A microphone right over here thats for the audience qanda. When it gets to that time, i encourage anybody that has a question, whoever you are, to just go up to the microphone there, why not and we will try to get as many questions as possible within the time we have. And with that, im very excited to introduce tonights event. Travis reeder, the author tonight, has channeled a background in philosophy into his current role on the faculty at the john hopkins Berman Institute for bioethics where he serves as the director for the program and also assistant director for education initiatives. As a person leading the program in the field associated with medicine and Public Health, he was obviously be one of the best people to talk to in order to understand what people should know about the current ways of opioid dependencies sweeping across the vast swaths of the american landscape. As you will see in his book, he comes to the topic from his own struggles against that very dependency. After crushing his foot in a motorcycle accident about four years ago now, an injury that almost necessitate amputation, he underwent numerous surgeries to put his body backhe in placea procesprocess an incomprehensibe amounthat an incomprehensibleamn various forms. To manage that, he creates relief in the form he wasor prescribed morphine content and all and more. The question then became of course how do you back away from those doses when the time is right and that is a question that is likely debated among the medical community is. That reader unfortunately came to experience for firsthand to grapple with it as best as he could. With the notes forming while she was still in the hospital documenting the shape of his bodily sensations, the book is an exceptionally vivid account of much debated and widely misunderstood subject matter all the more vital because it is grounded in experiences that we all might undergo some day or might have experienced ourselves. So, with that inn mind please joinrs me in welcoming him to politics and prose. Its a little bit surreal. I spent a couple of years in the dc area. Its been a while so i appreciate you being here with me. Bioethics is a strange sort of field. Those of us who do that are all sorts of disciplinary weirdos, but we all come from distinct disciplines and workt on these urgent pressing issues at hand entirely scholarly way that is s the way that i start my work in bioethics but it turns out if youre interested in the policy regarding the Health Care System, the really good way of the not recommended way of finding out some huge gaps in the American Healthcare system is to become a patient in that system and you will find it very quickly that its quite broken in all sorts of ways, so not the best way to find a Research Program but its the way that i found this Research Program so im going to tellst you some of the stories from some are mine, some are people i love and no and some oregon storie are the r culture and medicine. In 2015, i had just gotten my First Permanent faculty position at Johns Hopkins and my partner had gotten a permanent position as a Research Scientist and we were feeling quite ecstatic, we had a one and a half yearold daughter who is gorgeous and amazing and celebration and all of these i did a really dumb thing and bought the new motorcycle. Ive ridden for a long time but i was like now i can afford a really nice or cycle and on memorial day weekend i took the shiny bike out on a ride and made it about three blocks before a stop sign and tbone at the bike crushing my left foot between the bumper and the motorcycle itself. Im not going to describe the details of my injury and hes not all of your up for that tonight. I wont describe in detail. It in detail. Im going to give you enough of a sense of wh why it would have been next happen. So, basically the first that anconnects shattered and blew ot the inside of my foot and as you heard in the introduction, that would bee in a limb salvage situation, one where the surgeon thinks theyre to b there to bet of amputation of their job is to see if they can salvageo the lad so that is where i found myself in may of 2015 and a story that im going to tell about to kick things off is a particular day that happened it was actually almost a month after the accident i get up into three different hospitals at this point. I was undergoing my fifth major surgery and this was a big reconstructive surgery, so its one where they dealt with the shattered bone but the only way that the doctor could save it as if they found a way to plug the hole. And its something that had never been considered before but not all injuries can be stitched together if you lose a big chunk of flesh you have to do something about that. So there is a very aggressive and ambitious surgery where they made an incision on my left d lg and carved out a bunch of flesh. It is more than just a skin graft. They take skin, muscle, fat and thin they will transplant an artery just in case i ever want to feelve anything in the foot again. It took almost nine hours. Itit involved three different surgical teams had when i woke up, the next morning kind of slowly coming out of the anesthesia, i was in the excruciating pain. Ive been in pain from a and thought i knew about it. I had been under medicated at month. Nce a i now have a new surgical sites, a big one and the original was also expanded into never experienced anything like this in my life. The result of the site was desperate to get relief and i had been hospitalized for several weeks. I had morphine, since all, i was taking things and i asked for more and they didnt give it to me so i asked a little bit louder and they still didnt give it to me then i started to get a little frustrated. I dont remember this perfectly, but i imagine i stopped being quite as compliant as a patient i used to be and i ask people a little bit more aggressive wait until finally as they check this out they finally did rounds on me and very inpatient she finally gets to my room and im digging for more pain meds and she says youve repeated it and its been noted i will discuss it with my team and she and her flock moveout. I have no idea what had happened at that moment. I was ashamed because she