Travis Rieder: The agony of opioid withdrawal -- and what doctors should tell patients about it
Travis Rieder: Agonia sevrajului în tratamentul cu opioide - și ce ar trebui să le spună medicii pacienților despre aceasta
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.
mi-a schimbat viața.
I nearly lost my foot
mi-am pierdut piciorul
surgeon's office
în cabinetul ortopedului
oxycodone," I responded.
am răspuns.
this information to many doctors
această informație multor doctori
about getting off the meds now."
să renunți la medicație."
tot mai numeroase,
that anyone had expressed concern.
și-a exprimat îngrijorarea.
real conversation I'd had
my entire experience of medical trauma.
toată experiența mea de traume medicale.
is a much too aggressive tapering regimen,
mult prea agresiv,
my medication into four doses,
medicația în patru doze,
over the course of the month.
pe parcursul unei luni.
into acute opioid withdrawal.
într-un sevraj acut.
feel a lot like a bad case of the flu.
sunt ca un caz mai grav de gripă.
in my rather mangled foot;
due to a general feeling of restlessness.
din cauza agitației care mă cuprinsese.
what was coming.
seemed to go haywire.
părea că a luat-o razna.
into the hot August sun,
sub soarele din august,
covered in goosebumps.
sleep difficult during that first week
de somn în prima săptămână
as the withdrawal feeling.
that would keep me twitching.
care mă făcea să tremur
disturbing was the crying.
like a neural misfire,
and she called the prescribing doctor
și l-a sunat pe doctor,
lots of fluids for the nausea.
multe lichide anti-greață.
"You know, he's really quite badly off,"
că nu mă simt bine deloc,
"Well, if it's that bad,
previous dose for a little while."
pentru o vreme."
to go back on my previous dose
la doza anterioară
it through the withdrawal next time.
pentru următoarea fază de sevraj.
and dropped another dose.
și am mai renunțat la o doză.
that would keep me writhing all night.
care mă chinuiau toată noaptea.
like a misfire before
I would get that welling in my chest
simțeam acel izvor în piept
desperation and hopelessness.
de disperare și deznădejde.
that I would never recover
că n-o sa-mi revin niciodată
or from the withdrawal.
with the prescriber
that we contact our pain management team
pe cei care prescriseseră medicația
when nobody would speak with us.
n-a vrut să vorbească cu noi.
the phone advised us
provides an inpatient service;
oferă serviciul de internare;
to get pain under control,
durerea sub control,
tapering and withdrawal.
reducerea lor și sevrajul.
and begged him for anything --
și l-am implorat să-mi dea orice,
is that Travis go back on the medication
să se întoarcă la tratament
more competent to wean him off."
care să-l dezvețe."
to go back on the medication.
să revin la tratament.
myself from the withdrawal with the drugs
prin sevrajul renunțării,
without prescription opioids
cum e fără opiacee,
didn't kill me outright,
standing up here years later,
acum, după atâta timp
with virtually no sleep,
on the floor of our basement bathroom.
pe jos, în baia de la subsol.
my feverish head
despite not having eaten anything in days.
deși nu mâncasem deloc în ultimele zile.
at the end of the night
and general practitioners --
doctori și generaliști,
would help me.
speak with on the phone
said that they prescribe opioids
că ei prescriu opioide,
tapering or withdrawal.
sau întreruperea lor.
was clearly coming through my voice,
a devenit vizibilă în voce
took a deep breath and said,
și mi-a spus:
what you need is a rehab facility
de o clinică de reabilitare
so I took her advice.
așa că i-am urmat sfatul.
calling those places,
să sun la acele clinici,
long-term substance use disorder.
cu dependențe pe termen lung.
weaning the patient off the medication,
pacientului la ele,
onto the safer, longer-acting opioids:
și cu durată mai lungă de acțiune:
for maintenance treatment.
ca tratament de întreținere.
had an extensive waiting list.
lista de așteptare era lungă.
they were designed to see.
pe care să-l primească.
from a rehab facility,
de o clinică de recuperare,
going back on the medication.
că revin la pastile.
the lowest dose possible,
as I absolutely needed
effects of the withdrawal.
efecte ale sevrajului.
I actually went to bed.
am reușit să dorm.
prescription bottle,
had abated dramatically.
that was my response, too.
just a little bit.
precisely because I'm not special;
tocmai pentru că nu sunt special;
to me was all that unique.
n-a fost neobișnuit.
was entirely predictable
a fost previzibilă
for which I was prescribed it.
response to an opioid-rich environment
la un mediu bogat în opioide,
to think that from the beginning,
să credem că de la început
well-formed tapering plan,
bine pus la punct,
seemingly hasn't decided
se pare că nu a decis
pentru pacienți ca mine.
as a complex patient
m-au văzut ca un pacient complicat
as getting pain under control
e să țină durerea sub control
renunța la medicamente
get off the medication,
of addiction medicine.
e ultrasolicitată
from long-term substance use disorder.
de dependențe pe termen lung.
that needed long-term management
cu administrare pe termen lung,
această administrare
whose job such management was.
cine era responsabil.
and worth talking about --
despre fiecare,
is a particular concern
este o preocupare reală
from overdose in 2015.
în 2015 din cauza supradozelor.
involved prescription opioids.
au avut la bază prescripții de opioide.
started to react to this crisis,
să ia atitudine la această criză,
trying to prescribe fewer pills --
doar să prescrie mai puține pastile
that's going to be important.
we're now gaining evidence
often prescribe medication
prescriu adesea tratament
much more than is needed.
help to explain why America,
of the global population,
doar 5% din populația lumii,
of the total global opioid supply.
mondial de opioide.
on the rate of prescribing
doar pe rata de prescripții,
two crucially important points.
două aspecte importante.
important pain therapies.
tratamente importante pentru durere.
severe, real, long-lasting pain,
și de lungă durată,
can make life worth living.
pot face viața mai frumoasă.
while judiciously prescribing opioids
oferind în mod rațional opioide
manage the pills that they do prescribe.
în mod corespunzător aceste pastile.
that I was given.
knows that that is too aggressive?
să știe că e extrem de agresiv?
in an academic journal,
într-un jurnal academic,
their pocket guide for tapering opioids.
o broșură despre reducerea opioidelor.
how to taper opioids in the easier cases,
opioidele în cazuri ușoare
than a 10 percent dose reduction per week.
mai mare de 10% pe săptămână.
instead of a few weeks.
câteva luni în loc de săptămâni.
pretty uncomfortable,
the kind of information
this medication ought to have.
ar trebui să o aibă.
prescribed opioids
administrarea corectă a opioidelor
is far bigger than that,
for tens of thousands of deaths a year,
pentru zeci de mii de decese pe an,
of that medication is indefensible.
este de neiertat.
to get off the medication
în reducerea opioidelor
to our epidemic,
la problema noastră,
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