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

崔佛斯雷德: 戒斷類鴉片藥物的痛苦,以及醫生該告訴病人什麼相關資訊

Filmed:
2,438,348 views

美國人口只佔了世界人口的 5%,耗費掉的類鴉片藥物卻佔全球總供應的 70%,導致每年有數萬人死亡。我們怎麼走到這一步的?我們能怎麼做?在這場很個人化的演說中,崔佛斯雷德談戒斷類鴉片藥物的痛苦和背後的掙扎,也揭示醫生如何快速和過度處方類鴉片藥物,卻沒能協助病人最後戒除這些藥物。
- 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藥物治療 are you taking服用?"
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「你服用多少止痛藥?」
00:16
That was the very routine常規 question
that changed my life.
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這個非常例行性的問題
改變了我的人生。
00:19
It was July七月 2015,
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時間是 2015 年 7 月,
00:21
about two months個月 after
I nearly幾乎 lost丟失 my foot腳丫子
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兩個月前,我差點在一場嚴重的
00:23
in a serious嚴重 motorcycle摩托車 accident事故.
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摩托車意外中險些失去了我的腳。
00:26
So I was back in my orthopedic骨科
surgeon's外科醫生 office辦公室
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我回到我的整形外科醫生的辦公室,
00:28
for yet然而 another另一個 follow-up跟進 appointment約定.
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這是另一次後續追蹤的會面。
00:31
I looked看著 at my wife妻子, SadiyeSadiye;
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我看著我的太太莎蒂耶;
我們做了一些計算。
00:32
we did some calculating計算.
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00:35
"About 115 milligrams毫克
oxycodone," I responded回應.
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我回應:「大約 115 毫克的氧可酮。」
00:38
"Maybe more."
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「或許更多一些。」
00:40
I was nonchalant不經意, having given特定
this information信息 to many許多 doctors醫生
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我很冷靜,畢竟以前
已經告訴過許多醫生
00:44
many許多 times before,
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這項資訊很多次了,
00:46
but this time was different不同.
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但這一次卻不同。
00:48
My doctor醫生 turned轉身 serious嚴重
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我的醫生開始嚴肅起來,
00:50
and he looked看著 at me and said,
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他看著我說:
00:51
"Travis特拉維斯, that's a lot of opioids阿片類藥物.
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「崔佛斯,那是很大量的鴉片類藥物。
00:54
You need to think
about getting得到 off the meds吃藥 now."
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你得要考慮現在
就開始脫離這些藥物。」
00:57
In two months個月 of escalating不斷升級 prescriptions處方,
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兩個月來,處方的藥量不斷增高,
00:59
this was the first time
that anyone任何人 had expressed表達 concern關心.
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這倒是頭一次有人表示關心。
01:03
Indeed確實, this was the first
real真實 conversation會話 I'd had
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的確,這是我第一次針對
我的類鴉片藥物治療
01:05
about my opioid阿片 therapy治療, period.
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所進行真正的談話,沒別的。
01:08
I had been given特定 no warnings警告,
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之前都沒人給我過任何警告、
01:10
no counseling輔導服務,
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任何咨詢、
01:12
no plan計劃 ...
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任何計劃……
01:14
just lots and lots of prescriptions處方.
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只是給我很多很多的處方。
01:17
What happened發生 next下一個 really came來了 to define確定
my entire整個 experience經驗 of medical trauma外傷.
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接著發生的事,真的可說是定義了
我對於醫療創傷的整個經驗。
01:22
I was given特定 what I now know
is a much too aggressive侵略性 tapering尖細 regimen方案,
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我現在知道了,當時他們給我
太積極的漸減式給藥方案,
01:27
according根據 to which哪一個 I divided分為
my medication藥物治療 into four doses劑量,
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根據這個方案,
我將我的藥物劑量分為四份,
01:30
dropping落下 one each week
over the course課程 of the month.
