《习、拜握手与“芬太尼”那张牌》（Xi, Biden Handshake and the Fentanyl Card）

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习、拜握手与“芬太尼”那张牌 （Xi, Biden Handshake and the Fentanyl Card）

借着APEC的机会，习近平主席飘洋过海，带着他的红旗防弹车，来到旧金山与拜登第二次握手了。上一次握手时拜登是副总统。快80岁了还坚持工作且有promotion，在美国历史上也是奇迹。

Taking advantage of the APEC opportunity, President Xi Jinping sailed across the ocean, bringing his "Red Flag" armored vehicle to San Francisco to shake hands with Biden for the second time. The last time they shook hands, Biden was the Vice President. Approaching 80 and still holding a job with promotions, he is indeed a “miracle” in American history.

双边会谈4个多小时，涉及很多大事，比如恢复两军高层沟通、台湾问题、乌克兰问题、哈马斯问题等等。说实话这些我都不太关心，这些事情该怎样就怎样，不是两人握个手就有什么改变的。

The bilateral talks lasted for more than four hours, covering many major issues such as restoring high-level military communication, the Taiwan issue, the Ukraine issue, the Hamas issue, and more. To be honest, I'm not very concerned about these matters; they will unfold as they will, and a handshake won't necessarily bring about any changes.

然而在他们的交流中，却涉及了一桩“小事”，即芬太尼问题。其实这个问题对美国是个大问题，它是目前导致美国中、青年死亡的首要因素，而且愈演愈烈。我希望在这次见面以后，根据习主席的承诺，在未来的N年，事情能够好起来。

However, in their exchange, a "small matter" was involved: the fentanyl issue. In fact, this problem is a significant one for the United States. It is currently the leading cause of death among middle-aged and young Americans and is escalating. I hope that after this meeting, according to President Xi's commitment, things can improve in the coming years.

什么是芬太尼  What is Fentanyl?

芬太尼（Fentanyl）是一种强效的阿片类（opioids）止痛剂，它比吗啡效力高百倍。芬太尼于1960年代研发出来，很快成为医学中使用最广泛的合成阿片类药物。【注：阿片类（opioids）与鸦片（opium）在含义上是有一些区别的。鸦片是从罂粟果实里提取的生物碱的混合物，可镇痛，有成瘾性。而阿片是一大类合成或半合成的，具有类似生物活性的化合物，包括芬太尼。Opioids一般比opium效力要强得多。】

Fentanyl is a potent opioid analgesic, about 100 times more powerful than morphine. Developed in the 1960s, it quickly became the most widely used synthetic opioid in medicine. [Note: There is a distinction between opioids and opium. Opium is a mixture of alkaloids extracted from poppy fruit and has analgesic and addictive properties. Opioids encompass a broader category of synthetic or semi-synthetic compounds, including fentanyl, and are generally more potent than opium.]

可能有人会问，不是已经有布诺芬、泰诺、利多卡因等镇痛剂吗？为什么还要使用阿片镇痛剂呢？主要原因是，虽然布诺芬之类对于头疼脑热或一般局部疼痛有不错的镇痛效果，但对于因外伤、手术和晚期癌症等导致的剧烈疼痛，这些弱镇痛剂就不行了，还需要依靠阿片类强镇痛剂，如吗啡（Morphine）、杜冷丁（Demerol）、羟考酮（Oxycodone）等，当然也包括芬太尼。简单而言，芬太尼传统上是作为强镇痛剂在临床上使用的。

Some may wonder, with pain relievers like ibuprofen, acetaminophen, lidocaine, etc., why use opioid analgesics? The main reason is that while drugs like ibuprofen are effective for headaches, fever, or general localized pain, they are not sufficient for severe pain resulting from injuries, surgeries, late-stage cancer, etc. For such intense pain, opioid analgesics like morphine, meperidine (Demerol), oxycodone (OxyContin), and fentanyl are needed. In short, fentanyl is used clinically as a powerful analgesic.

