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In Pain: A Bioethicist's Personal Struggle with Opioids
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 in America 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.
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 in America 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.
299 pages, Hardcover
First published June 18, 2019
195 people are currently reading
2,577 people want to read
About the author
Travis Rieder
3books40followersTravis Rieder was born and raised in Indiana, after which he has slowly and steadily moved eastward. After completing his BA at Hanover College in southern Indiana, he moved to South Carolina to do an MA in philosophy. He then did a PhD in philosophy at Georgetown University before taking a faculty position at Johns Hopkins, where he currently teaches.
Travis’s writing is wide-ranging, but took a sharp turn in 2015 after a motorcycle accident and a traumatic experience with pain and pain management that resulted. Since that experience, he has worked to turn his intimate struggle with opioid painkillers into a research program and a mission to reduce harm from irresponsible prescribing. IN PAIN, published by HarperCollins in June 2019, combines his personal story with fascinating and disturbing facts about the history of pain and opioid use, the American healthcare system, and suggestions for how the tide can be turned on the interlocking epidemics of pain, opioids, and addiction.
Travis’s writing is wide-ranging, but took a sharp turn in 2015 after a motorcycle accident and a traumatic experience with pain and pain management that resulted. Since that experience, he has worked to turn his intimate struggle with opioid painkillers into a research program and a mission to reduce harm from irresponsible prescribing. IN PAIN, published by HarperCollins in June 2019, combines his personal story with fascinating and disturbing facts about the history of pain and opioid use, the American healthcare system, and suggestions for how the tide can be turned on the interlocking epidemics of pain, opioids, and addiction.
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February 5, 2020
This is a fascinating book and one I would recommend to anyone trying to better understand the opioid crisis and addiction in general. The author writes honestly and in a way that felt compassionate and informative at once. He is frustrated, but does not easily cast blame, though he must have gone through hell. It made me better understand that addiction, in particular addiction to prescription pain killers, could happen to anyone, and that addiction to any substance has the underlying cause of the user needing to fill a void, to salve a pain, to distract from hurt. It is a very humanizing, thoughtful, and enlightening book and one that will remain with me for some time to come.
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Find more reviews and bookish fun at
February 11, 2022
In Pain is FUCKING BRILLIANT and BRUTAL.
This is my favorite kind of book about mental health issues of any sort. An educated third person “objective� perspective (the author Travis Rieder is a bioethicist) blended with honest, vulnerable writing from the first-person “subjective� perspective (Rieder experienced extreme acute pain due to an awful motorcycle accident, and chronic pain occurring in the months and years that followed).
Rieder describes his pain experiences from the first person (phenomenological) perspective.
And let me just tell you.
It’s very effective writing.
I didn’t literally “feel� what he described.
But it got me about as close to that experience as reading someone’s words, and empathizing with them could.
The writing is so explicit, and so descriptive, (without being at all gratuitous) that I was literally writhing and wincing again and again.
Without knocking you over the head with it, he really makes you understand how fucking bad that experience was.
And it was FUCKING bad.
To say it was a living hell (for whatever that tired old cliché is actually worth) would be accurate.
This book is worth it just for that stuff alone.
But that is quite simply, only the vestibule at the front door of hell. Only the very beginning of a long descent into the ravages and prolonged suffering of every shade and variety that he endured.
In fact, Rieder speaks of the many varieties of pain with the expertise and specificity of a fine wine connoisseur.
Rieder’s descriptions are almost poetic at times, full of imagistic metaphor, not for gratuitous esthetic effect, but out of pure necessity, because other, more clinically “precise� descriptions simply fail at this frontier of communication.
Although this type of writing and self disclosure is quite contrary to Rieder’s training as an academic philosopher. It is clear that if he stayed to academic form, and was as such, unwilling to “come out� and speak honestly from his raw first person experience, it would amount to another type of intellectual dishonesty and failure via omission.
And so, he made the extremely brave decision to serve the brutal, tender, honest realness of his darkest hours, along with reasonable, modulated, thoughtful passages, without being dramatic or pedantic.
Hence the “Brutal� and “Brilliant� adjectives that bookend this review.
This book also contains some of the best phenomenological writing on opioid withdrawal that I am aware of.
Rieder became dependent on opioids over the course of his protracted pain management, and then was advised to abruptly discontinue them by a doctor (of all people).
Advice that was so woefully incompetent that I was LITERALLY face palming and saying NO out loud.
SNOL?
I guess?
Anyway
One of the BIG problems (probably the biggest problem) with opioids (and all drugs of abuse for that matter, but particularly opioids) is that they disable the brain and body‘s natural ability to do what the drugs do for you.
Opioids do stuff like modulate pain, slow bowel motility, enhance sleep and promote euphoria.
So another words.
Opioids:
- take away the pain
- make you feel peaceful and care free
- make you sleep like a baby
- they are a nice decongestant
- and they make it so you can’t poop (huge problem that you can die from)
In opioid withdrawal, you get the equal and opposite rebound effect.
In Opioid Withdrawal:
- you’re extremely pain sensitive (hyperalgesia)
- you feel dysphoric (suicidal even)
- you can’t sleep (often for days on end)
- your eyes and nose run like gooey rivers
- you have chronic diarrhea
- extremely painful vomiting and dry heaving
I have worked with hundreds of opioid addicts.
