Ketamine Becomes Pain Treatment Drug with Little Research

Ketamine Becomes Pain Treatment Drug with Little Research

氯胺酮成为疼痛治疗药物，但研究不足

【原文听力】

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　　By Andrew Smith

　　13 November 2023

　　As doctors in the United States reduce their use of opioid painkillers, another drug is becoming popular: ketamine.

　　For more than 50 years, ketamine has been used as a painkiller for patients having surgery. Now, for profit medical centers and online health services have increasingly used the drug as a treatment for pain, depression, anxiety and other conditions.

　　However, some experts worry about the increased use of the drug. They say there is not much research about how well the drug works to control pain. And they worry that, like opioids, too many patients may get prescriptions for it even though the drug carries safety and abuse risks.

　　Studying ketamine use

　　Dr. Padma Gulur is a pain specialist at Duke University in the state of North Carolina. She is studying ketamine's use. She says there are few pain medicines that doctors can choose from. So, limited research showing possible benefits of ketamine can lead to a big increase in its use, she told The Associated Press.

　　Gulur and her co-workers followed 300 patients receiving ketamine at Duke. They found that more than one-third of them reported important side effects that required professional help. These included hallucinations, troubling thoughts, and visual problems.

　　Ketamine also did not reduce opioid prescriptions in the months following treatment, Gulur said. The research is under review for publication.

　　Ketamine targets a brain chemical messenger called glutamate, which is thought to effect both pain and depression. A small amount of ketamine can produce strong effects on the brain, including hallucination.

　　Daniel Bass lives in the state of Kentucky. He was given ketamine for pain related to a rare bone and joint disorder. He said the drug reduced his pain, but the visual effects of the drug were "horrifying."

　　The business of ketamine

　　The U.S. Food and Drug Administration (FDA) approved ketamine 50 years ago as a painkiller for patients having surgery. The drug can now be purchased cheaply and prescribed by most doctors and some healthcare workers, like nurses, with less training.

　　Since 2017, prescriptions for ketamine have increased more than 500 percent, Epic Research, a medical data company said. Pain was the top condition for which ketamine was prescribed, though depression has been rising quickly.

　　Dr. David Mahjoubi owns the Ketamine Healing Clinic in Los Angeles, California. He offers ketamine for several conditions including pain, alcohol addiction and anxiety. "We want patients to disassociate or feel separate from their pain, depression or anxiety," he said. "If they feel like they're just sitting in the chair the whole time, we actually give them more."

　　Doctors can buy ketamine for less than $100 per treatment. They then charge between $500 and $1,500 to inject patients with the drug.

　　Online prescriptions have also become easier since COVID-19. So, health centers face increasing competition from online health services like MindBloom and Joyous. These companies connect patients with doctors who can prescribe mixed versions of ketamine, like nasal spray and pills, remotely and send it through the mail.

　　In May, health officials tried to end the policy permitting online prescriptions of high-risk drugs like ketamine and opioids. But they agreed to extend the policy through 2024 after pushback from online health companies and doctors.

　　Dr. Samuel Wilkinson is a Yale University psychiatrist who prescribes ketamine and other drugs for depression. He says the current rules for prescribing ketamine are not very strict. "There's good things about that and not-so-good things about that," he said.

　　Last month, the FDA warned doctors and patients against mixed versions of ketamine. The agency said it does not regulate what goes into the mixtures and cannot say if they are safe. The warning followed a similar one last year about nasal spray versions of ketamine.

　　For now, experts say it is unlikely health officials will go beyond their recent warnings about mixtures of the drug.

　　Dr. Caleb Alexander is a drug safety researcher at Johns Hopkins University. He said controlling health centers is beyond the power government officials currently have.

　　I'm Andrew Smith. And I'm Faith Pirlo.

　　Matthew Perrone wrote this story for the Associated Press. Andrew Smith adapted it for VOA Learning English.

