ABOUT THE SPEAKER
Travis Rieder - Bioethicist
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.

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.

More profile about the speaker
Travis Rieder | Speaker | TED.com
TEDxMidAtlantic

Travis Rieder: The agony of opioid withdrawal -- and what doctors should tell patients about it

Travis Rieder: A agonía da abstinencia aos opioides, e o que os médicos nos deberían contar.

Filmed:
2,438,348 views

Nos Estados Unidos atópase o cinco por cento da poboación mundial pero consume case o setenta por cento da producción de opioides total. América sofre unha epidemia que provoca deceas de miles de mortes cada ano. Cómo chegamos a este punto, e qué podemos facer? Nesta charla chea de experiencias persoais, Travis Rieder rememora a dolorosa, con frecuencia silenciada, loita contra a síndrome de abstinencia e expón cómo os médicos, que rápidamente prescriben (máis do necesario) opioides, non se atopan preparados para a súa deshabituación.
- Bioethicist
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.

Cantos analxésicos tomas?
00:12
"How much pain medication are you taking?"
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00:16
That was the very routine question
that changed my life.
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Unha pregunta rutineira
que me cambiou a vida.
00:19
It was July 2015,
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Era xullo de 2015,
00:21
about two months after
I nearly lost my foot
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dous meses despois de case perder o pé
00:23
in a serious motorcycle accident.
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nun grave accidente de moto.
00:26
So I was back in my orthopedic
surgeon's office
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Atopábame na consulta do meu traumatólogo
00:28
for yet another follow-up appointment.
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para outra revisión.
00:31
I looked at my wife, Sadiye;
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Mirei a miña muller, Sadiye;
00:32
we did some calculating.
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e calculamos.
00:35
"About 115 milligrams
oxycodone," I responded.
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“Ao redor de 115 miligramos de oxicodona”
00:38
"Maybe more."
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"Quizais algo máis", engadín.
00:40
I was nonchalant, having given
this information to many doctors
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Xa lles dera esta información previamente
a varios doutores,
00:44
many times before,
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polo que respondín con indiferenza,
00:46
but this time was different.
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pero esta vez foi distinto.
00:48
My doctor turned serious
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O médico púxose serio, miroume e dixo:
00:50
and he looked at me and said,
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00:51
"Travis, that's a lot of opioids.
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"Travis iso é unha morea de opioides,
00:54
You need to think
about getting off the meds now."
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é hora de deixar a medicación".
00:57
In two months of escalating prescriptions,
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Durante dous meses aumentando a dose,
00:59
this was the first time
that anyone had expressed concern.
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esta foi a primeira vez
que alguén se preocupou.
01:03
Indeed, this was the first
real conversation I'd had
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De feito, esta foi
a primeira conversa que tiven
01:05
about my opioid therapy, period.
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sobre o meu tratamento con opioides.
01:08
I had been given no warnings,
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Ninguén me advertira,
01:10
no counseling,
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asesorara,
01:12
no plan ...
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ou propuxera un plan.
01:14
just lots and lots of prescriptions.
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Só receitas e máis receitas.
01:17
What happened next really came to define
my entire experience of medical trauma.
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O que pasou despois,
foi un verdadeiro trauma.
Programáronme unha redución
de dose moi agresiva,
01:22
I was given what I now know
is a much too aggressive tapering regimen,
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segundo a cal tiña que dividir
a miña medicación en catro tomas,
01:27
according to which I divided
my medication into four doses,
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01:30
dropping one each week
over the course of the month.
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baixando unha por semana
no transcurso dun mes.
01:34
The result is that I was launched
into acute opioid withdrawal.
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O que me levou a padecer
unha crise de abstinencia a opioides.
01:39
The result, put another way,
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Noutras palabras,
01:42
was hell.
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un inferno.
01:45
The early stages of withdrawal
feel a lot like a bad case of the flu.
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Ao principio,
[1ª SEMANA]
asemellábase a unha gripe grave.
01:50
I became nauseated,
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Tiña náuseas,
01:52
lost my appetite,
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perdín o apetito,
01:54
I ached everywhere,
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doíame todo
01:56
had increased pain
in my rather mangled foot;
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e o meu pé esnaquizado
doíame cada vez máis.
01:59
I developed trouble sleeping
due to a general feeling of restlessness.
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Comecei a ter problemas para durmir
xa que me atopaba inquedo.
02:05
At the time,
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Daquela,
02:07
I thought this was all pretty miserable.
