tabbysnape - Wanna add some medical detail to your housefic? *Part 1*

Yeah, I know... Fanfics don't really need medical details. Hardly any of us know what we are talking about, so fics with invented medical conditions can be just as satisfying as a medically correct one. You may find this information interesting though!

This section is for people interested in House's addiction/dependance on Vicodin. No prior medical knowledge needed.



*What is Vicodin?*


It's an nifty painkiller. It actually contains two different types of painkillers, which work in different ways, and have different problems/side effects.



Firstly - there's paracetamol (or acetaminophen if you are American, or para-acetylaminophenol if you are a nerd). I'm going to stick with paracetamol because I am neither a nerd or American (and it's the only version I can spell). House is set in America, so in your fanfics it would be best to refer to it as acetaminophen. It's the stuff you probably take when you have a headache, and its probably in your cold and flu tablets. The exact mechanism of action isn't really known, and chances are you don't care anyway. Basically, it has fever reducing (antipyretic), pain reducing (analgesic) and very slight anti-inflammatory effects. Side effects are rare.

A lot of fanfic writers will try to tell you that paracetamol is killing House's liver. This is actually possible, and makes a nice plot device. Studies show that 'paracetamol toxicity' is the most common cause of liver failure in the Western world, and that the risk can be increased in alcoholics. I think most of the fanfic writers stop researching at this point or before, which is a bit lazy, so read on... Once paracetamol is used, the body needs to get rid of it. The paracetamol travels in the blood to the liver, where it is 'metabolised', or broken down. Normally it is broken down in two seperate ways. Most is broken down into inactive forms, which then end up in the urine and faeces. A smaller amount is broken down into a toxic form, which is then 'detoxified' pretty much immediately while it is still in the liver. In normal doses (4 grams/day), it is safe (considered the safest pain reliever on the market). The toxic amount varies from person to person but is apparantly around 10 grams. At that point, the liver can't increase the rate that it metabolises the paracetamol into inactive components, so more is metabolised into the toxic component, and the liver can't keep up the the 'detoxifying'. This causes a build up of toxic stuff in the liver, which causes liver failure, which causes a slow and painful death (unless you conveniently have an organ donor nearby). It's safe to say that House may take a bit more than the recommended dose, but he doesn't take enough to cause an 'acute overdose'. We know this because he isn't dead. Theoretically it is possible (I think...) that he could be taking enough to cause only a small amount of damage at a time, but it is debatable. "Long-term ingestion of paracetamol and liver disease" (an article by Neuberger, Davis, Williams), claims that there isn't suficient evidence to suggest that chronic use of paracetamol causes an increased risk of liver disease, but this isn't a particularly good resourse. If there is liver damage, this can be picked up in 'liver function tests' and the patient my notice pain in the lower right area of their chest and/or 'jaundice' (where the skin and whites of the eyes turn yellow).




Secondly, Vicodin contains hydrocodone. This is the fun, addictive part. It acts in the brain and spinal cord on opioid receptors to block pain signals. Possible side effects include dizzyness, lightheadedness, drowsiness, nausea, constipation and euphoria (the euphoria is the fun bit). Because one common side effect is constipation, patients on high doses often also take laxatives. One nifty tidbit is that you can increase the pain control effect by taking the hydrocodone with hydroxyzine (Carisoprodol, Nefopam, Orphenadrine and antihistamines work also). It can cause hearing loss if used for a long period of time. In one episode (season 1) Cuddy mentions that House is taking more Vicodin than he was when she hired him. This is probably (at least partly) because people become tolerant to the effects of hydrocodone over time (ie, they need a higher dose to get the same effect). It is also addictive. ...

Quoting from http://www.drug-addiction.com/hydrocodone_withdrawls.htm :
"If a regular hydrocodone user stops taking hydrocodone, he or she will experience withdrawal symptoms within six to twelve hours but the symptoms are usually not life-threatening. The intensity of withdrawal symptoms from hydrocodone depend on the degree of the addiction. For example, the symptoms withdrawal from hydrocodone may grow stronger for twenty-four to seventy-two hours and then gradually decline over a period of seven to fourteen days. The duration of withdrawal symptoms from Hydrocodone varies greatly from person to person. Hydrocodone withdrawal symptoms include but are not limited to:

intense cravings for the drug
irritability
nausea or vomiting
muscle aches
runny nose or eyes
dilated pupils
sweating
diarrhea
yawning
fevers
chills
inability to sleep
depression"



Sneaky people, nerds and drug addicts are probably aware that you can separate the hydrocodone from the paracetamol (a bit, anyway) by dissolving it in water. Hydrocodone is a lot more soluble in water than paracetamol, so House were to dissolve some tablets in a glass of water, the paracetamol would mostly stay as gunk at the bottom, and there would be more of the hydrocodone in the water. It's not a very good idea, really, because you don't really know what dose you are actually taking. It just strikes me as the type of mad/nerdy/stupid thing that House would do.




Further Reading:
Vicodin: http://en.wikipedia.org/wiki/Vicodin

Paracetamol: http://en.wikipedia.org/wiki/Paracetamol
Paracetamol Overdose: http://en.wikipedia.org/wiki/Paracetamol_poisoning

Hydrocodone: http://en.wikipedia.org/wiki/Hydrocodone
Hydrocodone Overdose: http://en.wikipedia.org/wiki/Hydrocodone#Overdosing_risks]
Hydrocodone Withdrawal: http://www.drug-addiction.com/hydrocodone_withdrawls.htm

Narcotics Anonymous: http://www.na.org/index.htm