美国国家公共电台 NPR It's The Go-To Drug To Treat Opioid Addiction. Why Won't More Pharmacies Stock It?

It's The Go-To Drug To Treat Opioid Addiction¹. Why Won't More Pharmacies² Stock It?

RACHEL MARTIN, HOST:

With America in the throes of a drug addiction epidemic³, there's been a big push to make a crucial treatment drug easier to get. It's called buprenorphine, and people who take it are more likely to stay in treatment and less likely to die from an overdose. But there's a problem. Pharmacists are the gatekeepers for filling the prescriptions⁵. And as Nina Feldman at WHYY in Philadelphia explains, not all pharmacies want that role.

NINA FELDMAN, BYLINE⁶: Louis Morano was sick of being in and out of rehab. He was a dad now and wanted to be at home more with his son in northeast Philly. This time, he was determined⁷ to make his recovery stick.

LOUIS MORANO: My plan is to go and show that, like, I don't want to do this anymore. I can't do this anymore.

FELDMAN: In all his stints⁸ in rehab, Morano says he had never been prescribed buprenorphine, a drug that staves off withdrawal⁹ symptoms and ongoing¹⁰ cravings. But he had bought it off the street before.

MORANO: I would use it so I wasn't sick while I was at work, and then I would get high after work.

FELDMAN: So he knew the drug would work to curb¹¹ his cravings. Morano heard he could get a prescription⁴ from a bus that housed a mobile medical clinic. It's usually parked on a corner in Kensington, the Philadelphia neighborhood at the center of the opioid epidemic. People there just call it the bupe bus, for buprenorphine.

BEN COCCHIARO: Hello. Dr. Ben Cocchiaro - it's nice to meet you.

MORANO: Hello.

FELDMAN: The bus belongs to the syringe exchange Prevention Point. It's one of Philadelphia's latest efforts to help more people get buprenorphine. Doctors with Prevention Point see patients in a tiny, peaceful consult room at the back of the bus. Morano and a doctor talk about what he'll need to make recovery work for him this time. The doctor gives him instructions for taking the drug, and then he calls in the script.

COCCHIARO: Hi, there. It's Ben from the MAT van.

FELDMAN: The bus parks right outside a Walgreens, but Morano's doctor doesn't bother calling it in there. And Morano won't be filling the script at a nearby independent pharmacy¹² either.

Richard Ost, the owner there, says his pharmacy was one of the first in the neighborhood to stock buprenorphine. But after a while, Ost started noticing that people were not using the medication as directed. They were selling it instead.

RICHARD OST: We started seeing people doing it in our store in front of us. Ethically¹³, we should not be dispensing¹⁴ their prescriptions. And once we saw that with a patient, we terminated them as a patient.

FELDMAN: Ost says the illegal market for buprenorphine, also known as Suboxone, didn't just bring unwanted foot traffic. It also meant customers trying to stay sober were being continually targeted and tempted¹⁵.

OST: So if we were having a lot of people that were in recovery coming out of our stores, the people who were dealing¹⁶ illicit¹⁷ drugs knew that. And they would be there to talk to them. And they would say - well, I'll give you this, or I'll give you that. Or I'll buy your Suboxone, or I'll trade you for this.

FELDMAN: Ost says, eventually, his staff didn't feel safe, and neither did the customers. He understands the value of bupe, but it just wasn't worth it. He's mostly stopped carrying it.

Another problem is that sometimes pharmacists have trouble stocking buprenorphine, even if they want to. Wholesalers set limits on how many controlled substances a pharmacy can order at a time. If you're in a high-needs area like Kensington, you might max out, especially if you stock other prescription opioids. And lots of pharmacists get different information about buprenorphine compared to doctors.

DAN VENTRICELLI: It's not even that they're on different pages; they're reading completely different books.

FELDMAN: Dan Ventricelli is a professor at the Philadelphia College of Pharmacy.

VENTRICELLI: There's this perception in the pharmacy community that if you're using this medication for a year and you haven't started tapering¹⁸, that you are doing something wrong - or maybe the provider is doing something wrong.

FELDMAN: But lots of doctors prescribe buprenorphine for longer than a year, and that's consistent with recent guidelines. If a pharmacy doesn't have buprenorphine or the pharmacist won't fill it, the stakes are high. Silvana Mazzella of Prevention Point says when it's not available, patients struggle and can turn back to heroin¹⁹ or fentanyl.

SILVANA MAZZELLA: We're in a situation where, if you are in withdrawal, you're sick - you need to get well. You want help today, and you can't get it through medication-assisted treatment. Unfortunately, you will find it a block away - very quickly and very cheaply.

FELDMAN: Doctors with Prevention Point have found a pharmacy that will reliably dispense²⁰ buprenorphine to their patients. It's called Pharmacy of America.

UNIDENTIFIED PHARMACY EMPLOYEE: Can I have your birthday please?

UNIDENTIFIED PHARMACY CUSTOMER: (Unintelligible) - '78.

UNIDENTIFIED PHARMACY EMPLOYEE: OK. You can sign for me when you're ready.

FELDMAN: Anthony Shirley is head pharmacist there. He says he's comfortable filling the scripts because of his relationship with the doctors at Prevention Point.

ANTHONY SHIRLEY: Trust is an issue. You know? You have to kind of know what their processes are and make sure that, you know, they're not just giving prescriptions to patients that don't need the medication. It's a very controlled environment at Prevention Point.

FELDMAN: He says he tries to connect with the patients, too.

SHIRLEY: I've heard firsthand from patients - that saved my life. You know, that's something that, you know, you can't really put a price tag on.

FELDMAN: Shirley says, for him, it's simple. His store is in an area where lots of people need buprenorphine. That means it's his job to get it to them. For NPR News, I'm Nina Feldman in Philadelphia.

