Individual stories are what inspired Pilleve’s mission and continue to inspire Pilleve to do our work. With this in mind, I would like to focus on the story of one individual’s interaction with the healthcare system through his opioid withdrawal and recovery, thus recentering towards our mission. This specific narrative references the "Narrative Matters" article in the Health Affairs magazine.
In this narrative, Travis Reider recounts his interaction with the healthcare system after his traumatic motorcycle accident in 2015. After four weeks in and out of various hospitals, he had been heavily medicated with varying degrees of success. He was given immediate- and extended-release oxycodone, intravenous morphine, fentanyl, and hydromorphone. However, after several surgeries, the hospital’s pain management team kept upping the doses of opioids to keep Travis’s pain under control.
To some degree, Travis was scared of his pain, so he kept informing the doctor of a need for new prescriptions. No one told Travis that he should actively seek the first opportunity to decrease medications. The plastic surgeon later advised tapering a quarter of his daily does over each week for the next month. Even after the first week of tapering, Travis was restless, lost his appetite, and could not sleep. The second week, withdrawal symptoms caused spontaneous crying, depressive episodes, and a profound feeling of brokenness. Travis notes that “it felt like being on fire inside, with muscles that restlessly twitched.” When confronted with these symptoms, the doctor that had prescribed these opioids said to find someone else who was more capable of dealing with opioid dependence. In fact, none of the doctors at any of the hospitals offered help. Furthermore, the pain management team said that they were an inpatient team that could not treat withdrawal, only manage pain within the hospital. Overall, the physicians did not take responsibility for Travis across the entire continuum of care.
This narrative shows how the medical system often fails patients. The physician’s tapering advice was incredibly aggressive. They did not know common strategies such as drop 10% per week of one substance. In Travis’s words, “physicians are the gatekeepers of medicine,” so they should be able to control both the administration and weaning end of the drug timeline. Maybe the opioid epidemic is not a result of the power of the pain-relieving drugs, but rather the misinformation of the physicians. If a physician prescribes medication to mitigate pain symptoms, he or she is responsible for the management of that patient until they are stabilized, or at least have a system to refer addicted individuals to resources. If a physician opens the door to harm, such as addiction, then the physician should do everything in his or her power to minimize this harm.
Not only did the physicians fail, but the health system failed. The current medical system makes it difficult for physicians to take withdrawal responsibility. Primarily, the medical education system does not teach best practices for opioid prescription or pain management. Furthermore, the pain management teams saw their jobs as prescribing pain medication, not see pain through the continuum. A more team-based approach needs to be employed to ensure that patients receive care at every stage.
Absorbing these stories refreshes us on why innovation is so important in this industry. Pilleve hopes that patients have every opportunity for early detection and intervention.