Over the past 20 years more than 800,000 people have died in the United States due do drug overdose. Yes, more than all the lives lost in all the wars this country has fought in. The majority of these cases are due to opioid drugs. Sadly, while we're having this very conversation, at least one person will die from a drug overdose, and a child will be born experiencing severe withdrawals due to in utero opioid exposure.
過去二十年來, 全美有超過 80 萬人 因藥物過量死亡。 是的, 比這個國家因打仗而死亡的人還要多。 而大多數服藥過量的死因 為類鴉片藥物。 令人遺憾的是,就在我們講話的同時, 至少有一人會死於服藥過量; 一名體內帶有類鴉片的嬰兒會出生, 並產生嚴重的戒斷症狀。
Only recently have some pharmaceutical companies been held legally responsible for the opioid crisis. And compared to their multibillion-dollar revenues, the economic penalties they're paying seem minuscule. So let me as a question: why does addiction and the stigma of addiction make it OK to undervalue human lives?
直到最近, 才有藥廠因類鴉片危機被依法究責。 與他們數十億的進帳相比, 經濟裁罰對他們根本不痛不癢。 我有個疑問: 為什麼藥癮及其污名 會使得人命被看輕?
Ironically, I'm often asked the opposite question. Why should we care about "addicts?" Sometimes I'm even shouted at by people who think that anyone who suffers from a substance use disorder brought it on themselves. They must be weak, they lack any moral compass and therefore don't deserve any help. But if you know anything about opioid addiction, you know that this population does not fit that stereotype -- not that any addiction every really does. These are mothers, fathers and grandmothers. They're teachers, business leaders, cheerleaders, athletes, nurses and bus drivers. They're your brother or sister. They represent every fiber in the fabric of our society. Yes, each person came to addiction in a different way, but a major cause of the current epidemic is that medical overprescription of opioid drugs for the treatment of chronic pain. And that is one thing that makes this epidemic different. This particular epidemic was caused by doctors' prescriptions.
諷刺的是,我常常被問相反的問題: 「我們為什麼要關心有藥癮的人?」 有的時候,我甚至被罵, 因為他們認為那些人 因藥物濫用所受的苦果 都是自找的。 他們一定很脆弱、 沒有道德標準, 所以不值得我們伸出援手。 但假使你真的了解類鴉片成癮, 你就會知道這群人 其實不符合那些刻板印象; 對其他東西上癮的人也都不是。 這些人可能是母親、父親、祖母、 老師、老闆、 啦啦隊長、運動員、 護理師、公車司機。 他們是你的兄弟姐妹。 他們代表我們社會的每一員。 沒錯,每個人成癮的原因不盡相同, 但造成目前氾濫的主要原因 是開立過多治療慢性疼痛的 類鴉片藥物處方。 這就是為什麼這個 普遍的藥癮跟其他不同: 它是因醫師處方而起。
The cycle started when pharmaceutical companies convinced physicians that their patients should not feel any pain. Opioid makers claimed that their very potent drugs would not lead to addiction unless individuals were certain kinds of people from certain kinds of communities. Such disinformation, compounded with clinicians' limited education and public ignorance about addiction, is what created the epidemic. So that's how we got here.
藥廠說服醫師 「病人不應感到任何疼痛」, 因而開啟了惡性循環。 類鴉片業者宣稱 他們的特效藥不會導致任何成癮, 除非患者來自特殊的群體 或特定族群。 這些不實資訊, 再加上醫護人員有限的知識 及大眾對於成癮的無知, 造成了這場藥癮的流行。 這造成了我們今天的局面。
Now the question is: how do you treat a national opioid epidemic? During an epidemic, normally governments, clinicians and scientists are brought together to help the afflicted. They develop new and even unconventional treatment strategies to rapidly address the condition. That has not been the case for the opioid epidemic. However, the picture is changing. We're beginning to see more aggressive government actions. For example, the NIH recently started a new initiative called HEAL. HEAL stands for Helping End Addiction Long-term, and it's designed to accelerate research for pain management and addiction through funding new treatment strategies.
