成瘾剂量（2021）

Dopesick S01E04

Part 7 Nov. 5, 2021, 11:59 a.m.

关于服用阿片类药物的病人的成瘾率
regarding addiction rates and patients taking opioids.
在20世纪70年代末我建立了医院病例数据库
In the late '70s, I built a database of hospital records,
后来它为人所知这是最早的数据库之一
which became known, as it was one of the first.
在报纸上读了药物成瘾的文章后
After reading a newspaper article on addiction,
我决定统计一下有多少病人
I decided to calculate how many patients in my database
显示出麻醉剂止痛药成瘾的症状
showed signs of addiction to narcotic painkillers.
结果出乎意料只有1%
Number was shockingly low, less than 1%.
于是我写信
So I wrote up a letter
给新英格兰医学期刊
and sent it to the New England Journal of Medicine.
你的数据
‐ This letter was based on patients
仅限于住院的患者对吗
confined to a hospital setting, is that correct?
对
‐ Yes. ‐ Mm‐hmm.
如果这些患者没有住院的话
Is‐‐so is the likelihood of addiction
百分比
higher in these same patients
会升高吗
if they were not confined to a hospital?
是的这不是正式的研究结论
HERSHEL: That is correct. It wasn't an official study.
只是基于一小部分患者
It was an observation based on a small group of patients
在住院期间的观察
in a highly controlled environment.
所以信写的很短
That's why the letter was so short.
只有5句话
‐ Yes. It was five sentences long.
通常药物成瘾的科学研究论文
How long would an average scientific study
会有几页
on addiction be?
25到50页吧
‐ Between 25 and 50 pages.
这可比5句话长多了
‐ Which is more than five sentences.
很明显
HERSHEL: Obviously.
你为普渡制药工作过吗
‐ Have you ever worked for Purdue Pharma?
没有
‐ No.
你做过他们的顾问吗
RICK: Have you ever consulted for them
收过他们的钱吗
or received money from them?
没有我和普渡制药没有任何关系
‐ No, I have no affiliation with Purdue Pharma.
那你知道普渡制药的销♥售♥代表
‐ Well, are you aware that sales reps at Purdue
引用了你写给杂♥志♥社的信
cite your letter as a scientific study
将其作为科研结论用来劝说医生吗
to convince doctors that less than 1% of patients
他们指出奥施康定的成瘾率只有1%
would get addicted to their narcotic OxyContin?
我不知道
‐ No, I'm not.
你知道自己只有5句话的那封信
‐ And are you aware that your five‐sentence letter is cited
被全国的医学院拿来当做主要研究课题吗
as a major study by medical schools all across the country,
而且同时出现在时代和科学美国人杂♥志♥中
and in magazine articles from TIME magazine,
用以证明阿片类药物是安全的
Scientific American as proof that opioids are safe?
我不知道
‐ I was not aware of that.
那我来告诉你
‐ Well, I'm gonna tell you what,
有学派支持使用阿片类药物
there is an entire school of thought espousing opioids
说这些药物不会上瘾
as being practically non‐addictive,
在这类论文中
and your letter is often cited
你的信成为了支持这一观点的主要依据
as a major source for this thesis.
这封信跟我发表的论文比起来
‐ This particular letter is very near the bottom
微不足道
of a long list of my published work.
只是根据一小部分人
It's simply provides some basic numbers
进行的简单调研
based on a small group of people.
我不知道它为什么会被广泛讨论
I have no idea how it became so discussed.
我告诉你为什么
‐ I'll tell you how.
在1986年的疼痛杂♥志♥的一篇文章中
So it became the primary source that opioids are non‐addictive
这封信成为证明阿片类药物
when it was cited in a 1986 article
不会成瘾的主要依据
in PAIN magazine,
而这篇文章则完全转变了大家对阿片类药物的看法
which was highly influential in transforming
认为它们是安全的不具成瘾性
the perception of opioids from addictive to safe.
