TEDMED 2017
Mark Tyndall: The harm reduction model of drug addiction treatment
馬克丁鐸爾: 毒癮治療的減少傷害方案
Filmed:
Readability: 5.4
1,341,450 views
為什麼我們仍然認為施用毒品是個執法議題？公共健康專家馬克丁鐸爾認為，把毒品非法化並不會阻止人們施用毒品。那麼甚麼才是有效的方法？丁鐸爾用社區基礎研究來說明減少傷害策略（例如設置安全注射站）能有效處理毒品濫用的危機。
Mark Tyndall - Epidemiologist, physician, public health expert
Mark Tyndall has dedicated his career to studying HIV, poverty and drug use in multiple places around the world, starting with Nairobi, and now in Vancouver. Full bio
Mark Tyndall has dedicated his career to studying HIV, poverty and drug use in multiple places around the world, starting with Nairobi, and now in Vancouver. Full bio
Double-click the English transcript below to play the video.
00:12
I remember the first time
that I saw people injecting drugs.
that I saw people injecting drugs.
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我還記得第一次看到
別人注射毒品的經驗
別人注射毒品的經驗
00:18
I had just arrived in Vancouver
to lead a research project
to lead a research project
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我才剛剛到溫哥華主導一個研究計畫
是一個愛滋病防治計畫
00:21
in HIV prevention in the
infamous Downtown East Side.
infamous Downtown East Side.
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就在惡名昭彰的溫哥華城中東區
00:27
It was in the lobby of the Portland Hotel,
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事情就發生在波特蘭旅館的大廳
00:29
a supportive housing
project that gave rooms
project that gave rooms
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那裡有個住房支持計畫提供住所
00:32
to the most marginalized
people in the city,
people in the city,
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給城市中最邊緣化的一群人
00:34
the so-called "difficult to house."
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所謂「很難收容的人」
00:38
I'll never forget the young woman
standing on the stairs
standing on the stairs
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我永遠無法忘記
那個站在樓梯上的年輕女子
那個站在樓梯上的年輕女子
00:42
repeatedly jabbing herself with a needle,
and screaming,
and screaming,
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一邊不斷地用注射針猛刺自己
一邊大喊「我找不到血管」
00:46
"I can't find a vein,"
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00:47
as blood splattered on the wall.
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同時血飛濺到牆上
為了因應層出不窮的
00:52
In response to the desperate
state of affairs, the drug use,
state of affairs, the drug use,
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毒品濫用 貧窮 暴力
00:56
the poverty, the violence,
the soaring rates of HIV,
the soaring rates of HIV,
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和飆升的愛滋病罹患率
01:00
Vancouver declared a public
health emergency in 1997.
health emergency in 1997.
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溫哥華市在 1997 年
宣佈進入公共衛生警戒狀態
宣佈進入公共衛生警戒狀態
01:05
This opened the door to
expanding harm reduction services,
expanding harm reduction services,
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此舉開啟了一扇門來擴展減害服務
01:08
distributing more needles,
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分發更多注射針
01:10
increasing access to methadone,
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讓美沙酮更容易取得
01:12
and, finally, opening
a supervised injection site.
a supervised injection site.
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最後，還開設了一個
有人管理的安全注射站
有人管理的安全注射站
01:16
Things that make injecting
drugs less hazardous.
drugs less hazardous.
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這些都能讓毒品注射的危險降低
01:20
But today, 20 years later,
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但 20 年後的今天
01:23
harm reduction is still viewed
as some sort of radical concept.
as some sort of radical concept.
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減害的概念仍然被視為
是某種極端的觀念
是某種極端的觀念
01:27
In some places, it's still illegal
to carry a clean needle.
to carry a clean needle.
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帶著乾淨的注射針
在某些地方仍然不合法
在某些地方仍然不合法
01:31
Drug users are far more likely
to be arrested
to be arrested
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毒癮者被逮捕的機會
01:34
than to be offered methadone therapy.
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高過得到美沙酮治療的機會
01:37
Recent proposals for
supervised injection sites
supervised injection sites
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有些近期提案建議把安全注射站
01:40
in cities like Seattle,
Baltimore and New York
Baltimore and New York
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開設在像是西雅圖
巴爾的摩及紐約這類城市
巴爾的摩及紐約這類城市
01:43
have been met with stiff opposition:
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卻被強力抵制
01:46
opposition that goes against
everything we know about addiction.
everything we know about addiction.
