Dr. Gregory House has an uncanny knowledge of the medicine. He is able to approach medical issues from a different perspective than other doctors in the series and his biting criticism, though abundantly entertaining to viewers is unwanted but tolerated because of the man’s diagnostic expertise. So what can’t House do? Though his problem-solving skills are second to none, House is unable to break his serious addiction to vicoden, a commonly prescribed opiate used to temporarily attenuate serious pain. House began self-medicating chronic pain resulting from a leg infarction, and his addiction is hardly a surprise. Considering that opiates such as vicoden, morphine, and heroin all biologically change the way in which the brain works, discontinuing opiate intake can lead to serious and potentially life-threatening withdrawal side effects.
House is among thousands of people who suffer from opiate addiction and this is the primary reason that opiates are a last resort therapy to alleviating pain. Even short term dosage of opiates lead to tolerance by changing the landscape of the brain. When opiates are taken, they bind to opiate receptors in the brain, which eventually decrease the transmission of pain signals through our neurons. As opiates are continually taken to lessen pain signaling, a tolerance establishes, thus a higher opioid dosage is required to produce the same painkilling response.
Tolerance is most likely due to one of two hypotheses: 1.) Continued dosage of opioids cause pathways to be activated in the body, which reduce to amount of opioid receptors on the neuron, thus decreasing the overall possible opioid signal. 2.) The opioid receptor itself is disconnected from the G-protein on the inside of the neuron, which facilitates opioid signal transduction. These two possible causes of tolerance do not apply to all opioids, for instance, morphine causes a disconnection between the opioid receptor and the associated G-protein but does not cause the expression of opioid receptors on the surface of the neuron to decrease. The two hypotheses can both apply to a particular opioid or one of them can apply, but what has been shown is that in all cases, increased opioid treatment leads to tolerance. The tolerance that is developed is likely the addictive mechanism behind the danger of opioids. For example, if a frequent opioid user were to stop taking opioids, the body would be very susceptible to pain amplification which is a result of the biological change that has occurred on their neurons.
With the negative side effects of opioid treatment it is no wonder that doctors are reluctant to prescribe opioids for pain treatment and why Dr. House is reluctant stop taking them.
House, Medical Genius and Opiate Addict
