Medical Ethics Discussion Panel (MEDPanel), a student group that explores ethical issues in medicine and healthcare policy, hosted a roundtable discussion titled “The Opioid Epidemic & the Ethics of Pharma” in Charles Commons Salon B on Saturday.
Travis N. Rieder, the assistant director of education initiatives at the Berman Institute of Bioethics, a Hopkins research center, shared his personal experiences with opioids at the event.
In July 2015, Rieder had been on opioid medications for two months after a motorcycle accident that had severely injured his foot.
He explained that he had undergone multiple surgeries, and his doctors had been gradually increasing his opioid intake to help him manage the pain.
Up until that point, he said, he hadn’t realized getting off opioids would be a problem.
“The surgeon turned serious and said... ‘You need to think about getting off the pain medication’,” Rieder said. “This was the first time anybody had told me that this was something I needed to think about. I had been given no warning, no counseling, no plan at all, just a whole lot of prescriptions.”
Rieder discussed how he began to stop taking the drugs without realizing he was doing so at over twice as fast as the recommended rate. He said that his first week of withdrawal was extremely uncomfortable.
“The result, I’ll tell you now, was hell,” he said. “The early stages of opioid withdrawal feel a lot like a terrible case of the flu. I ached all over, the mangled foot from the accident really flared up. I also became restless and developed trouble sleeping.”
According to Rieder, however, the pain only increased as time went on.
“At the beginning of week two, I got significantly worse,” he said. “There was constant jittering in my muscles which made sleep almost impossible.”
Rieder said that he also suffered from frequent unexpected crying spells.
His wife called the prescribing doctor to see if there was anything that could alleviate his discomfort, but Rieder explained that his only real solution was to drink lots of fluids or go back on the medication.
By the third week, Rieder said he began to feel a deep depression.
“I would start crying, and then I would come to believe that I would never recover from the accident or the withdrawal,” he said. “[The doctor] said to call the pain management facility... They said that although they prescribed opioids, they don’t manage tapering or withdrawal.”
Rieder said that he headed into the fourth and final week of his taper without any medical assistance for his discomfort.
He refused to go back on the medication because he didn’t think he could ever handle withdrawal again.
According to Rieder, the fourth week was the most difficult.
“I assumed that I would die because if the symptoms didn’t kill me outright, I would kill myself,” he said. “I know that sounds dramatic... but at the time I believed this to my core.”
He said that he went almost three days without sleeping.
“I spent the nights lying on the bathroom floor and trying to throw up even though I hadn’t eaten anything at all in days,” he said. “I believed the withdrawal would never end and life in the throes of withdrawal wasn’t worth living.”
Today roughly half of all opioid overdose deaths are from prescription medications, totaling about 15,000 deaths a year. Rieder believes that his story fits into a much larger narrative of the over-prescription of opioids in the United States.
“When a medication is responsible for tens of thousands of deaths every year, reckless management of that medication is indefensible,” Rieder said.
Additionally, he noted how the discomfort associated with withdrawal symptoms combined with its high costs can drive people receiving opioid prescriptions to try heroin instead.
Freshman Andrew Massoud thought Rieder’s message was important.
“I thought he was very informative, and he gave a different perspective,” Massoud said. “Being from a town where this crisis has spiked in the past few years, it was interesting to get more perspective about what is happening.”
Vice President of the MEDPanel Amy Clarke said that the event made her realize how difficult it is for physicians to deal with the crisis. She believes more should be done to regulate opioid prescriptions.
“I know that physicians in primary care are very cautious when prescribing opioids to begin with,” she said. “But from this discussion, what I learned is that physicians are kind of lost whenever they are dealing with a patient who has been prescribed.”
