Episode 50: Travis Rieder

“It was all-encompassing pain. I’d never experienced anything like this before”

Travis had taken his boot off for a first look at the foot which had just been crushed in a collision with a van. It had been shattered and he saw bone. In the ambulance, he experienced pain medication for the first time, morphine. Later, in hospital, surgeons sprung to action in a ‘limb salvage situation’, and Travis endured the first of five excrutiating operations, culminating in tissue and skin grafts from other parts of his body to save his foot. To withstand the pain, Travis was routinely prescribed high doses of oxycodone, an opioid painkiller. His foot and body slowly began to heal, yet a cruel irony took shape as he realised the true nature of withdrawal from pain meds.

Travis talked to me about the shocking trauma of withdrawal; the horrendous side effects that lasted no fewer than 29 days, and crushing depression that drove him to suicidal thoughts. His body was slammed by what felt like the worst case of flu he could imagine multiplied by a thousand, and he questioned whether he could escape such a deep misery. At the time Travis had an on-paper idyllic life - a happy marriage, a baby girl and a successful career at Johns Hopkins University, one of America’s most respected academic institutions - and he was still almost destroyed mentally and physically by this dependence. Despite desperately and repeatedly asking for help, he faced a shocking lack of support and guidance on withdrawal from his medical team.

The cruel twist of opioids is what happens with tolerance. The body develops tolerance to different parts of the drug at varying rates; first a tolerance to the euphoric and pain-relieving effects, before a much slower developing tolerance to respiratory depression, i.e. the dangerous side. The reason opioids kill is because they sedate the respiratory system and can stop breathing. People take more and more to achieve the euphoria but their respiratory systems don’t develop in the same way – and their breathing cannot keep up.

After finally gaining distance from the trauma of withdrawal, Travis was able to start sharing his experience and learnings. The guidance he has put out into the world through a TED talk and book as well as his academic research, policy and teaching is a wonder.

In the US today, opioids kill more people than car accidents and gun violence. In 2017, more died from opioid overdose than at the height of the AIDS epidemic. And it’s not just the US; research out this month indicates there is a hidden epidemic of dependence on prescription meds in the UK, yet only two free rehab centres specialising in opioids in the entire country. Those experiencing opioid dependence or addiction don’t tend to seek help at traditional drug misuse treatment centres due to the stigma – and admissions to private rehabs for prescription drug addiction have risen 40% since 2015.

We get into the detail of Travis’s own experience with opioids, and he helps educate me about the difference between dependence and addiction as well as the areas of change so desperately needed in the US medical care system. Everything from medication assisted treatment (opioid agonist or antagonist treatments) and healthcare-led tapering strategies to education and awareness raising.

Thanks Travis for sharing your story with us! Check out the show notes – especially the amazing TED talk – and download the episode in all the usual places from Friday 8am GMT.


Apple Podcasts



Finally, why not explore and join the Patreon community this weekend, to access bonus ‘behind the mic’ content? This will help me hugely in putting out another 50 episodes!

Show notes

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