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TravisRieder_2017X-_戒断类鸦片药物的痛苦，以及医生该告诉病人什么相关资讯_
'"How much pain medication are you taking?" 「你服用多少止痛药？」
medication:n.药;药物;
That was the very routine question that changed my life. 这个非常例行性的问题 改变了我的人生。
It was July 2015, about two months after I nearly lost my foot in a serious motorcycle accident. 时间是 2015 年 7 月, 两个月前,我差点在一场严重的 摩托车意外中险些失去了我的脚。
So I was back in my orthopedic surgeon's office for yet another follow-up appointment . 我回到我的整形外科医生的办公室, 这是另一次后续追踪的会面。
orthopedic:adj.整形外科的(等于orthopaedic); follow-up:adj.后续的;增补的;n.随访;跟进;后续行动; appointment:n.任命;约定;任命的职位;
I looked at my wife, Sadiye; we did some calculating. 我看着我的太太莎蒂耶; 我们做了一些计算。
'"About 115 milligrams oxycodone ," I responded . 我回应:「大约 115 毫克的氧可酮。」
milligrams:[计量]毫克; oxycodone:n.氧可酮;羟考酮; responded:v.回答,回应;作出反应;响应;反应灵敏;(respond的过去式和过去分词)
'"Maybe more." 「或许更多一些。」
I was nonchalant , having given this information to many doctors many times before, but this time was different. 我很冷静,毕竟以前 已经告诉过许多医生 这项资讯很多次了, 但这一次却不同。
nonchalant:adj.冷淡的,漠不关心的;
My doctor turned serious and he looked at me and said, "Travis, that's a lot of opioids . 我的医生开始严肃起来, 他看着我说: 「崔佛斯,那是很大量的鸦片类药物。
opioids:n.阿片类药物;类阿片;鸦片类药剂(opioid的复数形式);
You need to think about getting off the meds now." 你得要考虑现在 就开始脱离这些药物。」
meds:n.药物:
In two months of escalating prescriptions , this was the first time that anyone had expressed concern . 两个月来,处方的药量不断增高, 这倒是头一次有人表示关心。
escalating:v.(使)逐步扩大,不断恶化,加剧;(escalate的现在分词) prescriptions:n.医药处方,[医]药方(prescription复数形式); expressed:v.表示;表达;显而易见;不言自明;(express的过去分词和过去式) concern:v.涉及,关系到;使担心;n.关系;关心;关心的事;
Indeed, this was the first real conversation I'd had about my opioid therapy , period. 的确,这是我第一次针对 我的类鸦片药物治疗 所进行真正的谈话,没别的。
therapy:n.治疗,疗法;
I had been given no warnings, no counseling , no plan ... 之前都没人给我过任何警告、 任何咨询、 任何计划……
counseling:n.咨询服务;v.建议;劝告;商讨;(counsel的现在分词形式)
just lots and lots of prescriptions. 只是给我很多很多的处方。
What happened next really came to define my entire experience of medical trauma . 接着发生的事,真的可说是定义了
define:v.定义;使明确;规定; trauma:n.[外科]创伤(由心理创伤造成精神上的异常);外伤;
I was given what I now know is a much too aggressive tapering regimen , according to which I divided my medication into four doses , dropping one each week over the course of the month. 我现在知道了,当时他们给我 太积极的渐减式给药方案, 根据这个方案, 我将我的药物剂量分为四份, 在一个月的期间,每周减少一份。
aggressive:adj.侵略性的;好斗的;有进取心的;有闯劲的; tapering:adj.尖端细的;渐渐减少的;v.逐渐变尖细;逐渐减少(taper的ing形式); regimen:n.[医]养生法;生活规则;政体;支配; according to:根据,据说; doses:v.服药(dose的三单形式);n.[药][核]剂量(dose的复数);
The result is that I was launched into acute opioid withdrawal . 结果是,我开始发生急性类鸦片戒断。
launched:v.发射;发起;开展;开始;(launch的过去式和过去分词) acute:adj.严重的,[医]急性的;敏锐的;激烈的;尖声的; withdrawal:n.撤退,收回;提款;取消;退股;
The result, put another way, was hell. 换一种说法,结果就是 像地狱一样。
The early stages of withdrawal feel a lot like a bad case of the flu. 戒断的初期, 感觉像是糟糕的感冒。
I became nauseated , lost my appetite , 我会感到恶心, 失去食欲,
nauseated:v.使恶心;使作呕;使厌恶(nauseate的过去分词和过去式) appetite:n.食欲;嗜好;
