Is There A Way To Keep Using Opioid Painkillers And Reduce Risk?-有没有办法既能持续使用止痛药还能降低风险？
November 13, 20174:48 AM ETAllison Aubrey
Maria Fabrizio for NPR
Jon McHann, 56, got started on prescription opioids the way a lot of adults in the U.S. did: he was in pain following an accident. In his case, it was a fall.
Jon McHann，56岁，像大多数美国人一样使用处方类止痛药，：他在一次摔倒事故中受伤，伤痛一直伴随着他。
"I hit my tailbone just right, and created a severebulging disc" that required surgery, McHann says.
“我伤到了我的尾骨，造成严重的腰椎间盘突出”并需要手术，McHann说。
McHann, who lives in Smithville, Tenn., expected to make a full recovery and go back to work as a heavy haul truck driver. But 10 years after his accident, he's still at home.
McHann，住在史密斯维尔，Tenn.，预计能够完全康复，并回去继续做重载卡车司机。但事故发生10年后，他仍在家中。
"After the surgery the pain was justexcruciating," McHann recalls. "I was unable to function." His spinal problems turned out to be more complicated and hard to treat. And he developed other health problems, too. He had several more surgical procedures for his back, but he got no relief. He says on days when his pain is through the roof, "I can't open my eyes because I know if I blink it's going to hurt."
手术后的疼痛是难以忍受的，”McHann回忆说。”我无法恢复正常身体机能了。”他的脊椎问题变得更加复杂和困难。并且并发了其他健康问题，他的背部经历了几次外科手术，但都没有减轻痛苦，在白天，疼痛能直达头顶，“我不能睁开我的眼睛，因为我知道如果我眨眼就会非常疼痛。
His doctor prescribedmethadone, a powerful opioid. He stayed on the drug for seven years.
他的医生开了一种强效的镇痛类药物美沙酮。他服药七年了。
"It helped immensely, it brought my pain down to a 5 or 6 [on a 10 point scale]," McHann says. "I could function fairly well throughout the day. I could go to church every weekend, I could help my wife shop, I could help around the house a little bit."
“这极大的帮助了我，它能给降低我的痛苦5或6个度[0-10度]，”McHann说。”我一整天都能正常工作。我每周末可以去教堂，可以帮助我的妻子购物，也可以在家里转一会儿。
McHann knew therisksof opioid drugs, including the risk of dependence. "It was a concern to me," he says. His goal was to get off the drugs. But for many years, it felt like the benefits of the pain relief outweighed the risks.
McHann知道镇痛类药物的风险，包括依赖的风险。“这是我关心的问题，”他说。他的目的是摆脱毒品。但多年来，它感觉就像是痛苦的好处大于风险。
But as concern about the opioid epidemic grew, McHann started getting pushback from his doctors. They began reducing the strength and dose of hisprescription"Every time I saw aclinician, my opioids were reduced," McHann says.
但对镇痛类药物的依赖日益增长，McHann开始听从他的医生的建议。他们开始减少他的处方药的强度和剂量“每次我看到一个临床医生，我的镇痛类药物，都减少了，”McHann说。
As the dosage was decreased, his pain began to increase and he worried that he'd be cut off the drug. "Life wasn't going to be worth living if I couldn't get the pain under control," McHann says.
随着剂量的减少，他的疼痛开始增加，他担心他会有药物截断反应。“如果我不能控制我的痛苦，生活将不会变得有意义”McHann说。
McHann is not alone; pain is one of the most common and debilitating medical conditions, with about one-third of Americans dealing with some form of acute or chronic pain. In 2014, 3 to 4 percent of adults wereprescribed opioid painkillers long term— 9.6 to 11.5 million people.
mchann并不孤独；疼痛是一种常见的使人衰弱的疾病，约有三分之一的美国人忍受某些形式的急性的或慢性的疼痛。在2014, 3到4%的美国成年人长期服用止痛药-约960万-1500万人。
In response to the epidemic of opioid addiction and deaths, in 2016 the Centers for Disease Control and Prevention released guidelines urging physicians to try non-opioid methods first for chronic pain. In a viewpointpublishedlast month inJAMA, the journal of the American Medical Association, CDC officials wrote that while illicit opioids such as fentanyl seem to be driving the recent increase in opioid-related overdose deaths, "unnecessary exposure to prescription opioids must be reduced to prevent development of opioid use disorder in the first place."
