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除了疫情,美國(guó)還面臨止疼藥危機(jī)

Joseph Stauffer
2020-12-21

美國(guó)需要加快研發(fā)的步伐,以發(fā)現(xiàn)有效的低風(fēng)險(xiǎn)止疼藥。

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手術(shù)從來(lái)都不是什么有趣的事情。然而,在全球疫情期間進(jìn)行手術(shù)尤為恐怖。當(dāng)我最近因?yàn)轲逇舛煌粕鲜中g(shù)臺(tái)時(shí),在我不得不擔(dān)心的潛在致命后果長(zhǎng)篇清單中又多了新冠病毒一項(xiàng)。

長(zhǎng)篇清單?是的:我和手術(shù)室之間的緣分由來(lái)已久, 10年前我進(jìn)行了一次開胸手術(shù),治療主動(dòng)脈瘤和鈣化瓣膜。術(shù)后留下了很多潛在風(fēng)險(xiǎn)和隱患。我的胸腔內(nèi)如今用的是一塊鈦瓣膜。我還在使用血液稀釋劑,這意味著我無(wú)法使用傳統(tǒng)的非甾體類消炎止痛藥(NSAID),例如布洛芬、阿司匹林和萘普生,因?yàn)檫@類藥物的副作用(包括腸胃穿孔和出血)可能造成身體的嚴(yán)重傷害或死亡。同時(shí),我還不想使用阿片類藥物,因?yàn)橛谐砂a風(fēng)險(xiǎn),何況還有便秘和一系列其他副作用。

當(dāng)我躺上手術(shù)臺(tái)上時(shí),我必須接受不適用于長(zhǎng)效止疼的對(duì)乙酰氨基酚,而且對(duì)術(shù)后組織損傷引發(fā)的炎癥也只能聽之任之。真的是太疼了。

我希望自己是唯一有這種體驗(yàn)的人,但事實(shí)上很多人在這一療法面前也面臨著同樣的痛苦和選擇?!禤harmacy Times》最近的報(bào)道稱,服用血液稀釋劑的美國(guó)人達(dá)到800萬(wàn)之多。

然而,作為生物科技研究公司的首席醫(yī)療官,我對(duì)急性和慢性疼痛的用藥要求有著高于常人的認(rèn)識(shí)。我唯一了解到的事情就是:社會(huì)需要新的藥物和療法,以避免將普通的小病或常規(guī)醫(yī)療流程變?yōu)椴槐匾馁€博。

在手術(shù)之后不能使用非甾體類止疼藥確實(shí)是相當(dāng)痛苦的事情。然而,這里還有慢性疼痛,有四分之一的成年人都會(huì)有這樣或那樣的慢性病。我會(huì)定期地出現(xiàn)全身性的疼痛,源于少年時(shí)的運(yùn)動(dòng)損傷、服役時(shí)受的傷,以及歲數(shù)漸長(zhǎng)這個(gè)簡(jiǎn)單的事實(shí)。對(duì)那些同時(shí)具有多種風(fēng)險(xiǎn)因素的人來(lái)說(shuō),服錯(cuò)止疼藥可能會(huì)引發(fā)嚴(yán)重的后果。我們有必要認(rèn)真衡量一切所攝取藥物的利弊。

有很多人嘗試過阿片類藥物,通常用于緩解中度到重度疼痛。然而,此舉讓更多的人陷入了北美肆虐的成癮危機(jī)之中。2019年,7.2萬(wàn)美國(guó)人死于藥物過量,其中有三分之二跟阿片類藥物有關(guān)。

在我前半生擔(dān)任美國(guó)海軍醫(yī)生期間,我曾經(jīng)在費(fèi)城北部很多初級(jí)醫(yī)療診所和農(nóng)村診所兼職。在那里,我切身體會(huì)了阿片類藥物對(duì)人類真實(shí)而充滿了破壞性的影響。很簡(jiǎn)單,這種藥物會(huì)讓人成癮。即便少量的誤用也會(huì)導(dǎo)致嚴(yán)重的神經(jīng)問題,包括昏迷、腦損傷或死亡,更不用說(shuō)有關(guān)成癮的頑固惡習(xí)。醫(yī)療專業(yè)人士和制藥商應(yīng)該發(fā)揮主導(dǎo)作用,在社區(qū)內(nèi)提升人們對(duì)成癮的認(rèn)識(shí),并開展戒癮對(duì)話。