I ached everywhere, had increased pain in my rather mangled foot; 全身都疼痛, 我那只被压坏的脚也越来越痛;
mangled:v.压碎;撕烂;严重损坏;糟蹋;(mangle的过去分词和过去式)
I developed trouble sleeping due to a general feeling of restlessness . 因为总是感到焦躁不安, 我甚至开始难以入眠。
restlessness:n.坐立不安;不安定;
At the time, 当时,
I thought this was all pretty miserable . 我以为这些状况算是很悲惨。
miserable:adj.悲惨的;痛苦的;卑鄙的;
That's because I didn't know what was coming. 那是因为我还不知道 后面有什么在等着我。
At the beginning of week two, my life got much worse. 第二周刚开始时, 我的人生变得很糟。
At the beginning of:在…的开始;
As the symptoms dialed up in intensity , my internal thermostat seemed to go haywire . 症状的强度都增加了, 我的内部恒温器似乎在混乱暴走。
symptoms:n.症状;征候;征兆;(symptom的复数) intensity:n.强度;强烈;[电子]亮度;紧张; internal:n.内脏;本质;adj.内部的;里面的;体内的;(机构)内部的; thermostat:n.恒温器;温度自动调节器 go haywire:发疯;陷于混乱;变得疯疯癫癫;
I would sweat profusely almost constantly , and yet if I managed to get myself out into the hot August sun, 我几乎常常会大汗淋漓, 但如果在炎热的八月 我有办法出门到大太阳底下,
profusely:adv.丰富地; constantly:adv.不断地;时常地;
I might look down and find myself covered in goosebumps . 我可能低头就会看到 我自己满身鸡皮疙瘩。
goosebumps:n.鸡皮疙瘩;
The restlessness that had made sleep difficult during that first week now turned into what I came to think of as the withdrawal feeling. 在第一周,焦躁不安让我难以入眠, 现在则变成了一种 我渐渐认为是戒断的感觉。
It was a deep sense of jitters that would keep me twitching . 它是一种很深刻的神经过敏感, 会让我一直抽动。
jitters:n.神经过敏; v.抖动(jitter的三单形式); twitching:n.颤搐;v.使抽搐;猛拉;夺走(twitch的ing形式);
It made sleep nearly impossible. 它让睡眠变成几乎不可能。
But perhaps the most disturbing was the crying. 但最恼人也许是哭泣吧。
disturbing:adj.引起烦恼的;令人不安的;v.打扰;干扰;搅乱;使不安;(disturb的现在分词)
I would find myself with tears coming on for seemingly no reason and with no warning. 我会发现自己泪流满面, 但似乎没什么理由, 且毫无预警。
seemingly:adv.看来似乎;表面上看来;
At the time they felt like a neural misfire , similar to the goosebumps. 当下的感觉就像是神经故障, 跟鸡皮疙瘩很类似。
neural:adj.神经的;神经系统的;背的;神经中枢的; misfire:vi.失败;不发火;n.失败;不发火;
Sadiye became concerned , and she called the prescribing doctor who very helpfully advised lots of fluids for the nausea. 莎蒂耶很担心, 便打电话给开处方的医生, 他非常有幫助,
concerned:adj.有关的;关心的;v.关心;与…有关;(concern的过去时和过去分词) prescribing:v.给…开(药);让…采用(疗法);开(处方);命令;(prescribe的现在分词) helpfully:adv.有益地;有用地; advised:adj.考虑过的; v.劝告; (advise的过去分词和过去式) fluids:n.液体;流体;液;(fluid的复数)
When she pushed him and said, "You know, he's really quite badly off," 她进一步逼问他: 「他的状况真的很不好。」
the doctor responded, "Well, if it's that bad, he can just go back to his previous dose for a little while." 医生回应:「嗯,如果有那么糟, 他可以暂时恢复他之前的剂量。」
previous:adj.以前的;早先的;过早的;adv.在先;在…以前;
'"And then what?" I wondered. 我纳闷:「那接着呢？」
'"Try again later," he responded. 他回答:「之后再试一次。」
Now, there's no way that I was going to go back on my previous dose unless I had a better plan for making it through the withdrawal next time. 我绝对不可能再恢复先前的剂量, 除非我有更好的计画 能让我下次顺利通过戒断。
go back on:违背;背弃;
And so we stuck to riding it out and dropped another dose. 所以我们坚持要拼过这一次, 且再减少一份剂量。
At the beginning of week three, my world got very dark. 第三周刚开始时, 我的世界非常黑暗。
