H.: On Heroin and Harm Reduction (Sarah Resnick, n+1)
There is a photo of you standing outside the house in Borough Park, grin wide, head back, laughing.
有一张照片，你站在自治市公园的房子外面，咧着嘴笑，头向后仰，大笑。
Slender in faded blue jeans against the brick and white stucco, your hair a mass of thick black curls, a little unkempt.
你穿着褪色的蓝色牛仔裤，在砖白色灰泥的映衬下显得修长，头发浓密的黑色卷发，有点蓬乱。
This was you: “the fun one.” On our summer visits to New York, after the long drive south from Ontario, it is you I want to see most of all.
这就是你：“有趣的人。”在我们夏季访问纽约时，从安大略省长途驾车南下后，我最想见到的就是你。
When your daughter was born, I was 5.
你女儿出生时，我五岁。
As I grew older I envied her for having you as a father.
随着年龄的增长，我羡慕她有你这样的父亲。
We rode the F train to Coney Island, surveying the city through painted windows; ate frankfurters on the boardwalk.
我们乘坐 F 火车前往康尼岛，透过彩绘窗户俯瞰这座城市。在木板路上吃法兰克福香肠。
When I was 12, your mother, my grandmother, passed.
当我 12 岁的时候，你的母亲，也就是我的祖母去世了。
We stopped visiting New York.
我们停止访问纽约。
I didn’t see or speak to you for fifteen years.
我已经十五年没有见到你，也没有和你说过话了。
By the time I went to college, it was apparent that no one knew where you were.
当我上大学时，显然没有人知道你在哪里。
I am living in New York now.
我现在住在纽约。
You tell your brother, my father, that you are living at a shelter on the Bowery.
你告诉你的兄弟，我的父亲，你住在包厘街的避难所里。
He comes to town soon after, and the three of us go out to dinner.
不久他就进城了，我们三个人出去吃饭。
We don’t speak much of the past.
我们不太谈论过去。
You say you are doing well, and we agree to meet again soon.
你说你做得很好，我们同意很快再见面。
Your hair is cropped short and you are thin, very thin.
你的头发剪得很短，而且你很瘦，非常瘦。
You are not there when I stop by after work.
当我下班后过来的时候你不在。
The man at the desk gives me this news, not for the first time.
前台的那位男士告诉我这个消息，这已经不是第一次了。
I am tired of relying on luck in order to see you.
我厌倦了依靠运气才能见到你。
On my next visit I bring you a prepaid cell phone so we can make plans in advance.
下次访问时，我会给您带来一部预付费手机，以便我们提前制定计划。
This makes you happy.
这让你很高兴。
We walk to B&H Dairy, where I order cold borscht and you cherry blintzes.
我们步行到 B&H Dairy，我在那里点了冷罗宋汤和樱桃薄饼。
I show you how to use the phone.
我向您展示如何使用电话。
My father calls, tells me he has urgent news to share.
我父亲打电话告诉我他有紧急消息要分享。
I always thought it was cocaine , he says.
“我一直以为那是可卡因，”他说。
But it was heroin .
但那是海洛因。
He repeats the last word, drawing out the first two syllables.
他重复最后一个词，拉出前两个音节。
He is wounded, disbelieving.
他受伤了，不相信。
The way his sibling foundered was worse than he had believed.
他的兄弟沉没的方式比他想象的还要糟糕。
Cocaine is nefarious, sure, but heroin is depraved.
可卡因当然是邪恶的，但海洛因却是堕落的。
He is waiting for me to interrupt — to affirm that I, too, am appalled.
他正在等我打断——以确认我也感到震惊。
The first time we meet just the two of us, you tell me you have been diagnosed with bipolar disorder.
我们第一次只有我们两个人见面时，你告诉我你被诊断出患有双相情感障碍。
I hardly believe it.
我简直不敢相信。
You do not conform to any idea I have of a person with bipolar disorder, though the ideas I do have are received, not based on experience.
你不符合我对躁郁症患者的任何想法，尽管我的想法是接受的，而不是基于经验。
It’s just that you seem to me all right, not terribly different from the way I remember you, though your affect is flatter, hollowed.
只是在我看来你还不错，与我记忆中的你并没有太大不同，尽管你的情感更加平淡、空洞。
You wear your defeat.
你穿着你的失败。
You complain of ceaseless fatigue, a haze in your head.
你抱怨持续的疲劳，头脑中一片阴霾。
You list your medications: lithium, Topamax, prazosin, Thorazine, lorazepam, also methadone, more I am forgetting, they are always changing.
你列出了你的药物：锂，Topamax，哌唑嗪，Thorazine，劳拉西泮，还有美沙酮，更多我忘记了，它们总是在变化。
Frankly I am astonished at, worried by, the number of medications you are taking.
坦白说，我对你服用的药物数量感到惊讶和担忧。
The lithium concerns me most.
锂是我最关心的。
I know that it has dangerous side effects.
我知道它有危险的副作用。
I know that it is used in batteries.
我知道它是用在电池上的。
Never once does it occur to me that you seem all right because of the meds and not despite them.
我从来没有想过，你看起来一切都好是因为药物，而不是尽管有药物。
You are impressionable and take what I say seriously.
你很容易受影响，而且很认真地对待我说的话。
The only people you talk to are social workers, counselors, medical doctors, psychiatrists, and you do not seek to inform yourself about your own condition.
你唯一交谈的人是社会工作者、咨询师、医生、精神科医生，而且你不会试图让自己了解自己的状况。
You are not a skeptic.
你不是怀疑论者。
You do not read.
你不读书。
You trust what others tell you.
你相信别人告诉你的话。
The source is of no relevance.
来源无关紧要。
Within weeks — or is it months?
几周之内——还是几个月？
— your behavior seems to me more erratic.
——我觉得你的行为更加古怪。
You are quick to anger.
你很容易生气。
You demand things of me in your text messages.
你在短信中向我提出要求。
Usually money.
通常是钱。
I put fifty dollars’ worth of minutes on your phone; the next day you’ve run out, ask for more.
我在你的手机上花了五十美元的时间；第二天你用完时，要更多。
Three, four times in a week, you run out of minutes.
一周三四次，你的时间就不够了。
I tell you it’s too expensive to be using the phone in this way, and who are you talking to all of a sudden in any case?
我告诉你这样用电话太贵了，而且你突然在和谁说话呢？
You say it is your friend Lenny.
你说这是你的朋友莱尼。
He is agoraphobic, you add.
你补充说，他有广场恐惧症。
He rarely leaves the house.
他很少离开家。
By now you think that I am trying to control you, to do you harm, and you begin making accusations.
现在你认为我试图控制你，伤害你，你开始提出指控。
I get you a better phone plan, and for a few weeks, we do not speak.
我给你提供了更好的电话套餐，接下来的几个星期我们都没有说话。
Later you explain that you adjusted the dosage of your lithium without first telling your doctor.
后来您解释说，您在没有事先告诉医生的情况下调整了锂的剂量。
That was you in a manic phase.
那是你处于躁狂阶段。
Mostly we talk about your daughter , Sophie.
我们主要谈论的是你的女儿，索菲。
She is 21 now and the mother of a boy, 18 months.
她现在 21 岁，是一个 18 个月男孩的母亲。
The father is a young naval officer with whom she has parted ways, but his parents take care of the baby often.
孩子的父亲是一名年轻的海军军官，她已经与他分道扬镳，但他的父母经常照顾孩子。
You have not seen or spoken to Sophie since long before her son was born.
早在索菲的儿子出生之前，你就没有见过她，也没有和她说过话。
She wants nothing to do with you.
她不想和你有任何关系。
You have tried phoning her, you tell me, but she will not take your calls.
你告诉我，你曾尝试给她打电话，但她不接你的电话。
You know of her whereabouts, though, because you are in touch with the naval officer’s parents.
不过，你知道她的下落，因为你与海军军官的父母保持联系。
You call them regularly, hear the latest on Sophie and the baby.
你定期给他们打电话，了解苏菲和孩子的最新消息。
They must empathize with you, perceive good intentions.
他们必须同情你，感知你的善意。
One day they allow you to visit when Sophie is not around.
有一天，当索菲不在的时候，他们允许你去拜访。
You meet your grandson and you are ecstatic.
你见到你的孙子，你欣喜若狂。
You talk about it for weeks.
你们谈论这件事好几个星期了。
Then one day you phone and they say they will no longer take your calls.
然后有一天你打电话，他们说他们将不再接听你的电话。
They ask you not to call again, hang up.
他们要求你不要再打电话了，挂断电话。
I am optimistic.
我很乐观。
This phase will pass; Sophie will come to see that you have changed.
这个阶段将会过去；苏菲会看到你的改变。
I think I know you will be reunited.
我想我知道你们会重聚。
We like eating at B&H Dairy and return there often.
我们喜欢在 B&H Dairy 吃饭并且经常去那里。
Today I bring you Tompkins Square Park , a recent book of black-and-white photographs by Q.
今天我给大家带来了《汤普金斯广场公园》，这是 Q. 最近出版的一本黑白照片集。
Sakamaki.
坂卷。
In 1986, Sakamaki moved from Osaka, Japan, to the East Village.
1986年，坂卷从日本大阪搬到了东村。
Throughout the 1980s and ’90s, he documented the park and its surrounding streets, then a gathering place for the city’s marginalized and homeless and a stronghold of the antigentrification movement.
在整个 80 年代和 90 年代，他记录了公园及其周围的街道，当时这里是城市边缘化群体和无家可归者的聚集地，也是反化运动的据点。
We turn the pages, examine the pictures.
我们翻页，检查图片。
I ask you what it was like.
我问你那是什么样的。
You tell me about when you loitered outside an abandoned building turned shooting gallery, waiting in line to buy your next fix.
你告诉我，当你在一座废弃的建筑外徘徊，变成了射击场，排队等待购买你的下一个修复品时。
Police officers approached you, but you were neither questioned nor arrested.
警察走近你，但你既没有受到讯问，也没有被逮捕。
Instead, they emptied your pockets, took your money.
相反，他们掏空了你的口袋，拿走了你的钱。
They took everyone’s money.
他们拿走了所有人的钱。
Then they left.
然后他们就离开了。
It is difficult to know whether your memory is reliable, whether you can be relied on.
很难知道你的记忆是否可靠，你是否可以信赖。
But I have no reason not to believe you.
但我没有理由不相信你。
Today is a good day for you.
今天对你来说是美好的一天。
You get new teeth.
你会长出新牙。
You are more confident.
你更有信心了。
July 2013 .
2013 年 7 月。
My eye lands on a headline in the New York Times : “Heroin in New England, More Abundant and Deadly.” I can’t recall the last time I saw heroin in the news.
我的目光落在《纽约时报》的头条新闻上：“新英格兰的海洛因更加丰富和致命。”我不记得上次在新闻中看到海洛因是什么时候了。
Media coverage of drug use had shifted, or so it seemed to me, to meth.
媒体对吸毒的报道已经转向（至少在我看来）转向冰毒。
Officials in Maine, New Hampshire, and Vermont, from “quaint fishing villages” to “the interior of the Great North Woods,” are reporting an “alarming comeback” of “one of the most addictive drugs in the world.” What’s remarkable about the story, according to its authors, is where the comeback is taking place: not in urban centers, but in the smaller cities and rural towns of New England.
缅因州、新罕布什尔州和佛蒙特州的官员，从“古色古香的渔村”到“大北方森林的内陆地区”，都在报告“世界上最容易上瘾的毒品之一”的“令人震惊的卷土重来”。据作者称，这个故事的引人注目之处在于卷土重来的地点：不是在城市中心，而是在新英格兰的小城市和乡村城镇。
Experts offer observations.
专家提出看法。
A police captain in Rutland, Vermont, states that heroin is the department’s “biggest problem right now.” A doctor, an addiction specialist, says, “It’s easier to get heroin in some of these places than it is to get a UPS delivery.”
佛蒙特州拉特兰市的一名警察队长表示，海洛因是该部门“目前最大的问题”。一位医生兼成瘾专家表示，“在这些地方获取海洛因比通过 UPS 送货更容易。”
Most of the heroin reaching New England originates in Colombia and comes over the US-Mexico border.
到达新英格兰的大部分海洛因源自哥伦比亚，并越过美国和墨西哥边境。
Between 2005 and 2011, the number of seizures jumped sixfold — presumably in part because of increased border security — but plenty of heroin still got through.
2005 年至 2011 年间，缉获的海洛因数量增加了六倍（可能部分原因是边境安全加强），但仍有大量海洛因被缉获。
In May 2013, six people were arrested in connection with a $3.3 million heroin ring in Springfield and Holyoke, Massachusetts.
2013 年 5 月，马萨诸塞州斯普林菲尔德和霍利奥克有六人因涉嫌价值 330 万美元的海洛因团伙被捕。
The article describes two addicts in particular, both young women.
这篇文章特别描述了两名瘾君子，她们都是年轻女性。
They sell sex for drug money.
他们为了贩毒钱而出卖性。
One overdosed and died after injecting some very pure heroin.
一名吸毒过量的人在注射了一些非常纯净的海洛因后死亡。
The addiction specialist tells us that he is “treating 21-, 22-year-old pregnant women with intravenous heroin addiction.” The lone man identified is the companion of one of the women.
这位成瘾专家告诉我们，他正在“治疗患有静脉注射海洛因成瘾的 21 岁、22 岁孕妇”。这名孤独的男子是其中一名女子的同伴。
Beyond his name and age, nothing about him or his circumstances is mentioned.
除了他的名字和年龄之外，没有提及任何有关他或他的情况的信息。
All three are white.