Many report that they would rather die than experience precipitated opioid withdrawal again.
Detoxing from any drug is rough.
Try skipping caffeine for a few days if you don’t believe me.
Detoxing from alcohol and benzodiazepines can be fucking deadly. It can literally kill you.
Withdrawing from opioids is rarely deadly.
But people do crazy stuff to avoid that misery.
Including suicide.
Kicking dope is no joke.
And the real kicker here, is that Rieder was completely unaware, and completely unprepared for any of this.
All the guy needed was a little bit of education, and a little bit of support, and maybe just a little bit of medicated assisted opioid withdrawal.
And he would’ve been spared an awful misery.
ܳ�
He (under explicit directives of his doctor) made some of the most harmful, and dangerous mistakes you can make.
For instance, his primary physician advised him to taper down over the course of a week or so.
That’s the equivalent of advising somebody to jump off a 10 story building, 2 or 3 floors at a time.
NO!
Take the FUCKING stairs for fucks sake.
ONE STEP AT A TIME!
In other words, a medically indicated opioid taper takes weeks, or even months, or even longer in some cases.
Abrupt opioid discontinuation is the ULTIMATE rookie move.
And it almost killed the guy.
That’s right, he became severely depressed and suicidal.
Any addiction professional could have seen that coming a mile away.
The problem was.
Rieder wasn’t in addiction treatment.
ܲ�
Rieder wasn’t an “addict�.
He wasn’t stealing from his grandma‘s purse, or turning tricks, or dealing to grade schoolers, or (insert any of the myriad dehumanizing clichés about addicts here) to buy heroin.
He wasn’t misusing the medications.
He didn’t like being on the opioids.
He desperately wanted to be off of them.
He was simply a “regular guy� who was trying to get off of a prescribed medication.
So when his medical team suggested that his opioid withdrawals were “not their problem� and directed him to addiction treatment, he rightfully balked.
Although, if he had gotten just a little good advice and support, his experience of withdrawal would’ve been much less dangerous and awful.
One of the benefits (if you could call it a benefit) of being a heroin “addict� is that you are probably inside a community of people who (one way or another) understand stuff like opioid withdrawal.
In other words, junkies know how to kick dope.
At least they know how not to.
And of course, if you are engaged in good treatment (hard to find but certainly out there), your team will educate you as to what to expect in opioid withdrawal, and provide you with guidance, a taper schedule, and medications to make that experience MUCH more survivable.
The problem is, you’ll get a bunch of shitty therapy and a bunch of 12 step jammed down your throat.
And for a guy like Rieder.
None of that sounded necessary or appropriate.
And he may have actually been right.
Lots of people get strung out on prescription opioids. But that doesn’t mean that they are addicted (a terrible and completely dysfunctional word to be sure).
People like Rieder would be better described as having complex protracted opioid dependence.
But probably not substance use disorder.
So does someone like Rieder go get on methadone? Or go to residential treatment?
All the guy needed was just a little good advice.
And maybe some buprenorphine.
And perhaps a little sleep medication.
And some good support.
And we’re done.
In addition to being an amazing memoir.
This is some of the most interesting and compelling writing about the medical and social systemic aspects of the opioid epidemic and opioid use more generally, that I am aware of.
It’s a thoughtful, balanced, and fair accounting of the relative use value and risks associated with pain management.
Rieder discusses the benefits and problems with scientific and medical reductionism.
The Benefits of Reductionism:
- you can identify, isolate and control variables.
The Problem of Reductionism:
- you can’t see the forest through the trees.
The Problem With Reductionistic Medicine:
- the image of the “whole person� in the environment gets lost.
Rieder also discusses the merits of the systems perspective, and the benefits of integral medicine, without outright referring to it as such.
Probably most importantly, Rieder describes the dangers of the stigma surrounding opioids and drug use in general. And the need for rational, evidence-based, prescribing practice, which includes medically assisted withdrawal, with the responsibility of withdrawal management placed squarely on the prescriber.
Rieder doesn’t blame medical clinicians, he has a broader more systemic view than that. But he does call for reform of the current system, and ascribes responsibility for educating and assisting clients in their detox efforts to the prescribing clinician.
�
Yes!
Additionally, Rieder advocates for better addiction treatment. Including harm reduction policies that decriminalize, and even legalize drugs like heroin, and provide clean needles and safe places for people to use, so that they don’t catch diseases and die, and so that they can get access to good information, and addiction treatment if they want/need it.
�
Yes, yes, yes, and hell yes!
This is a long review.
But this is a really fucking important book.
I’d say it’s the best one of these that I know about.
I think it is the perfect counterbalance, to Dr. Carl Hart’s Drug Use For Grownups (read my review of it here - /review/show...)
I read these two books back to back.
I highly recommend doing exactly that.
If I ever teach another course on the bio/psycho/social/systemic issues pertinent to drug use and addiction, I will make these two books required reading.
I will end this review like I started it.
In Pain is FUCKING BRILLIANT and BRUTAL.
5/5 STARS ⭐️
This is my favorite kind of book about mental health issues of any sort. An educated third person “objective� perspective (the author Travis Rieder is a bioethicist) blended with honest, vulnerable writing from the first-person “subjective� perspective (Rieder experienced extreme acute pain due to an awful motorcycle accident, and chronic pain occurring in the months and years that followed).
