PBS高端访谈:美国应该如何控制和管理致瘾性止痛药?

 　　JUDY WOODRUFF: Each day, 46 people die in this country after overdosing on prescription¹ painkillers². In 2012 alone, the CDC says 259 million prescriptions⁴ were written for painkillers, enough to supply every American adult with a bottle of pills.

　　Now many states are pushing back, including New York, Tennessee, Kentucky, Florida, and Washington State. Three of those states now require doctors to check a patient database before writing a prescription. This year, Massachusetts, Rhode Island, Georgia, and Texas are also considering tighter laws.

　　But some physicians and patient advocates say this crackdown is creating new problems.

　　We get two views now.

　　Dr. Andrew Kolodny is the director of Physicians for Responsible Opioid Prescribing. He's also chief medical officer for the Phoenix⁵ House Foundation. It's a national nonprofit addiction⁶ agency. Bob Twillman is the executive director of the American Academy of Pain Management and also a clinical psychologist at the University of Kansas Medical Center. Mr. Twillman was caught in a traffic jam tonight. He couldn't make it to the studio, so he joins us by telephone.

　　And we welcome both of you.

　　Dr. Kolodny, I'm going to turn to you first. You believe that it is important to impose more regulations on the use of painkillers. Why?

　　DR. ANDREW KOLODNY, Physicians for Responsible Opioid Prescribing: Well, the United States is in the midst of a severe epidemic⁷ of opioid addiction and overdose deaths. According to the CDC, this is the worst drug epidemic in United States' history.

　　And the CDC has been very clear about what's causing this epidemic. The CDC has said that, as prescriptions for opioid painkillers began to skyrocket in the late 1990s, that it's led to parallel increases in rates of addiction and overdose deaths. And what this is suggesting is that we may not be able to turn this epidemic around until doctors and dentists begin to prescribe more cautiously.

　　JUDY WOODRUFF: And what — just quickly, what do you mean by that, more cautiously?

　　DR. ANDREW KOLODNY: Well, the United States, with about 5 percent of the world's population, is consuming 80 percent of the world's entire oxycodone supply and 99 percent of the world's hydrocodone supply.

　　Opioids are essential medicines for end-of-life care or when used short term for acute pain, but this vast overprescribing of opioids is mainly for conditions where use of opioids are probably not safe or effective, like low back pain with a normal spine⁸, fibromyalgia, chronic⁹ headache.

　　JUDY WOODRUFF: Well, Bob Twillman, let me turn to you now. And, again, apologies that we're — you are not able to join us on television, but we can hear you.

　　You have told us that you believe some regulations of painkillers makes sense, but you think the regulations have gone too far. Why do you believe that?

　　BOB TWILLMAN, American Academy of Pain Management: Well, I think what we have seen with regulations in this area has been an attempt to find very simple solutions to what is really two complex problems, those two problems being the problems with prescription drug abuse, but also the problem of chronic pain.

　　And, you know, just a point on that, if prescription drug abuse is an epidemic, then I think chronic pain may be a pandemic, because the Institute of Medicine tells us that affects over 100 million people in the United States. So I think what we have to do is to find the kinds of solutions that really address both of these problems and don't wind up giving us what's essentially¹⁰ a zero sum game.

　　JUDY WOODRUFF: Dr. Kolodny, what about his point? You heard him, that there's a problem with chronic pain and something has to be done about that.

　　DR. ANDREW KOLODNY: Chronic pain is a serious problem, and many Americans do suffer with chronic pain.

　　But, unfortunately, we are harming far more people with chronic pain than we're helping¹¹ when we treat them with long-term opioid medications.

　　When we talk about drugs like oxycodone and hydrocodone, these are drugs that come from opium¹², in the same way that heroin¹³ comes from opium. And, in fact, the effects that hydrocodone and oxycodone produce are indistinguishable from heroin. So these drugs are essential. We should be using them, but we shouldn't be treating low back pain, fibromyalgia and chronic headaches with long-term opioids.

