In Pain: A Bioethicist's Personal Struggle with Opioids

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A bioethicists eloquent and riveting memoir of opioid dependence and withdrawala harrowing personal reckoning and clarion call for change not only for government but medicine itself, revealing the lack of crucial resources and structures to handle this insidious nationwide epidemic.

Travis Rieders terrifying journey down the rabbit hole of opioid dependence began with a motorcycle accident in 2015. Enduring half a dozen surgeries, the drugs he received were both miraculous and essential to his recovery. But his most profound suffering came several months later when he went into acute opioid withdrawal while following his physicians orders. Over the course of four excruciating weeks, Rieder learned what it means to be dope sickthe physical and mental agony caused by opioid dependence. Clueless how to manage his opioid taper, Traviss doctors suggested he go back on the drugs and try again later. Yet returning to pills out of fear of withdrawal is one route to full-blown addiction. Instead, Rieder continued the painful process of weaning himself.

Rieders experience exposes a dark secret of American pain management: a healthcare system so conflicted about opioids, and so inept at managing them, that the crisis currently facing us is both unsurprising and inevitable. As he recounts his story, Rieder provides a fascinating look at the history of these drugs first invented in the 1800s, changing attitudes about pain management over the following decades, and the implementation of the pain scale at the beginning of the twenty-first century. He explores both the science of addiction and the systemic and cultural barriers we must overcome if we are to address the problem effectively in the contemporary American healthcare system.

In Pain is not only a gripping personal account of dependence, but a groundbreaking exploration of the intractable causes of Americas opioid problem and their implications for resolving the crisis. Rieder makes clear that the opioid crisis exists against a backdrop of real, debilitating painand that anyone can fall victim to this epidemic.

Reviews

Travis Rieders gripping In Pain illuminates just how unprepared doctors are to treat pain while offering a multi-faceted examination of the raw sadness, fatalism and misery experienced by opioid users who unwittingly find themselves dopesick, or in painful withdrawal. This book will engender empathy not just for patients like Rieder, who find themselves trapped in a byzantine system that too often abandons them, but also for the 2.6 million Americans suffering from opioid use disorder. In Pain is a call for nuance and understanding, full of clear-eyed suggestions for doctors struggling to weigh the risks of addiction with treating pain, as well as a guidebook for any one of us who might yet end up in their care. Beth Macy, author of Dopesick With this smart, riveting, real-life account, the author proves himself a convincing and effective advocate for opioid use reform. A harrowing cautionary narrative that speaks to patients and physicians alike on the ugly reality of the enduring opioid epidemic. Kirkus Reviews Bioethicist Travis Rieder uses his own experience with opioid dependence to powerfully highlight how the American healthcare system needs to reform its approach to pain management. Paste Magazine, The Best Books of June 2019 A deep historical dive into the history of opioid use in America, the science behind pain and pain treatment, and the medical practice surrounding pain and how its changed over the last few decades. Inquiring Minds podcast As an academic bioethicist, Rieder provides a philosophical lens to his lived experiences. It is this contribution where In Pain departs from other published narratives on pain and substance use. Rieder discusses moral philosophy concepts such as first- and second-order desires, as well as duties and obligations, in digestible prose that is as profound as it is engaging. In Pain is an invitation for compassion for the millions of people around the world suffering with pain and substance use disorders, but it is also a call to action, not just for more responsible opioid prescribing but for a fundamental change to how pain management is delivered. Science An unflinching account of agony and addiction.Travis Rieders unique point of view and professional knowledge deliver a harrowing account with compassion at its core. Providence Journal "Pain is inevitably both subjective and poorly understood and managed, as Travis Rieder, a faculty member at the Johns Hopkins Berman Institute of Bioethics, explores inIn Pain.....Having lived through the many costs of opioids, Rieder endorses a more complex view of pain that considers not only the subjective feeling of pain intensity, but also how pain affects ones functioning and overall quality of life." Health Affairs "Rieders thoughtful approach to scrutinizing the opioid epidemic is strengthened by his honest, detailed, and often cringe-inducing recounting of his own experience with the powerful painkillers.In Painis a fascinating and engrossing read for anybody who aspires to be an educated consumer of healthcare. But it also should be required reading for every medical student vowing to do no harm in a system that offers all-too-easy access to these powerful drugs." New York Journal of Books "Rieders use of his own experience as a basis for his writing enables a broader approach, expanding the circle of empathy beyond the clinic, and inviting us all to reconsider our relationship with pain our own as well as that of others. Its a book that anyone who cares for people in pain should consider reading." Los Angeles Review of Books "Rieder is uniquely equipped to narrate not only his own story but also a broader look at Americas opioid problem. His prose is clear and compelling....The result is an important book that goes hand in hand with Beth MacysDopesick. Readers of both will not only be enlightened but likely find their attitudes about this devastating crisis transformed." BookPage This book is a wake-up call for anyone who thinks the opioid crisis cant touch them...Its part memoir, part indictment of the doctors and pharmaceutical companies that push painkillers without addressing the addiction issues that come with them. NPR.org

Author Bio

Travis Rieder, PhD, is the Assistant Director for Education Initiatives, Director of the Master of Bioethics degree program and Research Scholar at the Berman Institute of Bioethics. He is also a Faculty Affiliate at the Center for Public Health Advocacy within the Johns Hopkins School of Public Health.