I had just arrived in Vancouver to lead a research project

我還記得第一次看到 別人注射毒品的經驗

in HIV prevention in the infamous Downtown East Side.

我才剛剛到溫哥華主導一個研究計畫

It was in the lobby of the Portland Hotel,

是一個愛滋病防治計畫

a supportive housing project that gave rooms

就在惡名昭彰的溫哥華城中東區

to the most marginalized people in the city,

事情就發生在波特蘭旅館的大廳

the so-called "difficult to house."

那裡有個住房支持計畫提供住所

I'll never forget the young woman standing on the stairs

給城市中最邊緣化的一群人

repeatedly jabbing herself with a needle, and screaming,

所謂「很難收容的人」

"I can't find a vein,"

我永遠無法忘記 那個站在樓梯上的年輕女子

as blood splattered on the wall.

一邊不斷地用注射針猛刺自己

In response to the desperate state of affairs, the drug use,

一邊大喊「我找不到血管」

the poverty, the violence, the soaring rates of HIV,

同時血飛濺到牆上

Vancouver declared a public health emergency in 1997.

為了因應層出不窮的

This opened the door to expanding harm reduction services,

毒品濫用 貧窮 暴力

distributing more needles,

和飆升的愛滋病罹患率

increasing access to methadone,

溫哥華市在 1997 年 宣佈進入公共衛生警戒狀態

and, finally, opening a supervised injection site.

此舉開啟了一扇門來擴展減害服務

Things that make injecting drugs less hazardous.

分發更多注射針

But today, 20 years later,

讓美沙酮更容易取得

harm reduction is still viewed as some sort of radical concept.

最後，還開設了一個 有人管理的安全注射站

In some places, it's still illegal to carry a clean needle.

這些都能讓毒品注射的危險降低

Drug users are far more likely to be arrested

但 20 年後的今天

than to be offered methadone therapy.

減害的概念仍然被視為 是某種極端的觀念

Recent proposals for supervised injection sites

帶著乾淨的注射針 在某些地方仍然不合法

in cities like Seattle, Baltimore and New York

毒癮者被逮捕的機會

have been met with stiff opposition:

高過得到美沙酮治療的機會

opposition that goes against everything we know about addiction.

有些近期提案建議把安全注射站

Why is that?

開設在像是西雅圖 巴爾的摩及紐約這類城市

Why are we still stuck on the idea

卻被強力抵制

that the only option is to stop using -- that any drug use will not be tolerated?

這種抵制和所有我們 對成癮的認知背道而馳

Why do we ignore countless personal stories

怎麼說呢?

and overwhelming scientific evidence

為什麼很多人仍然堅持

that harm reduction works?

阻止濫用毒品的唯一的選擇 是全面禁止施打毒品？

Critics say that harm reduction doesn't stop people

為什麼我們還是不願意正眼看待

from using illegal drugs.

數不清的成功案例 和壓倒性的科學證據

Well, actually, that is the whole point.

證明減害計畫是有效的？

After every criminal and societal sanction

有評論說，減害方案沒有辦法遏止

that we can come up with,

大眾吸食毒品

people still use drugs, and far too many die.

其實這才是重點

Critics also say that we are giving up on people

就算加諸所有我們想到的 刑法和社會制裁

by not focusing our attention on treatment and recovery.

毒品濫用還是存在且太多人因此喪命

In fact, it is just the opposite.

很多批評說我們是在放棄毒癮者

We are not giving up on people.

因為我們沒有著重在治療和康復上

We know that if recovery is ever going to happen

事實上恰恰相反

we must keep people alive.

我們沒有放棄毒癮者

Offering someone a clean needle or a safe place to inject

我們很清楚如果要讓他們恢復

is the first step to treatment and recovery.

我們得先讓他們能活下來

Critics also claim that harm reduction

提供他們一支乾淨的注射針 或一個安全的注射地點

gives the wrong message to our children about drug users.

就是治療和康復的第一步

The last time I looked, these drug users are our children.

也有人批評說 減害計畫

The message of harm reduction is that while drugs can hurt you,

讓我們的孩子對毒癮者有錯誤的印象

we still must reach out to people who are addicted.

我最後一次看 這些毒癮者就是我們的孩子

A needle exchange is not an advertisement for drug use.

減少傷害所傳遞的訊息 是雖然毒品會傷害你

Neither is a methadone clinic or a supervised injection site.

我們還是得要向成癮的人伸出手

What you see there are people sick and hurting,

換新注射針並不是幫施打毒品打廣告

hardly an endorsement for drug use.

安全注射站或美沙酮診所也不是

Let's take supervised injection sites, for example.

在這些地方你只會看見生病受苦的人

Probably the most misunderstood health intervention ever.

