Travis Rieder: The agony of opioid withdrawal -- and what doctors should tell patients about it
ترافيس ريدر: عذاب التوقف عن مسكنات الألم الأفيونية وما يجب على الأطباء إخبار المرضى بشأنها.
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.
I nearly lost my foot
surgeon's office
oxycodone," I responded.
من أوكسيكودوني (نوع من مسكّنات الألم )"
this information to many doctors
هذه المعلومة للعديد من الأطباء
من المسكنات الأفيونية
about getting off the meds now."
عن الأدوية الآن."
that anyone had expressed concern.
يُعرب فيها أي شخص عن قلقه.
real conversation I'd had
محادثة حقيقية قمت بها
my entire experience of medical trauma.
تجربتي الكاملة للصدمة الطبية.
is a much too aggressive tapering regimen,
هو نظام فطم تدريجيٍ قاسٍ جداً،
my medication into four doses,
over the course of the month.
into acute opioid withdrawal.
بالانسحاب الأفيوني الحاد.
feel a lot like a bad case of the flu.
إلى حد كبير حالة سيئة من الانفلونزا.
in my rather mangled foot;
due to a general feeling of restlessness.
بسبب إحساس عام بالأرق.
what was coming.
seemed to go haywire.
الداخلي الخاص بي قد تعطل.
بشكل مستمر تقريباً،
into the hot August sun,
للخارج لشمس آب الحارة،
covered in goosebumps.
وقد أصبت بالقشعريرة.
sleep difficult during that first week
بالنوم خلال الأسبوع الأول
as the withdrawal feeling.
أعتقد أنه أعراض الإقلاع.
that would keep me twitching.
يسبب لي الإرتعاش.
disturbing was the crying.
إزعاجاً كان البكاء.
like a neural misfire,
المشاعر كالاختلال العصبي،
and she called the prescribing doctor
الطبيب الخاص بالوصفة الطبية
lots of fluids for the nausea.
الكثير من السوائل من أجل الغثيان.
"You know, he's really quite badly off,"
أن حالته سيئة للغاية،"
"Well, if it's that bad,
previous dose for a little while."
لفترة قصيرة."
to go back on my previous dose
أعود لجرعتي السابقة
it through the withdrawal next time.
أعراض الاقلاع للمرة المقبلة.
and dropped another dose.
that would keep me writhing all night.
كان يجعلني أتقلب طوال الليل.
like a misfire before
أنها بدون سبب من قبل
I would get that welling in my chest
أشعر بهذا التفجر في صدري
desperation and hopelessness.
that I would never recover
or from the withdrawal.
with the prescriber
that we contact our pain management team
مع فريق إدارة الألم
when nobody would speak with us.
the phone advised us
provides an inpatient service;
خدماتهم للمرضى الداخليين.
to get pain under control,
للسيطرة على الألم،
tapering and withdrawal.
and begged him for anything --
في حالة غضب وتوسلنا إليه من أجل أي شيء...
is that Travis go back on the medication
هي أن يعود ترافيس للدواء
more competent to wean him off."
أكثر كفائة لقطعه عنه."
to go back on the medication.
myself from the withdrawal with the drugs
من أعراض الإقلاع الخاصة بالدواء
without prescription opioids
بدون الوصفات الطبية الأفيونية
didn't kill me outright,
standing up here years later,
أن أقف هنا بعد سنوات،
with virtually no sleep,
on the floor of our basement bathroom.
حمام الطابق السفلي.
my feverish head
despite not having eaten anything in days.
رغم أنّي لم آكل شيئاً منذ أيام.
at the end of the night
and general practitioners --
والأطباء الممارسين
would help me.
speak with on the phone
الاتصال بهم
said that they prescribe opioids
قالوا أنهم يصفون مسكنات أفيونية
tapering or withdrawal.
