從鴉片、安非他命、愷他命到依托咪酯──由大歷史談管制藥品與毒品的區隔與管理趨勢

From Opium, Amphetamines, Ketamine to Etomidate−The Differentiation and Management Trend of Controlled Drugs and Illegal Narcotics from the Perspective of Macrohistory

本研究以大歷史觀的視角，重新檢視成癮物質使用與管理的歷史演變。藉由從回顧中古時期至今，各類成癮性物質（如鴉片、大麻、古柯、影響精神物質及新興影響精神物質等）在不同文化與時代下的角色轉變。本文指出成癮行為與政策並非單純的醫療或法律兩極化框架問題，而是會隨著時間變化，也牽涉文化與社會習俗、經濟、宗教、國際關係等面向的綜合性現象。本文進一步探討聯合國三大反毒公約的演進背景、目的與限制，在面對新興影響精神物質（新興毒品）與藥物多元使用的挑戰當下，也藉由鴉片、安非他命、愷他命和依托咪酯等四項成癮物質，分別代表臺灣物質濫用流行的四個時期，所得到的經驗與教訓，建議臺灣未來對成癮物質的管理，宜採取以公共衛生與人性尊嚴為本的政策導向進行風險評估與管理；對新興菸品與新興影響精神物質合流導致的負面健康影響宜加注意；應避免重蹈由藥廠或研究室流用的覆轍；並主張法令應與時俱進，以即時因應新興成癮物質可能造成的複雜危害。

This study re-examines the evolution of addictive substance use and management from the perspective of macrohistory. By looking back at the changing roles of various addictive substances (e.g. opium, marijuana, coca, psychotropic substances and new psychoactive substances) in different cultures and eras from the Middle Ages to the present. This paper argues that addictive behaviors and policies are not simply a matter of medical or legal polarization, but a comprehensive phenomenon that changes over time and involves cultural and social customs, economics, religion, and international relations. In the face of the challenges of new psychoactive substances and polydrug use, and through the experiences and lessons learned from Taiwan’s four periods of substance use epidemic, which are represented by opium, amphetamines, ketamine and etomidate, respectively, this paper suggests that the future management of addictive substances in Taiwan should adopt a policy orientation based on public health and human dignity for risk assessment and management; pay attention to the adverse health effects of the convergence of novel and emerging nicotine and tobacco products and new psychoactive substances; avoid repeating the mistakes of drug diversion from pharmaceutical companies or laboratories to illegal purposes; and advocate that the law should keep pace with the times in order to respond to the complex harms that may be caused by emerging addictive substances.