Lawyers on both sides of the issue argue the legal reasoning behind Court Decisions on the second amendment. The master ofs Bioethics Degree Program director at Johns Hopkins institute of bioethics. Aso the author of in pain, biologist personal struggle with opioids. Good morning. Experience, you start the book in great detail talking about an accident you had. Guest on memorial day weekend, 2015, i was going out for and i didntde make it three blocks from my house, i got tboned from the left side by a van and it crushed my foot. Limb salvage situation. We were not sure whether the foot would be salvageable. Host you go to the hospital. You start relating the pain involved in the prescribed effort from the doctors. Pain isiscussions of important. When you talk about opioids, there is a response, today oh, you will just be fear mongering about opioids. I had traumatic pain. Friendss were my best in the world. Life was not livable without them for weeks. Five surgeries over the first month. The aggressive prescribing they started in the hospital was not assigned to anyone for long term and followup. Discharge from the final visit, i get home with escalating doses of powerful drugs. No one is watching me. I keep following the advice. Stay ahead of the pain every four hours. Host what kind of doses . Guest oxycodone, immediate release. 46 hours. Oxycontin, every 12 hours as extendedrelease. Every 12 hours did not get me far. Every 4 hours like clockwork, i popped pills. Host when do you have to start weaning yourself off of these . Guest im not thinking of anything other than recovery and avoidance of pain and trying to be present for my family. It comes as a surprise, two months or so after the accident, i go back with the trauma surgeon, he looks and says oh, this is way too much. You need to get off the meds now. He doesnt have any advice for me. He has not been managing prescriptions. He sends me to the surgeon who had been, a Plastic Surgeon and he says, not a big deal. Divider daily dose into 4, drop one each week and you will be off them in a month. Spoiler alert. Fantastically bad advice. I tried to taper really high dose opioids over 4 weeks, dropping a quarter each week which immediately sent me to withdraw. Host what happened in week one to week 4 . Guest week one, i said i was miserable. I would describe it to my family and say, it is like the worst case of the flu times 1000, you sweat, nauseated, get goosebumps. Withdrawal is the opposite of the drug effects. If you get euphoria with the drug, you get dysphoria. That you get pain related relief, you get intensified pain. Everything hurts. Terrible. Violently ill. Those purely physical symptoms were nothing compared to what came next. After i dropped the next dose at the end of week one, that is when dysphoria kicked in. Depression, zaidi, i started crying all the time, anxiety. By week 4, i was thinking i will have to kill myself. If the withdrawal symptoms didnt come out right, i cannot live like this. Host was there a moment when he realized this was a problem . Guest right away, when you are that sick, you are thinking this is not right. She called thea, prescribing doctor in the first week and he was like well, take care of your bowels. He was not concerned. After i started the depression and spiraling down in the following weeks, that is when we called him back and he got worried because he is clearly out of his depth. Go back on the meds. I cant do this. You need to find an expert. If i go back on the meds, i will have to do it again at some point. I feel like im dying. I will never do that again. We start calling anyone who we could think of who might be an expert. Three different hospitals, a dozen clinicians. No one will help. Oh, is when we realized, they put me on this medication that is dangerous and hurting me and theyre not going to help. That was the terrifying moment. Host the book is, in pain. Travis joining us for the discussion. If you want to ask questions about his experience and the overall topic of opioid addiction and opioid issues, 8000, eastern and central time zones. Mountain and pacific time zones, 202 7488001. If youre part of the medical community, 202 7488002. You are a bioethicist by training. Describe what that is and how it relates when you examine addiction and opioids. Guest a bioethicist is someone who thinks about the ethics and policy issues raised by medicine and public health. I dont recommend this as a strategy. Becoming impatient is a good way becoming a patient is a good way for a bioethicist to study something. You see all these gaps, deep chasms in the health care system. You see failures and you are trained to identify them. The journey i described in the book, not just a journey of withdrawal and coming to recover from that, is also about realizing, i have a unique voice because im specifically trained to identify these problems. I spent 4 years since then working on this. Host what is the top line about what you discovered . Guest two clauses. We think about how broken Pain Medicine is. Overprescribing is the language you hear in the media, for the last decade, that is too simplistic of what has been going on. Alongside overprescribing, which is reckless or irresponsible, you have under prescribing which is miss identifying someone as drugseeking or suspicious. Doctors, especially as we have gotten fearful of opioids, withholding medication from patients who need it and that has been causing problems alongside the crisis of addiction and overdose deaths. That simplistic message of overprescribing has got to go. We need to think about ethically responsible prescribing, weighing the costs and benefits and not letting the fear get the better of us. Ist you write that pain puzzling to deal with. We demand that doctors help us deal with it and our best tool to communicate it is deeply flawed. We simply cannot make it work. We cannot turn a private, subjective experience into an objective phenomenon. Can you expand on that . Guest if you are my doctor and i go to you and you say, what hurts . My foot. How bad . What can i say to you to give you data that is actionable . On the one hand, nothing that is truly accurate. Because, my pain is purely subjective. It burns. It feels like fire and acid. The longer you work in pain, you get good at identifying what words correspond to different sorts of pain. That is one of the skills of an experienced doctor. We need to know something like, how bad is your pain . How important is it for me to do something about it . We developed a simple tool which is the pain scale. Anyone who has been in the hospital in the last 20 years has heard, how bad is her pain . 010. That has helped. I got good at using the scale for me. Below a five, i would not medicate because the medicine has costs. If i say to you, my pain is seven. You may rightly think, i am tougher than you, it would be three for me. There is nothing we can communicate that tells you, oh, here is the meter, the accurate reading is five. That is the deep puzzle of pain. Because that is true, because pain is subjective and because one of the key medications for treating it is liable to abuse, that causes euphoria and addiction, pain is deeply deeply suspicious. That is the central problem of Pain Medicine. Host is there a better