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pensei que era horrible.
Non sabía o que me esperaba...
02:10
That's because I didn't know
what was coming.
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[2ª SEMANA]
02:13
At the beginning of week two,
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Ao principio da segunda semana,
02:16
my life got much worse.
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a miña vida foi a peor.
02:18
As the symptoms dialed up in intensity,
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Tódolos síntomas intensificáronse,
02:22
my internal thermostat
seemed to go haywire.
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o meu termóstato interno toleou.
02:25
I would sweat profusely almost constantly,
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Suaba abondo e decontino
02:27
and yet if I managed to get myself out
into the hot August sun,
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e aínda así, cando conseguía saír
ao quente sol de agosto,
02:31
I might look down and find myself
covered in goosebumps.
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poñíaseme a pel de galiña.
02:35
The restlessness that had made
sleep difficult during that first week
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A inquedanza que me impedira durmir
durante a primeira semana
02:38
now turned into what I came to think of
as the withdrawal feeling.
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converteuse na típica
sensación de abstinencia.
02:42
It was a deep sense of jitters
that would keep me twitching.
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Era un desasosego
que me provocaba constantes espasmos,
02:47
It made sleep nearly impossible.
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impedíndome durmir.
02:50
But perhaps the most
disturbing was the crying.
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Pero o que máis me alteraba era o pranto.
02:55
I would find myself with tears coming on
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As bágoas brotaban
03:00
for seemingly no reason
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sen motivo aparente
03:02
and with no warning.
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e sen aviso previo.
03:05
At the time they felt
like a neural misfire,
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Daquela, asemellaba un fallo nervioso
03:07
similar to the goosebumps.
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semellante aos arrepíos.
03:09
Sadiye became concerned,
and she called the prescribing doctor
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Sadiye preocupouse e chamou ao médico,
03:13
who very helpfully advised
lots of fluids for the nausea.
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quen, dilixentemente, recomendou
moito líquido contra as náuseas.
03:18
When she pushed him and said,
"You know, he's really quite badly off,"
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Cando ela insistiu, dicindo:
"Atópase moi mal"
03:21
the doctor responded,
"Well, if it's that bad,
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O doutor respondeu, "se tan mal está,
03:24
he can just go back to his
previous dose for a little while."
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sempre pode reintroducir
a medicación durante unha tempada"
03:28
"And then what?" I wondered.
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"E despois que?" preguntei.
03:31
"Try again later," he responded.
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"Téntao de novo", dixo.
Pero eu non concibía volver
á miña dose anterior
03:34
Now, there's no way that I was going
to go back on my previous dose
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agás que tivese un plan mellor para lidar
coa síndrome de abstinencia de novo.
03:38
unless I had a better plan for making
it through the withdrawal next time.
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03:42
And so we stuck to riding it out
and dropped another dose.
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Así é que proseguimos co acordado
e baixamos outra dose.
[SEMANA 3]
03:47
At the beginning of week three,
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Ao comezo da terceira semana,
03:50
my world got very dark.
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o meu mundo ensombreceuse.
03:53
I basically stopped eating,
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Deixei de comer,
03:56
and I barely slept at all
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de durmir,
03:57
thanks to the jitters
that would keep me writhing all night.
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todo grazas ao desacougo
que me tiña retorcéndome toda a noite.
04:01
But the worst --
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Pero o peor...
04:03
the worst was the depression.
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o peor foi a depresión.
04:06
The tears that had felt
like a misfire before
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As bágoas que antes asemellaban
un mal funcionamento,
04:10
now felt meaningful.
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agora tiñan significado.
04:12
Several times a day
I would get that welling in my chest
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Varias veces ao día podía sentir
esa presión no meu peito
que vaticinaba que as bágoas
estaban a chegar,
04:15
where you know the tears are coming,
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04:18
but I couldn't stop them
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pero non as podía controlar,
04:20
and with them came
desperation and hopelessness.
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e con elas viñan a desesperación
e a desesperanza.
04:24
I began to believe
that I would never recover
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Comecei a crer que nunca me recuperaría
nin do accidente,
nin da síndrome de abstinencia.
04:27
either from the accident
or from the withdrawal.
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04:31
Sadiye got back on the phone
with the prescriber
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Sadiye volveu a chamar ao doutor
04:33
and this time he recommended
that we contact our pain management team
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e desta vez aconsellounos
que contactásemos coa unidade de dor
que nos atendera na hospitalización.
