Travis Rieder: The agony of opioid withdrawal -- and what doctors should tell patients about it
特拉维斯 · 里德: 阿片类药物戒断的痛苦——以及医生应该提供给病人的建议
Travis Rieder wants to help find a solution to America’s opioid crisis -- and if that sounds a bit too lofty, he’d settle for making clear, incremental progress in a responsible, evidence-based way. Full bio
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that changed my life.
I nearly lost my foot
oxycodone," I responded.
this information to many doctors
about getting off the meds now."
that anyone had expressed concern.
real conversation I'd had
my entire experience of medical trauma.
is a much too aggressive tapering regimen,
my medication into four doses,
over the course of the month.
into acute opioid withdrawal.
feel a lot like a bad case of the flu.
in my rather mangled foot;
due to a general feeling of restlessness.
what was coming.
seemed to go haywire.
into the hot August sun,
covered in goosebumps.
sleep difficult during that first week
as the withdrawal feeling.
that would keep me twitching.
disturbing was the crying.
like a neural misfire,
and she called the prescribing doctor
lots of fluids for the nausea.
"You know, he's really quite badly off,"
"Well, if it's that bad,
previous dose for a little while."
to go back on my previous dose
it through the withdrawal next time.
and dropped another dose.
that would keep me writhing all night.
like a misfire before
I would get that welling in my chest
desperation and hopelessness.
that I would never recover
or from the withdrawal.
with the prescriber
that we contact our pain management team
when nobody would speak with us.
the phone advised us
provides an inpatient service;
to get pain under control,
tapering and withdrawal.
and begged him for anything --
is that Travis go back on the medication
more competent to wean him off."
to go back on the medication.
myself from the withdrawal with the drugs
without prescription opioids
didn't kill me outright,
standing up here years later,
with virtually no sleep,
on the floor of our basement bathroom.
my feverish head
despite not having eaten anything in days.
at the end of the night
and general practitioners --
would help me.
speak with on the phone
said that they prescribe opioids
tapering or withdrawal.
was clearly coming through my voice,
took a deep breath and said,
what you need is a rehab facility
so I took her advice.
calling those places,
long-term substance use disorder.
weaning the patient off the medication,
onto the safer, longer-acting opioids:
for maintenance treatment.
had an extensive waiting list.
they were designed to see.
from a rehab facility,
going back on the medication.
the lowest dose possible,
as I absolutely needed
effects of the withdrawal.
I actually went to bed.
had abated dramatically.
that was my response, too.
just a little bit.
precisely because I'm not special;
to me was all that unique.
was entirely predictable
for which I was prescribed it.
response to an opioid-rich environment
to think that from the beginning,
well-formed tapering plan,
seemingly hasn't decided
as a complex patient
as getting pain under control
get off the medication,
of addiction medicine.
from long-term substance use disorder.
that needed long-term management
whose job such management was.
and worth talking about --
is a particular concern
from overdose in 2015.
involved prescription opioids.
started to react to this crisis,
trying to prescribe fewer pills --
that's going to be important.
we're now gaining evidence
often prescribe medication
much more than is needed.
help to explain why America,
of the global population,
of the total global opioid supply.
on the rate of prescribing
two crucially important points.
important pain therapies.
severe, real, long-lasting pain,
can make life worth living.
while judiciously prescribing opioids
manage the pills that they do prescribe.
that I was given.
knows that that is too aggressive?
in an academic journal,
their pocket guide for tapering opioids.
how to taper opioids in the easier cases,
than a 10 percent dose reduction per week.
instead of a few weeks.
the kind of information
this medication ought to have.
is far bigger than that,
for tens of thousands of deaths a year,
of that medication is indefensible.
to get off the medication
to our epidemic,
Reviewed by Yuanqing Edberg
ABOUT THE SPEAKERTravis Rieder - Bioethicist
Travis Rieder wants to help find a solution to America’s opioid crisis -- and if that sounds a bit too lofty, he’d settle for making clear, incremental progress in a responsible, evidence-based way.
Why you should listen
A philosopher by training, bioethicist by profession and communicator by passion, Travis Rieder writes and speaks on a variety of ethical and policy issues raised by both prescription and illicit opioid use.
This wasn't always his beat, though. Both in his doctoral training at Georgetown University, and as faculty at Johns Hopkins University’s Berman Institute of Bioethics, Rieder published widely on a variety of topics in philosophy and ethics. His interest in opioids came about suddenly, after a motorcycle accident, when he took too many pills for too long and suddenly found himself with a profound dependency. In the wake of that experience, he became driven to discover why medicine is so bad at dealing with prescription opioids, and how that problem is related to the broader drug overdose epidemic.
Rieder's first article on the topic, in the journal Health Affairs, was one of the most-read essays in 2017 and was excerpted by the Washington Post. Since then, Rieder has co-authored a Special Publication of the National Academy of Medicine on physician responsibility for the opioid epidemic, written several essays for the popular media and spoken widely on the topic to physicians, medical students and the general public. He expands on all of this work in a new book project forthcoming with HarperCollins, tentatively titled In Pain In America.
Travis Rieder | Speaker | TED.com