This photo shows an arrangement of pills of the opioid oxycodone-acetaminophen. 
美国国务院官员博文
华盛顿特区
2019年6月25日
应将滥用药物作为疾病治疗
安德鲁·汤普森（Andrew Thompson）
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 Illicit Trafficking），以使全球关注滥用药物对我们社会构成的日益严重威胁。联合国毒品和犯罪问题办公室（United Nations Office on Drugs and Crime）在每年这一天发布汇总全球各地毒品使用详尽数据的《世界毒品问题报告》（World Drug Report）。过去十年来的报告显示，全球使用毒品的人数逐步上升，而使用毒品带来的健康后果、经济代价和死亡也同步加剧。
我在学术界和国务院国际麻醉品和执法事务局（State Department’s Bureau of International Narcotics and Law Enforcement Affairs）的工作使我亲眼看到，美国受到的影响达到空前程度。阿片危机是每年夺走成千上万美国人生命的公共健康危机。虽然在美国这里围绕阿片泛滥的讨论经常将其视为国内问题，但根源许多来自海外。我所工作的国际麻醉品和执法事务局在全球各地作出努力——我在这里致力于帮助减少全球毒品供求——旨在加强执法行动和阻止毒品入境。此外，国际麻醉品和执法事务局也在公共健康领域努力通过在世界各地加强防范药物滥用和治疗服务，缩小国际毒品市场。
现在人们普遍认识到，滥用药物是一种长期的、反复发作的症状，需要持续治疗。但是，最近一项研究发现，在全球所有被诊断滥用药物的人当中，只有39%认识到需要接受治疗，前往接受治疗服务至少一次的人只有24%，仅有7%的人得到了最低限度的适当治疗（《世界神经病学》[World Psychiatry] 2017; 16:299-307）。造成全球在提供适当治疗上的差距的部分原因，是对什么是真正的“适当治疗”缺乏了解。
为解决这个问题，世界卫生组（World Health Organization）和联合国毒品和犯罪问题办公室联手，并在国际麻醉品和执法事务局的支持下，制定出世界第一个“治疗药物滥用国际标准”（International Standards on the Treatment of Drug Use Disorders）。这项富有开拓意义的文件指出了有效的治疗系统——从联系接触直至结束治疗——所具备的特征。“国际标准”所基于的信念是，对滥用药物症状的治疗不亚于对其他长期、反复发作疾病——如糖尿病或哮喘病——的治疗。应该积极鼓励人们在需要时寻求和接受治疗。对治疗应有隐私保护，并且是由经过正当培训的人员进行。任何治疗方案都应基于实情并针对患者的具体需要。也许十分重要的是，对治疗作用的衡量要基于病患在接受治疗过程中的效果，而不是在其离开以后。如果一位糖尿病患者在停止治疗后重新出现症状，人们不会认为是治疗失败；如果一位滥用药物患者在离开治疗后重新发作，我们为什么要说是治疗无效呢？
“国际标准”呼吁用与对待任何其他慢性、复发性疾病患者一样的方式对待滥用药物患者：给予关爱，给予理解，根据实情采取治疗方法。
这些“国际标准”在经过在九个国家和1200多名医疗专业人员的大量实地检验后，将于本周在日内瓦（Geneva）世界卫生组织总部的一个专项活动上公布。我非常高兴将代表我的国家在这次活动上讲话，支持以基于实情的方法治疗滥用药物。
国务院肩负着让世界对美国人民更安全的使命。国际麻醉品和执法事务局通过努力建设一个没有跨国犯罪活动——包括没有毒品走私和滥用非法药物——的世界，来推进这一使命。“治疗药物滥用国际标准”让我们朝着这个重要目标迈近一步。
作者简介：安德鲁·汤普森是神经学家，作为美国科学促进会（American Association for the Advancement of Science）会员在国际麻醉品和执法事务局服务。

By Andrew Thompson on June 25, 2019
June 26th marks the International Day Against Drug Abuse and Illicit Trafficking, a day to draw the world’s attention to the growing threats of drug abuse to our societies. On this day every year, the United Nations Office on Drugs and Crime (UNODC) releases the World Drug Report, an exhaustive collection of data on drug use around the world. For the past decade, this report has revealed a steady increase in the number of people globally who use drugs, and a parallel rise in the negative health effects, economic costs, and deaths associated with drug use.
As I have seen firsthand in my work both in academia and within the State Department’s Bureau of International Narcotics and Law Enforcement Affairs (INL), the United States is feeling these impacts to an unprecedented degree.  The opioid crisis is a public health emergency that takes tens of thousands of American lives every year.  While here in the United States this epidemic is often discussed as a domestic challenge, many of its root causes are overseas. INL, where I support global drug demand and supply reduction efforts, works around the globe to strengthen law enforcement operations and stop drugs from reaching our shores. Additionally, INL works in the public health sphere to shrink the global market for drugs by strengthening substance use prevention and treatment services around the world.
It is now commonly accepted that substance use disorder is a chronic, relapsing medical condition that requires continuous treatment. However, a recent study found that of all the people diagnosed with a substance use disorder worldwide, only 39 percent recognized a need for treatment, only 24 percent made at least one visit to a service, and only seven percent received minimally adequate treatment (World Psychiatry 2017; 16:299-307). Part of the reason for this worldwide gap in meeting the need for adequate treatment is a lack of understanding on what “adequate treatment” truly is.
In order to address this, the World Health Organization (WHO) and UNODC teamed up to produce — with INL’s support — the world’s first International Standards on the Treatment of Drug Use Disorders, a groundbreaking document that outlines the characteristics of an effective treatment system, from outreach to discharge. Baked into the International Standards is the belief that treatment for substance use disorders should be no less than treatment for other chronic, relapsing medical conditions, like diabetes or asthma. People should be actively encouraged to seek out and enter treatment when necessary. Treatment should be confidential and provided by properly trained staff. Any treatment plan should be based on evidence and responsive to the specific needs of the individual. And perhaps most importantly, the effectiveness of treatment should be measured by the success of the patient while in treatment, not after he or she leaves. You wouldn’t say that treatment had failed if a person with diabetes experienced a recurrence of symptoms after they stopped treatment; why would we say that treatment didn’t work if a person with a substance use disorder relapses after leaving treatment? The International Standards call for people with substance use disorders to be treated like any other person with a chronic, relapsing medical condition: with compassion, with understanding, and with evidence-based methods.
After extensive field-testing in nine countries with over 1,200 health professionals, these International Standards are being released during a special event this week at the WHO headquarters in Geneva. I’m excited to speak on behalf of my country at this event, supporting an evidence-based approach to treating substance use disorders.
The State Department is charged with making the world a safer place for Americans. INL advances this mission by working to create a world free from transnational crime, including drug trafficking, and abuse of illicit drugs. The International Standards for the Treatment of Drug Use Disorders move us one step closer to that worthy goal.
About the Author: Dr. Andrew Thompson is a neuroscientist serving as an American Association for the Advancement of Science (AAAS) Fellow in the Bureau of International Narcotics and Law Enforcement Affairs.