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在一個月的期間,每週減少一份。
01:34
The result結果 is that I was launched推出
into acute急性 opioid阿片 withdrawal退出.
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結果是,我開始發生急性類鴉片戒斷。
01:39
The result結果, put another另一個 way,
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換一種說法,結果就是
01:42
was hell地獄.
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像地獄一樣。
01:45
The early stages階段 of withdrawal退出
feel a lot like a bad case案件 of the flu流感.
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戒斷的初期,
感覺像是糟糕的感冒。
01:50
I became成為 nauseated噁心,
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我會感到惡心,
01:52
lost丟失 my appetite食慾,
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失去食慾,
01:54
I ached everywhere到處,
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全身都疼痛,
01:56
had increased增加 pain疼痛
in my rather mangled錯位 foot腳丫子;
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我那隻被壓壞的腳也越來越痛;
01:59
I developed發達 trouble麻煩 sleeping睡眠
due應有 to a general一般 feeling感覺 of restlessness躁動.
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因為總是感到焦躁不安,
我甚至開始難以入眠。
02:05
At the time,
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當時,
02:07
I thought this was all pretty漂亮 miserable.
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我以為這些狀況算是很悲慘。
02:10
That's because I didn't know
what was coming未來.
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那是因為我還不知道
後面有什麼在等著我。
02:13
At the beginning開始 of week two,
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第二週剛開始時,
02:16
my life got much worse更差.
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我的人生變得很糟。
02:18
As the symptoms症狀 dialed撥打 up in intensity強度,
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症狀的強度都增加了,
02:22
my internal內部 thermostat恆溫器
seemed似乎 to go haywire失控.
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我的內部恆溫器似乎在混亂暴走。
02:25
I would sweat profusely豐富地 almost幾乎 constantly經常,
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我幾乎常常會大汗淋漓,
02:27
and yet然而 if I managed管理 to get myself out
into the hot August八月 sun太陽,
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但如果在炎熱的八月
我有辦法出門到大太陽底下,
02:31
I might威力 look down and find myself
covered覆蓋 in goosebumps雞皮疙瘩.
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我可能低頭就會看到
我自己滿身雞皮疙瘩。
02:35
The restlessness躁動 that had made製作
sleep睡覺 difficult during that first week
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在第一週,焦躁不安讓我難以入眠,
02:38
now turned轉身 into what I came來了 to think of
as the withdrawal退出 feeling感覺.
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現在則變成了一種
我漸漸認為是戒斷的感覺。
02:42
It was a deep sense of jitters抖動
that would keep me twitching抽搐.
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它是一種很深刻的神經過敏感,
會讓我一直抽動。
02:47
It made製作 sleep睡覺 nearly幾乎 impossible不可能.
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它讓睡眠變成幾乎不可能。
02:50
But perhaps也許 the most
disturbing煩擾的 was the crying哭了.
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但最惱人也許是哭泣吧。
02:55
I would find myself with tears眼淚 coming未來 on
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我會發現自己淚流滿面,
03:00
for seemingly似乎 no reason原因
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但似乎沒什麼理由,
03:02
and with no warning警告.
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且毫無預警。
03:05
At the time they felt
like a neural神經 misfire失火,
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當下的感覺就像是神經故障,
03:07
similar類似 to the goosebumps雞皮疙瘩.
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跟雞皮疙瘩很類似。
03:09
SadiyeSadiye became成為 concerned關心,
and she called the prescribing處方 doctor醫生
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莎蒂耶很擔心,
便打電話給開處方的醫生,
03:13
who very helpfully有益 advised建議
lots of fluids流體 for the nausea噁心.
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他非常有幫助,
建議了一些適用於噁心時攝入的流體。
03:18
When she pushed him and said,
"You know, he's really quite相當 badly off,"
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她進一步逼問他:
「他的狀況真的很不好。」
03:21
the doctor醫生 responded回應,
"Well, if it's that bad,
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醫生回應:「嗯,如果有那麼糟,
03:24
he can just go back to his
previous以前 dose劑量 for a little while."