نظام الفطم أو الإقلاع.
was clearly coming through my voice,
took a deep breath and said,
نفساً عميقاً وقالت:
what you need is a rehab facility
إلى منشأة إعادة تأهيل على الأرجح
so I took her advice.
فأخذت بنصيحتها.
calling those places,
الاتصال بتلك الأماكن،
long-term substance use disorder.
تعاطي المخدرات على المدى الطويل.
weaning the patient off the medication,
عدم فطم المريض عن الدواء،
onto the safer, longer-acting opioids:
آمنه وأطول فعالية:
for maintenance treatment.
للاستمرار على العلاج.
had an extensive waiting list.
كان لديه قائمة إنتظار ممتدة.
they were designed to see.
الذي يتعاملون معه.
from a rehab facility,
من منشأة إعادة التأهيل،
going back on the medication.
the lowest dose possible,
as I absolutely needed
effects of the withdrawal.
I actually went to bed.
prescription bottle,
الصغيرة البرتقالية،
had abated dramatically.
قد خفت بشكل كبير.
that was my response, too.
هكذا كانت ردة فعلي أيضاً.
just a little bit.
precisely because I'm not special;
to me was all that unique.
was entirely predictable
كان متوقعاً تماماً
for which I was prescribed it.
response to an opioid-rich environment
لبيئة غنية بالمسكنات الأفيونية
to think that from the beginning,
well-formed tapering plan,
خطة تدريجية مهيئة بشكل جيد،
seemingly hasn't decided
لم يقرر على ما يبدو
as a complex patient
as getting pain under control
هي السيطرة على الألم
get off the medication,
of addiction medicine.
from long-term substance use disorder.
تعاطي المخدرات على المدى الطويل.
that needed long-term management
احتاج إلى عناية على المدى الطويل
whose job such management was.
من كانت وظيفته تلك العناية.
and worth talking about --
مثيرة للاهتمام وتستحق الحديث عنها
is a particular concern
عن المسكنات الأفيونية يشكل همٌ استثنائي
from overdose in 2015.
بسبب الجرعات الزائدة في عام 2015.
involved prescription opioids.
شملت متعاطي المسكنات الأفيونية.
started to react to this crisis,
بدأ في الاستجابة لهذه الأزمة،
trying to prescribe fewer pills --
لوصف حبوب أقل ...
that's going to be important.
we're now gaining evidence
نحن الآن لدينا أدلة
often prescribe medication
غالبا ما يصفون دواءً
المسكنات الأفيونية،
much more than is needed.
help to explain why America,
of the global population,
من عدد سكان العالم -
of the total global opioid supply.
المسكنات الأفيونية.
on the rate of prescribing
معدل الوصفات الطبية
two crucially important points.
important pain therapies.
severe, real, long-lasting pain,
can make life worth living.
يمكن أن تجعل الحياة تستحق العيش.
while judiciously prescribing opioids
بوصف المسكنات الأفيونية بحكمة
manage the pills that they do prescribe.
التي يصفونها بشكل صحيح.
that I was given.
knows that that is too aggressive?
يدرك أن ذلك قاسٍ جداً؟
in an academic journal,
في مجلة أكاديمية،
their pocket guide for tapering opioids.
أرسل لي دليلهم لنظام الفطم التدريجي.
how to taper opioids in the easier cases,
تدريج نظام الفطم بأسهل الطرق،
than a 10 percent dose reduction per week.
أكثر من 10 بالمئة أسبوعياً أبداً.
instead of a few weeks.
بدلاً من أسابيع قليلة.
pretty uncomfortable,
the kind of information
this medication ought to have.
يصف الدواء أن يعرفها.
prescribed opioids
للمسكنات الأفيونية الموصوفة
is far bigger than that,
for tens of thousands of deaths a year,
لعشرات الآلاف من الوفيات في كل عام،
of that medication is indefensible.
لا يمكن السكوت عنها.
to get off the medication
ليقلعوا عن الأدوية
to our epidemic,
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