Maimaita Tarihi: Darussan Manta na Magance Narcotic
A cikin inuwar jerin Netflix Ciwan painkiller, hade da Dokokin OxyContin- kuma annoba na fentanyl overdoses- ya kasance wani babi mai ɓoye na annobar cutar opioid ta Amurka: "ƙirƙirar" 1965 na "Maganin Kulawa na Methadone" (MMT) a Jami'ar Rockefeller. Ba da da ewa nan da nan da ƙarfi ta cibiyar kiwon lafiyar jama'a ya ninka sau goma (!), A cikin shekaru goma, adadin rayuka na al'ummar ƙasar.
Wannan faɗuwar fa'idar amfani da methadone ya haifar da misalan 'ƙasa mai daɗi'—a ciki wanda daga baya, sanannun kurangar inabi na rikicin opioid ya sami tushe kuma ya bunƙasa. Tabbas, tallace-tallace mai tsanani na Purdue Pharma's OxyContin da kwararar fentanyl daga China (ta hanyar Mexico) haɓaka ƙimar mutuwar opioid waɗannan 'yan shekarun da suka gabata, amma jujjuya dabi'u daga detoxification zuwa kiyayewa ya fara yi.
Shekaru da yawa nan da nan kafin, 1923 zuwa 1965 - a ra'ayin Farfesa David Courtwright, "zamanin zamani na sarrafa narcotic; 'classic' a cikin ma'anar mai sauƙi, daidaito, da tsauri" - ya kawo koma baya, raguwa mai zurfi a cikin shaye-shayen ƙwayoyi. Sobriety, abstinence, da ƙin yarda da al'umma sun kafa ginshiƙan abin da ya kasance babban nasara dabarun kawar da jaraba (daga opium, morphine, da jarabar tabar heroin na farkon 1900s).
Shekaru da yawa nan da nan bayan, a cikin "Dogon Boom" (1980-2010), wakiltar mafi dadewa na ci gaba da zaman wadata na Amurka. Abin da ake kira "mutuwar yanke ƙauna" ya ragu kusan a duk faɗin hukumar. An sami ƙarancin kashe kansa, kuma mutuwar barasa da shaye-shaye na kowane nau'i ya ƙi - ban da opioids, rukunin magungunan kawai da aka “sanya musu magani.”
Sabbin gyare-gyare da kuma karɓuwa "Model na Cuta" nan da nan analogized narcotics methadone tare da insulin masu ciwon sukari kamar yadda duka suna buƙatar dogon lokaci "maye gurbin" magani - duk da haka, ga kowane irin "cuta" na jaraba ga masu kwantar da hankali, cocaine, barasa, ko barbiturates - abstinence (antithetically da munafunci) ya kasance ƙarshen wasan. Ya kasance abin lura cewa har yau babu wani mai ba da shawara mai tsauri na Tsarin Cutar da ke goyan bayan kiyaye mutane akan benzodiazepines ko hodar iblis. Ba za a iya ganuwa wannan bambanci mai haske ba.
wannan likita na jarabar opioid, yayin da aka bambanta kuma watakila yana da niyya mai kyau, da alama ya ci tura shekaru da yawa da suka gabata. Maimakon rage amfani da shi, ya inganta yanayin da dogaro da opioid ya bunƙasa, ya zarce sauran abubuwa a cikin shekarun da suka fi wadata a Amurka. Wannan ya jefa methadone ba kawai a matsayin kayan aiki don magani ba har ma a matsayin mai yuwuwar mai ba da gudummawa ga ainihin matsalar opiate da yake neman ragewa.
Jadawalin lokaci na annoba na opioid na CDC ya tsara “taguwar ruwa” (ko raƙuman ruwa masu tasowa) na mutuwar opioid. Yana farawa da OxyContin, yana motsawa ta hanyar mafi girman isar tabar heroin mai rahusa, kuma yana kaiwa kololuwar cutar fentanyl.
Abin da jadawali na CDC bai nuna ba shine farkon, rashin kula da methadone, shuru shuru a cikin 70s, ruwan teku wanda ya tashe duk jiragen ruwa, yana ɗaga adadin waɗanda ke daure a jiki zuwa opioids tun kafin CDC's "1 na Wave" (sic) buga.
Wannan na gaba, babban lokaci mai girma yana ƙaddamar da wannan methadone "taguwar farko," ta komawa zuwa 1914. An maye gurbin ɗanɗanon ɗanyen opium na ƙarni na 19 ta hanyar amfani da mai haɗawa, morphine, (sau da yawa tare da na ƙarshe na "maganin" jaraba ga tsohon) - tare da sakamakon da ake iya faɗi: sabon jarabar morphine. A farkon karni, heroin (aka diacetylmorphine) ya shiga a matsayin irin wannan zai zama mai ceto ga barazanar morphine, kawai ya zama babbar matsala kanta: rabin miliyan tabar heroin addicts (tsakanin Amurkawa miliyan 100). Daidai a cikin 1914, ma'auni na rikicin opioid ya kusan girma kamar yadda yake a yau; duk da haka, ba kamar halin da ake ciki na zamani ba, matsalar ta ci gaba da raguwa, ta kai sifili yadda ya kamata.
A cikin shekarun 1920, Amurka ta dau tsayuwar daka a kan opiates, matakin da ya zo daidai da lokacin ci gaban tattalin arziki da al'adu. An ayyana shekarun Twenties na Roaring ta wadata da ci gaba (kuma a, Hani), tare da mayar da hankalin al'umma gabaɗaya zuwa ga ƙirƙira da murmurewa a zamanin baya-bayanan yaƙi maimakon hazo na jarabar narcotic. Tsare-tsaren tsare-tsare na lokacin, suna mai da hankali kan hankali da bin doka, sun ba da gudummawa ga al'ummar da ke shirin buƙatu da nasarorin shekaru masu zuwa. Lokaci ne da zabin kiwon lafiya da samar da aiki ya fito fili, kuma inuwar tabar heroin ta ja baya a sakamakon kishin kasa.
Rashin ƙin darussan tarihi ya kawo methadone a kan gaba na maganin jarabar tabar heroin-wani madaidaici daga ingantattun dabarun da ke gudana. 1960s-70s masu tsara manufofin kiwon lafiya sun rungumi opioid methadone a matsayin MMT, suna kwaikwayon tsohuwar, tsarin rashin amfani na amfani da opioid ɗaya don yaƙar wani.