escorted me and im a good kid. I knew enough to be ashamed in your school did but i didnt quite get it. I was, sized at least a little bit high and i didnt get it so it took me a little while to pull myself together and i would lay to take the lea be the leadd what happened. I have been treated like a drug seeker which is insane, lets be clear because i had my fifth major surgery but the fact was even in that situation, i just wanted them a little too badly. I said someones alarm bells off. So thats the first thing i want to tell you about. Its the middle of june and i have to recover somehow and you will hear a lot about my partner throughout the rest of the talk but she had to hold the house together and so this is one day i was by myself and i was freaking out ive got to pull myself together. I put this on afterwards but it seemed to matter to me that the doctor i asked for was the one doctor is called the doctor instead of mr. He was a younger guy that wanted to spend more time with me and ask about my research. Thats the one i wanted and i got him. I said you have to fix this and he said i will. My surgeon will fix you up and he kept his word that they called a Pain Management consoles and Pain Management consoles came to my room and fixed me. They gave me lots of the good stuff angood stuffand i was so. I faded into oblivion for my rest of my ten days of hospitalization and i remember it being hard in the way the whole couple of this was hard but it was fine. They hooked me up. Okay, so the description of this as i gave it to you sounds like i was treated badly and then well, i was like a drug seeker with suspicion and then i was given what i needed, pain relief. But i havent looked through the whole story yet because team that gave me all this medication started a train up a station oun that they had no intention of looking over. I never saw my Pain Management doctor again, and eventually the experience that came to define this entire trauma was not excruciating pain or getting my foot blown apart, it wasnt the months and years of physical therapy and learning to walk again, it is what happened next which is with your site eventuah what i had to go off the pain meds that they gave me a bunch of the seemingly unlimited supply and it was only when i checked in with the surgeon two two months after the accident he said this h is not good, its te for you to get off of the medicine now, alsalso not his pm though. Time for you to get off of the meds but someone elses job so he sent me to a surgeon and that the surgeon says scheuer you are ready to get off the meds the customer does and in a month you will be off of them, drop one dose each week. Im not going to give you the long version of what comes next but i wrote th the book so i wouldnt have to stay in public anymore. I also gave a talk if you want some gruesome details in 14 minutes, you can watch that with the short versiobutthe short vee was terrible. It was spectacularly bad. I spent four years researching this and i can tell you this is how it is supposed to be done and i am not an m. D. By the way. For weak tabor on a seven to eight 170milligram equivalent is phenomenally bad and sent me into aen withdrawal and every dy of the four weeks was the worst day of my life and the sick joke of tapering opioids which i hope that nobody in this room knows but im sure some of you do statistically speaking, it is the further you get into the process, the worse it gets. If somebody gives you a standard dose reduction like a quarter each week or if they are smart and get a 10 reduction in each week, thats 10 or quarter as you get through the process becomes a bigger percentage of the dose you are taking into the severity of symptoms is linked to the percentage of each week. One week i thought i was miserable because that is i had no idea what was coming. I was sick and i thought im not going tomac this for a month, then i dropped another dose into the seconded week scrutiny becae you get all the symptoms. Ithese symptoms. If youve ever watched the movie or seen tv, it looks like that but they are not done before a commercial break. They must every second of every minute and you stop being able to sleep so they must 24 hours a day and you shake and sweat and get goosebumps and cant sleep and you are just miserable. Eand the second week for me i started to cry and become depressed because withdrawal is the opposite of the drugs affect and one of the affect is euphoria so the withdrawal gives you dysphoria. I didnt know any of this at the time so all i can think is im dying slowly, excruciatingly. I go through this more and more. I asked doctorsnd for help, my partner startsta calling everyby and nobody will hope us. None of the doctors to prescribe the medicine, none of the surgeon, none of the people that were the descriptions, none of the nurse practitioners, none of that general practitioners that lived in the area that we got a hold of the ones that popped up on google that we just called because we were desperate, none of them would see us. Im going to do now is create a small selection of the book and this is a story during week number four and i just want to give you a sense of what this is like. My beautiful, wonderful baby daughter gets left out of a lot of the story and that is part of the pain. I simply wasnt present, so i barely remember her being there at all. I know she was managing child care and bchildcare and be runne house and occasionally crawling on me on the couch while she sat on ths the ottoman jus bottom as away watching so she could jump up and grab her if she got too close to myoo foot. Most of what i remember, solitude and pain. I do however remember one particular day it changed the view of what i wante wanted a halfyearold daughter was capable of. I made it ther whole day without crying and without the depression crushing and. I dared to hold this meant i was turning a corner and maybe i was going to get some of my life back and then around four or 5 00 i felt a tall tale whaling chest and darkness are darkness circling. It causewere going. It caused panic and then despair. I blurted out i almost made it today. Im so sorry i had to call you. I started to think i could survive this but i