美国国务院官方博客

华盛顿哥伦比亚特区

2018年6月 25日

打破恶性循环：降低全球毒品需求，战胜阿片危机

作者：安德鲁·汤普森（Andrew Thompson）

2018年6月25日

6月26日是禁止药物滥用和非法贩运国际日（International Day Against Drug Abuse and Trafficking），又称世界禁毒日（World Drug Day）。这项全球性活动由联合国（United Nations）于1987年创建，目的在于增强有关方面的合作，推动全世界为消除非法使用毒品现象的宏伟目标采取行动。

美国和全世界数百万人已经体会到使用毒品的后果；一些最严重的影响来自于阿片过量构成的危机。目前这种现象的广泛蔓延已经产生极为严重的后果，在很大程度上是因为强效合成阿片的推波助澜。2010年代早期，对阿片的需求很高，同时处方阿片供应减少，导致毒品使用的模式从处方阿片向海洛因转移。海洛因价格较便宜，往往更容易得到。由于人们对更便宜和药效更强的药物的需求日益上升，最近向强效合成阿片的转移也同样受到需求的驱使。这种模式已经一目了然；我们必须将解决需求问题作为解决方案的组成部分。

毒品上瘾具有造成人体依赖性和复发性的特性，毒品贩子利用和剥削药物使用失常的人，以此获得利润并扩大他们的市场。为此，防止毒品使用和对药物使用失常进行治疗是有效抗击毒品战略的必要组成部分。能否获得有效的治疗仍然是世界各地面临的一个主要问题。根据《世界精神病学》（World Psychiatry）期刊2017年10月发表的研究报告，全世界仅有34%被诊断患有药物使用失常症的人认识到需要接受治疗，仅24%至少前往医疗诊所看诊一次，仅7%接受最低限度的适当治疗（World Psychiatry 2017; 16:299-307）。

为了扩大接受优质治疗的人数，我在国务院工作的国际毒品和执法事务局（International Narcotics and Law Enforcement Affairs）支持为世界各地的教育人员、治疗师和决策者提供有关预防和治疗毒品使用的实证法培训。具体而言，国际毒品和执法事务局发放普通治疗教材（Universal Treatment Curriculum），内含23个系列课程，讲授有关毒品治疗的最佳方法。此外，国际毒品和执法事务局还支持为治疗毒品使用失常（Treatment of Drug Use Disorders）制定国际标准，为有效治疗的方法确立原则和标准，向治疗中心提供有关按照标准实施的指导。国际毒品和执法事务局邀集世界各地的专家组成员交流毒品治疗的最佳实践，其中包括上个月来自中国和越南的专家，同时与治疗中心、毒品法庭和地方社区组织者密切合作，重点介绍美国的毒品治疗服务。

帮助全球各国发展各自的治疗能力是降低全球毒品需求的一个重要组成部分，但仅仅是有效降低毒品需求的一个方面。在药物使用失常发生前加以预防具有关键意义，其中涉及今年世界禁毒日的主题：“請先聆听！傾听是帮助儿童及青少年健康成長的第一步”。童年是一个关键的成长时期。儿童接触毒品越早，就更容易产生毒品依赖。我们可以促进儿童选择健康的生活方式，从而降低成年人依赖毒品的程度。国际毒品和执法事务局倡导通过普通治疗教材，推广实证的预防措施。该教材强调从学校到媒体等一系列场合采取已被证明有效的预防战略。

在全世界范围内，阿片危机的形态在过去几年已发生巨大变化。强效的新型合成药物迅速扩散可以使罪犯向世界各地的网购者寄送小包装的危险药物，以此作为牟利方式。这些药物往往加入街头毒品的行列，或者被压制成仿冒药片，用于加强精神麻痹作用，同时扩大街头毒贩的利润空间。2013年，美国东北部地区的急诊室和警察法医实验室开始报告存在合成阿片芬太尼过量使用和成为街头毒品的案例。此后3年，芬太尼和其他合成阿片涉及美国34,000多因毒品过量死亡的案例，仅2016年一年就发生了19,000多例。在滥用毒品的现象蔓延之际，药物可能已经发生变化，但始终不变的是需求。今天，2018年6月，这种毒品上瘾的情况促进了需求，促使人们不顾自己身体和生活面临的危险，要求获得效力更强的毒品。通过有效的治疗和预防措施降低这方面的需求是以可持续的方式战胜这场危机的关键所在。

作者介绍：安德鲁·汤普森博士是美国科学促进会（American Association for the Advancement of Science）科学与技术政策研究员，现任美国国务院国际毒品和执法事务局政策、规划和协调办公室（Office of Policy, Planning, and Coordination）外交事务官。 

Breaking The Cycle: Combating The Opioid Crisis Through Global Drug Demand Reduction

June 26 marks the International Day Against Drug Abuse and Trafficking, or World Drug Day. This global event, established by the United Nations in 1987, strengthens cooperation and spurs action towards the ambitious goal of a world free of illicit drug use.

