Travis Rieder: The agony of opioid withdrawal -- and what doctors should tell patients about it
Travis Rieder: Opioid bırakma ızdırabı -- ve doktorlar hastalara bununla ilgili ne söylemeli
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.
bu rutin soruydu.
I nearly lost my foot
yaklaşık 2 ay sonra.
surgeon's office
oxycodone," I responded.
oksikodon," diye cevap verdim.
this information to many doctors
birçok kez doktorlara
about getting off the meds now."
that anyone had expressed concern.
gerçek endişe göstermişti.
real conversation I'd had
reçeteler verilmişti bana.
my entire experience of medical trauma.
tüm tecrübemi belirlemişti.
is a much too aggressive tapering regimen,
çok sert ve gittikçe sivrilen bir rutindi.
my medication into four doses,
over the course of the month.
dozu biraz düşürüyordum.
into acute opioid withdrawal.
feel a lot like a bad case of the flu.
ağır bir grip hastalığı gibiydi.
in my rather mangled foot;
due to a general feeling of restlessness.
bu yüzden uyumakta zorlanıyordum.
what was coming.
seemed to go haywire.
into the hot August sun,
Ağustos güneşinin içine sokabilseydim
covered in goosebumps.
tüylerim diken diken olurdu.
sleep difficult during that first week
as the withdrawal feeling.
düşünmeye başladığım şeye dönüştü.
that would keep me twitching.
disturbing was the crying.
like a neural misfire,
and she called the prescribing doctor
ve ilacı yazan doktoru aradı,
lots of fluids for the nausea.
bolca sıvı tüketmemi tavsiye etti.
"You know, he's really quite badly off,"
olduğunu biliyorsunuz" dediğinde
"Well, if it's that bad,
previous dose for a little while."
to go back on my previous dose
it through the withdrawal next time.
yeni bir plan bulmadığım müddetçe.
and dropped another dose.
ve dozu biraz daha düşürdük.
that would keep me writhing all night.
like a misfire before
gözüken göz yaşları,
I would get that welling in my chest
göğsümde boşluk hissederdim,
desperation and hopelessness.
ve umutsuzluk getiriyorlardı.
that I would never recover
or from the withdrawal.
with the prescriber
that we contact our pain management team
when nobody would speak with us.
konuşmadığında şok olduk.
the phone advised us
provides an inpatient service;
yatılı hastalar için olduğunu söyledi;
to get pain under control,
opioid tavsiye etseler de
tapering and withdrawal.
and begged him for anything --
bir şey yapması için yalvardık -
is that Travis go back on the medication
Travis, ilaç tedavisine geri dönün,
more competent to wean him off."
daha tecrübeli birini bulana kadar."
to go back on the medication.
myself from the withdrawal with the drugs
uzaklaşmak için yine ilaç kullanırsam
without prescription opioids
didn't kill me outright,
standing up here years later,
with virtually no sleep,
hakikaten uykusuz kalarak
on the floor of our basement bathroom.
banyonun zemininde geçirdim.
my feverish head
seramik karolara geçiriyor,
olmama rağmen
despite not having eaten anything in days.
at the end of the night
and general practitioners --
pratisyen doktorları -
would help me.
speak with on the phone
said that they prescribe opioids
opioid tavsiye ediyordu
tapering or withdrawal.
hesaba katmadan.
was clearly coming through my voice,
took a deep breath and said,
what you need is a rehab facility
rehabilitasyon tedavisi
so I took her advice.
onun tavsiyesine uydum.
calling those places,
neredeyse hiç zamanımı almadı:
madde kullanım bozukluğu ile
long-term substance use disorder.
weaning the patient off the medication,
uyuşturucudan vazgeçirmek değil,
onto the safer, longer-acting opioids:
diğer opioidlere transfer ediyorlar:
for maintenance treatment.
metadon ya da buprenorfin.
had an extensive waiting list.
kapsamlı bekleme listesi vardı.
they were designed to see.
hastalardan değildim.
from a rehab facility,
geri çevrildikden sonra,
going back on the medication.
istediğimi söyledim.
the lowest dose possible,
as I absolutely needed
effects of the withdrawal.
etkilerinden kurtulmak için.
I actually went to bed.
prescription bottle,
had abated dramatically.
that was my response, too.
just a little bit.
precisely because I'm not special;
ben kesinlikle özel değilim;
to me was all that unique.
was entirely predictable
for which I was prescribed it.
response to an opioid-rich environment
zengin ortama tepkisidir.
to think that from the beginning,
well-formed tapering plan,
ihtiyacım vardı
seemingly hasn't decided
benim gibi hastalardan
karar bile vermemiş.
as a complex patient
bir hasta gibi görmüşlerdi,
as getting pain under control
denetim altına almakta görüyorlardı.
get off the medication,
of addiction medicine.
uzun süre etki gösteren
from long-term substance use disorder.
onlar üzerinde gerginleşmişti.
that needed long-term management
ihtiyacı olan ilaçlar yazıldı
whose job such management was.
kimin işi olduğu bile tartışılırdı.
and worth talking about --
ve konuşmaya değer olurdu -
is a particular concern
from overdose in 2015.
33.000 kişi hayatını kaybetti.
involved prescription opioids.
opioid reçeteleri yüzünden oldu.
started to react to this crisis,
buna tepki vermeye başladı
trying to prescribe fewer pills --
daha az ilaç kapsayan reçeteler yazıyor -
that's going to be important.
we're now gaining evidence
often prescribe medication
ihtiyaç olmadığı hâlde
much more than is needed.
daha fazlasını reçeteliyorlar.
help to explain why America,
şunun sebebini anlıyoruz:
of the global population,
sadece yüzde beşine sahip olmasına rağmen
of the total global opioid supply.
yüzde yetmişini tüketiyor.
on the rate of prescribing
üzerinde yoğunlaşırsak
two crucially important points.
ağrı tedavisinde çok önemli oldular
important pain therapies.
severe, real, long-lasting pain,
sert ve uzun süren ağrıları olan biri için
can make life worth living.
while judiciously prescribing opioids
insanlar var ve biz doktorlardan hastalara
anlamalarını talep ederek
manage the pills that they do prescribe.
that I was given.
knows that that is too aggressive?
bildiğini düşünmek mantıklı mı?
in an academic journal,
hikâyemi yayınladıktan sonra
their pocket guide for tapering opioids.
opioid tedavisi kılavuzu gönderdi.
how to taper opioids in the easier cases,
nasıl yapılacağını açıklıyordu doktorlara.
than a 10 percent dose reduction per week.
öncekinin yüzde onunu geçmeyerek azaltın.
instead of a few weeks.
birkaç ay sürerdi.
pretty uncomfortable,
the kind of information
bu tür tedavi yapanların
this medication ought to have.
prescribed opioids
opioid reçeteleri
is far bigger than that,
for tens of thousands of deaths a year,
ölümünden sorumlu tutulduğunda
of that medication is indefensible.
bu tedaviler affedilemez.
to get off the medication
ilaçlardan kurtulmak için yardım etmek,
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