cant. This will never get better. Im so broken. Im just so broken. How can anybody possibly recover from this. She was already driving home. You will survive this, she said. Your home hormones and brain will get better. Just hold on. Im about to pick up baby girl and then we will be home to take care of you. I said okay and hung up. When they pulled up outside i tried toir stop crying. I do my best not to let her see me like that. But it was no use. The harder i tried the more more exclusivity came and i eventually just gave up. She enters the house like a Freight Train in this day was no exception when the door open she burst into the living room her lungt the top of until she saw me. She stopped in her face turned serious. She slowly walked over to where i was on the couch and i cried to her im so sorry i hope you wont remember this. She didnt seem upset about. She seemed in control. I was lying on my side about eye level with her. She walked into her face was inches away from nine with her deep dark eyes she got from her mom and she asked you crying . Yes, i told her. But it will be okay. I didnt believe it if i was trying my best to be strong for my daughter. Then she did something i didnt understand and will never forget. She put her tiny hands on my cheeks and held my face firmly while she looked at me and she kissed my eyes one at a time. Id never seen her do anything like that before and i could hardly believe it. Maybe she learned it had daycare or one of her helpers kissed her after she fell down one time. Or maybe it was an incredible and pathetic and tuitio intuitiy little girl. Whatever the explanation, i grabbed her w and hug her as tightly as i ever have and i told her she just hoped that he get through oneer more night. That wasnt a fun time in my life, not great. That was during week number four. The end of the story, i made it out. Heres something really important to know. I didnt make it out because the system helped me out or because im strong or pulled myself up by my bootstraps, i was a wreck and i made it out because i was lucky, i had an incredible support system and because i wanted to be a dad to my one and a half year old again and a partner in my house and a faculty member at Johns Hopkins and i had the Family Support to carry me through when i was unable to do it myself. But i did make it out. I gave up at the end actually. I filled a prescription because i was done but i managed to sleep a that night for the first time in three nights and that was to crack when i woke up in the morning i knew i could make it out. And in the wake of that, i was grateful at first because i thought i was going to di die inside and into the night was angry because i thought the Healthcare System is the reason i thought i was going to die. And then i was deeply, deeply confused and frustrated as the more i thought about it the more i thought how in the world did we get to a place we are so bad at Pain Medicine that no one failed me in one particular way that an entire group of doctors bandaged his ditch together my foot withhe wifi dont forget failed me in multiple ways that were sometimeson in tension with one another. I was withheld medication when i needed it because the it might e been a drug seeker and then i was medicated in a careless way that led to this m profound suffering that could hav could y led it to be going back on the meds and by the way something nice overtime when i was going through withdrawal if i go back on the meds i will never come off of them because i will never go through this again. So how in the world do we get here and get so messed up. Im a researcher said thats what ive done the last four years. I used to work on ais bunch of other stuff. I dont do that anymore. I think about americas Healthcare System and by the way we arepi not the only ones t turns out other people are just as messed up we are just number one in this instance. So, there is a lesson in the book i cant give you the full version now but history teaches us a lot about this one of the reasons is there is a pendulum when it comes to opioid attitudes and it swings back and forth. A lot longer than we think. About 150 years. Starting with the invention of morphine and heroin into the hypodermic needle. We swing back and forth, so how is the Pain Medicine so broken . Because we are displayin made t. We prescribe really aggressively and here is the key may be prescribing progressively would have been okay if we did it according to any Evidence Base that we didnt and heres the scary part, a whole bunch of doctors still dont. But now we are terrified of opioids because we read the newspaper and what is happening is they are killing a bunch of people so they are telling doctors to stop killing people so we are squeezing the supply and now we are hurting patients in another fun way. We are failing in multiple ways and thatt is crazy. So the next section im going to read is trying to figure out a little bit of just how bad we are at a justin and how much we have to improve before we do anything like responsible prescribing of opioids. This is about my mom in about two years after ive gone through my own, and my mom had to have both her knees replaced. This is an excruciatingly painful surgery. She and i knew she was going to need a lot of pain medication. She was terrified and i was terrified because i had just gone throughgh this, so by theni had exploited all of my access. I knew people in the new people, i had worldclass orthopedic surgeons advising me, and i took all that and applied it to my moms case and said here is the lesson me and my friends and my team have drawn up. I dont care what your surgeons say we are going to take ownership of this because i dont trust doctors anymore. And so, we made a plan and we stuck to it. My mom is an absolute boss and she did what she felt like she needed to do and it was hard to watch and very painful but in about two weeks she was also the medication more or less intoik e third week she needed and occasional nighttime dose but after shesh was a little more coherent and in less pain i texted and said can you count how many you have left because prescribedhe was 120. When i found out i said you are not going to need to do this for pill