04:37
from the last hospitalization.
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04:38
That sounded like a great idea,
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Semellaba unha boa idea,
04:40
so we did that immediately,
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polo que chamamos decontado,
04:42
and we were shocked
when nobody would speak with us.
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e asombrounos que ninguén
nos quixese atender.
04:45
The receptionist who answered
the phone advised us
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A recepcionista que contestou
a chamada informounos
04:48
that the pain management team
provides an inpatient service;
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de que a unidade de dor
só trata a doentes hospitalizados.
Aínda que prescriben opioides
para controlar a dor
04:52
although they prescribe opioids
to get pain under control,
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non supervisaban reducións
nin abstinencias.
04:55
they do not oversee
tapering and withdrawal.
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04:59
Furious, we called the prescriber back
and begged him for anything --
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Anoxados, chamamos de novo ao doutor
e suplicámoslle por calquera cousa...
05:05
anything that could help me --
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que me puidese axudar...
05:07
but instead he apologized,
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pero, en vez diso, desculpouse
05:09
saying that he was out of his depth.
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e admitiu que non sabía que facer.
05:11
"Look," he told us,
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"Mirade", dixo,
05:13
"my initial advice to you is clearly bad,
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"o meu consello inicial foi un erro,
así que a miña recomendación é
que Travis volva á medicación,
05:15
so my official recommendation
is that Travis go back on the medication
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ata que atope a alguén máis competente
para reducirlle a dose.
05:19
until he can find someone
more competent to wean him off."
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05:24
Of course I wanted
to go back on the medication.
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Por suposto que quería tomar a medicación.
05:27
I was in agony.
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Sentíame moribundo.
05:30
But I believed that if I saved
myself from the withdrawal with the drugs
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Pero cría que se evitaba
pasar pola abstinencia
05:37
that I would never be free of them,
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nunca podería deixar a medicación.
05:40
and so we buckled ourselves in,
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Polo que nos mantivemos firmes
05:42
and I dropped the last dose.
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e deixei a última dose.
[SEMANA 4]
05:46
As my brain experienced life
without prescription opioids
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Cando o meu cerebro sentiu
como era a vida sen opioides
05:49
for the first time in months,
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por primeira vez en meses,
05:52
I thought I would die.
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pensei que ía morrer.
05:54
I assumed I would die --
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Asumín que ía morrer.
05:55
(Crying)
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Síntoo.
05:57
I'm sorry.
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(Chora)
05:58
(Crying)
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Se os síntomas non me mataban,
06:04
Because if the symptoms
didn't kill me outright,
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06:07
I'd kill myself.
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faríao eu mesmo.
06:10
And I know that sounds dramatic,
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Sei que soa drástico,
06:12
because to me,
standing up here years later,
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porque para min estar aquí, anos despois,
06:15
whole and healthy --
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san e salvo...
06:16
to me, it sounds dramatic.
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é extraordinario.
06:19
But I believed it to my core
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Pero estaba totalmente convencido,
06:23
because I no longer had any hope
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non tiña esperanza ningunha
06:27
that I would be normal again.
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de volver á normalidade.
06:33
The insomnia became unbearable
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O insomnio fíxose insoportable
06:36
and after two days
with virtually no sleep,
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e despois de dous días sen apenas durmir,
06:40
I spent a whole night
on the floor of our basement bathroom.
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pasei unha noite enteira
tirado no chan do baño.
06:45
I alternated between cooling
my feverish head
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Alternaba entre pegar a cabeza
ás baldosas para baixar a febre
06:48
against the ceramic tiles
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06:51
and trying violently to throw up
despite not having eaten anything in days.
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e tentar trousar, pese a que non comera
nos últimos días.
Cando Sadiye me atopou ao final da noite,
06:56
When Sadiye found me
at the end of the night
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horrorizouse,
06:59
she was horrified,
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07:00
and we got back on the phone.
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e chamamos outra vez.
07:02
We called everyone.
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Chamamos a todo o mundo,
07:03
We called surgeons and pain docs
and general practitioners --
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chamamos a cirurxiáns e médicos da dor,
a médicos de familia.
07:07
anyone we could find on the internet,
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Calquera que atopamos en internet,
07:09
and not a single one of them
would help me.
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e ninguén podía facer nada para axudarme.
07:13
The few that we could
speak with on the phone
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Os poucos cos que puidemos falar,
07:16
advised us to go back on the medication.
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recomendaron volver á medicación.