A zahiri, wannan jujjuyawar da aka yi an sanye shi da lingo na kimiyya na zamani, tare da masu ƙirƙira na MMT suna ƙididdigewa kuma suna da'awar. "Theory of addiction" metabolic ka'idar. Duk da haka, da gangan ya kasance da gangan na tsarin juriya na kasa da alhakin da ya yi nasarar rage adadin mutuwar opioid zuwa kusan sifili - yana motsawa a cikin rikicin opioid mai dorewa da muke fama da shi a yau wanda yanzu ke kashe Amurkawa 100,000 a kowace shekara, kusan ninki biyu na dukan yakin Vietnam.
Rikicin gida, Martani na ƙasa: Faɗawar Batar da Methadone
Lokacin da Faransa ta yi atishawa, duk Turai ta kamu da mura.
Matar, 1848
A cikin 1966, asibitin methadone na farko na ƙasar ya fito (a zahiri da a zahiri) daga cikin keɓaɓɓen yanayin birnin New York: tare da ƙimar jarabarsa sau 25 fiye da sauran ƙasar. Manyan hanyoyin birni na birni sun sauƙaƙe kwararar matsananciyar kwarara daga yankunan da ke fama da talauci kamar Harlem zuwa gundumomi masu wadata, wanda ke haifar da sata don tallafawa halayen miyagun ƙwayoyi. Maganin garin? Methadone.
Methadone bai kasance game da farfadowa ba fiye da maganin kwantar da hankali na zamantakewa: an wajabta shi don ta'aziyya na babba maimakon fa'ida na dogon lokaci na masu shan maye, yana nuna babban canji daga bangaskiya cikin murmurewa zuwa murabus ɗin sarrafa alamun. Elite sun yanke shawarar kiyaye Talakawa. Samar da wata matsala ta birnin New York -matsala a cikin ƙasa gabaɗaya an buga su iri ɗaya yayin Covid-19. M, polyglot NYC-borough Queens' mai tsanani (amma daga baya) fashewar buɗewar ya haifar da ƙuntatawa da yawa da aka yi amfani da su a ko'ina - (sannan, kamar yadda a baya) ke so. New York Times' kansa hoto ko bidiyo mai zagaya yanar gizo da sauri isa. Zamanin sha tara da sittin New York Times ' methadone mai fa'ida tsare-tsaren tsare-tsare iri ɗaya a cikin ƙasa, duk da cewa an yi la’akari da cewa an yi hakan ba tare da ɓata lokaci ba.
Karɓar Alƙawari, Rashin Methadone: Ƙarin Laifuka DA Ƙari
Bari mu saita yanayin: New York na 1960, cibiyar kasuwanci da al'adu ta Amurka - duk da cewa tana da tsattsauran ra'ayi na tattalin arziki da kabilanci, sun fuskanci kalubalen zamantakewa saboda masu shan tabar heroin musamman a Harlem da Bedford-Stuyvesant.
Daga William L. White's Addiction na Heroin a cikin 1950s: "Halin karuwar amfani da tabar heroin a cikin matalautan Amurkawa na Afirka da Latino waɗanda suka fara kafin WWII ya ci gaba. Haƙiƙa, tabar heroin tana cikin unguwanni ɗaya da ya kasance a ciki, amma wanda zama a cikin wadannan unguwannin sun canza...[kuma mai mahimmanci…]Addiction, kamar William Burroughs ya taɓa lura, shine 'cutar fallasa,' kuma waɗanda aka fallasa a cikin 1950s sun canza yayin da unguwannin suka canza. "
Jaririn jarumtaka a lokacin ya yi nisa da matsalar kasa. Ƙididdigar birnin New York, ~ 17,000 mutane, duk da haka ya ƙunshi cikakken rabin ma'aikatan tabar heroin na ƙasar (tare da 4% kawai na yawan jama'ar Amurka). Fari ya ci gaba:
Abubuwan da ake amfani da su na narcotic sun ragu sosai a lokacin yakin duniya na biyu wanda Ofishin Narcotics ya yi niyyar yin wani yunƙuri na ƙarshe na ƙarfafa tilastawa. kawar Matsalolin miyagun ƙwayoyi na Amurka. Ofishin ya ci gaba da yin fahariya a cikin 1950s cewa adadin masu shan narcotic a Amurka ya ragu zuwa matakin mafi ƙasƙanci a tarihin zamani… daga 500,000 a 1914, zuwa 250,000 kafin Yaƙin Duniya na II kuma zuwa ƙaramin ƙima na 34,729 (a duk faɗin ƙasar). [kusan 1% na ƙungiyar yau].
Wannan "zamanin gargajiya" na sarrafa narcotics an nuna shi a cikin ƙananan laifuffuka, da ƙarancin kisan kai (kamar yadda aka kwatanta kasa); (NB: Yawan jama'ar NYC ya kasance a tsaye 1930-1990). Tabbas lambobi suna karuwa a farkon shekarun 1960, amma ba su fi na 1930s Babban Mawuyacin hali ba. Ba batun “lokaci mai tsauri yana buƙatar tsauraran matakai” har sai bayan wani ma'auni mai tsauri (juyawar manufar MMT) ta fashe adadin kisan kai, duba 1990's. Masu ci gaba (tabbas) "suna sa ido," kuma sun yi watsi da horo da matakan ladabtarwa waɗanda suka kawo kololuwar baya.
Ko da a wannan lokacin babban kololuwar bakin ciki, kisan kai ya ragu sau hudu fiye da na shekarun 1990, shekaru 20 a zamanin methadone. Akasin haka, shekaru 35 kafin MMT lokaci ne na kwanciyar hankali, tare da ƙarancin kisa. Daidaituwa ba dalili bane, amma akwai gagarumin tashin hankali a cikin kashe-kashen da suka yi daidai da fadada MMT. 'Yan shekarun 90 sun nuna koma baya mai ban mamaki, wanda ke da alaƙa da tsauraran doka a ƙarƙashin Giuliani (wanda ya yi duk mai yiwuwa don dakatar da tallafin birni na MMT) da kuma Bloomberg.