I basically stopped eating, and I barely slept at all thanks to the jitters that would keep me writhing all night. 基本上我已经不再进食了, 我也几乎没在睡觉, 这要归功于让我整晚扭动的神经过敏。
basically:adv.主要地,基本上; barely:adv.仅仅,勉强;几乎不;公开地;贫乏地; writhing:v.(常指因剧痛不停地)扭动,翻滚;(writhe的现在分词)
But the worst -- the worst was the depression . 但最糟的是—— 最糟的是忧郁。
depression:n.沮丧;洼地;不景气;忧愁;
The tears that had felt like a misfire before now felt meaningful . 本来感觉像是故障造成的眼泪, 现在感觉有意义了。
meaningful:adj.严肃的;重要的;重大的;意味深长的;
Several times a day I would get that welling in my chest where you know the tears are coming, but I couldn't stop them and with them came desperation and hopelessness . 一天会有好几次, 我的胸口会有什么涌上来的感觉, 你会知道眼泪马上就要来了, 但我无法阻止它们, 和它们一起来的, 是绝望和无望的感觉。
hopelessness:n.绝望,无望;不抱希望;
I began to believe that I would never recover either from the accident or from the withdrawal. 我开始相信,我永远不会复元了, 不论是车祸意外或戒断, 都无法复元了。
Sadiye got back on the phone with the prescriber and this time he recommended that we contact our pain management team from the last hospitalization . 莎蒂耶再度打电话给开处方的医生, 这次医生建议我们联络 我最后一次住院时的 疼痛管理团队。
prescriber:开药者; recommended:v.推荐;举荐;介绍;劝告;建议;(recommend的过去分词和过去式) contact:n.接触,联系;v.使接触,联系; management:n.管理;管理人员;管理部门;操纵;经营手段; hospitalization:n.住院治疗;医院收容;住院保险(等于hospitalizationinsurance);
That sounded like a great idea, so we did that immediately, and we were shocked when nobody would speak with us. 那听起来像是个好主意, 所以我们马上照做了, 令人惊讶的是, 没人愿意跟我们说话。
The receptionist who answered the phone advised us that the pain management team provides an inpatient service; although they prescribe opioids to get pain under control, they do not oversee tapering and withdrawal. 接电话的接待人员告诉我们, 疼痛管理团队 提供服务给住院病人; 虽然他们会开类鸦片药物来控制疼痛, 但他们不管渐渐减量和戒断。
receptionist:n.接待员;传达员; inpatient:n.住院病人;住院的; oversee:vt.监督;审查;俯瞰;偷看到,无意中看到;
Furious , we called the prescriber back and begged him for anything -- anything that could help me -- but instead he apologized, saying that he was out of his depth. 我们火大了, 又打电话给开处方的医生, 任何能幫助我的都好—— 但他却只是道歉, 说这已经超过他的能力范围。
Furious:adj.激烈的;狂怒的;热烈兴奋的;喧闹的;
'"Look," he told us, "my initial advice to you is clearly bad, so my official recommendation is that Travis go back on the medication until he can find someone more competent to wean him off." 「听着,」他告诉我们: 「我一开始给你的建议 很显然是不好的, 所以我的正式建议是, 崔佛斯应该回到先前的剂量, 直到他找到更有能力的人 来幫他戒掉。」
initial:adj.最初的; n.(名字的)首字母; v.用姓名的首字母作标记(或签名)于; official:adj.官方的;正式的;公务的;n.官员;公务员;高级职员; recommendation:n.推荐;介绍;提议;正式建议; competent:adj.胜任的;有能力的;能干的;足够的; wean:vt.使断奶;使断念;使放弃;n.(苏格兰)幼儿;
Of course I wanted to go back on the medication. 我当然很想要回到之前的剂量。
I was in agony . 我很痛苦。
agony:n.苦恼;极大的痛苦;临死的挣扎;
But I believed that if I saved myself from the withdrawal with the drugs that I would never be free of them, and so we buckled ourselves in, and I dropped the last dose. 但我相信如果我不去戒断这些药物, 我永远脱离不了它们, 所以我们狠下心, 减掉最后一份剂量。
buckled:adj.有扣的; v.用扣子把…扣紧;
As my brain experienced life without prescription opioids for the first time in months, 这是数个月来头一次, 我的大脑能在 没有处方类鸦片药物的 情况下体验人生,
I thought I would die. 我觉得我要死了。
I assumed I would die -- 我假设我要死了——
assumed:adj.假定的;假设的;v.假定;假设;认为;承担;(assume的过去分词和过去式)
