ABOUT THE SPEAKER
Travis Rieder - Bioethicist
Travis Rieder wants to help find a solution to America’s opioid crisis -- and if that sounds a bit too lofty, he’d settle for making clear, incremental progress in a responsible, evidence-based way.

Why you should listen

A philosopher by training, bioethicist by profession and communicator by passion, Travis Rieder writes and speaks on a variety of ethical and policy issues raised by both prescription and illicit opioid use.

This wasn't always his beat, though. Both in his doctoral training at Georgetown University, and as faculty at Johns Hopkins University’s Berman Institute of Bioethics, Rieder published widely on a variety of topics in philosophy and ethics. His interest in opioids came about suddenly, after a motorcycle accident, when he took too many pills for too long and suddenly found himself with a profound dependency. In the wake of that experience, he became driven to discover why medicine is so bad at dealing with prescription opioids, and how that problem is related to the broader drug overdose epidemic.

Rieder's first article on the topic, in the journal Health Affairs, was one of the most-read essays in 2017 and was excerpted by the Washington Post. Since then, Rieder has co-authored a Special Publication of the National Academy of Medicine on physician responsibility for the opioid epidemic, written several essays for the popular media and spoken widely on the topic to physicians, medical students and the general public. He expands on all of this work in a new book project forthcoming with HarperCollins, tentatively titled In Pain In America.

More profile about the speaker
Travis Rieder | Speaker | TED.com
TEDxMidAtlantic

Travis Rieder: The agony of opioid withdrawal -- and what doctors should tell patients about it

特拉维斯 · 里德: 阿片类药物戒断的痛苦——以及医生应该提供给病人的建议

Filmed:
2,438,348 views

美国人口占世界人口的5%,但消耗了全球阿片类药物供应总量的近70%,造成了每年导致数万人死亡的流行病。其背后的来龙去脉是什么?我们能做些什么呢?在这次推心置腹的演讲中,特拉维斯 · 里德讲述了阿片类药物戒断的痛苦和他所做出的不为人知的斗争,并揭示了那些快速(和过度)开阿片类药物的医生们使患者在摆脱药物的路上渐行渐远的原因。
- Bioethicist
Travis Rieder wants to help find a solution to America’s opioid crisis -- and if that sounds a bit too lofty, he’d settle for making clear, incremental progress in a responsible, evidence-based way. Full bio

Double-click the English transcript below to play the video.