現在的問題是: 該怎麼處理全國性類鴉片藥癮的流行? 一般來說,當流行疾病發生, 政府、醫護人員及科學家會合力協助患者。 他們會開發全新,甚至非傳統療法, 以期盡速處理情況。 但這場類鴉片藥癮流行卻不是這麼回事。 還好,事情正在轉變。 我們開始看到政府採取更積極的作為。 例如,美國國家衛生研究院 最近開始了一項叫 HEAL 的新措施, 全名為「協助長期戒除藥癮」。 其規畫目的是希望透過資助新療法 來加速對疼痛管理及成癮的研究。
The current treatment strategy for opioid addiction is the use of other opioids such as methadone. These few medications have been used during the past 50 years. They're considered substitution therapy -- basically fighting fire with fire. They have saved numerous lives, yet they're not used by many who still need them. Why? These medications are themselves addictive, and therefore come with many governmental regulations. Hundreds of thousands of people must be strictly monitored each day. They must find an opioid clinic -- often far from home -- take their meds and then try to make it into work. Obviously, that is not the most effective treatment strategy for an epidemic.
現行對類鴉片藥癮的治療方針 是使用另一種類鴉片,例如美沙冬。 過去五十年來都是使用這類新藥物, 他們被當作是替代療法, 簡單來說就是以毒攻毒。 這些藥救了無數性命, 但還是有很多需要的人沒用過。 為什麼? 這個藥本身就具成癮性, 因此有許多法律規範。 每天都有上萬名民眾被密切監視, 他們往往必須找到一家類鴉片診所, 還可能要跑很遠, 吃了藥,然後趕去上班。 顯然,這不是流行病 最有效的治療策略,
And it raises obvious questions as well. For example: why is the treatment of addiction disorders different from other medical disorders? With most other medical disorders, a nonaddictive, prescribed medication is picked up at the pharmacy. Why do physicians treating their patients with a substance use disorder have limited treatment options? No one ever says that two to three treatments are enough for cancer, especially when it's not a cure.
況且它還衍生出其他更顯而易見的問題, 例如:為什麼針對成癮症的療法 會跟其他疾病的療法不一樣? 其他大部分疾患的非成癮性處方 在藥局就領得到; 為什麼醫師治療藥癮患者的 處方選擇這麼少? 就像不會有人說 兩到三種療法就足以治療癌症, 更何況那些療法無法徹底治癒。
And that brings us to that 200 billion-dollar problem. Fighting fire with fire is a reasonable strategy, but what about using a different form of fire -- a safer form of fire? What about actually developing a nonaddictive treatment derived from another drug? That has been my journey towards trying to develop a treatment for opioid addiction, and it's taken me in some really surprising directions.
這又牽涉到另一個 2000 億的問題。 以毒攻毒是合理的策略, 但何不用另一種更加安全的毒? 或者從其他藥的衍生物 開發出不會上癮的療法? 這就是我一路走來 試圖開發治療類鴉片成癮的過程, 其中有許多意外的轉折。
My journey started with studying cannabis, the drug most people call marijuana. In order to understand how cannabis may connect to combating the opioid epidemic, first it helps to understand a little bit about the science behind the drug and the politics.
我的研究之旅始於大麻屬植物, 就俗稱「大麻」。 要了解大麻如何對抗類鴉片疾病, 我們要先了解 藥物背後的科學機制 以及相關的政治背景。
Cannabis is a complex plant. It's actually made up of over 140 cannabinoids. Cannabinoids are active chemicals from the plant that binds to cannabinoid receptors in our bodies. The potent psychoactive cannabinoid that leads to the reward -- the high -- is THC, which we scientists call tetrahydrocannabinol. Pretty simple, right?
大麻是很複雜的植物, 它其實是由超過 140 種的大麻素所組成。 大麻素是植物內的活性化學物質, 能與人體內的大麻受體結合。 精神作用強大的大麻素中 讓人產生「快感」的 是 THC, 我們科學家稱之為四氫大麻酚。 挺簡單的吧?
But the politics is a lot more complicated. Attitudes towards cannabis and the amount of THC that's considered safe to consume have dramatically changed over the years. In fact, this country's had a roller-coaster relationship with the drug. Cannabis is either highly demonized or glorified. On the demonized side, cannabis was deemed a Schedule I drug by the DEA -- the Drug Enforcement Agency -- meaning that cannabis is considered to be a drug of the highest abuse potential and to have no medicinal value. Moreover, the Schedule I label led to the mass, biased arrest for the use of cannabis, particularly among young Black and brown men. However, things are changing. The pendulum is shifting in the opposite direction. Today, cannabis is legal for medical or recreational use in most states. And a bill is even being considered in Congress to remove cannabis from the list of schedule drugs.