Bayan-de Blasio, kuma an sami karuwar aikata laifuka. Yana da kyau a ce methadone, ko da yake yana daɗe a matsayin "gyara" na tarihi (wanda aka yi niyya), gaba ɗaya ya kasa magance ainihin batun da aka tura shi. Bayanan sun nuna cewa duka manufofin narcotics da ƙa'idodin zamantakewar al'umma suna tasiri yawan laifuka. Lambobin gaskiya ne, kuma suna ba mu saƙo mai haske wanda masu ba da shawara na Tsarin Cutar suka zaɓi yin watsi da su.
A farkon shekarun 1960, yawan laifuffuka na birnin New York ya haura, yana riƙe da tsayayyen rarar kashi 50 cikin ɗari sama da matsakaicin ƙasa. Babu shakka, an samu karuwar yawan shan tabar tabar tabar wiwi a kasar da kuma sata. Don haka, laifin-"maganin bincike" daidai ne, amma MMT "maganin" (kamar zuwa "karin letches") Wataƙila ya zama sanadin, kuma tsayawa tare da shi kawai ya ƙara tsananta batun narcotic, ƙara yawan masu amfani, aikata laifuka, da mutuwa. Sabanin haka, Giuliani ya yanke laifuka da rabi "karshe tagogi" - 'yan sanda, faduwa birnin New York KASA matsakaicin ƙasa.
In 1970, Dr. Robert Baird na Harlem's "Taimakawa masu shan barasa da son rai na Ƙarshen Narcotics" sun fahimci hakan, suna tsinkayar abin da zai iya haifar da fashewar methadone:
Methadone ba babban ci gaba ba ne; babban rushewa ne. Babu shakka babu bambanci a musanya methadone ga tabar heroin; Sakamakon ƙarshe ɗaya ne — kuna da mutum wanda ya kamu da cutar. Ya kasance (yana kan tituna) tun 1945; Yara a Harlem suna kiran su 'dollies'.
Ga masu karɓar methadone, binary ya samo asali: tsaya kan gyare-gyare ko sayar da kashi, haramtacciyar iska - wanda ya haifar da sababbin dillalan narcotic "wakili". Dillalai na asali, nesa da barin kasuwancinsu, kawai sun faɗaɗa turf ɗinsu. Methadone, wanda aka yi niyya azaman salve na al'umma, maimakon haka ya zama ƙarfin kasuwa, yana tura tabar heroin zuwa sabbin yankuna.
Ga methadone-“masu ba da gudummawa,” suna zaune lafiya a jami’o’i da asibitoci, samar da sabuwar doka ta maye gurbin tabar heroin ya yi daidai da aikin jin kai na zamani na aske kai cikin haɗin kai tare da mai cutar kansa. Koyaya, sabanin wannan motsin motsa jiki wanda baya canza duk wani gaskiyar likita, shirin methadone ya yada “ciwon daji” na amfani da kwayoyi, yana kawo adadi mai yawa a cikin al'umma mai fa'ida zuwa wani sabon matakin dogaro, da asarar hukumar gaba daya a rayuwarsu, hade yayin da suke tafiya ta yau da kullun zuwa asibitin methadone kowace safiya, ana lura da su a zahiri cinye miyagun ƙwayoyi, kuma ana ba da su bazuwar. Masu ba da shawarwarin Model Cuta ba su yi nufin marasa lafiyar Methadone su zama mutane masu zaman kansu ba har tsawon rayuwarsu.
Daidaituwar Zuciya: Methadone Bai Gyara Harlem ba, Ya Yada Bacin rai
Maimaita ra'ayin Winston Churchill na gurguzu- "Mummunan halin jari-hujja shine rashin daidaito rabon albarka. Halin dabi'ar gurguzu shine rabon zullumi daidai gwargwado-ɗaukar maganin kula da methadone (MMT) ya haifar da wannan “daidaitacce.”
A cikin haɗarin samun misalan aske-kai ɗaya da yawa, wannan yana kawo a hankali abin dariya:
Wani magidanci ya ba da dala 1,000 don a yi masa kama da “kamar” na wanzami. Wanzami ya ci gaba da aske kawunansu duka, gaba ɗaya—ya mai da su gashin baki ɗaya, ya sa kuɗin aljihu. Abokin ciniki yana da ƙasa da farin ciki.
Hakazalika, kula da methadone, wanda aka sayar da shi azaman gyaran kimiyyar likitanci ga matsalar tabar heroin ta Harlem, kawai ya yada zullumi a cikin ƙasa baki ɗaya, ba tare da warware matsalar da gaske ba. A cikin 1960, Baƙar fata sun kasance mafi kusantar ɗaukar tabar heroin sau bakwai. Bayan shekaru hamsin, farar fata sun kasance daidai da waɗanda ba farar fata ba. A halin da ake ciki jimlar yawan masu shan taba sun karu sau 25.
(NB: Wannan jadawali yana ba da ra'ayi na ƙarya na inganta marasa farar fata. Wannan bambance-bambancen da ke bayyana ya samo asali ne saboda karuwar 7X- a tsakanin fararen fata, kamar yadda sabbin kaso na dangi a ƙarshe ke nuna rabe-raben yawan jama'a, ba tare da nuna ainihin raguwar amfani a cikin jama'ar da ba fararen fata ba.n.)
Sakamakon masana'antar-a nan kawai partially-in-cheek da ake kira, "Rukunin Masana'antu na Methadone"(MIC) - yana da, har ma a cikin matakansa na farko, PR mai mahimmanci, ta hanyar gida. New York Times, shugabannin kiwon lafiyar jama'a, da masu hankali. Kamar yadda yake tare da Covid-19, an yanke hukunci a tsakiya, tarayya tare da sakamako da sakamako masu tayar da hankali. Ƙarshen shekarun 1960 ya ga wasu ƙarin asibitocin methadone, amma adadin su ya yaɗu sosai a farkon shekarun 1970 a ƙarƙashin shaƙatawa na dokokin tarayya da nassi na Nixon na Dokar Abubuwan Kula da Abu na 1970 wanda ya haifar da babban tsarin mulki na tarayya wanda ya maye gurbin shawarar kula da lafiya na matakin jiha.
A watan Afrilu 1971, FDA ta sake rarraba methadone daga “sabon magani na bincike” zuwa “sabon aikace-aikacen magani,” yana faɗaɗa amfani da shi sosai. Wannan canjin ya kawar da mahimman ka'idoji, musamman haramcin yin doka ga mata masu juna biyu, wanda ya haifar da gazawarsu na kare jariran da aka haifa daga irin alamun cututtukan narcotic-janyewar methadone-masu rubutawa waɗanda ke da wahala ga iyaye mata su jure. Wannan ya kasance mummunan tasiri na manufofin da aka saki a ƙarƙashin sunan samun dama saboda jaraba (wataƙila) cuta ce da ke buƙatar magani mai gudana.
