February, 23, 2006

Doctors find little humor in TV's handling of painkillers

In a heavily promoted live episode of "Will & Grace" that NBC recently broadcast, the title characters opened a linen closet in the palatial bathroom belonging to their wealthy friend Karen Walker. Out gushed hundreds and hundreds of pill bottles, a river of amber-colored plastic.

The studio audience went wild. Karen's fondness for booze and prescription painkillers such as Vicodin, which she apparently goes through like Tic Tacs, is one of the show's most reliable running jokes, a laugh-getter as surefire as Kramer's entrances or Frasier Crane's pomposity.

Dr. David Crausman thinks Karen's drug use is about as funny as food poisoning, which is what he says her withdrawal symptoms would resemble if they were ever shown forthrightly.

"It's not a joke at all," said Crausman, director of the Center for Healthful Living, an outpatient counseling facility in Beverly Hills, Calif. "It depicts a woman who's held hostage to her addiction. They're not showing her when she doesn't get her pain pill, when she doesn't have the alcohol. How she gets diarrhea, how she starts vomiting, how her skin will crawl, her legs will cramp. They don't show that, because that's not cute."

This is a pretty heavy guilt load to lay on a popular, Emmy-winning sitcom that aspires only to impertinent farce and an occasional heartstring tug. In fairness, the show's comic references to Karen's dependency on prescription painkillers are only an exaggerated example of what concerns addiction specialists about entertainment TV in general when it comes to portraying the use such medications: minimizing the downside.

Laid-back attitude

Prescription pain medications "are often discussed in a real casual manner, almost as if there's real acceptance, whether it's prescribed or not," said Dr. Marvin Seppala, a physician and chief medical officer at The Hazelden Foundation, an alcohol and drug treatment center near Minneapolis.

It's so casual at times, Crausman said, it's as if Vicodin and other prescription painkillers were "glorified aspirin."

There are notable exceptions. While TV networks these days rarely order "lesson" movies as they did in the 1970s with the likes of "Go Ask Alice" (anti-LSD) or "The Morning After" (alcoholism), some episodic dramas integrate social issues into their story lines. This approach is probably wiser given how audiences have come to expect ambivalence and imperfect heroes.

CBS' crime series "Without a Trace," for instance, has been working its way through a subplot in which FBI agent Martin Fitzgerald (Eric Close) is wrestling with addiction to painkillers prescribed by a doctor after Fitzgerald was shot in the line of duty. A recent episode depicted him anxiously rummaging through office trash in search of a pill bottle that earlier, in a stronger moment, he had thrown away.

In Fox's "House," the addiction to painkillers of the title character (played by Hugh Laurie), a brilliant medical diagnostician with a bum leg, is, as executive producer David Shore put it, "a thread we pull on occasionally." He said he and his staff feel an obligation to depict Dr. House's drug problem honestly.

"It's not a show about addiction, but you can't throw something like this into the mix and not expect it to be noticed and commented on," Shore said. "There have been references to the amount of his consumption increasing over time. It's becoming less and less useful a tool for dealing with his pain, and it's something we're going to continue to deal with, continue to explore."

Two more examples

More commonplace, however, are such shows as ABC's new sitcom "Crumbs," in which Jane Curtin's character's recent stint in a mental institution and the medication that makes her release possible are played mostly for laughs, and NBC's recently withdrawn "The Book of Daniel," in which a pill-popping minister (Aidan Quinn) headed an ensemble of calculatedly outrageous characters.

Seppala said patients who come to Hazelden for treatment for addiction to prescription painkillers often "think it's OK, that somehow it really isn't that serious. They think: 'It was prescribed by my doctor. I'm using it for pain. How can that be bad?' I don't think the media equate addiction to prescribed pain medication with addiction to heroin. But they're the same class of medication, just as powerful. In fact, some are more powerful."

"They're downplaying the danger," said Dr. Clifford Bernstein, director of the Waismann Institute, a detox center in San Diego. "It fosters the attitude, 'How bad can these things be?' And that's one reason why so many people have gotten hooked on them."

How many is "so many"? According to a report by Columbia University's National Center on Addiction and Substance Abuse, the number of Americans who abuse controlled prescription drugs has nearly doubled — from 7.8 million to 15.1 million — since 1992. Abuse of such medications among teens has more than tripled over the period.

A study by the National Institute on Drug Abuse released in December said 9.5 percent of 12th-graders reported using the painkiller Vicodin and 5.5 percent reported using OxyContin.

You probably wouldn't guess that if entertainment TV was your primary window on society. You would more likely believe there was an epidemic of serial killers.

Still, in the case of prescription-drug abuse, television is mirroring its audiences' ignorance.

A realistic touch

When characters in an upscale soap such as Fox's "The O.C." drop the brand nickname "Oxy" as blithely as they might "iPod," it's actually one of the more realistic aspects of the show.

Nearly half the adults interviewed in a recent random survey funded by Reckitt Benckiser Pharmaceuticals didn't understand that prescription painkillers such as OxyContin, codeine and Demerol are as addictive as heroin.

Doctors interviewed for this article acknowledge that prescription-drug abuse is a tricky problem for TV entertainment shows. They point out that the medications have tremendous benefits as well as frightening downsides, that most people who use them don't become addicted, and that even those who do may not exhibit behaviors that we associate with heroin addicts and crackheads — at least not for a while.

Bernstein noted, for instance, that the portrayal of Karen isn't necessarily unrealistic. "Karen is popping Vicodin all the time, and she hasn't lost her wit," he said. "She hasn't lost her edge. And that's the point. You're too functional on it. It's almost too good of a drug."

Almost. If a user of a prescription painkiller gets into an addictive cycle, tolerance develops rapidly, leaving the abuser to choose between taking more and more pills or painful, debilitating withdrawal.

Copyright © 2006 The Seattle Times Company

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