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這種抵制和所有我們
對成癮的認知背道而馳
對成癮的認知背道而馳
01:52
Why is that?
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怎麼說呢?
01:53
Why are we still stuck on the idea
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為什麼很多人仍然堅持
01:56
that the only option is to stop using --
that any drug use will not be tolerated?
that any drug use will not be tolerated?
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阻止濫用毒品的唯一的選擇
是全面禁止施打毒品？
是全面禁止施打毒品？
02:03
Why do we ignore
countless personal stories
countless personal stories
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為什麼我們還是不願意正眼看待
數不清的成功案例
和壓倒性的科學證據
和壓倒性的科學證據
02:06
and overwhelming scientific evidence
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02:09
that harm reduction works?
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證明減害計畫是有效的？
02:12
Critics say that harm
reduction doesn't stop people
reduction doesn't stop people
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有評論說，減害方案沒有辦法遏止
02:16
from using illegal drugs.
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大眾吸食毒品
02:19
Well, actually, that is the whole point.
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其實這才是重點
02:21
After every criminal and societal sanction
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就算加諸所有我們想到的
刑法和社會制裁
刑法和社會制裁
02:24
that we can come up with,
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02:26
people still use drugs,
and far too many die.
and far too many die.
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毒品濫用還是存在且太多人因此喪命
02:31
Critics also say that
we are giving up on people
we are giving up on people
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很多批評說我們是在放棄毒癮者
02:33
by not focusing our attention
on treatment and recovery.
on treatment and recovery.
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因為我們沒有著重在治療和康復上
02:38
In fact, it is just the opposite.
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事實上恰恰相反
02:40
We are not giving up on people.
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我們沒有放棄毒癮者
02:42
We know that if recovery
is ever going to happen
is ever going to happen
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我們很清楚如果要讓他們恢復
02:44
we must keep people alive.
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我們得先讓他們能活下來
02:46
Offering someone a clean needle
or a safe place to inject
or a safe place to inject
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提供他們一支乾淨的注射針
或一個安全的注射地點
或一個安全的注射地點
02:50
is the first step to
treatment and recovery.
treatment and recovery.
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就是治療和康復的第一步
02:54
Critics also claim that harm reduction
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也有人批評說 減害計畫
02:57
gives the wrong message to
our children about drug users.
our children about drug users.
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讓我們的孩子對毒癮者有錯誤的印象
03:01
The last time I looked,
these drug users are our children.
these drug users are our children.
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我最後一次看
這些毒癮者就是我們的孩子
這些毒癮者就是我們的孩子
03:06
The message of harm reduction
is that while drugs can hurt you,
is that while drugs can hurt you,
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減少傷害所傳遞的訊息
是雖然毒品會傷害你
是雖然毒品會傷害你
03:10
we still must reach out to
people who are addicted.
people who are addicted.
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我們還是得要向成癮的人伸出手
03:13
A needle exchange is not an
advertisement for drug use.
advertisement for drug use.
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換新注射針並不是幫施打毒品打廣告
03:17
Neither is a methadone clinic
or a supervised injection site.
or a supervised injection site.
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安全注射站或美沙酮診所也不是
03:21
What you see there are
people sick and hurting,
people sick and hurting,
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在這些地方你只會看見生病受苦的人
03:25
hardly an endorsement for drug use.
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根本不是在為吸食毒品做背書
03:28
Let's take supervised
injection sites, for example.
injection sites, for example.
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以安全注射站為例
03:31
Probably the most misunderstood
health intervention ever.
health intervention ever.
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它可能是史上最被誤解的醫療介入了
03:35
All we are saying is that allowing people
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我們要說的是 讓毒品成癮者
03:38
to inject in a clean, dry space
with fresh needles,
with fresh needles,
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能在一個衛生乾淨的空間中
用新的注射針來施打藥物
用新的注射針來施打藥物
03:42
surrounded by people who care
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身邊圍繞的是在乎他們的人
03:44
is a lot better than
injecting in a dingy alley,
injecting in a dingy alley,
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這樣的做法遠遠勝過讓他們
在骯髒巷子裡注射
在骯髒巷子裡注射
03:47
sharing contaminated needles
and hiding out from police.
and hiding out from police.
