Name: What causes opioid addiction, and why is it so tough to combat? - Mike Davis
Uploaded: 2020-12-03T19:26:05.000Z
Duration: 8 min 22 s

More than 3,000 years ago,  a flower began to appear in remedies

三千多年前，有一種花開始出現在

古埃及醫學文獻記載的療法當中。

Across the Mediterranean, the ancient Minoans

在地中海地區各地，古米諾斯人

likely found ways to use the same plant for its high.

很可能找到一些方法 來使用同一種花帶來的快感。

Both ancient civilizations  were on to something—

這兩個古文明都找到了 一樣很重要的東西—

opium, an extract of the poppy in question,

從前面提到的罌粟花 所粹取出來的鴉片，

can both induce pleasure and reduce pain.

Though opium has remained in use ever since,

雖然從那之後就一直有人在使用鴉片，

it wasn't until the 19th century that one of its chemical compounds,

要到十九世紀時，它的一種化合物，

morphine, was identified and isolated for medical use.

嗎啡，才被發現並獨立出來做為醫療用途。

Morphine, codeine, and other substances made directly from the poppy

嗎啡、可待因，及其他直接由罌粟花製成的物質

In the 20th century, drug companies created a slew of synthetic substances

二十世紀時，藥廠創造出許多合成物質，

including heroin, hydrocodone, oxycodone, and fentanyl.

包括海洛英、氫可酮、 氧可酮、芬太奴。

不論是合成的或從鴉片衍生出來，

these compounds are collectively known as opioids.

這些化合物統稱為鴉片類藥物。

不論是合成的或天然的、合法的或非法的，

opioid drugs are very effective painkillers, but they are also highly addictive.

鴉片類藥物都是非常有效的止痛劑，但也極容易上癮。

pharmaceutical companies began to market opioid painkillers aggressively,

藥廠開始積極推銷鴉片類止痛劑，

actively downplaying their addictive potential

還積極淡化它們會成癮的可能性，

to both the medical community and the public.

The number of opioid painkillers prescriptions skyrocketed,

鴉片類止痛劑的處方數量大增，

and so did cases of opioid addiction, beginning a crisis that continues today.

鴉片類藥物成癮的案例數亦大增，從此這個危機就一直持續至今。

To understand why opioids are so addictive,

若要了解為什麼鴉片類藥物如此容易上癮，

it helps to trace how these drugs affect the human body from the first dose,

可以先去追蹤這些藥物會如何影響人體，從第一劑開始，

through repeated use, to what happens when long-term use stops.

經過重覆使用，一直到長期使用停止之後會發生什麼事。

Each of these drugs  has slightly different chemistry,

but all act on the body's opioid system by binding to opioid receptors in the brain.

這類藥物的化學性質各有些微不同，但對人體鴉片系統的影響方式都是和大腦中的鴉片受體結合。

The body's endorphins temper pain signals by binding to these receptors,

身體的腦內啡會結合這些受體，用這種方式來減少痛苦訊號，

and opioid drugs bind much more strongly, for longer.

而鴉片類藥物的結合力更強、更持久。

So opioid drugs can manage much more severe pain than endorphins can.

所以鴉片類藥物比腦內啡更能處理強烈的痛苦。

Opioid receptors also influence everything from mood to normal bodily functions.

鴉片受體也會造成許多影響，影響範圍從心情到正常身體功能。

With these functions, too, opioids' binding strength and durability

鴉片類藥物也有這些功能，且更強、更持久，

mean their effects are more pronounced and widespread

這就表示它們的效果會比人體本身的傳訊分子

than those of the body's natural signaling molecules.

When a drug binds to opioid receptors, it triggers the release of dopamine,

當藥物和鴉片受體結合時，就會觸發多巴胺的釋放，

which is linked to feelings of pleasure and may be responsible

for the sense of euphoria that characterizes an opioid high.

可能是鴉片類藥物帶來快感的成因。

At the same time, opioids suppress  the release of noradrenaline,

同時，鴉片類藥物會抑制正腎上腺素的釋放，

which influences wakefulness, breathing, digestion, and blood pressure.

正腎上腺素會影響到失眠、呼吸、消化，和血壓。

A therapeutic dose decreases noradrenaline enough to cause side effects

治療用的劑量能夠 將正腎上腺素減少到足以產生副作用

At higher doses opioids can decrease heart and breathing rates to dangerous levels,

更高劑量的鴉片類藥物能將心跳和呼吸頻率降低到危險的程度，

causing loss of consciousness and even death.

Over time, the body starts to develop a tolerance for opioids.

隨著時間，身體開始發展出對鴉片類藥物的耐受性。

It may decrease its number of opioid receptors,

身體可能會減少鴉片受體的數目，

or the receptors may become less responsive.