根本不是在為吸食毒品做背書

All we are saying is that allowing people

以安全注射站為例

to inject in a clean, dry space with fresh needles,

它可能是史上最被誤解的醫療介入了

surrounded by people who care

我們要說的是 讓毒品成癮者

is a lot better than injecting in a dingy alley,

能在一個衛生乾淨的空間中 用新的注射針來施打藥物

sharing contaminated needles and hiding out from police.

身邊圍繞的是在乎他們的人

It's better for everybody.

這樣的做法遠遠勝過讓他們 在骯髒巷子裡注射

The first supervised injection site in Vancouver was at 327 Carol Street,

共用針頭 躲著警察

a narrow room with a concrete floor, a few chairs and a box of clean needles.

這樣對大家都好

The police would often lock it down,

溫哥華的第一個安全注射站 位在卡羅街 327 號

but somehow it always mysteriously reopened,

一個小小的房間 水泥地板 幾張椅子 和一盒乾淨的針頭

often with the aid of a crowbar.

警方常常把它鎖起來

I would go down there some evenings

可是它總是很神奇地又重新開張

to provide medical care for people who were injecting drugs.

通常是有鐵橇的幫忙

I was always struck with the commitment and compassion

我有時候會晚上到那裡去

of the people who operated and used the site.

提供醫療照護給在注射毒品的人

No judgment, no hassles, no fear,

我總是被營運和使用該站點的人

lots of profound conversation.

展現的投入和同理心深深感動

I learned that despite unimaginable trauma,

沒有評斷 沒有口角 沒有恐懼

physical pain and mental illness,

有的是很多深刻的對談

that everyone there thought that things would get better.

我了解到儘管有無法想像的傷痛

Most were convinced that, someday, they'd stop using drugs altogether.

身體痛苦和精神疾病

That room was the forerunner to North America's

但那裡的每個人相信 一切都會好轉

first government-sanctioned supervised injection site, called INSITE.

大部分人深信 有一天他們會完全脫離毒品

It opened in September of 2003 as a three-year research project.

那間房間可說是引領北美的先驅

The conservative government was intent on closing it down at the end of the study.

第一個政府批准的安全注射站點

After eight years, the battle to close INSITE

稱為 INSITE

went all the way up to Canada's Supreme Court.

它在 2003 年 9 月開張 是一項 3 年研究計畫

It pitted the government of Canada

保守黨政府一直試圖 在研究結束之後關閉它

against two people with a long history of drug use

8 年後 關閉 INSITE 的官司

who knew the benefits of INSITE firsthand:

一路打到加拿大的最高法庭

Dean Wilson and Shelley Tomic.

和加拿大政府分庭抗禮的是

The court ruled in favor of keeping INSITE open by nine to zero.

兩個有多年毒癮

The justices were scathing in their response to the government's case.

親身體驗過 INSITE 益處的人

And I quote:

狄恩威爾森和雪莉托米克

"The effect of denying the services of INSITE to the population that it serves

法庭的判決同意讓 INSITE 從早上 9 點營運到午夜

and the correlative increase in the risk of death and disease

法官在回應檢方時嚴厲痛斥

to injection drug users is grossly disproportionate to any benefit

我引述一段話：

that Canada might derive

「否認 INSITE 提供服務給受惠大眾產生的效應

from presenting a uniform stance on the possession of narcotics."

和毒品注射者相對增加的 死亡和生病的風險

This was a hopeful moment for harm reduction.

和加拿大對持有致幻毒品的一致態度

Yet, despite this strong message from the Supreme Court,

以及從中獲得的利益

it was, until very recently,

大相逕庭」

impossible to open up any new sites in Canada.

對減害方案來說 這是個充滿希望的時刻

There was one interesting thing that happened in December of 2016,

然而 儘管最高法庭強烈表態

when due to the overdose crisis,

直到近期仍無法

the government of British Columbia allowed the opening of overdose prevention sites.

在加拿大設立任何新站點

Essentially ignoring the federal approval process,

在 2016 年 12 月 發生了一件有趣的事

community groups opened up about 22 of these de facto illegal

當時因為用藥過量的危機

supervised injection sites across the province.

卑詩省政府允許開設用藥過量預防站

Virtually overnight,

完全不理會聯邦審核流程

thousands of people could use drugs under supervision.

社區團體在全省開設了 大約 22 個事實上

Hundreds of overdoses were reversed by Naloxone, and nobody died.

非法營運的安全注射站

In fact, this is what's happened at INSITE over the last 14 years:

差不多就是一夜之間

75,000 different individuals have injected illegal drugs

數千人得以在安全監督下施打毒品

more than three and a half million times,

靠著納洛酮救回數百個用藥過量的人 沒有人因此喪命

and not one person has died.

事實上 過去 14 年間 在 INSITE 也是這樣子

Nobody has ever died at INSITE.