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他可以暫時恢復他之前的劑量。」
03:28
"And then what?" I wondered想知道.
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我納悶:「那接著呢?」
03:31
"Try again later後來," he responded回應.
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他回答:「之後再試一次。」
03:34
Now, there's no way that I was going
to go back on my previous以前 dose劑量
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我絕對不可能再恢復先前的劑量,
03:38
unless除非 I had a better plan計劃 for making製造
it through通過 the withdrawal退出 next下一個 time.
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除非我有更好的計畫
能讓我下次順利通過戒斷。
03:42
And so we stuck卡住 to riding騎術 it out
and dropped下降 another另一個 dose劑量.
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所以我們堅持要拼過這一次,
且再減少一份劑量。
03:47
At the beginning開始 of week three,
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第三週剛開始時,
03:50
my world世界 got very dark黑暗.
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我的世界非常黑暗。
03:53
I basically基本上 stopped停止 eating,
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基本上我已經不再進食了,
03:56
and I barely僅僅 slept at all
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我也幾乎沒在睡覺,
03:57
thanks謝謝 to the jitters抖動
that would keep me writhing扭動 all night.
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這要歸功於讓我整晚扭動的神經過敏。
04:01
But the worst最差 --
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但最糟的是——
04:03
the worst最差 was the depression蕭條.
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最糟的是憂鬱。
04:06
The tears眼淚 that had felt
like a misfire失火 before
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本來感覺像是故障造成的眼淚,
現在感覺有意義了。
04:10
now felt meaningful富有意義的.
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04:12
Several一些 times a day
I would get that welling奪眶而出 in my chest胸部
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一天會有好幾次,
我的胸口會有什麼湧上來的感覺,
04:15
where you know the tears眼淚 are coming未來,
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你會知道眼淚馬上就要來了,
04:18
but I couldn't不能 stop them
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但我無法阻止它們,
04:20
and with them came來了
desperation絕望 and hopelessness絕望.
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和它們一起來的,
是絕望和無望的感覺。
04:24
I began開始 to believe
that I would never recover恢復
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我開始相信,我永遠不會復元了,
04:27
either from the accident事故
or from the withdrawal退出.
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不論是車禍意外或戒斷,
都無法復元了。
04:31
SadiyeSadiye got back on the phone電話
with the prescriber處方
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莎蒂耶再度打電話給開處方的醫生,
04:33
and this time he recommended推薦的
that we contact聯繫 our pain疼痛 management管理 team球隊
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這次醫生建議我們聯絡
我最後一次住院時的
04:37
from the last hospitalization住院治療.
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疼痛管理團隊。
04:38
That sounded滿面 like a great idea理念,
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那聽起來像是個好主意,
04:40
so we did that immediately立即,
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所以我們馬上照做了,
04:42
and we were shocked吃驚
when nobody沒有人 would speak說話 with us.
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令人驚訝的是,
沒人願意跟我們說話。
04:45
The receptionist接待員 who answered回答
the phone電話 advised建議 us
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接電話的接待人員告訴我們,
04:48
that the pain疼痛 management管理 team球隊
provides提供 an inpatient住院 service服務;
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疼痛管理團隊
提供服務給住院病人;
04:52
although雖然 they prescribe規定 opioids阿片類藥物
to get pain疼痛 under control控制,
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雖然他們會開類鴉片藥物來控制疼痛,
04:55
they do not oversee監視
tapering尖細 and withdrawal退出.
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但他們不管漸漸減量和戒斷。
04:59
Furious憤怒, we called the prescriber處方 back
and begged him for anything --
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我們火大了,
又打電話給開處方的醫生,
求他給我一點什麼——
05:05
anything that could help me --
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任何能幫助我的都好——
05:07
but instead代替 he apologized道歉,
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但他卻只是道歉,
05:09
saying that he was out of his depth深度.