To experience the same release of dopamine and resulting mood effects as before,

若要感受到和以往同等的多巴胺釋放量以及它造成的心情效應，

people have to take larger and larger doses—

a cycle that leads to physical dependence and addiction.

這個循環會導致身體的依賴性以及上癮。

As people take more opioids to compensate for tolerance,

若攝取更高的劑量來彌補耐受性，

noradrenaline levels become lower and lower,

正腎上腺素的量就會越來越低，

to a point that could impact basic bodily functions.

低到可能會影響基本的身體功能。

The body compensates by increasing its number of noradrenaline receptors

身體的代償方式就是增加正腎上腺素受體的數量，

so it can detect much smaller amounts of noradrenaline.

這樣便能偵測到更少量的正腎上腺素。

This increased sensitivity to noradrenaline

這麼做會增加對正腎上腺素的敏感度，

allows the body to continue functioning normally—

in fact, it becomes dependent on opioids to maintain the new balance.

事實上，身體會變成要依賴鴉片類藥物才能維持這種新的平衡。

When someone who is physically dependent on opioids stops taking them abruptly,

如果一個人的身體已經在依賴鴉片類藥物，卻突然停止這類藥物，

Noradrenaline levels can increase within a day of ceasing opioid use.

正腎上腺素的量會在中止使用鴉片類藥物的一天內就增加。

But the body takes much longer to get rid of

all the extra noradrenaline receptors it made.

它額外製造的正腎上腺素受體。

when the body is too sensitive to noradrenaline.

身體會對正腎上腺素太過敏感。

This oversensitivity causes withdrawal symptoms,

這種況度敏感會造成戒斷症狀，

including muscle aches, stomach pains, fever, and vomiting.

包括肌肉疼痛、胃痛、發燒、嘔吐。

Though temporary, opioid withdrawal can be incredibly debilitating.

雖然是鴉片類藥物戒斷暫時性的，也有可能會讓人變得非常虛弱。

In serious cases, someone in withdrawal can be violently ill

People who are addicted to opioids aren't necessarily using the drugs

鴉片類藥物成癮的人此時就不見得只是為了快感而用藥，

to get high anymore, but rather to avoid being sick.

Many risk losing wages or even jobs while in withdrawal,

許多人在戒斷時，要冒著失去薪水甚至工作的風險，

or may not have anyone to take care of them during withdrawal.

或者可能在戒斷時期 沒有人能去照顧他們。

If someone goes back to using opioids later,

如果之後又再回頭用鴉片類藥物，

they can be at particularly high risk for overdose,

because what would have been a standard dose while their tolerance was high,

因為當他們的耐受度很高時所使用的標準劑量

Since 1980, accidental deaths  from opioid overdose

1980 年起，在美國因鴉片類藥物過量

have grown exponentially in the United States,

and opioid addictions have also exploded around the world.

鴉片類藥物成癮也在世界各地爆發。

While opioid painkiller prescriptions are becoming more closely regulated,

雖然對鴉片類止痛劑處方的規制變得更嚴謹，

cases of overdose and addiction are still increasing,

用藥過量和成癮的案例數仍然不斷增加，

Many of the early cases of addiction were middle-aged people

早期，許多成癮的案例是中年人，

who became addicted to painkillers they had been prescribed,

他們上癮是因為處方中的止痛劑，

or received from friends and family members with prescriptions.

或取自有處方的親朋好友的止痛劑。

Today, young people are often introduced to prescription opioid drugs in those ways

現今，年輕人通常也經由這些方式初次接觸到處方鴉片類藥物，

but move on to heroin or illicit synthetic opioids that are cheaper

但接著就開始改用海洛英或非法的合成鴉片類藥物，

Beyond tighter regulation of opioid painkillers,

除了對鴉片類止痛劑訂更嚴格的規定之外，

what can we do to reverse the growing rates of addiction and overdose?

我們還能怎樣反轉不斷增長的上癮和過量用藥？

A drug called naloxone is currently our best defense against overdose.

目前對抗用藥過量的最佳防禦是一種叫做納洛酮的藥物。

Naloxone binds to opioid receptors but doesn't activate them.

納洛酮會和鴉片受體結合，但不會啟動它們。

It blocks other opioids from binding to the receptors,

納洛酮會阻擋其他鴉片類藥物和受體結合，

and even knocks them off the receptors to reverse an overdose.

甚至將它們踼出受體，反轉用藥過量。

Opioid addiction is rarely a stand-alone illness;

鴉片類藥物成癮通常不是獨立的疾病；

frequently, people with opioid dependence are also struggling

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What causes opioid addiction, and why is it so tough to combat? - Mike Davis

struggle

period

ancient

dopamine