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In Pain: A Bioethicist's Personal Struggle with Opioids

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A bioethicist’s eloquent and riveting memoir of opioid dependence and withdrawal—a 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 Rieder’s terrifying journey down the rabbit hole of opioid dependence began with a A bioethicist’s eloquent and riveting memoir of opioid dependence and withdrawal—a 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 Rieder’s 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 physician’s orders. Over the course of four excruciating weeks, Rieder learned what it means to be “dope sick”—the physical and mental agony caused by opioid dependence. Clueless how to manage his opioid taper, Travis’s 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. Rieder’s 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 America’s opioid problem and their implications for resolving the crisis. Rieder makes clear that the opioid crisis exists against a backdrop of real, debilitating pain—and that anyone can fall victim to this epidemic.


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A bioethicist’s eloquent and riveting memoir of opioid dependence and withdrawal—a 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 Rieder’s terrifying journey down the rabbit hole of opioid dependence began with a A bioethicist’s eloquent and riveting memoir of opioid dependence and withdrawal—a 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 Rieder’s 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 physician’s orders. Over the course of four excruciating weeks, Rieder learned what it means to be “dope sick”—the physical and mental agony caused by opioid dependence. Clueless how to manage his opioid taper, Travis’s 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. Rieder’s 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 America’s opioid problem and their implications for resolving the crisis. Rieder makes clear that the opioid crisis exists against a backdrop of real, debilitating pain—and that anyone can fall victim to this epidemic.