07:21
An independent pain management clinic
said that they prescribe opioids
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Unha clínica privada da dor
díxonos que prescribían opioides
pero que non supervisaban
a redución ou a abstinencia.
07:25
but they don't oversee
tapering or withdrawal.
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07:29
When my desperation
was clearly coming through my voice,
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Cando a desesperación
podía ouvirse na miña voz,
07:32
much as it is now,
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como agora,
07:35
the receptionist
took a deep breath and said,
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unha recepcionista suspirou e dixo,
"Señor Rieder, quizais o que precise
sexa un centro de desintoxicación
07:38
"Mr. Rieder, it sounds like perhaps
what you need is a rehab facility
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07:41
or a methadone clinic."
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ou unha unidade de drogodependencia"
Non se me ocorría nada mellor,
así que seguín o seu consello,
07:43
I didn't know any better at the time,
so I took her advice.
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07:46
I hung up and I started
calling those places,
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colguei e empecei a chamar a eses centros.
07:48
but it took me virtually no time at all
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Pero non tardei nada en descubrir
07:51
to discover that many of these facilities
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que están centrados en quen leva anos
loitando coa súa adicción a substancias.
07:54
are geared towards those battling
long-term substance use disorder.
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07:57
In the case of opioids,
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No caso dos opioides,
07:59
this often involves precisely not
weaning the patient off the medication,
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normalmente isto non implica
que os deixen,
08:02
but transitioning them
onto the safer, longer-acting opioids:
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senón que os substitúan por outros
máis seguros a longo prazo:
08:06
methadone or buprenorphine
for maintenance treatment.
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metadona ou buprenorfina, para
o tratamento de mantemento.
08:10
In addition, everywhere I called
had an extensive waiting list.
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Amais, tódolos sitios aos que chamei
tiñan unha longa lista de espera.
08:13
I was simply not the kind of patient
they were designed to see.
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Non era o tipo de paciente
que están acostumados a tratar.
08:18
After being turned away
from a rehab facility,
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Despois de ser rexeitado
polos centros de desintoxicación
08:21
I finally admitted defeat.
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aceptei a miña derrota.
08:23
I was broken and beaten,
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Estaba desfeito e frustrado,
08:26
and I couldn't do it anymore.
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non podía continuar.
08:29
So I told Sadiye that I was
going back on the medication.
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Díxenlle a Sadiye que ía volver medicarme.
08:33
I would start with
the lowest dose possible,
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Comezaría coa dose máis baixa posible
08:35
and I would take only as much
as I absolutely needed
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e tomaría soamente o necesario
08:38
to escape the most crippling
effects of the withdrawal.
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para escapar dos efectos demoledores
da abstinencia.
Esa noite, axudoume a subir as escaleiras,
08:41
So that night she helped me up the stairs
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e por primeira vez en semanas fun á cama.
08:43
and for the first time in weeks
I actually went to bed.
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08:46
I took the little orange
prescription bottle,
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Collín o bote laranxa das menciñas,
apoieino na mesa de noite...
08:49
I set it on my nightstand ...
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e non o toquei.
08:52
and then I didn't touch it.
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08:55
I fell asleep,
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Adormecín,
08:56
I slept through the night
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durmín toda a noite
08:58
and when I woke up,
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e cando espertei,
08:59
the most severe symptoms
had abated dramatically.
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os síntomas máis graves
case desapareceran.
09:03
I'd made it out.
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Lográrao.
09:04
(Applause)
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5440
(Aplausos)
(Suspira)
(Aplausos)
09:14
Thanks for that,
that was my response, too.
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Grazas, esa foi a miña reacción.
09:16
(Laughter)
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(Suspira aliviado e ri)
09:19
So --
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09:24
I'm sorry, I have to gather myself
just a little bit.
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Síntoo, teño que recompoñerme un pouco.
09:27
I think this story is important.
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Creo que esta historia é importante,
09:30
It's not because I think I'm special.
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2256
non porque me crea especial.
09:32
This story is important
precisely because I'm not special;
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Isto é importante precisamente
porque non son especial,
09:35
because nothing that happened
to me was all that unique.
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2880
nada do que me aconteceu foi inusual.
09:39
My dependence on opioids
was entirely predictable
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3296
A miña dependencia aos opioides
era totalmente predicible
09:43
given the amount that I was prescribed
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1896
dada a cantidade que tomaba
09:44
and the duration
for which I was prescribed it.