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說這已經超過他的能力範圍。
05:11
"Look," he told us,
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「聽著,」他告訴我們:
05:13
"my initial初始 advice忠告 to you is clearly明確地 bad,
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「我一開始給你的建議
很顯然是不好的,
05:15
so my official官方 recommendation建議
is that Travis特拉維斯 go back on the medication藥物治療
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所以我的正式建議是,
崔佛斯應該回到先前的劑量,
05:19
until直到 he can find someone有人
more competent勝任 to wean斷奶 him off."
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直到他找到更有能力的人
來幫他戒掉。」
05:24
Of course課程 I wanted
to go back on the medication藥物治療.
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我當然很想要回到之前的劑量。
05:27
I was in agony痛苦.
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我很痛苦。
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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但我相信如果我不去戒斷這些藥物,
05:37
that I would never be free自由 of them,
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我永遠脫離不了它們,
05:40
and so we buckled沉著應戰 ourselves我們自己 in,
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所以我們狠下心,
05:42
and I dropped下降 the last dose劑量.
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減掉最後一份劑量。
05:46
As my brain experienced有經驗的 life
without prescription處方 opioids阿片類藥物
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這是數個月來頭一次,
我的大腦能在
沒有處方類鴉片藥物的
情況下體驗人生,
05:49
for the first time in months個月,
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05:52
I thought I would die.
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我覺得我要死了。
我假設我要死了——
05:54
I assumed假定 I would die --
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05:55
(Crying哭泣)
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(哭泣)
05:57
I'm sorry.
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抱歉。
05:58
(Crying哭泣)
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(哭泣)
06:04
Because if the symptoms症狀
didn't kill me outright公然,
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因為如果症狀沒有徹底把我殺死,
06:07
I'd kill myself.
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我也會自殺。
06:10
And I know that sounds聲音 dramatic戲劇性,
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我知道那聽起來很戲劇化,
06:12
because to me,
standing常設 up here years年份 later後來,
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因為對我來說,幾年後站在這裡,
06:15
whole整個 and healthy健康 --
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完整且健康——
06:16
to me, it sounds聲音 dramatic戲劇性.
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對我來說,聽起來很戲劇化。
06:19
But I believed相信 it to my core核心
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但我發自內心相信,
06:23
because I no longer had any hope希望
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因為我不再抱有
我能夠再次恢復正常的任何希望。
06:27
that I would be normal正常 again.
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06:33
The insomnia失眠 became成為 unbearable不堪忍受
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失眠變得讓人無法忍受,
06:36
and after two days
with virtually實質上 no sleep睡覺,
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在足足兩天無法入睡之後,
06:40
I spent花費 a whole整個 night
on the floor地板 of our basement地下室 bathroom浴室.
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我整晚都待在地下室浴室的地板上。
06:45
I alternated交替 between之間 cooling冷卻
my feverish狂熱 head
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一下子是把我發燒的頭部靠在磁磗上
06:48
against反對 the ceramic陶瓷的 tiles瓷磚
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讓它冷卻下來,
06:51
and trying violently猛烈 to throw up
despite儘管 not having eaten吃過 anything in days.
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一下子是用力嘔吐,
即使數天都幾乎沒有吃什麼。
06:56
When SadiyeSadiye found發現 me
at the end結束 of the night
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莎蒂耶在夜將盡時找到了我,
06:59
she was horrified嚇壞了,
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她嚇壞了,
07:00
and we got back on the phone電話.
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我們又去打電話。
07:02
We called everyone大家.
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我們打給每個人。
07:03
We called surgeons外科醫生 and pain疼痛 docs文檔
and general一般 practitioners從業者 --
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我們打給外科醫生、疼痛醫生,
還有家庭醫生——
07:07
anyone任何人 we could find on the internet互聯網,
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任何我們在網路上能找到的人,
07:09
and not a single one of them
would help me.