30 review for In Pain: A Bioethicist's Personal Struggle with Opioids

  1. 4 out of 5

    Nikola

    I did a Q&A with Travis for my book blog and if you're interested you can check it out here. You can also find this review on my book blog. 05/21/19 If you’ve been following this blog for a while you’ll know that I tend to read non-fiction books on a variety of different topics. I genuinely enjoy reading non-fiction because I learn a lot of new things about e.g. science, biology, personal struggles of memoir writers etc. What first attracted me to In Pain: A Bioethicist’s Personal Struggle I did a Q&A with Travis for my book blog and if you're interested you can check it out here. You can also find this review on my book blog. 05/21/19 If you’ve been following this blog for a while you’ll know that I tend to read non-fiction books on a variety of different topics. I genuinely enjoy reading non-fiction because I learn a lot of new things about e.g. science, biology, personal struggles of memoir writers etc. What first attracted me to In Pain: A Bioethicist’s Personal Struggle with Opioids was the cover – it’s just so powerful and bang on in showing what the book is mainly about. I just love that! Of course, a reader mustn’t judge a book by its cover but…. it helps when a book has a cool cover you can stare at for hours. Now, for all of you who like short reviews…. well…. this won’t be one BUT I’ll try and make it as on-point as possible. Let’s begin with what the book is about – In Pain: A Bioethicist’s Personal Struggle with Opioids by Travis Rieder is about [you guessed it] Travis Rieder, who winds up getting in a motorcycle accident which lands him in a hospital having to endure a number of surgeries to fix his foot. While staying in hospital he has to take medication to keep his pain away – the medication is a blessing but after several months of being under their influence he realises that something’s not right. Following his doctor’s order he begins to get off the medication – most of us would think ‘Great, now I’m off the meds and I’ll be able to function better’ but that’s not what happened. Rieder went under opioid withdrawal which caused him a lot of pain and suffering. Rieder and his family try every door to get help but every single one seems to be shut. What most doctors suggest to him is that he should go back to the medication and try to get off them later but having endured what he has Rieder knows that it’s not a good idea to go back, instead what he does is something that’s very brave and something that made him a stronger person. What this painful and exhausting experience sets off in Rieder is the search for answers and loopholes in the American healthcare system. What he does in this book is a result of meticulous research on history of opioids, the production of opioids, the effects of opioids, healthcare system and how it’s failing when it comes to prescribing medication and giving needed information to its users and more. What I loved a lot in this book was that even before writing about his experience and other things the author writes a note to the reader saying that he asks of the reader to go into his book with an open mind because some people won’t like what he states in the following pages and some might even disagree.What’s most important is that you go into In Pain without any prejudice because while reading the book you’ll see in what way Rieder presents the subject matter he discusses in each chapter. You can find some talks about his book here and Travis’ TED Talk here. In Pain: A Bioethicist’s Personal Struggle with Opioids will be out on June 18th 2019. I’ve put links where to pre-order it and add it to your TBR below in the Get the book section. So, this is my review in short for those of you who don’t like long reviews – if you wish to know more in the following I’ll be discussing the chapter structure and what each chapters deals with. Thanks for reading and please let me know your thoughts on whether you think you’ll add this one to your TBR! For those who like more lengthy reviews - here you go: In Pain: A Bioethicist’s Personal Struggle with Opioids consists of three parts and an epilogue. When it comes to the beginning of the book we are introduced to Travis and how he ended up in hospital. His accident and his painful journey he’s about to describe to the reader. What I liked is how Rieder doesn’t spoon-feed you his beliefs – as I’ve mentioned before in the review, what Rieder does is asks the reader to go in with an open mind. He’s definitely skilled in writing and describes his situation in a fantastic way which is readable and makes you read on. Moving slowly onto the second chapter, Rieder introduces the reader to Pain 101, basically what pain is and how it’s defined. What caught my attention in this chapter is the pain scale – [I’m describing it in my own words so it might not be completely accurate] the pain scale is a method/scale used by physicians where a physician asks the patient ‘On a scale of 1 to 10, rate your pain’ and the patient provides an answer. Rieder raises a question here how can someone who hasn’t experienced the same amount of pain know anything about the other person’s pain? This is an interesting question because Rieder states the facts – how can someone know other person’s pain and in this case how to treat it? While staying in a hospital Rieder experiences the worst pain of his life and although he went through this torture he did make some use of it because he knew how to differentiate his pain, to be precise, how to rate his pain on the pain scale. He then on goes to discuss pain medicine which deals with how people perceive pain as well as how to turn something that’s completely subjective into something that’s somewhat objective. In the third chapter Rieder presents the history of opium – from its origin to its use and more. What struck my attention the most is the part where he discusses pain as the fifth vital sign. I find this to be very interesting because I haven’t come across this kind of thinking. Rieder says that ‘the basic claim is that pain is not merely a symptom – it is a vital sign akin to heart rate, respiration, temperature, and blood pressure and should be similarly monitored’ [pg. 58). This is something that’s very interesting and important – a physician should definitely check his patients pain levels in order to give her/him adequate treatment. In this chapter, Rieder also discusses how people as well as societies were mislead during the making of opioids, to be precise, in the times when new drugs were being introduced to the public. There are many loopholes when it comes to the whole approving-of-the-drugs. In a chapter called The Opioid Dilemma [chapter 4] Rieder presents us with an example of a doctor-patient visit regarding prescription of an opioid. He describes two cases and weaves through stereotypes as well as prejudice and asks the reader a question ‘How would you react in this case?’. The two cases are about one patient: white, male, well-dressed, tired because of working too hard who asks a doctor for opioids because of back pain and the other patient is black, not well dressed,tired and also seeking opioid medication. He then poses a question of who would you [doctor or the reader of the book] more likely prescribe an opioid to? Will this decision be made by your objective assessment of the person or will your subjective side [prejudice, stereotypes] take hold and make that decision for you? The whole chapter deals with the question How does one treat a drug seeking patient? Do we believe them or not? Based on what does a person prescribe a drug to someone? The fifth chapter is a tough one because it deals with Rieder getting off of opioids and struggling while doing that. Rieder and his wife Sadiye have realised that there’s something they must do in order to fully get him off of opioids. I loved this chapter a lot. When it comes to the sixth chapter Dependence and Addiction, Rieder states many valid points when it comes to the drug patient crisis where a physician who prescribes such drugs must know how to fully deal with them. What most physician don’t do is fully advise their patients either because lack of knowledge or simply because of being over-worked. What’s important to note is that each individual’s brain chemistry is different as well as their reactions to drugs – one might succumb to addiction whilst the other might not. Rieder also discusses how isolation can drive a person towards becoming an addict – where his society for example won’t accept her/him which can cause this reaction. In the seventh chapter What Doctors Owe Patients, Rieder raises a question of how a doctor should react to prescribing of opioids. What doctors need to realise is that patients are experiencing a lot of pain and should react accordingly to that. He gives us an example of two cases where people lost their lives because of not getting the correct opioid treatment and medical treatment. Ninth chapter deals with Rieder’s recovery and here Rieder shares what he went through with physical therapy and overall trying to heal and against all odds show that he can and will walk again without using crutches. He shines a light on how important it is to share one’s story with the world because other people can hear it and will know what to do in these situations if they ever end up in them. In the chapter titled Pain, Drugs, and Doing the Right Thing. Rieder suggests that stopping overprescribing won’t stop the opioid crisis but rather help doctors/clinicians manage pain of their patients more efficiently. Every patient deserves the best care possible. Rieder writes that clinicians need to get more and better educated on pain as well as patient pain because it’s the only way of stopping what’s happening all over America – inadequate care of patients which causes many problems. Tenth chapter deals with the three opioid epidemics which according to Rieder are [in chronological order]: 1. Old Heroin epidemic ; 2. Prescription crisis and 3. Opioid epidemic [which is the current one]. He then begins to discuss each of them but what stood out to me was the part where Rieder talks about overdose and where he says that in order to deal better with overdosing, what needs to be done is the following: creating more facilities which offer help to users. In terms of clean needles, sites where to inject [heroin for example] safely instead of the streets. Rieder says that drug use isn’t bad which is something I find questionable – but he does provide examples of coffee, energy drinks which can also be classified as addictive substances. In the epilogue Rieder discusses many things among which stood out the following: he went to veteran doctors who gave him insights into alternative medicine where one doctor introduced him to acupuncture. This is very interesting and something I enjoyed reading about. What’s hopeful about today is that there is a revised pain scale with more question regarding pain which introduces four different considerations: activity, stress, mood and sleep. I believe that this will provide much better insight to physicians when it comes to the treatment of pain. In Pain: A Bioethicist’s Personal Struggle with Opioids is a fantastic exploration of opioids, the effect they have on the body, the issues America and its healthcare system face when it comes to prescribing and a personal experience of opioid withdrawal. If you’re a person who enjoys reading about social issues, memoirs and getting more educated then this is the book for you! I will leave you with this quote from the book that I found interesting: ‘Life hurts – quite a lot for some of us – but not all of those pains require pharmacological intervention’ (pg. 246). If you’ve come to the end of this review I want to say a huge thank you for taking the time to read it. I really enjoyed reading this book and hope that my review shows that. Thank you again. I would like to thank the publisher Harper Books for my free advance reader’s copy of this book in exchange for an honest review. Also a special thank you to the author for being amazing and helping clear few things up. All opinions written here are my own and weren’t influenced by the fact that I got it for free from the publisher. ------------- In Pain: A Bioethicist's Personal Struggle with Opioids is such a fascinating exploration of the opioid epidemic still plaguing America as well as a raw and real personal story of Rieder and his struggles with the health care system and dependence on opioids. The book comes out in June, to be precise, 18th June. If you're someone who loves reading non-fiction and stories that make you think and learn then 'In Pain' should be on your to-be-read list. Full review to follow.

