I was in opioid withdrawal for a month — here's what I learned | Travis Rieder | TEDxMidAtlanticJul 11, 2021
How much pain reliever are you taking? That was the routine question that changed my life. It was July 2015, about two
months after I nearly lost my foot in a serious motorcycle accident, so I went back to my orthopedic surgeon's office for another follow-up. quote I looked at my wife Satya we did some calculations on one hundred and fifteen milligrams of oxycodone I answered maybe more I was indifferent after giving this information to many doctors many times before but this time it was different my doctor got serious and looked at me and said Travis which is a lot of
opioids you need to think about coming off meds now in two
months of increased prescriptions this was the first time anyone had raised concerns in fact this was the first real conversation i had about my
opioidtherapy stint. i had been given no warning no advice no plan just lots and lots of prescriptions
whathappened next really came to define my entire experience of medical trauma that i was given is
whati now know is an overly aggressive tapering regimen according to which i divided my medication in four doses dropping one every week for the course of the month the result is that i went into acute opioid
withdrawalthe result stated another way was Hell, the early stages of
withdrawalfeel like a bad case of the flu.
I felt nauseated. I lost my appetite. I ate everyw
here. The pain was increasing and my foot was pretty bad. It was all pretty miserable, but that's because I didn't know what to expect at the start of week 2. My life got much worse as the symptoms increased in intensity. My internal thermostat seemed to be going haywire. He was sweating profusely almost constantly. I managed to get out into a hot August sun. I could look down and find goosebumps. The restlessness that had made it difficult to sleep for the first week now became what I came to think of the withdrawal feeling as a deep jittery feeling that made me shaky and almost impossible to sleep, but perhaps most disturbing was the crying.
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i was in opioid withdrawal for a month here s what i learned travis rieder tedxmidatlantic...
I was in tears for seemingly no reason and no warning at the time. By the time they felt like a neural glitch similar to goosebumps Sadia got worried and called the prescribing doctor who very kindly advised lots of fluids for nausea when she pushed it said she knows it's pretty bad the doctor replied well if that's bad you can go back to your old dose for a while and then what I was wondering try again later he replied now t
herewas no way I was going back to my old dose unless I had a better plan for achieve it. withdrawal next time so we just wrote it down and went down another dose at the start of week 3 my world went really dark I basically stopped eating and barely slept thanks to the jitt ers that would keep me squirming all night the worst was worse was the depression the tears that used to feel like a misfire now felt significant several times a day i felt that welling in my chest where you know tears come but i couldn't i didn't stop them and with them came despair and hopelessness I started to believe that I would never recover from either the accident or the withdrawal.
Sadia got on the phone with the prescriber again and this time he recommended that we contact our pain management team from the last hospitalization which sounded like a great idea so we did. we did right away and were surprised no one spoke to us. The receptionist who answered the phone informed us that the pain management team provides an inpatient service, although they prescribed Opie forms for pain relief. control they don't monitor reduction and withdrawal furious we called the prescriber and begged him for anything he could help me but instead he apologized s saying it was out of his deep point of view he told us my initial advice that it was clearly bad , so my official recommendation is for Travis to go back on the drug until he can find someone more confident to wean him off, of course he wanted to get back on treatment.
I was in agony, but I think if I saved myself from drug withdrawal, I would never be drug free, so we buckled down and I dropped the last dose as my brain experienced life without prescription opioids for the first time. time in months i thought i would die i assumed i would die i'm sorry because if the symptoms didn't kill me outright i would kill myself and i know that sounds dramatic because for me to be here years later whole and healthy for me it sounds dramatic but i thought it was my core because I no longer had any hope of being normal again.
The insomnia became unbearable and after two days with virtually no sleep, I spent a whole night on my basement bathroom floor. between cooling my feverish head against the ceramic tiles and trying to vomit violently despite not having eaten anything in days when Saudi found me at the end of the night I was horrified and we got back on the phone we called everyone we called surgeons and pain Doctors and GPs anyone we could find on the internet and none of them would help me the few we could talk to on the phone advised us to go back on the medication an independent pain control clinic said they prescribe opioids but don't monitor tapering or withdrawal when my desperation was clearly through my voice as now the receptionist took a deep breath and said Mr.