　　What we heard from Bob Twillman is really the argument that the industry has been making from the very beginning of this epidemic. They would like policy-makers to think there are these two distinct populations, millions of pain patients who are helped by these medications and drug abusers.

　　And what they're saying is, let's not penalize¹⁴ the pain patients for the bad behavior of the drug abusers. The reality is that we don't have two distinct populations. There's a tremendous amount of overlap¹⁵. And when you look at who's dying from painkiller³ overdose deaths, the majority appear to be patients having these medications prescribed to them for chronic pain.

　　In fact, there are more Americans dying from painkiller overdoses who are getting these medications from doctors than young people who we now see switching to heroin.

　　JUDY WOODRUFF: And, Bob Twillman, if that's the case, why shouldn't there be much more careful regulation of the prescription of these painkillers?

　　BOB TWILLMAN: Well, we do think there should be much more careful use of these medications.

　　We also agree that they are being overprescribed and prescribed for the wrong kinds of pain. So, I think we have to do, though, is to find the solutions that will allow to us really use these medications for those patients for whom they do provide benefit, and not get into a situation where what we're doing is saying, let's just — let's just lower the supply across the board, because what we have seen is that the policies that we have put in place in the last few years that have actually done that have caused patients who have legitimate¹⁶ pain and need these medications to be fully¹⁷ functional¹⁸ have trouble getting those medications.

　　JUDY WOODRUFF: How have you seen that? Where is the evidence for that?

　　BOB TWILLMAN: Well, you know, it's hard evidence to collect, because, in essence, what you're doing is asking people to collect evidence about services that have not been delivered to them, as opposed to services that have been delivered.

　　But I have talked to patients who call into our offices and tell us they're having trouble getting their prescriptions filled. One gentleman I talked to had been to 35 pharmacies¹⁹ trying to get his prescription filled. And he had been to — going to the same pharmacy²⁰ year after year, month after month, and one month he shows up and they say, we won't fill this anymore. We can't fill this anymore.

　　And so he winds up going to 35 pharmacies trying to get his prescription filled.

　　JUDY WOODRUFF: Well, we are clearly not going to be able to resolve this tonight.

　　Dr. Kolodny, just very quickly, what is your answer, in brief, to those individuals who can't get prescriptions who need them?

　　DR. ANDREW KOLODNY: I think that we do all need to worry about access to opioid medications, and we're beginning to see pharmacies put signs in the window that say, “No oxycodone here.”

　　The pharmacists are not doing that because of state or federal interventions²¹ or regulations. They're doing this because they're worried about getting robbed or shot. We have a severe epidemic of opioid addiction. And if we want to preserve access to opioids so that they're available for all of us when we need them, we need to bring this epidemic under control. And that may not happen until doctors and dentists begin to prescribe more cautiously.

　　JUDY WOODRUFF: Dr. Andrew Kolodny, Bob Twillman, we thank you both.

　　BOB TWILLMAN: Thank you.

　　DR. ANDREW KOLODNY: Thank you.

1 prescription   

n.处方，开药；指示，规定

参考例句：

• The physician made a prescription against sea- sickness for him.医生给他开了个治晕船的药方。
• The drug is available on prescription only.这种药只能凭处方购买。

2 painkillers   

n.止痛药( painkiller的名词复数 )

参考例句：

• The doctor gave him some painkillers to ease the pain. 医生给了他一些止疼片以减缓疼痛。 来自辞典例句
• The primary painkillers - opiates, like OxyContin - are widely feared, misunderstood and underused. 人们对主要的镇痛药——如鸦片剂奥施康定——存在广泛的恐惧、误解，因此没有充分利用。 来自时文部分

3 painkiller   

n.止痛药

参考例句：

• I shall persuade him to take the painkiller.我将说服他把药吃下去。
• The painkiller only provides him a short respite from his pain.止痛药仅仅让他在疼痛中有短暂的疏解。