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　　作者：安德鲁·史密斯

　　2023年11月13日

　　随着美国医生减少使用阿片类止痛药，另一种药物正在变得流行：氯胺酮。

　　氯胺酮已经被用作手术患者的止痛药超过50年。现在，以盈利为目的的医疗中心和在线健康服务越来越多地使用这种药物来治疗疼痛、抑郁、焦虑和其他病症。

　　然而，一些专家对这种药物的使用增加表示担忧。他们说，关于这种药物如何控制疼痛的研究并不多。他们担心，就像阿片类药物一样，尽管这种药物带有安全和滥用的风险，但可能会有太多的患者得到它的处方。

　　研究氯胺酮的使用帕德玛·古卢尔博士是北卡罗来纳州杜克大学的疼痛专家。她正在研究氯胺酮的使用。她说，医生可以选择的止痛药物很少。所以，有限的研究显示氯胺酮可能有益，可以导致其使用的大幅增加，她告诉美联社。

　　古卢尔和她的同事们跟踪了在杜克接受氯胺酮治疗的300名患者。他们发现，超过三分之一的患者报告了需要专业帮助的重要副作用。这些包括幻觉、困扰的思想和视觉问题。

　　古卢尔说，氯胺酮在治疗后的几个月内也没有减少阿片类药物的处方。这项研究正在接受出版审查。

　　氯胺酮针对的是一种名为谷氨酸的大脑化学信使，人们认为它会影响疼痛和抑郁。少量的氯胺酮可以对大脑产生强烈的影响，包括幻觉。

　　丹尼尔·巴斯住在肯塔基州。他因罕见的骨关节疾病相关的疼痛而被给予氯胺酮。他说这种药物减轻了他的疼痛，但药物的视觉效果“令人恐惧”。

　　氯胺酮的商业化美国食品和药物管理局（FDA）在50年前批准了氯胺酮作为手术患者的止痛药。这种药物现在可以被大多数医生和一些接受较少培训的医疗工作者，如护士，以低廉的价格购买和处方。

　　Epic Research，一家医疗数据公司说，自2017年以来，氯胺酮的处方增加了500%以上。疼痛是氯胺酮被处方的最主要病症，尽管抑郁症的增长速度很快。

　　大卫·马乔比博士在加利福尼亚州洛杉矶拥有氯胺酮治疗诊所。他提供氯胺酮来治疗包括疼痛、酒精成瘾和焦虑在内的几种病症。他说：“我们希望患者能够与他们的疼痛、抑郁或焦虑分离。如果他们感觉像是一直坐在椅子上，我们实际上会给他们更多。”

　　医生可以以每次治疗不到100美元的价格购买氯胺酮。然后他们收取500到1500美元的费用，将这种药物注射给患者。

　　自从COVID-19以来，网上处方也变得更容易。因此，健康中心面临来自像MindBloom和Joyous这样的在线健康服务的日益增加的竞争。这些公司将患者与可以远程开出氯胺酮混合版本，如鼻喷剂和药片的医生联系起来，并通过邮寄发送。

　　今年5月，卫生官员试图结束允许在线处方高风险药物如氯胺酮和阿片类药物的政策。但在在线健康公司和医生的反对下，他们同意将该政策延长至2024年。

　　塞缪尔·威尔金森博士是耶鲁大学的一名精神病医生，他为抑郁症患者开具氯胺酮和其他药物的处方。他说，当前对氯胺酮的处方规定并不严格。他说：“这有好的一面，也有不那么好的一面。”

　　上个月，美国食品和药物管理局警告医生和患者不要使用混合版本的氯胺酮。该机构表示，它不监管混合物中的成分，也不能说它们是否安全。这个警告是在去年对氯胺酮鼻喷剂版本的类似警告之后发出的。

　　目前，专家们表示，卫生官员不太可能超越他们最近对药物混合物的警告。

　　约翰霍普金斯大学的药品安全研究员卡莱布·亚历山大博士表示，控制健康中心超出了政府官员目前的权力范围。

　　我是安德鲁·史密斯。我是费思·皮尔洛。

　　马修·佩罗内为美联社撰写了这篇报道。安德鲁·史密斯为美国之音学习英语改编了它。

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　　这个故事中的词汇

　　anxiety -n. 感到担忧或紧张的情绪

　　prescription -n. 医疗专业人员为患者可以服用的药物签署的订单

　　benefit -n.好的或积极的效果或结果

　　hallucination -n. 一种精神状态，看到并不存在的东西，通常是因为你生病或者服用了药物。

　　visual -adj. 与视觉或看见有关的

　　under review -adj.短语；被仔细查看和检查

　　horrifying -adj. 产生强烈的恐惧感或极度令人不安

　　addiction -n. 服用有害药物并无法停止服用的状况

　　version -n. 某物的特定形式或类型