Rieder describes his pain experiences from the first person (phenomenological) perspective.
And let me just tell you.
It’s very effective writing.
I didn’t literally “feel� what he described.
But it got me about as close to that experience as reading someone’s words, and empathizing with them could.
The writing is so explicit, and so descriptive, (without being at all gratuitous) that I was literally writhing and wincing again and again.
Without knocking you over the head with it, he really makes you understand how fucking bad that experience was.
And it was FUCKING bad.
To say it was a living hell (for whatever that tired old cliché is actually worth) would be accurate.
This book is worth it just for that stuff alone.
But that is quite simply, only the vestibule at the front door of hell. Only the very beginning of a long descent into the ravages and prolonged suffering of every shade and variety that he endured.
In fact, Rieder speaks of the many varieties of pain with the expertise and specificity of a fine wine connoisseur.
Rieder’s descriptions are almost poetic at times, full of imagistic metaphor, not for gratuitous esthetic effect, but out of pure necessity, because other, more clinically “precise� descriptions simply fail at this frontier of communication.
Although this type of writing and self disclosure is quite contrary to Rieder’s training as an academic philosopher. It is clear that if he stayed to academic form, and was as such, unwilling to “come out� and speak honestly from his raw first person experience, it would amount to another type of intellectual dishonesty and failure via omission.
And so, he made the extremely brave decision to serve the brutal, tender, honest realness of his darkest hours, along with reasonable, modulated, thoughtful passages, without being dramatic or pedantic.
Hence the “Brutal� and “Brilliant� adjectives that bookend this review.
This book also contains some of the best phenomenological writing on opioid withdrawal that I am aware of.
Rieder became dependent on opioids over the course of his protracted pain management, and then was advised to abruptly discontinue them by a doctor (of all people).
Advice that was so woefully incompetent that I was LITERALLY face palming and saying NO out loud.
SNOL?
I guess?
Anyway
One of the BIG problems (probably the biggest problem) with opioids (and all drugs of abuse for that matter, but particularly opioids) is that they disable the brain and body‘s natural ability to do what the drugs do for you.
Opioids do stuff like modulate pain, slow bowel motility, enhance sleep and promote euphoria.
So another words.
Opioids:
- take away the pain
- make you feel peaceful and care free
- make you sleep like a baby
- they are a nice decongestant
- and they make it so you can’t poop (huge problem that you can die from)
In opioid withdrawal, you get the equal and opposite rebound effect.
In Opioid Withdrawal:
- you’re extremely pain sensitive (hyperalgesia)
- you feel dysphoric (suicidal even)
- you can’t sleep (often for days on end)
- your eyes and nose run like gooey rivers
- you have chronic diarrhea
- extremely painful vomiting and dry heaving
I have worked with hundreds of opioid addicts.
Many report that they would rather die than experience precipitated opioid withdrawal again.
Detoxing from any drug is rough.
Try skipping caffeine for a few days if you don’t believe me.
Detoxing from alcohol and benzodiazepines can be fucking deadly. It can literally kill you.
Withdrawing from opioids is rarely deadly.
But people do crazy stuff to avoid that misery.
Including suicide.
Kicking dope is no joke.
And the real kicker here, is that Rieder was completely unaware, and completely unprepared for any of this.
All the guy needed was a little bit of education, and a little bit of support, and maybe just a little bit of medicated assisted opioid withdrawal.
And he would’ve been spared an awful misery.
ܳ�
He (under explicit directives of his doctor) made some of the most harmful, and dangerous mistakes you can make.
For instance, his primary physician advised him to taper down over the course of a week or so.
That’s the equivalent of advising somebody to jump off a 10 story building, 2 or 3 floors at a time.
NO!
Take the FUCKING stairs for fucks sake.
ONE STEP AT A TIME!
In other words, a medically indicated opioid taper takes weeks, or even months, or even longer in some cases.
Abrupt opioid discontinuation is the ULTIMATE rookie move.
And it almost killed the guy.
That’s right, he became severely depressed and suicidal.
Any addiction professional could have seen that coming a mile away.
The problem was.
Rieder wasn’t in addiction treatment.
ܲ�
Rieder wasn’t an “addict�.
He wasn’t stealing from his grandma‘s purse, or turning tricks, or dealing to grade schoolers, or (insert any of the myriad dehumanizing clichés about addicts here) to buy heroin.
He wasn’t misusing the medications.
He didn’t like being on the opioids.
He desperately wanted to be off of them.
He was simply a “regular guy� who was trying to get off of a prescribed medication.
So when his medical team suggested that his opioid withdrawals were “not their problem� and directed him to addiction treatment, he rightfully balked.
Although, if he had gotten just a little good advice and support, his experience of withdrawal would’ve been much less dangerous and awful.
One of the benefits (if you could call it a benefit) of being a heroin “addict� is that you are probably inside a community of people who (one way or another) understand stuff like opioid withdrawal.
In other words, junkies know how to kick dope.
At least they know how not to.
And of course, if you are engaged in good treatment (hard to find but certainly out there), your team will educate you as to what to expect in opioid withdrawal, and provide you with guidance, a taper schedule, and medications to make that experience MUCH more survivable.
