他在某些时候,有助于竞争的加强。

15 ethical   

adj.伦理的，道德的，合乎道德的

参考例句：

• It is necessary to get the youth to have a high ethical concept.必须使青年具有高度的道德观念。
• It was a debate which aroused fervent ethical arguments.那是一场引发强烈的伦理道德争论的辩论。

16 dealers   

n.商人( dealer的名词复数 )；贩毒者；毒品贩子；发牌者

参考例句：

• There was fast bidding between private collectors and dealers. 私人收藏家和交易商急速竞相喊价。
• The police were corrupt and were operating in collusion with the drug dealers. 警察腐败，与那伙毒品贩子内外勾结。

17 ethically   

adv.在伦理上，道德上

参考例句：

• Ethically , we have nothing to be ashamed about . 从伦理上说，我们没有什么好羞愧的。
• Describe the appropriate action to take in an ethically ambiguous situation. 描述适当行为采取在一个道德地模棱两可的情况。

18 outweigh   

vt.比...更重，...更重要

参考例句：

• The merits of your plan outweigh the defects.你制定的计划其优点胜过缺点。
• One's merits outweigh one's short-comings.功大于过。

19 initiate   

vt.开始，创始，发动；启蒙，使入门；引入

参考例句：

• A language teacher should initiate pupils into the elements of grammar.语言老师应该把基本语法教给学生。
• They wanted to initiate a discussion on economics.他们想启动一次经济学讨论。

20 tangled   

adj. 纠缠的，紊乱的 动词tangle的过去式和过去分词

参考例句：

• Your hair's so tangled that I can't comb it. 你的头发太乱了，我梳不动。
• A movement caught his eye in the tangled undergrowth. 乱灌木丛里的晃动引起了他的注意。

21 epidemic   

n.流行病；盛行；adj.流行性的，流传极广的

参考例句：

• That kind of epidemic disease has long been stamped out.那种传染病早已绝迹。
• The authorities tried to localise the epidemic.当局试图把流行病限制在局部范围。

22 addicted   

adj.沉溺于....的，对...上瘾的

参考例句：

• He was addicted to heroin at the age of 17.他17岁的时候对海洛因上了瘾。
• She's become addicted to love stories.她迷上了爱情小说。

23 cocaine   

n.可卡因，古柯碱（用作局部麻醉剂）

参考例句：

• That young man is a cocaine addict.那个年轻人吸食可卡因成瘾。
• Don't have cocaine abusively.不可滥服古柯碱。

24 replicated   

复制( replicate的过去式和过去分词 )； 重复； 再造； 再生

参考例句：

• Later outplant the seedlings in a replicated permanent test plantation. 以后苗木出圃栽植成重复的永久性试验林。
• The phage has replicated and the donor cells have lysed. 噬菌体已复制和给体细胞已发生裂解。

25 setback   

n.退步，挫折，挫败

参考例句：

• Since that time there has never been any setback in his career.从那时起他在事业上一直没有遇到周折。
• She views every minor setback as a disaster.她把每个较小的挫折都看成重大灾难。