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共用針頭 躲著警察
03:51
It's better for everybody.
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這樣對大家都好
03:54
The first supervised injection site
in Vancouver was at 327 Carol Street,
in Vancouver was at 327 Carol Street,
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溫哥華的第一個安全注射站
位在卡羅街 327 號
位在卡羅街 327 號
04:00
a narrow room with a concrete floor,
a few chairs and a box of clean needles.
a few chairs and a box of clean needles.
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一個小小的房間 水泥地板
幾張椅子 和一盒乾淨的針頭
幾張椅子 和一盒乾淨的針頭
04:06
The police would often lock it down,
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警方常常把它鎖起來
04:08
but somehow it always
mysteriously reopened,
mysteriously reopened,
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可是它總是很神奇地又重新開張
04:12
often with the aid of a crowbar.
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通常是有鐵橇的幫忙
04:15
I would go down there some evenings
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我有時候會晚上到那裡去
04:17
to provide medical care
for people who were injecting drugs.
for people who were injecting drugs.
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提供醫療照護給在注射毒品的人
04:20
I was always struck with the
commitment and compassion
commitment and compassion
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我總是被營運和使用該站點的人
04:23
of the people who operated
and used the site.
and used the site.
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展現的投入和同理心深深感動
04:27
No judgment, no hassles, no fear,
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沒有評斷 沒有口角 沒有恐懼
04:30
lots of profound conversation.
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有的是很多深刻的對談
04:32
I learned that despite
unimaginable trauma,
unimaginable trauma,
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我了解到儘管有無法想像的傷痛
04:35
physical pain and mental illness,
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身體痛苦和精神疾病
04:38
that everyone there thought
that things would get better.
that things would get better.
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但那裡的每個人相信 一切都會好轉
04:42
Most were convinced that, someday,
they'd stop using drugs altogether.
they'd stop using drugs altogether.
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大部分人深信
有一天他們會完全脫離毒品
有一天他們會完全脫離毒品
04:50
That room was the forerunner
to North America's
to North America's
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那間房間可說是引領北美的先驅
04:53
first government-sanctioned
supervised injection site, called INSITE.
supervised injection site, called INSITE.
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第一個政府批准的安全注射站點
稱為 INSITE
04:58
It opened in September of 2003
as a three-year research project.
as a three-year research project.
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它在 2003 年 9 月開張
是一項 3 年研究計畫
是一項 3 年研究計畫
05:03
The conservative government was intent on
closing it down at the end of the study.
closing it down at the end of the study.
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保守黨政府一直試圖
在研究結束之後關閉它
在研究結束之後關閉它
05:08
After eight years,
the battle to close INSITE
the battle to close INSITE
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8 年後 關閉 INSITE 的官司
05:12
went all the way up to
Canada's Supreme Court.
Canada's Supreme Court.
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一路打到加拿大的最高法庭
05:14
It pitted the government of Canada
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和加拿大政府分庭抗禮的是
05:16
against two people with a
long history of drug use
long history of drug use
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兩個有多年毒癮
05:20
who knew the benefits of INSITE firsthand:
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親身體驗過 INSITE 益處的人
05:22
Dean Wilson and Shelley Tomic.
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狄恩威爾森和雪莉托米克
05:26
The court ruled in favor
of keeping INSITE open by nine to zero.
of keeping INSITE open by nine to zero.
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法庭的判決同意讓 INSITE
從早上 9 點營運到午夜
從早上 9 點營運到午夜
05:31
The justices were scathing in
their response to the government's case.
their response to the government's case.
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法官在回應檢方時嚴厲痛斥
05:36
And I quote:
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我引述一段話：
05:38
"The effect of denying the services
of INSITE to the population that it serves
of INSITE to the population that it serves
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「否認 INSITE
提供服務給受惠大眾產生的效應
提供服務給受惠大眾產生的效應
05:42
and the correlative increase in the risk
of death and disease
of death and disease
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和毒品注射者相對增加的
死亡和生病的風險
死亡和生病的風險
05:45
to injection drug users
is grossly disproportionate to any benefit
is grossly disproportionate to any benefit
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和加拿大對持有致幻毒品的一致態度
05:50
that Canada might derive
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05:53
from presenting a uniform stance
on the possession of narcotics."
on the possession of narcotics."