但政治因素就複雜得多了。 過去幾年來,民眾對大麻的觀感 及 THC 的安全服用量 都有了劇烈的變化。 老實說,我們國家跟這個藥的關係 就像是坐雲霄飛車一樣, 不是高度妖魔化就是美化。 從妖魔化的一面來說, 大麻曾被緝毒局 認為是一級毒品。 也就是說, 服用大麻不僅有最高的濫用風險, 也不具有任何醫療效用。 除此之外,一級毒品的標籤 也使得許多使用大麻的人 遭受不公正的逮捕, 年輕黑人及褐色人種尤其首當其衝。 但事情正在轉變。 人們的觀點又走向相反方向。 今日多數州政府皆已將 醫療及娛樂用大麻合法化。 國會甚至還有一項法案在考慮 將大麻從管制藥品中除名。
We've also seen a great increase in cannabis research. Most research studies, including some of my own, focus on THC. In fact, our animal research has shown a negative relationship between THC and opioid addiction. However, as I mentioned, the cannabis plant has over 100 cannabinoids. So THC was not the only one to study. In examining another cannabinoid, cannabidiol -- that is, CBD -- we were actually surprised to see features relevant to alleviating opioid addiction-related behaviors. So there my journey turned to CBD.
我們也看到大麻研究的數量上升。 大部分的研究,包括我自己的研究, 都聚焦在 THC。 事實上,動物研究顯示: THC 與類鴉片成癮呈現負相關。 但就像我先前說的, 大麻裡有超過 100 種大麻素, 所以不只有 THC 被研究到。 在研究另一種大麻素的過程中, 我們很驚訝的發現大麻二酚, 也就是 CBD, 有一項特性有助於 減緩類鴉片成癮的相關行為。 我便將研究標的轉向 CBD。
So what's this CBD that has moved from virtual obscurity only a few years ago to everywhere in society -- in your coffee in the morning, your water at lunch and your beer at dinner? CBD comes from the cannabis plant, but in contrast to THC that has the high, CBD has no addictive properties. We're still trying to figure out how CBD fully works, but it is known that CBD alters chemicals in the brain that regulate emotions and anxiety.
究竟 CBD 是怎麼在幾年之間, 從一個無名小卒 變得在社會上無所不在? 早上的咖啡、 午餐喝的水 晚餐的啤酒都有它的蹤跡。 CBD 從大麻植物而來, 但不像 THC 會產生快感, CBD 沒有任何讓人上癮的特性。 我們還在努力了解 CBD 的全面作用機制, 但已知 CBD 能轉化腦內 調節情緒及緊張的化學物質。
Interestingly, giving CBD to our animal models that had a history of self-administering heroin, reduced their heroin-seeking behavior. Specifically, CBD reduced heroin-seeking triggered by environmental cues that were previously associated with the drug. Let me say that again. CBD reduced heroin-seeking triggered by drug cues. This is significant, because craving is often triggered by the memories of the cues previously associated with drug use. And craving is a matter of life or death daily for people with an opioid use disorder. Simply put, craving can lead to relapse and death from overdose. So reducing craving is an important treatment strategy.
有趣的是,若提供 CBD 給習慣 自主使用海洛因的動物模型, 他們尋求海洛因的行為會減少。 更具體來說,CBD 可降低 與毒品相關的環境誘因 所引發的海洛因需求。 讓我再說一次: CBD 可以降低毒品暗示 所引發的海洛因需求。 這非常重要, 因為渴望往往是被 跟吸毒相關的記憶所引發。 而這份渴望對於 類鴉片癮患者的人來說, 是每天都在經歷的 攸關生死的大事。 簡單來說, 渴望感可能導致復發 或因服藥過量而死亡。 所以降低渴望感 在治療方針中相當重要。
Getting results from animal models like this is actually the first critical step in the FDA process for developing new medications. The next step: human studies. In our first human study, we demonstrated that CBD is safe, even though individuals taking it had also consumed a potent opioid. Next, to determine efficacy, we conducted clinical trials and made sure that both the study investigators and the study participants were blind to the CBD or the placebo substances. The results from those studies replicated the findings that we had in the animal experiments.
