With Clinical Congress 2023 well underway, one of the most anticipated Named Lectures is set to be delivered today at 9:45 am in Room 104ABC of the Boston Convention & Exhibition Center. Travis N. Rieder, a well-regarded bioethicist and former opioid therapy patient, will present the John J. Conley Ethics and Philosophy Lecture: America’s Opioid Dilemma: Ethical Prescribing during an Overdose Epidemic. In his talk, Dr. Rieder will explore the complexities of opioid prescribing within the context of the ongoing overdose crisis.
One of the key themes that Dr. Rieder will address is the multifaceted nature of ethical prescribing amid what he calls a cultural landscape that typically demonizes opioid use. Contrary to the simplistic notion of reducing opioid prescriptions, he will maintain that prescribing should involve discerning distinctions between initiating opioid therapy and adjusting it for existing patients.
“Many clinicians and members of society tend to think that what we need to do about opioid prescribing is simple in theory—we need to decrease prescribing. After all, opioids are addictive and dangerous, and caused an overdose crisis. But things are not that simple,” said Dr. Rieder, who directs the master of bioethics degree program and is an associate research professor at the Johns Hopkins University Berman Institute of Bioethics in Baltimore, Maryland. “Pain medicine during such a crisis requires recognizing that ethically responsible prescribing may include using opioids against a cultural backdrop that pushes strongly against them. I will explore what that looks like.”
Dr. Rieder will highlight the critical nuances that underpin the ethical dilemmas faced by clinicians who prescribe opioids, and what will make his insights invaluable will be his ability to connect personal experiences with his extensive bioethics research. He will share details of his journey of pain and opioid therapy following a traumatic motorcycle accident in 2015 that led to six surgeries, months of opioids, and eventually, catastrophic withdrawal. His book, In Pain: A Bioethicist’s Personal Struggle with Opioids, stands as a valuable resource, offering additional personal narratives that shed light on the contemporary challenges in pain medicine.
Speaking from experience, Dr. Rieder plans to emphasize the poignant struggles of pain patients left in the lurch due to abrupt tapering or termination of opioid therapy. He will advocate for a more cautious approach in dealing with these delicate cases and touch upon contentious topics such as the management of long-term opioid therapy for “legacy patients” who were titrated onto high doses of opioids over years or decades.
“Almost everything about my talk is challenging and controversial,” said Dr. Rieder. “Sadly, even now in 2023, we are not particularly good at pain medicine, and I’ll be exploring how to treat patients in some of the most difficult cases.”
Dr. Rieder said he intends to underscore the need for surgeons to become adept at balancing the risks and benefits of opioid use, given the indispensable role opioids play in managing acute pain postoperatively. His goal is to compel attendees to reassess their own prescribing practices and approach patients with a more nuanced and empathetic perspective.
“For the near future at least, most surgeons will require the use of opioids. Surgeons cause a lot of acute, severe pain, and opioids are good tools for treating such pain. That means surgeons—perhaps more than any other class of clinician—need to be comfortable using these tools despite their risk profile.”
The John J. Conley Ethics and Philosophy Lecture, sponsored by the ACS Committee on Ethics, will be available for on-demand viewing shortly after the live presentation.