Mafi mahimmancin sauyi, duk da haka, shine kawar da ma'auni- da tsawon lokacin jiyya. Wannan ingantaccen tsari da kuma ci gaba da dogaro da haƙuri, yana mai da jiyya na methadone zuwa rayuwa marar ƙarfi. samfurin biyan kuɗi. Wannan samfurin, wanda aka dore ta hanyar goyan bayan tsari da lasisi, yana ba da tabbacin asibitocin methadone rashin lafiya: yana ba da gudummawa ga riba ta har abada "methadone masana'antu hadaddun"-wanda ke bunƙasa akan dorewar jaraba maimakon warkar da shi. Gwamnati da kotuna sun tilasta wa ''abokan ciniki'' su ci gaba da kasuwanci.
Kamar yadda aka nuna a cikin jadawali da ke ƙasa, waɗannan ƙa'idodin annashuwa sun haifar da haɓakar haɓakawa a cikin marasa lafiya na methadone-daga 9,100 a cikin 1971 zuwa kusan 85,000 ta 1973-saitin motsi a cikin 'taguwar farko' na dogaro da opioid wanda ke nuni da haɓaka daga baya.
An tsara shi azaman maganin lafiyar jama'a, asibitocin methadone, musamman a cikin New York City, sun girma daidai da "Starbucks for opioids:" ci gaba da jaraba ya tabbatar da tsayayyen kudaden shiga daga asusun tarayya da na gida, duk da haka. alamun gargaɗin farko da juriya na al'umma.
Mista Austin ya ce:
"Na firgita don tunanin matsalar Gabashin Harlem za ta fuskanta idan an samar da tabar heroin kyauta kamar methadone." Mrs. Mildred Brown, shugabar hukumar al’umma: “Shirin gyaran daya so ya shigo ya kawo masu shan barasa 500 da shi. Na ce East Harlem yana da isassun mashaya na kanmu, ba ma bukatar mu shigo da kowa. Dole ne mu tuntubi kowane mai shan taba a matsayin mutum kuma mu gano abin da ke motsa sha'awar sa kuma mu canza shi.
TSARI-TSARE METHADONE A HARLEM 23 ga Afrilu, 1972
"Rage cutarwa"
Ba tare da samun gaba da kanmu ba, yana da mahimmanci a yi kamanceceniya tsakanin MMTs da aka qaddamar a ƙarshen 1960s da musayar allura da suka zo daga baya, duka suna fitowa a matsayin ƙwararrun ƙwararrun ƙwararrun ƙwararrun ƙwararrun ƙwararrun ƙwararrun mutane. MMT-ma'ana ya fadi a karkashin rubric, "likita." Babu shakka, wannan shine mafarin kalmar "rage cutarwa". Ga a Google Ngram alamar mitar wallafe-wallafen kalmomin (tare da wani ma'anar taimakon methadone maimakon yin amfani da tabar heroin a cikin lokaci makamancin haka).
Ƙarshen-1980s (HIV/AIDS-era) asalin musayar allura ya faɗi ƙarƙashin kalmar "Rage cutarwa” - kalma mai yarda kamar 'gidaje masu araha'da kumainganta samun kulawaKuma lalle ne, mun fi son allurar mu da tsabta; duk da haka, waɗannan watsa shirye-shiryen yarda da mummunan hali. Allura a cikin kantin magani da kwaroron roba a makarantun tsakiya sune abubuwan da ba su da kyau ga alhakin mutum da horo na ciki. Cire sakamakon ba ya haɓaka hankali. magungunan-pharma ta hanyar takardar sayan magani.
Irin waɗannan dabarun koyaushe suna haɓaka matsalolin da suke neman magancewa.
A cikin 1988, Majalisar Birnin New York Baƙar fata da Ƙungiyar Hispanic sun yi gargaɗi game da musayar allura:
Ya wuce duk wani tunani na ɗan adam da hankali na gari don raba allura ga masu shaye-shaye yayin da 'yan sanda da 'yan ƙasa suka mutu a yaƙin miyagun ƙwayoyi.
Wadannan manufofi an sanya su a kan al'ummomin da ainihin bukatunsu da yanayin su ya bambanta da na masu tsara manufofi, waɗanda ke gaya wa kansu cewa sun fi sani kamar yadda suka fi ilimi, kimiyya, kuma suna da nauyin "ɗauka" masu girma waɗanda ba a wanke ba. Ɗaliban ƙasƙantattu, waɗanda galibi irin waɗannan manufofin ke shafar su, suna samun muryoyinsu da abubuwan da suke so sun shafe su ta hanyar sama-sama da ba ta dace da abubuwan da suka faru ba.
Dabarun rage cutarwa sun shiga cikin aiki na zahiri wanda wasu masu sukar suka yi jayayya kan iyaka akan cin kashi. Sabanin haka, kauracewa hanya ce da ke kalubalantar daidaikun mutane su tashi sama da yanayinsu, suna ba da shawarar karfafawa daidaikun mutane kan gudanarwa kawai. Kokarin kauracewa ra'ayi kadan ne kamar ra'ayin Churchill game da nadamar jari hujja "raba albarkar da ba daidai ba:” cike da bambance-bambance a cikin nasara.
Kamar yadda barin shan taba aiki ne wasu izgili da suka ƙware sau da yawa, rashin hankali ba ya hana yiwuwar samun nasara a ƙarshe. Mahimmancin “zamanin gargajiya” akan ƙarfin mutum da juriya sun kai ga kusan-sifili amfani; Matsayin halayya na yau yana ganin ƙimar jarabar jaraba fiye da kowane lokaci, tare da sakamakon wannan sassaucin da ke tabbatar da hakan. ya fi hatsarin mota mutuwa, wanda aƙalla yana faruwa lokacin ƙoƙarin zuwa “wani wuri” sabanin “babu.”