00:12
"How much pain疼痛 medication药物治疗 are you taking服用?"
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“你使用了多少止痛药?”
00:16
That was the very routine常规 question
that changed my life.
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那曾是一个改变过我生活的
例行公事般的问题。
00:19
It was July七月 2015,
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2015年7月,
在经历了一场严重的
摩托车事故的两个月以后,
00:21
about two months个月 after
I nearly几乎 lost丢失 my foot脚丫子
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那次事故差点让我失去了双脚。
00:23
in a serious严重 motorcycle摩托车 accident事故.
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00:26
So I was back in my orthopedic骨科
surgeon's外科医生 office办公室
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我回到骨科医生的办公室
00:28
for yet然而 another另一个 follow-up跟进 appointment约定.
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等待复查。
00:31
I looked看着 at my wife妻子, Sadiye萨迪耶;
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我看着我的妻子,塞耶;
00:32
we did some calculating计算.
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我们计算了一下。
00:35
"About 115 milligrams毫克
oxycodone氧可待因," I responded回应.
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“大约115毫克氧可酮,” 我回答。
00:38
"Maybe more."
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“也许还不止。”
我有些漫不经心,我已经对很多医生
00:40
I was nonchalant不经意, having given特定
this information信息 to many许多 doctors医生
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重复过这个说法了,
00:44
many许多 times before,
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00:46
but this time was different不同.
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但是这一次情况不太一样。
00:48
My doctor医生 turned转身 serious严重
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我的医生表情严肃地
看着我说:
00:50
and he looked看着 at me and said,
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“特拉维斯,这剂量可不轻啊。
00:51
"Travis特拉维斯, that's a lot of opioids阿片类药物.
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00:54
You need to think
about getting得到 off the meds吃药 now."
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现在你需要考虑戒掉这种药物了。”
00:57
In two months个月 of escalating不断升级 prescriptions处方,
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两个月内我的处方药剂量不断增大,
但这是第一次有人开始表示担心。
00:59
this was the first time
that anyone任何人 had expressed表达 concern关心.
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01:03
Indeed确实, this was the first
real真实 conversation会话 I'd had
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的确,也是在那个时期,
我开始了第一次关于
01:05
about my opioid阿片 therapy治疗, period.
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自己阿片治疗的谈话。
01:08
I had been given特定 no warnings警告,
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我没有收到过警告,
01:10
no counseling辅导服务,
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没有接受过咨询,
也没有任何戒断计划.....
01:12
no plan计划 ...
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01:14
just lots and lots of prescriptions处方.
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有的只是越来越多的处方药。
01:17
What happened发生 next下一个 really came来了 to define确定
my entire整个 experience经验 of medical trauma外伤.
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接下来发生的事,就是我的
整个创伤治疗经历的真实写照。
01:22
I was given特定 what I now know
is a much too aggressive侵略性 tapering尖细 regimen方案,
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我现在才明白,自己当时所采用的
是一个过于激进的缩减方案,
01:27
according根据 to which哪一个 I divided分为
my medication药物治疗 into four doses剂量,
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根据这个方案,我把药物分成了四个剂量,
01:30
dropping落下 one each week
over the course课程 of the month.
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在一个月内,每周降低一个剂量。
01:34
The result结果 is that I was launched推出
into acute急性 opioid阿片 withdrawal退出.
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结果我出现了急性阿片戒断的症状。
01:39
The result结果, put another另一个 way,
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换句话说,这个过程让我
01:42
was hell地狱.
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痛不欲生。
01:45
The early stages阶段 of withdrawal退出
feel a lot like a bad case案件 of the flu流感.
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戒断的早期阶段感觉像得了急性流感。
01:50
I became成为 nauseated恶心,
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我感到恶心,
01:52
lost丢失 my appetite食欲,
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食欲不振,
01:54
I ached everywhere到处,
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浑身疼痛,
01:56
had increased增加 pain疼痛
in my rather mangled错位 foot脚丫子;
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受伤的脚的状况更是雪上加霜;
01:59
I developed发达 trouble麻烦 sleeping睡眠
due应有 to a general一般 feeling感觉 of restlessness躁动.
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这种坐立不安的感觉让我难以入睡。
02:05
At the time,
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当时,
我就觉得这简直太痛苦了。
02:07
I thought this was all pretty漂亮 miserable.
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02:10
That's because I didn't know
what was coming未来.
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这是因为我还不知道接下来会发生什么。
02:13
At the beginning开始 of week two,
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第二周刚开始,
02:16
my life got much worse更差.
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我的生活变得愈发痛苦不堪。
02:18
As the symptoms症状 dialed拨打 up in intensity强度,
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当症状向更深的程度蔓延,
02:22
my internal内部 thermostat恒温器
seemed似乎 to go haywire失控.
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我身体内的恒温计似乎开始变得混乱。