The problem is, you’ll get a bunch of shitty therapy and a bunch of 12 step jammed down your throat.
And for a guy like Rieder.
None of that sounded necessary or appropriate.
And he may have actually been right.
Lots of people get strung out on prescription opioids. But that doesn’t mean that they are addicted (a terrible and completely dysfunctional word to be sure).
People like Rieder would be better described as having complex protracted opioid dependence.
But probably not substance use disorder.
So does someone like Rieder go get on methadone? Or go to residential treatment?
All the guy needed was just a little good advice.
And maybe some buprenorphine.
And perhaps a little sleep medication.
And some good support.
And we’re done.
In addition to being an amazing memoir.
This is some of the most interesting and compelling writing about the medical and social systemic aspects of the opioid epidemic and opioid use more generally, that I am aware of.
It’s a thoughtful, balanced, and fair accounting of the relative use value and risks associated with pain management.
Rieder discusses the benefits and problems with scientific and medical reductionism.
The Benefits of Reductionism:
- you can identify, isolate and control variables.
The Problem of Reductionism:
- you can’t see the forest through the trees.
The Problem With Reductionistic Medicine:
- the image of the “whole person� in the environment gets lost.
Rieder also discusses the merits of the systems perspective, and the benefits of integral medicine, without outright referring to it as such.
Probably most importantly, Rieder describes the dangers of the stigma surrounding opioids and drug use in general. And the need for rational, evidence-based, prescribing practice, which includes medically assisted withdrawal, with the responsibility of withdrawal management placed squarely on the prescriber.
Rieder doesn’t blame medical clinicians, he has a broader more systemic view than that. But he does call for reform of the current system, and ascribes responsibility for educating and assisting clients in their detox efforts to the prescribing clinician.
�
Yes!
Additionally, Rieder advocates for better addiction treatment. Including harm reduction policies that decriminalize, and even legalize drugs like heroin, and provide clean needles and safe places for people to use, so that they don’t catch diseases and die, and so that they can get access to good information, and addiction treatment if they want/need it.
�
Yes, yes, yes, and hell yes!
This is a long review.
But this is a really fucking important book.
I’d say it’s the best one of these that I know about.
I think it is the perfect counterbalance, to Dr. Carl Hart’s Drug Use For Grownups (read my review of it here - /review/show...)
I read these two books back to back.
I highly recommend doing exactly that.
If I ever teach another course on the bio/psycho/social/systemic issues pertinent to drug use and addiction, I will make these two books required reading.
I will end this review like I started it.
In Pain is FUCKING BRILLIANT and BRUTAL.
5/5 STARS ⭐️
August 30, 2019
I’m going to pass this book on to my doctor. A fascinating memoir and exploration of how we mishandle pain management in America.
June 19, 2019
I did a Q&A with Travis for my book blog and if you're interested you can check it out
You can also find this review on my
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 and Travis� TED Talk .
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.
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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.
You can also find this review on my
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 and Travis� TED Talk .
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.
August 18, 2019
A bioethicist who works in John Hopkins had a motorcycle accident and had to go through several surgeries. He was prescribed high dosages opioids. When trying to get off the drug, he couldn't find doctors to give him proper medical advice and suffered horrible withdraw symptoms.
What I find shocking is that although many American doctors prescribe opioids freely, very few address the long term consequence of these drugs and even less doctors except a few specialists give proper instruction to patients who want to get off the drugs. On the other hand, the stigma around drug abuse is still present, making patients like Travis Rieder feeling shamed even though drug dependence is not drug addiction. Opioids are not suitable for chronicle pain and not always the best pain medicine for some types of acute pains, but they are the cheapest therefore mostly prescribed despite their long term harms.
There is a nice summary of America's opioid crisis. I like the fact the author acknowledged that there are not one but three crisis right now, including one that has been going on for many decades and mostly affecting non-white Americans. A lot of what covered in the book I have read elsewhere, such as the role of pharmaceutical companies in the ongoing and the historical crisis, as well as American's war on pain (the assumption that pain is an illness that must be eliminated), and the promising but expensive multichannel pain care.
Perhaps the most promising chapter is the epilogue, where the author mentioned the new US military pain management technologies. The only problem is it's too short. I am very interested in other pain management methods, such as CBT, mindfulness meditation. Again the author's touch is too brief in the book.
What I find shocking is that although many American doctors prescribe opioids freely, very few address the long term consequence of these drugs and even less doctors except a few specialists give proper instruction to patients who want to get off the drugs. On the other hand, the stigma around drug abuse is still present, making patients like Travis Rieder feeling shamed even though drug dependence is not drug addiction. Opioids are not suitable for chronicle pain and not always the best pain medicine for some types of acute pains, but they are the cheapest therefore mostly prescribed despite their long term harms.
There is a nice summary of America's opioid crisis. I like the fact the author acknowledged that there are not one but three crisis right now, including one that has been going on for many decades and mostly affecting non-white Americans. A lot of what covered in the book I have read elsewhere, such as the role of pharmaceutical companies in the ongoing and the historical crisis, as well as American's war on pain (the assumption that pain is an illness that must be eliminated), and the promising but expensive multichannel pain care.
Perhaps the most promising chapter is the epilogue, where the author mentioned the new US military pain management technologies. The only problem is it's too short. I am very interested in other pain management methods, such as CBT, mindfulness meditation. Again the author's touch is too brief in the book.
