医学博士Nora D. Volkow是美国国立卫生研究院国家药物滥用研究所的主任。Volkow博士是一名研究精神科医生和科学家，呼吁美国对药物成瘾的政策进行转变：对于患有药物使用障碍的人，治疗而不是惩罚。

She argues that current laws and policies that criminalize and incarcerate people who use drugs are counter-productive, and exacerbate the current opioid overdose crisis and other addiction-related problems.

Dr. Volkow discussesher recent Perspective， 出版于神经心理药理学,with Elizabeth Yepez, Executive Editor for Medicine and Life Science Journals, and Rachel Daniel, Co-chair of the SN SDG Mental Health Research Group and Editorial Director for Springer Behavioral and Health Sciences Books.

Tell us about your decision to express these views in your official capacity of Director.
In my role as director of the National Institute on Drug Abuse, I oversee the largest portfolio of funded research on addiction and related issues, and I see the scientific evidence every day. Last year, 2020, was the worst year on record for drug overdose deaths, despite advances in medical treatment for opioid use disorder and widespread recognition of the addiction and overdoses crises in the United States. As a country, we have to re-evaluate how we are addressing drug use, and the science provides some answers as to what is working and isn’t regarding the issue of criminalization.

We notice you use the term “substance use disorders.” Why that language?
对成瘾者最常见的一种误解ion is thinking that it is a choice, or a character flaw. It is not. It is a brain disease, a chronic, relapsing disorder characterized by compulsive drug seeking and continued use despite harmful consequences, along with changes in brain circuitry. It is considered both a complex brain disorder and a mental illness. The Diagnostic and Statistical Manual of Mental Disorders V, the gold-standard text on mental illness that establishes diagnostic terminology, uses the term “substance use disorder.” It is important that our language choices, particularly in a professional context, reinforce that this is a disease that requires evidence-based medical treatment. This is still a major gap in the United States, both culturally as well as within healthcare settings.

Your piece highlights published studies (“abundant data”) that show that current enforcement, punishment, and treatment access disproportionately and negatively impacts Black lives. If this is already known, why does it persist?
显然，美国目前正在估计歧视性和种族主义政策的悠久历史，其中许多政策今天仍在继续。关于毒品战争也不例外，通过以不成比例的速度监禁黑人，它对健康，经济安全和流动性，教育，住房，家庭产生了辐射影响黑人和其他有色人种。在科学中，我们经常必须说我们还没有答案，“需要更多的研究”。但是这里的证据是简单明了的，需要告知紧急对话。

犯罪的“基于公共卫生的替代方案”的例子是什么？有证据表明它可以起作用吗？
There is evidence of positive outcomes associated with public-health approaches to drug use, however, there is considerable variation in drug laws and enforcement practices. Of the six current models of decriminalization for dealing with drug possession, four include an approach that employs a pathway to education, treatment, or social services.

As part of the Helping to End Addiction Long-term Initiative, or NIH HEAL Initiative, the Justice Community Opioid Innovation Network (JCOIN) multi-site study is a good example of a public health-based approach. The JCOIN study is investigating approaches to increase high-quality treatment and care for people with opioid misuse and OUD in justice settings. JCOIN will test strategies to expand effective treatment and care in partnership with local and state justice systems and community-based treatment providers. Additionally, the JCOIN hub in New York is also studying an opioid court model as an alternative to imprisonment and aimed at reducing overdose, recidivism, and improve service delivery and linkage to medication for opioid use disorder.

Do you believe there is consensus behind this public health approach?
我们有认真的工作要做。与吸毒和成瘾有关的污名与世界各地的文化和社会深深根深蒂固。许多疾病，尤其是心理健康障碍，受到污名化。作为人类，我们被教导要害怕疾病，并疏远与我们不同的东西。但这是一个失败的主张。我们都生病了，我们都有需求，我们都从一个以证据的护理和同情心来治疗疾病和疾病的系统中受益。进行这种认知转变对于实现实施广泛公共卫生方法的政治意愿可能至关重要。

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