02:25
I would sweat profusely丰富地 almost几乎 constantly经常,
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大量流汗成为了家常便饭,
然而,如果我好不容易
在8月的烈日下出了门,
02:27
and yet然而 if I managed管理 to get myself out
into the hot August八月 sun太阳,
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却在低头时发现自己浑身是鸡皮疙瘩。
02:31
I might威力 look down and find myself
covered覆盖 in goosebumps鸡皮疙瘩.
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02:35
The restlessness躁动 that had made制作
sleep睡觉 difficult during that first week
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现在我意识到,让我在第一周
02:38
now turned转身 into what I came来了 to think of
as the withdrawal退出 feeling感觉.
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彻夜难眠的那种坐立不安,
正是戒断的症状。
02:42
It was a deep sense of jitters抖动
that would keep me twitching抽搐.
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这是一种深入骨髓的
坐立不安,让我不停颤抖。
02:47
It made制作 sleep睡觉 nearly几乎 impossible不可能.
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入睡几乎是不可能的。
02:50
But perhaps也许 the most
disturbing烦扰的 was the crying哭了.
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但最令我一筹莫展的是哭泣。
02:55
I would find myself with tears眼泪 coming未来 on
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我发现自己会无端地,
03:00
for seemingly似乎 no reason原因
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没有任何预示地
03:02
and with no warning警告.
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开始流泪。
03:05
At the time they felt
like a neural神经 misfire失火,
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就像神经错乱了一样,
03:07
similar类似 to the goosebumps鸡皮疙瘩.
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类似起了鸡皮疙瘩的感觉。
03:09
Sadiye萨迪耶 became成为 concerned关心,
and she called the prescribing处方 doctor医生
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塞耶也忧心忡忡,她替我
给开处方的医生打了电话,
03:13
who very helpfully有益 advised建议
lots of fluids流体 for the nausea恶心.
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这位医生贴心地针对我的
恶心症状建议了许多种流质食物。
03:18
When she pushed him and said,
"You know, he's really quite相当 badly off,"
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她在催促他的时候说:
“他现在的状况十分糟糕。”
医生答道,“如果真是这样的话,
03:21
the doctor医生 responded回应,
"Well, if it's that bad,
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他可以暂时按原剂量服药。”
03:24
he can just go back to his
previous以前 dose剂量 for a little while."
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03:28
"And then what?" I wondered想知道.
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“然后呢?”我问。
03:31
"Try again later后来," he responded回应.
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“过段时间再试一下,”他答道。
03:34
Now, there's no way that I was going
to go back on my previous以前 dose剂量
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但那时,我根本不可能倒退至原剂量了,
03:38
unless除非 I had a better plan计划 for making制造
it through通过 the withdrawal退出 next下一个 time.
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除非下一次戒药之前
我能做个更好的计划。
03:42
And so we stuck卡住 to riding骑术 it out
and dropped下降 another另一个 dose剂量.
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之后我坚持原计划,又降了一个剂量。
03:47
At the beginning开始 of week three,
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在第三周开始的时候,
03:50
my world世界 got very dark黑暗.
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我的世界陷入了黑暗。
03:53
I basically基本上 stopped停止 eating,
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我基本上已经无法进食,
03:56
and I barely仅仅 slept at all
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也几乎不能睡觉,
03:57
thanks谢谢 to the jitters抖动
that would keep me writhing扭动 all night.
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坐立不安使我整夜都在不停颤抖。
04:01
But the worst最差 --
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但最糟糕的是——
04:03
the worst最差 was the depression萧条.
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最糟的是那种压抑的感觉。
04:06
The tears眼泪 that had felt
like a misfire失火 before
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原本感觉像是无端涌出的泪水,
04:10
now felt meaningful富有意义的.
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现在有了意义。
04:12
Several一些 times a day
I would get that welling夺眶而出 in my chest胸部
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一天几次,我感到胸腔的喷涌感,
04:15
where you know the tears眼泪 are coming未来,
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意识到马上就会开始流泪,
04:18
but I couldn't不能 stop them
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但我无法抑制,
04:20
and with them came来了
desperation绝望 and hopelessness绝望.
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随之而来的还有绝望和无助。
04:24
I began开始 to believe
that I would never recover恢复
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我开始认为我永远不会康复了,
04:27
either from the accident事故
or from the withdrawal退出.
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无论是从那场意外事故,还是戒药过程。
04:31
Sadiye萨迪耶 got back on the phone电话
with the prescriber处方
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于是塞耶再次联系了开药方的医生,
04:33
and this time he recommended推荐的
that we contact联系 our pain疼痛 management管理 team球队
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这次他建议我们联系上次住院的
那家医院的疼痛管理团队。
04:37
from the last hospitalization住院治疗.
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这听起来是个好主意,
04:38
That sounded满面 like a great idea理念,
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因此我们立即行动,
04:40
so we did that immediately立即,
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04:42
and we were shocked吃惊
when nobody没有人 would speak说话 with us.