4 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。

5 phoenix   

n.凤凰，长生(不死)鸟；引申为重生

参考例句：

• The airline rose like a phoenix from the ashes.这家航空公司又起死回生了。
• The phoenix worship of China is fetish worship not totem adoration.中国凤崇拜是灵物崇拜而非图腾崇拜。

6 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。

7 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。

8 spine   

n.脊柱，脊椎；(动植物的)刺；书脊

参考例句：

• He broke his spine in a fall from a horse.他从马上跌下摔断了脊梁骨。
• His spine developed a slight curve.他的脊柱有点弯曲。

9 chronic   

adj.(疾病)长期未愈的，慢性的；极坏的

参考例句：

• Famine differs from chronic malnutrition.饥荒不同于慢性营养不良。
• Chronic poisoning may lead to death from inanition.慢性中毒也可能由虚弱导致死亡。

10 essentially   

adv.本质上，实质上，基本上

参考例句：

• Really great men are essentially modest.真正的伟人大都很谦虚。
• She is an essentially selfish person.她本质上是个自私自利的人。

11 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。

12 opium   

n.鸦片；adj.鸦片的

参考例句：

• That man gave her a dose of opium.那男人给了她一剂鸦片。
• Opium is classed under the head of narcotic.鸦片是归入麻醉剂一类的东西。

13 heroin   

n.海洛因

参考例句：

• Customs have made their biggest ever seizure of heroin.海关查获了有史以来最大的一批海洛因。
• Heroin has been smuggled out by sea.海洛因已从海上偷运出境。

14 penalize   

vt.对…处以刑罚，宣告…有罪；处罚

参考例句：

• It would be unfair to penalize those without a job.失业人员待遇低下是不公平的。
• The association decided not to penalize you for the race.赛马协会决定对你不予处罚。

15 overlap   

v.重叠，与…交叠；n.重叠

参考例句：

• The overlap between the jacket and the trousers is not good.夹克和裤子重叠的部分不好看。
• Tiles overlap each other.屋瓦相互叠盖。

16 legitimate   

adj.合法的，合理的，合乎逻辑的；v.使合法

参考例句：

• Sickness is a legitimate reason for asking for leave.生病是请假的一个正当的理由。
• That's a perfectly legitimate fear.怀有这种恐惧完全在情理之中。

17 fully   

adv.完全地，全部地，彻底地；充分地

参考例句：

• The doctor asked me to breathe in,then to breathe out fully.医生让我先吸气，然后全部呼出。
• They soon became fully integrated into the local community.他们很快就完全融入了当地人的圈子。

18 functional   

adj.为实用而设计的，具备功能的，起作用的

参考例句：

• The telephone was out of order,but is functional now.电话刚才坏了，但现在可以用了。
• The furniture is not fancy,just functional.这些家具不是摆着好看的，只是为了实用。

19 pharmacies   

药店

参考例句：

• Still, 32 percent of the pharmacies filled the prescriptions. 但仍然有32%的药剂师配发了这两张药方。 来自互联网
• Chinese herbal pharmacies, and traditional massage therapists in the Vancouver telephone book. 中药店，和传统的按摩师在温哥华的电话簿里。 来自互联网

20 pharmacy   

n.药房，药剂学，制药业，配药业，一批备用药品

参考例句：

• She works at the pharmacy.她在药房工作。
• Modern pharmacy has solved the problem of sleeplessness.现代制药学已经解决了失眠问题。

21 interventions   

n.介入，干涉，干预( intervention的名词复数 )

参考例句：

• Economic analysis of government interventions deserves detailed discussion. 政府对经济的干预应该给予充分的论述。 来自辞典例句
• The judge's frequent interventions made a mockery of justice. 法官的屡屡干预是对正义的践踏。 来自互联网