上述这些强镇痛剂是通过它们在脑的神经细胞上的三种受体，即μ型、δ型和k型受体起作用的。不幸的是，这几种受体被激动，既是产生强镇痛的条件，又与产生依赖性有密切的关系，所以这些药物也都是控制药物。由于成瘾性这个巨大的缺点，发现不带成瘾性的强镇痛剂就成了药物研发的一个重要课题。美国国立健康研究院NIH在几年前也开始了一个PSPP计划，试图有所发现，但目前来看困难极大。有些学者甚至认为，将与成瘾有关的阿片受体与强镇痛效果分开是行不通的。

Opioid analgesics act on three receptors in the brain's nerve cells (neurons): μ-type, δ-type, and κ-type receptors. Unfortunately, these receptors, when activated, not only produce strong analgesia but also have a close relationship with the development of dependence. Therefore, these drugs are controlled substances. Due to the significant drawback of addiction, developing non-addictive analgesics has become an important topic in drug research. The National Institutes of Health (NIH) in the United States started a PSPP program a few years ago, attempting to make breakthroughs, but it seems very challenging. Some scholars even believe that separating opioid receptors associated with addiction from the analgesic effect is not feasible.

芬太尼为什么杀人  Why is Fentanyl Deadly?

瘾君子服用各种违禁药物，但大多数的死亡都是因服用阿片类药物所致。即使在医疗上作为镇痛药，如果使用不当，也会出现过服（overdose），严重者会导致死亡。而其他种类的毒品，如可卡因（Cocaine）、冰毒（甲基苯丙胺，Methamphetamine）、氯胺酮（Ketamine）等致死较少，这是为什么呢？

While drug addicts use various illicit substances, most deaths are caused by opioid use. Even in medical settings as pain relievers, improper use can lead to overdose, with severe cases resulting in death. Other types of drugs, such as cocaine, methamphetamine, ketamine, etc., are less likely to cause death. Why is that?

原来，阿片受体，特别是k受体在下丘脑呼吸中枢广泛分布。如果过服，就会导致呼吸抑制。特别重要的是，阿片受体都具有很明显的“耐受”的特性。当反复服用阿片类药物时，受体的敏感性会下降。这时候，同样剂量的阿片类药物就不那么“有劲”，不能产生相同的镇痛效果或愉悦感了。 这就叫做药物耐受性（tolerance）。 阿片类药物的耐受性驱使使用者增加剂量，这样他们才能保持镇痛效果或愉悦感。但如果增加太多，就会因过量导致呼吸衰竭。

Opioid receptors, especially the κ receptors, are widely distributed in the brain's respiratory center in hypothalamus. Overdosing can lead to respiratory failure. Importantly, opioid receptors exhibit clear "tolerance." When opioids are repeatedly used, the receptors become less sensitive. At this point, the same dose of opioids is not as effective, failing to produce the same analgesic or euphoric effects. This phenomenon is known as drug tolerance. The tolerance drives users to increase the dosage to maintain the analgesic or euphoric effects. However, excessive dosage can lead to respiratory failure and, ultimately, death.

另一个特别重要的致死原因是，瘾君子因故停服了一段时间（比如因为想戒断、阿片类药物断供了或者没钱买了），一段时间以后再服。可是他们不懂，在停服以后，受体的敏感性会逐渐恢复。如果他们恢复用药时使用的剂量，是上次他们停止之前的剂量，那么，因为受体敏感性已经恢复，该剂量就大大过量了，很可能立刻导致呼吸中枢衰竭而死亡。这就是为什么阿片类药物对瘾君子非常危险。

Another crucial reason for fatalities is when drug users stop using for a period (e.g., for detox, lack of opioid supply, or lack of funds) and then resume use. They may not be aware that after discontinuation, the sensitivity of the receptors gradually recovers. If they resume using the same dosage as before, the dosage becomes significantly excessive due to the restored receptor sensitivity, potentially causing immediate respiratory failure and death. This is why opioid drugs are particularly dangerous for addicts.