为了应对镇痛类药物成瘾和死亡的流行，2016疾病控制和预防中心发布了指导方针，要求医生首先尝试非镇痛类药物来治疗慢性尿路感染。在一个观点在JAMA上个月发表，美国医学协会的期刊上，疾病预防控制中心的官员说，尽管非法镇痛类药物如芬太尼的使用似乎最近有所增加，在与镇痛类药物使用过量的死亡中，必须减少对处方镇痛类药物的不必要使用，以防止镇痛类药物使用问题的发生。
But figuring out what's unnecessary, and how best to reduce the risk, can be a challenge.
但是，搞清楚什么是不必要的，以及如何最好地减少风险，是一个挑战。
"I have certainly met a good number of patients who have not found better options and are now taking opioids for chronic pain," saysStefan Kertesz, a physician who is a professor at the University of Alabama at Birmingham, certified in addiction medicine.
“我遇到一定数量的人还没有找到更好的选择，现在服用阿片类药物治疗慢性疼痛的病人，”Stefan Kertesz说，阿拉巴马州伯明翰大学的教授，并获得成瘾医学认证。
Kertesz, who is not McHann's doctor, says some physicians feel caught between a rock and a hard place. With the rise in opioid overdose deaths, there's a lot of pressure to limit prescriptions.
凯尔泰斯，不是mchann的医生，说一些医生感到陷入进退两难的境地。在镇痛类药物过量会引起的死亡，有很多的压力在限制处方药。
The CDCguidelinespoint to the serious risks of high dosages and long-term use, including addiction. They offerguidanceto physicians on how to taper doses, or discontinue the use of the drugs.
疾病预防控制中心指出了高剂量和长期使用的严重风险，包括成瘾。他们指导医生如何减量剂量，或不连续使用药物。
Kertesz agrees that opioids have been prescribed too much in the past. "Absolutely, [doctors] caused new addiction in some people by prescribing too aggressively," Kertesz says. "But the idea that you can simply take [the drugs] away, sometimes from people who need them, is mistaken."
凯尔泰斯认为，“镇痛类药物在过去确实是使用过量了。”当然，[医生]的剂量过大，引起了一些病人成瘾，凯尔泰斯说。“但是你如果只是简单的认为消除成瘾就将镇痛类药物去除，从需要的人那里拿走，这是错误的。”
Kertesz' position iscontroversial.His stance led me to wonder whether he had had ever worked for the pharmaceutical companies that promoted these drugs? "I have never worked a day in my life for the pharmaceutical industry and I have no interest in doing it in the future," Kertesz says. "Do I want to be in situation where I'm forced to take people off a medicine that is helping them? No! "
凯尔泰斯的立场是有争议的。他的态度使我想知道是否他曾经在制药企业中工作过，推进过这些药物？“我没有一天在医药行业工作过，未来我也不感兴趣，”凯尔泰斯说。“我是不是想在这种情况下，强迫别人服用帮助他们的药？不！”
Going forward, Kertesz says he hopes that new medications will be developed that will have less potential for addiction, "but I think human suffering is really complicated and doctors need to have the room to make professional decisions — together with their patients — about what works best for them."
在未来，凯尔泰斯说，他希望新的药物将被开发出阿里，成瘾潜力更小，“但我认为，人类的痛苦是非常复杂的，医生需要有与他们的病人一起做专业决策——什么对他们最有效。”
As for Jon McHann, last month he had anotherprocedureaimed at easing nerve compression in his back, and for now he's optimistic. His pain is diminished, and he's on a much lower dose of medication. He's taking Percocet, which gives him a lower dose of opioids andacetaminophen. "I'm hoping to be opioid free, I don't know if I'll get there, but I want to try."
至于Jon McHann，上个月他经历了另一次手术旨在缓解背部的神经压迫，现在他很乐观。他的疼痛减轻了，并且服用了一剂低剂量的药。他服用Percocet，这给了他一个低剂量的镇痛类药物和对乙酰氨基酚。”我希望是能够戒掉药物成瘾性，我不知道我是否做到，但我愿意尝试一下。”
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原文来自 NPR Maria Fabrizio November 13, 20174:48 AM ETAllison Aubrey