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2640
e durante o tempo que o fixen.
09:48
Dependence is simply the brain's natural
response to an opioid-rich environment
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4816
A dependencia é a resposta innata
do cerebro a un medio rico en opioides.
Polo tanto, era evidente dende o comezo
que ía precisar
09:53
and so there was every reason
to think that from the beginning,
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581200
3816
09:57
I would need a supervised,
well-formed tapering plan,
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2720
un plan supervisado de redución de dose.
10:00
but our health care system
seemingly hasn't decided
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588840
4096
Pero aparentemente, o noso
sistema sanitario aínda non decidiu
quen é o responsable
de pacientes coma min.
10:04
who's responsible for patients like me.
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2240
Os médicos víanme coma
un paciente complexo
10:08
The prescribers saw me
as a complex patient
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3576
con necesidade de coidados especiais
para o control da analxesia.
10:11
needing specialized care,
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1496
10:13
probably from pain medicine.
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1456
10:14
The pain docs saw their job
as getting pain under control
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3736
Os especialistas en dor entendían que
a súa función era controlar a dor
e cando non logrei deixar a medicación,
10:18
and when I couldn't
get off the medication,
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606480
2056
pasaron a verme como un caso
de especialistas en adiccións.
10:20
they saw me as the purview
of addiction medicine.
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608560
2696
Pero esta especialidade está colapsada,
10:23
But addiction medicine is overstressed
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611280
2136
10:25
and focused on those suffering
from long-term substance use disorder.
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613440
3240
e centrada en doentes cunha
longa historia de abuso de substancias.
10:29
In short, I was prescribed a drug
that needed long-term management
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3760
En resumo, receitáronme unha menciña
que precisaba unha prolongada supervisión
10:33
and then I wasn't given that management,
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621960
2016
que non me ofreceron,
10:36
and it wasn't even clear
whose job such management was.
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624000
2840
nin quedaba claro quen a tiña que ofrecer.
10:39
This is a recipe for disaster
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1560
Esta é a receita dun desastre
10:42
and any such disaster would be interesting
and worth talking about --
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3656
do que sería interesante falar
10:46
probably worth a TED Talk --
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1360
inclusive nunha charla TED.
10:48
but the failure of opioid tapering
is a particular concern
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4336
O fallo no manexo dos opioides
suscita unha gran preocupación
na actualidade nos EE. UU.
10:53
at this moment in America
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641320
1440
10:56
because we are in the midst of an epidemic
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644160
2280
porque nos atopamos
no medio dunha epidemia
10:59
in which 33,000 people died
from overdose in 2015.
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647280
4040
na que en 2015 houbo 33000 mortes
por sobredose.
11:04
Nearly half of those deaths
involved prescription opioids.
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652640
3520
Case a metade desas mortes,
debéronse a opioides receitados.
11:09
The medical community has in fact
started to react to this crisis,
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657680
5256
A comunidade médica comezou
a actuar contra esta crise
11:14
but much of their response has involved
trying to prescribe fewer pills --
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662960
4536
pero a súa resposta consistiu
en prescribir menos pílulas.
11:19
and absolutely,
that's going to be important.
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667520
2616
Por suposto que é importante.
11:22
So for instance,
we're now gaining evidence
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670160
2256
Por exemplo, sabemos
11:24
that American physicians
often prescribe medication
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672440
3976
que os médicos estadounidenses
a miúdo prescriben fármacos
11:28
even when it's not necessary
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676440
1536
que non se precisan.
11:30
in the case of opioids.
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No caso dos opioides,
11:31
And even when opioids are called for,
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679240
1976
aínda cando son necesarios,
11:33
they often prescribe
much more than is needed.
219
681240
2280
prescríbense máis do que cumpriría.
11:36
These sorts of considerations
help to explain why America,
220
684320
5176
Este tipo de feitos axudan a comprender
por que os EE. UU.,
11:41
despite accounting for only five percent
of the global population,
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689520
3616
a pesar de ter o 5% da poboación mundial,
11:45
consumes nearly 70 percent
of the total global opioid supply.
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4080
consume o 70% da produción total
dos opioides.
11:50
But focusing only
on the rate of prescribing
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698680
4496
Non obstante, se nos centramos só
na porcentaxe de prescrición
11:55
risks overlooking
two crucially important points.
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703200
3320
podemos estar esquecendo
dous feitos importantes.
11:59
The first is that opioids just are
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707760
4856
Para comezar, os opioides son
12:04
and will continue to be
important pain therapies.
