Travis Rieder: The agony of opioid withdrawal -- and what doctors should tell patients about it
崔佛斯雷德: 戒斷類鴉片藥物的痛苦,以及醫生該告訴病人什麼相關資訊
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.
改變了我的人生。
I nearly lost my foot
surgeon's office
我們做了一些計算。
oxycodone," I responded.
this information to many doctors
已經告訴過許多醫生
about getting off the meds now."
就開始脫離這些藥物。」
that anyone had expressed concern.
real conversation I'd had
我的類鴉片藥物治療
my entire experience of medical trauma.
is a much too aggressive tapering regimen,
太積極的漸減式給藥方案,
my medication into four doses,
我將我的藥物劑量分為四份,
over the course of the month.
into acute opioid withdrawal.
feel a lot like a bad case of the flu.
感覺像是糟糕的感冒。
in my rather mangled foot;
due to a general feeling of restlessness.
我甚至開始難以入眠。
what was coming.
後面有什麼在等著我。
seemed to go haywire.
into the hot August sun,
我有辦法出門到大太陽底下,
covered in goosebumps.
我自己滿身雞皮疙瘩。
sleep difficult during that first week
as the withdrawal feeling.
我漸漸認為是戒斷的感覺。
that would keep me twitching.
會讓我一直抽動。
disturbing was the crying.
like a neural misfire,
and she called the prescribing doctor
便打電話給開處方的醫生,
lots of fluids for the nausea.
"You know, he's really quite badly off,"
「他的狀況真的很不好。」
"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.
能讓我下次順利通過戒斷。
and dropped another dose.
且再減少一份劑量。
that would keep me writhing all night.
like a misfire before
I would get that welling in my chest
我的胸口會有什麼湧上來的感覺,
desperation and hopelessness.
是絕望和無望的感覺。
that I would never recover
or from the withdrawal.
都無法復元了。
with the prescriber
that we contact our pain management team
我最後一次住院時的
when nobody would speak with us.
沒人願意跟我們說話。
the phone advised us
provides an inpatient service;
提供服務給住院病人;
to get pain under control,
tapering and withdrawal.
and begged him for anything --
又打電話給開處方的醫生,
很顯然是不好的,
is that Travis go back on the medication
崔佛斯應該回到先前的劑量,
more competent to wean him off."
來幫他戒掉。」
to go back on the medication.
myself from the withdrawal with the drugs
without prescription opioids
我的大腦能在
情況下體驗人生,
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.
即使數天都幾乎沒有吃什麼。
at the end of the night
and general practitioners --
還有家庭醫生——
would help me.
speak with on the phone
在電話上和我們說話,
said that they prescribe opioids
說他們會開類鴉片藥物的處方,
tapering or withdrawal.
was clearly coming through my voice,
都帶著明顯的絕望時,
took a deep breath and said,
what you need is a rehab facility
你可能需要去勒戒機構
so I took her advice.
就接受了她的建議。
calling those places,
開始打電話到這些地方,
long-term substance use disorder.
weaning the patient off the medication,
onto the safer, longer-acting opioids:
更長效的類鴉片藥物:
for maintenance treatment.
had an extensive waiting list.
等候名單都很長。
they were designed to see.
from a rehab facility,
going back on the medication.
我要恢復原本的劑量。
the lowest dose possible,
as I absolutely needed
effects of the withdrawal.
I actually went to bed.
我第一次真的爬上床。
prescription bottle,
had abated dramatically.
that was my response, too.
just a little bit.
precisely because I'm not special;
正是因為我不特別;
to me was all that unique.
並非獨一無二。
was entirely predictable
完全是可預期的,
for which I was prescribed it.
response to an opioid-rich environment
藥物的環境所做出的自然反應,
to think that from the beginning,
打從一開始,
well-formed tapering plan,
受監控且合適的減量計畫,
seemingly hasn't decided
as a complex patient
把我視為一個複雜的病人,
as getting pain under control
是要控制疼痛,
get off the medication,
of addiction medicine.
from long-term substance use disorder.
that needed long-term management
是需要長期管理的藥物,
whose job such management was.
and worth talking about --
會很有意思且值得拿出來談——
is a particular concern
類鴉片藥物減量的失敗
from overdose in 2015.
因為用藥過量致死。
involved prescription opioids.
和有處方的類鴉片藥物有關。
started to react to this crisis,
對這項危機做出反應,
trying to prescribe fewer pills --
開比較少的處方藥——
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.
卻佔全球總供應的近 70%。
on the rate of prescribing
two crucially important points.
important pain therapies.
severe, real, long-lasting pain,
嚴重、真實、長久的痛苦,
can make life worth living.
這些藥物能讓人生變得值得活下去。
while judiciously prescribing opioids
一邊明智而謹慎地處方類鴉片藥物
manage the pills that they do prescribe.
他們處方的藥物。
that I was given.
knows that that is too aggressive?
這種期待是合理的嗎?
in an academic journal,
一本學術期刊上之後,
their pocket guide for tapering opioids.
類鴉片藥物劑量漸減的口袋指南。
如何針對比較容易的案例
how to taper opioids in the easier cases,
他們的建議之一是,
than a 10 percent dose reduction per week.
不要超過 10%。
instead of a few weeks.
數個月時間,而不是幾週。
pretty uncomfortable,
the kind of information
this medication ought to have.
prescribed opioids
處方的類鴉片藥物
is far bigger than that,
for tens of thousands of deaths a year,
造成一年數萬人死亡,
of that medication is indefensible.
to get off the medication
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