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接着我们傻眼了,没有人与我们沟通。
04:45
The receptionist接待员 who answered回答
the phone电话 advised建议 us
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电话那边的接待员告诉我们,
04:48
that the pain疼痛 management管理 team球队
provides提供 an inpatient住院 service服务;
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疼痛管理团队提供的
服务是针对住院病人的;
04:52
although虽然 they prescribe规定 opioids阿片类药物
to get pain疼痛 under control控制,
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尽管他们开了控制疼痛的阿片药方,
却并不负责药方减量和戒药症状。
04:55
they do not oversee监视
tapering尖细 and withdrawal退出.
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04:59
Furious愤怒, we called the prescriber处方 back
and begged him for anything --
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盛怒之下,我们又联系了
那个开药方的医生——
05:05
anything that could help me --
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向他寻求任何能帮助我的方法——
05:07
but instead代替 he apologized道歉,
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然而,他只是深表歉意,
05:09
saying that he was out of his depth深度.
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表示他已尽了全力。
“听着,”他对我们说,
05:11
"Look," he told us,
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“我一开始对你的建议很明显是错的,
05:13
"my initial初始 advice忠告 to you is clearly明确地 bad,
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05:15
so my official官方 recommendation建议
is that Travis特拉维斯 go back on the medication药物治疗
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所以我的官方建议是
让特拉维斯恢复原先的剂量,
05:19
until直到 he can find someone有人
more competent胜任 to wean断奶 him off."
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直到找到医术更加精湛的人帮助他戒药。”
05:24
Of course课程 I wanted
to go back on the medication药物治疗.
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当然,我愿意恢复当初的剂量。
05:27
I was in agony痛苦.
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我早已痛苦不堪。
05:30
But I believed相信 that if I saved保存
myself from the withdrawal退出 with the drugs毒品
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但我认为,如果就这样放弃了戒药,
我将永远受制于它们。
05:37
that I would never be free自由 of them,
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05:40
and so we buckled沉着应战 ourselves我们自己 in,
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因此我们决定破釜沉舟,
05:42
and I dropped下降 the last dose剂量.
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放弃了最后的剂量。
05:46
As my brain experienced有经验的 life
without prescription处方 opioids阿片类药物
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当我的大脑在几个月来第一次经历着
05:49
for the first time in months个月,
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没有阿片处方的日子时,
05:52
I thought I would die.
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我认为我会死去。
05:54
I assumed假定 I would die --
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我觉得自己必死无疑——
05:55
(Crying哭泣)
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(抽噎)
抱歉。
05:57
I'm sorry.
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05:58
(Crying哭泣)
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(抽噎)
06:04
Because if the symptoms症状
didn't kill me outright公然,
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因为即使疾病不会完全致我于死地,
06:07
I'd kill myself.
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我也会自我了断。
06:10
And I know that sounds声音 dramatic戏剧性,
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我知道这听起来很夸张,
06:12
because to me,
standing常设 up here years年份 later后来,
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因为对几年后站在这里的健全且健康的
我来说——
06:15
whole整个 and healthy健康 --
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06:16
to me, it sounds声音 dramatic戏剧性.
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这听起来的确很夸张。
06:19
But I believed相信 it to my core核心
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但当时,我发自内心地相信,
06:23
because I no longer had any hope希望
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正因为我不再抱有任何希望,
06:27
that I would be normal正常 again.
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所以我会恢复正常。
06:33
The insomnia失眠 became成为 unbearable不堪忍受
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失眠变得让人无法忍受,
06:36
and after two days
with virtually实质上 no sleep睡觉,
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在连续两天彻夜未眠后,
06:40
I spent花费 a whole整个 night
on the floor地板 of our basement地下室 bathroom浴室.
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我在地下室的卫生间待了一晚。
06:45
I alternated交替 between之间 cooling冷却
my feverish狂热 head
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我时不时地将发热的头颅
06:48
against反对 the ceramic陶瓷的 tiles瓷砖
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靠着瓷砖降温,
06:51
and trying violently猛烈 to throw up
despite尽管 not having eaten吃过 anything in days.
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并且强制自己呕吐,
尽管我已经连续几天滴米未进。
06:56
When Sadiye萨迪耶 found发现 me
at the end结束 of the night
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当塞耶在黎明之初发现我时,
她惊恐万分,
06:59
she was horrified吓坏了,
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于是我们回到了电话旁。
07:00
and we got back on the phone电话.
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07:02
We called everyone大家.
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我们打给了所有人。
07:03
We called surgeons外科医生 and pain疼痛 docs文档
and general一般 practitioners从业者 --
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我们给外科医生,疼痛医生
和全科医师都打了电话——
所有我们能在网上找到的人,
07:07
anyone任何人 we could find on the internet互联网,
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07:09