March 21, 2021
An accident can change everything - and for Travis Rieder, on one fine spring day, it did. After Rieder is hit by a van while riding his motorcycle, he undergoes a number of surgeries to save his foot. His doctor predicted he'd never be the same, but Travis was determined to regain some sense of normalcy, if only for his wife and daughter. After the surgeries were over and he'd returned home from the hospital, however, he found that while he had been able to keep his foot, he still had a long road ahead of him. Not only did Travis Rieder have to overcome a physical disability, he also had to overcome the type of pain he'd never imagined. The doctors advised he manage this pain with medication, and so he followed their instructions. Little did he know that this would open him up to a whole new life-threatening dilemma; opioid dependency. He first realized the mistakes that had been made when he started the tapering process to wean himself from his prescriptions. Withdrawal hit hard and fast, and Rieder feared he wouldn't make it through. There were few resources available, and the more he researched his options the angrier he became at the doctors who started him down this path and then abandoned him.
It would be easy for this book to be an all out tirade against doctors and the medical system, but Travis Rieder, a Bioethicist, gives us a more nuanced story. He admits to his anger and frustration, but then he begins to look into just what caused these failures and how they can be addressed. He lays out problems and suggests fixes, and his work in the medical community to bring these issues to light and help to be a part of the solution is commendable. This is a fascinating study with a very personal touch; Rieder doesn't hold back in sharing his experiences and his struggles. I am sorry that he had to suffer through so much, and continues to this day to manage his battle with pain, but I am thankful he was willing to share his story in hopes of making things better for others. Every person who can avoid falling into the spiral of opioid addiction, and who can get honest, thoughtful help in managing either traumatic or chronic pain, is one less person who will fall through the cracks of our imperfect medical system.
It would be easy for this book to be an all out tirade against doctors and the medical system, but Travis Rieder, a Bioethicist, gives us a more nuanced story. He admits to his anger and frustration, but then he begins to look into just what caused these failures and how they can be addressed. He lays out problems and suggests fixes, and his work in the medical community to bring these issues to light and help to be a part of the solution is commendable. This is a fascinating study with a very personal touch; Rieder doesn't hold back in sharing his experiences and his struggles. I am sorry that he had to suffer through so much, and continues to this day to manage his battle with pain, but I am thankful he was willing to share his story in hopes of making things better for others. Every person who can avoid falling into the spiral of opioid addiction, and who can get honest, thoughtful help in managing either traumatic or chronic pain, is one less person who will fall through the cracks of our imperfect medical system.
November 6, 2022
Summary: Both the personal story and the thoughtful analysis in this book made it a clear favorite of the books I've read on the opioid epidemic.
This memoir by a bioethics research is by far the best book I've read about the opioid epidemic. Author Travis Rieder was in a motorcycle accident, after which he was prescribed opioids that he struggled to stop taking. One obvious strong point of this book is that personal perspective. The author does an incredible job of getting you to image you're going through what he experienced. His descriptions of his thoughts and physical sensations were explained very clearly. His description of his accident and of withdrawal were equally terrifying. Together, the two experiences viscerally demonstrated the power of opioids to help and to harm.
In addition to the personal perspective the author brought to this story, I was surprised by how much I appreciated the parts that drew on his training as a bioethicist. He talks about the concept of pain, showing how the lack of subjective measures of pain complicate the way doctors prescribe opioids. He also discusses how this subjective assessment allows room for bias in doctors' reactions. The book wraps up with a great discussion of the moral obligations doctors have to their patients; the different incentives currently influencing doctors; and ways doctors and patients can work to fix this broken system.
This was by far the most thoughtful and nuanced discussion of the problems contributing to the opioid epidemic that I've read. The author does an incredible job humanizing these ethical questions through his own experience. The combination of personal experience and analysis made this an engaging, informative nonfiction read. If you want to understand the events related to the latest opioid epidemic, I think Dopesick gives a more thorough accounting of the big picture story. However, if you're just going to read one book on the opioid epidemic, I'd encourage you to pick this one.
This memoir by a bioethics research is by far the best book I've read about the opioid epidemic. Author Travis Rieder was in a motorcycle accident, after which he was prescribed opioids that he struggled to stop taking. One obvious strong point of this book is that personal perspective. The author does an incredible job of getting you to image you're going through what he experienced. His descriptions of his thoughts and physical sensations were explained very clearly. His description of his accident and of withdrawal were equally terrifying. Together, the two experiences viscerally demonstrated the power of opioids to help and to harm.
In addition to the personal perspective the author brought to this story, I was surprised by how much I appreciated the parts that drew on his training as a bioethicist. He talks about the concept of pain, showing how the lack of subjective measures of pain complicate the way doctors prescribe opioids. He also discusses how this subjective assessment allows room for bias in doctors' reactions. The book wraps up with a great discussion of the moral obligations doctors have to their patients; the different incentives currently influencing doctors; and ways doctors and patients can work to fix this broken system.
This was by far the most thoughtful and nuanced discussion of the problems contributing to the opioid epidemic that I've read. The author does an incredible job humanizing these ethical questions through his own experience. The combination of personal experience and analysis made this an engaging, informative nonfiction read. If you want to understand the events related to the latest opioid epidemic, I think Dopesick gives a more thorough accounting of the big picture story. However, if you're just going to read one book on the opioid epidemic, I'd encourage you to pick this one.
