The new season of Nurse Jackie, the Showtime series starring Edie Falco as a super-competent emergency-room nurse with a fondness for pain pills, begins with her character in rehab. Unlike Gregory House, the brilliant diagnostician played by Hugh Laurie on Fox, Jackie Peyton does not actually suffer from severe chronic pain; rather, she uses narcotics to manage her emotional state. But like House, she is very good at her job, which never seems to be compromised by her drug use except to the extent that she lies and cheats to get painkillers (along with the occasional stimulant) and to cover up her habit. Her drug-related problems stem almost entirely from the fact that the drugs she favors are legal only for doctor-approved medical use. Hence she invents injuries, deceives her friends, swipes medication, and starts an ill-advised extramarital affair with the hospital pharmacist who supplies her with painkillers. If she could simply walk into a store and buy the oxycodone, hydrocodone, and amphetamine that help get her through the day, those problems would disappear. Which raises the question: Does Jackie have a drug problem or a prohibition problem?
That issue is stark in Nurse Jackie because, as far as I can recall from the first three seasons, she is not portrayed as screwing up at work or screwing over her friends and family because of her drug use per se. It would be different if she compromised a patient's welfare or forgot to pick her daughter up at school because she was high on OxyContin. But as far as we can tell, the drugs she takes do not impair her performance or keep her from meeting her responsibilities; if anything, they help her deal with pressure and get the job done. Likewise on House, popping Vicodin did not seem to disrupt the central character's life until it was unambiguously declared a problem at the beginning of the sixth season, when he, like Jackie, ended up in rehab for reasons that were never entirely clear. The plot turn was especially puzzling on House because we were frequently reminded that he suffered from ongoing pain as a result of surgery that left him with a limp, meaning he had a legitimate medical need for the pills he took. In the end, House went back to the Vicodin as if rehab had never happened and continued to perform his job exceptionally well.
Jackie Peyton and Gregory House both have serious personal issues (don't we all?), but they are not caused by the drugs they take, although the problems may help explain why they take those drugs. You could argue that relying on these chemical crutches prevents them from dealing with their problems as they should. Characters on House occasionally make that claim, but we never really see it. (The last episode of the series airs on May 21, and the plot description suggests it will try to tie together these loose threads, possibly with embarrassing results.) It seems the writers of both shows are torn between a desire to credibly portray a high-functioning addict and the expectation that every addict must eventually meet his downfall, as anti-drug propaganda demands. But real life is more complicated. People can regularly take psychoactive substances, including opiates, for many years without suffering any serious physical or occupational problems as a result, provided they can avoid legal complications. If OxyContin and the occasional Adderall really do help Jackie Peyton cope (as opposed to helping her avoid coping), why is that a problem? How is it different in principle from the antidepressants and stimulants that millions of Americans legally consume for similar purposes? Does it all come down to a doctor's permission slip?