“He’s there, isn’t he?” — Foreman, to Wilson over the phone
“That would certainly explain the inappropriate responses.” — Wilson
I’m not usually one for shaking things up on House — I like the formula and I make no excuses for my tunnel vision and my narrow mind. Tonight’s episode, though, veered from the formula a bit and it worked for me.
The part that worked? House on Methadone. I liked seeing House in a good mood; he was still funny, if not particularly quotable. He still toyed with his team, faking not breathing after his near-miss … poor Kutner.
So the quotes came from Cuddy (regarding not having sex with House), Wilson (on the phone with Foreman) and Taub (Foreman impressions) this week — is that so wrong? And more funniness ensued as everyone was sure House was on Heroin.
One thing I don’t get, not being a drug addict or a doctor: what’s the difference between Vicodin and Methadone? They are both opiates, so they must work the same way. Is one just stronger than the other?
It must be huge, because House’s pain was eliminated, and that’s so important to him that he chooses “lack of pain over this job” when Cuddy gives him the ultimatum — no Methadone or no job. So he cleans up, shaves and is prepared to go to another hospital for a job interview. Cuddy knows he belongs at Princeton-Plainsboro, so she offers him his job back if they can monitor his Methadone use.
Now, here’s where it gets good. When House realizes that his good mood allowed him to approve an unnecessary MRI that actually caused the boy’s health problems (beyond the dehydration he was admitted for), he decides that he needs to have pain, Vicodin and a mean streak.
So what do you think? Is House right, or can he still be a good doctor when he’s not in pain?
Clacked by Debbie McDuffee
on Feb 24, 2009 @ 09:00 EST5EDT
I just stumbled across this.. so I’ll go ahead and answer your question (as a Methadone patient).
Methadone is a pretty strong opiate. A LOT stronger than morphine in terms of pain relief, with probably around the same risk of respiratory problems. It is not something that people are likely to get on a whim, as opposed to Vicodin or Oxycodone, even. In fact the mere mention of Methadone can even produce vulgar reactions in most personal physicians, to the point where they want nothing to do with you.. But this is unfortunate, Methadone gets a real bad rep because of ignorance and lack of education, even within the medical community.
Everyone hears Methadone and they automatically come to the conclusion you are a drug addict, addicted to painkillers or something illicit like Heroin. Some people even mistakenly assume Methadone was invented FOR drug addiction, when it was in fact researched by the Germans during the run up to WW2. They were looking for a synthetic alternative to morphine for post surgical pain because of the risk of their opium supply being cut off during the War. At least that’s my understanding.
Methadone, while extremely useful for maintaining drug addicts, or weening them off opiates entirely, is also a very efficient and long acting tool that can be used for chronic pain. It’s not uncommon to see someone with cancer taking Methadone either.
In the interest of full disclosure, I am taking it as a dual purpose drug. On my medical charts its listed as treating my Restless Leg Syndrome (another ignorantly approached subject by doctors and the masses), however I also consider myself a recovering addict and had to push my doctor hard to get him to prescribe it to me. Mainly because of his lack of experience in prescribing it for RLS, but an article from a reputable medical database gave me enough credability, and now Methadone is even listed in the Mayo Clinic’s Algorithm for treatment of RLS. I ultimately had to push for it because I had been on Vicodin and many other opiates but reached the point where my symptoms were so severe, all day long, that I could not trust myself to manage a large supply of short acting opiates, Vicodin in particular. My self control would obliterate if I came anywhere near Vicodin. It’s a little different for everyone though. Vicodin just makes some people puke, and others feel not much at all, but those of us who do just feel like we are wrapped in this warm blanket of goodness.
Anyway.. I thought it was an interesting change up for House, but I was very disturbed with the way the portrayed Methadone on the show.. It almost seems like they went out of their way to say it was no better than a drug like Heroin, which is simply NOT true.. The character reactions were WAY overblown, and the oft repeated “You’ll DIE if you keep taking this stuff” is flat out FALSE and severely misleading. I was very torn between “it’s just TV” and being disgusted, perhaps because I have personal experience?