三个人都是白色的。
I stop when I read, “Maine is the first state that has limited access to specific medications, including buprenorphine and methadone.” I open a new tab, search for what the writers mean by the vague phrase, “has limited access to.” Earlier that year, the state enacted legislation to limit how long recovering addicts could stay on methadone, or similar drug‑replacement therapies, before they had to start paying out of pocket.
当我读到“缅因州是第一个限制获得特定药物（包括丁丙诺啡和美沙酮）的州”时，我停了下来。我打开一个新选项卡，搜索作者所说的模糊短语“访问权限有限”的含义。那年早些时候，该州颁布了立法，限制康复中的成瘾者在必须开始自付费用之前可以继续使用美沙酮或类似药物替代疗法的时间。
Medicaid patients will receive coverage for a maximum of two years.
医疗补助患者将获得最长两年的承保。
I know that for some people, like you, this is not enough time.
我知道对于像你这样的一些人来说，这时间不够。
Moving to the United States from Canada was, for me, eight years earlier, an easy enough transition.
对我来说，八年前从加拿大搬到美国是一个很容易的过渡。
Much is shared between the two countries, and the culture shock was minimal.
两国之间有很多共同点，文化冲击也很小。
Yet even after all this time, I still find that certain ideas I’d taken for granted throughout adolescence and early adulthood — ideas about what a good society tries to make available for its citizens — are here not to be taken for granted at all.
然而，即使过了这么久，我仍然发现，我在青春期和成年早期认为理所当然的某些想法——关于一个良好的社会试图为其公民提供什么的想法——在这里根本不被认为是理所当然的。
At the Bowery shelter you are a model resident.
在包厘街收容所，您是模范居民。
You participate in group.
你参加团体。
You see a counselor.
你会看到一位辅导员。
You follow the methadone program.
您遵循美沙酮计划。
You are friendly with others.
你对别人很友善。
It is on account of this that you are recommended for Section 8 housing, and before long you are moved into a 200-square-foot studio with a single bed, a private bathroom, a tiny kitchen.
正因为如此，我们推荐您入住第 8 条住房，不久您就搬进了一间 200 平方英尺的单间公寓，配有一张单人床、一间私人浴室和一个小厨房。
The facility, a four-story building, is designated for people living with psychiatric disabilities.
该设施是一栋四层楼的建筑，专为精神障碍患者服务。
Your share of the rent is $260.
您分担的租金为 260 美元。
You are also responsible for your own utilities.
您还负责自己的公用事业。
These are subsidized based on your income.
这些补贴根据您的收入而定。
For a time you find yourself in a vexing predicament.
一时间你发现自己陷入了令人烦恼的困境。
The state has deemed you “unfit to work.” But each of your applications for disability benefits is denied.
国家认为您“不适合工作”。但您的每项残疾福利申请都被拒绝。
It is not at all clear how you are meant to survive.
根本不清楚你该如何生存。
November 2013 .
2013 年 11 月。
The front page of the Saturday paper features a story on buprenorphine under the headline “Addiction Treatment with a Dark Side.” Buprenorphine is an opioid used for maintenance therapy like methadone, but is available by prescription.
周六报纸的头版以“成瘾治疗的阴暗面”为标题，刊登了一篇关于丁丙诺啡的报道。丁丙诺啡是一种阿片类药物，与美沙酮一样用于维持治疗，但可以通过处方获得。
This is new.
这是新的。
Since the 1970s, methadone has been distributed through clinics.
自 20 世纪 70 年代以来，美沙酮一直通过诊所分发。
People participating in methadone programs must go to the clinic at least once a week, and in some cases every day.
参加美沙酮计划的人必须每周至少去诊所一次，有时甚至每天去一次。
This is obstructive, even oppressive.
这是一种阻碍，甚至是压迫。
A similar drug that can be had by prescription seems like an improvement.
可以通过处方获得的类似药物似乎是一种改进。
But doctors must receive federal certification to be able to prescribe buprenorphine.
但医生必须获得联邦认证才能开出丁丙诺啡处方。
Federal law limits how many patients a physician can help with the drug at one time.
联邦法律限制医生一次可以帮助多少患者使用该药物。
This means that only people with good insurance, or the ability to pay high fees out of pocket, can access it.
这意味着只有拥有良好保险或有能力自掏腰包支付高额费用的人才能使用它。
“The rich man’s methadone,” the article calls it.
文章称其为“富人的美沙酮”。
But this — the part that interests me — isn’t what the article is about.
但这——我感兴趣的部分——不是这篇文章的主题。
The article is about how the drug gets “diverted, misused and abused”; how, since 2003, the drug has led to 420 deaths.
这篇文章讲述了该药物如何被“转移、误用和滥用”；自 2003 年以来，这种药物已导致 420 人死亡。
(By comparison, there are more than 15,500 deaths from opioid overdose each year.) The article is not about the drug’s demonstrated efficacy at helping people with opioid dependencies that negatively impact their lives.
（相比之下，每年有超过 15,500 人死于阿片类药物过量。）这篇文章并不是关于该药物在帮助对阿片类药物依赖产生负面影响的人们方面所表现出的功效。
Or about how restricted access to the drug is likely contributing to its diversion and misuse in the first place.
或者说限制获取该药物可能如何导致其转移和滥用。
Studies report that at least some people are self-treating their dependencies and withdrawal symptoms.
研究报告称，至少有些人正在自我治疗他们的依赖性和戒断症状。
I read elsewhere that medication-assisted treatment with an opioid agonist, such as buprenorphine, is the most effective treatment available for opioid dependencies.
我在其他地方读到，使用阿片类激动剂（例如丁丙诺啡）进行药物辅助治疗是治疗阿片类药物依赖的最有效的治疗方法。
This is what you tell me : From the time you were young, you possessed an antiauthoritarian streak.
你是这样告诉我的：从你年轻的时候起，你就具有反独裁的倾向。
This disposition did not emerge from any particular maltreatment, by family members, say, or teachers; it was your natural orientation toward the world.
这种性格并不是由于家庭成员或老师等任何特定的虐待而产生的；这是你对世界的自然取向。
You were enthralled by the neighborhood kids who attracted trouble even as you yourself did not act out.
你被邻居家的孩子们迷住了，他们给你带来了麻烦，尽管你自己并没有表现出来。
You desired proximity to danger and rebelliousness.
你渴望接近危险和叛逆。
Unlike your brother, you attempted to differentiate yourself from your family not by transcending your class, but by assuming a posture of nonconformity.
与你的兄弟不同，你试图将自己与家人区分开来，不是通过超越阶级，而是采取一种不随波逐流的姿态。
You liked drugs because you weren’t supposed to like them.
你喜欢毒品是因为你不应该喜欢它们。
For a long time — more than a decade — you were able to manage your use, to keep it, for the most part, recreational.
在很长一段时间里——十多年——你能够管理你的使用，并在很大程度上保持它的娱乐性。
One time your father found your needle and other supplies for shooting up.
有一次，你父亲发现了你的针头和其他注射用品。
He was furious.
他很愤怒。
You wouldn’t hear it.
你不会听到的。
When he died years later his heart was still broken.
多年后，当他去世时，他的心仍然破碎。
I have difficulty reconciling all this with what else you have told me of your past.
我很难将这一切与你告诉我的关于你过去的其他事情联系起来。
I know that you worked for the police as a 9-1-1 dispatcher.
我知道你在警察部门担任 9-1-1 调度员。
You were good at your job, liked and respected, and soon you found yourself in a supervisory position.
你很擅长自己的工作，受到喜爱和尊重，很快你就发现自己处于主管职位。
You enjoyed the night shift, especially, and for a long stretch the Bronx was your district.
你尤其喜欢夜班，而且很长一段时间布朗克斯都是你的区。
The position is notoriously stressful, but you were sharp, capable, levelheaded, and you excelled.
这个职位的压力是出了名的大，但你很敏锐、有能力、头脑冷静，而且表现出色。
You were fired when your fidelity to heroin was stronger than it was to your job.
当你对海洛因的忠诚度超过对工作的忠诚度时，你就会被解雇。
You love your new apartment , can’t believe your good fortune.
你喜欢你的新公寓，简直不敢相信你的好运。
When I stop to consider it, neither can I.
当我停下来考虑时，我也不能。
Sometimes I imagine what you will do with your time.
有时我会想象你会用你的时间做什么。
I picture you as a volunteer — with other people who use drugs, maybe, or at a food kitchen or shelter.
我把你想象成一名志愿者——也许和其他吸毒者一起，或者在食品厨房或避难所。
I feel certain that you will want to do this, that you will do something good, in the way that others did good for you.
我确信你会想做这件事，你会做一些好事，就像别人为你做的好事一样。
That maybe we will do something good together.
也许我们会一起做一些好事。
Once, when I am volunteering on American Thanksgiving, I invite you to come along.
有一次，当我在美国感恩节做志愿者时，我邀请你一起去。
I know that you have nowhere else to go.
我知道你无处可去。
You tell me you’d prefer to stay home.
你告诉我你更愿意呆在家里。
A few months later, I make the suggestion once more.
几个月后，我再次提出这个建议。
Again you decline.
你再次拒绝。
Later I come to recognize this as my own bizarre fantasy, a projection of my savior complex, perhaps.
后来我开始认识到这是我自己的奇异幻想，也许是我的救世主情结的投射。
I laugh, not for the first time, at the naïveté of my younger self.
我笑了，这不是第一次，我嘲笑年轻时的天真。
December 2013 .
2013 年 12 月。
Two articles command my attention.
有两篇文章引起了我的注意。
The first, a few weeks old, is about a radical clinical trial in Canada comparing the effectiveness of diacetylmorphine — prescription heroin — and the oral painkiller hydromorphone, i.e., Dilaudid, in treating severe heroin dependency in people for whom other therapies have failed.
第一个是几周前在加拿大进行的一项激进的临床试验，比较了二乙酰吗啡（处方海洛因）和口服止痛药氢吗啡酮（即 Dilaudid）在治疗其他疗法无效的人的严重海洛因依赖方面的有效性。
An earlier study in Canada had demonstrated that both diacetylmorphine and hydromorphone are better than methadone at improving the health and quality of life of longtime opiate users.
加拿大的一项早期研究表明，二乙酰吗啡和氢吗啡酮在改善长期阿片类药物使用者的健康和生活质量方面均优于美沙酮。
An unexpected finding was that many participants couldn’t tell the difference between the effects of diacetylmorphine and hydromorphone.
一个意外的发现是，许多参与者无法区分二乙酰吗啡和氢吗啡酮的作用之间的区别。
But the sample group receiving hydromorphone wasn’t large enough to draw scientifically valid conclusions.
但接受氢吗啡酮的样本组不够大，无法得出科学有效的结论。
So the study investigators created a new trial to test this finding.
因此，研究人员创建了一项新的试验来测试这一发现。
If hydromorphone were to be found as effective as diacetylmorphine, it could mean offering people the benefits of prescription heroin without the legal barriers and associated stigma.
如果氢吗啡酮被发现与二乙酰吗啡一样有效，这可能意味着为人们提供处方海洛因的好处，而无需法律障碍和相关的耻辱。
The study results have yet to be published.
研究结果尚未公布。
Larry Love, 62, a longtime dependent: “My health and well-being improved vastly” during the trial.
拉里·洛夫 (Larry Love)，62 岁，长期受抚养人：在审判期间“我的健康和幸福感得到了极大改善”。
Love’s doctor applied to Health Canada for permission to continue prescribing heroin to Love and twenty other patients after their year in the trial was up.
洛夫的医生向加拿大卫生部申请允许在试验一年结束后继续为洛夫和其他二十名患者开海洛因处方。
The applications were approved, although renewal was required after ninety days.
申请获得批准，但九十天后需要续签。
The federal health minister responded by creating new regulations to prevent such approvals.
作为回应，联邦卫生部长制定了新的法规来阻止此类批准。
He insisted Ottawa would not “give illicit drugs to drug addicts.” Love, four additional patients, and the health-care center that runs the hospital that oversaw the trial are suing the government in turn.
他坚称渥太华不会“向吸毒者提供非法药物”。洛夫、另外四名患者以及负责监督试验的医院的医疗保健中心正在依次起诉政府。
The doctor who submitted the applications, Scott MacDonald: “As a human being, as a Canadian, as a doctor, I want to be able to offer this treatment to the people who need it.
提交申请的医生斯科特·麦克唐纳 (Scott MacDonald) 表示：“作为一个人，作为一个加拿大人，作为一名医生，我希望能够为需要的人提供这种治疗。
.
。
.
。
.
。
It is effective, it is safe, and it works.
它有效、安全、有效。
.
。
.
。
.
。
I do not know what they are thinking.”
我不知道他们在想什么。”
The second is an editorial about a Canadian bill that, if passed, would set new guidelines for opening supervised-injection facilities.
第二篇是关于加拿大一项法案的社论，该法案如果获得通过，将为开放监督注射设施制定新的指导方针。
Like syringe-distribution programs, supervised-injection facilities act as a frontline service for people who use drugs intravenously, giving out sterile needles and other paraphernalia.
与注射器分发计划一样，监督注射设施为静脉注射毒品的人提供一线服务，分发无菌针头和其他用具。
But they go one step further: users may bring in drugs procured elsewhere and inject them under the watchful eye of trained nurses.
但他们更进一步：使用者可以携带从其他地方购买的药物，并在训练有素的护士的监视下进行注射。
Staff members offer instruction on safer technique (“Wash your hands,” “Remove the tourniquet before pushing the plunger,” “Insert the needle bevel up”) and monitor for overdose, which they counteract with naloxone.
工作人员提供有关更安全技术的指导（“洗手”、“推动柱塞之前取下止血带”、“将针斜向上插入”）并监测药物过量，并用纳洛酮来抵消。
They do not directly administer injections.