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以及從中獲得的利益
大相逕庭」
05:59
This was a hopeful moment
for harm reduction.
for harm reduction.
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對減害方案來說
這是個充滿希望的時刻
這是個充滿希望的時刻
06:02
Yet, despite this strong message
from the Supreme Court,
from the Supreme Court,
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然而 儘管最高法庭強烈表態
06:06
it was, until very recently,
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直到近期仍無法
06:09
impossible to open up
any new sites in Canada.
any new sites in Canada.
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在加拿大設立任何新站點
06:12
There was one interesting thing
that happened in December of 2016,
that happened in December of 2016,
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在 2016 年 12 月
發生了一件有趣的事
發生了一件有趣的事
06:17
when due to the overdose crisis,
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當時因為用藥過量的危機
06:20
the government of British Columbia allowed
the opening of overdose prevention sites.
the opening of overdose prevention sites.
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卑詩省政府允許開設用藥過量預防站
06:27
Essentially ignoring the
federal approval process,
federal approval process,
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完全不理會聯邦審核流程
06:30
community groups opened up
about 22 of these de facto illegal
about 22 of these de facto illegal
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社區團體在全省開設了
大約 22 個事實上
大約 22 個事實上
06:34
supervised injection sites
across the province.
across the province.
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非法營運的安全注射站
06:38
Virtually overnight,
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差不多就是一夜之間
06:40
thousands of people could
use drugs under supervision.
use drugs under supervision.
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數千人得以在安全監督下施打毒品
06:43
Hundreds of overdoses were reversed
by Naloxone, and nobody died.
by Naloxone, and nobody died.
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靠著納洛酮救回數百個用藥過量的人
沒有人因此喪命
沒有人因此喪命
06:48
In fact, this is what's happened
at INSITE over the last 14 years:
at INSITE over the last 14 years:
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事實上 過去 14 年間
在 INSITE 也是這樣子
在 INSITE 也是這樣子
06:53
75,000 different individuals
have injected illegal drugs
have injected illegal drugs
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7 萬 5 千名注射非法毒品的人
06:58
more than three and a half million times,
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注射次數超過 350 萬次
07:01
and not one person has died.
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沒有任何人死亡
07:04
Nobody has ever died at INSITE.
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沒有任何人在 INSITE 身亡
07:10
So there you have it.
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這些就是
07:12
We have scientific evidence
and successes from needle exchanges
and successes from needle exchanges
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替換針頭 美沙酮 和安全注射站的
07:17
methadone and supervised injection sites.
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相關科學證據和成功案例
07:20
These are common-sense,
compassionate approaches to drug use
compassionate approaches to drug use
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這些常識性且充滿關懷的
處理毒癮方法
處理毒癮方法
07:25
that improve health, bring connection
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能夠改善健康 增進人與人的連結
07:27
and greatly reduce suffering and death.
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並大大減少痛苦以及死亡
07:32
So why haven't harm reduction
programs taken off?
programs taken off?
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可是減害方案為什麼沒有大受歡迎？
07:35
Why do we still think
that drug use is law enforcement issue?
that drug use is law enforcement issue?
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為什麼我們還認為
施打毒品是執法議題？
施打毒品是執法議題？
07:42
Our disdain for drugs and
drug users goes very deep.
drug users goes very deep.
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我們對於毒品和毒癮者有很深的誤解
07:46
We are bombarded with
images and media stories
images and media stories
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我們受到大量影視媒體的誤導
07:49
about the horrible impacts of drugs.
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內容都是關於毒品的可怕影響
07:52
We have stigmatized entire communities.
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我們把整個族群污名化了
07:55
We applaud military-inspired operations
that bring down drug dealers.
that bring down drug dealers.
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我們對鏟除毒販的軍事行動喝采
08:01
And we appear unfazed
by building more jails
by building more jails
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毫不懷疑地建立更多監獄來監禁
08:05
to incarcerate people whose
only crime is using drugs.
only crime is using drugs.
