Travis Rieder: The agony of opioid withdrawal -- and what doctors should tell patients about it
Travis Rieder: A agonía da abstinencia aos opioides, e o que os médicos nos deberían contar.
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.
que me cambiou a vida.
I nearly lost my foot
surgeon's office
oxycodone," I responded.
this information to many doctors
a varios doutores,
about getting off the meds now."
that anyone had expressed concern.
que alguén se preocupou.
real conversation I'd had
a primeira conversa que tiven
my entire experience of medical trauma.
foi un verdadeiro trauma.
de dose moi agresiva,
is a much too aggressive tapering regimen,
a miña medicación en catro tomas,
my medication into four doses,
over the course of the month.
no transcurso dun mes.
into acute opioid withdrawal.
unha crise de abstinencia a opioides.
feel a lot like a bad case of the flu.
in my rather mangled foot;
doíame cada vez máis.
due to a general feeling of restlessness.
xa que me atopaba inquedo.
what was coming.
seemed to go haywire.
into the hot August sun,
ao quente sol de agosto,
covered in goosebumps.
sleep difficult during that first week
durante a primeira semana
as the withdrawal feeling.
sensación de abstinencia.
that would keep me twitching.
que me provocaba constantes espasmos,
disturbing was the crying.
like a neural misfire,
and she called the prescribing doctor
lots of fluids for the nausea.
moito líquido contra as náuseas.
"You know, he's really quite badly off,"
"Atópase moi mal"
"Well, if it's that bad,
previous dose for a little while."
a medicación durante unha tempada"
á miña dose anterior
to go back on my previous dose
coa síndrome de abstinencia de novo.
it through the withdrawal next time.
and dropped another dose.
e baixamos outra dose.
that would keep me writhing all night.
que me tiña retorcéndome toda a noite.
like a misfire before
un mal funcionamento,
I would get that welling in my chest
esa presión no meu peito
estaban a chegar,
desperation and hopelessness.
e a desesperanza.
that I would never recover
nin da síndrome de abstinencia.
or from the withdrawal.
with the prescriber
that we contact our pain management team
que contactásemos coa unidade de dor
when nobody would speak with us.
nos quixese atender.
the phone advised us
a chamada informounos
provides an inpatient service;
só trata a doentes hospitalizados.
para controlar a dor
to get pain under control,
nin abstinencias.
tapering and withdrawal.
and begged him for anything --
e suplicámoslle por calquera cousa...
que Travis volva á medicación,
is that Travis go back on the medication
para reducirlle a dose.
more competent to wean him off."
to go back on the medication.
myself from the withdrawal with the drugs
pasar pola abstinencia
without prescription opioids
como era a vida sen opioides
didn't kill me outright,
standing up here years later,
with virtually no sleep,
on the floor of our basement bathroom.
tirado no chan do baño.
my feverish head
ás baldosas para baixar a febre
despite not having eaten anything in days.
nos últimos días.
at the end of the night
and general practitioners --
a médicos de familia.
would help me.
speak with on the phone
said that they prescribe opioids
díxonos que prescribían opioides
a redución ou a abstinencia.
tapering or withdrawal.
was clearly coming through my voice,
podía ouvirse na miña voz,
took a deep breath and said,
sexa un centro de desintoxicación
what you need is a rehab facility
así que seguín o seu consello,
so I took her advice.
calling those places,
loitando coa súa adicción a substancias.
long-term substance use disorder.
weaning the patient off the medication,
que os deixen,
onto the safer, longer-acting opioids:
máis seguros a longo prazo:
for maintenance treatment.
o tratamento de mantemento.
had an extensive waiting list.
tiñan unha longa lista de espera.
they were designed to see.
que están acostumados a tratar.
from a rehab facility,
polos centros de desintoxicación
going back on the medication.
the lowest dose possible,
as I absolutely needed
effects of the withdrawal.
da abstinencia.
I actually went to bed.
prescription bottle,
had abated dramatically.
case desapareceran.
that was my response, too.
just a little bit.
precisely because I'm not special;
porque non son especial,
to me was all that unique.
was entirely predictable
era totalmente predicible
for which I was prescribed it.
response to an opioid-rich environment
do cerebro a un medio rico en opioides.
que ía precisar
to think that from the beginning,
well-formed tapering plan,
seemingly hasn't decided
sistema sanitario aínda non decidiu
de pacientes coma min.
un paciente complexo
as a complex patient
para o control da analxesia.
as getting pain under control
a súa función era controlar a dor
get off the medication,
de especialistas en adiccións.
of addiction medicine.
from long-term substance use disorder.
longa historia de abuso de substancias.
that needed long-term management
que precisaba unha prolongada supervisión
whose job such management was.
and worth talking about --
is a particular concern
na actualidade nos EE. UU.
no medio dunha epidemia
from overdose in 2015.
por sobredose.
involved prescription opioids.
debéronse a opioides receitados.
started to react to this crisis,
a actuar contra esta crise
trying to prescribe fewer pills --
en prescribir menos pílulas.
that's going to be important.
we're now gaining evidence
often prescribe medication
a miúdo prescriben fármacos
much more than is needed.
help to explain why America,
por que os EE. UU.,
of the global population,
of the total global opioid supply.
dos opioides.
on the rate of prescribing
na porcentaxe de prescrición
two crucially important points.
dous feitos importantes.
important pain therapies.
para o tratamento da dor.
severe, real, long-lasting pain,
real e constante,
can make life worth living.
que pague a pena vivir.
while judiciously prescribing opioids
sen deixar de receitar opioides
manage the pills that they do prescribe.
todo o que prescriban.
that I was given.
knows that that is too aggressive?
saiba o potentes que son?
in an academic journal,
nunha revista científica,
their pocket guide for tapering opioids.
para a redución gradual de opioides.
how to taper opioids in the easier cases,
a dose nos casos máis sinxelos
than a 10 percent dose reduction per week.
superior ao 10 % por semana.
instead of a few weeks.
en meses, en vez de en semanas.
pretty uncomfortable,
the kind of information
this medication ought to have.
que prescriba opioides.
prescribed opioids
o manexo axeitado dos opioides
is far bigger than that,
é máis grande que iso.
for tens of thousands of deaths a year,
de decenas de miles de mortes
of that medication is indefensible.
to get off the medication
to our epidemic,
á nosa epidemia,
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