Vicodin addiction/withdrawal

Factual Questions
1

My wife has been getting into watching some back seasons of House on DVD. I don’t watch much TV, but I’m a Hugh Laurie fan from way back, so I’ve watched a few. It seems that Gregory House is addicted to Vicodin, I presume from taking it to ease the pain in his leg. The thing that I’m curious about is how it doesn’t seem to affect his performance. (I know, it’s TV. Even so, it made me realize I am not very knowledgeable about how addiction works.)

If he stopped taking the pills, would he be in pain? That is, would his leg hurt more than ever, or would he just feel like he had the flu or something? If not, is it more of a psychological thing? Would he just have cravings for it?

Does being on it affect his performance in any measurable way?
I have a lot of questions now, but at least I got to see an excellent TV show, and that’s pretty unusual.

Thanks for any answers,
RR

2

Vicodin Withdrawal As far as the pain coming back, I would imagine that would be the least of his problems compared to the symptoms of the narcotic withdrawal.

3

I might check out that link from home. For some reason, I don’t relish the idea of pulling up that particular URL at work.

Thanks,
RR

4

Over in the Cafe Society, it has probably been discussed that House is House because of the Vicoden, and when he went without it, his performance suffered.

5

My SIL has been addicted to it for years, and she’s fully capable of doing her life. YOu build up a resistance to it.

6

In a lot of cases, people who are taking it just for pain and aren’t psychologically addicted don’t suffer from withdrawal nearly as much as an addict does.

7

Speaking as a Hopkins Med grad with a past history of opiate addiction (decades ago now, thankfully), I can say that during withdrawal performance will suffer, but afterwards performance gets a hell of a lot better.

Hopkins and opiates are a sort of tradition, going back to the father of Modern Surgery, William Halstead. William Stewart Halsted - Wikipedia

8

Actually, it does affect his performance … positively. :wink: He’s way too complainy when he’s off it.

One of the physical symptoms of withdrawal is hypersensitivity to pain – the medication isn’t filling the opiate receptors, and the brain’s production of endorphins hasn’t returned to its normal level, so there’s a dearth of painkilling chemicals around, and pain hurts worse than ever. So yes, his leg would hurt a lot worse during withdrawal.

This next part may be more Cafe Society related, but I’ll put it here since it’s related to your specific question.

House himself is … a bit of a difficult call. Ostensibly he’s taking the Vicodin because his leg hurts, and there’s no doubt he does need pain medication, and (this next part may be a spoiler, because it didn’t happen until the end of last season / beginning of this latest season):

when his leg stopped hurting, he stopped taking it the painkillers, and didn’t start taking them again until the pain returned.

But he also displays a lot of the characteristics of an addict, like hoarding, forging prescriptions, etc. That indicates a psychological component, i.e. addiction – that he’s afraid to go without the pills. But then again, he really does need them to function…

I’m not sure whether I’d characterize him as an ordinary pain patient or an addict. But I love the show, and I think the depiction of his painkiller use is slightly more realistic than most.

9

Feh. He’s hooked through the bag. Period.

10

Can’t say I had ever heard that term before. It brings up an unpleasant image. :eek:

I hope I’m interpreting it wrong.

11

No, you got it in one.

12

This reminds me of another question: how long would he have to stay off of it for the above situation to resolve? Months? Years? Is it the same for other forms of addiction – say, alcohol or tobacco?
Now I really want to look up that link.

13

In someone who behaves like House is portrayed to behave, they should not use opiates again, except for moderate to severe acute pain (after injury, surgery, etc) or for malignant pain (such as progressive cancer).

Using it again for chronic pain would be strongly relatively contraindicated (some experts think it would be absolutely contraindicated in a person with such a history, but I’m only 99% convinced of that).

14

I’m curious about what the recommended alternative would be. House has stated that alternative medications don’t alleviate his pain. Assume he’s telling the truth about that. Do The Powers That Be recommend that he simply live a miserable life of chronic pain?

15

If House had his leg amputated would the pain stop? He might get along better with a prosthesis.

StG

16

Pain is a significant factor in opiate withdrawal. In fact, the pain would be worse since the body stops making some natural painkillers when there is a steady supply of exogenous opiates such as pills.

House would be in more pain. This often affects performance.

17

Meh. I still think there’s some ambiguity.

In fact, I think the spoiled portion I posted above pretty much proves that he’s NOT addicted, at least not in the normal sense of the word.

A regular addict wouldn’t quit taking the pills when his pain was gone.

18

Depends on what you mean by “for the situation to resolve.” If you mean how long would it take for the withdrawal symptoms to subside … acute withdrawal, the part that is flu-like and miserable, usually lasts 48-72 hours for an opioid like Vicodin. It can last weeks or months, but be less severe, for longer-lasting opioids like methadone or LAAM.

The cravings from addiction, on the other hand, can last pretty much forever, although people usually say they get less severe as time goes by.

19

If it were only that simple.

Many, many folks with chronic pain who end up on opiates tend to end up on massive doses of opiates and still report just as much pain as they used to have, along with mild to moderate sedation and severe constipation. So opiates are not good for your basic long-term chronic pain treatment.

If the pain is neuropathic in nature, tricyclics like amitripylene can help, as can anti-seizure medications like gabapentin, tegretol, and others. These meds can sort of ‘reprogram’ the pain fibers to stop sending so many damn pain messages.

Otherwise, judicious use of medications like acetaminophen, or ibuprofen and related compounds along with stretching and exercise, distraction, meditation, nerve blocks, TENS units, and so forth have actually been demonstrated to give greater long-term relief of chronic pain than opiates.

If opiates are used, the pain patient should be placed on a medication contract, spelling out just when and where and how to get his refills, with the notation that violation of this contract will result in termination of prescribing of opiates for chronic pain.

Violations would include soliciting pain meds from other physicians or providers, using street drugs along with the pain meds, and very often, use of alcohol along with the pain meds.

Meds reported as ‘stolen’ would not be replaced unless accompanied by a police report detailing the information on the theft. Excuses like “I spilled my pills down the sink” or “the dog ate my meds” or “I left them at my mom’s when I visited her last weekend” will not be accepted.

Bottom line: Most patients I have encountered who report that nothing except opiates helps their chronic pain turn out to be psychologically dependent (at a minimum). They are also tending to somatize all their stress, anxiety, depression, & emotional and spiritual malaise into perceived physical pain.

Coming off these meds is hard. It may take 6 months or more before the patient begins to feel better, as the opiate receptors and other neural connections reset themselves to reasonable levels. And all during that time, the patient is generally complaining that they need opiates.

But all too many chronic pain patients don’t need them, they only want them with all their heart and mind and spirit.

20

I’ve known lots of addicts who managed to put the cap back on the bottle for extended periods, including myself. The hoarding, the breaking the law to obtain the drug, are far bigger red flags that there is a problem.

Besides, this is a fictional character. The writers can make him do whatever they want.

Also, he’s from Hopkins! They gave us Halstead, Hannibal Lecter, Julius Hibbert, and me! All extremely dysfunctional physicians! C’mon!