and not a single one of them
would help me.
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然而没有一个人愿意帮我。
07:13
The few少数 that we could
speak说话 with on the phone电话
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少数我们通上电话的,
07:16
advised建议 us to go back on the medication药物治疗.
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都建议我恢复原剂量。
07:21
An independent独立 pain疼痛 management管理 clinic诊所
said that they prescribe规定 opioids阿片类药物
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一个独立的疼痛管理诊所
说他们可以开阿片药方,
但他们不负责减少剂量或戒药。
07:25
but they don't oversee监视
tapering尖细 or withdrawal退出.
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07:29
When my desperation绝望
was clearly明确地 coming未来 through通过 my voice语音,
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当我的声音完全透着绝望时,
07:32
much as it is now,
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差不多像现在这样,
07:35
the receptionist接待员
took a deep breath呼吸 and said,
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接待员深吸了一口气,说道:
07:38
"Mr先生. Rieder里德尔, it sounds声音 like perhaps也许
what you need is a rehab康复 facility设施
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“里德先生,听起来你需要的是康复机构,
或者一个美沙酮诊所。”
07:41
or a methadone美 沙 酮 clinic诊所."
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07:43
I didn't know any better at the time,
so I took her advice忠告.
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鉴于当时我没有更好的主意,
于是遵循了她的建议。
我挂了电话,打给了她所说的地方,
07:46
I hung鸿 up and I started开始
calling调用 those places地方,
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07:48
but it took me virtually实质上 no time at all
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但我很快就发现,
事实上,许多这样的机构
07:51
to discover发现 that many许多 of these facilities设备
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07:54
are geared面向 towards those battling作战
long-term长期 substance物质 use disorder紊乱.
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都是为了长期戒毒的需要而设立。
07:57
In the case案件 of opioids阿片类药物,
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而在阿片的事例中,
07:59
this often经常 involves涉及 precisely恰恰 not
weaning断奶 the patient患者 off the medication药物治疗,
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这牵涉的不是让患者戒药,
08:02
but transitioning过渡 them
onto the safer更安全, longer-acting更长的作用 opioids阿片类药物:
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而是帮助他们过渡至
更安全,更长效的阿片:
08:06
methadone美 沙 酮 or buprenorphine丁丙诺 啡
for maintenance保养 treatment治疗.
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美沙酮或者丁丙诺啡来维持治疗。
除此之外,我打过电话的每一个
地方都有着一大串的等候名单。
08:10
In addition加成, everywhere到处 I called
had an extensive广泛 waiting等候 list名单.
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08:13
I was simply只是 not the kind of patient患者
they were designed设计 to see.
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显然我也不是它们所期待的患者。
08:18
After being存在 turned转身 away
from a rehab康复 facility设施,
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当被一个康复机构回绝时,
我最终认输了,
08:21
I finally最后 admitted承认 defeat打败.
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08:23
I was broken破碎 and beaten殴打,
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我被击溃了,
08:26
and I couldn't不能 do it anymore.
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无法再继续坚持下去了。
08:29
So I told Sadiye萨迪耶 that I was
going back on the medication药物治疗.
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因于是我告诉塞耶,我想恢复原剂量。
08:33
I would start开始 with
the lowest最低 dose剂量 possible可能,
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尽可能从最低剂量开始,
08:35
and I would take only as much
as I absolutely绝对 needed需要
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并且只有在必须的时候才服用,
以此来避开戒药中最恐怖的影响。
08:38
to escape逃逸 the most crippling瘫痪
effects效果 of the withdrawal退出.
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08:41
So that night she helped帮助 me up the stairs楼梯
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那晚,她扶我上了台阶,
几周以来,我第一次真正上床了。
08:43
and for the first time in weeks
I actually其实 went to bed.
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08:46
I took the little orange橙子
prescription处方 bottle瓶子,
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我拿起橘色的小药瓶,
放在了床头柜上...
08:49
I set it on my nightstand床头柜上 ...
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08:52
and then I didn't touch触摸 it.
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接着我就没再碰它。
08:55
I fell下跌 asleep睡着,
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我睡着了,
08:56
I slept through通过 the night
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我睡了一整夜,
08:58
and when I woke醒来 up,
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当我醒来时,
最严重的症状已奇迹般地减轻了不少。
08:59
the most severe严重 symptoms症状
had abated减弱 dramatically显着.
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09:03
I'd made制作 it out.
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我做到了。
09:04
(Applause掌声)
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(掌声)
09:14
Thanks谢谢 for that,
that was my response响应, too.
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非常感谢,我当时亦有同感。
09:16
(Laughter笑声)
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(笑声)
09:19
So --
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因此——
09:24
I'm sorry, I have to gather收集 myself
just a little bit.
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抱歉,我不得不稍理一下思路。
09:27
I think this story故事 is important重要.
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我认为这是个重要的故事。