美国最近10年的芬太尼之殇  The Fentanyl Tragedy in the Last 10 Years in the U.S.

美国的毒品（各种类型）的泛滥历史很长，反映美国社会自身的问题，这个此处不赘述。而美国对于疼痛又有一种“镇痛文化”。所谓“镇痛文化”，是说的当病人出现疼痛时，倾向于使用药物控制，保证基本的生活质量，而不是忍耐。然而，医源性广泛使用阿片类药物镇痛（特别是长期使用），不免使得少数病人成为瘾君子。另外，在本世纪以前，药厂为了赚钱，有淡化合成类阿片药物成瘾性的问题，FDA的监管曾经也不够严格。但这些问题，大约从本世纪开始有了比较大的改观，这些年，医源性药物滥用，特别是因此导致的死亡并没有明显增加。

The history of drug abuse in the United States, across various types, reflects the country's societal issues, which will not be elaborated on here. The U.S. also has a "pain culture" wherein both patients and healthcare providers tend to use medications to control pain, ensuring basic quality of life rather than enduring it. However, the widespread use of opioid analgesics, especially for prolonged periods, has led to a minority of patients becoming addicts. Additionally, until the early 21st century, pharmaceutical companies downplayed the addictive nature of synthetic opioids, and the FDA was not stringent enough in regulating them. However, these issues have seen significant changes in recent years. Although there is still misuse, opioid-related deaths relevant to medical use have not increased significantly.

然而，大约从10年前的2013年开始，过量服用（overdose）阿片类药物导致的死亡的案例直线上升，2015年超过5万（超过交通事故或枪杀死亡人数），2017年超过7万，2020年超过9万，2022年达到11万。这些非正常死亡大都数跟医生开药镇痛无关。而且，与新冠不同，这些药物过服的死亡者，主要是年轻人，很多是美国“铁锈带”中小城镇的年轻人。这些地方，本是美国产业的重要组成部分。但全球化使得这些地方衰败、破落，年轻人很多失去了工作，用药物来填补精神空虚。

However, starting around 10 years ago in 2013, the number of deaths due to the overdose of opioid drugs has been steadily increasing. In 2015, it exceeded 50,000, surpassing the number of deaths from traffic accidents or gun violence. In 2017, it exceeded 70,000, and by 2020, it had surpassed 90,000. In 2022, it reached 110,000. Most of these abnormal deaths are not related to prescribed pain medication. Unlike COVID-19, the victims of overdosing on these drugs are primarily young people, many of whom come from small towns in the "Rust Belt" of the United States. These places were once vital components of the American industry. However, globalization has led to their decline, and many young people in these areas have lost their jobs, resorting to drugs to fill the void in their lives.

下面这条曲线是减去其他药物，专门显示合成类阿片（主要是芬太尼）每年导致的死亡人数，从中可以看到最近10年死亡人数如火箭式上升。这些案例几乎完全与医疗无关，药物全部从黑市上获得。现在，美国每年因芬太尼死亡8万多鲜活的生命，而且还在加速上升，这是美国的不能承受之重。多年以前，美国就说这是“芬太尼危机”（Fentanyl crisis），一定要尽快解决，可是从图上看，除了2017-2019这三年稍显希望外，其他年份的情况令人沮丧。因为芬太尼问题不是美国自己能解决得了的。

The curve below subtracts deaths caused by other drugs and specifically shows the annual number of deaths caused by synthetic opioids, mainly fentanyl. From it, we can observe a skyrocketing trend in the number of deaths over the past decade. These cases are almost entirely unrelated to medical treatment, as the drugs are obtained entirely from the black market. Currently, more than 80,000 lives are lost each year in the United States due to fentanyl, and this number is still rapidly increasing. It has become an unbearable burden for the United States. Many years ago, the U.S. referred to this as the "Fentanyl crisis" and emphasized the need for urgent resolution. However, looking at the graph, apart from a slight improvement in the years 2017-2019, the situation in other years is disheartening. The fentanyl problem is not something the United States can solve on its own.