A lokacin sauye-sauyen al'adu na shekarun 60s da 70s, yawan shan barasa ya karu duk da haka adadin masu sha ya tsaya tsayin daka, kuma wadanda suka mutu ba su yi yawa ba. Bartenders, kodayake masu rarraba ruhohi, ba su ga lambobin majiɓintan su sun kumbura ba kamar yadda asibitoci suka ga masu amfani da opioid suna ƙaruwa. Za su iya yi wa likitoci hassada saboda ikon da suke da shi na ƙirƙirar irin wannan kasuwa mai kama (wanda takunkumin likitanci ya motsa maimakon zaɓin mabukaci). Yana da ilimantarwa yayin da muke yin tambayar "Su wanene suka fi cin gajiyar wannan hanyar likitanci ga jaraba?" don duba "masu kiwon lafiya" da aka ware. Da fatan za a duba wannan kyakkyawar maƙalar hoto, 2016: "RAI DA RASHI AKAN MILE DIN METHADONE".
Ambaliyar Kasuwa: Magungunan Narcotics da aka Kayyade suna Korar Farashin Jarumin
Yayin da asibitocin methadone ke yaɗuwa, an daidaita laifukan da aka tsara-axiomatically, duka masu laifi da kuma tsararru. Dillalan Heroin, suna fuskantar raguwar tushen abokan ciniki, ba su koma baya ba (ko kuma sun zama masu ba da lissafi da wakilai na balaguro); sun yi reshe, suna niyya ga ƙananan ƙididdiga da ƙauyukan da ba a yi amfani da su ba tare da ƙananan farashi. Mun ga bangarorin biyu a cikin wadannan maganganu guda biyu:
Sabbin masu amfani da tabar heroin sun haɗa da samari a cikin lambobi masu ƙaruwa koyaushe. A cikin 1988 matsakaicin shekarun amfani da tabar heroin a Amurka shine 27; a cikin 1995, matsakaicin shekarun da ake ba da rahoton kai rahoton amfani da tabar heroin ya ragu zuwa shekaru 19.
Amfanin heroin na matasa: bita, 1998
Amfani da Heroin yana daɗaɗaɗaɗaɗaɗawa tsakanin masu matsakaicin matsayi, matasa na kewayen birni...Tun daga 2002, ƙaddamar da maganin tabar heroin ya karu da kashi 80 cikin 12 tsakanin masu shekaru 17 zuwa XNUMX.
2012
Shigar da gwamnati ta yi ya mamaye kasuwar da methadone, inda ya rage farashin tabar heroin. Kamar yadda Adam Smith zai iya lura, ƙananan farashin babu makawa ya jawo ƙarin masu amfani. Haka kuma, kowane mai amfani da methadone ya kasance mai saurin kamuwa da sake buguwa nan take.
"Wave 2" na rikicin opioid na 2000 ya kwatanta wannan tsarin farko: "mafi tsarki heroin a ƙananan farashin” yayi daidai da gabatarwar Suboxone. Wannan canjin ya biyo bayan 2000 Dokar Kula da Muggan Kwayoyi (DATA), wanda ya kara da buprenorphine- ƙarancin kwantar da hankali na opioid-zuwa arsenal na likita game da jaraba, da nufin rage rashin jin daɗin da ake gani a asibitocin methadone; yayin da yake nuna gazawar magabata.
Shekaru goma na farko na Suboxone sun ga girma da sauri fiye da na methadone, daga sifili zuwa masu amfani da miliyan. Shekaru goma da suka biyo baya sun kawo ƙarin 50% zuwa ~ 1.5 masu amfani da yanzu. Kuma duk wannan ba tare da sanannen raguwa a cikin methadone "- ƙidaya ba." Har yanzu duk da wannan ƙarin "maganin" na "cutar" abu ne kamar kare yana bin wutsiyarsa. Mafi wuya shine "maƙasudin" kamar yadda gaba ɗaya asusun mai amfani da opioid "wanda ba a kula da shi ba" ya wuce adadin da muke bayarwa a cikin jiyya. Shin an taɓa samun wata cuta wacce masu amfani da ita ba tare da magani ba suna faɗaɗa yadda muke jin daɗin sauran? Misali daya tilo zai sake zama misali na “karin leek” na tsakiyar zamanai na zubar da jini don warkar da gajiya.
Jadawalin da ke gaba yana nuna cewa akwai raguwar "gizo" a cikin "ba a kula da shi ba," amfani da opioid mai zaman kansa; amma wannan "Suboxone-decade" ya ga karuwar 50% gaba ɗaya a amfani da opioid. Akwai sabbin masu amfani da buprenorphine miliyan guda, kuma kusan 850,000 ƙarin amfani da opiates/opioids gabaɗaya. Kuma, idan manufar buprenorphine shine don fitar da masu amfani da methadone daga cikin mummuna muhallin su zuwa wurare masu farin ciki, ofisoshin likita-da alama, asibitocin methadone (da kuma "MIC”) bai yi kama da ya sanya hannu kan hakan ba: kiyaye lambobi masu ƙarfi, ruhohi masu ɗaure rabin miliyan (a $ 126 / mako, $ 3.2 biliyan / shekara).
Ƙara buprenorphine, duk da haka wani opioid na gwamnati da aka ƙara zuwa gaurayawan ya sake yin daidai da raguwa a cikin ingantaccen farashin tabar heroin (ƙananan farashin don samun girma; farashi / tsabta). Anan ga yanayin farashin heroin na Turai. Turai ta amince da Suboxone a cikin 2006. Tsarin mu ba shakka yana kama da shi, yana samun tabar heroin daga wurare iri ɗaya, da kuma hanyar sadarwa.
Zagayowar jiyya na opioid mara karewa yana nuna wauta ta amfani da mercury don maganin syphilis a cikin karni na 19, inda 'maganin' yakan kara tsananta cutar. A zamaninmu, kowane motsi na “maganin” kawai yana ƙara yawan masu fama da wahala, abin baƙin ciki ne inda maganin ke ciyar da cutar, yana ta zagayowa har abada.
Cui Bono?
Kasuwannin methadone da buprenorphine masu tasowa basu yi kama da wani shiri na likita ba fiye da na tattalin arziki, suna haɓaka masana'antar dala biliyan 16 waɗanda dalar masu biyan haraji ke ƙarƙashinsu (ta hanyar biyan kuɗi na Medicaid da Medicare). Farashin tabar heroin, methadone, da Suboxone ya kasance koyaushe sama da ƙasƙantattun husks na poppy, kamar yadda suke allurai. Yayin da allurai da dogaro ke girma, haka ma ribar ke karuwa - kuma farashin zamantakewa yana ƙaruwa daidai. Superimposing na yau da kullun methadone lambobi akan Ƙarin Bayanan Samun Nakasa na Tsaro taswirori a lokaci guda biyu na biyu a cikin 1990s. Shin hakan ya faru?