09:30
It's not because I think I'm special特别.
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并不是因为我认为我很特殊,
09:32
This story故事 is important重要
precisely恰恰 because I'm not special特别;
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而恰恰是因为我并不特别;
09:35
because nothing that happened发生
to me was all that unique独特.
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因为那些事不仅只发生在我身上。
09:39
My dependence依赖 on opioids阿片类药物
was entirely完全 predictable可预测
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我对阿片的依赖是完全可预见的,
09:43
given特定 the amount that I was prescribed规定
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医生给多少,我服多少,
09:44
and the duration持续时间
for which哪一个 I was prescribed规定 it.
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并且还有规定的时长。
09:48
Dependence依赖 is simply只是 the brain's大脑的 natural自然
response响应 to an opioid-rich富含阿片类药物 environment环境
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依赖只是大脑对富含阿片环境的自然反应,
09:53
and so there was every一切 reason原因
to think that from the beginning开始,
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就是这样,每个人都认为从一开始,
我就需要一个受监督的,合理的的减药计划,
09:57
I would need a supervised监督,
well-formed合式 tapering尖细 plan计划,
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10:00
but our health健康 care关心 system系统
seemingly似乎 hasn't有没有 decided决定
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但我们的健康护理系统似乎并未准备好面对
谁该对我这样的病人负责的问题。
10:04
who's谁是 responsible主管 for patients耐心 like me.
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10:08
The prescribers处方 saw me
as a complex复杂 patient患者
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那个开药的医生认为我是一个复杂的患者,
10:11
needing需要 specialized专门 care关心,
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需要特殊照顾,
10:13
probably大概 from pain疼痛 medicine医学.
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甚至是止痛药。
而疼痛医生认为他们的工作是控制疼痛,
10:14
The pain疼痛 docs文档 saw their job工作
as getting得到 pain疼痛 under control控制
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当我无法摆脱药物时,
10:18
and when I couldn't不能
get off the medication药物治疗,
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他们认为我已经发生了药物上瘾。
10:20
they saw me as the purview范围
of addiction medicine医学.
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10:23
But addiction medicine医学 is overstressed压力过大
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但是成瘾药主要是强调
10:25
and focused重点 on those suffering痛苦
from long-term长期 substance物质 use disorder紊乱.
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和针对那些面临长期药物使用障碍的患者。
10:29
In short, I was prescribed规定 a drug药物
that needed需要 long-term长期 management管理
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简而言之,医生给我开了一种
需要进行长期管理的药物,
10:33
and then I wasn't given特定 that management管理,
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2016
但我并没有得到接受监管的机会,
10:36
and it wasn't even clear明确
whose谁的 job工作 such这样 management管理 was.
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我甚至不清楚这种管理性措施归谁负责。
10:39
This is a recipe食谱 for disaster灾害
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这一整个过程堪称灾难,
10:42
and any such这样 disaster灾害 would be interesting有趣
and worth价值 talking about --
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任何这样的灾难或许
都值得关注和分享——
10:46
probably大概 worth价值 a TEDTED Talk --
205
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或许值得一个TED演讲——
10:48
but the failure失败 of opioid阿片 tapering尖细
is a particular特定 concern关心
206
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但阿片减药的失败仍然应该引起重视,
10:53
at this moment时刻 in America美国
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特别是在当今的美国,
10:56
because we are in the midst中间 of an epidemic疫情
208
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由于我们生活在这样一类的流行病中,
10:59
in which哪一个 33,000 people died死亡
from overdose过量 in 2015.
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仅在2015年因用药过度
致死的人数就达到了33000人。
11:04
Nearly几乎 half of those deaths死亡
involved参与 prescription处方 opioids阿片类药物.
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而这些人中,有近一半
与处方阿片类药物上瘾有关。
11:09
The medical community社区 has in fact事实
started开始 to react应对 to this crisis危机,
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医疗群体事实上已开始
对这类危机做出反应,
11:14
but much of their response响应 has involved参与
trying to prescribe规定 fewer pills --
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但他们的措施无外乎是开更少的药——
11:19
and absolutely绝对,
that's going to be important重要.
213
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那的确十分重要。
11:22
So for instance,
we're now gaining取得 evidence证据
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举个例子,我们有证据证明
11:24
that American美国 physicians医师
often经常 prescribe规定 medication药物治疗
215
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美国医生会主动为病人开药,
11:28
even when it's not necessary必要
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即使在阿片的例子中,
11:30
in the case案件 of opioids阿片类药物.
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这并不是必须的。
11:31
And even when opioids阿片类药物 are called for,
218
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甚至当患者需要阿片时,
医生们也会经常开出过高的剂量。
11:33
they often经常 prescribe规定
much more than is needed需要.
219
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11:36
These sorts排序 of considerations注意事项
help to explain说明 why America美国,
220
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这类情况解释了为什么美国,
11:41
despite尽管 accounting会计 for only five percent百分
of the global全球 population人口,
