■美國每12名醫生中，就有1人收取鴉片類藥物生產商提供的利益，包括金錢、免費旅遊或免費餐飲等。圖為美國醫生診症。 網上圖片【原文】下文摘錄自香港《文匯報》2017年11月27日報道：
美國政府數據顯示，2015年鴉片類藥物（opioid）的處方（prescription）數量，較1999年超出逾3倍。波士頓醫療中心研究發現，美國每12名醫生中，就有1人收取鴉片類藥物生產商（manufacturer）提供的利益，包括金錢、免費旅遊或免費餐飲等。
藥廠推銷鴉片類藥物所花的時間和金錢，較其他可成癮止痛藥（addictive analgesic）更多，不惜花費數千萬美元，反映醫生在濫用鴉片問題上扮演關鍵角色。
「利誘」多元化 致嚴重濫藥
在2013年至2015年間，藥廠向逾6.8萬名醫生合共支付38萬筆費用，涉及4,600萬美元（約3.6億港元），通常以演講費、諮詢（consultation）費和酬金（gratuity）等名目支付。
去年一項研究更指出，醫生即使只獲藥廠提供免費飲食，也願意向病人處方該藥廠的藥物。美國疾病控制與預防中心（CDC）批評醫生處方過量鴉片類藥物給病人，加劇濫藥（drug abuse）問題。
有專家指出，醫生處方鴉片類止痛藥物，明顯缺乏足夠指引，認為應把指引加入醫學院、牙醫學院和護理學院的課程。
CDC署理主任（Acting Director）舒查特（Anne Schuchat）指出，有太多人長期服食過量鴉片類藥物。有意見認為，濫藥個案的資料不全，使政府無法有效調動（mobilize）資源應對濫藥，國民整體健康狀況已響起警號，長遠造成龐大經濟負擔（economic burden）。
CDC研究從全國逾5.9萬間藥房（pharmacy）收集的數據，發現逾200萬名服用鴉片類藥物的人有濫藥情況，用於戒毒治療（drug addiction treatment）、醫療保健及法律個案的開支，每年超過780億美元（約6,102億港元）。
白宮（White House）經濟顧問委員會早前發表報告，指出2015年有3.3萬人死於濫用鴉片類藥物，相關藥物造成的總經濟成本為5,040億美元（約3.9萬億港元），相當於當年國內生產總值（gross domestic product）（GDP）的2.8%。
死亡證不列明 個案遠超公佈數字
舒查特指出，太多美國人長期過度服食鴉片類藥物，單是2015年的處方量，已足夠每一名美國人持續服用三周。
弗吉尼亞大學公共政策及經濟學教授魯姆則指出，濫藥致死人士的死亡證（death certificate）中，沒列明涉及的藥物，故此在賓夕法尼亞（Pennsylvania）及印第安納（Indiana）等州份，因鴉片類藥物致命的個案往往被低估（undercount），例如服食鴉片的死亡率，實際較此前公佈的數字高出24%，認為政府需盡可能掌握確實數據，才能有效制訂政策。
賓夕法尼亞州州長沃爾夫的發言人表示，當局將設立公共數據庫（database），收集濫藥及治療方面的資料。當地法醫（medical examiners）聯會指出，由於部分家屬不想外界知道死者體內含有什麼藥物，加上受私隱（privacy）法例保護，法醫或因此不在死亡證上列出所有藥物。
US doctors "bribed" for issuing excessive opioid-related drugs
【譯文】Statistics of the US government have indicated the number of opioid prescriptions in 2015 was three times more than that in 1999. A research by the Boston Medical Center found that one in every 12 doctors in America receives benefits from opioid manufacturers in the form of money, free travel, free meals, etc.
It also revealed that pharmaceutical companies spent lots of time and as many as tens of millions of dollars on the promotion of opioid, which were far more than that of other addictive analgesics, reflecting the medical professionals' key role on the problem of opium addiction.
A variety of benefits given
From 2013 to 2015, the pharmaceutical companies paid a total of US$46 million (approximately HK$360 million) to over 68,000 doctors through 380,000 transactions in the names of gratuities or honorarium payments for speech and consultation.
A study released last year showed that doctors even prescribed specific drugs to patients in exchange for free meals. The US Centers for Disease Control and Prevention (CDC) has blamed medical professionals for prescribing too many opioids and hence intensifying drug abuse.
Experts criticized there is currently a lack of well-developed guidelines for issuing opioid prescriptions, and suggested such guidelines be established and incorporated into the courses of the medical, dental and nursing schools.
As Acting Director of the CDC Anne Schuchat pointed out, a large number of people have been taking unnecessary or excessive amounts of opioids. It is believed that inadequate information on opioid abuse cases makes it difficult for the government to effectively mobilize resources to cope with the problem, leading to the deteriorating health condition of the general public and bringing about huge economic burden in the long run.
Based on the data collected from more than 59,000 pharmacies across the country, the CDC found that over two million people who take opioid are addicted to the drug. Meanwhile, the annual expenditure on drug addiction treatment, healthcare and legal cases of medical malpractice has exceeded US$78 billion (approximately HK$610.2 billion).
An early report published by the Council of Economic Advisers of the White House indicated that the death toll of drug overdose in 2015 reached 33,000, and the economic loss caused by drug addiction was estimated at US$504 billion (approximately HK$3.9 trillion), equivalent to 2.8% of the gross domestic product (GDP) of that year.
Death certs do not disclose all medicines
Many people in the US are in fact frequent opioid users and relevant prescriptions in 2015 alone can satisfy the daily medication needs of each American for 3 weeks, said Schuchat.
Christopher Ruhm, a public policy and economics professor of the University of Virginia, said the details of medicines were often not specified on the death certificate for cases of drug abuse deaths, such that opioid overdose deaths in Pennsylvania, Indiana and other states in the US were actually undercounted. He estimated such deaths should be some 24% higher than reported, and believed that only by acquiring the correct figures can the government formulate the relevant policies effectively.
A spokesperson of the Governor of Pennsylvania Tom Wolf expressed that the government is going to set up a common database to collect data on drug abuse and treatment.
However, the local association of medical examiners pointed out that the family members often refuse to disclose to others about the drugs in the decedent's body, added with the consideration for privacy protection, therefore medical examiners may not list out all the drugs on the death certificates.■龐嘉儀
Q&A
1. 鴉片類藥物有何作用？
2. 對藥物成癮的另一種說法是什麼？
3. 現時較常被濫用的藥物類別有哪些？
4. 香港衛生署轄下的什麼診所提供戒毒服務？
5. 目前有哪些毒品普遍被認為合法化？
1. 可用於鎮痛和治療憂鬱症（depression）
2. 藥物依賴性（dependence）
3. 麻醉劑（anesthetic）、興奮劑（stimulant）、鎮定劑（sedative）等
4. 美沙酮診所（methadone clinic）
5.煙草（tobacco）、酒精（alcohol）、大麻（marijuana）（部分國家合法）