Travis Rieder: The agony of opioid withdrawal -- and what doctors should tell patients about it
特拉维斯 · 里德: 阿片类药物戒断的痛苦——以及医生应该提供给病人的建议
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.
例行公事般的问题。
摩托车事故的两个月以后,
I nearly lost my foot
surgeon's office
oxycodone," I responded.
this information to many doctors
about getting off the meds now."
that anyone had expressed concern.
real conversation I'd had
我开始了第一次关于
my entire experience of medical trauma.
整个创伤治疗经历的真实写照。
is a much too aggressive tapering regimen,
是一个过于激进的缩减方案,
my medication into four doses,
over the course of the month.
into acute opioid withdrawal.
feel a lot like a bad case of the flu.
in my rather mangled foot;
due to a general feeling of restlessness.
what was coming.
seemed to go haywire.
在8月的烈日下出了门,
into the hot August sun,
covered in goosebumps.
sleep difficult during that first week
as the withdrawal feeling.
正是戒断的症状。
that would keep me twitching.
坐立不安,让我不停颤抖。
disturbing was the crying.
like a neural misfire,
and she called the prescribing doctor
给开处方的医生打了电话,
lots of fluids for the nausea.
恶心症状建议了许多种流质食物。
"You know, he's really quite badly off,"
“他现在的状况十分糟糕。”
"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.
我能做个更好的计划。
and dropped another dose.
that would keep me writhing all night.
like a misfire before
I would get that welling in my chest
desperation and hopelessness.
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.
the phone advised us
provides an inpatient service;
服务是针对住院病人的;
to get pain under control,
tapering and withdrawal.
and begged him for anything --
那个开药方的医生——
is that Travis go back on the medication
让特拉维斯恢复原先的剂量,
more competent to wean him off."
to go back on the medication.
myself from the withdrawal with the drugs
without prescription opioids
didn't kill me outright,
standing up here years later,
with virtually no sleep,
on the floor of our basement bathroom.
my feverish head
despite not having eaten anything in days.
尽管我已经连续几天滴米未进。
at the end of the night
and general practitioners --
和全科医师都打了电话——
would help me.
speak with on the phone
said that they prescribe opioids
说他们可以开阿片药方,
tapering or withdrawal.
was clearly coming through my voice,
took a deep breath and said,
what you need is a rehab facility
so I took her advice.
于是遵循了她的建议。
calling those places,
long-term substance use disorder.
weaning the patient off the medication,
onto the safer, longer-acting opioids:
更安全,更长效的阿片:
for maintenance treatment.
地方都有着一大串的等候名单。
had an extensive waiting list.
they were designed to see.
from a rehab facility,
going back on the medication.
the lowest dose possible,
as I absolutely needed
effects of the withdrawal.
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;
to me was all that unique.
was entirely predictable
for which I was prescribed it.
response to an opioid-rich environment
to think that from the beginning,
well-formed tapering plan,
seemingly hasn't decided
as a complex patient
as getting pain under control
get off the medication,
of addiction medicine.
from long-term substance use disorder.
that needed long-term management
需要进行长期管理的药物,
whose job such management was.
and worth talking about --
都值得关注和分享——
is a particular concern
from overdose in 2015.
致死的人数就达到了33000人。
involved prescription opioids.
与处方阿片类药物上瘾有关。
started to react to this crisis,
对这类危机做出反应,
trying to prescribe fewer pills --
that's going to be important.
we're now gaining evidence
often prescribe medication
much more than is needed.
help to explain why America,
of the global population,
of the total global opioid supply.
on the rate of prescribing
two crucially important points.
important pain therapies.
severe, real, long-lasting pain,
支撑你继续活下去。
can make life worth living.
while judiciously prescribing opioids
同时明智地将处方阿片
manage the pills that they do prescribe.
that I was given.
knows that that is too aggressive?
意识到病人是不是用药过猛。
in an academic journal,
给了我他们减药的袖珍指南。
their pocket guide for tapering opioids.
how to taper opioids in the easier cases,
如何针对简单病例减少阿片剂量,
than a 10 percent dose reduction per week.
instead of a few weeks.
pretty uncomfortable,
the kind of information
this medication ought to have.
prescribed opioids
is far bigger than that,
for tens of thousands of deaths a year,
几万生灵的逝去负责时,
of that medication is indefensible.
to get off the medication
to our epidemic,
也许不是一个万全之策,
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