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Gavin: Narrative Does Matter: Self-Guided Opioid Weaning

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Perhaps it's obvious. I write blog posts with regularity, I consume news voraciously and I've never met a microphone I didn't enjoy speaking into. But in the event it's not readily apparent, I'm happy to share that the single most important concept in contemporary communications is this: narrative. 

Michael Gavin

Michael Gavin

"Narrative" is occasionally used as an epithet in political discourse (as in "you're just choosing facts that fit your narrative"), and I'm as concerned as anyone else about the balkanization of modern media (which I describe as "choose your own narrative"), but the power of well-told stories to shape, change or at least influence thinking, is undeniable. We live in a world of competing narratives, and while the ability to identify such is critical, the ability to create such can be transformative. 

Health Affairs understands this. Whenever I get a new issue, I typically flip directly to my favorite section: "Narrative Matters." Here, public health workers on the front lines share stories of what it means when platitudes turn into policy. It's one thing to talk in the abstract about the Centers for Disease Control and Prevention's Ebola response. It's quite another to listen to a doctor tell the story of running an ebola clinic in Liberia. 

This month's issue contains another in a long line of compelling stories, though this one hits close to home for those of us fighting to stem the tide of prescription drug misuse and abuse.

The story comes to us from Travis Rieder, a research scholar at the Johns Hopkins Berman Institute of Bioethics. His journey, despite his role at Hopkins, doesn't have anything to do with his role in public health. Travis likes to ride motorcycles, and his story begins with a horrific motorcycle accident. 

I won't retell the story (you really should read it for yourself), but to summarize: Travis ended up deeply dependent on opioid painkillers. Knowing he needed to stop taking them, he initiated his own weaning protocol (which was, in retrospect, far too aggressive — even thought it was suggested by one of his doctors). He lived in agony for days, then weeks. But he stuck to his plan. At one point it got so bad, he contemplated suicide. 

Where were his doctors, you ask? He found the medical profession to be some combination of afraid, inept, reluctant — perhaps all of the above — to assist in the weaning of his opioids. And this was a motivated patient, asking to be weaned.  A highly educated, white collar academic who was begging for help, and got none.  

"How could it be that my doctor's best tapering advice led to that experience?" Travis asks, "and how could it be that not one of my more than 10 doctors could help?" And think: This story found its way to Health Affairs because Travis is a known author in the field of bioethics. How many non-bioethicists out there are suffering in this same opioid purgatory?

As my colleague Mark Pew has written about extensively, we've arrived at the hard work of cleaning up the mess. He even created a hashtag for it (#cleanupthemess), not because we're trying to score marketing points, but because we needed an organizing principle for the combined and coordinated effort its going to take to accomplish our collective goal. 

Travis' story highlights the fact that the cleaning up may be harder than we imagine.

Michael Gavin is president of Prium, a medical managed care provider for the workers' compensation industry. This column was reprinted with permission from the firm's Evidence Based blog.

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