I have always been the first one to tell people the risks of Methadone, when I talk with people considering it, or recommend someone look into it (within the scope of severe RLS treatment). The portroyal of Houses’ breathing problems was pretty accurate of someone starting Methadone. If the strongest thing you have taken consistently (ignoring his occasional morphine injections) is Vicodin, then you have to start Methadone extremely carefully. I always tell people to break their pill in half and only take 2.5mg if they have little or no previous opiate tolerance. Give it some time and if you feel alright, work your way up to your prescribed dose over the next couple of days.
The majority of Methadone related deaths have either been caused by a patient ignoring their doctors instructions, or the doctor giving poor, or no instructions at all. You should not drink Alcohol when starting Methadone, although over time you may be able to get away with a 4oz glass of wine with dinner or something like that. You can’t mix it with other CNS depressants (benzos mainly, Valium, Xanax, Alcohol etc) because it is a big enough depressant all by itself.
The beain fogginess and tiredness was pretty accurate, although I don’t suffer from it most of the time, and it goes away for many people. But I just take huge issue with the whole “House is gonna die if he takes Methadone” and his boss lady referring to “using it” as if it was some kind of illicit and extremely dangerous street drug.
Well that’s my view on it anyway. You probably didn’t expect a huge reply, but you asked and I told.. Wikipedia’s Methadone page has some pretty good and relatively accurate information if you want to know more about it.
Totally agree with Zach! They did a huge injustice to methadone as a treatment option for opiate addiction. I wonder how the writers were influenced this story line.
I actually like my House pre season 5, this season is just a mess. Out of this season through this is the best episode in many many months.
The writers are taking alot of liberty and not addressing Methadone treatment and its positive effects,
they call him the melow drugged house when on Methadone and well dressed and out of pain, isnt the mean, anxious, pill popping, limpinmg house the DRUGGY!!!!!
I stumbled across this site and agree with Zach.
Though I do not use Methadone, my father does for chronic pain. I, who have the same congenital problems (though less advanced) use Vicodin and Ultram.
The general public as well as much of the medical community misunderstand Methadone and I am upset by how it was portrayed on House.
Methadone, though is a CNS depressant is not as risky as it was portrayed. Moreover, it is not as mind-altering as Vicodin. The medical consultants for this show need to take greater care with such important issues.
“House” has always lacked accuracy when it comes to its portrayal of opiate use. For one thing, if House popped Vicodin like candy, he’d soon die from the Tylenol in each pill. But, Methadone is one of the safest, most studied opiate available. Many, many, many pain patients take Methadone without being “monitored” with urine tests like some street addick. I’ve been taking it since 2000 and it has helped me greatly with lifelong chronic pain.
This kind of inaccuracy substantially detracts from the sho.
Good point about the acetaminophen content.. From the looks of it they’re probably 5/500mg’s too, one of the least efficient formulas available.. Although we really don’t know how many he takes for sure every day (I’ve seen reference to different numbers here and there).. To play devils advocate, I used to routinely take 7 or 8 grams of acetaminophen, because I just stopped caring. The literature on 4grams being the maximum safe limit is likely a conservative estimate based on average population liver/kidney functions as well; I’ve seen reports about addicts taking upwards of close to 20grams (although they were very young, so they could take a lot more punishment) and people were rightly surprised they weren’t dead..
I took the 10/325mg formula for a while, but that is where I really went off the deep end, and ended up with a 100mg/day habbit for a while… Consequentially it was the best week of my life, ever. Heh… They need to bundle it with a better medication that just makes you puke or something if you take way too much, like they do with Dextromethorphan in cough medicines. That will deter people a lot more than the prospect of acetaminophen poisoning, as painful as it may be to die from.
Also worth noting.. Vicodin does not hit you the second you swallow it, much less when taking 1 or 2 pills with a sustained high tolerance, as portrayed on the show.. The only drugs that will ever hit you THAT fast have to be injected or smoked.
But I digress.. I supposed I’ll now have to view the show with a little more skepticism.
I took HUGE issue with this episode. I enjoy this show, but I hate the way the writers portray chronic pain by treating House with Vicodin: a short-term pain med that causes both tolerance and dependance. Cuddy and Wilson should be MUCH more concerned about House taking Vicodin for his chronic pain – it’s much more dangerous.