  2. 5 out of 5

    Tracy Miller

    This book was an important and enjoyable read, and the topic is quite serious. I appreciated the author's candid account of his own experiences with prescription opioids in the context of recovery from a serious injury. I thought he did a good job of treating those in the medical profession fairly while also calling attention to a serious gap in pain management in America. Given that the author is a philosopher, it makes perfect sense that his treatment of the topic was thoughtful and nuanced. I This book was an important and enjoyable read, and the topic is quite serious. I appreciated the author's candid account of his own experiences with prescription opioids in the context of recovery from a serious injury. I thought he did a good job of treating those in the medical profession fairly while also calling attention to a serious gap in pain management in America. Given that the author is a philosopher, it makes perfect sense that his treatment of the topic was thoughtful and nuanced. I found this book to be both well-written and well-paced. I look forward to reading more from this author!

  3. 5 out of 5

    L. Scott

    This book should be mandatory reading for anyone in the U.S. Healthcare system for any length of time, either as provider, insurer, or patient. Primarily a research paper worked into a book for the layman into the roles and responsibilities doctors and other health care workers have (or ought to have) in managing pain and managing pain medication. The author's personal introduction to the topic via a motorcycle accident and his subsequent treatment played a pivotal role in this book getting writ This book should be mandatory reading for anyone in the U.S. Healthcare system for any length of time, either as provider, insurer, or patient. Primarily a research paper worked into a book for the layman into the roles and responsibilities doctors and other health care workers have (or ought to have) in managing pain and managing pain medication. The author's personal introduction to the topic via a motorcycle accident and his subsequent treatment played a pivotal role in this book getting written, and it is featured prominently and movingly throughout the book.

  4. 5 out of 5

    Erin

    SO informative, well researched, and well written. While it got a bit technical and long in the end, I'm so glad I read this book and learned so much about this epidemic.