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只是因為吸毒而入獄的人
08:10
Virtually millions of people are caught up
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有數百萬人被困在一個毫無希望的
08:13
in a hopeless cycle
of incarceration, violence and poverty
of incarceration, violence and poverty
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充滿監禁 暴力 以及貧窮的循環
08:18
that has been created by our drug laws
and not the drugs themselves.
and not the drugs themselves.
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造成這個循環的並非毒品本身
而是我們的法律
而是我們的法律
08:24
How do I explain to people
that drug users deserve care and support
that drug users deserve care and support
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我該怎麼解釋
毒癮者也值得被關心和支持
毒癮者也值得被關心和支持
08:29
and the freedom to live their lives
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值得擁有生活自主權
08:30
when all we see are images of guns
and handcuffs and jail cells?
and handcuffs and jail cells?
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而不是跟槍枝 手銬 牢房
這些印象綁在一起？
這些印象綁在一起？
08:37
Let's be clear:
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簡單來說
08:39
criminalization is just a way
to institutionalize stigma.
to institutionalize stigma.
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加諸罪名是一種
把汙名化合理納入體制的做法
把汙名化合理納入體制的做法
08:45
Making drugs illegal does nothing
to stop people from using them.
to stop people from using them.
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將毒品非法化
並不能阻止大眾施打毒品
並不能阻止大眾施打毒品
08:53
Our paralysis to see things differently
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我們僵化的觀點
08:57
is also based on an entirely
false narrative about drug use.
false narrative about drug use.
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是來自對施打毒品全然錯誤的描述
09:01
We have been led to believe
that drug users
that drug users
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我們被誤導去相信
09:04
are irresponsible people who just
want to get high,
want to get high,
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吸毒者是不負責任只追求快感的人
09:07
and then through their
own personal failings
own personal failings
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他們是被自己個人的失敗
09:10
spiral down into a life
of crime and poverty,
of crime and poverty,
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捲入一個充滿犯罪和貧窮的人生
09:14
losing their jobs, their families
and, ultimately, their lives.
and, ultimately, their lives.
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失去工作 家人 最終也失去了性命
09:19
In reality, most drug users have a story,
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事實上大部分用毒者有自己的故事
09:22
whether it's childhood trauma,
sexual abuse, mental illness
sexual abuse, mental illness
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不論是兒時的創傷 性侵害 精神疾病
09:27
or a personal tragedy.
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或是個人的不幸
09:28
The drugs are used to numb the pain.
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毒品是用來麻痺痛苦的
09:34
We must understand that
as we approach people with so much trauma.
as we approach people with so much trauma.
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當面對有著深沉創傷的人
我們必須要有這樣的理解
我們必須要有這樣的理解
09:41
At its core, our drug policies
are really a social justice issue.
are really a social justice issue.
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毒品政策的核心
其實是個社會正義議題
其實是個社會正義議題
09:46
While the media may focus on overdose
deaths like Prince and Michael Jackson,
deaths like Prince and Michael Jackson,
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雖然媒體聚焦在用藥過量致死的例子
像王子和麥可傑克森
像王子和麥可傑克森
09:51
the majority of the suffering
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但是大部分的苦難
09:53
happens to people who are
living on the margins,
living on the margins,
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發生在處於社會邊緣的人身上
09:56
the poor and the dispossessed.
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貧窮和無依無靠的人
09:59
They don't vote; they are often alone.
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他們不投票 他們通常獨自一人
10:02
They are society's disposable people.
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他們是隨時會被社會拋棄的人
10:07
Even within health care,
drug use is highly stigmatized.
drug use is highly stigmatized.
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即使在醫療衛生領域中
吸毒也被嚴重污名化
吸毒也被嚴重污名化
10:11
People using drugs avoid
the health care system.
the health care system.
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施用毒品的人
通常會避開醫療衛生系統
通常會避開醫療衛生系統
10:15
They know that once
engaged in clinical care
engaged in clinical care
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他們知道一旦有
醫療照護介入或是住院
醫療照護介入或是住院
10:17
or admitted to hospital,
they will be treated poorly.
they will be treated poorly.
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他們就會受到很差的待遇
10:20
And their supply line, be it heroin,
cocaine or crystal meth
cocaine or crystal meth
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而他們的供應線
不論是海洛因 古柯鹼或冰毒
不論是海洛因 古柯鹼或冰毒
10:24
will be interrupted.