賓州的農(nóng)場(chǎng)鄉(xiāng)村、軍隊(duì)、商界,只要我待過的地方,我都曾經(jīng)看到過阿片類藥物成癮現(xiàn)象。這一危機(jī)在城鎮(zhèn)、農(nóng)場(chǎng)和大廈中遠(yuǎn)近皆有,已經(jīng)達(dá)到了肆虐的地步。如今,全球新冠疫情帶來(lái)的不安、用藥者的隔離、未污染藥物供應(yīng)的中斷,以及醫(yī)療服務(wù)的收稅,讓阿片類藥物危機(jī)更加致命。

當(dāng)我最近一次做手術(shù)時(shí),醫(yī)生在手術(shù)后立即給我服用了阿片類藥物。離開醫(yī)院的恢復(fù)區(qū)之后,我就決定強(qiáng)忍著術(shù)后疼痛,不服用阿片類藥物和非甾體類止疼藥,美其名曰:不靠藥物而活。我的決定以及隨之而來(lái)的身體不適再次提醒著社會(huì),我們迫切需要替代類藥物。

幸運(yùn)的是,我加入了一個(gè)強(qiáng)大的生物科技和醫(yī)療專業(yè)人士團(tuán)體,他們一直在尋找非成癮性止疼解決方案。

隨著醫(yī)療界在接下來(lái)的幾個(gè)月中推出新冠疫苗,我們需要加快研發(fā)的步伐,以發(fā)現(xiàn)有效的低風(fēng)險(xiǎn)止疼藥。我自己的公司正在開發(fā)三種源自于傳統(tǒng)非甾體類藥物的止疼藥,但它們對(duì)消化系統(tǒng)更加安全。

我們還需要更新傳統(tǒng)的藥物發(fā)現(xiàn)流程,因?yàn)檫@個(gè)流程是出了名的耗時(shí)。我們需要?jiǎng)?chuàng)建一種模式,這樣,科學(xué)家可以從事他們的工作,與此同時(shí),醫(yī)療專業(yè)人士則能夠迅速地從研發(fā)轉(zhuǎn)向臨床試驗(yàn),再到政府批準(zhǔn)和替代藥物上市的部署階段。

我相信終有實(shí)現(xiàn)的這一天,就像我相信我們可以打敗新冠病毒一樣。我樂觀地認(rèn)為,像我經(jīng)歷過的手術(shù)在未來(lái)可能會(huì)成為一種常規(guī)性的手術(shù),即便對(duì)于具有風(fēng)險(xiǎn)因素的人來(lái)說(shuō)亦是如此。要獲得成功,我們只需確保止疼藥解決的唯一問題就是疼痛。(財(cái)富中文網(wǎng))

約瑟夫?斯托弗是Antibe Therapeutics公司的首席醫(yī)療官。

譯者:馮豐

審校:夏林

手術(shù)從來(lái)都不是什么有趣的事情。然而,在全球疫情期間進(jìn)行手術(shù)尤為恐怖。當(dāng)我最近因?yàn)轲逇舛煌粕鲜中g(shù)臺(tái)時(shí),在我不得不擔(dān)心的潛在致命后果長(zhǎng)篇清單中又多了新冠病毒一項(xiàng)。

長(zhǎng)篇清單?是的:我和手術(shù)室之間的緣分由來(lái)已久, 10年前我進(jìn)行了一次開胸手術(shù),治療主動(dòng)脈瘤和鈣化瓣膜。術(shù)后留下了很多潛在風(fēng)險(xiǎn)和隱患。我的胸腔內(nèi)如今用的是一塊鈦瓣膜。我還在使用血液稀釋劑,這意味著我無(wú)法使用傳統(tǒng)的非甾體類消炎止痛藥(NSAID),例如布洛芬、阿司匹林和萘普生,因?yàn)檫@類藥物的副作用(包括腸胃穿孔和出血)可能造成身體的嚴(yán)重傷害或死亡。同時(shí),我還不想使用阿片類藥物,因?yàn)橛谐砂a風(fēng)險(xiǎn),何況還有便秘和一系列其他副作用。

當(dāng)我躺上手術(shù)臺(tái)上時(shí),我必須接受不適用于長(zhǎng)效止疼的對(duì)乙酰氨基酚,而且對(duì)術(shù)后組織損傷引發(fā)的炎癥也只能聽之任之。真的是太疼了。

我希望自己是唯一有這種體驗(yàn)的人,但事實(shí)上很多人在這一療法面前也面臨著同樣的痛苦和選擇?!禤harmacy Times》最近的報(bào)道稱,服用血液稀釋劑的美國(guó)人達(dá)到800萬(wàn)之多。

然而,作為生物科技研究公司的首席醫(yī)療官,我對(duì)急性和慢性疼痛的用藥要求有著高于常人的認(rèn)識(shí)。我唯一了解到的事情就是:社會(huì)需要新的藥物和療法,以避免將普通的小病或常規(guī)醫(yī)療流程變?yōu)椴槐匾馁€博。