(Crying) （哭泣）
I'm sorry. 抱歉。
(Crying) （哭泣）
Because if the symptoms didn't kill me outright , 因为如果症状没有彻底把我杀死,
outright:v.全部地; adj.完全的,彻底的;
I'd kill myself. 我也会自杀。
And I know that sounds dramatic , because to me, standing up here years later, whole and healthy -- to me, it sounds dramatic. 我知道那听起来很戏剧化, 因为对我来说,几年后站在这里, 完整且健康—— 对我来说,听起来很戏剧化。
dramatic:adj.突然的;巨大的;令人吃惊的;激动人心的;
But I believed it to my core because I no longer had any hope that I would be normal again. 但我发自内心相信, 因为我不再抱有 我能够再次恢复正常的任何希望。
core:n.核心;要点;果心;[计]磁心;vt.挖...的核;
The insomnia became unbearable and after two days with virtually no sleep, 失眠变得让人无法忍受, 在足足两天无法入睡之后,
insomnia:n.失眠症,失眠; unbearable:adj.难以忍受的;承受不住的; virtually:adv.事实上,几乎;实质上;
I spent a whole night on the floor of our basement bathroom. 我整晚都待在地下室浴室的地板上。
I alternated between cooling my feverish head against the ceramic tiles and trying violently to throw up despite not having eaten anything in days. 一下子是把我发烧的头部靠在磁磗上 让它冷却下来, 一下子是用力呕吐, 即使数天都几乎没有吃什么。
alternated:交替;轮流(alternate的过去分词);间隔的;轮流的;交替的; feverish:adj.发热的;极度兴奋的; ceramic:adj.陶瓷的;陶器的;制陶艺术的;n.陶瓷;陶瓷制品; tiles:n.[建]瓷砖(tile的复数形式);v.铺砖(tile的第三人称单数形式); violently:adv.猛烈地,激烈地;极端地; despite:prep.尽管,不管;n.轻视;憎恨;侮辱;
When Sadiye found me at the end of the night she was horrified , and we got back on the phone. 莎蒂耶在夜将尽时找到了我, 她吓坏了, 我们又去打电话。
horrified:adj.惊骇的;带有恐怖感的;v.惊骇(horrify的过去式和过去分词);使…战悚;
We called everyone. 我们打给每个人。
We called surgeons and pain docs and general practitioners -- anyone we could find on the internet, and not a single one of them would help me. 我们打给外科医生、疼痛医生, 还有家庭医生—— 任何我们在网路上能找到的人, 却没有一个人能够幫我。
surgeons:n.外科医生;(surgeon的复数) docs:n.说明文件;文献; practitioners:n.实践者;开业者;实习者(practitioner的复数);
The few that we could speak with on the phone advised us to go back on the medication. 有少数几个人愿意 在电话上和我们说话, 建议我们再把剂量加回来。
An independent pain management clinic said that they prescribe opioids but they don't oversee tapering or withdrawal. 有一间独立的疼痛管理诊所, 说他们会开类鸦片药物的处方, 但他们不负责减量或戒断的部分。
independent:adj.独立的; n.无党派议员(或候选人等); clinic:n.诊所;临床实习;(医院的)门诊部;门诊时间;
When my desperation was clearly coming through my voice, much as it is now , the receptionist took a deep breath and said, "Mr. Rieder, it sounds like perhaps what you need is a rehab facility or a methadone clinic." 当我説话的声音中 都带着明显的绝望时, 就像现在一样, 接待人员深呼吸之后说: 「雷德先生,听起来 你可能需要去勒戒机构 或美沙酮诊所。」
as it is now:像现在这样; rehab:n.修复(等于rehabilitation);v.修复(等于rehabilitate); facility:n.设施;设备;特别装置;特色;场所;天资; methadone:n.美沙酮;美散痛;
I didn't know any better at the time, so I took her advice. 我当时什么也不懂, 就接受了她的建议。
I hung up and I started calling those places, but it took me virtually no time at all to discover that many of these facilities are geared towards those battling long-term substance use disorder . 我挂了电话, 开始打电话到这些地方, 但我完全没花什么时间, 就发现许多这类机构 适合的是与药物滥用长期抗战的人。
facilities:n.设施;设备;特别装置;特色;场所;(facility的复数) geared:adj.齿轮传动的,变速螺旋桨; v.用齿轮连接; long-term:adj.长期的;从长远来看; substance:n.物质;实质;主旨;物品; disorder:n.混乱;骚乱;vt.使失调;扰乱;
