Former KIE Fellow Travis Rieder wrote a personal and philosophical essay, published this month at Health Affairs, on opioid dependence and the ethics of long-term pain management.
The essay, titled “America’s Deadly Opioid Epidemic: Is There a Path Forward?,” traces a century of public and medical opinion concerning prescription opioids as it swings back and forth between seeing these drugs as an under-used miracle, and an over-used poison.
Interwoven is Rieder’s narrative, which follows a motorcycle accident that caused him to nearly lose his foot, the prescription opioids provided to him in the aftermath, and the lack of support from his physicians as he weans himself off the medication. The essay culminates in a question: How do we prevent the predictable harms of widespread opioid prescribing without harming pain patients?
A favorite passage of ours is excerpted below.
“It’s an emergency,” I told the woman on the phone.
She told me I should go to the emergency department then; all she could do was put me down for the end of the week. I thought to myself (and I think I believed it) that I would be dead by then, and I hung up.
Day three without sleep. I had not left the couch. By this time, my wife was scared. She asked me to refill the lowest-dose prescription I had. It had been nearly four weeks of absolute misery, and I had been without any prescription pain medication for six days. I desperately wanted to make it out the other side, but I had started to doubt that there was one. I refilled the prescription. That night, I went to bed instead of staying on the couch and put the meds on my nightstand. I told myself that if I was still awake in four hours, I would take a dose. An hour later I was asleep, and I didn’t wake up until morning.
I had come out the other side.
Rieder will speak on the topic at National Institutes of Health (NIH) on Feb 6th, 2017, on this topic. He was recently interviewed on Washington’s Top News (WTOP) about his experience and his recommendations for a new ethical protocol governing long-term opioid pain management.