Reeder, it looks like maybe what you need is a rehab center or a methadone clinic. I didn't know any better at the time, so I took his advice, hung up, and started calling those places, but it took me next to no time to find out that many of these facilities are geared toward those struggling with substance use disorder. in the long-term in the case of opioids, this often means precisely not taking the patient off the medication, but rather transitioning to the safer long-acting opioids, methadone or buprenorphine, for maintenance treatment. Plus every place I called had a long wait ready I just wasn't the type of patient they were designed to see after I was turned away from a rehab center I finally admitted defeat I was broken and bruised and couldn't do it any more, so I told Sadia I was going back on the medication, starting with the lowest dose possible and taking only the amount absolutely necessary to escape the more paralyzing effects of withdrawal, so that night she helped me up the stairs and first time in weeks i actually went to bed they took the little orange prescription bottle put it on my nightstand then left it untouched i fell asleep slept through the night and when i woke up the most severe symptoms had subsided dramatically i made it thanks for that that was my response to sorry i have to pull myself together a bit i think the story is important it's not because i think i'm special this story is important preci Simply because I'm not special because nothing that happened to me was so unique my opioid dependency was totally predictable given the amount I was being prescribed and the duration for which I was prescribed dependency is simply the brain's natural response to an opioid rich so there was every reason to think that he would need a well-formed, supervised reduction plan from the start, but apparently our healthcare system hasn't decided who is responsible for patients like me.
The prescribers saw me as a complex patient who probably needed specialized care. of pain medicine pain The doctor saw that his job is to control pain and when I couldn't get off the medicine, they saw me as the field of addiction medicine but addiction doctor ine is too stressed and focused on those who suffer long-term substance use disorder, in short, I was prescribed a drug that needed long-term management and then they didn't give me that management and it wasn't even clear whose job it was that management is a prescription for the disaster and any such disaster would be interesting and worth talking about, probably worth a TED talk, but the failure of opioid phase-out is a particular concern right now in the United States because we're in the middle of of an epidemic in which 33,000 people died. overdose in 2015 almost half of those deaths involved prescription opioids actually the medical community has started to react to this crisis but a lot of their response has been to try to prescribe fewer pills and absolutely that's going to be important So, for example, we're now getting evidence that American doctors often prescribe drugs even when they're not needed in the case of opioids, and even when opioids are required, they often prescribe them. needed, these kinds of considerations help explain why the United States, despite representing only 5% of the world's population, consumes almost 70% of the total world supply of opioids, yet focuses only on the risk ratio of prescription and misses two crucially important points: First is that opioids are and will continue to be important pain therapies as someone who has had severe pain. tense and durable.
I can assure you that these drugs can make life worth living and second, we can still fight the epidemic while judiciously prescribing opioids to people. that they really need them demanding that doctors properly handle the pills they prescribe, for example, go back to the tapering regimen they gave me. Is it reasonable to expect any doctor who prescribes opioids to know that's too aggressive long after I initially published my story in an academic journal someone from the CDC sent me their pocket guide to tapering off opioids this is a four-page document most of his pictures teaching doctors how to gradually reduce opioids in the easiest cases and one of his recommendations is to never start with a dose reduction of more than 10% per week if my doctor had given me that my plan the reduction would have taken several months instead of a few weeks.
I'm sure it wouldn't have been easy, it probably would have been pretty uncomfortable, but maybe it wouldn't have been hell and that seems like the kind of information someone prescribing this medication should have. In closing, I have to say that proper management of prescription opioids do not resolve the crisis on their own. America's epidemic is much bigger than that, but when a drug is responsible for tens of thousands of deaths a year, reckless handling of that drug is indefensible. helping patients on opioid therapy to come off their prescribed medication may not be a complete solution to our epidemic, but it will clearly be progress, thank you
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