In the case of opioids, this often involves precisely not weaning the patient off the medication, but transitioning them onto the safer, longer-acting opioids: methadone or buprenorphine for maintenance treatment . 至于类鸦片药物, 通常就是不要让病人马上戒掉药物, 而是要让他们转换到更安全、 更长效的类鸦片药物: 美沙酮或丁丙诺啡,以维持治疗。
involves:v.包含;需要;牵涉;牵连;影响;(使)参加,加入(involve的第三人称单数) weaning:n.断奶;v.断奶(wean的ing形式);使断绝;adj.断奶的; transitioning:v.经历转变过程;过渡;(transition的现在分词) buprenorphine:n.丁丙诺啡;叔丁啡; maintenance:n.维护,维修;保持;生活费用; treatment:n.治疗;疗法;对待;处理;讨论;
In addition , everywhere I called had an extensive waiting list . 此外,我找的每个地方, 等候名单都很长。
addition:n.添加;[数]加法;增加物; extensive:adj.广泛的;大量的;广阔的; waiting list:n.(服务或医疗的)等候者名单;
I was simply not the kind of patient they were designed to see. 我很明确就不是他们的目标对象。
After being turned away from a rehab facility, 在被一间勒戒机构拒绝了之后,
I finally admitted defeat. 我终于承认失败。
finally:adv.终于;最终;(用于列举)最后;彻底地;
I was broken and beaten, and I couldn't do it anymore. 我彻底被打倒了, 我没办法再继续了。
So I told Sadiye that I was going back on the medication. 我告诉莎蒂耶, 我要恢复原本的剂量。
I would start with the lowest dose possible, and I would take only as much as I absolutely needed to escape the most crippling effects of the withdrawal. 我先尽可能从最低的剂量开始, 只取用我绝对必要的量就好, 只是为了脱离最严重的戒断效应。
absolutely:adv.绝对地;完全地; crippling:adj.残废的; v.使残废; (cripple的现在分词)
So that night she helped me up the stairs and for the first time in weeks I actually went to bed. 那晚,她扶我起来,爬上楼, 数个星期以来, 我第一次真的爬上床。
I took the little orange prescription bottle, 我拿了装处方药的橘色小瓶子,
I set it on my nightstand ... 放在我的床头柜上……
nightstand:n.(美)床头几(等于nighttable);
and then I didn't touch it. 我并没有去碰它。
I fell asleep, 我入睡了,
I slept through the night and when I woke up, the most severe symptoms had abated dramatically . 我睡了整晚, 当我醒来时, 最严重的症状已经大大减轻。
severe:adj.极为恶劣的;十分严重的;严厉的;苛刻的; abated:vt.减轻;减少;废除;vi.减轻;失效; dramatically:adv.戏剧地;引人注目地;adv.显著地,剧烈地;
I'd made it out. 我挺过去了。
(Applause) （掌声）
Thanks for that, that was my response , too. 谢谢,那也是我的第一个反应。
response:n.响应;反应;回答;
(Laughter) （笑声）
So -- 所以——
I'm sorry, I have to gather myself just a little bit. 抱歉,我得要调整一下心情。
I think this story is important. 我认为这个故事很重要。
It's not because I think I'm special. 并不是因为我认为我很特别。
This story is important precisely because I'm not special; because nothing that happened to me was all that unique . 这个故事之所以重要, 正是因为我不特别; 因为发生在我身上的事 并非独一无二。
unique:adj.独特的,稀罕的;[数]唯一的;n.独一无二的人或物;
My dependence on opioids was entirely predictable given the amount that I was prescribed and the duration for which I was prescribed it. 我对于类鸦片药物的依赖 完全是可预期的, 毕竟我拿到的处方剂量相当大, 我吃处方药的期间也很长。
dependence:n.依赖;依靠;信任;信赖; predictable:adj.可预言的; prescribed:v.给…开(药); (prescribe的过去式和过去分词) duration:n.持续时间;期间;
Dependence is simply the brain's natural response to an opioid-rich environment and so there was every reason to think that from the beginning, 依赖只是大脑对于富含类鸦片 药物的环境所做出的自然反应, 所以绝对有理由可以相信, 打从一开始,
I would need a supervised , well-formed tapering plan, but our health care system seemingly hasn't decided who's responsible for patients like me. 我就需要一个 受监控且合适的减量计画, 但我们的健康照护制度似乎还没有决定 像我这样的病人要由谁来负责。
