A Bitter Pill to Swallow

Prime time is OD'ing on characters addicted to painkillers, but doctors say their depictions could use a shot of realism

By NOEL HOLSTON SPECIAL TO NEWSDAY
February 19, 2006

Part of a character

In Fox's "House," the addiction to painkillers of the title character (played by Hugh Laurie), a brilliant medical diagnostician with a bum leg, is, as executive producer David Shore put it, "a thread we pull on occasionally." He said he and his staff feel an obligation to depict Dr. House's drug problem honestly. "It's not a show about addiction, but you can't throw something like this into the mix and not expect it to be noticed and commented on," Shore said. "There have been references to the amount of his consumption increasing over time. It's becoming less and less useful a tool for dealing with his pain, and it's something we're going to continue to deal with, continue to explore."

More commonplace, however, are shows like ABC's new sitcom "Crumbs," in which Jane Curtin's character's recent stint in a mental institution and the medication that makes her release possible are played mostly for laughs, and NBC's recently withdrawn "The Book of Daniel," in which a pill-popping minister (Aidan Quinn) heads an ensemble of calculatedly outrageous characters.

Seppala said patients who come to Hazelden for treatment for addiction to prescription painkillers often "think it's OK, that somehow it really isn't that serious. They think: 'It was prescribed by my doctor. I'm using it for pain. How can that be bad?' I don't think the media equate addiction to prescribed pain medication with addiction to heroin. But they're the same class of medication, just as powerful. In fact, some are more powerful."

"They're downplaying the danger," said Dr. Clifford Bernstein, director of the Waismann Institute, a detox center in San Diego. "It fosters the attitude, 'How bad can these things be?' And that's one reason why so many people have gotten hooked on them."

How many is "so many"? According to a report by Columbia University's National Center on Addiction and Substance Abuse, the number of Americans who abuse controlled prescription drugs has nearly doubled - from 7.8 million to 15.1 million - since 1992. Abuse of such medications among teens has more than tripled over the period.

A study by the National Institute on Drug Abuse released last December said that 9.5 percent of 12th-graders reported using the painkiller Vicodin and 5.5 percent reported using OxyContin.

You probably wouldn't guess this if entertainment TV is your primary window on society. You would more likely believe there's an epidemic of serial killers. Still, in the case of prescription-drug abuse, television is basically mirroring its audiences' ignorance. When characters in an upscale soap such as Fox's "The O.C." drop the brand nickname "Oxy" as blithely as they might "iPod," it's actually one of the more realistic aspects of the show. Nearly half the adults interviewed in a recent random survey funded by Reckitt Benckiser Pharmaceuticals didn't understand that prescription painkillers such as OxyContin, codeine and Demerol are fully as addictive as heroin.

How should shows tackle addiction?

Doctors interviewed for this article acknowledge that prescription-drug abuse is a tricky problem for TV entertainment shows. They point out that the medications have tremendous benefits as well as frightening downsides, that most people who use them don't become addicted, and that even those who do may not exhibit behaviors that we associate with heroin addicts and crackheads - at least not for a while.

Bernstein noted, for instance, that the portrayal of Karen isn't necessarily unrealistic. "Karen is popping Vicodin all the time, and she hasn't lost her wit," he said. "She hasn't lost her edge. And that's the point. You're too functional on it. It's almost too good of a drug.

Almost. If a user of a prescription painkiller gets into an addictive cycle, tolerance develops rapidly, leaving the abuser to chose between taking more and more pills or painful, debilitating withdrawal. "It's medication that changes the body's biochemistry and that, if it's not being taken, makes the body feel as though it's being poisoned," Crausman said.

That's what he and the other doctors would like to see more of on television. That, and how much it costs to break an addiction. "We see people who just can't get off these drugs, even with treatment," Sepalla said. "There's great difficulty associated with that. And for those who can afford the kind of treatments we offer, people who don't have insurance, don't have the money, it's really troublesome."