在食藥局許可開發新藥的過程中, 從動物模型身上取得這樣的結果 是相當關鍵的一步。 下一步就是人體試驗。 在我們首次的人體試驗中, 雖然受試者服用強效的類鴉片, 我們展示了 CBD 仍然很安全。 接著為了測定其效度, 我們進行了臨床試驗, 同時確保實驗方 與受試者雙方 皆對 CBD 與安慰劑是雙盲的狀態。 我們臨床所得的結果 與動物實驗的結果一致,
So now we know that CBD can reduce craving triggered by environmental cues in human heroin users. What's more, our results demonstrated that CBD reduced anxiety associated with the drug use. This is also significant because anxiety is another critical factor that triggers craving. Importantly, CBD also reduced the levels of the stress hormone cortisol that is often elevated when addicted individuals are exposed to drug use. Another intriguing finding was the CBD continued to decrease craving and anxiety even a week following its final use. This aspect of prolonged efficacy is very beneficial for people taking any medication.
所以我們可以知道, CBD 的確能降低海洛因使用者 因環境誘因而引發的渴求。 我們的結果還顯示了 CBD 可減輕伴隨吸毒而來的焦慮感。 這點也相當重要, 因為焦慮是引發渴求感的 另一個關鍵誘因。 重要的是,成癮者接觸毒品時, 壓力荷爾蒙「皮質醇」濃度 通常會升高; CBD 也可降低其濃度。 另一耐人尋味的發現是, 即使在最後一次服用後又過了一週, CBD 仍可持續降低渴求感及焦慮。 這般長時間的效力 對服各種藥的民眾相當有助益。
So the evidence is mounting. CBD does show potential to reduce critical features for opioid addiction such as craving and anxiety. But we're still not at the end of the road for medication development. The gold standard for medicine established by the FDA is large, clinical trials. Recently, I was fortunate enough to be given that rare opportunity to conduct a large, clinical trial with CBD in people with an opioid use disorder. And that study is expected to continue for at least another two years. CBD is now being investigated for numerous medical conditions. Also, during the past decade, our society has seen an explosion of CBD. It's being put into drink, food, wellness and skincare products. They're even giving CBD to pets.
如此眾多的證據都在顯示, CBD 的確有潛力 可降低類鴉片成癮的關鍵特性, 例如渴求感和焦慮。 但藥品開發的道路尚未走到盡頭, 食藥局對藥物的黃金標準 是要有大規模臨床試驗。 很幸運地,我最近有個寶貴的機會 能與類鴉片上癮患者 進行大規模的臨床試驗。 這份研究預計還會再持續至少兩年。 現在 CBD 的研究也廣泛應用於 不同的醫療症狀。 此外,過去十年來, 大眾也見到 CBD 的爆炸性成長, 飲料、食物、保健食品、保養品裡 都看得到 CBD, 甚至寵物也使用 CBD。
So is CBD a wonder drug as now touted by many? No. Does it have potential medicinal benefits? It does. But the only way to get definitive information about CBD's full safety and efficacy is through large, clinical trials.
那麼,現今受衆人吹捧的 CBD 真的就是仙丹嗎? 不是。 它能帶來潛在的醫療益處嗎? 它能。 但是要取得最完整可靠的 CBD 所有安全性和效力的資料, 唯一途徑就是透過大量臨床試驗。
So is it possible that we could actually change the game by taking this very familiar plant and developing a nonaddictive, FDA-approved medication for opioid use disorder? Absolutely. That is why we're working so hard right now to develop a solution based on CBD.
我們究竟是否可能一舉扭轉乾坤, 從這個已經非常熟悉的植物上 製得非成癮性、 食藥局又認可的 類鴉片上癮的治療藥物? 當然可以。 這就是為什麼我們現在這麼努力地 傾全力發展以 CBD 為基礎的解決方案。
For me, the potential benefits are obvious and also overwhelming. It means helping to give families back their mother or father. It means having your child graduate from high school or college. But most of all, it means helping to save many of the hundreds of thousands of lives that will otherwise be lost to opioids in the next decade.
在我看來, 預期可帶來的益處既明確且巨大。 它意謂著幫助父母回歸他們的家庭; 讓孩子們順利從高中、大學畢業。 最重要的是, 這也代表它拯救了未來十年 數十萬條可能因類鴉片失去的人命。
Thank you.
謝謝大家。
(Applause)
(掌聲)