Travis Rieder: The agony of opioid withdrawal -- and what doctors should tell patients about it
Travis Rieder: A agonia da abstinência de opioides - e o que os médicos devem dizer aos pacientes sobre isso
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.
você está tomando?"
that changed my life.
que mudou minha vida.
I nearly lost my foot
de quase perder meu pé
surgeon's office
do meu cirurgião ortopédico
fizemos alguns cálculos.
oxycodone," I responded.
de oxicodona", respondi.
this information to many doctors
essa informação para muitos médicos
about getting off the meds now."
com os remédios agora".
que alguém expressou preocupação.
that anyone had expressed concern.
real conversation I'd had
conversa real que eu tive
my entire experience of medical trauma.
toda a minha experiência de trauma médico.
is a much too aggressive tapering regimen,
um tratamento muito agressivo,
my medication into four doses,
minha medicação em quatro doses,
over the course of the month.
into acute opioid withdrawal.
numa abstinência aguda de opioides.
feel a lot like a bad case of the flu.
parecem muito com um caso grave de gripe.
in my rather mangled foot;
due to a general feeling of restlessness.
a um sentimento geral de inquietação.
what was coming.
o que estava por vir.
minha vida ficou muito pior.
seemed to go haywire.
into the hot August sun,
sair para o sol quente de agosto,
covered in goosebumps.
sleep difficult during that first week
durante a primeira semana
as the withdrawal feeling.
que era o sentimento de abstinência.
that would keep me twitching.
de perturbação que me fazia me contorcer.
disturbing was the crying.
like a neural misfire,
and she called the prescribing doctor
para o médico que prescreveu os opioides,
lots of fluids for the nausea.
recomendou líquidos para a náusea.
"You know, he's really quite badly off,"
"Você sabe, ele está muito mal",
"Bem, se está tão ruim assim,
"Well, if it's that bad,
previous dose for a little while."
anterior por um tempo".
to go back on my previous dose
para a minha dose anterior,
it through the withdrawal next time.
para a abstinência na próxima vez.
and dropped another dose.
para enfrentar e reduzir outra dose.
that would keep me writhing all night.
me contorcer a noite toda.
like a misfire before
agora pareciam significativas.
I would get that welling in my chest
sentia um aperto no peito
desperation and hopelessness.
that I would never recover
que nunca iria me recuperar
or from the withdrawal.
with the prescriber
a equipe de gerenciamento de dor
that we contact our pain management team
então o fizemos imediatamente,
when nobody would speak with us.
quando ninguém falou conosco.
the phone advised us
o telefone nos informou
provides an inpatient service;
fornece um serviço de internação;
to get pain under control,
para controlar a dor,
a redução e a abstinência.
tapering and withdrawal.
and begged him for anything --
e imploramos por qualquer coisa;
mas em vez disso ele pediu desculpas,
is that Travis go back on the medication
é que Travis volte com a medicação
more competent to wean him off."
mais competente para ajudá-lo".
to go back on the medication.
myself from the withdrawal with the drugs
da abstinência das drogas,
without prescription opioids
a vida sem a prescrição de opioides
didn't kill me outright,
standing up here years later,
with virtually no sleep,
praticamente sem dormir,
on the floor of our basement bathroom.
no chão do banheiro do porão.
my feverish head
minha cabeça febril
despite not having eaten anything in days.
apesar de não ter comido nada em dias.
at the end of the night
no fim dessa noite, ela ficou horrorizada,
and general practitioners --
médicos de dor e clínicos gerais;
would help me.
speak with on the phone
falar ao telefone
said that they prescribe opioids
de dor disse que eles prescrevem opioides,
tapering or withdrawal.
a redução ou a abstinência.
was clearly coming through my voice,
transparecendo na minha voz,
took a deep breath and said,
what you need is a rehab facility
de uma clínica de reabilitação
então aceitei o conselho dela.
so I took her advice.
para esses lugares,
calling those places,
desses estabelecimentos
long-term substance use disorder.
o uso de substâncias a longo prazo.
weaning the patient off the medication,
em não desabituar o paciente da medicação,
onto the safer, longer-acting opioids:
mais seguros e de ação prolongada:
for maintenance treatment.
para o tratamento de manutenção.
had an extensive waiting list.
tinham uma extensa lista de espera.
they were designed to see.
que eles foram preparados para atender.
from a rehab facility,
por uma clínica de reabilitação,
going back on the medication.
que voltaria à medicação.
the lowest dose possible,
as I absolutely needed
o absolutamente necessário
effects of the withdrawal.
mais terríveis da abstinência.
a subir as escadas
I actually went to bed.
eu realmente fui para a cama.
prescription bottle,
tinham diminuído drasticamente.
had abated dramatically.
that was my response, too.
just a little bit.
me recompor um pouquinho.
precisely because I'm not special;
exatamente porque não sou especial,
to me was all that unique.
comigo foi inédito.
was entirely predictable
era totalmente previsível,
for which I was prescribed it.
response to an opioid-rich environment
do cérebro a um ambiente rico em opioides
to think that from the beginning,
para pensar, desde o começo,
well-formed tapering plan,
supervisionado e bem-estruturado,
seemingly hasn't decided
aparentemente não determinou
as a complex patient
como um paciente complexo,
provavelmente da medicina da dor.
as getting pain under control
o trabalho deles era mantê-la sob controle
get off the medication,
me viram como objeto da medicina do vício.
of addiction medicine.
é enfatizada demais
from long-term substance use disorder.
de substâncias a longo prazo.
that needed long-term management
que precisava de controle a longo prazo
whose job such management was.
quem devia fazer esse controle.
and worth talking about --
interessante e valeria a pena falar;
is a particular concern
é uma preocupação particular
from overdose in 2015.
morreram de overdose em 2015.
involved prescription opioids.
envolveu opioides prescritos.
started to react to this crisis,
começou a reagir a essa crise,
trying to prescribe fewer pills --
tentar prescrever menos comprimidos;
that's going to be important.
we're now gaining evidence
often prescribe medication
prescrevem medicamentos
much more than is needed.
muito mais do que o necessário.
help to explain why America,
ajudam a explicar por que os EUA,
of the global population,
apenas 5% da população global,
of the total global opioid supply.
do suprimento global de opioides.
on the rate of prescribing
two crucially important points.
dois pontos crucialmente importantes.
important pain therapies.
importantes para a dor.
severe, real, long-lasting pain,
uma dor severa, real e duradoura,
can make life worth living.
podem fazer a vida valer a pena.
while judiciously prescribing opioids
prescrevendo opioides criteriosamente
manage the pills that they do prescribe.
adequadamente as pílulas que prescrevem.
that I was given.
que me foi sugerida.
knows that that is too aggressive?
saiba que isso é muito agressivo?
in an academic journal,
minha história em um periódico acadêmico,
their pocket guide for tapering opioids.
de bolso para redução de opioides.
e a maior parte dele são fotos.
how to taper opioids in the easier cases,
os opioides nos casos mais fáceis,
than a 10 percent dose reduction per week.
de dose de mais de 10% por semana.
instead of a few weeks.
em vez de algumas semanas.
pretty uncomfortable,
bem desconfortável,
the kind of information
este medicamento deveria ter.
this medication ought to have.
prescribed opioids
adequadamente os opioides prescritos
is far bigger than that,
é muito maior do que isso,
for tens of thousands of deaths a year,
por dezenas de milhares de mortes por ano,
of that medication is indefensible.
dessa medicação é indefensável.
to get off the medication
a parar com a medicação
to our epidemic,
para a nossa 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