Enhanced descriptions from Syndetics:

NPR Best Book of 2019

A bioethicist's eloquent and riveting memoir of opioid dependence and withdrawal--a harrowing personal reckoning and clarion call for change not only for government but medicine itself, revealing the lack of crucial resources and structures to handle this insidious nationwide epidemic.

Travis Rieder's terrifying journey down the rabbit hole of opioid dependence began with a motorcycle accident in 2015. Enduring half a dozen surgeries, the drugs he received were both miraculous and essential to his recovery. But his most profound suffering came several months later when he went into acute opioid withdrawal while following his physician's orders. Over the course of four excruciating weeks, Rieder learned what it means to be "dope sick"--the physical and mental agony caused by opioid dependence. Clueless how to manage his opioid taper, Travis's doctors suggested he go back on the drugs and try again later. Yet returning to pills out of fear of withdrawal is one route to full-blown addiction. Instead, Rieder continued the painful process of weaning himself.

Rieder's experience exposes a dark secret of American pain management: a healthcare system so conflicted about opioids, and so inept at managing them, that the crisis currently facing us is both unsurprising and inevitable. As he recounts his story, Rieder provides a fascinating look at the history of these drugs first invented in the 1800s, changing attitudes about pain management over the following decades, and the implementation of the pain scale at the beginning of the twenty-first century. He explores both the science of addiction and the systemic and cultural barriers we must overcome if we are to address the problem effectively in the contemporary American healthcare system.

In Pain is not only a gripping personal account of dependence, but a groundbreaking exploration of the intractable causes of America's opioid problem and their implications for resolving the crisis. Rieder makes clear that the opioid crisis exists against a backdrop of real, debilitating pain--and that anyone can fall victim to this epidemic.

Table of contents provided by Syndetics

• Author's Note (p. xi)
• Part I
• Chapter 1 A Salvage Situation (p. 3)
• Chapter 2 Pain and Drugs (p. 25)
• Chapter 3 The Swinging Pendulum (p. 45)
• Chapter 4 The Opioid Dilemma (p. 67)
• Part II
• Chapter 5 Abandoned (p. 85)
• Chapter 6 Dependence and Addiction (p. 113)
• Chapter 7 What Doctors Owe Patients (p. 139)
• Part III
• Chapter 8 Recovery (p. 161)
• Chapter 9 Pain, Drugs, and Doing the Right Thing (p. 181)
• Chapter 10 America's Three Opioid Epidemics (p. 213)
• Epilogue Making a Difference (p. 241)
• Acknowledgments (p. 259)
• Notes (p. 265)
• Index (p. 285)

Reviews provided by Syndetics

Kirkus Book Review

A debilitating accident prompts a man's descent into opioid dependence.Rieder (Toward a Small Family Ethic, 2016, etc.), the assistant director for Education Initiatives at the Johns Hopkins Berman Institute of Bioethics, retraces the aftermath of a traumatic 2015 accident that shattered his foot and forced him to endure six grueling surgeries. Eventually, the author was sent home with a stockpile of opioid painkillers for his excruciating pain. Rieder doesn't skimp on the grisly post-surgical details, including "the boiling pain of carved tissue" or how "coming out of anesthesia was basically the process of discovering how awful it was to be conscious." Sprinkled among the chronological chapters of his recovery are fascinating sections in which the author discusses the historical narrative of opioids, racial differences in pain assessment, and the intricate mechanics of physical pain, that "fiery, boiling, acidic" suffering that Rieder knows well. As he recovered, his physician advised him to wean himself off the high doses of oxycodone he was taking. The author describes weeks of agonizing withdrawal symptoms, including insomnia, nausea, cold sweats, and terrifying emotional darkness, which, as a new father to a young daughter, left him unable to care for her at home. Though he fortunately overcame his opioid dependence, Rieder believes he is one of the lucky ones and that improved withdrawal management and behavioral intervention programs must be mandated in hospitals to "help patients escape the grip of this medication." Later in the book, the author takes a critical detour to skillfully address the primary challenge facing opioid-prescribing physicians: initiating dependency while dutifully attempting to alleviate severe patient discomfort. Rieder recognizes in himselfand others, including his mother, who had knee replacement surgerythe dilemma facing the medical community: treating patients in pain with dangerously addictive medications responsible for killing thousands yearly. With this smart, riveting, real-life account, the author proves himself a convincing and effective advocate for opioid use reform.A harrowing cautionary narrative that speaks to patients and physicians alike on the ugly reality of the enduring opioid epidemic. Copyright Kirkus Reviews, used with permission.