December 14, 2020
Really well-done. Shines a clear light onto the opioid crisis both global and personal. Strong bias toward evidence-based science always works for me, and this book has it in spades. Rieder's suggestions are humane and actionable.
December 20, 2019
This story was informative and gave a better description of the symptoms of opioid withdrawals than any other I've read. But it did get a little repetitive towards the end.
May 20, 2020
A bit dry for me. I think a better context for me to have read this would be as part of a class in relation to my field (human services).
October 9, 2024
5�
I really appreciate this perspective on the opioid epidemic and I appreciate the vulnerability it took to tell this story and commit to the research. This was a well-structured, easily to follow exploration into Rieder’s personal experience with opioid dependency and withdrawal, how it touched other aspects (and people) in his life, research and thoughtful commentary on the root cause of the epidemic and where we can change the tide. What boosted this to a 5� was how I felt when it was over. I feel like I’m walking away with an adjusted mindset toward opioid use, how I’m going to think about drug use in general feels just a little bit different, a little bit more empathetic. I can’t say that it’s Rieder’s writing that made this change or even the content of the book specifically, but I think rather the path I’m on and where it’s leading me. Glad to have listened to this, and will be seeking more from Rieder and about the opioid epidemic.
�
✍� Follow me on ŷ for more reviews like this!
📚 Instagram: @whataprilreads
🐝 Keep tabs on me here, so you know when I start a new project!
I really appreciate this perspective on the opioid epidemic and I appreciate the vulnerability it took to tell this story and commit to the research. This was a well-structured, easily to follow exploration into Rieder’s personal experience with opioid dependency and withdrawal, how it touched other aspects (and people) in his life, research and thoughtful commentary on the root cause of the epidemic and where we can change the tide. What boosted this to a 5� was how I felt when it was over. I feel like I’m walking away with an adjusted mindset toward opioid use, how I’m going to think about drug use in general feels just a little bit different, a little bit more empathetic. I can’t say that it’s Rieder’s writing that made this change or even the content of the book specifically, but I think rather the path I’m on and where it’s leading me. Glad to have listened to this, and will be seeking more from Rieder and about the opioid epidemic.
�
✍� Follow me on ŷ for more reviews like this!
📚 Instagram: @whataprilreads
🐝 Keep tabs on me here, so you know when I start a new project!
January 31, 2025
A highly important book that YOU should read.
Just because I don’t give a book 5/5 stars doesn’t mean it’s not amazing and worth reading.
Just because I don’t give a book 5/5 stars doesn’t mean it’s not amazing and worth reading.
June 10, 2019
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.
May 7, 2023
This was such an interesting read for me. Rieder gets real about his own experiences with dependence and withdrawal of Opioids after a motorcycle accident. Then he goes into research of the opioid crisis while also acknowledging that because of Heroin it's been a problem way longer than just since Drs have been prescribing Oxys.
I had so much to talk about with my pharmacists since for the last 14 years I have been a witness of these medications in the pharmacy. I have so many thoughts of how things have changed over that time and how the medical community is trying to figure it out.
Rieder was able to give me different perspectives and helped me learn more. There are some things that I think he was a bit naive on since he was really trying to be upbeat about it all. I think he really gave prescribers the benefit of the doubt and said multiple times they just don't know better and are trying to help people. In my experience, while that is true some of the time, I do believe prescribers have a pretty big hand in the abuse of narcotics.
I am also not sure how I feel about some of his solutions to the problem, I don't know how realistic some of them are although his reasoning behind them seemed pragmatic. As someone who has had 2 major abdominal surgeries this year and also been dealing with other things I do love when he talked about how it is more beneficial to get comfortable with some pain rather than trying to get rid of it all completely. As a society we need to understand that at some points we will be in pain and if we can wrap our heads around dealing with some pain we will be able to recover from procedures better. I wonder how he would feel about the changes that have been made since he wrote this book as there has been a lot going on in the pharmaceutical world pertaining to opioids.
Anyway, like I said I have a lot of thoughts about everything discussed in this book, I've gone on for a couple of 8 hour shifts with my coworkers. I don't think I would recommend this to anyone unless they have experience with opioids as I think it would be less engaging or interesting to you.
I had so much to talk about with my pharmacists since for the last 14 years I have been a witness of these medications in the pharmacy. I have so many thoughts of how things have changed over that time and how the medical community is trying to figure it out.
Rieder was able to give me different perspectives and helped me learn more. There are some things that I think he was a bit naive on since he was really trying to be upbeat about it all. I think he really gave prescribers the benefit of the doubt and said multiple times they just don't know better and are trying to help people. In my experience, while that is true some of the time, I do believe prescribers have a pretty big hand in the abuse of narcotics.
I am also not sure how I feel about some of his solutions to the problem, I don't know how realistic some of them are although his reasoning behind them seemed pragmatic. As someone who has had 2 major abdominal surgeries this year and also been dealing with other things I do love when he talked about how it is more beneficial to get comfortable with some pain rather than trying to get rid of it all completely. As a society we need to understand that at some points we will be in pain and if we can wrap our heads around dealing with some pain we will be able to recover from procedures better. I wonder how he would feel about the changes that have been made since he wrote this book as there has been a lot going on in the pharmaceutical world pertaining to opioids.