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卻沒有一個人能夠幫我。
07:13
The few少數 that we could
speak說話 with on the phone電話
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有少數幾個人願意
在電話上和我們說話,
07:16
advised建議 us to go back on the medication藥物治療.
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建議我們再把劑量加回來。
07:21
An independent獨立 pain疼痛 management管理 clinic診所
said that they prescribe規定 opioids阿片類藥物
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有一間獨立的疼痛管理診所,
說他們會開類鴉片藥物的處方,
07:25
but they don't oversee監視
tapering尖細 or withdrawal退出.
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但他們不負責減量或戒斷的部分。
07:29
When my desperation絕望
was clearly明確地 coming未來 through通過 my voice語音,
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當我説話的聲音中
都帶著明顯的絕望時,
07:32
much as it is now,
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就像現在一樣,
07:35
the receptionist接待員
took a deep breath呼吸 and said,
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接待人員深呼吸之後說:
07:38
"Mr先生. Rieder裡德, it sounds聲音 like perhaps也許
what you need is a rehab康復 facility設施
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「雷德先生,聽起來
你可能需要去勒戒機構
07:41
or a methadone clinic診所."
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或美沙酮診所。」
07:43
I didn't know any better at the time,
so I took her advice忠告.
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我當時什麼也不懂,
就接受了她的建議。
07:46
I hung up and I started開始
calling調用 those places地方,
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我掛了電話,
開始打電話到這些地方,
07:48
but it took me virtually實質上 no time at all
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但我完全沒花什麼時間,
07:51
to discover發現 that many許多 of these facilities設備
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就發現許多這類機構
07:54
are geared面向 towards those battling作戰
long-term長期 substance物質 use disorder紊亂.
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適合的是與藥物濫用長期抗戰的人。
07:57
In the case案件 of opioids阿片類藥物,
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至於類鴉片藥物,
07:59
this often經常 involves涉及 precisely恰恰 not
weaning斷奶 the patient患者 off the medication藥物治療,
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通常就是不要讓病人馬上戒掉藥物,
08:02
but transitioning過渡 them
onto the safer更安全, longer-acting更長的行動 opioids阿片類藥物:
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而是要讓他們轉換到更安全、
更長效的類鴉片藥物:
08:06
methadone or buprenorphine丁丙諾 啡
for maintenance保養 treatment治療.
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美沙酮或丁丙諾啡,以維持治療。
08:10
In addition加成, everywhere到處 I called
had an extensive廣泛 waiting等候 list名單.
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此外,我找的每個地方,
等候名單都很長。
08:13
I was simply只是 not the kind of patient患者
they were designed設計 to see.
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我很明確就不是他們的目標對象。
08:18
After being存在 turned轉身 away
from a rehab康復 facility設施,
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在被一間勒戒機構拒絕了之後,
08:21
I finally最後 admitted承認 defeat打敗.
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我終於承認失敗。
08:23
I was broken破碎 and beaten毆打,
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我徹底被打倒了,
08:26
and I couldn't不能 do it anymore.
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我沒辦法再繼續了。
08:29
So I told SadiyeSadiye that I was
going back on the medication藥物治療.
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我告訴莎蒂耶,
我要恢復原本的劑量。
08:33
I would start開始 with
the lowest最低 dose劑量 possible可能,
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我先盡可能從最低的劑量開始,
08:35
and I would take only as much
as I absolutely絕對 needed需要
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只取用我絕對必要的量就好,
08:38
to escape逃逸 the most crippling癱瘓
effects效果 of the withdrawal退出.
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只是為了脫離最嚴重的戒斷效應。
08:41
So that night she helped幫助 me up the stairs樓梯
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那晚,她扶我起來,爬上樓,
08:43
and for the first time in weeks
I actually其實 went to bed.
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數個星期以來,
我第一次真的爬上床。
08:46
I took the little orange橙子
prescription處方 bottle瓶子,
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我拿了裝處方藥的橘色小瓶子,
08:49
I set it on my nightstand床頭櫃上 ...