Ba kamar shekarun 1990 ba ne musamman lokacin haɗari. Wannan kuma ya kasance a lokacin "dogon bunƙasa" na wadata wanda ya zo daidai da aiki da kai, da kuma mafi aminci. Kamar kwatanta, adadin gobarar da ake ba da rahoto ya ragu da kashi 50 cikin ɗari a cikin wannan shekaru goma.
Dakunan shan magani na Methadone da masu kera buprenorphine, kamar Suboxone's Reckitt Benckiser (yanzu an sake masa suna Invidior), sun ƙera kasuwar kama-karya wacce ke bunƙasa ba tare da tallace-tallace na al'ada da talla ba-ta hanyar sake zagayowar jiyya na yau da kullun da likitoci da alƙalai suka sanya.
Samfurin cutar jaraba ya haifar da haɓakawa guda biyu a lokaci guda: masana'antar likitancin opioid da ke haɓaka da haɓaka mutuwar masu alaƙa da opioid. Wannan ya haifar da babbar tambaya: Shin muna ba da magani, ko kuma muna ciyar da annoba?
Samfurin Cuta na Addiction ya kasa. Mutane Suna da Ruhi.
Ma’aurata ne suka yi hidimar kula da methadone Drs. Vincent Dole da Marie Nyswander tare da Dr, Mary Jeanne Kreek a Jami'ar Rockefeller.
Suka
…dauki hangen nesa cewa masu shan tabar na dogon lokaci sun ci gaba da amfani da tabar heroin kuma suka sake komawa zuwa amfani da tabar heroin bayan shafe-shafe, magani mara magani, ko ɗaurin kurkuku a yunƙurin gyara rashin daidaituwa na rayuwa (sic). Ko rashin daidaituwar kwayoyin ne suka haifar da su, ta hanyar baiwar kwayoyin halittar mutum, ta hanyar ci gaba mai rauni da abubuwan muhalli, ko wasu hadewar wadannan abubuwan ba a san su ba. An san hangen nesansu da "ka'idar metabolic."
Methadone: tarihi, ilimin harhada magunguna, neurobiology, da amfani; Green, Kellogg da Kreek (ita kanta)
Maganar cewa jaraba ta samo asali ne daga takamaiman lahani na rayuwa ba ta da tabbataccen shaida. Mutane suna da saurin jaraba (wasannin bidiyo, hotunan batsa, caca, tiyatar kwaskwarima, steroids, philandering, hodar iblis, kofi, barasa - kuna sunansa) - yin lakabin "cututtukan" duka biyu masu haɗari da son rai. Yawancin waɗannan “cututtuka” nawa ne suka fuskanta a zamanin Roma?
Akasin haka, “farfadowa” yana nuna juriya mai dacewa fiye da nakasu na dindindin. Brain Scans et al. yana nuna “canje-canje” yayin jarabawar madubi martanin kwakwalwa ga duk wani babban asara, kuma mahimmanci, ana iya juyawa. Fadawa cikin (da fita) na soyayya suna bin tsarin iri ɗaya, neuro-chemically, da dai sauransu. Wasu ma suna so su "maganin" "jarabar soyayya."
Duk da haka, ana ganin MMT a matsayin mafita 'ci gaba', wanda ya yi daidai da mafi girman canjin tsakiyar ƙarni a Amurka inda aka ƙara ganin fasahar likitanci a matsayin mafita ga matsalolin zamantakewa. Masu samar da methadone na farko sun kwatanta:
Dogaran likita na tsohon mai shan maganin akan methadone yayi daidai da (nau'in I) mai ciwon sukari ya dogara da insulin....Cutar ba ta warkewa amma ana kula da lafiyarta.
(likita da yawa) Kwamitin Fadada Maganin Methadone, 1970
Methadone ba zai iya ba ku aiki, ko kyawawan ɗabi'a ko sa ku yi karatu ba. Amma don warkar da alamun likita na jarabar tabar heroin, (methadone yayi daidai da) menene insulin ga masu ciwon sukari.
Dr. Edwin A. Salsitz, darektan (Farashin NYC da kuma most Shirin MMT, Beth Israel NY 1997
Sai dai ba haka bane! Cikakkun masu ciwon sukari waɗanda ba su da insulin suna mutuwa; masu shan tabar heroin (bayan gwaji na janyewa) suna bunƙasa. Haka kuma, matsakaicin adadin insulin iri ɗaya ne na jiha-da-jihar-amma ba don methadone ba:
Dokta Kreek ya koka da cewa kashi 90% na duniya ba sa samun MMT, amma duk da haka babu wata ƙasa mai 'yanci ta methadone da ta ƙaru da mutuwar opioid fiye da Amurka, a cikin waɗannan shekaru 60 na ƙarshe. Mafi kusa gasa zai kasance Rasha, duk da haka suna da kawai ~20% na yawan mace-macen mu na opioid.
Heroin ba a san shi ba a cikin Tarayyar Soviet har sai da sojojinsa suka mamaye Afghanistan a cikin 1979 (- don haka yanzu) Rasha tana da rikicin jarabar opioid game da kabari kamar Amurka (amma) babu methadone azaman madadin magani. Likitocin Rasha sun ƙi irin wannan magani na "laushi". Muna kiran jarabar mutum a gafartawa idan ba su da kwaya. Ba in ba haka ba.
Dokta Morozova yana daya daga cikin labarun nasara na tsarin; Ta yaba da "ƙauna mai tsauri" tare da warkar da ita daga jarabar tabar heroin. Amma da zarar shirinta na shekaru uku ya ƙare, sai ta juya zuwa ga ƙwaƙƙwaran sarrafa jarabar Yammacin Turai wanda ya mamaye ko'ina a cikin Rasha-Narcotics Anonymous. "Mataki 12 sun ceci rayuwata," in ji ta.
(2017)
Sake Tunani Addiction: Idan Ba Cuta ba, To Me?
