In Pain: A Bioethicist’s Personal Struggle with Opioids by Travis Rieder is an infuriating read. In a slick, blunt style, Rieder, an ethicist and professor, describes the fallout of a motorcycle accident that led to his dependence on opioids for a brief but harrowing couple of months. In crystalline detail, Rieder breaks down the way the US healthcare system failed him—from treating him with suspicion when he desperately needed pain relief to failing to create an adequate plan to wean him off opioids once they were prescribed. At one point, Rieder narrates how the doctors literally told him to simply get back on the drugs when the withdrawal symptoms were too much for him to bear. This is a problematic solution, as it would only forestall the inevitable pain of withdrawal and deepen his brain’s dependence on opioids.
The book is made all the more infuriating when you realize how wildly privileged Rieder is: he is a cisgender, heterosexual white man working as a professor in a prestigious university. Many of his colleagues even work in the healthcare system! He had a strong family support, including a bad ass wife who really held him down throughout his slow and painful recovery. If the most white of white people isn’t safe from opioid dependence, if the most white of white people doesn’t receive adequate care from the health care system. what hope do trans people, do people of color, do poor people have? Rieder’s harrowing account makes it painfully obvious why so many authors fall victim to opioid dependence and addiction.
Rieder, ultimately, does a decent job navigating his privilege as he shares his story. Early on, he notes that people of color, especially Black people, are frequently under-prescribed pain medicine because doctor’s assume that they don’t feel as much pain as white people. Later on, Rieder narrates a moment where his colleagues point out his immense privilege to him. In the moment, his university colleagues ask him why he didn’t share his challenges with them earlier, later pointing out the immense strength of stigma surrounding opioid dependence. None of these reflections does much to soften the blow, however, and I found myself gritting my teeth in frustration as I learned the disappointing shortcomings of our healthcare system specifically when it comes to opioids.
In Pain is a bit of a oddball when it comes to reading. I would compare it most to Michael Pollan’s How to Change Your Mind. Rieder shifts between emotional memoir style writing, easily the most compelling parts of the book, to a medical history of the use of opioids, outlining its major challengers and proponents. True to the ethicist in him, it includes philosophical breakdowns of the difficulty of measuring pain and the difference between dependence and addiction. Early on, it becomes clear that Rieder is one smart cookie, well equipped to tease out the issues at stake and how his experience illuminates aspects of the opioid crisis. Taking a even-handed approach, Rieder argues against the outright expulsion of opioids from medicine, instead advocating for more careful use and better pain education for medical professionals.
On a personal note, I deeply appreciated Rieder’s narration of his trauma. Those who have undergone immense trauma will hear echoes of their own stories in Rieder’s, no matter how different. Trauma is time-consuming. It’s incredible how on fire one’s world can be, while the rest of the world moves on carelessly. It’s heartbreaking and heartwarming to read about how much one’s family (or friends) will sacrifice to keep the victim sane and afloat. Survivors will recognize Rieder as one of their own.
I recommend this read for anyone interested in our healthcare system, medical humanities, the war on drugs, memoir, and philosophy.