(SOUNDBITE OF WE CAME FROM THE NORTH'S "WHITE SANDS")

MARTIN: This story comes from a reporting partnership²¹ between NPR, WHYY and Kaiser Health News.

1 addiction   

n.上瘾入迷，嗜好

参考例句：

• He stole money from his parents to feed his addiction.他从父母那儿偷钱以满足自己的嗜好。
• Areas of drug dealing are hellholes of addiction,poverty and murder.贩卖毒品的地区往往是吸毒上瘾、贫困和发生谋杀的地方。

2 pharmacies   

药店

参考例句：

• Still, 32 percent of the pharmacies filled the prescriptions. 但仍然有32%的药剂师配发了这两张药方。 来自互联网
• Chinese herbal pharmacies, and traditional massage therapists in the Vancouver telephone book. 中药店，和传统的按摩师在温哥华的电话簿里。 来自互联网

3 epidemic   

n.流行病；盛行；adj.流行性的，流传极广的

参考例句：

• That kind of epidemic disease has long been stamped out.那种传染病早已绝迹。
• The authorities tried to localise the epidemic.当局试图把流行病限制在局部范围。

4 prescription   

n.处方，开药；指示，规定

参考例句：

• The physician made a prescription against sea- sickness for him.医生给他开了个治晕船的药方。
• The drug is available on prescription only.这种药只能凭处方购买。

5 prescriptions   

药( prescription的名词复数 )； 处方； 开处方； 计划

参考例句：

• The hospital of traditional Chinese medicine installed a computer to fill prescriptions. 中医医院装上了电子计算机来抓药。
• Her main job was filling the doctor's prescriptions. 她的主要工作就是给大夫开的药方配药。

6 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

7 determined   

adj.坚定的；有决心的

参考例句：

• I have determined on going to Tibet after graduation.我已决定毕业后去西藏。
• He determined to view the rooms behind the office.他决定查看一下办公室后面的房间。

8 stints   

n.定额工作( stint的名词复数 )；定量；限额；慷慨地做某事

参考例句：

• He stints himself in [of] sleep. 他节制睡眠。 来自辞典例句
• She never stints herself of money to buy books for her children. 她从不吝惜掏钱让子女们买书。 来自互联网

9 withdrawal   

n.取回，提款；撤退，撤军；收回，撤销

参考例句：

• The police were forced to make a tactical withdrawal.警方被迫进行战术撤退。
• They insisted upon a withdrawal of the statement and a public apology.他们坚持要收回那些话并公开道歉。

10 ongoing   

adj.进行中的，前进的

参考例句：

• The problem is ongoing.这个问题尚未解决。
• The issues raised in the report relate directly to Age Concern's ongoing work in this area.报告中提出的问题与“关心老人”组织在这方面正在做的工作有直接的关系。

11 curb   

n.场外证券市场，场外交易；vt.制止，抑制

参考例句：

• I could not curb my anger.我按捺不住我的愤怒。
• You must curb your daughter when you are in church.你在教堂时必须管住你的女儿。

12 pharmacy   

n.药房，药剂学，制药业，配药业，一批备用药品

参考例句：

• She works at the pharmacy.她在药房工作。
• Modern pharmacy has solved the problem of sleeplessness.现代制药学已经解决了失眠问题。

13 ethically   

adv.在伦理上，道德上

参考例句：

• Ethically , we have nothing to be ashamed about . 从伦理上说，我们没有什么好羞愧的。
• Describe the appropriate action to take in an ethically ambiguous situation. 描述适当行为采取在一个道德地模棱两可的情况。

14 dispensing   

v.分配( dispense的现在分词 )；施与；配（药）

参考例句：

• A dispensing optician supplies glasses, but doesn't test your eyes. 配镜师为你提供眼镜，但不检查眼睛。 来自《简明英汉词典》
• The firm has been dispensing ointments. 本公司配制药膏。 来自《简明英汉词典》

15 tempted   

v.怂恿（某人）干不正当的事；冒…的险（tempt的过去分词）

参考例句：

• I was sorely tempted to complain, but I didn't. 我极想发牢骚，但还是没开口。
• I was tempted by the dessert menu. 甜食菜单馋得我垂涎欲滴。

16 dealing   

n.经商方法，待人态度

参考例句：

• This store has an excellent reputation for fair dealing.该商店因买卖公道而享有极高的声誉。
• His fair dealing earned our confidence.他的诚实的行为获得我们的信任。

17 illicit   

adj.非法的，禁止的，不正当的

参考例句：

• He had an illicit association with Jane.他和简曾有过不正当关系。
• Seizures of illicit drugs have increased by 30% this year.今年违禁药品的扣押增长了30%。

18 tapering   

adj.尖端细的

参考例句：

• Interest in the scandal seems to be tapering off. 人们对那件丑闻的兴趣似乎越来越小了。
• Nonproductive expenditures keep tapering down. 非生产性开支一直在下降。

19 heroin   

n.海洛因

参考例句：

• Customs have made their biggest ever seizure of heroin.海关查获了有史以来最大的一批海洛因。
• Heroin has been smuggled out by sea.海洛因已从海上偷运出境。

20 dispense   

vt.分配，分发；配(药)，发(药)；实施

参考例句：

• Let us dispense the food.咱们来分发这食物。
• The charity has been given a large sum of money to dispense as it sees fit.这个慈善机构获得一大笔钱，可自行适当分配。

21 partnership   

n.合作关系，伙伴关系

参考例句：

• The company has gone into partnership with Swiss Bank Corporation.这家公司已经和瑞士银行公司建立合作关系。
• Martin has taken him into general partnership in his company.马丁已让他成为公司的普通合伙人。