而这篇文章的第二作者
And this article was co‐authored
就是罗素·波特诺伊
by Dr. Russell Portenoy,
现任普渡制药的代言人
who is now a paid spokesperson for Purdue Pharma
他力主在国内
and one of the chief medical proponents
提高阿片类药物和
for increased use of opioids and OxyContin
奥施康定的使用
in the United States of America.
很快就回到阿宾顿的家了
‐ Halfway home to Abington, baby.
小胜利我也很兴奋
I'm all about those small victories.
什么叫小胜利
‐ Aw, what do you mean, small victories?
今天可是个大日子
We had a big day.
没错
‐ Sure was.
也许能多给我们拨点款
Maybe it'll help us get more funding?
不敢说
‐ I doubt it.
里克·蒙卡斯尔
Rick Mountcastle.
我记得你托比缉毒局那边事情如何
Oh yeah, I remember you, Toby. How're things at the DEA?
嗯
Mm‐hmm.
定案还为时过早
Well, it's still early in the case.
我们还没查到什么
We haven't found anything yet. You know what?
我现在不太方便说话
I'll tell you what‐‐ it isn't a good time to talk.
过后再打给你吧
Try you another time? Yeah.
没事好的拜
It's all right. Great, bye.
缉毒署来问制药公♥司♥的案子了
DEA wants to know how the pharma case is going.
之前他们没兴趣
They have zero interest,
现在我们刚查出点东西来
and right when we land something big,
他们就突然有兴趣了
they just‐‐they call us right outta nowhere?
我们得守口如瓶才行
‐ Let's keep this buttoned up.
你我还有布朗利知道就行
Just me, you, and Brownlee.
这案子我可信不过别人
I don't trust anyone on this case.
即便我已经戒断9年了
AA MEMBER: Even after nine years staying sober,
我还是不敢松懈
I know I got a disease.
很高兴我能每周来一次
So grateful I can come here every week as a reminder
提醒自己不能再上瘾
of what I need to do to stay on my path.
谢谢你的分享贝拉你不是孤军奋战
‐ Thank you for sharing, Belle, and you're not alone.
贝琪你说说吧
‐ Betsy, would you like to speak?
一定要说吗
‐ Do I have to?
说出来对你会有帮助
ERIC: You might find it helpful.
这是个安全的空间
This is a very safe space.
分享内心的想法就行
‐ Just share from your heart, dear.
我们都会支持你的
We're all here to support you.
好吧
‐ Okay, um.
我叫贝琪
I'm Betsy.
你好贝琪
ALL: Hi, Betsy.
因为我背痛
BETSY: I was prescribed OxyContin
所以医生给开了奥施康定
for, uh, a back injury...
一开始特别管用但是
And it worked great at first, but...
很快就没效果了要多吃几片才行
Then it stopped working, and I needed more.
给你亲爱的
‐ Here you are, sweetheart.
我
BETSY: I guess‐‐
以前人一多我就不自在
I guess I always felt kinda tense
紧张焦虑
and uncomfortable around people.
但吃了药以后
But taking the pills, it was...
我觉得一点压力都没有了
It was the first time I felt normal.
从未有过这种感觉
In maybe my whole life.
现在
And now...
现在
And now I don't feel
我什么感觉都没有了
anything at all anymore.
就只想吃药
All I think about is getting more pills.
很可怕的一种感觉
And it can get scary.
一切都会好起来
‐ Aww, everything's gonna be just fine.
别担心
Don't you worry.
你多久没吃药了
How long has it been?
两天觉得我快死了
‐ Two days. I feel like I'm gonna die.
这可太难受了
‐ Oh, honey, it's the worst feeling in the world,
我可以帮你
but I can help with that.
- 你能帮我 - 嗯
‐ You can? ‐ Mm‐hmm.
我有10 20和40毫克的
‐ I got 10s, 20s, and 40s.
一毫克一块钱如果你有40块的话
It's a dollar a milligram, so if you've got $40,
我可以给你4颗10毫克的
I can give you four 10s right now.
毕竟可以让你摆脱痛苦对吧
I mean, wouldn't it be nice if all this pain just went away?
嗯
‐ Yeah.
给你
Here you go.
太感谢了
Thank you so much.
你会没事的
‐ It's gonna be all right, sugar.
谢谢
‐ Thank you.