Dr. Mitchell Rosenthal, ba tare da hannun jari a MMT (ko MIC) ba amma - don yin adalci, mai fafatawa a kaurace wa jagoranci. Gidan Phoenix-yace:
Methadone magani ne mai matukar amfani ga mutane masu iyaka. An sayar da shi ga mutane da yawa. Domin da yawa masu shaye-shaye suna cin zarafin ƙwayoyi da yawa kuma suna da ƙarancin ilimi da ƙwarewar aiki, ba za a gyara su ta hanyar ba su wani magani ba.
(1997)
Mutanen da suka shigo gidan Phoenix baƙon ne ga kansu, Muna ba su tallafin da suke buƙata don raba asirinsu mai lalata, don zubar da laifinsu, don kawar da fushinsu, kuma don buɗe damarsu.
(2009)
Magance “Tsarin Cuta,” ra’ayin Dokta Rosenthal ya yi daidai da akasin haka "Tsarin Daidaitawa" wanda ke kallon jaraba a matsayin martani ga matsalolin muhalli da na mutum-kamar wahalar tattalin arziki, warewar jama'a, ko batutuwan dangi da kuma jaddada rawar da ke tattare da shiga tsakani da zamantakewa. Ya bayyana cewa ingantattun dabarun jurewa na iya magance jaraba yadda ya kamata.
Ga kowane jarabar cin zarafi na kayan maye, Samfurin Adaɗi yana aiki (ko da yake ba a yarda da shi ba; komai “cuta” ne). Alcoholics Anonymous da Narcotics Anonymous suna jaddada ci gaban mutum da goyon bayan al'umma. Membobi suna bincika ƙalubalen su na sirri da halayensu a cikin saitin ƙungiyar tallafi, wanda ke taimaka musu haɓaka sabbin hanyoyin magancewa da sake gina alaƙar zamantakewar su. AA na samun nasara a babban bangare ta hanyar cika "Ramin girman Allah a zuciyar mutum."
Menene kuma wannan sha'awar, da wannan rashin taimako, ke shelanta amma cewa akwai wani lokaci a cikin mutum farin ciki na gaskiya, wanda duk abin da ya rage a yanzu shine bugu na banza? Wannan yana ƙoƙari ya cika da duk abin da ke kewaye da shi, yana neman abubuwan da ba su nan ba taimakon da ba zai iya samu a cikin waɗanda suke ba, ko da yake ba wanda zai iya taimakawa, tun da yake wannan rami marar iyaka yana iya cika shi da wani abu marar iyaka kuma marar iyaka; Wato Allah da kansa.
BlaisePascal, Pensée VII(425)
Pascal hakika ba ya tunanin jarabar tabar heroin lokacin da ya rubuta wannan, amma babu wani abin da zai hana mu tunanin sa lokacin da muka karanta shi. Ya ci gaba da faɗin wani abu da waɗanda ke cikin murmurewa za su iya fahimta: mu ne "An haife mu cikin duniya mai ban mamaki wanda ke siffanta mu zuwa batutuwa masu ban mamaki don haka muna samun sauƙin ƙin Allah a koyaushe mu yaudari kanmu game da namu zunubi."
A cikin kwarewar kaina na magance masu shan narcotic (kusan shekaru goma; ta yin amfani da Suboxone a matsayin watanni 4 "ƙasa" zuwa ga hankali), Na gano cewa waɗanda suka sami damar samun nasara (a wannan lokacin) sune waɗanda suka bi hanya don yin mafi kyau a cikin "Five F's" (Imani, Kuɗi (watau aiki), Iyali, Abokai, Ƙarshe kawai).
Farfadowa daga jaraba ba tafiya ce ta layi ba, kuma ana siffanta ta da gwaji, koma baya, da kuma a ƙarshe, juriya. An misalta wannan a cikin labarin wani majiyyaci: wani jami'in gyara (ya tafi mummuna, ya kashe kwayoyi cikin kurkuku don "kwamiti na narcotic") wanda ya kasa shirin da kansa, ya yi kuka cikin takaici, (da ƙarfi) ya kira ni 'rami'. Sai ga—watanni bayan ya bincika zaɓuɓɓukan da suka dace da sha'awar sa na nan take, ya dawo. Tare da tunani ya zo da fahimtar cewa ƙauna mai tsanani ita ce ke haifar da bambanci: "Ina tsammanin ina buƙatar rami kamar ku don taimaka mini in sami 'tsabta,' a zahiri." Wannan lokacin ya kasance nasara, tare da bambanci: halayensa, kwarin gwiwa, da niyyarsa.
Shafi na I: Bambance-bambancen “Cutar” da “Daɗaɗawa” Samfuran Addiction
Wannan shafi yana gabatarwa Bruce K. Alexanderaiki daga 1990 Jaridar Ma'anar Drug, bincika Samfurin Adaɗi na jaraba. Karatunsa, Tushen Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙarya na Ƙarfafawa na Ƙarfafawa na Ƙarfafa ) Ya Yi, ya ba da shawarar cewa jaraba yakan zama dabarar daidaitawa don tinkarar ƙalubalen rayuwa, ta bambanta daga madaidaitan ra'ayoyin ilimin halittu waɗanda suka mamaye fagen.
wannan N-gram mai duba jadawali ya bayyana wace ka'idar ta "lashe" wannan muhawarar. Tun a kusa da 1990, Tsarin Cutar ya sami yaɗuwa sosai akan Samfurin Adaɗi. Wannan sauye-sauye yana nuna babban motsi zuwa kallon jaraba ta hanyar ruwan tabarau na biomedical, yana daidaita hanyoyin jiyya da manufofin jama'a.
Ga bambance-bambance masu mahimmanci guda biyar:
- Yanayin Addiction:
- Model Cuta: Ana kallon jaraba a matsayin cuta da ke buƙatar ƙwararrun magani. Mutanen da ke da jaraba ana ganin sun kamu da cutar da ke motsa halayensu na jaraba.
- Samfurin Karɓa: Ba a ɗaukar jaraba a matsayin cuta ko kowace irin cuta. Madadin haka, yana nuna masu shaye-shaye a matsayin (a zahiri) in ba haka ba mutane masu lafiya waɗanda ba su da cikakkiyar damar shiga cikin al'umma don haka su juya zuwa ga mafi dacewa da abin da za su iya samu.
- Hanyar Dalili da Tasiri:
- Misalin Cuta: Ana ganin jaraba a matsayin sanadin ɗimbin matsaloli.