I have severe rheumatoid arthritis, and vicodin was downright cruel as a pain med in the beginning. There’s a 4hr roller coaster ride you go on – a dramatic up and down in pain relief, and the up doesn’t even come close when you have extreme pain – it’s just enough that you can sort of think straight for a minute, then get ready for the downhill slide where you’re counting the minutes til your next pills. You cannot just pop fistfuls of vicodin and LIVE, certainly not day after day like they portray House in every episode.
Vicodin is a short-acting med that’s effective for short-term pain – like if you need a root canal or something. For long-term chronic pain it is cruel and ineffective. Besides the roller coaster effect, it builds tolerance and dependence, meaning you need to take more and more over time to achieve the same level of pain relief, until it no longer functions to relieve pain at all, yet you now have a physical dependence on the med. So essentially now you’re in pain with no relief AND addicted to a med that doesn’t work to relieve pain. Thank you very much US doctors.
Methadone is a much better option for a person with long-term chronic pain than vicodin. It doesn’t lose effectiveness over time, and it works better to relieve pain than the short-acting pain meds. It doesn’t “kill” you when you’re “using” like they portrayed on this episode of House. At the time I was taking methadone, I was too sick to even think about drinking alcohol, but I also had hydrocodone prescribed for “breakthrough pain.” I never stopped breathing, experienced fatigue (from the med), lost my good judgment/intellect, etc. That’s what I liked about it – it treated my pain, period, and was fairly stable in the way it helped over 12 hrs – not the 4hr rollercoaster ride of vicodin. If there was anything, it did lift my mood slightly, and that was not a bad side effect. I guess that’s what they were getting at with House suddenly wanting to shave and clean up, ask if he could eat Wilson’s food, etc.
Another thing I didn’t like was House saying his pain was gone, throwing away his cane and walking away. I wish. Methadone helped with a more long-term stable effect rather than the roller-coaster ride of short-term pain meds, but I still couldn’t walk without help, get out of a chair, dress myself, get off a toilet seat without assistance, etc. It’s not like you get up and dance – I would still wake up in the middle of the night gasping for breath because of the pain, then rock myself back and forth with tears streaming out of my eyes. I don’t know if there’s a panacea out there for extreme chronic pain that doesn’t leave you comatose. I just don’t know if you can describe that kind of pain to someone who’s never experienced it, but obviously none of the writers on House have ever been there.
I don’t get that House suddenly loses his level of observation, loses his judgement. If anything, with less pain he would think more clearly, be able to pay better attention to subtle things, etc. Pain doesn’t help you focus – it’s hard to describe how distracting contant pain is.
By the way, I’m doing really well and getting by with occasional short-term pain med use now, which is wonderful. I had to go through withdrawal from methadone, which was not fun, I’d not want to face that again – but I still say that if the meds to control my RA quit working and I had to face long-term chronic pain, I’d go back on methadone. It gave me the strength to fight when I needed it most, and it helped with the pain in more consistent manner. I hated the way the writers of House maligned this med. And vicodin also for that matter – it has its place also. But you cannot pop fistfuls of vicodin for long-term pain without serious problems. Just ask Rush Limbaugh.
After that Grey’s episode I wondered whether it was National Transgender Day or something.
While the poll is a nice idea this was basically a Superman episode where Superman lost all of his power. You simply can’t ask if you like him better without powers for then it wouldn’t be Superman anymore. The reset was the logical result at the end. House without Vicodin wouldn’t be House and that’s just it.
I am so glad that I am not the only one who took issue with the methadone myth that episode of House portrayed. I have long had issue with the accuracy with which they portrayed House’s addiction to Vicodin. As someone stated, and as I know from unfortunate personal experience that long term use of Vicodin (5/500, any other dose would be referred to by a diff name such as Lorcet etc.) will result in unfortunate effects from the Tylenol. Also, after years of Vicodin use, the drug would do virtually nothing for his pain, he would be practically immune. At any rate, his supposed symptoms from the methadone use were RIDICULOUSLY exaggerated and I wonder at the validity of their medical advisors. Are they just so used to dealing with the fictional medical symptoms that they took liberty with reality? I struggled with the methadone stereotypes and it took me a long time to overcome my feelings about the drug. I have been taking it for 2 years and it saved my life, literally. True, some people and clinics give the drug a bad name through misuse, but it has it’s place and when used properly it can be amazing. Had I not bought into the stereotypes I would have gotten myself into a meth program a long time before I did. I struggle with getting others around me to accept my use of methadone. Shows and propaganda like this perpetuate the misinformation about methadone. It’s unfortunate that this happened.