伤天害理的买卖  The Lawless and Immoral Trade

大量流入美国的芬太尼绝大部分直接或间接来自中国。芬太尼是全人工合成阿片，工艺成熟，原料药（前体化合物）容易得到，成本很低。而且芬太尼可以口服，不需要像海洛因或吗啡那样注射，对“消费者”也方便。而在相当长的一段时间里，中国没有针对相关问题的立法。于是，合成芬太尼成了挣钱的行业，很多民营化工厂都做。中国生产的“物美价廉”的芬太尼开始飘洋过海 。比如在2016-2017年，美国执法部门从国际邮件中查获的芬太尼中，97%来自中国。

The majority of the fentanyl flowing into the United States comes directly or indirectly from China. Fentanyl is a fully synthetic opioid with mature technology, easily obtainable precursor chemicals, and low production costs. Moreover, fentanyl can be taken orally, eliminating the need for injection like heroin or morphine, making it convenient for "consumers." For a considerable period, China had no legislation specifically targeting these drugs. As a result, the production of fentanyl became a lucrative industry, with many private chemical factories involved. China's "affordable" fentanyl products were shipped across the ocean. For example, 97% of fentanyl seized from international mail to the U.S. originated from China in 2016-2017.

在2018年以前，从美国毒贩从中国诸多网站直接邮购芬太尼达到令人发指的程度。美国毒贩可以在网上轻松下单，中国公斤级的芬太尼直接快递到美国。比如，杭州有一个网站叫“维库”（Weiku.com），上面有近百家公司销售芬太尼。每磅有的才一、两千美元，如此的白菜价（加上芬太尼的极高药力），即使流通的每个环节都挣大钱，到“消费者”手上，每剂仍然可以便宜到1美元，这是吸食海洛因、可卡因等不可想象的，所以买不起麦当劳的瘾君子也用得起芬太尼。

Before 2018, U.S. drug dealers could heinously order fentanyl directly from numerous Chinese websites. They could effortlessly place orders online, and kilograms of fentanyl from China would be sent directly to the U.S. For instance, there was a website in Hangzhou called "Weiku.com," where nearly a hundred companies once sold fentanyl. Each pound cost only one or two thousand dollars, an incredibly low price (combined with fentanyl's high potency). Even with substantial profits at every stage of circulation, the cost to the "consumer" was still low, around $1 per dose. This affordability made fentanyl accessible even to addicts who couldn't afford fast food.

中美的不平坦的合作  Bumpy Cooperation Between China and the U.S.

在早期，美国便敦促中国查办非法生产芬太尼的中国企业，中国反应比较冷淡。芬太尼在中国国内没有滥用的危险，因此中国方面没有太多动力进行监管。特朗普刚任美国总统时，两国有一个比较友好的试探期。期间美国敦促中国在此事上加强力度。于是中国颁布了全面禁止合成阿片类药物的新法律，对国内规模庞大、不受监管的芬太尼行业进行了打击，对美国的死亡人数减少起到了立竿见影的作用。上面两个图中，2017-2019变得平缓就反映了这一点。

Many years ago, the U.S. started to urge China to investigate Chinese companies involved in illegal fentanyl production, but China's response was lukewarm. Fentanyl did not pose a risk of abuse in China, so there was not much motivation on the Chinese side to regulate it. In the early days of Trump's presidency, there was a relatively friendly trial period between the two countries. During this time, the U.S. urged China to intensify efforts on this matter. Consequently, China enacted a new law banning the synthesis of opioid drugs comprehensively, dealing a blow to the unregulated fentanyl industry at home and leading to an immediate reduction in the number of deaths in the U.S. The flattened curves from 2017 to 2019 in the two graphs above reflect this.