在手術(shù)之后不能使用非甾體類止疼藥確實(shí)是相當(dāng)痛苦的事情。然而,這里還有慢性疼痛,有四分之一的成年人都會(huì)有這樣或那樣的慢性病。我會(huì)定期地出現(xiàn)全身性的疼痛,源于少年時(shí)的運(yùn)動(dòng)損傷、服役時(shí)受的傷,以及歲數(shù)漸長(zhǎng)這個(gè)簡(jiǎn)單的事實(shí)。對(duì)那些同時(shí)具有多種風(fēng)險(xiǎn)因素的人來(lái)說(shuō),服錯(cuò)止疼藥可能會(huì)引發(fā)嚴(yán)重的后果。我們有必要認(rèn)真衡量一切所攝取藥物的利弊。

有很多人嘗試過阿片類藥物,通常用于緩解中度到重度疼痛。然而,此舉讓更多的人陷入了北美肆虐的成癮危機(jī)之中。2019年,7.2萬(wàn)美國(guó)人死于藥物過量,其中有三分之二跟阿片類藥物有關(guān)。

在我前半生擔(dān)任美國(guó)海軍醫(yī)生期間,我曾經(jīng)在費(fèi)城北部很多初級(jí)醫(yī)療診所和農(nóng)村診所兼職。在那里,我切身體會(huì)了阿片類藥物對(duì)人類真實(shí)而充滿了破壞性的影響。很簡(jiǎn)單,這種藥物會(huì)讓人成癮。即便少量的誤用也會(huì)導(dǎo)致嚴(yán)重的神經(jīng)問題,包括昏迷、腦損傷或死亡,更不用說(shuō)有關(guān)成癮的頑固惡習(xí)。醫(yī)療專業(yè)人士和制藥商應(yīng)該發(fā)揮主導(dǎo)作用,在社區(qū)內(nèi)提升人們對(duì)成癮的認(rèn)識(shí),并開展戒癮對(duì)話。

賓州的農(nóng)場(chǎng)鄉(xiāng)村、軍隊(duì)、商界,只要我待過的地方,我都曾經(jīng)看到過阿片類藥物成癮現(xiàn)象。這一危機(jī)在城鎮(zhèn)、農(nóng)場(chǎng)和大廈中遠(yuǎn)近皆有,已經(jīng)達(dá)到了肆虐的地步。如今,全球新冠疫情帶來(lái)的不安、用藥者的隔離、未污染藥物供應(yīng)的中斷,以及醫(yī)療服務(wù)的收稅,讓阿片類藥物危機(jī)更加致命。

當(dāng)我最近一次做手術(shù)時(shí),醫(yī)生在手術(shù)后立即給我服用了阿片類藥物。離開醫(yī)院的恢復(fù)區(qū)之后,我就決定強(qiáng)忍著術(shù)后疼痛,不服用阿片類藥物和非甾體類止疼藥,美其名曰:不靠藥物而活。我的決定以及隨之而來(lái)的身體不適再次提醒著社會(huì),我們迫切需要替代類藥物。

幸運(yùn)的是,我加入了一個(gè)強(qiáng)大的生物科技和醫(yī)療專業(yè)人士團(tuán)體,他們一直在尋找非成癮性止疼解決方案。

隨著醫(yī)療界在接下來(lái)的幾個(gè)月中推出新冠疫苗,我們需要加快研發(fā)的步伐,以發(fā)現(xiàn)有效的低風(fēng)險(xiǎn)止疼藥。我自己的公司正在開發(fā)三種源自于傳統(tǒng)非甾體類藥物的止疼藥,但它們對(duì)消化系統(tǒng)更加安全。

我們還需要更新傳統(tǒng)的藥物發(fā)現(xiàn)流程,因?yàn)檫@個(gè)流程是出了名的耗時(shí)。我們需要?jiǎng)?chuàng)建一種模式,這樣,科學(xué)家可以從事他們的工作,與此同時(shí),醫(yī)療專業(yè)人士則能夠迅速地從研發(fā)轉(zhuǎn)向臨床試驗(yàn),再到政府批準(zhǔn)和替代藥物上市的部署階段。

我相信終有實(shí)現(xiàn)的這一天,就像我相信我們可以打敗新冠病毒一樣。我樂觀地認(rèn)為,像我經(jīng)歷過的手術(shù)在未來(lái)可能會(huì)成為一種常規(guī)性的手術(shù),即便對(duì)于具有風(fēng)險(xiǎn)因素的人來(lái)說(shuō)亦是如此。要獲得成功,我們只需確保止疼藥解決的唯一問題就是疼痛。(財(cái)富中文網(wǎng))

約瑟夫?斯托弗是Antibe Therapeutics公司的首席醫(yī)療官。

譯者:馮豐

審校:夏林

Surgery is never fun. But surgery during a global pandemic is an especially frightening prospect. When I went under the knife for a corrective hernia procedure recently, COVID-19 got added to the long list of potentially fatal outcomes I had to worry about.

