Unless you’ve been living under a rock (or a non-US country, in which case, lucky you!), you likely know that there’s a massive opioid epidemic going on here in the US and has been for over a decade now. Doctors overprescribe, patients get hooked, and little by little, whole towns have been devastated because of this dependence on opioids. But that’s not the whole story, and in his book In Pain: A Bioethicist’s Personal Struggle with Opioids (Harper, 2019), Dr. Travis Rieder unveils his own struggle with opioids and the underlying problems the US has that have created and continue to sustain this crisis. As a person who suffers from chronic pain with periods of acute pain caused by flares of various sorts, I’ve taken opioids before, and they scare me, so I knew this book was something I needed to read.
Travis Rieder’s life was going perfectly fine – great wife, beautiful baby daughter, a new job – until a motorcycle accident in 2015 that crushed and partially degloved his left foot changed everything. His doctors referred to his foot as ‘a salvage situation,’ his injuries were that severe. After five surgeries in five weeks and a lengthy hospital stay, Rieder was on a substantial amount of opioid pain medication – a necessary amount at first, to be sure, after an injury of that caliber. But when it came time to decrease his dosages, none of his doctors knew what to do, and none of them would take responsibility for helping him through what turned out to be an absolutely horrific withdrawal process lasting over a month and getting increasingly worse throughout that time before it got better.
Shaken by his experiences and feeling the societal shame that goes with dependence/addiction (there’s a different that he explains!), it takes Travis Rieder a while before he’s able to speak up about what happened and his suspicion that something went very, very wrong. And as he learns, his experiences weren’t uncommon. Taking a deep dive into America’s history and ongoing problem with opioids and pain control, Dr. Rieder illustrates the urgency of this problem and the steps we must take – the steps we absolutely, 100% lack the political will to take – in order to fully conquer this crisis.
What a remarkable book. Dr. Rieder’s description of what opioid withdrawal put him through alone was enough to make this a five-star read. During my last major flare, a nurse practitioner sent me home with a muscle relaxer (which I occasionally need for spasms; I only ever treat the worst of these) and a very small amount of what I think was Tylenol with codeine (of which I still have like half of the bottle left). All of this was to get me through until the next week, until my appointment with my physiatrist, who immediately put me on the schedule for a steroid epidural (which helped so much…until I mangled something else in my back and needed it redone a month later). Before this, it was about a decade before I’d received opioids for another acute flare (which took about ten weeks until I could walk normally, without a cane, and without dragging my leg behind). I could absolutely sense the danger in that Vicodin; it took away the awful pain, but it also made me feel deliciously relaxed and floaty, and that’s not something I want to get used to. There are BOOKS TO READ. THINGS TO DO. I don’t have time to sit around floating like that, and I knew I had to do whatever it took to NOT need those meds as much as possible. Fortunately for me, my doctor had also prescribed steroids, and by day three, the steroids had taken the swelling down enough that my pain had dropped to a level low enough that I could tolerate it with my normal Celebrex.
That experience alone, though not the first time my back had gone bad, was enough to scare me away from opioids, and it’s why I knew I needed to read this book. Dr. Rieder’s story is absolutely terrifying, and I never, ever want to go through what he went through while in withdrawal. This convinced me that any future use of opioids for acute pain (especially if I ever need surgery) will have me asking my doctor what the plan is to get me off those meds, and how soon.
Dr. Rieder delves into things I hadn’t considered before, such as the difference between dependence and addiction, and the societal shame surrounding both. He does mention the racial issues of the opioid crisis: why was this not a crisis when it was black folks dying of heroin use in the inner cities, but it’s a crisis now that white folks are? (Racism, obvs, and this is very much something we need to have in the forefront of our minds when it comes other present and future crises), which I appreciated. He also discusses our attitude toward pain and how living with zero pain is unrealistic, and how that’s something we all need to think about. That’s a truth I long ago accepted for myself, and while it takes a while to get there, it IS possible. And what I really appreciated most about this book: Dr. Rieder absolutely understands how unrealistic the solutions to this crisis are. We don’t care enough about each other. We don’t have the political will. We look at drug addiction and dependence as a moral failure, instead of a health condition, and thus we look at addicts as people who made a personal choice to place themselves in a bad situation, and we don’t want our tax dollars going to that. We also don’t want our money going towards a socialist, healthcare-for-all system, and thus the more expensive solutions, like extensive physical therapy for pain control, etc., are only available to wealthier patients; the rest get prescriptions for opioids, which can cost pennies per pill. As a nation, we’ve built a system set up for failure, Dr. Rieder argues, and now we’re sitting here wringing our hands over it while rejecting all the solutions.
In Pain isn’t necessarily a hopeful book, but in the right hands, it could very much be an eye-opener that gets the ball rolling. I hope that’s the case. We all deserve better.