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放在我的床頭櫃上……
08:52
and then I didn't touch觸摸 it.
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我並沒有去碰它。
08:55
I fell下跌 asleep睡著,
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我入睡了,
08:56
I slept through通過 the night
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我睡了整晚,
08:58
and when I woke醒來 up,
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當我醒來時,
08:59
the most severe嚴重 symptoms症狀
had abated減弱 dramatically顯著.
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最嚴重的症狀已經大大減輕。
09:03
I'd made製作 it out.
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我挺過去了。
09:04
(Applause掌聲)
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(掌聲)
09:14
Thanks謝謝 for that,
that was my response響應, too.
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謝謝,那也是我的第一個反應。
09:16
(Laughter笑聲)
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(笑聲)
09:19
So --
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所以——
09:24
I'm sorry, I have to gather收集 myself
just a little bit.
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抱歉,我得要調整一下心情。
09:27
I think this story故事 is important重要.
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我認為這個故事很重要。
09:30
It's not because I think I'm special特別.
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並不是因為我認為我很特別。
09:32
This story故事 is important重要
precisely恰恰 because I'm not special特別;
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這個故事之所以重要,
正是因為我不特別;
09:35
because nothing that happened發生
to me was all that unique獨特.
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因為發生在我身上的事
並非獨一無二。
09:39
My dependence依賴 on opioids阿片類藥物
was entirely完全 predictable可預測
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我對於類鴉片藥物的依賴
完全是可預期的,
09:43
given特定 the amount that I was prescribed規定
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畢竟我拿到的處方劑量相當大,
09:44
and the duration持續時間
for which哪一個 I was prescribed規定 it.
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我吃處方藥的期間也很長。
09:48
Dependence依賴 is simply只是 the brain's大腦的 natural自然
response響應 to an opioid-rich富含阿片類物質 environment環境
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依賴只是大腦對於富含類鴉片
藥物的環境所做出的自然反應,
09:53
and so there was every一切 reason原因
to think that from the beginning開始,
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所以絕對有理由可以相信,
打從一開始,
09:57
I would need a supervised監督,
well-formed合式 tapering尖細 plan計劃,
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我就需要一個
受監控且合適的減量計畫,
10:00
but our health健康 care關心 system系統
seemingly似乎 hasn't有沒有 decided決定
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但我們的健康照護制度似乎還沒有決定
10:04
who's誰是 responsible主管 for patients耐心 like me.
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像我這樣的病人要由誰來負責。
10:08
The prescribers處方 saw me
as a complex複雜 patient患者
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開處方藥的醫生
把我視為一個複雜的病人,
10:11
needing需要 specialized專門 care關心,
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需要專門的照護,
10:13
probably大概 from pain疼痛 medicine醫學.
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可能戒除止痛藥物。
10:14
The pain疼痛 docs文檔 saw their job工作
as getting得到 pain疼痛 under control控制
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疼痛醫生認為他們的工作
是要控制疼痛,
10:18
and when I couldn't不能
get off the medication藥物治療,
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當我無法脫離藥物時,
10:20
they saw me as the purview範圍
of addiction medicine醫學.
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他們認為我屬於上癮藥物的範圍。
10:23
But addiction medicine醫學 is overstressed壓力過大
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但上癮藥物主要是強調
10:25
and focused重點 on those suffering痛苦
from long-term長期 substance物質 use disorder紊亂.
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和著重那些對抗長期藥物濫用的人。
10:29
In short, I was prescribed規定 a drug藥物
that needed需要 long-term長期 management管理
200
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簡言之,我拿到的處方藥
是需要長期管理的藥物,
10:33
and then I wasn't given特定 that management管理,
201
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2016
但卻沒人提供我這種管理,
10:36
and it wasn't even clear明確
whose誰的 job工作 such這樣 management管理 was.
