Imagine having your foot pinned between a moving van and a motorcycle and subsequently undergoing five surgeries to restore function to your mangled limb over a 1-month period. In order to endure the debilitating pain, you are prescribed high doses of opioid analgesics, only to discover that your care team has no exit strategy. Feeling abandoned by the medical establishment, you decide to subject yourself to a process of aggressive self-tapering and subsequently experience a gruesome withdrawal. Travis Rieder tells such a story—his story—in his new book, In Pain: A Bioethicist’s Personal Struggle with Opioids.

In Pain situates Rieder’s traumatic experience within the context of North America’s “triple wave” opioid overdose crisis (1). As he explains, high prescribing volumes and aggressive marketing of opioids such as OxyContin initiated the crisis in the 1990s and 2000s. When their opioid prescriptions stopped or were scaled back, some patients turned to illicit sources. Most of the tens of thousands of overdose deaths that occurred in the United States and Canada within the past several years were due to a toxic street supply of heroin and fentanyl analogs.

Although opioid prescribing rates have fallen in recent years, the ethics of how and when these drugs are administered is still relevant. As Rieder shows, patients on long-term opioid therapy may be harmed when subjected to forced opioid tapering. And not prescribing an opioid when one is needed can be harmful as well.

…continue reading ‘A Bioethicist’s Harrowing Encounter with Prescription Painkillers Highlights Systemic Health Care Problems’

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