他们不直接进行注射。
The new law would erect application hurdles so onerous it would effectively prevent the establishment of any new sites.
新法律将设置如此繁重的申请障碍，从而有效地阻止任何新站点的建立。
The columnist attacks the government for acting on ideological rather than scientific grounds.
这位专栏作家攻击政府的行动是基于意识形态而不是科学依据。
“Supervised injection sites are places where horrible things take place.” I cringe a little.
“受监管的注射地点是发生可怕事情的地方。”我有点畏缩。
“The fact is, however, that these activities are even more horrifying when they take place in the streets, and strict prohibition has never been even remotely successful.”
“然而事实是，这些活动发生在街头就更加可怕，而严格的禁止从来没有取得过哪怕一丁点成功。”
There is, I know, only one such facility in all of North America.
据我所知，整个北美只有一处这样的设施。
It’s called Insite, and it’s in Vancouver.
它叫 Insite，位于温哥华。
It is a fall evening and we are on our way to a movie.
那是一个秋天的晚上，我们正在去看电影的路上。
We pass a small group of Chabad men on the street.
我们在街上经过一小群查巴德人。
It is Sukkot and they are trying to identify secular Jews by sight, inviting them to perform the ritual with the date-tree fronds ( lulav ) and lemonlike fruit ( etrog ), shaking them together three times in six different directions.
这是住棚节，他们试图通过视觉来识别世俗的犹太人，邀请他们用枣树叶子 (lulav) 和柠檬状的水果 (etrog) 进行仪式，将它们向六个不同的方向一起摇晃三次。
They have a small truck nearby (the Sukkahmobile).
他们附近有一辆小卡车（Sukkahmobile）。
You tell me how a Chabad man befriended you once, how you almost became religious.
你告诉我一个查巴德人曾经如何与你成为朋友，你是如何差点变得虔诚的。
He wanted to help you, and you had no one else.
他想帮助你，而你身边没有其他人。
You went to dinners at his house.
你去他家吃饭。
He would call to ask how you were.
他会打电话问你怎么样。
You say that he and his family were some of the kindest people you had ever met.
你说他和他的家人是你见过的最善良的人。
But you couldn’t stick with it, and one day you stopped responding.
但你无法坚持下去，有一天你不再回复了。
I take you to see Ballast , that film of austere, understated realism about a drifter boy and a grieving man in the Mississippi Delta.
我带你去看《镇流器》，这是一部朴素、低调的现实主义电影，讲述了密西西比三角洲的一个漂泊男孩和一个悲伤的男人的故事。
It’s more about tone than narrative, and I am moved by the beauty and sadness of its barren landscapes.
它更多的是关于基调而不是叙事，我被其贫瘠风景的美丽和悲伤所感动。
I worry that you are bored, you nod in and out; but afterward you tell me how much you liked it.
我担心你无聊，你进进出出；但后来你告诉我你有多喜欢它。
I decide I will take you to movies often.
我决定经常带你去看电影。
Within weeks of Philip Seymour Hoffman’s death, a surfeit of reporting:
菲利普·塞默·霍夫曼去世后几周内，出现了大量报道：
Why heroin is spreading in America’s suburbs How Did Idyllic Vermont Become America’s Heroin Capital?
为什么海洛因在美国郊区蔓延 田园诗般的佛蒙特州如何成为美国的海洛因之都？
New England town ripped apart by heroin Today’s Heroin Addict Is Young, White and Suburban Heroin’s New Hometown: On Staten Island, Rising Tide of Heroin Takes Hold When heroin use hit the suburbs, everything changed Heroin in the Suburbs: A Rising Trend in Teens Heroin reaching into the suburbs Heroin Scourge Overtakes a “Quaint” Vermont Town Heroin-gone-wild in Central New York causes jumps in overdoses, deaths Actor’s heroin death underscores scourge closer to home Heroin scourge begs for answers New Wisconsin laws fight scourge of heroin The scourge of heroin addiction Heroin scourge cuts across cultural and economic barriers Colombian, Mexican cartels drive LI heroin scourge Senate task force hears from Rockland on heroin scourge Report shows heroin use reaching epidemic proportions in NH America’s heroin epidemic: A St. Louis story Heroin: Has Virginia Reached an Epidemic?
新英格兰小镇被海洛因撕裂 今天的海洛因成瘾者是年轻、白人和郊区海洛因的新故乡：在史泰登岛，海洛因浪潮兴起 当海洛因使用袭击郊区时，一切都改变了 郊区的海洛因：青少年海洛因进入郊区的上升趋势 海洛因祸害席卷了“古色古香”的佛蒙特州小镇 纽约州中部海洛因泛滥导致人口激增吸毒过量、死亡 演员海洛因之死突显灾祸离家更近 海洛因灾祸寻求答案 威斯康星州新法律打击海洛因灾祸 海洛因成瘾灾祸跨越文化和经济障碍 哥伦比亚、墨西哥贩毒集团推动海洛因灾祸 参议院工作组听取了罗克兰关于海洛因祸害的意见 报告显示，新罕布什尔州海洛因流行病中海洛因的使用达到了流行病的程度：圣路易斯的故事 海洛因：弗吉尼亚州爆发疫情？
United States in the grips of a heroin epidemic Cheap, Plentiful, Deadly: Police See Heroin “Epidemic” in Region How Staten Island Is Fighting a Raging Heroin and Prescription-Pill Epidemic A Call to Arms on a Vermont Heroin Epidemic Fighting Back Against the Heroin Epidemic Ohio struggles with “epidemic” of heroin overdoses Cuomo Adds 100 Officers to Units Fighting Heroin Governors Unite to Fight Heroin in New England Police Struggle to Fight America’s Growing Heroin Epidemic DuPage officials suggest laws to fight heroin Taunton Launches Plan to Fight Heroin After Dozens of Overdoses
美国深陷海洛因流行病 廉价、充足、致命：警方发现该地区海洛因“流行” 史泰登岛如何抗击肆虐的海洛因和处方药流行病 佛蒙特州海洛因流行病号召人们奋力抗击海洛因流行病 俄亥俄州与海洛因过量“流行病”作斗争 科莫向抗击海洛因的部队增加了 100 名警员 州长联合起来抗击海洛因新英格兰警方努力抗击美国日益严重的海洛因流行杜佩奇官员建议制定抗击海洛因的法律汤顿在数十次吸毒过量后启动了抗击海洛因的计划
Your disability application is finally approved.
您的残疾申请终于获得批准。
You will receive monthly Social Security payments of $780.
您每月将收到 780 美元的社会保障金。
You are also entitled to the disability that has accrued from the time of your first denied application, which, because it was several years ago, now amounts to several thousand dollars.
您还有权享受自您第一次申请被拒绝时起所产生的残疾，因为那是几年前的事，现在已经达到数千美元。
There is one condition, however.
不过，有一个条件。
The state has decided that, given your history, you are unfit to oversee your own finances.
鉴于您的历史，州政府已决定您不适合监督自己的财务。
You will need someone who can demonstrate gainful employment, preferably a family member, to tend to the money on your behalf.
您需要能够证明有酬工作的人（最好是家庭成员）来代表您管理这笔钱。
On a winter morning, early, I take the bus from Prospect Heights to the Social Security office in Bushwick.
一个冬天的早晨，一早，我从普罗斯佩克特高地乘坐公共汽车前往布什威克的社会保障办公室。
We have an appointment but we wait a long time.
我们有预约，但我们等了很长时间。
I sign where I am asked to.
我在要求的地方签名。
I attest to my reliability.
我证明我的可靠性。
I assume responsibility.
我承担责任。
Soon after I set up a bank account where I am your “representative payee.” Your money is deposited to it on the first of each month.
在我开设银行账户后不久，我就是您的“代表收款人”。您的钱会在每个月的第一天存入其中。
From this account I pay your rent, your utilities.
我用这个账户支付你的房租和水电费。
We meet every week or two, for food, for a movie, but always so that I can provide you with cash for provisions.
我们每周或每两周见面一次，一起吃饭、看电影，但总是这样我可以为你提供现金作为生活必需品。
On the phone one day you tell me you hurt your arm, a man on the street walked right into you, knocked you down to the ground.
有一天，你在电话里告诉我你的手臂受伤了，街上的一个男人径直撞到你身上，把你撞倒在地。
When I call a few days later to see how you are feeling, you tell me how strange it is, nearly every guy you pass on the street is eyeing you as if he wants to start a fight.
几天后，当我打电话询问你的感受时，你告诉我这有多么奇怪，几乎每个你在街上经过的人都在看着你，好像他想挑起一场战斗。
These men, they are always brushing up against you on purpose.
这些人，他们总是故意与你擦肩而过。
Within a week, maybe two, you begin to ramble about the lock on your door, how it’s broken, and how you’re sure someone is breaking into your apartment to spy on you.
在一周内，也许两周内，你开始喋喋不休地谈论你门上的锁，它是如何被打破的，以及你如何确定有人闯入你的公寓来监视你。
You tell me that one day you came home to find a syringe on the floor.
你告诉我，有一天你回到家，发现地板上有一个注射器。
Someone planted it there for a supervisor to find, you’re certain of it, other residents want your apartment, they want you gone.
有人把它放在那里供主管发现，你确信这一点，其他居民想要你的公寓，他们希望你离开。
I suggest various ways you might resolve these issues.
我建议您可以采用多种方法来解决这些问题。
You have excuses, explanations for why each of my recommendations won’t work.
你有借口、解释为什么我的每一条建议都行不通。
I ask a lot of questions.
我问了很多问题。
Your paranoia does not involve state secrets, the CIA or FBI, tinfoil hats or aliens, the twin towers or global-government conspiracy theories, but the elevation of small anxieties and fears to delusions of persecution.
你的偏执不涉及国家机密、中央情报局或联邦调查局、锡箔帽或外星人、双子塔或全球政府阴谋论，而是将微小的焦虑和恐惧提升为迫害的妄想。
I try reasoning with you, but sometimes, in order to empathize, I must suspend my desire to be rational and take part in your fantasy world.
我试着和你讲道理，但有时，为了换位思考，我必须暂停理性的渴望，参与到你的幻想世界中。
I learn there is nothing I can do for you; you are autonomous in overseeing your own health care.
我知道我无法为你做任何事；您可以自主监督自己的医疗保健。
I encourage you to see your psychiatrist and wait.
我鼓励您去看精神科医生并等待。
Once your medication is adjusted, you are no longer afraid.
一旦调整了药物，你就不再害怕了。
Not long after your disability payments kick in, the debt collectors send notices to my apartment.
在你的伤残补助金开始发放后不久，收债人就向我的公寓发出了通知。
One is on behalf of an old landlord who, years ago, sued you for rent payments you never made.
其中一位代表一位老房东，几年前，他起诉您，要求您支付从未支付的租金。
It has been more than a decade, but this debt has not been forgotten.
十几年过去了，这笔债却没有被忘记。
I mail a check.
我邮寄一张支票。
Here are some things you might do on a given day: Walk to the methadone clinic to pick up your dose (you are required to go three times a week).
以下是您在某一天可以做的一些事情： 步行到美沙酮诊所领取您的剂量（您需要每周去 3 次）。
Wait in line.
排队等候。
Take one bus to the Medicaid office (when your pension kicked in, your monthly benefits went up, pushing you just slightly over the minimum-income requirement).
乘坐一辆公共汽车前往医疗补助办公室（当您的养老金开始生效时，您的每月福利会增加，使您略高于最低收入要求）。
Wait in line.
排队等候。
Take one bus to see your psychiatrist (you live in Bushwick; your psychiatrist is in Crown Heights).
乘坐一辆公共汽车去看您的精神科医生（您住在布什威克；您的精神科医生在皇冠高地）。
Wait.
等待。
Take one bus to the Supplemental Assistance Program office (you lost your EBT card and need to request a new one).
乘坐一辆巴士前往补充援助计划办公室（您丢失了 EBT 卡，需要申请一张新卡）。
Wait in line.
排队等候。
Take two trains to see your hepatologist at NYU Langone Medical Center.
乘坐两趟火车去纽约大学朗格尼医学中心看肝病专家。
Wait.
等待。
Walk to the post office (to pick up the check my father has sent you).
步行到邮局（领取我父亲寄给你的支票）。
Wait in line.
排队等候。
Walk to the nearest Western Union (where you would cash checks before you had a bank account).
步行到最近的西联汇款（您在拥有银行账户之前可以在那里兑现支票）。
Wait in line.
排队等候。
Take the bus and two trains to Maimonides Medical Center in Borough Park (you need a colonoscopy).
乘坐巴士和两趟火车前往自治市公园的迈蒙尼德医疗中心（需要进行结肠镜检查）。
Wait.
等待。
I write down statistics , try to make sense of what I’m reading.
我写下统计数据，尝试理解我正在阅读的内容。
In 2012, US physicians wrote 240.9 million prescriptions for painkillers, an increase of 33 percent since 2001.
2012年，美国医生开了2.409亿张止痛药处方，比2001年增加了33%。
The growth can be attributed to a few related factors: patient-advocacy groups calling for better pain treatment; patients, perhaps influenced by pharmaceutical marketing, requesting drugs from their doctors; doctors, some with questionable ethics, overprescribing drugs.
这种增长可归因于一些相关因素：患者权益团体呼吁更好的疼痛治疗；患者可能受到药品营销的影响，向医生索要药物；医生过度开药，其中一些医生的道德有问题。
The US government responded in a predictable way.
美国政府的反应是可以预见的。
It introduced more stringent prescription guidelines, authorized DEA investigations and closures of “pill mills.” State governments began to use databases to track “doctor shoppers,” patients who sought out prescriptions from multiple physicians.