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尽管只占世界人口的5%,
11:45
consumes消耗 nearly几乎 70 percent百分
of the total global全球 opioid阿片 supply供应.
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却消耗了全球总阿片用量的近70%。
11:50
But focusing调焦 only
on the rate of prescribing处方
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但如果仅关注开药的速率风险,
11:55
risks风险 overlooking俯瞰
two crucially关键 important重要 points.
224
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会忽略两个至关重要的因素。
11:59
The first is that opioids阿片类药物 just are
225
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其一,阿片无论是现在
12:04
and will continue继续 to be
important重要 pain疼痛 therapies治疗.
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还是未来,都会是重要的疼痛疗方。
12:08
As somebody who has had
severe严重, real真实, long-lasting持久的 pain疼痛,
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如果有人承受着十分严重的慢性疼痛,
我向你们保证,这些药能够
支撑你继续活下去。
12:13
I can assure保证 you these medications药物治疗
can make life worth价值 living活的.
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12:18
And second第二:
229
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其二:
12:20
we can still fight斗争 the epidemic疫情
while judiciously明智 prescribing处方 opioids阿片类药物
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我们仍需与流行病搏斗,
同时明智地将处方阿片
12:25
to people who really need them
231
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留给确实需要它们的人,
12:27
by requiring要求 that doctors医生 properly正确
manage管理 the pills that they do prescribe规定.
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这就需要医生在开药时正确管控剂量。
12:32
So for instance,
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举个例子,
12:33
go back to the tapering尖细 regimen方案
that I was given特定.
234
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回到我的减药经历中。
12:36
Is it reasonable合理 to expect期望
235
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合理的情况是,
12:39
that any physician医师 who prescribes规定 opioids阿片类药物
knows知道 that that is too aggressive侵略性?
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任何开阿片处方的医生都能
意识到病人是不是用药过猛。
12:43
Well, after I initially原来 published发表 my story故事
in an academic学术的 journal日志,
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在我在一篇学术期刊上发表我的故事后,
就有CDC(疾病防治中心)的人
给了我他们减药的袖珍指南。
12:47
someone有人 from the CDCCDC sent发送 me
their pocket口袋 guide指南 for tapering尖细 opioids阿片类药物.
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12:52
This is a four-page四页 document文件,
239
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1936
这是一份4页的文档,
12:54
and most of it's pictures图片.
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大多数内容都是图片。
12:57
In it, they teach physicians医师
how to taper锥体 opioids阿片类药物 in the easier更轻松 cases,
241
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这些图片会指导医生
如何针对简单病例减少阿片剂量,
13:02
and one of the their recommendations建议
242
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其中有条建议是
13:03
is that you never start开始 at more
than a 10 percent百分 dose剂量 reduction减少 per week.
243
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每周减少的剂量不得多于10%。
13:09
If my physician医师 had given特定 me that plan计划,
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如果当初我的医生让我遵从了这个计划,
13:12
my taper锥体 would have taken采取 several一些 months个月
instead代替 of a few少数 weeks.
245
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我的减药周期将会持续几个月,而不是几周。
13:18
I'm sure it wouldn't不会 have been easy简单.
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我确信那样会更容易一些,
13:20
It probably大概 would have been
pretty漂亮 uncomfortable不舒服,
247
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有可能还是会感到十分不适,
13:23
but maybe it wouldn't不会 have been hell地狱.
248
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但也许不至于让人痛不欲生。
13:26
And that seems似乎 like
the kind of information信息
249
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而且那似乎也是
医生开药时应该考虑的信息。
13:28
that someone有人 who prescribes规定
this medication药物治疗 ought应该 to have.
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13:33
In closing关闭,
251
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最后,
13:35
I need to say that properly正确 managing管理的
prescribed规定 opioids阿片类药物
252
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我要说,仅靠正确使用处方阿片
13:40
will not by itself本身 solve解决 the crisis危机.
253
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并不会彻底解决危机。
13:43
America's美国 epidemic疫情
is far bigger than that,
254
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美国的流行病治疗任重道远,
13:47
but when a medication药物治疗 is responsible主管
for tens of thousands数千 of deaths死亡 a year,
255
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但当一类药物要为每年
几万生灵的逝去负责时,
13:53
reckless鲁莽 management管理
of that medication药物治疗 is indefensible站不住脚的.
256
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对用药的鲁莽处理就十分不可取。
13:58
Helping帮助 opioid阿片 therapy治疗 patients耐心
to get off the medication药物治疗
257
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帮助阿片治疗患者摆脱
14:01
that they were prescribed规定
258
829960
2016
对处方药物的依赖,
14:04
may可能 not be a complete完成 solution
to our epidemic疫情,
259
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对于我们的流行病治疗来说
也许不是一个万全之策,
14:07
but it would clearly明确地 constitute构成 progress进展.
260
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但它显然是一种突破。
14:10
Thank you.
261
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谢谢。
(掌声)
14:11
(Applause掌声)
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Translated by Homer Li
Reviewed by Yuanqing Edberg