supervised:v.监督;管理;指导;主管(supervise的过去分词和过去式) well-formed:adj.身材苗条的;结构良好的;符合语法规则的; health care:n.卫生保健; responsible:adj.负责的,可靠的;有责任的; patients:n.接受治疗者,病人;(patient的复数)
The prescribers saw me as a complex patient needing specialized care, probably from pain medicine. 开处方药的医生 把我视为一个复杂的病人, 需要专门的照护, 可能戒除止痛药物。
prescribers:开处方者; complex:adj.复杂的;合成的;n.复合体;综合设施; specialized:adj.专业的; v.专门研究(或从事); (specialize的过去式和过去分词)
The pain docs saw their job as getting pain under control and when I couldn't get off the medication, they saw me as the purview of addiction medicine. 疼痛医生认为他们的工作 是要控制疼痛, 当我无法脱离药物时, 他们认为我属于上瘾药物的范围。
purview:n.范围,权限;视界;条款; addiction:n.瘾;嗜好;入迷;
But addiction medicine is overstressed and focused on those suffering from long-term substance use disorder. 但上瘾药物主要是强调 和着重那些对抗长期药物滥用的人。
overstressed:vt.过分强调;过分拉紧(或紧张);n.过分的强调;紧张过度;
In short, I was prescribed a drug that needed long-term management and then I wasn't given that management, and it wasn't even clear whose job such management was. 简言之,我拿到的处方药 是需要长期管理的药物, 但却没人提供我这种管理, 甚至不清楚这种管理到底是谁的工作。
This is a recipe for disaster and any such disaster would be interesting and worth talking about -- probably worth a TED Talk -- but the failure of opioid tapering is a particular concern at this moment in America because we are in the midst of an epidemic in which 33,000 people died from overdose in 2015. 这注定会导致灾祸, 任何像这样的灾祸 会很有意思且值得拿出来谈—— 可能值得做一场 TED 演说—— 但此时,在美国, 类鸦片药物减量的失败 是个特别需要关注的议题, 因为我们现在正在流行期当中, 2015 年就有三万三千人 因为用药过量致死。
recipe:n.食谱;方法;诀窍;烹饪法; disaster:n.灾难,灾祸;不幸; midst:n.当中,中间;prep.在…中间(等于amidst); epidemic:n.流行病;蔓延;adj.传染病;流行性的; overdose:n.(一次用药)过量;v.一次用药过量;
Nearly half of those deaths involved prescription opioids. 这些人当中,有近一半 和有处方的类鸦片药物有关。
involved:adj.有关的; v.涉及; (involve的过去式和过去分词)
The medical community has in fact started to react to this crisis , but much of their response has involved trying to prescribe fewer pills -- and absolutely, that's going to be important. 事实上,医疗圈已经开始 对这项危机做出反应, 但他们的反应大多是在试图 开比较少的处方药—— 当然,那是很重要的。
community:n.社区;[生态]群落;共同体;团体; react:v.起反应;回应;(对食物等)有不良反应,过敏;起化学反应; crisis:n.危机;危险期;决定性时刻;adj.危机的;用于处理危机的; pills:n.药丸; v.起球; (pill的第三人称单数和复数)
So for instance , we're now gaining evidence that American physicians often prescribe medication even when it's not necessary in the case of opioids. 比如,我们现在有证据显示, 美国医生常在即使不必要的时候, 也会开处方药, 如类鸦片药物。
instance:n.实例;情况;建议;v.举...为例; evidence:n.证据,证明;迹象;明显;v.证明; physicians:n.[内科]内科医生(physician的复数);
And even when opioids are called for, they often prescribe much more than is needed. 即使是需要类鸦片药物时, 他们处方的剂量也比需要的多很多。
These sorts of considerations help to explain why America, despite accounting for only five percent of the global population, consumes nearly 70 percent of the total global opioid supply. 这类原因说明为什么美国人口 只占了世界人口的 5%, 消耗掉的类鸦片药物 却占全球总供应的近 70%。
considerations:n.考虑;注意事项(consideration的复数形式);体贴; global:adj.全球的;总体的;球形的; consumes:v.消耗,耗费;吃;喝;饮;使充满(强烈的感情);(consume的第三人称单数)
