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Travis Rieder's 'Pain' Tells Of Bioethicist's Lonely Struggle To Quit Opioids
Alone : Shots - Health News When medical bioethicist Travis Rieder tried to
taper off pain medication after a roadway accident, he was disappointed by his
doctors' reaction: "Everybody had a reason to send me to somebody else."


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SHOTS - HEALTH NEWS


MOTORCYCLE CRASH SHOWS BIOETHICIST THE DARK SIDE OF QUITTING OPIOIDS ALONE

   
   
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July 8, 20193:44 PM ET
Heard on Fresh Air



Terry Gross

MOTORCYCLE CRASH SHOWS BIOETHICIST THE DARK SIDE OF QUITTING OPIOIDS ALONE

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Travis Rieder, author of In Pain: A Bioethicist's Personal Struggle With
Opioids, says none of the doctors who prescribed opioids for his waves of
"fiery" or "electrical" pain taught him how to safely taper his use of the drugs
when he wanted to quit. Stockbyte/Getty Images hide caption

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Stockbyte/Getty Images


Travis Rieder, author of In Pain: A Bioethicist's Personal Struggle With
Opioids, says none of the doctors who prescribed opioids for his waves of
"fiery" or "electrical" pain taught him how to safely taper his use of the drugs
when he wanted to quit.

Stockbyte/Getty Images

In 2015, Travis Rieder, a medical bioethicist with Johns Hopkins University's
Berman Institute of Bioethics, was involved in a motorcycle accident that
crushed his left foot. In the months that followed, he underwent six different
surgeries as doctors struggled first to save his foot and then to reconstruct
it.

Rieder says that each surgery brought a new wave of pain, sometimes "searing and
electrical," other times "fiery and shocking." Doctors tried to mitigate the
pain by prescribing large doses of opioids, including morphine, fentanyl,
Dilaudid, oxycodone and OxyContin. But when it came time to taper off the drugs,
Rieder found it nearly impossible to get good advice from any of the clinicians
who had treated him.


SHOTS - HEALTH NEWS


IN MIDST OF OPIOID CRISIS, FDA MAY BLOCK NEW ADDICTION DRUG FROM MARKET

"We called everybody, and a bunch of them wouldn't even talk to me," he says.
"And this includes the pain management team. They would not speak with me, and
the message they sent through a nurse was, 'We prescribe opioids but we don't
help with tapering.' "

Rieder likens his experiences trying to get off prescription pain meds to a game
of hot potato. "The patient is the potato," he says. "Everybody had a reason to
send me to somebody else."



Eventually Rieder was able to wean himself off the drugs, but not before
receiving bad advice and going through intense periods of withdrawal. He shares
his insights as both a patient and a bioethicist in a new book, In Pain: A
Bioethicist's Personal Struggle With Opioids.

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IN PAIN

A Bioethicist's Personal Struggle With Opioids

by Travis Rieder

Hardcover, 297 pages |

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INTERVIEW HIGHLIGHTS

On what happened when he tried tapering opioids after an ill-advised
consultation with a plastic surgeon, who recommended abruptly reducing his
dosage

He didn't know what he was talking about; that wasn't his area of expertise. He
just tried to think of something that was reasonable — and he would eventually
admit this, so this isn't too much editorializing — but we went home and the
next day we dropped the first dose and it immediately sent me into withdrawal.
... It got worse over the first few days, and so we start to get really freaked
out, because I feel like I've got the worst flu I've ever had multiplied by some
order of magnitude. And I'm thinking, I have an entire month of this to get
through. And so [my partner and I] get pretty freaked out.

On why it was so hard to find a doctor to help him taper opioids

I asked myself that question every day, every hour for a very long time. And
once I transitioned from being an opioid patient to being an opioid researcher
the answer I came to was something like "a lot of doctors don't know, so this is
just a knowledge gap." So this is probably the best description of my plastic
surgeon. He just had no idea how to do this. And that's understandable, because
clinicians — doctors — don't get a lot of pain education in medical school. It's
not required — a bunch of them get zero — and, on average, you only get a
handful of hours. So there's a knowledge gap for sure.


SHOTS - HEALTH NEWS


ASPIRING DOCTORS SEEK ADVANCED TRAINING IN ADDICTION MEDICINE

On being sent to an addiction clinic

We called addiction clinics and they very nicely and very gently said, "Boy, you
are not our job. We're dealing with people who might die from a heroin overdose
anytime they get turned away. We're triaging here. You just took too many pain
meds. You just need your prescriber to get you off them."

On the ways in which money plays a role in opioid use

Opioids are dirt cheap, because a bunch of them have been off patent for
decades, and these other sorts of therapies can be really expensive. ... A lot
of what I was supposed to do to help that pain was physical therapy. Physical
therapy stopped getting coverage by my insurance when I turned over the new
year. And I no longer hit my deductible, so it was too expensive. So I stopped.
Because I was a relatively new faculty member — I couldn't afford it. And so I
keep thinking, well, surely a bunch of other people would also struggle to pay
for this.


SHOTS - HEALTH NEWS


ADDICTION TREATMENT GAP IS DRIVING A BLACK MARKET FOR SUBOXONE

So there are all of these different methods for handling pain that they could be
arrows in the quiver of medicine, but they're hard. They get covered less.
They're expensive. And so what do we know about opioids? Well, they're
incredibly cheap. Morphine is a couple cents per dose. And they are easy. You
give them to the patient, the patient feels better immediately. You give pills
to a patient who comes in complaining about pain, they leave happy. So this
really led me to investigate this, like, deep system of perverse incentives that
have pushed us toward just prescribing opioids instead of doing something more
integrative and holistic.



On how opioid dependence is treated as a medical issue, but heroin addiction is
treated as a criminal issue


SHOTS - HEALTH NEWS


OPIOID ADDICTION DRUG GOING MOSTLY TO WHITES, EVEN AS BLACK DEATH RATE RISES

Now we're all very concerned about the opioid epidemic — when there have been
people of color dying from heroin disproportionately for a really long time, and
we just don't talk about it. And we treated them like criminals. That's a
travesty. It's absolutely tragic. It's a stain on our response to drugs in this
country. My story is not the only one that matters. Stories that look like mine
aren't the only ones that matter. People take drugs for a reason. And whether
you started with oxycodone or with heroin, if you were medicating something and
it hurt you, and you ended up dying from overdose, your life matters. And we
need to just kind of announce that loudly every time we have this conversation.

Lauren Krenzel and Seth Kelley produced and edited this interview for broadcast.
Kelley, Bridget Bentz and Deborah Franklin adapted it for the Web.

 * addiction recovery
 * addiction treatment
 * Pain Relief
 * bioethics
 * opioids
 * medical school
 * Doctors

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