The consequences of drug use are felt by millions of people in the United States and around the world; some of the most dramatic effects are due to the crisis of opioid overdose. This epidemic, in its current, deadly manifestation is fueled in large part by potent synthetic opioids. In the early 2010’s, high demand for opioid drugs and a reduction in the available supply of prescription opioids prompted a shift in use patterns from prescription opioids to heroin, which was cheaper and often easier to acquire. The recent shift to more powerful synthetic opioids was similarly driven by growing demand for cheaper and stronger substances. The pattern is clear; we must address the problem of demand as part of the solution.

Due to the physical dependency and relapsing nature of addiction, drug traffickers rely on and exploit people with substance use disorders to generate profits and expand their markets. Therefore, prevention of drug use and treatment of substance use disorder are necessary components of an effective counternarcotics strategy. Access to effective treatment remains a major problem around the world. According to a study published in World Psychiatry in October 2017, only 34 percent of people diagnosed with substance use disorders around the world recognized a need for treatment, only 24 percent made at least one visit to a treatment service, and only seven percent received minimally adequate treatment (World Psychiatry 2017; 16:299-307).

In order to expand the number of people who receive quality treatment, the State Department bureau in which I work, International Narcotics and Law Enforcement Affairs (INL), supports training educators, treatment practitioners, and policymakers around the world in evidence-based methodologies for prevention and treatment of substance use. Specifically, INL disseminates the Universal Treatment Curriculum, a series of 23 courses offering research-based best practices in drug treatment. Additionally, INL supported the development of International Standards for the Treatment of Drug Use Disorders, which outline principles and standards of effective treatment practices and provide guidance for treatment centers on how to align their practices with the Standards. To share best practices in drug treatment, INL hosts groups of experts from around the world, including from China and Vietnam last month, and works closely with treatment centers, drug courts, and local community organizers to highlight drug treatment services in the United States.

Helping countries around the globe build their treatment capacity is an important part of reducing the global demand for drugs, but it is only one component of effective drug demand reduction. Prevention of substance use disorder before it develops is critical, and it relates to the theme of this year’s World Drug Day: “Listen First – Listening to children and youth is the first step to help them grow healthy and safe.” Childhood is a critical period of development. The earlier children start experimenting with drugs, the more likely they are to develop drug dependence. By promoting healthy lifestyle choices in childhood, we can reduce the prevalence of drug dependence in adults. INL promotes the dissemination of evidence-based prevention practices through the Universal Prevention Curriculum, which emphasizes proven prevention strategies in a variety of settings, from schools to the media.

Worldwide, the shape of the opioid crisis has changed dramatically in the past few years. The rapid proliferation of highly potent new synthetic drugs has made it profitable for criminals to send small shipments of dangerous substances to internet buyers all around the world. These substances are often added to street drugs or pressed into counterfeit pills to boost their psychoactive effects and increase the profit margins for street dealers. In 2013, emergency rooms and police forensic labs in the northeast United States began to report the presence of the synthetic opioid fentanyl in overdose cases and street drugs. In the three following years, fentanyl and other synthetic opioids were involved in over 34,000 overdose deaths in the United States, including over 19,000 in 2016 alone. While the drugs being abused in this epidemic may have changed, the one constant has been demand. Today, in June 2018, the addiction that fuels that demand drives people to consume stronger drugs despite the risks to their health and their lives. Reducing this demand through effective treatment and prevention is the key to any sustainable solution to this crisis.

About the Author: Dr. Andrew Thompson is a Science and Technology Policy Fellow of the American Association for the Advancement of Science (AAAS), serving as a Foreign Affairs Officer in the Office of Policy, Planning, and Coordination in the Bureau of International Narcotics and Law Enforcement Affairs at the U.S. Department of State.

Editor’s Note: This entry also appears in the U.S. Department of State’s publication on Medium.com.