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712640
2920
e serán fármacos necesarios
para o tratamento da dor.
12:08
As somebody who has had
severe, real, long-lasting pain,
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716200
5016
Como doente que sufriu dor intensa,
real e constante,
12:13
I can assure you these medications
can make life worth living.
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3720
podo afirmar que poden facer
que pague a pena vivir.
12:18
And second:
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726480
1696
Por último,
12:20
we can still fight the epidemic
while judiciously prescribing opioids
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728200
4936
podemos loitar contra esta epidemia
sen deixar de receitar opioides
12:25
to people who really need them
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733160
2576
a aqueles que de verdade os necesitan,
12:27
by requiring that doctors properly
manage the pills that they do prescribe.
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735760
3560
obrigando aos médicos a que supervisen
todo o que prescriban.
12:32
So for instance,
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740200
1616
Por exemplo,
12:33
go back to the tapering regimen
that I was given.
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741840
2320
volvendo ao meu réxime de deshabituación.
12:36
Is it reasonable to expect
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744920
2096
Non é razoable esperar
12:39
that any physician who prescribes opioids
knows that that is too aggressive?
236
747040
3840
que calquera médico que prescriba opioides
saiba o potentes que son?
12:43
Well, after I initially published my story
in an academic journal,
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3776
Despois de publicar a miña historia
nunha revista científica,
12:47
someone from the CDC sent me
their pocket guide for tapering opioids.
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4160
alguén do CDC envioume a súa guía
para a redución gradual de opioides.
12:52
This is a four-page document,
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1936
Era un documento de 4 páxinas
cheo de imaxes.
12:54
and most of it's pictures.
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762600
1240
12:57
In it, they teach physicians
how to taper opioids in the easier cases,
241
765200
4776
Nel ensínaselles aos médicos a reducir
a dose nos casos máis sinxelos
13:02
and one of the their recommendations
242
770000
1736
e unha das súas recomendacións
13:03
is that you never start at more
than a 10 percent dose reduction per week.
243
771760
4240
é que nunca se paute unha redución
superior ao 10 % por semana.
13:09
If my physician had given me that plan,
244
777360
2736
Se o meu médico me aconsellara ese plan
13:12
my taper would have taken several months
instead of a few weeks.
245
780120
4920
a miña deshabituación ocorrería
en meses, en vez de en semanas.
13:18
I'm sure it wouldn't have been easy.
246
786440
2136
Estou seguro de que non ía ser sinxelo,
13:20
It probably would have been
pretty uncomfortable,
247
788600
2360
seguramente fose molesto
13:23
but maybe it wouldn't have been hell.
248
791840
1800
pero quizais non sería un inferno.
13:26
And that seems like
the kind of information
249
794720
2056
Asemella que ese tipo de información
13:28
that someone who prescribes
this medication ought to have.
250
796800
2720
deberíaa ter calquera
que prescriba opioides.
13:33
In closing,
251
801080
1240
Para rematar,
13:35
I need to say that properly managing
prescribed opioids
252
803200
5416
teño que dicir que
o manexo axeitado dos opioides
13:40
will not by itself solve the crisis.
253
808640
2160
non resolverá por si mesmo a crise.
13:43
America's epidemic
is far bigger than that,
254
811640
3360
A epidemia nos EE.UU.
é máis grande que iso.
13:47
but when a medication is responsible
for tens of thousands of deaths a year,
255
815960
5056
Pero cando un fármaco é responsable
de decenas de miles de mortes
13:53
reckless management
of that medication is indefensible.
256
821040
4200
un control inadecuado non é admisible.
13:58
Helping opioid therapy patients
to get off the medication
257
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3296
Axudar a estes doentes a suspender
14:01
that they were prescribed
258
829960
2016
o que lles prescribiron
14:04
may not be a complete solution
to our epidemic,
259
832000
2440
pode non ser a solución completa
á nosa epidemia,
14:07
but it would clearly constitute progress.
260
835320
2120
pero sería un adianto.
14:10
Thank you.
261
838240
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Grazas.
14:11
(Applause)
262
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(Aplausos)
Translated by Sara Fandiño
Reviewed by Servizo de Normalización Lingüística

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ABOUT THE SPEAKER
Travis Rieder - Bioethicist
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.

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.

More profile about the speaker
Travis Rieder | Speaker | TED.com
THE ORIGINAL VIDEO ON TED.COM