7 萬 5 千名注射非法毒品的人

So there you have it.

注射次數超過 350 萬次

We have scientific evidence and successes from needle exchanges

沒有任何人死亡

methadone and supervised injection sites.

沒有任何人在 INSITE 身亡

These are common-sense, compassionate approaches to drug use

這些就是

that improve health, bring connection

替換針頭 美沙酮 和安全注射站的

and greatly reduce suffering and death.

相關科學證據和成功案例

So why haven't harm reduction programs taken off?

這些常識性且充滿關懷的 處理毒癮方法

Why do we still think that drug use is law enforcement issue?

能夠改善健康 增進人與人的連結

Our disdain for drugs and drug users goes very deep.

並大大減少痛苦以及死亡

We are bombarded with images and media stories

可是減害方案為什麼沒有大受歡迎？

about the horrible impacts of drugs.

為什麼我們還認為 施打毒品是執法議題？

We have stigmatized entire communities.

我們對於毒品和毒癮者有很深的誤解

We applaud military-inspired operations that bring down drug dealers.

我們受到大量影視媒體的誤導

And we appear unfazed by building more jails

內容都是關於毒品的可怕影響

to incarcerate people whose only crime is using drugs.

我們把整個族群污名化了

Virtually millions of people are caught up

我們對鏟除毒販的軍事行動喝采

in a hopeless cycle of incarceration, violence and poverty

毫不懷疑地建立更多監獄來監禁

that has been created by our drug laws and not the drugs themselves.

只是因為吸毒而入獄的人

How do I explain to people that drug users deserve care and support

有數百萬人被困在一個毫無希望的

and the freedom to live their lives

充滿監禁 暴力 以及貧窮的循環

when all we see are images of guns and handcuffs and jail cells?

造成這個循環的並非毒品本身 而是我們的法律

Let's be clear:

我該怎麼解釋 毒癮者也值得被關心和支持

criminalization is just a way to institutionalize stigma.

值得擁有生活自主權

Making drugs illegal does nothing to stop people from using them.

而不是跟槍枝 手銬 牢房 這些印象綁在一起？

Our paralysis to see things differently

簡單來說

is also based on an entirely false narrative about drug use.

加諸罪名是一種 把汙名化合理納入體制的做法

We have been led to believe that drug users

將毒品非法化 並不能阻止大眾施打毒品

are irresponsible people who just want to get high,

我們僵化的觀點

and then through their own personal failings

是來自對施打毒品全然錯誤的描述

spiral down into a life of crime and poverty,

我們被誤導去相信

losing their jobs, their families and, ultimately, their lives.

吸毒者是不負責任只追求快感的人

In reality, most drug users have a story,

他們是被自己個人的失敗

whether it's childhood trauma, sexual abuse, mental illness

捲入一個充滿犯罪和貧窮的人生

or a personal tragedy.

失去工作 家人 最終也失去了性命

The drugs are used to numb the pain.

事實上大部分用毒者有自己的故事

We must understand that as we approach people with so much trauma.

不論是兒時的創傷 性侵害 精神疾病

At its core, our drug policies are really a social justice issue.

或是個人的不幸

While the media may focus on overdose deaths like Prince and Michael Jackson,

毒品是用來麻痺痛苦的

the majority of the suffering

當面對有著深沉創傷的人 我們必須要有這樣的理解

happens to people who are living on the margins,

毒品政策的核心 其實是個社會正義議題

the poor and the dispossessed.

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

They don't vote; they are often alone.

但是大部分的苦難

They are society's disposable people.

發生在處於社會邊緣的人身上

Even within health care, drug use is highly stigmatized.

貧窮和無依無靠的人

People using drugs avoid the health care system.

他們不投票 他們通常獨自一人

They know that once engaged in clinical care

他們是隨時會被社會拋棄的人

or admitted to hospital, they will be treated poorly.

即使在醫療衛生領域中 吸毒也被嚴重污名化

And their supply line, be it heroin, cocaine or crystal meth

施用毒品的人 通常會避開醫療衛生系統

will be interrupted.

他們知道一旦有 醫療照護介入或是住院

On top of that, they will be asked a barrage of questions

他們就會受到很差的待遇

that only serve to expose their losses and shame.

而他們的供應線 不論是海洛因 古柯鹼或冰毒

"What drugs do you use?"

都會被切斷

"How long have you been living on the street?"

此外 他們會被一大堆問題轟炸

"Where are your children?"

逼他們揭露自己的失敗和恥辱

"When were you last in jail?"

「你吸食哪一種毒品？」

Essentially: "Why the hell don't you stop using drugs?"

「你流落街頭多久了？」

In fact, our entire medical approach to drug use is upside down.

