this is an excruciatingly painful surgery, getting one knee replaced this painful, both of them is excruciating. she knew and i knew she was going to need a lot of pain medication. she was terrified and i was terrified because i had just gonethrough this so by then i had exploited all my access . i knew people who knew people. i had a world-class orthopedic surgeon and pain doctor advising me and i applied it to my mom's case and said there's a lesson me and my friends and my team have drawn up, i don't care whatyour surgeon says . were going to take ownership of this is i don't trust doctors anymore. so we made a plan, stuck to it. my mom is an absolute boss and she did what she felt like she needed to do and it was hard to watch. it was very painful but in about two weeks she was off of medication more or less and the third week he needed an occasional nighttime dose

and after she was a little bit more coherent and in less pain i texted her and said an account how many pills you have left because i knew she'd been prescribed hundred 20 nor does, that's a 7.5 milligram nordic own tablet and when, that's what she'd been described , that's four pills a day for 30 days read bad news is what that is. what you might need to come out of it, i was interested to knowhow much . the reading picks up when she answered me, she texted a little while after i asked writing i have 73 ofthe hundred 20 remaining . he used well under half of what she'd been prescribed. i should have been surprised but by this point i begun to see the data on overprescribing for surgery. practitioners in all different feel are examining their prescribing practices, pushing with the average prescription is and then attempting to find out how many pills patients and up taking. results like my moms are not uncommon.

a particularly striking result was published in 2017 by researchers at the university of michigan. their study looked at a particular procedure, gallbladder removal and found the average prescription for this surgery was about 250 milligrams, measured in morphine equivalent for the sake of standardization. when the researchers interviewed patients, average amount of medication taken was 30 milligrams area as a result the group produced a prescribing guideline and included an educational component that informed patients they would need only a few pills for a handful of days andthey shouldn't take the pills unless they really needed them . in the months following the implementation of this guideline average amount of opioids prescribed drop from 250 to 75 milligrams and was no increase in refill requests. just because opioids are seen as necessary in cases of surgery or severe injury is not mean we can't make very real progress. exposed to opioids at all but one at risk.

the evidence suggests the length of exposure influences risk to a remarkable degree. we cannot justify sending more opioids out into the world and can't allow doctors to write prescriptions for 120 pills when 60 will do or for 30 pills when five will do. so i get to this point in my research and one of the things i'm realizing is we need a discussion about responsible opioid prescribing and responsibilities is and deficits right so hammer, nail area we needed discussion about appropriateness and responsibility because the conversation is happening during this pendulum swing is either drug for everybody because they have pain and drugs should be given for drugs for nobody because these are evil black magic . those are both insane positions. they're completely unsupportable by the evidence . it turns out some paint responds well to opioids for some amount of time and we should responsibly use opioids in those cases only and that sounds like a plausible, you need to have a

phd to say that mark apparently area apparently someone does have to say that . this is about responsible opioid prescribing and another thing that was interesting was you go back to my experience and it wasn't just about the number. a number was almost certainly a problem and the reason is because i got a hands-off. there's an unlimited number of pills and by the way you're going to be in unscrew shooting pain area every four hours likeclockwork . what happens when you take opioids to mark your intolerant to them, it's a physiological response so if you're looking for the same response youneed more to achieve that response so i just kept upping the dose . there wereproblems with the amounts had i known what i know now then , my hope is that i would have tried to increase the dosage a lot sooner. way way the benefits of pain relief against the risks of future suffering. but i didn't have an information so i couldn't go

there's a bunch that's happening, the number of pills is a problem but there's this management problem . is a physician or a news or pa, if someone isn't looking at you while you go through this, no one's going to be there to help you when things start to go off the rails. if no one knows how to get you off the medication for no one sees it as their job, even if you've been prescribed well you might be in trouble when you try to get off them. don't do it well, go into withdrawal and say life is better on the pills. so click up shot of the research, responsible prescribing is harder than we think. you can't just do all or nothing and it's going to take a lot of work. unfortunately the nuance is hard and we don't like to do it so we're going to have to think a lot about what it means to have clinicians ascribe the right number of pills in the right circumstances for the right amount of time with the right kind of oversight. >> if you want to watch the rest of this program, visit booktv.org and search for the title of his book "in pain: a

bioethicist'spersonal struggle with opioids" at the top of the page . >> here's a look at authors whom appeared recently on book tvs "after words", our author interview program that includes best-selling nonfiction books and guest interviewers. last week greg jarrett argued against the validity of the investigation into russian interference in the 2016 presidential election. coming up david shelton will recount his time as secretary of veterans affairs and this weekend on "after words", republican senator rand paul provides a history of socialism and contends there is a new threat of socialist thinking on the rise in america . >> if i'm going to be a capitalist and i sell something i'm not caring about my desires. i may want to be successful but i have to care about what you want. i have to care about everything you want if you're the consumer so everything is focused outwards in adding you to buy my services or product find a socialist i'm not caring too much about popular opinion or pleasing a

consumer. when we socialize things like healthcare, they just say everybody's going to get it. you'll no longer be bankrupt and worry about your bills but you will have to have rationing. they don't seemto care you'll have to wait a year for your replacement . it's directed more towards their ideological concerns. >> how does that drive selfishness because it seems as though you're making our human a country that is more socialist becomes more selfish. >> i think that is true and i think it's an irony in a way because they would profess to be it's for the other man, everything for someone else but in the end it is driven by selfishness and also by their ends up being an elite in their society and they consume and accumulate power and money and homes and everything else based on the cronyism of their system. >> "after words" airs this saturday at 10 pm and sundays

at 9 pm eastern and pacific on book tv. and all previous programs are available as podcasts and to watch online at booktv.org. >> here are some of the current best-selling nonfiction books according to the new york times . topping the list, msnbc's rachel maddow argues that the oil and gas industry as weekend mocker sees acrossthe world in blowout . next it's talking to strangers, new yorker staff writer malcolm gladwell's examination of how we misread strangers words and actions . after that, fox news greg offers his thoughts on the molar investigation in which followed by the united states of trump, bill o'reilly's look at the life and career of president from and wrapping up outlook at some of the best-selling nonfiction books according to the new york times is the book of betsy women, hillary and chelsea clinton's thoughts on the women who've

inspired them. these authors have appeared on book tv and you can watch them online at booktv.org. >> here's a look at the events book tv will be covering this week. on monday we are at the marriott books in jackson mississippi for historian sc wins study of the final year ofthe civil war . and on tuesday look for us at the schonberg center in new york city for eric k washington start on james williams, chief order of the grand central terminal red caps in the early 1900s was the face of his african-american workforce and champion of their upward mobility. on wednesday in new haven connecticut, yale lecturer charles carter will report on the life of william june outlaw and his journey from a convicted felon to a community advocate. then on friday we will the san francisco public library with a presentation of the 40th annual american book awards, all these events are

open to the public. if you're independent picture and tag us at book tv on twitter, facebook or instagram. >> now we're back live at the texas book festival with journalists ben westhoff on the opioidcrisis . [inaudible] >> .. >> ..