Anyway, like I said I have a lot of thoughts about everything discussed in this book, I've gone on for a couple of 8 hour shifts with my coworkers. I don't think I would recommend this to anyone unless they have experience with opioids as I think it would be less engaging or interesting to you.
August 10, 2019
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
CW for discussions of suicide
June 22, 2019
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!
July 21, 2019
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.
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.
May 20, 2019
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.
August 31, 2019
I little clunky at times, but the author has a compelling story and thoughts on opiates.
September 7, 2020
In Pain: A Bioethicist's Personal Struggle With Opioids by Travis Rieder (Harper Collins 2019) (362.293) (3459).
Author Travis Rieder is a philosopher who earned a doctorate in Medical Bioethics. He was a young father when he crashed a motorcycle and crushed his foot. He was forced to undergo multiple invasive surgeries in what his surgeons termed an attempt to “salvage� as much of his foot from amputation as they could but that he clearly would never walk again.
Rieder bought into the idea of the doctor and patient working as a team to produce the best possible result for the patient. After all, the first part of the Hippocratic Oath taken by all physicians includes the ironclad rule of “First, do no harm.�
Reider learned that, with a great deal of painfully hard physical therapy, the scope of his recovery was not as limited as he had been told. But a bigger problem remained: How to safely discontinue the use of the absolutely necessary opiate and opioid pain medicines which had been prescribed.
For Travis Rieder had accidentally become an opioid addict from taking the medicines prescribed by his physicians. And what he then encountered was terrifying: the fact that the American medical establishment has no clue how to successfully taper patients off of prescribed opioid medicines. Indeed, when Reidel sought assistance (or even advice) from his medical providers on how to safely discontinue the use of the pills they had prescribed to him, every single doctor uniformly disclaimed any responsibility for any of their patients' addictions. Incredibly, each prescribing physician claimed that it was someone else's responsiblity to oversee a patient's controlled detoxification by tapering or weaning the patient off the narcotics without creating withdrawal pain so intolerable that the healing process is compromised. Most importantly, none of these medical providers were able to come up with the name of any medical provider or service that would ultimately be responsible for patient care during withdrawal from medically prescribed opioids.
The author makes the point that patients in this position have effectively been completely abandoned by the medical system. And as Rieder points out, when a portion of these patients are refused further medications by their prescribing physicians, the patients find that they are unable to successfully taper off of opioids on their own. Without further prescriptions forthcoming from the medical establishment, these patients turn to the street market for extremely dangerous substitutes which often means heroin contaminated by even more powerful opioid analogues.
According to the author, the “gold standard� for treating opioid addiction (also known as “opioid use disorder�) is MAT, or medication-assisted treatment. MAT combines traditional recovery strategies with one of three types of medications: (1) Methadone, which is a “full opioid agonist�, meaning that it acts on the brain like all other opioids by activating the opioid receptors and causing all of the effects of other opioids (it gets you high). This is simply a maintenance treatment which won't get anyone off of opioids but it will keep them away from contaminated street drug substitutes; (2) Buprenorphine is a partial opioid agonist which means that it won't activate all of the brain's opioid receptors, but it gives the brain enough to forestall withdrawal; and (3) Naltrexone, which is an opioid antagonist. It blocks the patient's opioid receptors so that the opioids cannot bind with the brain. Naltrexalone does not treat dependence or fend off withdrawal. It defends against the use of opioids by making it impossible for the user to get high in the first place. (Note: this drug is effective only if the patient was clean and abstinent to begin with.)
A fourth important tool in the medical kit is the drug Naloxone, which is a virtual overdose-reversal medication. If given to someone who has overdosed, Naloxone works by knocking opioids out of the brain's receptors, thus reversing the sedating and euphoric effects of opioids.
That's quite a lot to think about. Shame on the medical establishment for what it has created.
My rating: 7.25/10, finished 9/7/20 (3459).
June 3, 2024
I’m a recovering opioid addict who got clean in 2012, so this is a topic I find super important. I loved Travis� newest book Catastophe Ethics, and I was super excited to check out this book when I learned about it. Travis is a philosopher and ethicist, so I was curious to read his thoughts on the opioid epidemic, and he didn’t disappoint.
Travis got in a bad motorcycle accident, and some intensive surgeries led him to be prescribed opioids. In this book, he discusses how he became dependent on the opioids, the brutal withdrawals, and his work now to advocate for more ethical prescribing of these medications. What I love about this book from a philosopher’s perspective is that it asks a lot of important questions that require nuanced discussion.
This is often lacking when talking about the opioid epidemic. People who want to end the epidemic sometimes want too harsh restrictions on the drugs while chronic pain patients think it’s far too much. Travis sees both perspectives and starts some very important conversations.
I will say that the one thing that drove me nuts was how little Travis, his doctors, and even some colleagues knew about the opioid epidemic. But after reflecting on it, that’s the primary issue Travis addresses in this book. When he was going through withdrawal, none of the doctors who prescribed the meds had any decent advice for coming off the drugs.
This is a super important book, and I’m flabbergasted that I never heard about it until reading Travis� newer book. This book needs a lot more attention because the opioid epidemic is still going strong.