Can you provide more information on this? i have read other websites that are on similar subjects.
I loved this episode of House. I think it said exactly what is wrong with the unfortunate situation of doctors prescribing methadone for pain. I lost my 20 year old son to an accdiental overdose of methadone and our lives have been destroyed. This is not a drug to take lightly and it is taking the lives of so many people who did not understand it’s potency and dangers in mixxing it with other drugs. Vicodin is not an opiate. According to the Department of Justice’s National Drug Intelligence Center, the number of prescriptions written by physicians for methadone increased by 715 percent from 2001 to 2006. Similarly, according to the Centers for Disease Control and Prevention (CDC), in 2005, there were a total of 4,462 methadone-related deaths, representing an increase of 468 percent since 1999. Although methadone may have it’s place it should be considered as a last resort for treatment of pain with the doctor being involved in monitoring the patients other drug use and educating the patient as to the risks of taking this drug. I believe House was not “faking it” as someone stated above. The FDA warning says:
FDA has received reports of death and life-threatening side effects in patients taking methadone. These deaths and life-threatening side effects have occurred in patients newly starting methadone for pain control and in patients who have switched to methadone after being treated for pain with other strong narcotic pain relievers. Methadone can cause slow or shallow breathing and dangerous changes in heart beat that may not be felt by the patient.
Prescribing methadone is complex. Methadone should only be prescribed for patients with moderate to severe pain when their pain is not improved with other non-narcotic pain relievers. Pain relief from a dose of methadone lasts about 4 to 8 hours. However methadone stays in the body much longer—from 8 to 59 hours after it is taken. As a result, patients may feel the need for more pain relief before methadone is gone from the body. Methadone may build up in the body to a toxic level if it is taken too often, if the amount taken is too high, or if it is taken with certain other medicines or supplements.
To prevent serious complications from methadone, health care professionals who prescribe methadone should read and carefully follow the methadone (Dolophine) prescribing information
link: https://www.fda.gov/cder/foi/label/2006/006134s028lbl.pdf
If you are taking methadone, only take as prescribed, and be sure to keep in under lock & key to avoid diversion. I would hate for anyone else to have to go through the pain our family is going to live with the rest of our lives in losing my only son, my daughters only sibling and our only namesake….
I’ve been going to a methadone clinic for chronic pain/narcotic addiction for more than 12 years. The House episode may have been funny and even attempted to be poignant, but as far as helping viewers understand the nature of methadone vs. hydrocodone/apap, it’s like watching Fox News to get a perspective on liberal politics. For chronic pain or drug addiction, which from my experience is one and the same, vicodin is the worst treatment, worse even by far than heroin. It is very small time temporary pain relief but keeps you addicted as painfully as heroin. The biggest danger is the excess acetaphemine that will build up in you with chronic even short term use. You can die or lose your liver very quickly. If you use methadone as prescribed, you will have very effective longer term pain relief with virtually no danger or problem. The problem is in going off methadone or taking it outside of established norms. You will have severe withdrawal and wish to be dead. But with proper control, and a smart prescriber who understands that the drug is most effective as a life-long pain reliever, you will have no problems. If House were real, he would have found methadone long ago, found his pain controlled so effectively he would never have to explain it to people, and been able to work and socialize with no negative effect.It is because of ignorant doctors and patients that methadone has a bad name anywhere and very unknowledgeable scriptwriters that House portrays it so stupidly. I would never go off it.
Our son, 34, was taking methadone, as prescribed. He died last August. He is one of the many victims of methadone. It is a dangerous drug because of it’s halflife leading to toxicity and cardiac problems.
One of the main reasons that it is prescribed so often is that it is very inexpensive compared to other pain medications.