它引入了更严格的处方指南，授权 DEA 进行调查并关闭“药厂”。州政府开始使用数据库来追踪“医生购物者”，即向多名医生寻求处方的患者。
In 2010, Purdue Pharma, the producer and patent holder of OxyContin, introduced an abuse-deterrent version of the drug ostensibly impervious to crushing, breaking, chewing, and dissolving, and therefore more difficult to inhale or inject.
2010 年，奥施康定的生产商和专利持有者普渡制药公司推出了该药物的防滥用版本，该药物表面上不受压碎、打破、咀嚼和溶解的影响，因此更难以吸入或注射。
That same year, the number of US drug poisoning deaths involving any opioid analgesic (oxycodone, methadone, or hydrocodone) accounted for 43 percent of the 38,329 drug poisoning deaths, a fourfold increase from 1999, when opioid analgesics were involved in 24 percent of the 16,849 drug poisoning deaths.
同年，美国涉及任何阿片类镇痛剂（羟考酮、美沙酮或氢可酮）的药物中毒死亡人数占 38,329 例药物中毒死亡人数的 43%，比 1999 年增加了四倍，1999 年，阿片类镇痛剂涉及 16,849 例药物中毒死亡的 24%。
Following the government crackdown, supply of pharmaceutical opioids decreased sharply.
随着政府的镇压，阿片类药物的供应急剧减少。
Demand did not.
需求没有。
The street price of prescription painkillers inflated, and many pharmaceutical opioid users opted instead for heroin.
处方止痛药的市场价格上涨，许多阿片类药物使用者转而选择海洛因。
A rising supply of heroin kept prices low.
海洛因供应量的增加使价格保持在较低水平。
According to one study, more than 81 percent of recent heroin users say they switched after first trying prescription painkillers.
根据一项研究，超过 81% 的最近吸食海洛因的人表示，他们在第一次尝试处方止痛药后就改用了海洛因。
You say that one day , out of the blue, you decided to give it up.
你说有一天，你突然决定放弃。
Just like that.
就这样。
You call at around eleven on a weeknight to tell me you are going to call an ambulance — you are in pain.
你在工作日晚上十一点左右打电话告诉我你要叫救护车——你很痛苦。
Ten days earlier you had surgery on an abdominal hernia.
十天前，您接受了腹部疝气手术。
The procedure was supposed to have been minimally invasive, performed with a scope, a few hours all told, and I waited to take you home.
该手术应该是微创的，用示波器进行，总共需要几个小时，然后我等着带你回家。
But there were complications.
但也有一些并发症。
They had to cut you open.
他们不得不把你切开。
You were admitted to the hospital, stayed seven nights.
你被送进医院，住了七晚。
Now you are home again but certain that you are not healing properly.
现在您又回到家了，但确信您没有正常康复。
When I arrive at your place in Bushwick, the paramedics are helping you into the back of the ambulance.
当我到达您在布什威克的住所时，护理人员正在帮助您进入救护车的后部。
I get in with you.
我和你在一起。
We sit opposite each other.
我们面对面坐着。
I ask you questions.
我问你问题。
You are lucid.
你很清醒。
I expected you to be doubled over, but you are not.
我原以为你会加倍努力，但你没有。
The paramedics confirm that your vitals are good.
护理人员确认您的生命体征良好。
You have no fever.
你没有发烧。
At this point, I am confident that this trip is unnecessary; that there is nothing to worry about except that you are alone, and you understand what that means.
至此，我确信这次旅行是没有必要的；除了你独自一人之外，没有什么可担心的，你明白这意味着什么。
But I stay silent as you tell the paramedics to take you to where you want to go.
但当你告诉医护人员带你去你想去的地方时，我保持沉默。
When we arrive at the emergency room, the triage nurse evaluates you.
当我们到达急诊室时，分诊护士会对您进行评估。
You tell her about your pain, your recent surgery.
你告诉她你的疼痛和你最近的手术。
Soon you are wearing a bracelet and gown, sound asleep in a bed.
很快你就戴着手镯，穿着长袍，在床上呼呼大睡。
It is past midnight.
已经过了午夜了。
I sit in the vinyl sled-base chair to read, but am more interested in the ER nurses shuffling through the ward, the gurneys wheeling by, bodies and machines, the perverse game of observation and diagnosis.
我坐在乙烯基雪橇椅上读书，但更感兴趣的是急诊室护士在病房里拖着脚步，轮床轮流而过，尸体和机器，以及观察和诊断的反常游戏。
Who among the patients holds the fate worse than all the others?
病人中谁的命运比其他人更糟糕？
I know that if you’re asleep the pain is not as bad as you said it was.
我知道如果你睡着了，疼痛就不会像你说的那么严重。
Not far from your bed, just outside the curtain, a young man in a wheelchair, his neck slackened, his chin drooping close to the chest, vomits.
离你的床不远，就在帘子外面，一个坐在轮椅上的年轻人，脖子松弛，下巴耷拉到胸前，正在呕吐。
It’s viscous, like cake batter.
它很粘稠，就像蛋糕糊一样。
It pours out of his mouth and covers the front of his gown.
它从他的嘴里流出来，覆盖了他的礼服前部。
He is unconscious and makes barely any sound.
他失去知觉，几乎不发出任何声音。
Now is a good time for a walk.
现在正是散步的好时机。
I head outside, buy some chips from the gas station.
我走到外面，从加油站买了一些薯片。
When I return, the young man has been moved to the center of the ward, where, shuddering now, he continues to vomit.
当我回来时，年轻人已经被转移到病房中央，他现在浑身发抖，继续呕吐。
The former contents of his abdomen pool and spread on the floor.
他腹部以前的内容物汇集并散布在地板上。
A nurse approaches.
一名护士走近。
I point to the man and ask whether something might be done for him.
我指着那个人，询问是否可以为他做点什么。
The nurse frowns, tells me that the man is getting what he deserves; he has done this to himself.
护士皱起眉头，告诉我这个男人得到了他应得的；他已经这样对自己了。
She walks away.
她走开了。
Several nurses pass the gurney, but no one looks at the man.
几名护士经过轮床，但没有人看那个男人。
It is 4 AM by the time the doctor sees you.
医生来看你时已经是凌晨 4 点了。
Everything is fine, he tells us.
一切都很好，他告诉我们。
By now the chaos of the ER has quieted.
至此，急诊室的混乱已经平静下来。
You slept right through it.
你在整个过程中都睡着了。
Tomorrow, I will get up early and go into work at an office.
明天，我会早起去办公室上班。
The morning I visit Insite I awake to a winter sun, a rare reprieve from Vancouver rain.
参观 Insite 的那天早上，我在冬日的阳光下醒来，这是温哥华雨中难得的喘息之机。
It is still early when I take the bus downtown.
坐公交车去市中心的时候时间还早。
The buildings glimmer gold and red under the warming light.
建筑物在温暖的灯光下闪烁着金色和红色的光芒。
I decided to come here, to make the long trip to Vancouver, because I wanted to see Insite for myself.
我决定来这里，长途跋涉去温哥华，因为我想亲眼看看Insite。
I wanted to see the place where people who use drugs intravenously can go to inject more safely, the place where, according even to the supportive editorial I’d read earlier, “horrible things take place.” By then I had read enough about supervised injection to know that I thought it less horrible than humane.
我想看看静脉注射毒品的人可以更安全地注射的地方，甚至根据我之前读过的支持社论，“可怕的事情发生了”。到那时，我已经阅读了足够多有关监督注射的内容，知道我认为它不那么可怕，而是人道。
There is much else for which I would reserve the word horrible , including the treatment by law enforcement of people who use drugs.
还有很多其他事情我会保留“可怕”这个词，包括执法部门对吸毒者的治疗。
Between 1992 and 2000, more than 1,200 fatal overdoses were recorded in Vancouver.
1992 年至 2000 年间，温哥华记录了 1,200 多起因吸毒过量致死的事件。
Many of these took place in the Downtown Eastside, a neighborhood of ten or so square blocks where more than 4,600 people who inject drugs intravenously were known to live.
其中许多事件发生在市中心东区，这是一个大约十个街区的街区，据了解，那里居住着超过 4,600 名静脉注射毒品者。
The HIV conversion rate was the highest in the Western world.
西方世界的艾滋病毒感染率最高。
(This was due in part to the popularity in Vancouver of using cocaine intravenously: cocaine has a very short half-life, and people injecting the drug habitually might do so as many as forty times a day, as compared with heroin, which tends to be injected one to four times a day.) The city, recognizing that American-style prohibition had failed to bring about any improvement, undertook a kind of crash course on drug policy.
（部分原因是温哥华静脉注射可卡因很流行：可卡因的半衰期很短，习惯性注射这种药物的人每天可能会注射多达四十次，而海洛因往往每天注射一到四次。）该市认识到美国式的禁令未能带来任何改善，因此对毒品政策进行了一场速成班。
A succession of public forums, meetings, demonstrations, and conferences with experts from all over the world brought together drug users and their families, service providers, academic researchers, police, and policymakers to examine alternative approaches — heroin-prescription programs, supervised-injection sites, decriminalization.
一系列公共论坛、会议、示威活动以及来自世界各地的专家参加的会议将吸毒者及其家人、服务提供者、学术研究人员、警察和政策制定者聚集在一起，研究替代方法——海洛因处方计划、监督注射场所、非刑事化。
In 2003, Insite opened as a pilot research program, exempt from the criminal code.
2003 年，Insite 作为试点研究项目启动，不受刑法的约束。
It was not the only new service offered in the city, and it was “no silver-bullet solution,” a disclaimer Canadian policymakers, activists, and other supporters used often to describe its alternative approaches.
这并不是该市提供的唯一新服务，而且它“没有灵丹妙药”，这是加拿大政策制定者、活动人士和其他支持者经常用来描述其替代方法的免责声明。
But because it seemed to stand at the threshold of what progressive-minded people deemed acceptable — because, for many, it seemed intuitively wrong — it received the most attention, and was widely discussed both province- and nationwide.
但因为它似乎处于进步思想人士认为可以接受的门槛上——因为对许多人来说，直觉上它似乎是错误的——它受到了最多的关注，并在全省和全国范围内得到了广泛讨论。
This, too, interested me.
这也引起了我的兴趣。
Most Vancouver residents initially opposed the facility but came to support it; this took a lot of convincing, and a shift in the way people understand illegal drugs and those who use them.
大多数温哥华居民最初反对该设施，但后来转为支持；这需要很大的说服力，并且人们对非法毒品及其使用者的理解方式也发生了转变。
I wanted to know how this had happened.
我想知道这是怎么发生的。
In 2006, the Conservative Party in Canada won the national election, ousting the Liberals.
2006年，加拿大保守党赢得全国大选，击败自由党。
For the first time since 1993, Canada had a Conservative prime minister; from the start, he began dismantling the country’s social programs.
自 1993 年以来，加拿大首次出现一位保守党总理；从一开始，他就开始废除该国的社会计划。
Early on, Insite became a battleground for drug policy across the country.
早期，Insite 成为全国毒品政策的战场。
The government tried to shut it down, but the Portland Hotel Society (now PHS Community Services Society), the nonprofit group that runs Insite, mounted a human rights case and took it to the Supreme Court.
政府试图关闭它，但运营 Insite 的非营利组织波特兰酒店协会（现为 PHS 社区服务协会）提起了人权诉讼，并将其上诉至最高法院。
In 2011, Insite won the right to stay open.
2011年，Insite获得了继续营业的权利。
Still, I wondered how long it could last.
不过，我想知道它能持续多久。
I wanted to know, too, if something like it could ever exist in the United States.
我也想知道美国是否存在类似的东西。
At 9 AM , five men and women sit on the sidewalk on flattened cardboard boxes, first in line to enter when the doors open in an hour.
上午 9 点，五名男女坐在人行道上压扁的纸板箱上，一小时后开门时，他们首先排队进入。
Outside I meet Russ Maynard, Insite’s program coordinator.
在外面，我遇到了 Insite 的项目协调员 Russ Maynard。
He’s with several college students from a health-administration program, there on a class visit.
他和几名来自卫生管理项目的大学生一起去班级参观。
As a group, we walk through the reception area into the injection room.
作为一个团队，我们穿过接待区进入注射室。
At first glance, it reminds me of a hair salon.
乍一看，它让我想起了发廊。
The room is wide and bright, lined on one side by mirrors and a row of numbered bays, thirteen in all.
房间宽敞明亮，一侧排列着镜子和一排编号的隔间，总共十三个。
Each has a stainless-steel counter, a sink for hand washing, a sharps container, a plastic chair, and an extraction hood to collect smoke and vapors.
每个房间都有一个不锈钢柜台、一个洗手池、一个锐器容器、一把塑料椅子和一个收集烟雾和蒸汽的抽油烟机。
A platform with a curvilinear counter, the kind you see in hospitals, is raised behind the booths.
摊位后面有一个带有曲线柜台的平台，就像您在医院看到的那样。
Lining the countertop are bins that contain all the supplies a person would need to inject drugs — a syringe, a cooker for mixing the drug with water, a sterilized-water capsule for flushing the needle, a tourniquet to tie off a vein.
工作台上排列着一些箱子，里面装着注射毒品所需的所有用品——注射器、用于将药物与水混合的炊具、用于冲洗针头的消毒水胶囊、用于结扎静脉的止血带。
There is, too, a tool for crushing pills.
还有一种粉碎药丸的工具。
In the injection room, we arrange our chairs in a loose semicircle around Russ, who stands.
在注射室里，我们把椅子围成一个松散的半圆形，围绕着站着的拉斯。
Russ begins his introduction.
