PHOTO ILLUSTRATION Doug Dobey
by Fran Withrow
In 2015, Travis Rieder was involved in a motorcycle accident that crushed his foot. The ensuing five surgeries in five weeks, as well as the months of recovery afterward, were horrific. His pain was massive, and every surgeon and attending physician freely prescribed generous quantities of opioids to help him deal with his agony. The opioids worked, but when he finally decided to wean himself off, the withdrawal from what had become his opioid dependency was perhaps worse than what had come before. “In Pain” is the description of Rieder’s struggle with opioids and his determination to use this personal experience to change the face of pain management in America.
As I read about the truly appalling withdrawal symptoms Rieder experienced as he struggled to wean himself from opioids, I wondered how on earth anyone ever manages to be successful in casting off these addictive drugs. Rieder is a bioethicist at Johns Hopkins University. He has an extremely supportive family, especially his partner and adored daughter. These were crucial factors in his ability to finally emerge from his dependency. Even so, there were days Rieder did not think he would survive.
It took four excruciating weeks for Rieder to get off the drugs, without the aid of the medical community, each of whom passed him off to someone else or who told him to just go back on the drugs if he was having trouble getting off the opioids. Rieder discovered that though physicians learn how to prescribe these drugs, they know very little about how to safely and effectively help patients to stop using them.
Opioids are powerfully addictive drugs. They attach to the brain and affect it in two ways: they not only reduce pain but also give one a sense of euphoria. No wonder people are eager to continue them. And some people, due to their genetic makeup and their environment, are more likely to become dependent than others.
Rieder is using his story to make the case that pain management in America is in poor shape. The commonly used pain chart (“How bad is your pain on a scale of 1 to 10?”) is actually not a very good indicator of pain, because pain is subjective, meaning a doctor can’t measure it or see it. This is a problem, as physicians must make a judgment call about how bad someone’s pain really is. And physicians prescribe pain meds all too easily, succumbing to pressure from drug manufacturers as well as patient demand.
Rieder makes a solid case for using opioids as a last resort for pain management. He maintains that we need to adjust our thinking about pain: some pain is tolerable for short time periods, Tylenol and Ibuprofen can manage a good deal of pain well, and prescribers need to learn more about alternative pain management like yoga, acupuncture, and massage.
His discussion of the history of heroin use, the rise of opioids, and the stigma, racism and classism connected with opioid use is revealing. This book should be required reading for all medical and legal professionals. And after closing Rieder’s book, I know the next time I feel a twinge, I’ll think twice about whether I really need a little pill.
By Travis Rieder