  5. 4 out of 5

    Marcus Hedahl

    This is the kind of book that comes along only very rarely. It is both a first-personal, non-fictional account written with the eloquence and imagery of great fiction and an educated and thoughtful reflection on significant policy debates that are constantly on the front pages of the nation’s newspapers. The book somehow seamlessly accomplishes both tasks, clarifying the complex without sacrificing nuance. It is an eloquent and riveting account of opioid dependence that deftly integrates history This is the kind of book that comes along only very rarely. It is both a first-personal, non-fictional account written with the eloquence and imagery of great fiction and an educated and thoughtful reflection on significant policy debates that are constantly on the front pages of the nation’s newspapers. The book somehow seamlessly accomplishes both tasks, clarifying the complex without sacrificing nuance. It is an eloquent and riveting account of opioid dependence that deftly integrates history, philosophy, policy, and narrative in order to provide a new way of considering one of the defining crises of our age. Regardless of how much you know about one of the greatest epidemics in American history (and the numbers are staggering: more dead in one year than in any year at the height of the AIDS epidemic, more dead in one year than the total American dead during the whole of the Viet Nam War), this book will change the way you look at that crisis.

  6. 4 out of 5

    Haley

    This review has been hidden because it contains spoilers. To view it, click here. I would have given this book three stars, but it went on and on and on and on. This book should have been a 150 page book and it should have been more condensed with his side of how opioids have affected him, as well as his research and the history of pain. The book overall, was too much information packed into one book. Don't get me wrong, some of the research and history were informative, however after chapter eight, there was more information and more and more and then it continued and contin I would have given this book three stars, but it went on and on and on and on. This book should have been a 150 page book and it should have been more condensed with his side of how opioids have affected him, as well as his research and the history of pain. The book overall, was too much information packed into one book. Don't get me wrong, some of the research and history were informative, however after chapter eight, there was more information and more and more and then it continued and continued.

  7. 4 out of 5

    Kathy (Bermudaonion)

    4.5 stars

  8. 4 out of 5

    Brian

    This book helped me understand the tragedy that is America’s opioid epidemic. It also taught me how lucky I’ve been in my life to have never needed opioids. From the individual perspective—how one can so easily become dependent on opioids—to the societal view—how this national tragedy happened—Travis Rieder has written a very important book. He takes us through his personal journey of horror and the historical and economic reasons that these pain meds so quickly engulfed our country. The book pr This book helped me understand the tragedy that is America’s opioid epidemic. It also taught me how lucky I’ve been in my life to have never needed opioids. From the individual perspective—how one can so easily become dependent on opioids—to the societal view—how this national tragedy happened—Travis Rieder has written a very important book. He takes us through his personal journey of horror and the historical and economic reasons that these pain meds so quickly engulfed our country. The book provides many important lessons. Perhaps the most important is: If a well-educated bioethicist like Rieder can be ensnared in opioid dependency, it can clearly happen to all of us. And all of us need to demand solutions.

