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.
Rieder applied the “Page 99 Test” to his new book, In Pain: A Bioethicist's Personal Struggle with Opioids, and reported the following:
This test may have been designed specifically for my book. At least, that’s how it felt when I received the prompt and opened In Pain to page 99. On this page, the reader finds herself right smack in the middle of the meatiest part of my story—my own little personal hell that eventually drove me to write a book. After a motorcycle accident and five surgeries, I had been sent home on high and escalating doses of opioids, which I had continued to take for several more weeks. It wasn’t until two months after the initial accident that my trauma surgeon saw how many pain meds I was taking, and urged me to get off them.Visit Travis Rieder's website.
How? Well, that wasn’t his job. So he sent me to the plastic surgeon who had been writing my prescriptions. That surgeon had given me a much-too-aggressive tapering schedule, which launched me into opioid withdrawal. My description of that trauma—of a kind of physical and mental torment that can drive someone to start thinking about suicide—is what I’ve been describing in the pages just before page 99. At this point, I’ve become so desperate that my partner, Sadiye, and I began calling every clinician who cared for me at three different hospitals. And finally, one of them recommended that we contact the pain management team who instigated my opioid therapy after the last surgery.
It seemed like such a good idea; however…We were never even able to speak with anyone from the pain team at our hospital. After calling around and begging to be put in contact with the doctor who had overseen my care, we finally reached a nurse who put us on hold for a long time while she tracked someone down. She did not, however, return with a physician; she returned with a message.That last quote from the nurse echoed around my brain for months, raising one of the central questions that motivated the writing of In Pain: whose responsibility is it to manage opioid therapy? Every day, all around America, thousands of people are prescribed opioid pills. This medication is addictive and dangerous, and yet apparently—if my experience is any indication—clinicians don’t think they have any obligation to manage the medication long-term after prescribing.
“Hello, Mrs. Rieder?” The nurse was on speakerphone, since we'd been waiting on hold. “I'm sorry to have kept you waiting. Unfortunately, no one from the team is able to see your husband.”
I was confused, and Sadiye was furious. “What do you mean ‘no one's able to see him'? Like—ever?” Her normally calm voice rose as she unfurled the incredulity we both felt. “I'm sure they're busy, but we just need to talk with someone. He just needs someone to help with the withdrawal process ... from the medication they prescribed. Can't you just put someone on the phone?” I sat quietly, hurt, abandoned, while she tried desperately to convince the nurse that this was not okay.
“I understand your frustration,” the woman softly replied. “But our pain management team provides an inpatient service. Their job is to get pain under control during a patient's hospitalization. Al-though they prescribe opioids to manage pain, they do not oversee opioid tapering or manage withdrawal.”
As a bioethicist at Johns Hopkins University, I turned all of my intellectual energy to finding an answer to this question (and many others that I uncovered once I started digging). And what I found is incredibly distressing. So I decided to share it with the world. My hope is that In Pain starts a very loud, very public discussion of pain, opioids, and their relationship to America’s broader drug overdose crisis.
Writers Read: Travis Rieder.
--Marshal Zeringue
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