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都會被切斷
10:26
On top of that, they will be asked
a barrage of questions
a barrage of questions
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此外 他們會被一大堆問題轟炸
10:30
that only serve
to expose their losses and shame.
to expose their losses and shame.
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逼他們揭露自己的失敗和恥辱
10:34
"What drugs do you use?"
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「你吸食哪一種毒品？」
10:35
"How long have you been
living on the street?"
living on the street?"
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「你流落街頭多久了？」
10:37
"Where are your children?"
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「你的孩子在哪裡？」
10:40
"When were you last in jail?"
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「你上次坐牢是甚麼時候？」
10:42
Essentially: "Why the hell
don't you stop using drugs?"
don't you stop using drugs?"
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基本上就是在問：
「你為什麼不停止吸毒？」
「你為什麼不停止吸毒？」
10:47
In fact, our entire medical
approach to drug use is upside down.
approach to drug use is upside down.
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事實上整個醫療系統
處理毒癮的方法弄反了
處理毒癮的方法弄反了
10:52
For some reason,
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基於某種原因
10:54
we have decided that abstinence
is the best way to treat this.
is the best way to treat this.
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我們自顧自地認定
最好的治療方式就是全面戒除
最好的治療方式就是全面戒除
10:59
If you're lucky enough,
you may get into a detox program.
you may get into a detox program.
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如果你夠幸運 或可參加戒癮計畫
11:03
If you live in a community
with Suboxone or methadone,
with Suboxone or methadone,
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如果你住在一個提供舒倍生
或美沙酮療法的社區
或美沙酮療法的社區
11:06
you may get on a substitution program.
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你或許可以參與替代品計畫
11:09
Hardly ever would we offer people
what they desperately need to survive:
what they desperately need to survive:
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我們幾乎從來沒有提供毒癮者
他們生存最迫切需要的東西：
他們生存最迫切需要的東西：
11:13
a safe prescription for opioids.
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一個安全的類鴉片藥物處方
11:18
Starting with abstinence is
like asking a new diabetic to quit sugar
like asking a new diabetic to quit sugar
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直接從完全戒除開始治療
就像是要糖尿病患者一下子戒掉糖
就像是要糖尿病患者一下子戒掉糖
11:22
or a severe asthmatic
to start running marathons
to start running marathons
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或是要嚴重氣喘患者去跑馬拉松
11:26
or a depressed person to just be happy.
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或是要憂鬱症患者開心點
11:28
For any other medical condition,
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既然對任何其他醫療疾病
11:30
we would never start with
the most extreme option.
the most extreme option.
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我們從來不會從最極端的療法開始
11:33
What makes us think that strategy
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那麼我們為什麼會認為這種方法
11:35
would work for something
as complex as addiction?
as complex as addiction?
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對於成癮這麼複雜的狀況會有用？
11:40
While unintentional overdoses are not new,
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意外用藥過量不足為奇
11:43
the scale of the current
crisis is unprecedented.
crisis is unprecedented.
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但是當前危機的規模是前所未見的
11:46
The Center for Disease Control estimated
189
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疾病管制局估計
11:48
that 64,000 Americans died
of a drug overdose in 2016,
of a drug overdose in 2016,
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2016 年就有 6 萬 4 千名
美國人死於用藥過量
美國人死於用藥過量
11:54
far exceeding car crashes or homicides.
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遠遠超過車禍或自殺的死亡人數
11:57
Drug-related mortality is now
the leading cause of death
the leading cause of death
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毒品相關造成的死亡
如今是 20 到 50 歲
北美男性與女性的主要死因
北美男性與女性的主要死因
12:01
among men and women between
20 and 50 years old in North America
20 and 50 years old in North America
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12:07
Think about that.
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想一想
12:09
How did we get to this point, and why now?
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我們是怎麼落入這個境況？
為什麼是現在？
為什麼是現在？
12:14
There is a kind of perfect
storm around opioids.
storm around opioids.
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類鴉片藥物帶來著一連串的災難
12:16
Drugs like Oxycontin,
Percocet and Dilaudid
Percocet and Dilaudid
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像奧施康定（土海洛因）
醅鈳塞 第勞第拖這類毒品
醅鈳塞 第勞第拖這類毒品
12:20
have been liberally distributed
for decades for all kinds of pain.
for decades for all kinds of pain.
