Travis Rieder: The agony of opioid withdrawal -- and what doctors should tell patients about it
Travis Rider (Travis Rieder): Agonija skidanja sa opijata - šta bi doktori trebalo da kažu pacijentima o tome?
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.
that changed my life.
mi je promenilo život.
I nearly lost my foot
sam skoro izgubio stopalo
surgeon's office
oxycodone," I responded.
this information to many doctors
na to pitanje odgovorio doktorima
about getting off the meds now."
o skidanju sa lekova.“
that anyone had expressed concern.
iko izrazio zabrinutost.
real conversation I'd had
razgovor koji sam vodio
my entire experience of medical trauma.
obeležilo moje celo iskustvo ove povrede.
is a much too aggressive tapering regimen,
previše agresivan režim smanjenja doze,
my medication into four doses,
moje lekove na četiri doze,
over the course of the month.
nedelje tokom mesec dana.
into acute opioid withdrawal.
apstinencijalnog sindroma.
feel a lot like a bad case of the flu.
ličile na teži oblik gripa.
in my rather mangled foot;
u mom povređenom stopalu;
due to a general feeling of restlessness.
usled opšteg osećaja nemira.
what was coming.
seemed to go haywire.
bio je u totalnom neredu.
into the hot August sun,
na vrelo avgustovsko sunce,
covered in goosebumps.
da sam se ceo naježio.
sleep difficult during that first week
mogao da spavam prve nedelje
as the withdrawal feeling.
na apstinencijalnu krizu.
that would keep me twitching.
disturbing was the crying.
verovatno je bilo plakanje.
like a neural misfire,
kao neurološka disfunkcija,
and she called the prescribing doctor
te je pozvala ordinirajućeg lekara
lots of fluids for the nausea.
dosta tečnosti za mučninu.
"You know, he's really quite badly off,"
njemu je zaista izuzetno loše,“
"Well, if it's that bad,
„Ukoliko je baš tako loše
previous dose for a little while."
bude na prethodnoj dozi.“
to go back on my previous dose
vratim na prethodnu dozu
da radim po pitanju krize.
it through the withdrawal next time.
and dropped another dose.
i ukinuli još jednu dozu.
that would keep me writhing all night.
bi me drmala celu noć.
kao greška u sistemu
like a misfire before
I would get that welling in my chest
desperation and hopelessness.
depresija i očajanje.
da se nikada neću oporaviti
that I would never recover
or from the withdrawal.
with the prescriber
that we contact our pain management team
lekare koji su prepisali lekove
niko nije hteo da priča sa nama.
when nobody would speak with us.
the phone advised us
kontrolisanje bola obezbeđuje terapiju,
provides an inpatient service;
opijate kako bi smanjili bol,
to get pain under control,
terapije ili skidanje sa iste.
tapering and withdrawal.
i molili ga da uradi bilo šta -
and begged him for anything --
je očigledno bio pogrešan,
da se Travis vrati na početnu dozu
is that Travis go back on the medication
stručnijeg da ga skine sa njih.”
more competent to wean him off."
da ponovo uzimam lekove.
to go back on the medication.
ponovo počnem da uzimam lekove
myself from the withdrawal with the drugs
without prescription opioids
bez prepisanih opijata
ne bi ubili simptomi,
didn't kill me outright,
standing up here years later,
ovde godinama kasnije,
with virtually no sleep,
na podu našeg kupatila.
on the floor of our basement bathroom.
my feverish head
povratim iako danima nisam ništa jeo.
despite not having eaten anything in days.
at the end of the night
and general practitioners --
i lekare opšte prakse -
would help me.
uspeli da razgovaramo
speak with on the phone
vratim redovnoj terapiji.
said that they prescribe opioids
rekla je da oni propisuju lekove
tapering or withdrawal.
doza ili skidanje sa istih.
was clearly coming through my voice,
jasno čuti koliko sam depresivan,
je duboko udahnula i rekla:
took a deep breath and said,
what you need is a rehab facility
kao da vam treba rehabilitacioni
stoga sam prihvatio njen savet.
so I took her advice.
calling those places,
dugotrajnih zloupotreba supstanci.
long-term substance use disorder.
skidanje pacijenata sa lekova,
weaning the patient off the medication,
dugotrajnije opijate:
onto the safer, longer-acting opioids:
kao terapiju prevencije kriza.
for maintenance treatment.
postojala je poduža lista čekanja.
had an extensive waiting list.
za kakvog su bili obučeni.
they were designed to see.
from a rehab facility,
rehabilitacione ustanove,
going back on the medication.
ponovo početi sa terapijom.
the lowest dose possible,
as I absolutely needed
koliko mi je trebalo
effects of the withdrawal.
da se popnem na sprat
I actually went to bed.
vremena spavao u krevetu.
bočicu sa lekovima,
prescription bottle,
had abated dramatically.
that was my response, too.
just a little bit.
da se priberem.
zato što nisam poseban;
precisely because I'm not special;
dogodilo ništa jedinstveno.
to me was all that unique.
je bila potpuno predvidiva
was entirely predictable
for which I was prescribed it.
mozga na opijatsko okruženje
response to an opioid-rich environment
to think that from the beginning,
pomišljate na to od samog početka.
skidanja sa lekova pod nadzorom lekara.
well-formed tapering plan,
još uvek nije odlučio
seemingly hasn't decided
komplikovanog pacijenta
as a complex patient
njihov posao da smanje bol,
as getting pain under control
get off the medication,
lečenja zavisnosti.
of addiction medicine.
je previše usmereno
pate od dugotrajne zavisnosti.
from long-term substance use disorder.
zahtevao dugoročno nadgledanje,
that needed long-term management
whose job such management was.
and worth talking about --
interesantna i vredna pričanja -
opijata je značajan problem
is a particular concern
from overdose in 2015.
33 000 ljudi umrlo usled predoziranja.
involved prescription opioids.
uključivala propisane opijate.
started to react to this crisis,
počela da reaguje na ove uzbune,
trying to prescribe fewer pills --
propisivanje manje količine lekova -
that's going to be important.
we're now gaining evidence
often prescribe medication
više nego što treba.
much more than is needed.
da se objasni zašto Amerika,
help to explain why America,
of the global population,
samo pet posto svetske populacije,
ukupne potrošnje opijata.
of the total global opioid supply.
samo na stopu propisanih lekova
on the rate of prescribing
two crucially important points.
dve ključne stvari.
important pain therapies.
deo terapije protiv bolova.
od jakog i dugotrajnog bola,
severe, real, long-lasting pain,
can make life worth living.
da ovi lekovi čine život podnošljivim.
while judiciously prescribing opioids
dok razumno propisujemo opijate
pažljivo rukovođenje propisanim lekovima.
manage the pills that they do prescribe.
that I was given.
smanjivanja koji mi je preporučen.
knows that that is too aggressive?
zna da su oni previše agresivni?
u naučnom časopisu,
in an academic journal,
their pocket guide for tapering opioids.
mi je poslao vodič za skidanje sa opijata.
dozu opijata u lakšim slučajevima
how to taper opioids in the easier cases,
10 procenata od ukupne doze nedeljno.
than a 10 percent dose reduction per week.
instead of a few weeks.
umesto nekoliko nedelja.
pretty uncomfortable,
the kind of information
this medication ought to have.
ove lekove trebalo da ima.
prescribed opioids
kontrolisanje propisanih opijata
is far bigger than that,
for tens of thousands of deaths a year,
za desetine hiljada smrti godišnje,
of that medication is indefensible.
korišćenje tih lekova.
da se skinu sa lekova
to get off the medication
rešenje naše epidemije,
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