Travis got in a bad motorcycle accident, and some intensive surgeries led him to be prescribed opioids. In this book, he discusses how he became dependent on the opioids, the brutal withdrawals, and his work now to advocate for more ethical prescribing of these medications. What I love about this book from a philosopher’s perspective is that it asks a lot of important questions that require nuanced discussion.
This is often lacking when talking about the opioid epidemic. People who want to end the epidemic sometimes want too harsh restrictions on the drugs while chronic pain patients think it’s far too much. Travis sees both perspectives and starts some very important conversations.
I will say that the one thing that drove me nuts was how little Travis, his doctors, and even some colleagues knew about the opioid epidemic. But after reflecting on it, that’s the primary issue Travis addresses in this book. When he was going through withdrawal, none of the doctors who prescribed the meds had any decent advice for coming off the drugs.
This is a super important book, and I’m flabbergasted that I never heard about it until reading Travis� newer book. This book needs a lot more attention because the opioid epidemic is still going strong.
June 28, 2020
A thoughtful analysis of the opioid epidemic seen through the lens of the author's own struggle with getting off opioids after a serious motorcycle accident resulted in several surgeries and much pain. One of his main points is that there are people assigned to get patients on pain medication but no organized program or designated persons in the medical system to help get people off such medication if they need help with it. There are only addiction programs with long waiting lists, and most patients aren't addicts attracted to the medication, rather they just want help getting off a medication they've become physically dependent on during treatment for pain. Another point is that people who have become dependent but functional and stable on high doses of medication for chronic pain should not be subject to involuntarily withdrawal of that medication. He mentions several cases where this has led to suicide. A worthwhile book.
July 31, 2020
Travis Rieder loved his motorcycle but knew his wife had reservations and now that they had a baby daughter, he agreed to give it up sometime, in the future. One day a van hit his motorcycle and his foot was crushed. He was wearing boots and he insisted in taking it off not heeding a bystander begging him not to. The foot became ungloved, meaning the skin peeled off. The pain was unbeatable and through several surgeries he was given opioids for the pain. He needed them but eventually it became apparent he was dependent with minimum direction from a doctor, it took him four weeks to wean himself off going through terrible withdrawal. Through his experience as well as his professional training he began to take a look at the opioid crisis and how he and others are left to deal with addiction. He doesn’t believe doctors are equipped to deal with it and not very obligated to help patients. He has some ideas.
February 22, 2022
Continuing my deep dive into addiction and the opioid crisis, In Pain by Travis Rieder is a look at how opioid might occur to anyone. Rieder, a bioethicist, was hit by a van while riding his motorcycle causing traumatic injury to his foot. During the five surgeries he was on many different powerful drugs to manage his pain.
This book is very well written and keeps you hooked from the first page. Rieder does an excellent job explaining pain and how his pain affected him physically and emotionally. Once he begins his recovery and decides to get off the pain medication, he realizes his full dependence on the opioids. His withdrawal was torturous, and he received no help from any of his doctors. They all claimed helping him get off the drugs THEY put him on “wasn’t their job.�
This book gives an insider investigation the gaps in our system and the lack of support for those who want to taper off opioids and other dependent drugs.
I would recommend this book to anyone interested in addiction, the opioid crises, or drug dependency.
This book is very well written and keeps you hooked from the first page. Rieder does an excellent job explaining pain and how his pain affected him physically and emotionally. Once he begins his recovery and decides to get off the pain medication, he realizes his full dependence on the opioids. His withdrawal was torturous, and he received no help from any of his doctors. They all claimed helping him get off the drugs THEY put him on “wasn’t their job.�
This book gives an insider investigation the gaps in our system and the lack of support for those who want to taper off opioids and other dependent drugs.
I would recommend this book to anyone interested in addiction, the opioid crises, or drug dependency.
November 16, 2021
Saying this is an enjoyable book seems sort of wrong given the subject matter, but I really enjoyed the book. I agree with the author, I think his story has value and gives some insight into how our country has gotten to where it is regarding opioid use and abuse. I hope it helps give a bit of a roadmap of how we can try to dig out of the situation the country finds itself in and a new direction it can go in.
November 20, 2021
If you've been watching Dopesick on Hulu, this is a great companion read (or listen -- the audiobook is excellent). Rieder's account of his injury, then battle with opioid dependence is horrifying and riveting. As a bioethicist, he's also uniquely able to tease out how we as a culture have thought about opioids over time, addition, medical ethics, and patient care. The takeaway: there's a lot wrong with our system, but the fixes are obvious and achievable.
December 29, 2022
Rieder takes on a lot in this one, highlighting his own experience as a case study, raising the complexities related to clinical pain management and highlighting the primordial views of many politicians related to policy change. The solutions that he suggests are a bit simplistic but that's likely because our healthcare delivery system is so flawed.
February 7, 2024
Engaging and educational read about opioids, pain management, and addiction.
Not quite as well written as books by T.R. Reid, who blends the personal and objective aspects of a story exceptionally well, but still quite good.
Not quite as well written as books by T.R. Reid, who blends the personal and objective aspects of a story exceptionally well, but still quite good.
September 13, 2019
This book is extremely well written and very carefully lays out some of the details about opioids and how they work and what is causing so many of the problems we face.
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