198
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數十年來都被大量開立配藥
做各種止痛用途
做各種止痛用途
12:26
It is estimated that two million
Americans are daily opioid users,
Americans are daily opioid users,
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據估計 有兩百萬美國人
每天服用類鴉片藥物
每天服用類鴉片藥物
12:31
and over 60 million people
200
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超過六千萬人
12:33
received at least one prescription
for opioids last year.
for opioids last year.
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去年至少拿過一次
類鴉片藥物的處方
類鴉片藥物的處方
12:38
This massive dump of
prescription drugs into communities
prescription drugs into communities
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大量開立給民眾的處方藥
12:41
has provided a steady source
for people wanting to self-medicate.
for people wanting to self-medicate.
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讓想要自行用藥的人
有穩定的藥品來源
有穩定的藥品來源
12:47
In response to this prescription epidemic,
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為了因應這種處方疫情
12:50
people have been cut off, and this
has greatly reduced the street supply
has greatly reduced the street supply
205
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很多人的處方被取消了
這做法大幅降低了街頭的供應量
這做法大幅降低了街頭的供應量
12:55
The unintended but predictable consequence
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結果就是非刻意製造但可以預期的
12:58
is an overdose epidemic.
207
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藥物濫用大流行
13:00
Many people who were reliant on
a steady supply of prescription drugs
a steady supply of prescription drugs
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許多原本依賴處方藥穩定供應的人
13:05
turned to heroin.
209
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轉向海洛因
13:06
And now the illegal drug market
has tragically switched
has tragically switched
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很不幸地現在的非法藥品市場需求
13:09
to synthetic drugs, mainly fentanyl.
211
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轉向合成藥品 主要是芬太奴
13:13
These new drugs are cheap,
potent and extremely hard to dose.
potent and extremely hard to dose.
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這些新藥很便宜 強效
但是極難控制劑量
但是極難控制劑量
13:18
People are literally being poisoned.
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使用者基本上是被毒害的
13:23
Can you imagine if this was
any other kind of poisoning epidemic?
any other kind of poisoning epidemic?
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各位能想像如果這是
另一種的中毒大流行嗎？
另一種的中毒大流行嗎？
13:27
What if thousands of people started dying
215
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如果有數以千計的人開始死於
13:30
from poisoned meat
or baby formula or coffee?
or baby formula or coffee?
216
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3634
被下毒的肉品 嬰兒配方奶粉或咖啡
13:34
We would be treating
this as a true emergency.
this as a true emergency.
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我們會把它視為真正的緊急狀況
13:36
We would immediately be
supplying safer alternatives.
supplying safer alternatives.
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3636
我們會馬上供應比較安全的替代品
13:40
There would be changes in legislation,
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立法也會因應改變
13:42
and we would be supporting
the victims and their families.
the victims and their families.
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我們會支持受害者和他們的家人
13:46
But for the drug overdose epidemic,
221
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但對於藥物濫用的流行病
13:48
we have done none of that.
222
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我們卻完全沒有那麼做
13:50
We continue to demonize the drugs
and the people who use them
and the people who use them
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我們持續把藥品和用藥的人給妖魔化
13:54
and blindly pour even more resources
into law enforcement.
into law enforcement.
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甚至盲目地把更多資源投入執法單位
14:02
So where should we go from here?
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我們接下來該怎麼做？
14:05
First, we should fully embrace,
fund and scale up
fund and scale up
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4134
首先 我們應該全面接受資助
和擴展北美各地的減害計畫
14:09
harm reduction programs
across North America.
across North America.
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2545
14:12
I know that in places like Vancouver,
228
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我知道像溫哥華這樣的地方
14:15
harm reduction has been a
lifeline to care and treatment.
lifeline to care and treatment.
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減害方案一直都是
照護和治療的生命線
照護和治療的生命線
14:19
I know that the number of overdose deaths
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我知道如果沒有減害方案
14:21
would be far higher
without harm reduction.
without harm reduction.
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用藥過量致死的人數會高出很多
14:25
And I personally know hundreds
of people who are alive today
of people who are alive today
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我自己本身就認識數百個
多虧減害方案才活到今天的人
14:30
because of harm reduction.
