Spoiler alert: This post discusses House of Cards Season 3.
Although House of Cards is known mostly for its political drama and manipulative characters, season three’s story line about character Doug Stamper has highlighted the importance of prescriber education and the realities of relapse during recovery.
After Doug’s six-month hospitalization to rehabilitate his leg, his doctor prescribes medication to address his anxiety and depression. She tells Doug she cannot prescribe him painkillers because of his history with alcohol use disorder. Yet after he falls and breaks his arm in the shower, an emergency room doctor prescribes Percocet, a mix of oxycodone and acetaminophen. Although Doug had been in recovery and attending Alcoholics Anonymous meetings for 14 years, the prescription triggers a relapse. Initially regulating the amount of alcohol he drinks with a syringe, Doug eventually begins drinking uncontrollably until he meets with President Frank Underwood while intoxicated and asks for help. With the help of his brother, Doug is able to get sober again and become the President’s Chief of Staff.
In recent years, the number of filled opioid prescriptions has increased dramatically. Although opioid pain relievers are among the most powerful medications available and can effectively relieve suffering for many patients, they also present grave potential for misuse.
The first and most crucial step for the prevention of opioid misuse is to educate drug prescribers and dispensers. Practitioners, nurses, and pharmacists have a role to play in reducing prescription drug misuse. Unfortunately, prescribers receive little training in the risks associated with dispensing opioid pain relievers, especially for persons in recovery.
The physician who treated Doug’s leg was familiar with her patient’s medical history. She knew an opioid prescription would be detrimental to his journey in long-term recovery. Meanwhile, the emergency-room doctor, who met with Doug only briefly, prescribed a highly addictive painkiller without first asking if Doug had any history of substance use or disorder. As we learn from House of Cards, it is essential that prescribers receive training regarding the substance use history of patients to prevent triggering a relapse for those in recovery.
It is important to note, however, that Doug’s relapse was not out of the ordinary. A substance use disorder is a chronic disease, which means that for many in recovery, relapse is not only possible, but likely. Relapse rates for substance use disorders are between 40 and 60 percent—similar to those for other chronic medical conditions, such as diabetes, hypertension, and asthma. Just like these other conditions, substance use disorders do not discriminate: Anyone can possess the risk factors or fall into the cycle of misuse. Relapse is never a sign of failure for any patient; rather, it is a speed bump on the road to recovery. It is essential that prescribers receive training to aid in the recovery process and make this journey as smooth as possible.
Doug Stamper is a fictional character in a dramatized television show, but his story of recovery and relapse is far from fictional. House of Cards illustrates how imperative it is for prescribers to know their patients’ histories before prescribing opioids. Doug’s story serves as a reminder to the friends and families of persons in long-term recovery that relapse of a substance-use disorder is as much a reality as it would be for any chronic medical condition, but that with their love and support, recovery is completely attainable.