- Samfurin Adawa: Ana fara ganin jaraba sakamakon matsalolin da aka riga aka samu. Kodayake salon jaraba na iya haifar da sabbin al'amura ko kuma ta'azzara abubuwan da ke akwai, waɗannan ba su isa su wuce fa'idodin daidaitawa ga mutum ba.
- Sarrafa Addiction:
- Model Cuta: Ana nuna daidaikun mutane a matsayin waɗanda ke ƙarƙashin ikon abin ko kuma a matsayin “marasa iko.”
- Samfurin Adabi: Yana kwatanta mutane masu shan shaye-shaye kamar yadda suke sarrafa nasu kaddara, suna yin zaɓi waɗanda suke da kai da manufa, koda kuwa waɗannan zaɓin ba koyaushe suke sane ba.
- Matsayin Bayyanawa:
- Model Cuta: Ana ganin bayyanar da magani ko aiki a matsayin babban abin da ke haifar da ci gaban jaraba.
- Samfurin Daidaitawa: Babban abin da ke haifar da jaraba ana danganta shi da gazawar haɗin kai tsakanin mutum da al'umma. Bayyanar da kwayoyi hanya ce kawai ta gabatar da wani ga yuwuwar karbuwa ta madadin; ba tare da batutuwan haɗin kai ba, fallasa kawai ba zai haifar da jaraba ba.
- Tushen Halitta:
- Samfurin Cuta: Zane akan al'adar likitanci na ilmin halitta, yana mai da hankali kan abubuwan da ke tattare da cutar da jaraba.
- Samfurin Adabi: Bisa ga ilimin juyin halitta, yana mai da hankali kan daidaitawa da ma'amala tsakanin halayen mutum da muhallinsu.
Duk da kyau kuma yana da kyau, amma kamar yadda yake tare da Covid, “masu nasara” na iya zama ɗan ƙaddara. “Masana” sun auna cikin:
Shafi na II: Gano Bakin Ciki na Aikin Bruce K. Alexander da Gwajin Tasirin Rat Park
A cikin shakka rubuta wannan labarin, Na kawai a yanzu ci karo da theories na masanin kimiyya Bruce K. Alexander, wani adadi wanda ban saba da ni ba duk da shekaru goma da na shafe ina aiki a jaraba da lalata. Na ji labarin Gwajin "Bera Park". (kamar yadda kila kuna da ku). Berayen da ke zaune a cikin wadataccen yanayi, yanayin zamantakewa ("Rat Park") sun cinye mafi ƙarancin morphine idan aka kwatanta da waɗanda ke cikin keɓancewar yanayi, yana ba da shawarar cewa jaraba ya fi mayar da martani ga abubuwan zamantakewa da muhalli fiye da ƙugiya masu sinadarai kawai.
An fayyace ra'ayoyin Alexander ta hanyar muhimman abubuwa guda uku waɗanda aka samo daga babban bincikensa:
- Ƙaunar miyagun ƙwayoyi ƙaramin kusurwa ce kawai na matsalar jaraba. Yawancin jaraba masu tsanani ba su haɗa da kwayoyi ko barasa ba. "Ma'anar 'Addiction'", 1988
- Addiction ya fi matsalar zamantakewa fiye da matsalar mutum ɗaya. Lokacin da al'ummomi masu haɗin kai suka rabu da ƙarfi na ciki ko na waje, jaraba kowane iri yana ƙaruwa sosai, ya zama kusan gama gari a cikin al'ummomin rarrabuwa. Zaman Duniya na Addiction 2009
- Addiction yana tasowa a cikin rarrabuwar al'ummomi saboda mutane suna amfani da shi azaman hanyar daidaitawa ga matsananciyar rashin zaman lafiya. A matsayin nau'i na daidaitawa, jaraba ba cuta ce da za a iya warkewa ba ko kuskuren ɗabi'a da za a iya gyara ta hanyar horo da ilimi. "Canjin wuri don jaraba: Daga Magunguna zuwa Kimiyyar zamantakewa" 2013
Ƙoƙarin magance jaraba (ta hanyar ƙirar cuta) bai yi tasiri ba; a zahiri ya kasance gazawar da ta fi dacewa. Yawancin ƙwararrun ƙwararru sun kasa taimakawa mafi yawan rayuka masu jaraba, kuma "ci gaban kimiyya" na MMT da maye gurbin jiyya na narcotic sun yi nasara kawai wajen inganta matsayinsu. Ainihin mafita ita ce kimanta hanya, balaga, da ci gaban da ake buƙata ga kowane mutum.
A lokacin zamanin Trump, daga 2017 har zuwa kulle-kulle na Covid-19 a cikin 2020, Amurka ta ga raguwar farko a cikin mutuwar yawan kitse na opioid a cikin shekarun da suka gabata, gaskiya. kafafen yada labarai sun yi watsi da su. Yayin da ake yawan bayar da rahoton tashin fentanyl, raguwar mutuwar gabaɗaya ta kusan ba a ambata ba. Anan, zan ba da New York Times daraja
Wannan faɗuwar mutuwar masu alaƙa da opioid na iya zama ba za a iya danganta shi ba, a kowane fanni, ga kowane ƙoƙarin miyagun ƙwayoyi kai tsaye daga Shugaba Trump-amma ga sihirin sihirinsa na tattalin arziki wanda ke haifar da ƙarancin rashin aikin yi na tarihi. A karkashin Trump, rashin aikin yi ya fadi kasa da kashi 4 cikin dari, kasa da matsakaicin ~7-8% a shekarun Obama. Wannan haɓakar tattalin arziƙin ya amfana musamman ɓangarorin jama'a da aka ware, waɗanda galibi suka fi fuskantar ƙalubalantar jaraba da yanke kauna. Tare da ƙarin mutane da aka yi aiki, sake zagayowar tallace-tallace na opioid, amfani, da wuce gona da iri sun nuna alamun rauni.
Wannan sakamakon yana da matuƙar dacewa da ƙirar Farfesa Alexander. Burina na ƙarshe shine cewa Tsarin Cutar ya dace da ita.
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Dokta Randall Bock ya sauke karatu daga Jami'ar Yale tare da BS a cikin ilmin sunadarai da kimiyyar lissafi; Jami'ar Rochester, tare da MD. Ya kuma binciki abin ban mamaki 'kwanciyar hankali' da ya biyo bayan cutar ta Zika-Microcephaly ta Brazil ta 2016 da firgita, a ƙarshe ya rubuta "Juyar da Zika."
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