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ABOUT THE SPEAKER
Travis Rieder - Bioethicist
Travis Rieder wants to help find a solution to America’s opioid crisis -- and if that sounds a bit too lofty, he’d settle for making clear, incremental progress in a responsible, evidence-based way.

Why you should listen

A philosopher by training, bioethicist by profession and communicator by passion, Travis Rieder writes and speaks on a variety of ethical and policy issues raised by both prescription and illicit opioid use.

This wasn't always his beat, though. Both in his doctoral training at Georgetown University, and as faculty at Johns Hopkins University’s Berman Institute of Bioethics, Rieder published widely on a variety of topics in philosophy and ethics. His interest in opioids came about suddenly, after a motorcycle accident, when he took too many pills for too long and suddenly found himself with a profound dependency. In the wake of that experience, he became driven to discover why medicine is so bad at dealing with prescription opioids, and how that problem is related to the broader drug overdose epidemic.

Rieder's first article on the topic, in the journal Health Affairs, was one of the most-read essays in 2017 and was excerpted by the Washington Post. Since then, Rieder has co-authored a Special Publication of the National Academy of Medicine on physician responsibility for the opioid epidemic, written several essays for the popular media and spoken widely on the topic to physicians, medical students and the general public. He expands on all of this work in a new book project forthcoming with HarperCollins, tentatively titled In Pain In America.

More profile about the speaker
Travis Rieder | Speaker | TED.com