拉斯开始他的介绍。
Insite is operated by Vancouver Coastal Health, the regional health authority, and PHS Community Services Society, a neighborhood nonprofit that focuses on the hard to house.
Insite 由地区卫生当局温哥华海岸卫生局和 PHS 社区服务协会运营，PHS 社区服务协会是一家专注于难以住房的社区非营利组织。
PHS started in 1991, after a residents association converted a hotel into housing for the homeless.
PHS 始于 1991 年，当时居民协会将一家酒店改造成无家可归者的住房。
Today it provides residences for 1,200 people across sixteen buildings.
如今，它为 1,200 人提供了 16 栋建筑的住宅。
PHS also provides a range of community-based programs, including a credit union, a community drop-in center, medical and dental services, a syringe exchange, and an art gallery.
PHS 还提供一系列基于社区的项目，包括信用合作社、社区救助中心、医疗和牙科服务、注射器交换处和艺术画廊。
Users of Insite can access all this simply by coming in, and to get them to come in is Insite’s goal.
Insite 的用户只需进来就可以访问这一切，而让他们进来就是 Insite 的目标。
Making contact is the first step toward connecting people, at their request, to vital services they might need.
建立联系是根据人们的要求将他们与他们可能需要的重要服务联系起来的第一步。
They call the people who use their services “clients.”
他们将使用其服务的人称为“客户”。
Russ presents the group with a moral dilemma.
拉斯给团队带来了道德困境。
“Imagine you’re working at the front desk and a woman walks in and she’s eight months pregnant, and she wants to come in and inject.
“想象一下，你在前台工作，一位女士走进来，她已经怀孕八个月了，她想进来注射。
You have to make a quick decision.
你必须快速做出决定。
If the line starts getting backed up, there’s going to be an argument, or maybe worse.
如果线路开始堵塞，就会发生争执，甚至更糟。
So what’s going to happen?”
那么会发生什么呢？
I try to visualize the scenario, but it tests the limits of my open-mindedness.
我试图想象这个场景，但这考验了我开放思想的极限。
It is difficult to imagine supporting a pregnant woman’s injection-drug habit.
很难想象支持孕妇注射毒品的习惯。
“Is she going to leave and the clouds will part and the sunshine will hit her face and she’ll see the error of her ways and never use again?
“她是否会离开，乌云散去，阳光照在她的脸上，她会看到自己的错误，不再使用？
Or is she going to take some equipment and go use in an alley or a doorway or a hotel room or something like that?
或者她会带一些设备去小巷、门口、酒店房间或类似的地方使用？
If you do take her in, you can connect her with the nursing staff.
如果您确实收留了她，您可以将她与护理人员联系起来。
You can have her housed by the end of the day.
您可以在当天结束之前安置她。
You can connect her with food, with services, all kinds of things.
你可以将她与食物、服务以及各种事物联系起来。
And you forgo all of that if you turn her away.”
如果你拒绝她，你就放弃了这一切。”
Someone asks about the mirrors.
有人问镜子的事。
They are a critical design feature, says Russ.
拉斯说，它们是一个关键的设计特征。
Staff use them to monitor clients while maintaining a respectful distance.
工作人员用它们来监视客户，同时保持尊重的距离。
Clients use them to ensure a certain amount of caution when injecting — to pay more attention to doing it properly.
客户使用它们来确保注射时一定程度的谨慎——更加注意正确注射。
Russ: “You want it in your veins.
拉斯：“你希望它融入你的血管里。
Because there’s a big wash — imagine a wave coming to hit you — and you won’t feel anything for a little while.
因为有很大的水流——想象一下海浪向你袭来——你有一段时间不会有任何感觉。
And if you make a mistake, it means that you have to go back out and perform sex work, or beg, or steal, or whatever it is you do to get the ten dollars you need.
如果你犯了一个错误，那就意味着你必须回去从事性工作，或者乞讨，或者偷窃，或者无论你做什么才能得到你需要的十美元。
And that is stressful.”
这很有压力。”
Since 2007, the staff at Insite has been able to refer visitors to Onsite, a detox center on the building’s second floor.
自 2007 年以来，Insite 的工作人员一直能够将访客推荐至位于大楼二楼的 Onsite 戒毒中心。
There are twelve private rooms, each with its own bathroom.
有十二个私人房间，每个房间都有自己的浴室。
Insite connects between 400 and 450 people each year to detox, which, Russ claims, is more than any other project in Canada.
Insite 每年为 400 至 450 人提供戒毒服务，Russ 声称，这一数字比加拿大任何其他项目都要多。
The students leave .
学生们离开。
One at a time, men and women, young, old, homeless, ordinary, are called in from the waiting room.
候诊室里一次一个地叫来男人和女人，无论年轻的、年老的、无家可归的、普通的。
As they enter, they announce the drug they will be injecting: “down,” “dillies,” “crystal” (heroin, Dilaudid, methamphetamine).
当他们进入时，他们宣布将注射的药物：“down”、“dillis”、“crystal”（海洛因、Dilaudid、甲基苯丙胺）。
The receptionist records their answers in a database, in case of emergency or overdose.
接待员将他们的答案记录在数据库中，以备紧急情况或服药过量时使用。
I watch the mirrors from across the room.
我从房间的另一边看着镜子。
A stately man in a wool sweater, navy with white snowflakes, drags a fine-tooth comb through his silvery hair, from the top of his forehead back to his nape.
一个穿着带有白色雪花图案的海军蓝羊毛毛衣的庄严男人，用一把细齿梳子梳理着银色的头发，从前额到后颈。
He does this twenty or thirty times before tending to his mustache with the same fastidiousness, never breaking focus.
他这样做了二十或三十次，然后以同样的一丝不苟的态度护理他的胡子，从不分散注意力。
Then he pulls a woolen cap over his head and walks out into the sun.
然后他把一顶羊毛帽拉到头上，走到阳光下。
A young nurse examines the arms of a fiftysomething woman.
一名年轻护士检查一名五十多岁妇女的手臂。
The woman looks afraid.
女人看上去很害怕。
The nurse speaks in soft tones as she runs her hands along the woman’s forearms, helps her to locate a vein that isn’t damaged, scarred, or collapsed.
护士一边用轻柔的语气说话，一边用手抚摸这位女士的前臂，帮助她找到没有受损、没有疤痕或塌陷的静脉。
The nurse ties a tourniquet around her biceps.
护士将止血带绑在她的二头肌上。
They both pause.
他们都停了下来。
The woman, hand trembling, inserts the needle.
女人的手颤抖着插入针头。
The nurse removes the tourniquet.
护士取下止血带。
The woman pushes the plunger.
女人推动柱塞。
Hours later, I see the same woman on the bus, traveling along Hastings Street.
几个小时后，我在巴士上看到同一个女人，沿着黑斯廷斯街行驶。
I want to speak to her, consider doing so, even as I know it’s not right (privacy).
我想和她说话，考虑这样做，即使我知道这是不对的（隐私）。
But the woman is with a friend.
但那个女人和一个朋友在一起。
Instead I watch her, imagine where she’s going, how she will spend her time, what her home is like.
相反，我看着她，想象她要去哪里，她将如何度过她的时间，她的家是什么样子。
If anyone awaits her there.
如果有人在那里等她的话。
I ask Russ whether he knows any clients who might be willing to speak with me.
我问拉斯是否认识任何愿意与我交谈的客户。
He hesitates.
他犹豫了。
Donovan Mahoney is doing well, he says.
多诺万·马奥尼表现不错，他说。
He puts me in touch.
他让我联系。
Now I am in Donovan’s living room.
现在我在多诺万的客厅里。
We sit opposite each other, on separate couches.
我们面对面坐在不同的沙发上。
A series of photographs he has taken hangs on the wall above his head.
他头顶上方的墙上挂着他拍摄的一系列照片。
Today Donovan is a talented photographer.
如今，多诺万是一位才华横溢的摄影师。
His apartment, the garden level of a house in a middle-class neighborhood, is spacious, with a chef’s kitchen and newly laid blond hardwood floors.
他的公寓位于中产阶级社区的花园层，很宽敞，配有厨师厨房和新铺设的金色硬木地板。
He wears khaki pants and a gray sweater, slim-fitting with an overlapping V-neck.
他穿着卡其色裤子和灰色毛衣，修身版型，V 领重叠。
A baseball cap covers his partially shaved head of thick black hair.
一顶棒球帽遮住了他部分剃光的浓密黑发。
Donovan tells me the story of his twenties: he followed a girl to Vancouver, fell into coke, then rock cocaine, then heroin.
多诺万向我讲述了他二十多岁时的故事：他跟随一个女孩来到温哥华，吸食可卡因，然后吸食可卡因，然后吸食海洛因。
He’d always thought heroin was dirty, but after trying it for the first time he felt its reputation was undeserved.
他一直认为海洛因很肮脏，但第一次尝试后，他觉得它的名声是不值得的。
For a while he made money as a dealer.
有一段时间，他作为经销商赚了钱。
When he wanted to binge, he would go to the Downtown Eastside, stay in an SRO hotel where no one would find him.
当他想狂欢时，他会去市中心东区，住在一家没人能找到他的 SRO 酒店。
Then one time he didn’t go home.
后来有一次他没有回家。
He let his monthly rent payments pass, grew paranoid.
他放弃了每月的租金支付，变得偏执起来。
He left behind all his belongings, including his car.
他留下了所有财产，包括他的汽车。
This was in 2001.
这是2001年的事。
He lived on the streets, mostly.
他大部分时间都流落街头。
He didn’t like to feel closed in by walls, especially when he was high.
他不喜欢被墙壁封闭的感觉，尤其是当他兴奋的时候。
He shoplifted, was caught often, spent many nights in jail.
他在商店行窃，经常被抓，在监狱里度过了很多个夜晚。
He was wary of Insite when he first heard about it.
当他第一次听说 Insite 时，他对此持谨慎态度。
On the street, he knew that everyone was working an angle.
在街上，他知道每个人都在努力。
There’s a forthrightness to interactions that doesn’t exist elsewhere.
互动的直率是其他地方所不存在的。
He found it freeing.
他发现这让他感到自由。
But he couldn’t understand what would motivate the staff at Insite.
但他不明白什么可以激励 Insite 的员工。
Now he credits them for helping him to achieve all that he has.
现在，他感谢他们帮助他实现了他所拥有的一切。
Donovan: “They’re inadvertently showing you that there’s another way of life.
多诺万：“他们无意中向你展示了另一种生活方式。
You start to have normal conversations.
你们开始进行正常的对话。
You say to them, ‘What do you do?’ They reply, ‘I don’t know, I’m in a band.’ Of course they are.
你对他们说，“你是做什么的？”他们回答说，“我不知道，我在乐队里。”当然是。
And then they tell you stuff about what they do with their girlfriend.
然后他们会告诉你他们和女朋友一起做了什么。
Or how they went away for the weekend and saw their parents.
或者他们如何去度周末并见到他们的父母。
To me, to an addict, they’re showing me something.
对于我这个瘾君子来说，他们向我展示了一些东西。
There’s a whole other world out there that I don’t even understand.
那里有一个我什至不了解的另一个世界。
They’re showing you what it looks like to be a normal human being.
他们向您展示了作为一个正常人的样子。
Which is incredible, because if I’m shooting dope in an alley, I may bump into somebody who’s been through recovery, and they may be able to guide me.
这太不可思议了，因为如果我在小巷里拍摄毒品，我可能会遇到正在康复的人，他们也许能够指导我。
But they’re not going to be around when you need them.
但当你需要他们的时候，他们却不会出现。
“Addiction isn’t nine to five.
“成瘾不是朝九晚五。
It’s not like, ‘OK, tomorrow at ten o’clock I’m going to go into recovery.’ It happens and you don’t really see it coming.
它不像，“好吧，明天十点我要进入康复状态。”它发生了，但你并没有真正预见到它的到来。
It’s like, I think right now, if you guys got me in, I think I could go.”
就像，我想现在，如果你们让我加入，我想我可以走了。”
You want to be in charge of your own money.
你想掌控自己的钱。
It is frustrating to have to travel to me every time you run out of cash.
每次你没钱的时候都得跑来找我，这真是令人沮丧。
Together we visit your social worker, talk about how this could work.
我们一起拜访您的社会工作者，讨论这如何运作。
He needs to make a recommendation to your psychiatrist, to the state, before this can happen.
在这一切发生之前，他需要向你的精神科医生、向国家提出建议。
We review your history.
我们回顾您的历史。
For the first time it is affirmed to me that you are likely to take methadone all your life.
我第一次确信您可能终生服用美沙酮。
The social worker mentions your dose — 120 mg — says it’s high, that you haven’t decreased it since beginning the therapy.
社工提到您的剂量（120 毫克），说剂量很高，而且自从开始治疗以来您就没有减少过剂量。
You acknowledge as much.
你也承认这一点。
Still, it has been stabilizing, and the social worker is not concerned.
尽管如此，情况已经稳定下来，社会工作者并不担心。
I tell the social worker that I will share the bank account with you, monitor your spending.
我告诉社工，我将与您共享银行账户，监控您的支出。
Satisfied, he makes the recommendation.
他很满意，提出了建议。
We open a joint account.
我们开设联名账户。
Your monthly checks will be deposited and you will be responsible for paying your bills, for making sure you have enough to get through the month.
您的每月支票将被存入，您将负责支付账单，以确保您有足够的钱度过这个月。
I will check on the account through online banking.
我将通过网上银行查看账户。
I keep your savings, a few thousand dollars left over from the disability back payments, in a separate account in your name.
