Travis Rieder: The agony of opioid withdrawal -- and what doctors should tell patients about it
트레비스 리더(Travis Rieder): 아편유사제 금단현상의 고통과 의사가 환자에게 알려줘야 하는 것
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
Double-click the English transcript below to play the video.
that changed my life.
제 인생을 바꾸어 놓았습니다.
I nearly lost my foot
2달 쯤 지난 후였습니다.
surgeon's office
oxycodone," I responded.
제가 대답했습니다.
this information to many doctors
아무렇지도 않았습니다.
about getting off the meds now."
생각해 보셔야 합니다."
that anyone had expressed concern.
real conversation I'd had
my entire experience of medical trauma.
악몽같은 경험이 되었습니다.
is a much too aggressive tapering regimen,
지나치게 공격적으로 약을 줄였었죠.
my medication into four doses,
over the course of the month.
into acute opioid withdrawal.
금단 증상이 시작되었습니다.
feel a lot like a bad case of the flu.
심한 독감과 비슷했습니다.
in my rather mangled foot;
due to a general feeling of restlessness.
what was coming.
seemed to go haywire.
완전히 고장난 것 같았습니다.
into the hot August sun,
covered in goosebumps.
온 몸에 소름이 돋아 있었죠.
sleep difficult during that first week
잠자기 좀 힘든 정도였는데
as the withdrawal feeling.
느낄 정도였습니다.
that would keep me twitching.
계속 경련이 일어났습니다.
disturbing was the crying.
제 자신을 발견했습니다.
like a neural misfire,
and she called the prescribing doctor
처방 의사에게 전화를 했습니다.
lots of fluids for the nausea.
"메스꺼울 땐 물을 많이 드세요" 라더군요.
"You know, he's really quite badly off,"
"제 남편 상태가 정말 안 좋아요."
"Well, if it's that bad,
잠시 동안 예전 만큼 약을 드세요."
previous dose for a little while."
저는 궁금했습니다.
의사가 대답했습니다.
to go back on my previous dose
돌아갈 수가 없었습니다.
it through the withdrawal next time.
어찌해야 할지 모르는 상태로는요.
and dropped another dose.
일주일에 한 번씩 약을 줄여갔습니다.
that would keep me writhing all night.
like a misfire before
눈물이 나는 것 같더니
I would get that welling in my chest
desperation and hopelessness.
that I would never recover
생각하기 시작했습니다.
or from the withdrawal.
with the prescriber
that we contact our pain management team
만나보라고 하더군요.
when nobody would speak with us.
하지 않아서 충격을 받았습니다.
the phone advised us
provides an inpatient service;
서비스라고 하더군요.
to get pain under control,
처방하기는 해도
tapering and withdrawal.
아무도 감독하지 않습니다.
and begged him for anything --
어떻게든 도와달라고 애걸했습니다.
is that Travis go back on the medication
예전처럼 약을 드시는 겁니다.
more competent to wean him off."
전문적인 사람을 찾을 때까지요."
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,
생각했었습니다.
with virtually no sleep,
on the floor of our basement bathroom.
my feverish head
갖다 대어 식히기도 했다가
despite not having eaten anything in days.
마구 토악질을 하기도 했죠.
at the end of the night
저를 발견하고는 기겁했습니다.
and general practitioners --
would help me.
speak with on the phone
said that they prescribe opioids
처방해 줄 수는 있지만
tapering or withdrawal.
지도할 수 없다고 했습니다.
was clearly coming through my voice,
took a deep breath and said,
what you need is a rehab facility
so I took her advice.
그녀의 조언을 따랐습니다.
calling those places,
long-term substance use disorder.
치료하는 곳이었습니다.
weaning the patient off the medication,
목표로 하지 않고
onto the safer, longer-acting opioids:
넘어가는 것을 목표로 합니다.
for maintenance treatment.
유지 요법으로 사용하죠.
had an extensive waiting list.
대기자가 한 가득이었습니다.
they were designed to see.
대상이 아니었습니다.
from a rehab facility,
going back on the medication.
the lowest dose possible,
as I absolutely needed
effects of the withdrawal.
없애려고 했습니다.
도와 주었고
I actually went to bed.
prescription bottle,
had abated dramatically.
현저히 줄어 있었습니다.
that was my response, too.
just a little bit.
추스릴 시간이 필요하네요.
precisely because I'm not special;
중요한 겁니다.
to me was all that unique.
전혀 특수한 경우가 아닙니다.
was entirely predictable
충분히 예측가능했어요.
for which I was prescribed it.
response to an opioid-rich environment
뇌가 자연히 반응한 것일 뿐이죠.
to think that from the beginning,
생각할 수 있었던 겁니다.
well-formed tapering plan,
환자를 감독해야 한다는 것을 말이죠.
seemingly hasn't decided
결정된 바가 없는 것 같습니다.
책임져야 하는 지조차 말입니다.
as a complex patient
복합적인 환자로 봅니다.
as getting pain under control
그들의 임무라고 생각합니다.
get off the medication,
of addiction medicine.
from long-term substance use disorder.
치료 대상으로 하는 거죠.
that needed long-term management
약물을 처방 받았던 것입니다.
whose job such management was.
재앙을 초래했죠.
and worth talking about --
이야기할 가치가 있습니다.
is a particular concern
특히 주의해야 할 일입니다.
점점 커지고 있거든요.
from overdose in 2015.
3만 3천 명이 사망했습니다.
involved prescription opioids.
관련 있습니다.
started to react to this crisis,
반응하기 시작했습니다.
trying to prescribe fewer pills --
처방하는 것에 그치고 있습니다.
that's going to be important.
we're now gaining evidence
확실한 증거가 있습니다.
often prescribe medication
much more than is needed.
help to explain why America,
of the global population,
of the total global opioid supply.
소비하는지 알 수 있게 됩니다.
on the rate of prescribing
two crucially important points.
간과하게 됩니다.
important pain therapies.
앞으로도 그럴 것입니다.
severe, real, long-lasting pain,
지속적으로 느끼는 사람에게
can make life worth living.
나아지게 만들 것이라 확신합니다.
while judiciously prescribing opioids
확산을 막을 수 있다는 것입니다.
manage the pills that they do prescribe.
적절하게 관리해야 합니다.
that I was given.
누구 하나라도
knows that that is too aggressive?
약을 줄였다는 걸 알았을까요?
in an academic journal,
CDC에서 일하는 어떤 분이
their pocket guide for tapering opioids.
작은 책자를 하나 보내주셨어요.
how to taper opioids in the easier cases,
의사들에게 알려주는 책이었는데
than a 10 percent dose reduction per week.
줄이면 안된다는 것이었습니다.
instead of a few weeks.
약을 줄였겠죠.
pretty uncomfortable,
the kind of information
this medication ought to have.
알아야한다고 생각합니다.
prescribed opioids
is far bigger than that,
그보다 훨씬 심각합니다.
for tens of thousands of deaths a year,
수만 명이 사망한다면
of that medication is indefensible.
변명의 여지가 없을 것입니다.
to get off the medication
그들이 처방받은 약의
to our epidemic,
완벽한 해결책은 아닐 것입니다.
될 것임은 분명합니다.
ABOUT THE SPEAKER
Travis Rieder - BioethicistTravis 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