What I love about the show Nurse Jackie is how remarkably well they capture the lifestyle of the prescription drug addict: lie layered upon lie, desperate measures to get one more pill, and selfish reactions to anything that threatens her ability to get access to Vicodin, Oxy, or any other painkiller (she isn’t picky, it seems).

Jackie even lies about the fact she’s married, hiding her wedding ring before she enters the hospital – mainly for the benefit of the hospital pharmacist who has essentially become her supplier.  When he confirms the hospital is getting a Pyxis (automated medication system) she goes nuts about how unfair it is – they will have to plug in a code just to get an aspirin or a Motrin!  You know she isn’t really thinking about the Motrin.

Pyxis machines are the bane of the addicted health care worker because there is one thing they do very well – diversion control.  I do think, however, this could result in more stealing of the pain medication meant for a patient (with a placebo slipped in as a substitute).  Face it, addicts are supremely capable of finding a work around no matter what the obstacles.

In this episode Nurse Jackie paws around the top of her home medicine cabinet to find that last Vicodin, only to have it fall down the drain. She chews a piece of gum and sticks it on the end of a toothbrush to try to get it back, but is interrupted by her husband.  She drops the home-made “drug catcher” in her pocket. Later at the hospital she pulls it out, discovers the pill actually did stick to it, and without one second of hesitation, pops it in her mouth right at the nurse’s station.

Nurse Jackie’s ears perked  up when a patient she figured out was withdrawing from opiates tells her, “They are so easy to get on the Internet.”  Oh boy.

I wrote a few days ago about the new HBO series Nurse Jackie  – a back pain-suffering nurse addicted to pain medication.  The little twist this week was the fact that the pharmacist she’s been having a little tryst with (making it easy to get her pain medication) has just informed her that the hospital will be getting an Automated Medication Dispenser.  This is basically a drug ATM, and while it is touted as not only a great time saver and way to avoid medication mistakes (eliminating human error, unless of course they input the wrong dosage in the first place), it is also an ideal way to prevent theft of narcotics.

Frankly, these little machines could go a long way toward making it less likely for health care workers to get addicted to pain medication, but I’m sure there are ways to get around that – like maybe stealing the patient’s medication and substituting a placebo.  Yikes.

Face it. If people are addicted to drugs they will find a way to work around most any system, and it will be interesting to see how Nurse Jackie finds her fix once the machines are there.

On another note – the show really captured an amazing little drug-addict moment this week. Jackie crushed her pain pills into powder, emptied some sugar substitute packets, filled them with the pain powder, then resealed them with glue.  Of course I immediately said, “Oh boy, who is going to accidentally get a hold of one of those packets?”  I hoped it wasn’t her children.  It ended up being a hospital administrator, who bumbled around the hospital clueless that she was addled with pain drugs.

The continuing sage of Tommy Gavin’s relapse on Rescue Me took a bizarre turn Tuesday – he got cornered by his sponsor into going to a meeting then “volunteered” to speak. He could have walked away, but instead decided to tell them all they were whiners – he could tell them a thing or two about pain and if they ever get caught in a fire they better hope he shows up – and that he really isn’t an alcoholic (all just a big mistake, thank you very much).

His sponsee (Gavin had 1 year and got his first sponsee  not long ago – much to his chagrin because the guy turned out to be super-needy-call-every-fifteen-minutes breed of sponsee and Tommy Gavin has enough super needy people in his life) sits with a horrified look on his face while his “hero” of sorts explains why he drank a lot before because of 9/11 and now he’s fine and now he’s going to go have a drink.  The stunned audience sits in silence as he bids adieu to go follow up on his promise.

Oh – and his crazy uncle showed up drunker than drunk just before the meeting – what chaos in the Gavin brood (did I mention before the whole family would make any normy the family a daily star at Al Anon?).

Some people might be horrified by this story of relapse, but I think it’s a great cautionary tale – just how much you can delude yourself into thinking your okay – just how much the alcoholic in me can blow smoke up my own…you know what I mean.

The new series starring Soprano’s Edie Falco started last week – and the first episode promises a very articulate and thoughtful series on addiction.  Nurse Jackie is a dedicated nurse with chronic back pain, and she has taken to having an affair with the pharmacist in the hospital so she’ll have easy access to OxyContin.  She doesn’t just pop pills – she pours out the grains and snorts them for a quicker and more intense reaction.

So far this looks like a more realistic portrayal of addiction in the medical field – unlike House, which although a great drama, does not really accurately portray how a hospital would react to an aggressively Vicodin-popping doctor. Nurse Jackie is the classic drug seeker – she has legitimate pain, but her path to relief is chaotic and destructive. No matter what pain you have – you can’t really live a normal life on increasing doses of heavy-duty opiate pain killers.  She is buond to make mistakes and put patients at risk. At one point she laments to an unconscious patient, “I’m almost killed you! I almost killed you!”  She is both horrified and resigned – in that classic between a rock and a hard place: she doesn’t know any other way to live.

I’ve been reading a lot lately about Oxycontin addiction – and the statistics are truly frightening.  This is one heavily abused drug and seems to be following the path of quaaludes, which were eventually banned altogether due to their wide-spread abuse.  We’ve certainly heard plenty of stories of celebrities dying due to prescription drug abuse (and oxys are often part of the mix), and the drug and it’s relatives have played a part in many other lurid celebrity tales (from Winona Ryder to OJ Simpson to Rush Limbaugh).

My hope is that Nurse Jackie will not glamorize addiction or make it cute and amusing the way House does (although House has taken a dark turn recently – and might address the issue more seriously) – and the first episode seems to indicate they have no intention of doing so.

So if you are a fan of Rescue Me you know that Tommy Gavin is off the wagon and man oh man he is the classic  “I was an alcoholic, but now I’ve got it all under control” guy.  For those of you who are not fans, Dennis Leary plays Gavin, a NY firefighter who went through 9/11, lost close friends to the Towers, and sees dead people.  He has a sponsor, his cousin who incidentally got drunk a few episodes earlier, then got right back to the rooms (and weirdly enough, seemed to think he could still be Tommy Gavin’s sponsor).

Rescue Me is classic family drama – actually family chaos – and they capture the out-of-control insanity of the Gavin brood particularly well, from his utterly self-destructive sister to his scarringly mean father.  But what it captures better than anything is the way addiction, particularly alcoholism, insinuates itself into every relationship, every decision, and every consequence.

Tommy’s progression to full-blow alcoholic drinking on this relapse has been blindingly fast, and really pretty accurate. He stays in what he calls control for about two hours.  He gets an enabler – his on-again-off-again girlfriend (wife of his best friend who was killed in 9/11) who tells him her house is a safe place for him to drink, have sex with her, and then agree to watch out for her son who is a probie fire fighter. God knows why she would trust a drinking Tommy Gavin with her young son’s health and well being.  She tells Tommy the best way to stay in control is to let everyone know he’s drinking again – see, then he will have to control his drinking because everyone will be watching.  Yeah, that’ll work.

Last week the episode closed with Tommy closing his eyes, then realizing he needed another guzzle – and then he pours about a fifth into a glass and downs it. So much for control. You can see it in his face: oh no. I’m in that place again.

It will be interesting to see where it takes him this week.