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甚至不清楚這種管理到底是誰的工作。
10:39
This is a recipe食譜 for disaster災害
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這注定會導致災禍,
10:42
and any such這樣 disaster災害 would be interesting有趣
and worth價值 talking about --
204
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任何像這樣的災禍
會很有意思且值得拿出來談——
10:46
probably大概 worth價值 a TEDTED Talk --
205
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可能值得做一場 TED 演說——
10:48
but the failure失敗 of opioid阿片 tapering尖細
is a particular特定 concern關心
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但此時,在美國,
類鴉片藥物減量的失敗
是個特別需要關注的議題,
10:53
at this moment時刻 in America美國
207
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10:56
because we are in the midst中間 of an epidemic疫情
208
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因為我們現在正在流行期當中,
10:59
in which哪一個 33,000 people died死亡
from overdose過量 in 2015.
209
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2015 年就有三萬三千人
因為用藥過量致死。
11:04
Nearly幾乎 half of those deaths死亡
involved參與 prescription處方 opioids阿片類藥物.
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這些人當中,有近一半
和有處方的類鴉片藥物有關。
11:09
The medical community社區 has in fact事實
started開始 to react應對 to this crisis危機,
211
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事實上,醫療圈已經開始
對這項危機做出反應,
11:14
but much of their response響應 has involved參與
trying to prescribe規定 fewer pills --
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但他們的反應大多是在試圖
開比較少的處方藥——
11:19
and absolutely絕對,
that's going to be important重要.
213
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當然,那是很重要的。
11:22
So for instance,
we're now gaining取得 evidence證據
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比如,我們現在有證據顯示,
11:24
that American美國 physicians醫師
often經常 prescribe規定 medication藥物治療
215
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美國醫生常在即使不必要的時候,
11:28
even when it's not necessary必要
216
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也會開處方藥,
11:30
in the case案件 of opioids阿片類藥物.
217
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如類鴉片藥物。
11:31
And even when opioids阿片類藥物 are called for,
218
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1976
即使是需要類鴉片藥物時,
11:33
they often經常 prescribe規定
much more than is needed需要.
219
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他們處方的劑量也比需要的多很多。
11:36
These sorts排序 of considerations注意事項
help to explain說明 why America美國,
220
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這類原因說明為什麼美國人口
11:41
despite儘管 accounting會計 for only five percent百分
of the global全球 population人口,
221
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只佔了世界人口的 5%,
11:45
consumes消耗 nearly幾乎 70 percent百分
of the total global全球 opioid阿片 supply供應.
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消耗掉的類鴉片藥物
卻佔全球總供應的近 70%。
11:50
But focusing調焦 only
on the rate of prescribing處方
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但如果只把焦點放在開處方的比率,
11:55
risks風險 overlooking俯瞰
two crucially關鍵 important重要 points.
224
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會有忽略兩個關鍵點的風險。
11:59
The first is that opioids阿片類藥物 just are
225
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第一,類鴉片藥物目前是,
12:04
and will continue繼續 to be
important重要 pain疼痛 therapies治療.
226
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將來也繼續會是重要的止痛方式。
12:08
As somebody who has had
severe嚴重, real真實, long-lasting持久的 pain疼痛,
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我自己不久前才經歷了
嚴重、真實、長久的痛苦,
12:13
I can assure保證 you these medications藥物治療
can make life worth價值 living活的.
228
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我可以向各位保證,
這些藥物能讓人生變得值得活下去。
12:18
And second第二:
229
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第二,
12:20
we can still fight鬥爭 the epidemic疫情
while judiciously明智 prescribing處方 opioids阿片類藥物
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我們可以一邊對抗流行期,
一邊明智而謹慎地處方類鴉片藥物
12:25
to people who really need them
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給真正需要它們的人,
12:27
by requiring要求 that doctors醫生 properly正確
manage管理 the pills that they do prescribe規定.
232
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做法是要求醫生要妥當管理
他們處方的藥物。
12:32
So for instance,
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舉例來說,
12:33
go back to the tapering尖細 regimen方案
that I was given特定.