  9. 4 out of 5

    Travis Lupick

    This is not a review but is based on an interview I had with the author. It was originally published in the Georgia Straight newspaper. Travis Rieder has bleak outlook on the current state of America’s overdose crisis. The author of In Pain: A Bioethicist’s Personal Struggle With Opioids told the Straight that not only have authorities failed to reduce deaths, they’re also badly hurting people with their attempts. In a telephone interview, Rieder explained that the epidemic that killed some 72,000 This is not a review but is based on an interview I had with the author. It was originally published in the Georgia Straight newspaper. Travis Rieder has bleak outlook on the current state of America’s overdose crisis. The author of In Pain: A Bioethicist’s Personal Struggle With Opioids told the Straight that not only have authorities failed to reduce deaths, they’re also badly hurting people with their attempts. In a telephone interview, Rieder explained that the epidemic that killed some 72,000 people in America in 2017 and roughly 4,000 in Canada was once largely driven by prescription opioids. And so regulators and law enforcement cracked down on doctors overprescribing addictive pain medications like OxyContin and Dilaudid. The problem, Rieder said, is that authorities continued with that response after it stopped working and despite its negative unintended consequences. “We did actually slow overdose deaths from prescription opioids,” he noted. “But it didn’t slow the opioids crisis. It actually exacerbated it. “Overdose-death rates have skyrocketed since then, and now we have this heroin and illicit-fentanyl crisis,” Rieder emphasized. The crackdown on prescription painkillers has left doctors significantly less likely to prescribe opioids to patients who truly need them, he continued. “We’re sort of in the worst possible moment here when you think about the Venn diagram of pain, opioids, and the opioids crisis,” Rieder concluded. “We made everything worse without solving anything.” America is not experiencing an overdose crisis, Rieder thus maintained. Rather, it is a “crisis of pain management”, where people who need opioids are not receiving them and are left in pain, and people who do not need opioids have found too many and are dying of overdoses. Rieder is uniquely qualified to reassess America’s opioid epidemic and critique the government’s response. In addition to his work as a bioethicist at Johns Hopkins University, where he’s a research scholar and director of the school’s master of bioethics program, he has struggled with opioids himself. As he recounts in In Pain, which hits bookstores Tuesday (June 18), Rieder was badly injured in a 2015 motorcycle accident. His left foot was crushed between his bike and a van, requiring a half-dozen surgeries and sending Rieder through many facets of the health-care system that he had spent his career studying as an academic. The pain was often unbearable and, in different combinations at various times, Rieder received morphine, OxyContin, immediate-release oxycodone, hydromorphone, and fentanyl. He describes these opioid-based medications as a godsend, but one which, for some people, comes with great risk. Rieder never became addicted to opioids. He didn’t crave the warm sense of euphoria that drives so many to seek street drugs like heroin. Rieder became dependent on the opioid medications that doctors prescribed for his injured foot. When he began to reduce his intake of the drugs, he felt torturous physical and mental symptoms, becoming ill, severely agitated, and depressed. The excruciating experience is meticulously documented over 21 pages. “For me, the sickness started within a day of the first missed dose,” he begins in the book. “The flu-like symptoms dialed up in intensity to a level that I really didn’t think was possible,” he writes about day six. “I would sweat profusely while lying in the cold of the air conditioning; and yet, if I managed to force myself outside, I would be covered in goosebumps while sitting in the hot summer sun. “The difficulty sleeping ramped up significantly,” he continues. “I no-longer felt merely alert—I was jittery, and often, if I lied down to really try to sleep, my limbs would start to feel like they needed to be moved; I found myself kicking, squirming, and shaking constantly. The result is that I would spend more and more time just lying on the couch, sweating, shivering, jittery, not sleeping but exhausted.” The following week, Rieder is crawling to the toilet in tears, his stomach heaving but unable to vomit, depressed to the brink of suicide. On the phone with the Straight, Rieder said he shared those moments of such vulnerability because he wants health-care professionals and members of the general public to feel empathy for anyone who is going through something similar. “I got my foot blown apart by a van running into me and the worst moments of my life were not that; they were withdrawal,” he said. “I want people to understand that opioid withdrawal is not ‘uncomfortable’. Opioid withdrawal is enough to drive someone to consider killing themselves.” During those weeks of utter despair, no one would help him. Rieder and his wife repeatedly called every single physician and specialist who had worked on his foot during the preceding months. No one offered a solution. One nurse directed him to a drug-rehab facility. Upon hearing he was now struggling with an addiction, some doctors refused to even speak with him. It was this aspect of Rieder’s long and numerous interactions with the health-care system that stuck with him and led him to write In Pain. In the book, he points out that when a health-care professional does something that causes a negative outcome in a patient, they are generally expected to take ownership of that outcome and provide the patient with a response. “Given that infection is one of the most consequential risks of undergoing surgery, surgeons go to great lengths to minimize the risk and then act quickly on any infection that does occur as a result of the procedure,” he writes. “If an infection does occur and progresses beyond the abilities of the surgeon, she gets infectious disease specialists involved. Surgeons see both harm mitigation and a smooth handoff as part of their responsibility.” Why is it different with addictive pain medications that can lead patients to experience brutal symptoms of withdrawal? “One of the things that we definitely have to do is assign responsibility for patients in a way that helps physicians and clinicians understand where their responsibilities lie,” Rieder said on the phone. “You need somebody within the health-care system to take responsibility for a bunch of work that usually just doesn’t get done.” There is a growing awareness of that need, he added, but how it should be met remains a matter of debate. “We’re probably not going to pay an orthopedic trauma surgeon or a plastic surgeon to do long-term pain-care follow-up, which means there needs to be some kind of creative structural solution that each health-care system or each outpatient centre needs to put somebody into that role,” Rieder said. That’s his ultimate goal with the book, he added. “That it really becomes incumbent on health-care systems to say, ‘Yes, that is totally sensible. We would be to blame if we acted like this wasn’t a problem.’”

