The eight-season-long, Hugh Laurie starrer television series House M.D. has been one of the most popular medical dramas of all time. Famous as the Sherlock Holmes of the medical world, Gregory House, the titular protagonist of the show, is a misanthropic, arrogant and sharp-tongued doctor who makes up for his crass bedside manner with his exceptional medical genius. He leads a group of diagnosticians in solving the most unconventional medical cases at Princeton-Plainsboro, a fictional hospital in New Jersey. Meanwhile, a prominent theme that runs throughout the show is House’s opioid addiction. He uses Vicodin—one of the most common prescription opioid medications—daily to manage the chronic pain in his right leg due to an infarction he had suffered years ago. Severely dependent on the drug, he is frequently seen popping pill after pill on the show. But how accurately does the series portray House’s opioid addiction and its symptoms?
In many ways, House presents a model case for opioid use disorder. Having developed a high tolerance for his medication over the years, he takes several Vicodin pills a day—much more than the ideal dosage. This is evident from numerous instances in the show. For example, in season three, Detective Tritter, who is interrogating House’s team as part of a malpractice case against House, enquires about his daily Vicodin consumption. Foreman—one of the doctors—insinuates that House easily takes six pills every hour—as opposed to the normal dosage of 1-2 pills every four to six hours (Habibi & Kim, 2022). Later, while sifting through House’s belongings at his home, Tritter discovers a huge stash of Vicodin, containing pills in a much larger quantity than the usual prescription. It is later revealed that House often coerced his team of doctors to write prescriptions for him. On occasion, he even resorted to other illegal ways of procuring the drug, such as forging prescriptions in the name of his colleague Wilson, or obtaining pain medication in the name of a dead patient (Dick, 2007). House’s excessive Vicodin consumption, his strong, desperate urge to use the drug, and the inordinate amount of time he spends trying to obtain it, in fact, satisfy some of the main diagnostic criteria of opioid abuse (American Psychiatric Association, 2013, p. 541).
Another sign of Vicodin addiction that appears to be represented in House’s case is reduced social and recreational activity—yet another diagnostic criterion for opioid abuse (American Psychiatric Association, 2013, p. 541). The show depicts House as a cantankerous doctor who has no care for his patients beyond the medical mystery. His brash, apathetic nature is of no help when it comes to making friends—which explains why he does not have many. In essence, he barely has a social or recreational life outside work. However, Stacy (his ex-girlfriend) and Cuddy (the hospital’s Dean of Medicine) claim that House was equally cranky and antisocial even before his infarction, or the beginning of Vicodin use. Therefore, while one can attribute his antisocial behaviour to opioid use, this attribution may be correlational at best, since viewers do not know what he was like before he began taking opioids.
For the most part, House remains in denial about his addiction to pain medicines. In the season one episode ‘Detox,’ in order to prove himself to Cuddy, he bets that he can go a week without Vicodin, in exchange for a month off from his clinic duty. However, he soon starts to present severe withdrawal symptoms. To begin with, he makes lapses in medical judgements resulting in grave life-threatening consequences for his patient. Furthermore, in dealing with the lack of Vicodin, House goes so far as to break his own finger in order to activate a surge of pain-relieving endorphins in his body. He also begins showing symptoms such as vomiting and nausea. At last, he comes to terms with his drug addiction and admits the truth to his best friend, Wilson (Kaplow et al., 2005). All of these withdrawal symptoms portrayed in the show, including vomiting, nausea, and impairment in important areas of functioning, are characteristic of the opioid withdrawal syndrome (American Psychiatric Association, 2013, pp. 547-548), indicating that House’s is indeed quite a typical case of opioid abuse disorder.
On the other hand, one thing that may be perceived as rather odd in the series’ representation of Vicodin addiction is the underplay of its effects in terms of cognitive functioning. The show gives the impression that opioid abuse, as severe as House’s, has no overall serious consequences for his mental functioning—besides the weakened medical judgement he experiences due to withdrawal. Research on cognitive impairment in substance-abuse disorders has shown that drug use can alter executive function and undermine cognitive processes such as attention, memory, reasoning, inhibition/regulation and decision-making (Gould, 2010; Ramey & Regier, 2018). Long-term opioid abuse is also known to have possible adverse effects on psychomotor performance because of opioids’ sedating and mental-clouding properties (Chapman et al., 2002; Jamison et al., 2003). However, no such side-effect of Vicodin is noted in the case of House. His extraordinary medical genius and the ability to successfully crack the rarest, most unusual cases remains largely intact, despite his increasing Vicodin abuse.
Certainly, the thought of a medical professional being a severe opioid addict would not be a comfortable one in real-life. It would be exceedingly difficult, almost nerve-wracking to trust the medical judgement of a doctor like House in reality. Therefore, although the TV series does seem to portray House’s Vicodin addiction accurately in many respects, it appears to downplay the potentially life-altering influence drug-abuse can have on cognitive and occupational functioning, which could have easily impaired House’s diagnostic capabilities and made him hard to trust.
References
American Psychiatric Association. (2013). DSM-5 TM. http://repository.poltekkes-kaltim.ac.id/657/1/Diagnostic%20and%20statistical%20manual%20of%20mental%20disorders%20_%20DSM-5%20%28%20PDFDrive.com%20%29.pdf
Chapman, S. L., Byas-Smith, M. G., & Reed, B. A. (2002). Effects of intermediate- and long-term use of opioids on cognition in patients with chronic pain. The Clinical Journal of Pain, 18(Supplement). https://doi.org/10.1097/00002508-200207001-00010
Dick, L. (Writer), & Sackheim, D. (Director). (2007, January 9). Words and Deeds (Season 3, Episode 11) [TV series episode]. In P. Attanasio, K. Jacobs, D. Shore, B. Singer, T. L. Moran, R. Friend, G. Lerner, G. Yaitanes, H. Laurie (Executive Producers), House. Heel and Toe Films; Shore Z Productions; Bad Hat Harry Productions; Universal Television.
Gould T. J. (2010). Addiction and cognition. Addiction science & clinical practice, 5(2), 4–14.
Habibi, M., & Kim, P. Y. (2022). Hydrocodone and acetaminophen - statpearls - NCBI bookshelf. National Library of Medicine. Retrieved November 6, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK538530/
Jamison, R. N., Schein, J. R., Vallow, S., Ascher, S., Vorsanger, G. J., & Katz, N. P. (2003). Neuropsychological effects of long-term opioid use in chronic pain patients. Journal of Pain and Symptom Management, 26(4), 913–921. https://doi.org/10.1016/s0885-3924(03)00310-5
Kaplow, L. (Writer), Moran, T. L. (Writer), & Nelson McCormick (Director). (2005, February 15). Detox (Season 1, Episode 11) [TV series episode]. In P. Attanasio, K. Jacobs, D. Shore, B. Singer, T. L. Moran, R. Friend, G. Lerner, G. Yaitanes, H. Laurie (Executive Producers), House. Heel and Toe Films; Shore Z Productions; Bad Hat Harry Productions; Universal Television.
Ramey, T., & Regier, P. S. (2018). Cognitive impairment in substance use disorders. CNS Spectrums, 24(1), 102–113. https://doi.org/10.1017/s1092852918001426
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