234
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回到他們給我的劑量漸減方案。
12:36
Is it reasonable合理 to expect期望
235
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期待處方類鴉片藥物給我的醫生
12:39
that any physician醫師 who prescribes規定 opioids阿片類藥物
knows知道 that that is too aggressive侵略性?
236
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知道這個方案太積極,
這種期待是合理的嗎?
12:43
Well, after I initially原來 published發表 my story故事
in an academic學術的 journal日誌,
237
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在我把我的故事初次刊登在
一本學術期刊上之後,
12:47
someone有人 from the CDCCDC sent發送 me
their pocket口袋 guide指南 for tapering尖細 opioids阿片類藥物.
238
755680
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疾病防治中心的人寄給我一本
類鴉片藥物劑量漸減的口袋指南。
12:52
This is a four-page四頁 document文件,
239
760640
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這份文件共四頁,
12:54
and most of it's pictures圖片.
240
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大部分是圖片。
在指南中,他們教醫生
如何針對比較容易的案例
12:57
In it, they teach physicians醫師
how to taper錐體 opioids阿片類藥物 in the easier更輕鬆 cases,
241
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4776
做類鴉片藥物的劑量漸減,
他們的建議之一是,
13:02
and one of the their recommendations建議
242
770000
1736
13:03
is that you never start開始 at more
than a 10 percent百分 dose劑量 reduction減少 per week.
243
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就是每週減少的劑量
不要超過 10%。
13:09
If my physician醫師 had given特定 me that plan計劃,
244
777360
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如果我的醫生有給我這樣的方案,
13:12
my taper錐體 would have taken採取 several一些 months個月
instead代替 of a few少數 weeks.
245
780120
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我的劑量漸減會需要花
數個月時間,而不是幾週。
13:18
I'm sure it wouldn't不會 have been easy簡單.
246
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2136
我確信不會太好過。
13:20
It probably大概 would have been
pretty漂亮 uncomfortable不舒服,
247
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2360
可能會很不舒服,
13:23
but maybe it wouldn't不會 have been hell地獄.
248
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1800
但也許不會像地獄一樣。
13:26
And that seems似乎 like
the kind of information信息
249
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2056
這些資訊似乎是
13:28
that someone有人 who prescribes規定
this medication藥物治療 ought應該 to have.
250
796800
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負責處方這類藥物的人應該要知道的。
13:33
In closing關閉,
251
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最後結尾,
13:35
I need to say that properly正確 managing管理的
prescribed規定 opioids阿片類藥物
252
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5416
我得要說,單靠妥當管理
處方的類鴉片藥物
13:40
will not by itself本身 solve解決 the crisis危機.
253
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不能解決危機。
13:43
America's美國 epidemic疫情
is far bigger than that,
254
811640
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美國的流行狀況嚴重到它無法解決,
13:47
but when a medication藥物治療 is responsible主管
for tens of thousands數千 of deaths死亡 a year,
255
815960
5056
但如果這種藥物
造成一年數萬人死亡,
13:53
reckless魯莽 management管理
of that medication藥物治療 is indefensible站不住腳的.
256
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4200
隨便管理這類藥物是不可原諒的。
13:58
Helping幫助 opioid阿片 therapy治療 patients耐心
to get off the medication藥物治療
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3296
協助類鴉片藥物治療的病人戒除
14:01
that they were prescribed規定
258
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2016
他們的處方藥物
14:04
may可能 not be a complete完成 solution
to our epidemic疫情,
259
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2440
或許不是能徹底解決流行問題的方案,
14:07
but it would clearly明確地 constitute構成 progress進展.
260
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2120
但它依然可以帶來進展。
14:10
Thank you.
261
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謝謝。
14:11
(Applause掌聲)
262
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(掌聲)
Translated by Lilian Chiu
Reviewed by Yanyan Hong

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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