我将你的积蓄，即伤残欠款中剩下的几千美元，以你的名义存入一个单独的账户。
I know that, in the late ’80s and ’90s , the rapid spread of HIV through needle sharing galvanized US activists to challenge state laws and distribute hypodermic syringes for free, without a prescription; that the rate of new HIV cases in Vancouver among intravenous drug users persuaded even conservative politicians to consider opening a supervised-injection site; that were it not for the HIV epidemic, many drug-policy reforms in the US and elsewhere might not have occurred.
我知道，在 80 年代末和 90 年代，艾滋病毒通过共用针头迅速传播，促使美国活动人士挑战各州法律，在没有处方的情况下免费分发皮下注射器；温哥华静脉吸毒者中艾滋病毒新增病例的比率甚至说服了保守派政客考虑开设监督注射点；如果没有艾滋病毒的流行，美国和其他地方的许多药物政策改革可能不会发生。
I find it curious how few articles on the emerging “epidemics” — heroin, opioid — mention the disease.
我感到奇怪的是，关于新兴“流行病”（海洛因、阿片类药物）的文章很少提到这种疾病。
I wonder whether it is because, with antiretrovirals so widely available, HIV is perceived to be less threatening than it once was.
我想知道这是否是因为，随着抗逆转录病毒药物的广泛使用，人们认为艾滋病毒的威胁性已经不如以前了。
I chase the question for a time.
我追问了一会儿。
I print out medical papers, underline findings.
我打印出医学论文，在研究结果下划线。
I call an epidemiologist at a prestigious university, who answers my questions patiently.
我给一所著名大学的流行病学家打电话，他耐心地回答了我的问题。
He tells me that some of the best research is being done by an epidemiologist in Kentucky, who has been following a cohort of intravenous drug users since 2008.
他告诉我，一些最好的研究是由肯塔基州的一位流行病学家进行的，他自 2008 年以来一直在跟踪一群静脉注射吸毒者。
(Appalachia has disproportionately high rates of nonmedical prescription-opioid use and overdose-related deaths.) No one in the cohort had yet been diagnosed HIV positive, but 70 percent have hepatitis C.
（阿巴拉契亚地区的非医疗处方阿片类药物使用率和与药物过量相关的死亡率异常高。）队列中尚未有人被诊断为 HIV 阳性，但 70% 的人患有丙型肝炎。
I ask why this matters, and he says that rising hepatitis C rates often forecast HIV outbreaks, because the viruses spread through the same behaviors — unprotected sexual intercourse and needle sharing — and both require a certain density of drug users to sustain transmission.
我问为什么这很重要，他说丙型肝炎发病率上升通常预示着艾滋病毒的爆发，因为病毒通过相同的行为传播——无保护的性交和共用针头——并且两者都需要一定密度的吸毒者来维持传播。
But hep C is ten times more infectious, can live outside the body longer, and is extremely difficult to kill; it spreads more easily.
但丙型肝炎的传染性是其十倍，在体外存活时间更长，而且极难杀死；它更容易传播。
A hepatitis C outbreak indicates that all the factors are present for an HIV outbreak.
丙型肝炎的爆发表明艾滋病毒爆发的所有因素都存在。
In many ways, it’s a ticking time bomb, the epidemiologist says, especially since, in rural Appalachian communities, knowledge about HIV tends to be minimal; these populations have not previously had to deal with the disease.
这位流行病学家说，从很多方面来说，这都是一颗定时炸弹，尤其是在阿巴拉契亚农村社区，人们对艾滋病毒的了解往往很少。这些人群以前从未接触过这种疾病。
I hang up the phone, look up the data set that tracks syringe‑distribution programs by state.
我挂断电话，查找按州跟踪注射器分发计划的数据集。
Kentucky, 0; Tennessee, 0; Georgia, 1; South Carolina, 0; North Carolina, 6; Alabama, 0; Mississippi, 0; Ohio, 2; Virginia, 0; West Virginia, 0; Pennsylvania, 2; New York, 22; Maryland, 1.
肯塔基州，0；田纳西州，0；乔治亚州，1；南卡罗来纳州，0；北卡罗来纳州，6；阿拉巴马州，0；密西西比州, 0;俄亥俄州，2；弗吉尼亚州，0；西弗吉尼亚州，0；宾夕法尼亚州，2；纽约，22；马里兰州，1。
You are weak and exhausted , have been for months.
你很虚弱，很疲惫，已经好几个月了。
Every time we make plans, you cancel.
每次我们制定计划时，你都会取消。
Months pass and I don’t see you.
几个月过去了，我却见不到你。
When by routine appointment you see your hepatologist, he sends you to the emergency room.
当您按照常规预约去看肝病专家时，他会带您去急诊室。
You will need a blood transfusion to give you the hemoglobin that you need.
您需要输血才能获得所需的血红蛋白。
By the time I arrive, the blood has been ordered from the bank, is being warmed.
当我到达时，血液已经从银行订购，正在加热。
We wait for hours.
我们等了几个小时。
The transfusion itself will take hours, too.
输血本身也需要几个小时。
I leave you there alone.
我把你一个人留在那里。
Before I go, the doctor tells me that what you are experiencing is a complication from hepatitis C.
在我走之前，医生告诉我，你遇到的是丙型肝炎并发症。
We sit at your kitchen table beside the four-drawer wooden dresser, its surface lined with pill vials and bottles of methadone.
我们坐在厨房的桌子旁，旁边有四个抽屉的木制梳妆台，梳妆台的表面摆满了药瓶和美沙酮瓶。
I tell you about Insite.
我告诉你关于 Insite 的事。
You appear bewildered, shocked even.
你显得很困惑，甚至震惊。
“How can that possibly help anyone get off drugs?”
“这怎么可能帮助人们戒毒呢？”
Your first reaction resembles most people’s, but it’s not what I want you to say.
你的第一反应与大多数人相似，但这不是我想让你说的。
I want you to argue that getting people off drugs need not be the primary goal.
我想让你争辩说，让人们戒毒不一定是首要目标。
I want you to be critical of the status quo —of the morass of law and policy in which you and millions of others are entangled.
我希望你对现状——对你和数百万人所陷入的法律和政策的泥沼持批评态度。
But you are not.
但你不是。
You have only ever been exposed to one idea, one approach: abstinence.
你只接触过一种想法、一种方法：禁欲。
I explain it to you this way: that the most serious harms that arise from drug use — HIV, endocarditis, tetanus, septicemia, thrombosis — come not from the drugs but from external factors.
我这样向你解释：吸毒引起的最严重的危害——艾滋病毒、心内膜炎、破伤风、败血症、血栓——不是来自药物，而是来自外部因素。
Of all the ways to administer drugs, injecting carries the most risks.
在所有给药方式中，注射风险最大。
The drug solution bypasses the body’s natural filtering mechanisms against disease and bacteria.
该药物溶液绕过了人体针对疾病和细菌的自然过滤机制。
Access to sterile equipment and hygienic injection conditions can mean the difference between living and dying.
能否获得无菌设备和卫生的注射条件可能意味着生与死的区别。
I say, thinking you might relate, that policing has an especially devastating effect on people who use drugs intravenously and are entrenched in street life.
我认为你可能会感同身受，警察对那些静脉注射毒品和长期融入街头生活的人具有特别毁灭性的影响。
When they fear the police, they don’t stop using, they just move elsewhere — to neighboring areas, where they may create new syringe-sharing networks, or to hidden or indoor locations.
当他们害怕警察时，他们不会停止使用，而是搬到其他地方——到邻近地区，在那里他们可能会建立新的注射器共享网络，或者到隐藏的或室内的地点。
In such places, needle sharing is more common, because access to clean needles is cut off.
在这些地方，共用针头更为常见，因为无法获得干净的针头。
When police are around, users avoid carrying clean needles, for fear of being identified as addicts and harassed.
当警察在场时，吸毒者会避免携带干净的针头，因为担心被认定为吸毒者并受到骚扰。
Overdoses increase.
服药过量增加。
Precarious witnesses, fearful that police will follow medical personnel to the scene, fail to seek help.
不稳定的目击者担心警察会跟随医务人员到达现场，因此没有寻求帮助。
I have stats at the ready.
我已经准备好了统计数据。
Nearly 500,000 Americans are incarcerated on drug charges.
近 50 万美国人因毒品指控被监禁。
Another 1.2 million are supervised on probation or parole.
另有 120 万人在缓刑或假释期间受到监督。
Overwhelmingly, those affected are black, and not because they use and sell drugs at higher rates — on the contrary.
绝大多数受影响者是黑人，这并不是因为他们使用和销售毒品的比例更高——相反。
I say that prison is no place for people who use drugs, help does not await them there.
我说监狱不是吸毒者的地方，那里不会有帮助。
Maintenance therapies using methadone and buprenorphine are not available for people with opioid dependencies.
使用美沙酮和丁丙诺啡的维持治疗不适用于阿片类药物依赖性患者。
Often an incarcerated person will continue to use drugs throughout a prison stay, and the clandestine nature of his use means that he is now more at risk than he might otherwise have been, using unsterile needles and sharing syringes among multiple inmates.
通常，被监禁者会在整个监狱期间继续吸毒，而其吸毒的秘密性质意味着他现在比原本可能面临的风险更大，因为他使用未经消毒的针头并在多名囚犯之间共用注射器。
Overdose rates peak in the first few weeks after release from prison, with mortality rates higher than what would be expected in similar demographic groups in the general population.
服药过量率在出狱后的最初几周内达到峰值，死亡率高于一般人群中类似人口群体的预期。
You begin to understand.
你开始明白了。
You agree none of this is good.
你同意这一切都不好。
But still you are uneasy.
但你还是不安。
You maintain it would be better to encourage people to stop using altogether.
您认为最好鼓励人们完全停止使用。
A year has passed since I spoke with the epidemiologist.
自从我与流行病学家交谈以来已经过去了一年。
I read in the newspaper that more than eighty people in Scott County, Indiana, have tested positive for HIV, most of them from a small town called Austin.
我在报纸上读到，印第安纳州斯科特县有八十多人艾滋病毒检测呈阳性，其中大多数来自一个叫奥斯汀的小镇。
The outbreak can be traced to intravenous use of the drug Opana, an opioid analgesic.
这次疫情的爆发可以追溯到静脉注射阿片类镇痛药 Opana。
The transmission rate has been around 80 percent.
传输率一直在80%左右。
Meanwhile a woman in Austin buys a license to carry a handgun because she fears for her young children.
与此同时，奥斯汀的一名妇女因为担心年幼的孩子而购买了携带手枪的许可证。
The woman takes pictures of “all this stuff going on” and calls the tip line.
这位女士拍下了“所有这些事情正在发生”的照片，并拨打了举报热线。
“I do nothing but,” she says.
“我什么也不做，”她说。
On her lawn is a sign: No loitering or prostituting is allowed in front of these premises .
她的草坪上有一个牌子：禁止在这些场所前闲逛或卖淫。
You resent me now .
你现在怨恨我了。
I am trying to help you budget your money.
我正在努力帮助你预算你的钱。
You are spending your entire monthly payment within the first week.
您将在第一周内花完每月的全部付款。
When your next deposit comes, I transfer it into the account you cannot access.
当您下次存款时，我会将其转入您无法访问的帐户。
Every week, I allow you one quarter of your stipend, after deducting your bills and rent.
扣除你的账单和租金后，我每周给你四分之一的津贴。
But you won’t stop texting me, asking for more money.
但你不会停止给我发短信，要求更多的钱。
I try to reason with you, explain why you need the budget.
我试着和你讲道理，解释为什么你需要预算。
I try putting my foot down, which amounts to ignoring your texts.
我试着坚定立场，这相当于无视你的短信。
You say you are buying a lot of $5 bootleg DVDs (Hitchcock is your favorite), but you forget that I know how to do math.
你说你买了很多 5 美元的盗版 DVD（希区柯克是你的最爱），但你忘了我会做数学。
And you are not interested in any of the solutions I come up with — a cheap computer, an internet connection, Netflix.
你对我提出的任何解决方案都不感兴趣——一台便宜的电脑、一个互联网连接、Netflix。
Every time I say no, I know I am passing judgment on you, on the things you desire for yourself (your collection of Adidas sneakers is by now substantial), what you prioritize.
每次我说“不”时，我都知道我是在对你、对你自己想要的东西（你收藏的阿迪达斯运动鞋现在已经很多了）、对你优先考虑的事情做出判断。
I am measuring you against an ethic of responsibility, a conception of the good life, that I do not want to force you to share.
我正在根据一种责任道德、一种美好生活的理念来衡量你，我不想强迫你分享这些。
I can recognize this, but I can’t hew my way out of the irony that accepting your irresponsibility only shifts the burden onto me, and this too seems unjust.
我可以认识到这一点，但我无法摆脱讽刺，接受你的不负责任只会将负担转移到我身上，这也似乎不公平。
You were lucky once.
你曾经很幸运。
You and my father sold your childhood home for $300,000.
你和我父亲以 30 万美元的价格卖掉了童年的房子。
You never risked going to prison to support yourself.
你从来没有冒着入狱的风险来养活自己。
But before long, your half was gone, and you started spending my father’s share.
但不久之后，你的那一半就没有了，你开始花我父亲的那一份。
He cut you off, begged you to stop, but you said no, you had never felt so alive, you were having the time of your life.
他打断了你的话，求你停下来，但你说不，你从来没有感觉如此充满活力，你正在享受生命中的时光。
We go to the bank and close the joint account, transfer your savings.
我们去银行关闭联名账户，转移您的存款。
You have total control.
您拥有完全的控制权。
You show up to an appointment with your psychiatrist, but it is the wrong day.
你去约见你的精神科医生，但那天不对。
You are confused, delirious.
你很困惑，神志不清。
You travel by ambulance to the psychiatric emergency room at a nearby hospital.
您乘坐救护车前往附近医院的精神科急诊室。
Your social worker calls to report what has happened.