Long list? Yes: The operating room and I go way back, which has left me with a lot of risk factors. I had open-heart surgery a decade ago to fix an aortic aneurysm and calcified valve. I have a titanium valve in my chest. I’m also on blood thinners, that means I can’t take traditional NSAID painkillers like ibuprofen, aspirin, and naproxen, because their side effects—which include gastrointestinal perforations and bleeding—could seriously injure or kill me. And I don’t want to take opioids, which pose the risk of addiction, not to mention severe constipation and a host of other side effects.

When I went under the knife, I had to make do with acetaminophen, which just isn’t suitable for durable pain relief—and does nothing for the inflammation that follows surgically injured tissue. It hurt like hell.

I wish I could say that my experience was unique, but many others face the same kind of pain and the same kind of choices around its treatment—8 million Americans take blood thinners, according to a recent report from Pharmacy Times.

However, as chief medical officer of a pain-focused biotech research company, I have better than usual line of sight into the requirement for medications for acute and chronic pain. And if I’ve learned one thing, it’s this: Society needs new drugs and remedies that don’t turn common ailments or routine health care procedures into unnecessary gambles.

It’s hard enough to be unable to use NSAID pain relievers after surgery. But there’s also chronic pain, which a quarter of all adults suffer from in one form or another. Again, my own story is relevant and not unusual. I experience regular pain throughout my body stemming from teenage sports and military service injuries, and due to the simple fact that I’m aging. For anyone with multiple risk factors, the wrong decision about what pain pill to take could have severe consequences. We need to seriously weigh the pros and cons of everything we ingest.

Many of us try opioids, which are often used for moderate to severe pain. But that risks turning even more people into statistics in North America’s raging addiction crisis. Opioids were a factor in two-thirds of America’s 72,000 drug overdose deaths in 2019.

In my previous life as a U.S. Navy doctor, I moonlighted in various North Philadelphia primary-care settings and rural clinics, where I saw the real and devastatingly human impact of opioids close up. They’re addictive—plain and simple. Even light misuse can lead to serious neurological effects, including coma, brain damage, or death—not to mention the persistent stigma around addiction. Medical professionals and pharmaceutical providers need to play a leading role in encouraging addiction awareness and stigma reduction conversations within communities like these.

Pennsylvania farm country, the military, the business world—everywhere I’ve spent time, I’ve seen opioid addiction. The crisis runs rampant in cities and towns, on farms and in mansions, far away and next door. And now, the global COVID-19 pandemic has made the opioid crisis even more deadly, by creating insecurity, isolating users, disrupting the flow of uncontaminated drug supplies, and taxing our health services.

When I had my latest surgery, I was given opioid medications during and immediately after the procedure. But once I left the hospital recovery area, I made the call to live with my postoperative pain, opioid- and NSAID-free, in the name of living beyond it. My decision, and the physical discomfort that came with it, was another reminder of how desperately we need alternative medications.

Fortunately, I’m part of a strong community of biotech and medical professionals looking for nonaddictive pain relief solutions.

As the medical community sprints toward rolling out COVID-19 vaccines in the coming months, we need to keep racing in parallel on the research and development required to introduce effective, lower-risk pain relief. My own company is developing three pain medications that are derived from traditional NSAIDs but designed to be safer for the gastrointestinal system.

We also need to renovate the traditional drug discovery process—a famously lengthy endeavor. We need a model that allows science to do its thing while empowering medical professionals to move quickly from R&D to trial to government approval to deployment phases of bringing alternatives to market.

I believe we’ll get there, just like I believe we’ll beat COVID-19. I am optimistic that future surgeries like mine will be as routine as it gets, even for people with risk factors. To succeed, we just need to make sure that pain is the only thing we’re killing with painkillers.

Dr. Joseph Stauffer is the chief medical officer at Antibe Therapeutics.

財(cái)富中文網(wǎng)所刊載內(nèi)容之知識(shí)產(chǎn)權(quán)為財(cái)富媒體知識(shí)產(chǎn)權(quán)有限公司及/或相關(guān)權(quán)利人專屬所有或持有。未經(jīng)許可,禁止進(jìn)行轉(zhuǎn)載、摘編、復(fù)制及建立鏡像等任何使用。
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