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Vicodin - by emymsm

Mom speaks up on House and pain meds

I've been reluctant to post this, and thus potentially instigate the wank again, but I've been talking to my mother, who has been in House's position pain-wise for many years, and while she feels for House, she is not so quick to apologize completely for his Vicodin dependence.

She wants to know, for example, who House's pain specialist is. Mom sees a pain specialist on a regular basis who takes care to cover the whole person, psychological as well as physical. But is House treating himself? That's a big medical no-no, no matter how brilliant any individual doctor might be.

She also believes it strains believability that House would be on Vicodin for a chronic pain condition. According to her, long-acting medication is indicated for chronic pain. She has been on both a Duragesic patch and on Oxycontin, a long-acting version of Percoset without the aspirin. Doses on these therapies are dispensed on a limited basis and are monitored, so there is less opportunity for abuse or accidental overdose. (I know this is true first hand because I've driven out of my way to pick up her Oxycontin for her because the local pharmacy is not allowed to carry it.) And because these therapies are long-acting, the absorption of medication into the body is more regulated- the patient is less likely to experience extreme highs or lows and the physical dependence is less severe. Why, my mother wonders, are these alternative therapies never mentioned?

Cross-posted to house_md.
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Hey there!

Hopefully no wank will occure. :)

There is an old phrase that I heard from my mother when I asked a question like this a long time ago while watching a movie. "If you shoot the horses, there wouldn't be a movie." It came from old Westerns where the good guys, or bad guys would be galloping away and people are firing all sorts of wild shots at the riders and missing and someone pointed out, "Wouldn't they have a better chance if they shot the horses?"

The idea being, well of course they would and in real life probably did but if they did that in the movie, the movie would be over before it began. :)

House, hopefully has a long life ahead of it and it's obvious that the Vicodin is going to be a plot piece over the expanse of that life. It's part of the character development for House and it looks like it's going to be a point of contention in the close friendship between House and Wilson so I don't think the writers are going to want to wrap it up neat and tidy in a quick manner. They're going to want to work on it as the show progresses and perhaps even come to explore some of the pain management therapies that your mother is working with.

But in the meantime they need the Vicodin addiction not only for the plot value but also as a part of House's character.
I agree with you. I'd also say that there are cases where patients are just stubborn and won't do what's best for them. My grandmother has been on prednisone for decades now and raises such a huge stink when her doctor tries to take her off it that he finally just shrugged and said "OK, if you want it that badly and won't listen to the side effects, then be it on your head." He did genuinely try, but my grandmother can be a force of nature when she wants to be, and all she knows is that this is the right drug for her.

Now, she's not a doctor, as House is, but they're both human. It's human to find something that you think works for you and refuse to give it up, even if there are better alternatives. I doubt that doctors are a lot less susceptible than the general public.

(And for all we know, Vicodin is either paying for product placement, or being paid for the use of the name, which could also be a factor in its continuing appearance on the show.)
It's human to find something that you think works for you and refuse to give it up, even if there are better alternatives. I doubt that doctors are a lot less susceptible than the general public.

Quite true. In fact, doctors may be more susceptible because they can throw a hell of a lot more medical science at their rationalizations and thus feel they are better authorities than most patients.
House, hopefully has a long life ahead of it and it's obvious that the Vicodin is going to be a plot piece over the expanse of that life. It's part of the character development for House and it looks like it's going to be a point of contention in the close friendship between House and Wilson so I don't think the writers are going to want to wrap it up neat and tidy in a quick manner.

Yes, I think this is the correct real world answer- dramatic tension.
I ran across a medical blogger who is probably on the same page as your mom. He ID'ed House's condition as dependence and pseudo-addiction rather than addiction:
http://politedissent.com/archives/572
*nods*

That's why I took care to use the word dependence. Do my mother and I think he's addicted? No, not in the truly pathological sense. His pain and his need for relief are real. But we wonder if he doesn't at least hold some responsibility for maladaptive choices that prevent him from seeking better options.
She wants to know, for example, who House's pain specialist is.

I think it was implied in an episode that Wilson is his doctor in that matter -- or was it? I can't remember. Something like that.
Perhaps I'm reading this wrong, but Wilson may be the one simply writing the prescription to cover for House's self-medication rather than his official treating physician. Afterall, Wilson is an oncologist. Why would an oncologist be treating someone with a simple infarction?

It's not uncommon in the medical fields to simply ask a colleague.
True, true.
Personally, I think it's a combination of factors. First there's the fact that Vicodin is a high-strength pain killer. With as coherent as House is, and how much he takes, it means he has an extremely high level of pain, and that he burns through his medication. Long-term painkillers would be easier to handle and prescribe, yes, but as I understand, they probably wouldn't have the same level of pain coverage. Add this to the fact that, after this long on Vicodin, his body has definitely physically adjusted to work with it. Taking him off now could cause any number of problems, even if they went slowly and adjusted him to a new painkiller regimen simultaneously.
Pardon my interjection here, but I'm a chronic pain patient who was on Vicodin for a while, so this interested me.
Long-term painkillers can be very strong. I was on one for a while called the Duragesic patch, which was a transdermal patch filled with gel that was switched every three days. A constant level of pain medication in my system 24/7 - and it's a medication that's three times stronger than morphine. Leaves Vicodin in the dust. And it's a different kind of opiate, so he could continue to take Vicodin until the Duragesic kicked in and got up to full strength. Then, if there was additional pain, he could take more Vicodin for "breakthrough" pain.
Another issue that no one has really brought up is that Vicodin has quite a lot of acetaminophen in it. If you take it regularly in large doses, you will no longer have a liver after a while. Or kidneys, for that matter. Or a stomach lining.
Of course, House exists on Planet Television and not in real life.
... trust me to completely forget to reply to this for weeks.

Now you've got me curious. On the surface, this patch sounds better than long term Vicodin. Of course, with painkillers, there's a lot of individual variation. What are the pros and possible cons of this patch? And if I may, what condition causes your chronic pain? Because pain varies from person to person and condition to condition, I'd like a baseline value.