然而，中国加大监管的力度像是给美国人情。于是当两国关系出问题的时候，情况便急转直下。像上面那种卓有成效的打击和双边的合作，很快就随着贸易战、美国对中国人权的批评，以及台湾问题而搁浅。于是芬太尼的买卖又活跃起来。

However, China's increased regulation seemed like a favor to the U.S.  When the relationship between the two countries soured due to trade wars, U.S. criticism of China's human rights, and disputes over the Taiwan issue, effective cooperation quickly stalled. Consequently, the fentanyl trade became active again.

此时，由于直接制造和销售芬太尼在中国已属非法，于是中国不法分子挣黑钱的方式又有所改变，他们开始与墨西哥毒枭合作。2019年以来，在大多数情况下，他们将原料药走私到墨西哥，在那里被非法合成后在贩运至美国。结果是阿片类（主要是芬太尼）过服导致的死亡再次急剧上升，2022年达到近11万人（包括少量医源性）。

Now, since direct manufacturing and export of fentanyl are illegal in China, illegal elements found alternative ways to profit. They began cooperating with Mexican drug cartels. Since 2019, in most cases, they smuggled precursor chemicals to Mexico, where they were illegally synthesized and then trafficked to the U.S. The result has been a sharp increase in deaths due to opioid overdose (mainly fentanyl), reaching nearly 110,000 in 2022, including a small number of medically sourced cases.

2023年夏天的时候，两国在这个问题上的合作前景极为暗淡。当时布林肯主持了一个84个国家参加的视频会议，希望多国一同向中国施压，要求其采取更强有力的措施遏制用于制造芬太尼的原料药流向他国。随后，美国联邦检察官宣布起诉四家中国企业，指控它们非法贩运化学品，经墨西哥贩毒集团，制造大量销往美国的芬太尼，美国的一些议员也强烈谴责中国不负责任。

As of the summer of 2023, the prospects for cooperation between the two countries on this issue are bleak. In July, Secretary of State Blinken chaired a video conference with 84 countries, hoping to pressure China collectively to take stronger measures to curb the flow of precursor chemicals used to manufacture fentanyl to other countries. Subsequently, U.S. federal prosecutors announced the indictment of four Chinese companies, accusing them of illegally trafficking chemicals, which were then used by Mexican drug trafficking groups to manufacture large quantities of fentanyl destined for the U.S. Some U.S. lawmakers also strongly criticized China on this issue, accusing it of irresponsibility.

对此，“中国不吃那一套”。比如7月27日《人民日报》就发表社论说：“在禁毒问题上，美方必须正视自身问题，不能讳疾忌医。攻击抹黑中国治不了美国国内毒品泛滥的痼疾。” 一段时间里，国内媒体猛烈抨击美国，指责美国将自身社会问题归咎于中国，弄得国内尽人皆知。在我给国内父母打电话时，他们就问我芬太尼是怎么回时，为什么美国人吸毒怪中国。

In response, "China does not buy it." For example, on July 27, the People's Daily published an editorial stating, "On the issue of drug control, the U.S. must face its own problems and not shy away from them. Attacking and smearing China cannot cure the chronic disease of drug abuse in the U.S." For a while, domestic media fiercely countered U.S. accusations, blaming the U.S. for attributing its social problems to China, making it widely known domestically. When I called my parents in China, they asked me about fentanyl and why Americans blame China for drug addiction.

筹码与回报  Chips and Returns

时间刚过去三个月，两国的关系出人意料地回暖了。双方都感到，冷淡与对抗不是最好的选择。于是习、拜怀着各自的愿望又握手了。正可谓“国与国之间没有永远的朋友，也没有永远的敌人，只有永远的利益。”这句话被很多人看得很不堪。其实，照顾利益未必丧失原则，特别是基本的道义原则。在这方面，我对美国有信心。

Just over the past three months, the relations between the two countries unexpectedly warmed. Both sides felt that coldness and confrontation were not their best interests. So, Xi and Biden shook hands again, each harboring their own wishes. It is indeed true that "nations have no permanent friendship or hostility, only permanent interests." Many find this saying distasteful. However, taking care of interests does not necessarily mean sacrificing basic moral principles. In this regard, I have confidence in the United States.