  10. 5 out of 5

    Lexie Graham

    Travis Rieder, a bioethicist at Johns Hopkins, was involved in a horrible motorcycle accident that crushed his left foot. Enduring five surgeries in as many weeks, Rieder was prescribed larger and larger doses of opioids as his body developed a higher tolerance to the medications. With conflicting advice from his doctors he eventually began to try tapering off the drugs, discovering that he had developed a dependence that led to an excruciating month of withdrawal. During his withdrawal period h Travis Rieder, a bioethicist at Johns Hopkins, was involved in a horrible motorcycle accident that crushed his left foot. Enduring five surgeries in as many weeks, Rieder was prescribed larger and larger doses of opioids as his body developed a higher tolerance to the medications. With conflicting advice from his doctors he eventually began to try tapering off the drugs, discovering that he had developed a dependence that led to an excruciating month of withdrawal. During his withdrawal period he and his wife discovered that in general physicians were of no help in the management of the effects of opioids that they prescribed. One doctor suggested that he go back to a low dose but Rieder was afraid that if he did he'd never get off the drugs because he couldn't go through the process again. On the brink of doing just that he began to feel better. The professional part of him began to think about what he had gone through, the lack of responsibility of the medical profession and the proliferation of drugs pushed by the large drug companies. Interspersed with his personal story is the story of opioids, the companies that produce them and how these drugs have devastated so many lives. He discusses how patients fall through the cracks, many becoming dependent or addicted to medications prescribed to them and who are then are cut off without any management of these drugs. Too many times this leads many of those who have become addicted to illegal sources for the prescription drugs or to the cheaper and often dangerous use of heroin. Rieder points out that the training for veterinary medicine is much more extensive in the area of pain management than that of medical schools. A timely work. .

  11. 5 out of 5

    John Ahrens

    Travis Rieder’s In Pain is essential reading for anyone who has to confront debilitating pain, either their own or someone else’s. And it is even more so for anyone who wants to understand the opioid crisis that is an unwanted consequence of contemporary medical practices. Professor Rieder is adept at finding the universal in the particular, and at explaining abstract philosophical issues in ways that connect them to very common and mundane problems. His account of his own experience with medica Travis Rieder’s In Pain is essential reading for anyone who has to confront debilitating pain, either their own or someone else’s. And it is even more so for anyone who wants to understand the opioid crisis that is an unwanted consequence of contemporary medical practices. Professor Rieder is adept at finding the universal in the particular, and at explaining abstract philosophical issues in ways that connect them to very common and mundane problems. His account of his own experience with medically induced opioid dependence illustrates the problems of pain treatment in a way that is emotionally quite powerful. He provides an intriguing analysis of these problems (and why it will be quite difficult to solve them) by looking at them through the lens of traditional philosophical discussions of personal responsibility and the limits of knowledge. And throughout, he avoids simply casting blame on doctors or patients or the pharmaceutical industry, focusing instead on the features of our contemporary medical system that create and perpetuate the opioid crisis. Professor Rieder’s book offers no easy approach to resolving the opioid crisis, or to the problem of treating pain. But his book provides an excellent framework for considering the difficult approaches that are needed.

  12. 5 out of 5

    Nancy

    In 2015, Bioethicist Dr. Travis Rieder went for a simple motorcycle ride and was sideswiped by another vehicle. In an accident that changed his life, his foot simply exploded into a bunch of bony, bloody pieces that the doctors doubted that they could fix. He underwent a number of surgeries and became hopelessly addicted to opioid painkillers along the way. Rieder recounts his struggles with addiction with equal strains of humor and pathos. He also traces the history of opiates in the medical ma In 2015, Bioethicist Dr. Travis Rieder went for a simple motorcycle ride and was sideswiped by another vehicle. In an accident that changed his life, his foot simply exploded into a bunch of bony, bloody pieces that the doctors doubted that they could fix. He underwent a number of surgeries and became hopelessly addicted to opioid painkillers along the way. Rieder recounts his struggles with addiction with equal strains of humor and pathos. He also traces the history of opiates in the medical marketplace, how so many people get so addicted, and possible solutions to the sweeping national epidemic. This book was a really quick read for me; I like books that are medical and about current events. About 1/3 to 1/2 of the book was the personal narrative of the author's medical issues and of those close to him. The remainder of the book is about opiates on a national scale. He addresses the history of them in America, how doctors fail the public by prescribing them, and possible solutions that have worked in various countries. This is an important issue for patients and physicians alike and food for thought next time you go to the doctor.

  13. 4 out of 5

    Kristina

    A slightly different take on the opioid epidemic. This book focuses less on the history of the epidemic and how it came to pass (I recommend the excellent “Dreamland” for that) but focuses on the author’s journey of being prescribed opioids after a horrific accident and then trying to get off them. He also brings into the discussion the ethics of opioid prescription, as he is a bioethicist by trade. I had heard an interview with him on Fresh Air so was intrigued by this. He discusses the pretty A slightly different take on the opioid epidemic. This book focuses less on the history of the epidemic and how it came to pass (I recommend the excellent “Dreamland” for that) but focuses on the author’s journey of being prescribed opioids after a horrific accident and then trying to get off them. He also brings into the discussion the ethics of opioid prescription, as he is a bioethicist by trade. I had heard an interview with him on Fresh Air so was intrigued by this. He discusses the pretty horrific withdrawal process he goes through when he tries to wean himself off his medication and how no one wants to take ownership of guiding him through this process. Doctors will prescribe but don’t want to deal with the management and tapering off. Fascinating. Also touched briefly (but wished more) on how this epidemic has gotten all the attention and decriminalization when it’s white rural and suburbanites when there were significant opioid issues in urban communities with strong law enforcement tied to it. This epidemic is rife with ethical dilemmas. This just begins to skim the surface.