您的社会工作者打电话报告所发生的事情。
He says you may be showing signs of early-onset dementia.
他说你可能表现出早发性痴呆的迹象。
He says you may be abusing your methadone.
他说你可能滥用美沙酮。
I tell him about our recent conversation, the one where you told me you were taking Klonopin to sleep at night; the one where you guardedly suggested you may not be taking it as directed.
我告诉他我们最近的谈话，你告诉我你晚上服用 Klonopin 入睡；您谨慎地建议您可能不按指示服用的那个。
Two weeks later the social worker calls me again.
两周后，社工再次给我打电话。
You have terminated your services with their facility.
您已经终止了他们的服务。
You are within your rights to do so, and by phoning to let me know, the social worker is breaking protocol.
你有权这样做，但打电话告诉我，社工违反了规定。
But he is worried, thinks you lied when you said you found a psychiatrist closer to home.
但他很担心，认为你在说你找到了离家较近的精神科医生时撒了谎。
He believes you may no longer be fit to take care of yourself.
他认为你可能不再适合照顾自己。
He wants to call Adult Protective Services, would I be all right with that, and might he provide them with my phone number?
他想给成人保护服务中心打电话，我可以吗？他可以向他们提供我的电话号码吗？
He says to me, Please, you are the only person H.
他对我说，拜托，你是唯一的H人。
has.
有。
It takes a few days , but I reach you.
虽然需要几天时间，但我还是能联系到你。
I come over with pastries from the Doughnut Plant.
我带着甜甜圈厂的糕点过来了。
You seem all right — lucid, lively.
你看上去一切都很好——头脑清醒，充满活力。
You want to know how I know about it all.
你想知道我是如何知道这一切的。
You are annoyed that someone would call me.
你很生气有人打电话给我。
You tell me that you like your new facility, that you are happy not to travel to Crown Heights to see your psychiatrist.
你告诉我你喜欢你的新设施，你很高兴不用去皇冠高地看你的精神科医生。
Getting around the city is hard now.
现在在城市里出行很困难。
Scoliosis has you bent in two.
脊柱侧弯让你弯成两半。
You are not lying about the existence of this new facility.
对于这个新设施的存在，你并没有撒谎。
But when I ask whether you have a new social worker, someone who can help manage your various appointments, who knows what services you are eligible for, who can connect you with the things you need, who you can talk to about your private thoughts, it occurs to you, for the first time, that you do not.
但当我问你是否有新的社会工作者，可以帮助你管理各种预约，知道你有资格获得哪些服务，可以为你联系你需要的东西，可以与你谈论你的私人想法时，你第一次意识到你没有。
I tell you to look into it.
我告诉你去调查一下。
A few weeks later, I hear from my father that you have started traveling to Crown Heights again.
几周后，我从父亲那里听说你又开始前往皇冠高地了。
I met R.
我遇见了R。
through a dating app .
通过约会应用程序。
Now I am sitting with him in a wooden booth in a dark bar drinking Campari with soda and lime.
现在我和他一起坐在一家黑暗酒吧的木制隔间里，喝着加了苏打水和酸橙的金巴利酒。
We talk, and it’s clear he knows a lot of things.
我们交谈过，很明显他知道很多事情。
He refuses to say much about it, but for years he studied Kabbalah.
他拒绝对此透露太多，但多年来他一直在研究卡巴拉。
He also lived in India, studied Buddhism.
他还住在印度，学习佛教。
Now he works as a professor.
现在他是一名教授。
We share some ideas about politics, enough to make him stand out among the other dates.
我们分享了一些关于政治的想法，足以让他在其他约会对象中脱颖而出。
We seem to be getting along all right.
我们似乎相处得很好。
Recently he has been to Vancouver.
最近他去了温哥华。
I tell him that I’ve also been there.
我告诉他我也去过那里。
We talk about the Downtown Eastside, and he tells me he knows and respects the work of Gabor Maté, whom I interviewed on my trip.
我们谈论市中心东区，他告诉我他了解并尊重我在旅途中采访过的加博尔·马特 (Gabor Maté) 的工作。
Maté is a physician and harm-reduction advocate, a proponent of safe injection sites, who worked in the Downtown Eastside for twelve years.
马特是一名医生和减少危害的倡导者，也是安全注射地点的支持者，他在市中心东区工作了十二年。
He’s also a proponent of the healing powers of ayahuasca, which is how R.
他也是死藤水治疗功效的支持者，这就是 R.
knows of him.
认识他。
I enjoy this conversation, the overlaps in our knowledge.
我喜欢这次谈话，我们的知识有重叠。
I tell him about Da Vinci’s Inquest , the Canadian television program based on Vancouver’s chief coroner turned mayor, the same mayor who was in office when Insite opened.
我向他讲述了达芬奇的《Inquest》，这是一档以温哥华首席验尸官出身的市长为背景的加拿大电视节目，这位市长在 Insite 开业时就在任。
R.
R。
tells me that he has done, still sometimes does do, heroin.
告诉我他曾经吸食海洛因，现在仍然有时吸食海洛因。
A casual user.
一个休闲用户。
It’s like a test.
这就像一个测试。
I can recall the many times I have pointed out, in abstract conversations, that heroin’s reputation does not align with scientific evidence; that although it can be devastating for some, it is not, in itself, any more dangerous than a lot of other drugs, and people who use heroin are unduly stigmatized.
我记得我曾多次在抽象的谈话中指出，海洛因的声誉与科学证据并不相符；虽然它对某些人来说可能是毁灭性的，但它本身并不比许多其他毒品更危险，而且使用海洛因的人受到了不当的耻辱。
But here it is no longer abstract.
但在这里它不再是抽象的。
Will I hold it against R.?
我会反对R.吗？
Later, when I mention this detail to a friend, she frowns.
后来，当我向朋友提起这个细节时，她皱起了眉头。
“I like the other guy better.”
“我更喜欢另一个人。”
You are cured of your hepatitis after a course of Sovaldi, a new pill that clears the disease in 95 percent of cases.
经过 Sovaldi 疗程后，您的肝炎就被治愈了，Sovaldi 是一种新药，可以治愈 95% 的病例。
The price of this near-certain cure: $84,000.
这种近乎确定的治愈方法的价格：84,000 美元。
Each pill costs $1,000.
每粒药丸售价 1,000 美元。
You are fortunate to live in New York, the state where Medicaid coverage of the drug is the most generous.
您很幸运生活在纽约州，该州的医疗补助对该药物的覆盖范围是最慷慨的。
Many states pay for only the sickest patients.
许多州只为病情最严重的患者付费。
You are, relatively speaking, not that sick.
相对而言，你的病还没有那么严重。
For the first time I come across an article in the popular press that challenges the accepted narrative.
我第一次在大众媒体上看到一篇挑战公认叙述的文章。
A professor of psychology and psychiatry named Carl Hart says the heroin public health crisis is a myth.
一位名叫卡尔·哈特的心理学和精神病学教授表示，海洛因公共卫生危机是一个神话。
He claims the attorney general is overstating the problem.
他声称司法部长夸大了这个问题。
The commonly cited metrics are insufficient and misleading: the number of people who have tried heroin doesn’t tell you how many people have dependency issues.
通常引用的指标是不充分且具有误导性的：尝试过海洛因的人数并不能告诉您有多少人有依赖性问题。
Weeks later, I underline a sentence in Drug War Heresies , a book that attempts to project and evaluate the consequences of various legalization regimes and drug-policy reforms: “One million occasional drug users may pose fewer crime and health problems than 100,000 frequent users.”
几周后，我在《毒品战争异端》中强调了一句话，这本书试图预测和评估各种合法化制度和毒品政策改革的后果：“一百万偶尔吸毒者可能比十万经常吸毒者造成的犯罪和健康问题要少。”
There are more interviews to transcribe.
还有更多采访需要转录。
I’ve been procrastinating.
我一直在拖延。
Today I am listening to my conversation with Gabor Maté.
今天我正在听我与 Gabor Maté 的对话。
My friends have been trying ayahuasca, going on retreats, and they all seem to know of him, to hold him in high regard.
我的朋友们一直在尝试死藤水，进行静修，他们似乎都认识他，并高度尊重他。
I know the quote I want, am waiting for him to say it, fast-forward through my own voice.
我知道我想要的引言，正在等待他说出，通过我自己的声音快进。
He says: “Abstinence is just not a model you can force on everybody.
他说：“禁欲并不是一种可以强加给每个人的模式。
There’s nothing wrong with it for those for whom it works.
对于那些它所服务的人来说，这并没有什么问题。
But when it comes to drug treatment there’s an assumption that one size fits all.
但当谈到药物治疗时，有一种假设是“一刀切”。
And if you’re going to wash your hands of people who can’t go the abstinence route, then you’re giving up.”
如果你要对那些无法禁欲的人洗手，那么你就放弃了。”
He says: “Harm reduction means you give out clean needles, you give out sterile water, you resuscitate people if they overdose.
他说：“减少危害意味着你要分发干净的针头，分发无菌水，如果人们服药过量，你要对他们进行复苏。
You help people inject more safely.
您帮助人们更安全地注射。
You’re not treating the addiction.
你没有治疗上瘾。
You’re not intending to.
你不是故意的。
You’re just reducing the harm.”
你只是在减少伤害。”
We decide to see a movie in Williamsburg.
我们决定在威廉斯堡看电影。
In the back of a livery car, you tell me that one thing you really miss, one thing you think you should try to do, is find a female companion.
在一辆出租车的后座上，你告诉我，你真正怀念的一件事，你认为你应该尝试做的一件事，就是找到一个女伴。
I agree that this would be ideal, but I’m not sure how to help.
我同意这将是理想的选择，但我不知道如何提供帮助。
I say that maybe you should go online.
我说也许你应该上网。
I show you the dating app on my phone and we laugh at its absurdity.
我向你展示了我手机上的约会应用程序，我们嘲笑它的荒谬。
I say there must be sites for older people.
我说必须有适合老年人的网站。
But you don’t have a computer, and you don’t have a smartphone.
但你没有电脑，也没有智能手机。
I’m certain you could count the times you’ve used the internet on one hand.
我相信您用一只手就能数出您使用互联网的次数。
You tell me about the woman in the apartment below you.
你告诉我关于你楼下公寓里那个女人的事。
Whenever you try to shower, she immediately turns on all her faucets and uses up the hot water before you even have time to undress.
每当你想洗澡时，她都会在你还没来得及脱衣服之前立即打开所有水龙头并用完热水。
I explain the unlikelihood of this — hot-water distribution in a multi-unit building just doesn’t work that way.
我解释了这种可能性的可能性——多单元建筑中的热水分配并不是这样进行的。
You seem reassured, but the next time we speak, you complain that the problem continues.
你看起来很放心，但下次我们谈话时，你抱怨问题仍然存在。
Weeks later, you call in a panic.
几周后，你惊慌地打电话来。
Con Edison is threatening to cut off your service, and you can’t afford to pay.
联合爱迪生公司威胁要切断你的服务，而你却付不起费用。
The bill is several hundred dollars, despite the subsidy you receive.
尽管您获得了补贴，但账单仍高达数百美元。
You tell me you had been running your space heater all day, every day, for weeks — the building had kept the heat on low.
你告诉我，你的小型取暖器一整天、每一天、连续几个星期都在运行——大楼的热量一直保持在较低水平。
You either underestimate my intelligence or the shame is too great.
你要么低估我的智商，要么耻辱太大。
I call Con Edison, take care of your bill.
我给联合爱迪生公司打电话，请处理好你的账单。
You haven’t sent a payment in six months.
您已经六个月没有付款了。
When I confront you with this, you insist on your version of the story.
当我面对你这个问题时，你坚持你的故事版本。
You call a car and ride over to my place because you don’t have money to get you through the month.
你叫了一辆车，骑到我家，因为你没有钱度过这个月。
My father says that if I lend it to you, he’ll pay me back.
我父亲说，如果我借给你，他就会还给我。
You are sitting at my dining table.
你坐在我的餐桌旁。
You are smiling, and you tell me that when you finally met the hot-water villain, you found her beautiful and fell in love.
你微笑着，告诉我，当你终于遇到热水小人时，你发现她很美丽，并爱上了她。
You gave her a holiday gift: a note and $30.
你给了她一份节日礼物：一张纸条和 30 美元。
You stuffed it under her door.
你把它塞到她门下了。
She kept the money, of course, but she never acknowledged you.
当然，她保留了钱，但她从未承认过你。
When you leave I give you extra cash for your car ride home.
当你离开时，我会给你额外的现金，供你开车回家。
A week later, you call to apologize for lying to me about the Con Ed bill.
一周后，你打电话道歉，因为在联合教育法案上对我撒谎。
This is a first.
这是第一次。
The Canadian government releases details of a damning audit.
加拿大政府公布了一项令人震惊的审计的细节。
The audit alleges that PHS Services, which runs Insite and in 2013 received provincial-government funding worth approximately $18 million, misused corporate credit cards and reimbursed improper expenses:
审计称，运营 Insite 的 PHS Services 在 2013 年接受了价值约 1800 万美元的省政府资金，滥用公司信用卡并报销不当费用：
$8,600 for limousine rides in 2013 almost $900 per night for a stay in a British hotel more than $2,600 for a stay in a Disneyland resort for two adults and two children $5,832 for a Danube cruise
2013 年乘坐豪华轿车的费用为 8,600 美元 英国酒店住宿每晚近 900 美元 两名成人和两名儿童入住迪士尼乐园度假村的费用超过 2,600 美元 多瑙河游船费用为 5,832 美元
I wince.
我皱起了眉头。
I know how hard these people have worked, how much they’ve done for the hard-to-house in Vancouver.