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1846
14:33
But harm reduction is just the start.
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但減害方案只是個開始
14:35
If we truly want to make
an impact on this drug crisis,
an impact on this drug crisis,
235
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如果我們真的想處理毒品危機
14:40
we need to have a serious
conversation about prohibition
conversation about prohibition
236
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3846
我們得要認真嚴肅地探討
禁藥令和刑事懲處
14:43
and criminal punishment.
237
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1546
14:46
We need to recognize that drug use is
first and foremost a public health issue
first and foremost a public health issue
238
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5817
我們得要承認
吸毒是最優先的公共健康議題
吸毒是最優先的公共健康議題
14:53
and turn to comprehensive social
and health solutions.
and health solutions.
239
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並尋求全面的社會與健康解決方案
我們已經有一個可依循的模式
15:00
We already have a model
for how this can work.
for how this can work.
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2151
15:03
In 2001, Portugal was
having its own drug crisis.
having its own drug crisis.
241
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3291
在 2001 年 葡萄牙發生毒品危機
15:06
Lots of people using
drugs, high crime rates
drugs, high crime rates
242
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高用藥率 高犯罪率
15:09
and an overdose epidemic.
243
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用藥過量也很普遍
15:11
They defied global conventions
and decriminalized all drug possession.
and decriminalized all drug possession.
244
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4784
他們不採用全球普遍的習慣做法
反而將毒品持有除罪化
反而將毒品持有除罪化
15:16
Money that was spent on drug enforcement
245
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2436
本來花在毒品執法的錢
15:19
was redirected to health
and rehabilitation programs.
and rehabilitation programs.
246
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3293
轉用到健康和康復計畫上
15:23
The results are in.
247
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出來的結果是
15:25
Overall drug use is down dramatically.
248
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3230
整體的吸毒比例大幅下降
15:29
Overdoses are uncommon.
249
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用藥過量案例變少了
15:31
Many more people are in treatment.
250
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2706
更多人接受治療
15:36
And people have been
given their lives back.
given their lives back.
251
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而且很多人被救回一條命
15:41
We have come so far down the road
of prohibition, punishment and prejudice
of prohibition, punishment and prejudice
252
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5801
我們長年以來一直使用
禁令 懲罰和偏見
禁令 懲罰和偏見
15:47
that we have become
indifferent to the suffering
indifferent to the suffering
253
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2589
使我們漠視人們的痛苦
15:49
that we have inflicted on the
most vulnerable people in our society.
most vulnerable people in our society.
254
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4158
我們竟然去打擊社會上
最脆弱的那群人
最脆弱的那群人
15:54
This year even more
people will get caught up
people will get caught up
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今年還會有更多人陷於
15:57
in the illegal drug trade.
256
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非法毒品交易
16:00
Thousands of children will learn
that their mother or father
that their mother or father
257
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數以千計孩童的父母親
16:04
has been sent to jail for using drugs.
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會因為吸毒而入獄
16:09
And far too many parents will be notified
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更多父母親會接到通知
16:12
that their son or daughter
has died of a drug overdose.
has died of a drug overdose.
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得知他們的兒女因為用藥過量而死
16:18
It doesn't have to be this way.
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這一切大可不必發生
16:22
Thank you.
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謝謝
16:23
(Applause)
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（掌聲）
ABOUT THE SPEAKER
Mark Tyndall - Epidemiologist, physician, public health expertMark Tyndall has dedicated his career to studying HIV, poverty and drug use in multiple places around the world, starting with Nairobi, and now in Vancouver.
Why you should listen
Mark Tyndall is an epidemiologist, physician and public health expert. An early advocate for harm reduction programs, Tyndall was at the forefront of North America's first legally sanctioned supervised injection facility, INSITE, established in Vancouver in 2003. Since then, studies have shown that safe injection sites save lives, reduce transmission of disease and help people access addiction treatment and other medical services. A proponent of evidence-based public health policy and interventions, Tyndall has authored more than 250 academic papers and has received multiple honors for his work. He is currently the Director of the British Columbia Centre for Disease Control and a professor at the School of Population and Public Health at the University of British Columbia.
Mark Tyndall | Speaker | TED.com