  14. 4 out of 5

    Jean

    In Pain is a gripping account of the author’s personal journey through traumatic injury that resulted in multiple surgeries requiring opioid use to manage legitimate pain. MANY readers are going to be able to relate to Dr. Rieder’s experience. In fact, I would anticipate that ALL readers have an opioid use story to tell; whether by personal injury/surgical experience, or the experiences of friends or family. There is a particularly strong feeling of shame that some may feel when experiencing thi In Pain is a gripping account of the author’s personal journey through traumatic injury that resulted in multiple surgeries requiring opioid use to manage legitimate pain. MANY readers are going to be able to relate to Dr. Rieder’s experience. In fact, I would anticipate that ALL readers have an opioid use story to tell; whether by personal injury/surgical experience, or the experiences of friends or family. There is a particularly strong feeling of shame that some may feel when experiencing this struggle so I believe that many keep their experience to themselves out of pure embarrassment. Dr Rieder concurs with that. The most profound take-away for me in reading this book is learning the difference between “dependence” and “addiction”. What is the medical community’s (particularly the prescriber’s) ethical obligation in these cases? This book is excellent and written from a very credible perspective. I’ll be purchasing my own copy to use as a reference. I’m thankful to my public library for adding this title to the non-fiction collection.

  15. 5 out of 5

    Jennie

    Should be mandatory reading for all medical workers or anyone involved with making public policy. There have been a lot of great in depth looks at the most recent opioid crisis in America, but In Pain brings a new and much needed perspective to the table. Rieder interweaves his personal story of trauma and opioid dependency in with his bioethical research, creating something insightful and moving. He delves deep into the nuances of the crisis, examining how complicated and morally fraught fighti Should be mandatory reading for all medical workers or anyone involved with making public policy. There have been a lot of great in depth looks at the most recent opioid crisis in America, but In Pain brings a new and much needed perspective to the table. Rieder interweaves his personal story of trauma and opioid dependency in with his bioethical research, creating something insightful and moving. He delves deep into the nuances of the crisis, examining how complicated and morally fraught fighting the epidemic really is. This is certainly a book that will be sitting with me for a long while and has influenced the way I'll look at future pain treatment for myself and my family. Pick this one up, it's a good one. CW for discussions of suicide

  16. 5 out of 5

    Danielle

    "Patients aren't data points in a study. Patients are the living, breathing, unique individuals standing in front of their doctor." "People are valuable and deserving of dignity, and that doesn't change if they choose to take drugs. After all, most of us take drugs..." "Life hurts-quite a lot for some of us- but not all of those pains require pharmacological intervention." " demanding isn't the kind of thing that we do when we're complacent. We demand when we're angry and uncomfortable-when we feel "Patients aren't data points in a study. Patients are the living, breathing, unique individuals standing in front of their doctor." "People are valuable and deserving of dignity, and that doesn't change if they choose to take drugs. After all, most of us take drugs..." "Life hurts-quite a lot for some of us- but not all of those pains require pharmacological intervention." " demanding isn't the kind of thing that we do when we're complacent. We demand when we're angry and uncomfortable-when we feel the urgency of a situation."

  17. 4 out of 5

    Andrea

    I've read several books on the opioid crisis, health care, and addiction so this book wasn't groundbreaking for me. However, it did underscore the importance of changing the way healthcare and health insurance works in the United States. As the author put it so eloquently, it's so cheap and easy to prescribe a pill for pain that the alternate options are rarely pursued - especially because they tend to be expensive (not covered by insurance), time-consuming (requiring time spent on exercises), o I've read several books on the opioid crisis, health care, and addiction so this book wasn't groundbreaking for me. However, it did underscore the importance of changing the way healthcare and health insurance works in the United States. As the author put it so eloquently, it's so cheap and easy to prescribe a pill for pain that the alternate options are rarely pursued - especially because they tend to be expensive (not covered by insurance), time-consuming (requiring time spent on exercises), or hard (changing habits or doing physical therapy is hard work).

