Treatment House

It looks like the running plot on House about the brilliant but cranky diagnostician's Vicodin habit is heading exactly where I feared: toward the realization that Gregory House (Hugh Laurie) pops all those pills not to relieve the chronic pain in his leg but because he's an addict. At first the story seemed to illustrate the injustices of the war on drugs, with a cop (David Morse) barging in to override the medical judgment of the doctors who had prescribed painkillers for House, freeze their bank accounts, disrupt their practices, and threaten them with jail. But in the latest episode House's colleagues cut off his supply of Vicodin, sending him into withdrawal and prompting desperate "drug-seeking behavior" that includes pretending to have a facial fracture and stealing a dead cancer patient's OxyContin. After he pops a few OxyContin, House is repeatedly asked whether he's "high"; then he finishes off the whole bottle in short order (a puzzling escalation for someone who was taking a weaker narcotic in smaller doses), washes it down with whiskey, and ends up lying on the floor of his apartment in a stupor. The episode closes with him trying to accept a plea deal involving drug treatment that the cop presented, in so many words, as a choice between House's principles and his career. The cop says the deal is no longer on the table. Scenes from episodes to be aired when the series resumes in January show House apologizing to the cop and announcing that he is checking himself into rehab.

I suppose there might still be a surprise that redeems what is shaping up to be (in a departure from what is usually a quirky and highly entertaining show) a morality play only slightly more sophisticated than an anti-drug after-school special. But it's hard to see how such a twist can be pulled off at this point. The last thing we need is yet another story about a proud professional forced to admit his drug problem only after he hits rock bottom. It would have been much more interesting (as well as useful to the cause of drug policy reform) to portray a doctor who takes Vicodin to control the pain in his leg but is mistaken for an addict by a heedless, ignorant, overzealous cop. All the ingredients were there: House, who walks with a limp, really does suffer from severe postsurgical leg pain. The one time he was able to function without painkillers (and without his cane) was after a radical neurological procedure that temporarily eliminated his pain. Most important, there has never been any indication that the Vicodin impaired his ability to do his job; to the contrary, his one misdiagnosis occurred when he was prevented from getting his usual dose. He plausibly attributed the mistake to distraction caused by untreated pain, while his colleagues saw it as confirmation that he was an addict in withdrawal. The show seems to be taking their side, reinforcing the ideas that 1) pain patients commonly become addicted to their medication and 2) even people with medical histories that support their complaints of chronic pain may be faking or exaggerating their symptoms so they can get high. These ideas are two of the reasons it is so difficult for people suffering from chronic pain to get adequate treatment in this country.

Ideally, it wouldn't matter whether House is a pain patient, an "addict," or some combination of the two. Morally, the relevant point is that he functions better when he's taking Vicodin than he does when he's not. His actual job performance, which (as other characters repeatedly emphasize) involves saving the lives of patients who otherwise might never have been correctly diagnosed, ought to be the relevant legal and professional criterion as well. But that is not the way the current system works, so the decision about how to label House and his Vicodin consumption has serious implications for him and his patients. It can ruin his career and send him to jail. Since that would end the show, it's not going to happen. The only plausible alternative is for House to admit he has "a drug problem," go into "rehab," and emerge a changed man. Or he could pretend to do all of that while privately continuing to reject the "addict" label, which would be in character for him as well as subversive, making a politically incorrect point about the forced re-education system that we call drug treatment. But then he would still face the challenge of getting the pain medication he needs, a problem faced by millions of Americans whose predicament is only reinforced by trite stories about addicts posing as pain patients.