But focusing only on the rate of prescribing risks overlooking two crucially important points. 但如果只把焦点放在开处方的比率, 会有忽略两个关键点的风险。
overlooking:v.忽略;不予理会;俯视;眺望;(overlook的现在分词) crucially:adv.关键地;至关重要地;
The first is that opioids just are and will continue to be important pain therapies . 第一,类鸦片药物目前是, 将来也继续会是重要的止痛方式。
therapies:n.治疗方法(therapy复数形式);
As somebody who has had severe, real, long-lasting pain, 我自己不久前才经历了 严重、真实、长久的痛苦,
long-lasting:adj.持续时间长的;
I can assure you these medications can make life worth living. 我可以向各位保证, 这些药物能让人生变得值得活下去。
assure:vt.保证;担保;使确信;弄清楚; medications:n.药;药物;(medication的复数)
And second: we can still fight the epidemic while judiciously prescribing opioids to people who really need them by requiring that doctors properly manage the pills that they do prescribe. 第二, 我们可以一边对抗流行期, 一边明智而谨慎地处方类鸦片药物 给真正需要它们的人, 做法是要求医生要妥当管理 他们处方的药物。
judiciously:adv.明智而审慎地;明断地;
So for instance, go back to the tapering regimen that I was given. 举例来说, 回到他们给我的剂量渐减方案。
Is it reasonable to expect that any physician who prescribes opioids knows that that is too aggressive? 期待处方类鸦片药物给我的医生 知道这个方案太积极, 这种期待是合理的吗？
reasonable:adj.合理的,公道的;通情达理的; prescribes:开药方;规定;
Well, after I initially published my story in an academic journal , someone from the CDC sent me their pocket guide for tapering opioids. 在我把我的故事初次刊登在 一本学术期刊上之后, 疾病防治中心的人寄给我一本 类鸦片药物剂量渐减的口袋指南。
initially:adv.最初,首先;开头; academic:adj.学术的;理论的;学院的;n.大学生,大学教师;学者; journal:n.杂志;日记;日志;(用于报纸名)…报;
This is a four-page document, and most of it's pictures. 这份文件共四页, 大部分是图片。
In it, they teach physicians how to taper opioids in the easier cases, and one of the their recommendations is that you never start at more than a 10 percent dose reduction per week. 在指南中,他们教医生 如何针对比较容易的案例 就是每周减少的剂量 不要超过 10%。
recommendations:n.推荐;推荐信;推荐规范(recommendation的复数形式); reduction:n.减少;缩小;降低;减价;折扣;缩图;
If my physician had given me that plan, my taper would have taken several months instead of a few weeks. 如果我的医生有给我这样的方案, 我的剂量渐减会需要花 数个月时间,而不是几周。
I'm sure it wouldn't have been easy. 我确信不会太好过。
It probably would have been pretty uncomfortable, but maybe it wouldn't have been hell. 可能会很不舒服, 但也许不会像地狱一样。
And that seems like the kind of information that someone who prescribes this medication ought to have. 这些资讯似乎是 负责处方这类药物的人应该要知道的。
In closing, 最后结尾,
I need to say that properly managing prescribed opioids will not by itself solve the crisis. 我得要说,单靠妥当管理 处方的类鸦片药物 不能解决危机。
America's epidemic is far bigger than that, but when a medication is responsible for tens of thousands of deaths a year, reckless management of that medication is indefensible . 美国的流行状况严重到它无法解决, 但如果这种药物 造成一年数万人死亡, 随便管理这类药物是不可原谅的。
reckless:adj.鲁莽的,不顾后果的;粗心大意的; indefensible:adj.站不住脚的;不能防卫的;无辩护余地的;
Helping opioid therapy patients to get off the medication that they were prescribed may not be a complete solution to our epidemic, but it would clearly constitute progress. 协助类鸦片药物治疗的病人戒除 他们的处方药物 或许不是能彻底解决流行问题的方案, 但它依然可以带来进展。
solution:n.解决方案;溶液;溶解;解答; constitute:v.组成;构成;(合法或正式地)成立,设立;
Thank you. 谢谢。
(Applause) （掌声）