「你的孩子在哪裡？」

For some reason,

「你上次坐牢是甚麼時候？」

we have decided that abstinence is the best way to treat this.

基本上就是在問： 「你為什麼不停止吸毒？」

If you're lucky enough, you may get into a detox program.

事實上整個醫療系統 處理毒癮的方法弄反了

If you live in a community with Suboxone or methadone,

基於某種原因

you may get on a substitution program.

我們自顧自地認定 最好的治療方式就是全面戒除

Hardly ever would we offer people what they desperately need to survive:

如果你夠幸運 或可參加戒癮計畫

a safe prescription for opioids.

如果你住在一個提供舒倍生 或美沙酮療法的社區

Starting with abstinence is like asking a new diabetic to quit sugar

你或許可以參與替代品計畫

or a severe asthmatic to start running marathons

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：

or a depressed person to just be happy.

一個安全的類鴉片藥物處方

For any other medical condition,

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

we would never start with the most extreme option.

或是要嚴重氣喘患者去跑馬拉松

What makes us think that strategy

或是要憂鬱症患者開心點

would work for something as complex as addiction?

既然對任何其他醫療疾病

While unintentional overdoses are not new,

我們從來不會從最極端的療法開始

the scale of the current crisis is unprecedented.

那麼我們為什麼會認為這種方法

The Center for Disease Control estimated

對於成癮這麼複雜的狀況會有用？

that 64,000 Americans died of a drug overdose in 2016,

意外用藥過量不足為奇

far exceeding car crashes or homicides.

但是當前危機的規模是前所未見的

Drug-related mortality is now the leading cause of death

疾病管制局估計

among men and women between 20 and 50 years old in North America

2016 年就有 6 萬 4 千名 美國人死於用藥過量

Think about that.

遠遠超過車禍或自殺的死亡人數

How did we get to this point, and why now?

毒品相關造成的死亡

There is a kind of perfect storm around opioids.

如今是 20 到 50 歲 北美男性與女性的主要死因

Drugs like Oxycontin, Percocet and Dilaudid

想一想

have been liberally distributed for decades for all kinds of pain.

我們是怎麼落入這個境況？ 為什麼是現在？

It is estimated that two million Americans are daily opioid users,

類鴉片藥物帶來著一連串的災難

and over 60 million people

像奧施康定（土海洛因） 醅鈳塞 第勞第拖這類毒品

received at least one prescription for opioids last year.

數十年來都被大量開立配藥 做各種止痛用途

This massive dump of prescription drugs into communities

據估計 有兩百萬美國人 每天服用類鴉片藥物

has provided a steady source for people wanting to self-medicate.

超過六千萬人

In response to this prescription epidemic,

去年至少拿過一次 類鴉片藥物的處方

people have been cut off, and this has greatly reduced the street supply

大量開立給民眾的處方藥

The unintended but predictable consequence

讓想要自行用藥的人 有穩定的藥品來源

is an overdose epidemic.

為了因應這種處方疫情

Many people who were reliant on a steady supply of prescription drugs

很多人的處方被取消了 這做法大幅降低了街頭的供應量

turned to heroin.

結果就是非刻意製造但可以預期的

And now the illegal drug market has tragically switched

藥物濫用大流行

to synthetic drugs, mainly fentanyl.

許多原本依賴處方藥穩定供應的人

These new drugs are cheap, potent and extremely hard to dose.

轉向海洛因

People are literally being poisoned.

很不幸地現在的非法藥品市場需求

Can you imagine if this was any other kind of poisoning epidemic?

轉向合成藥品 主要是芬太奴

What if thousands of people started dying

這些新藥很便宜 強效 但是極難控制劑量

from poisoned meat or baby formula or coffee?

使用者基本上是被毒害的

We would be treating this as a true emergency.

各位能想像如果這是 另一種的中毒大流行嗎？

We would immediately be supplying safer alternatives.

如果有數以千計的人開始死於

There would be changes in legislation,

被下毒的肉品 嬰兒配方奶粉或咖啡

and we would be supporting the victims and their families.

我們會把它視為真正的緊急狀況

But for the drug overdose epidemic,

我們會馬上供應比較安全的替代品

we have done none of that.

立法也會因應改變

We continue to demonize the drugs and the people who use them

我們會支持受害者和他們的家人

and blindly pour even more resources into law enforcement.

但對於藥物濫用的流行病

So where should we go from here?

我們卻完全沒有那麼做

First, we should fully embrace, fund and scale up

我們持續把藥品和用藥的人給妖魔化

harm reduction programs across North America.

甚至盲目地把更多資源投入執法單位

I know that in places like Vancouver,

我們接下來該怎麼做？

harm reduction has been a lifeline to care and treatment.

首先 我們應該全面接受資助

I know that the number of overdose deaths