我知道这些人有多么努力，他们为温哥华的困难群众做了多少事情。
I know this scandal will taint them forever.
我知道这个丑闻将永远玷污他们。
To open a facility like Insite, to set up crackpipe vending machines (as they have also done) — to challenge the status quo in this way — you can’t make mistakes.
要开设像 Insite 这样的设施，要设立管道自动售货机（他们也这样做过）——以这种方式挑战现状——你不能犯错误。
It’s like being a politician.
这就像成为一名政治家。
Someone will always want to drag you down.
总会有人想拖你后腿。
Even as the media narrative continues to focus on heroin use among middle-class youth in suburban neighborhoods and rural towns, I know that other populations are in need of resources and services.
尽管媒体报道继续关注郊区和农村城镇中产阶级青年吸食海洛因的情况，但我知道其他人群也需要资源和服务。
A study by the Centers for Disease Control and Prevention shows that rates of heroin use remain highest among males, 18- to 25-year-olds, people with household incomes below $20,000, people living in urban areas, and people with no health insurance or on Medicaid.
美国疾病控制与预防中心的一项研究表明，海洛因吸食率在男性、18 至 25 岁人群、家庭收入低于 20,000 美元的人群、居住在城市地区的人群以及没有医疗保险或享受医疗补助的人群中仍然最高。
I take the subway up to the Bronx to BOOM!Health, a peer-run harm-reduction organization.
我乘坐地铁前往布朗克斯区的 BOOM!Health，这是一家同行经营的减害组织。
With a small grant from the Drug Policy Alliance, BOOM!
有了毒品政策联盟的一笔小额赠款，BOOM！
is trying to open the first legal supervised-injection facility in the US.
正试图在美国开设第一家合法的监督注射设施。
They’ve even set up a model site, a single injection booth fashioned after those at Insite.
他们甚至建立了一个样板场，一个仿照 Insite 设计的单一注射室。
I meet with the organization’s president and chief programming officer.
我会见了该组织的总裁兼首席编程官。
He tells me that they want to create a pilot study, much like the one in Vancouver.
他告诉我，他们想要开展一项试点研究，就像温哥华的研究一样。
I know that when advocates in San Francisco tried to set up a facility, the opposition was too great.
我知道，当旧金山的倡导者试图建立一个设施时，反对声太大了。
But BOOM!
但是嘭！
is optimistic; having Bill de Blasio in the mayor’s office presents an opportunity.
乐观；比尔·白思豪 (Bill de Blasio) 进入市长办公室提供了一个机会。
I speak with a lawyer specializing in public-health law who argues that a pilot study is not the best strategy.
我与一位专门从事公共卫生法的律师交谈过，他认为试点研究并不是最好的策略。
“The people who are moved by evidence are not necessarily legislators.
“被证据感动的人不一定是立法者。
Insite was evaluated every which way.
Insite 从各个方面进行了评估。
There were so many papers.
有很多论文。
Most of them are some variation on the theme that it did pretty much what we thought it would do, and it didn’t do anything that its detractors thought it might do.
其中大多数都是主题的一些变体，即它几乎做了我们认为它会做的事情，并且它没有做任何批评者认为它可能做的事情。
Has that proven very persuasive, either in Canada or the US?
无论是在加拿大还是在美国，这是否都非常有说服力？
Not really!”
不是真的！”
Framing the facility as an incremental extension of services already available, he suggests, could prove more effective.
他建议，将该设施视为现有服务的增量延伸，可能会更有效。
“Almost do it under the radar.” He is not sure that he is correct, but claims that, at least to his knowledge, the federal government never busted a single syringe-exchange program; it was always the local cops and sheriffs.
“几乎是在雷达下进行的。”他不确定自己的说法是否正确，但声称，至少据他所知，联邦政府从未破坏过任何一个注射器交换计划；总是当地的警察和治安官。
He adds, hesitantly: “But then the question is: Is that model” — i.e., an unsanctioned facility — “exportable to other cities and states?”
他犹豫地补充道：“但问题是：这种模式”——即未经批准的设施——“可以出口到其他城市和州吗？”
When I began to follow the media coverage of the new “heroin scourge,” I didn’t have strong ideas about “addiction,” except that I knew it when I saw it.
当我开始关注新的“海洛因祸害”的媒体报道时，我对“成瘾”并没有强烈的想法，只是当我看到它时我就知道了。
I believed it was a disease, and that it should be treated as such.
我相信这是一种疾病，应该这样对待。
But the more I read, the more people I speak with, the more I begin to question this framework.
但我读的书越多，交谈的人越多，我就越开始质疑这个框架。
It is clear that no one — no neuroscientist, psychologist, psychiatrist, or physician — can explain what addiction is or account for its contradictions.
显然，没有人——没有神经科学家、心理学家、精神病学家或医生——能够解释什么是成瘾或解释其矛盾。
Tobacco, cocaine, heroin, alcohol, MDMA, amphetamines — are they inherently addictive?
烟草、可卡因、海洛因、酒精、MDMA、安非他明——它们本质上会让人上瘾吗？
Common knowledge suggests they are.
常识表明确实如此。
But all around me I see exceptions more than the rule, my friends who use, have used, some or all of these drugs, including heroin, casually.
但在我周围，我看到的例外多于规则，我的朋友们曾经或曾经使用过部分或全部这些药物，包括海洛因，随意使用。
I, too, am one of the exceptions.
我也是例外之一。
I conclude that my own point of view is now best represented by the more radical strands of the harm-reduction movement and by legalization; I can argue, morally, intellectually, why these alternatives are better than what we have now.
我的结论是，现在最能代表我自己观点的是减少危害运动和合法化中更激进的部分；我可以从道德上、智力上论证为什么这些替代方案比我们现在拥有的更好。
Following the lead of those in harm-reduction and drug-users’ rights groups, I decide to scrub the word addict from my vocabulary, to avoid using the term drug abuser.
在减少伤害和吸毒者权利团体的带领下，我决定从我的词汇中删除“成瘾者”这个词，以避免使用“吸毒者”这个词。
The alternatives can be awkward on the page, in a sentence, but it is more important not to reduce a person to this one aspect of her life, not to ascribe all the negative valences carried by these words.
用一句话来说，页面上的替代方案可能会很尴尬，但更重要的是不要将一个人简化为她生活的这一方面，不要将这些词所携带的所有负面价值归咎于这些词。
person with a substance-misuse disorder person experiencing a drug problem person who uses drugs habitually person committed to drug use
患有药物滥用障碍的人 遇到毒品问题的人 习惯性吸毒的人 长期吸毒的人
I try carrying these over into speech.
我尝试将这些运用到演讲中。
This, too, is challenging.
这也具有挑战性。
I meet Judith in her studio.
我在朱迪思的工作室见到了她。
She is 75, a painter of Indian peafowl, roseate spoonbills, reddish egrets, and other birds of refined plumage and delicate bills.
她今年 75 岁，是一位画家，画的有印度孔雀、玫瑰琵鹭、红白鹭和其他羽毛精致、喙细腻的鸟类。
Earlier in the winter, her son, Spencer, died of a methadone overdose.
今年初冬，她的儿子斯宾塞因服用美沙酮过量而死亡。
We face each other, seated in chairs, a small table and a glass of water between us.
我们面对面坐在椅子上，中间有一张小桌子和一杯水。
Judith looks the part of a painter.
朱迪思看起来像一位画家。
She is poised, like her subjects, and speaks of her son’s death with surprising ease.
她像她的臣民一样泰然自若，谈及儿子的死时出奇地轻松。
“Having a son die this way is not the absolute worst thing a mother can experience.
“儿子就这样死去并不是母亲所能经历的最糟糕的事情。
I can think of circumstances far worse.”
我能想到更糟糕的情况。”
Her stoicism is not an act.
她的坚忍不是一种行为。
Despite countless visits to detox programs and rehab centers, a frightening prison stay, longtime family support, and the benefit of resources unavailable to most, Spencer was unable to stop using drugs in a dangerous way.
尽管无数次前往戒毒项目和康复中心、可怕的监狱服刑、长期的家庭支持以及大多数人无法获得的资源，斯宾塞仍无法停止以危险的方式使用毒品。
Judith understands that she’s not to blame.
朱迪丝明白她不应该受到责备。
I examine a framed photograph of Spencer that Judith has pulled out on my behalf.
我检查了朱迪思替我取出的一张斯宾塞的镶框照片。
He’s tall and fit-looking, blue-eyed, sensitive.
他身材高大，看上去很健康，蓝眼睛，敏感。
Spencer binged.
斯宾塞暴饮暴食。
Methadone maintenance never worked for him.
美沙酮维持治疗对他来说从来没有效果。
Taking anything at all, including methadone, triggered a dangerous cycle.
服用任何东西，包括美沙酮，都会引发危险的循环。
When Spencer overdosed, it was with methadone he received through a program.
当斯宾塞服药过量时，他通过一个项目接受了美沙酮。
He had been trying to give up drugs.
他一直在努力戒毒。
Judith believes that Spencer was torn between the life he wanted for himself and the life he seemed fated to have.
朱迪思相信斯宾塞在他想要的生活和他似乎注定要拥有的生活之间左右为难。
“He had the right to let himself go if he couldn’t be happy.”
“如果他不快乐，他有权放手。”
Judith tells me that methadone-maintenance therapy is without a doubt a terrible thing.
朱迪思告诉我，美沙酮维持治疗无疑是一件可怕的事情。
I want to say: Maybe for some people, like your son, but it has also helped many others.
我想说：也许对某些人来说，比如你的儿子，但它也帮助了很多其他人。
But I can’t say it.
但我不能说。
Judith says that a person on methadone still has that “all about me” attitude.
朱迪思说，服用美沙酮的人仍然有“一切以我为中心”的态度。
What she means is that there is a kind of heroin mind, a way of behaving particular to a habitual drug user.
她的意思是，有一种海洛因心理，一种习惯性吸毒者特有的行为方式。
The person may prioritize access to heroin above all else, including relationships with loved ones.
该人可能会优先考虑获取海洛因，包括与亲人的关系。
Lying and stealing are constants in the repertoire of behavior.
撒谎和偷窃是常见的行为方式。
A person on methadone, Judith is saying, is still in heroin mind.
朱迪思说，服用美沙酮的人心里仍然存有海洛因。
I make an intellectual case for methadone, say that for some people it can help to stabilize their lives.
我为美沙酮做了一个理智的论证，说对于某些人来说它可以帮助稳定他们的生活。
But Judith stares at me blankly.
但朱迪思茫然地看着我。
She is not interested.
她不感兴趣。
I want to appeal with a personal example, but I find it hard to come up with one.
我想用一个个人的例子来呼吁，但我发现很难举出一个例子。
She compares those who rely on methadone with those who seek help, and support others, through Narcotics Anonymous, as her son did.
她将那些依赖美沙酮的人与那些像她儿子一样通过戒毒互助会寻求帮助和支持他人的人进行了比较。
The people who commit to these programs, she explains, commit to a life of service.
她解释说，那些致力于这些计划的人致力于终身服务。
Spencer may have given up on his own life, but he helped save innumerable others.
斯宾塞可能放弃了自己的生命，但他帮助拯救了无数其他人。
Judith claims the people she met through NA are among the saintliest she knows.
朱迪思声称她在北美遇到的人都是她认识的最神圣的人。
“You should disconnect from your uncle, leave him behind, drop him.
“你应该与你的叔叔断绝关系，把他抛在身后，抛弃他。
He is taking from you without ever giving back.”
他从你那里索取却从不给予回报。”
I feel defensive, uncomfortable, on your behalf and my own.
为了你和我自己，我感到防御、不舒服。
I feel I’m being perceived as weak for deciding that you, while difficult, are still a person worth knowing.
我觉得我被认为是软弱的，因为我认为你虽然很难相处，但仍然是一个值得认识的人。
Judith apologizes, tells me what I really need to do is to find a boyfriend who will treat me like a queen.
朱迪思道歉，告诉我我真正需要做的是找到一个像女王一样对待我的男朋友。
I am mistaken .
我错了。
Sophie never does come around.
苏菲始终没有出现。
I can’t remember the last time you mentioned her name.
我不记得你上次提到她的名字是什么时候了。
Two years, maybe more.
两年，也许更多。
By now your grandson must be 8 or 9.
现在你的孙子一定八九岁了。
With the right login credentials and some basic biographical information — first and last name, an approximate age, a residential state past or present, a relative’s given name — there’s a lot you can find out about a person, even when Google and Facebook turn up little.
有了正确的登录凭据和一些基本的传记信息——名字和姓氏、大致年龄、过去或现在的居住州、亲戚的名字——你就可以找到很多关于一个人的信息，即使谷歌和脸书上的信息很少。
When I decide, finally, that I will look for Sophie this way, through databases I can access through my job as a fact-checker, it takes me no more than sixty seconds to locate where she is living.
当我最终决定以这种方式寻找索菲时，通过我作为事实核查员的工作可以访问的数据库，我只需要不到六十秒就可以找到她住在哪里。
A trail of email addresses with varying domain names (aol.com, comcast.com, yahoo.com) reveals a few of the websites she’s created accounts on: a daily-horoscope generator, a payday-loan provider (cash4thanksgiving.com).
一系列具有不同域名的电子邮件地址（aol.com、comcast.com、yahoo.com）揭示了她创建帐户的一些网站：每日星座运势生成器、发薪日贷款提供商（cash4thanksgiving.com）。
Presumably these sites have lax privacy policies.
据推测，这些网站的隐私政策很宽松。
My heart sinks a little when I think of her needing a payday loan; it suggests her life has not been an easy one.
当我想到她需要发薪日贷款时，我的心有点沉。这表明她的生活并不轻松。