  18. 5 out of 5

    John McClarnon

    I highly recommend checking out this book. If you don’t think you know anyone impacted by this topic, then you probably have your head in the sand. This is an issue that likely impacts one of your friends or loved ones even if you are currently unaware of his/her struggles. If anything else, you may learn something new and gain new perspective. Travis Rieder does a great job describing in gripping detail how any of us or our loves ones can be impacted by flaws in our healthcare system, how we ca I highly recommend checking out this book. If you don’t think you know anyone impacted by this topic, then you probably have your head in the sand. This is an issue that likely impacts one of your friends or loved ones even if you are currently unaware of his/her struggles. If anything else, you may learn something new and gain new perspective. Travis Rieder does a great job describing in gripping detail how any of us or our loves ones can be impacted by flaws in our healthcare system, how we can take action, and how you can prepare yourself if you are in a similar situation.

  19. 4 out of 5

    Emily

    Required reading for all health care professionals —clinical, academic, or policy-focused. In Pain covers the history of the United States’ opioid crises through the lens of a bioethicist who struggled personally with opioid dependence after a serious traumatic injury in 2015. The book makes both compelling moral and policy arguments for minor changes and radical changes in the U.S. health care system. Readers will finish this book with a better-informed, recalibrated urge to act and educate oth Required reading for all health care professionals —clinical, academic, or policy-focused. In Pain covers the history of the United States’ opioid crises through the lens of a bioethicist who struggled personally with opioid dependence after a serious traumatic injury in 2015. The book makes both compelling moral and policy arguments for minor changes and radical changes in the U.S. health care system. Readers will finish this book with a better-informed, recalibrated urge to act and educate others about the current opioid epidemic.

  20. 4 out of 5

    Pam Martinolich

    An infuriating book that shows the gigantic holes in our health care system. Difficult to read in places but well done - you can certainly feel the author's anguish as he drifts through the drugged fog of post-traumatic injury trying desperately to find someone - anyone - who can guide him through the stormy waters of painkiller withdrawal. Our system is designed to relieve pain at any cost. The aftermath is an afterthought.

  21. 4 out of 5

    Ann

    I highly recommend this book for anyone going through surgery or in constant pain or anyone who wants to know more about the opioid "epidemic". While it centers on the author's own painful withdrawal after a traumatic injury to his foot in a motorcycle accident, it is a historic education into the use of pain drugs through history, other drug "epidemics" and how we got to the current crisis. Good read all around.

  22. 5 out of 5

    Carolyn D'Argenio

    WOW. I appreciate this book on many levels. It’s well written, with clear and compelling evidence. It looks not only at the author’s personal experience with opioid dependency, but it also includes a more systemic view of our “current” opioid crises (intentionally plural) and offers ways to move forward with logic, fairness, responsibility, and empathy.

  23. 4 out of 5

    Joann

    I had heard part of an interview with the author on NPR radio. Intrigued , I ordered the book from the local library. Brutally honest. An eye opening read. Mismanagement of pain medications with lack of support and/or resources is an issue when the author is asking for help.

  24. 5 out of 5

    Lisa

    No one expects to becomes addicted to opioids, especially those prescribed by a doctor after a traumatic physical injury. Reider’s experience strikes home the importance of knowledge of pain management and a medically supervised program to wean from opioids used in pain management.

  25. 5 out of 5

    Kathy Jackson

    THIS book is a MUST read for all healthcare providers. Seriously! We need to think through not those who prescribe, but those who administer opioids to patients and then do not educate on the consequences. I love that the Bioethicist author looks at this issue from all sides.

  26. 4 out of 5

    Lisa Macke

    One of the best books I have read in a very long time. Anyone who is having surgery, has an injury, or has been taking opioids for a while or knows someone who falls into any of these categories should read this. In other words, EVERYONE should read this.

  27. 4 out of 5

    Joannie Johnston

    If you know anyone affected by opioids, read this. If you have ever been prescribed opioids, read this. If you have ever experienced pain, read this. Makes a lot of things make a lot of sense. What a horrible thing capitalism has done to America.

  28. 4 out of 5

    Bonnie

    Wow. What an unbelievable insight into this man's journey. Just when the pain of injury and multiple surgeries is brought under control after months of agony, then the real hell of the reality of withdrawal sets in.

  29. 5 out of 5

    Veronica Trau

    This book reminded me of “The Omnivore’s dilemma, except with opioids instead of corn as the main ingredient.

  30. 5 out of 5

    Emily Kennard

    More history and philosophy behind pain (still interesting) less a narrative story. It’s all very useful and necessary info.

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