就芬太尼这件事情来讲，生产、出口芬太尼都不是中国政府所为，同时它也没有把药往美国人嘴里喂。而且中国纸面上的立法已经完成。因此，中国可以说它是很干净的。芬太尼问题可以当作一个筹码。究竟花多大力帮助美国解决芬太尼问题，取决于获得什么样的回报，包括在自己感兴趣的领域迫使美国让步，或者要求美国在一些地方不再给中国共产党难堪。

Regarding the fentanyl issue, neither the Chinese government advocates the production and export of fentanyl, nor does it force the drug into the mouths of Americans. Moreover, China has completed legislation on paper. Therefore, the Chinese government can claim to be clean. The fentanyl issue can be used by the Chinese government as leverage. How much effort China will put into helping the U.S. solve the fentanyl problem depends on the returns it gets, including compelling the U.S. to make concessions in areas of interest to China or requesting the U.S. not to embarrass the Chinese Communist Party in certain matters.

前天（16日），美国政府将中国公安部物证鉴定中心从商务部贸易制裁名单上移除。该机构于2020年被美国列入贸易制裁名单，因其涉嫌侵害维吾尔族人，中国一直对此相当不满。与此同时，中国国家禁毒委员会针对可用于制造毒品的物质，对有关行业的生产和销售发出警告。中国官方同时称不要拘泥于外国执法机构“长臂管辖”之中。它嘴上总要说，是我主动要做的，不是因为你的原因。

Two days ago (November 16th), the U.S. government removed the Chinese Ministry of Public Security's Forensic Identification Center from the Department of Commerce's trade sanctions list. The institution was listed in 2020 for allegedly violating the rights of the Uighur people, and China has been quite unhappy about it. Simultaneously, the China National Narcotics Control Commission issued a warning to domestic industries related to the production and sale of substances that could be used to manufacture drugs. Chinese officials also stated that they should not be confined to the "long-arm jurisdiction" of foreign law enforcement agencies. The official stance is that China took the initiative and did not act because of external pressure.

有趣的是，拜登继续称习近平是“独裁者”（dictator）。这虽然带有一点贬义，但也不那么坏，就是说定于一尊嘛，是习自己说的。这个定于一尊的系统有一个特殊的优点，就是在老大的管辖之下，如果他真想让某一种人的行为停止（病毒他可能力不从心），他一定能做到。一两年以后，美国这边的数据，会告诉我们究竟做得怎么样。

Interestingly, Biden continues to refer to Xi Jinping as a "dictator." Although this term carries some negative connotations, it's not that bad; it essentially means "holding supreme power," as Xi himself stated. An advantage of such a system of holding-supreme-power is that, under the leader's jurisdiction, if he truly wants to stop certain behaviors (although he may be powerless against a virus), he can certainly achieve it. One or two years later, data from the U.S. will tell us how well he has done.

这次会谈的场所是旧金山一个婚礼会馆。不知道汪洋同志对此有什么新的说辞。据报道，在双边会谈的间隙，习、拜两人到院子里去散了一会儿步，不带翻译。于是大家都好奇是如何交流的。要我看，如果心有灵犀，眼神就差不多了；如果鸡同鸭讲，后面跟着八个翻译也白搭。

The meeting took place at a wedding hall in San Francisco. I wonder if Wang Yang has any new rhetoric on this. According to reports, during the bilateral talks, Xi and Biden took a walk in the yard during the break, without a translator. So everyone is curious about how the two communicated. In my opinion, if they have “mind-meld” with each other, eye contact is probably enough; on the other hand, if they are like a chicken and a duck being stuffed into a cage, then even with eight translators, it's futile.

[manually edited from ChatGPT translation.]

 

【图片来自网上。】