Nurse Jackie Peyton (Edie Falco) is having trouble managing her growing addiction to painkillers. Nevertheless, she continues to snort an opiate in the supply room and pop pills in the bathroom during shifts at the hospital. Jackie works in the busy emergency room, where she helps take care of a boy who wedged a dental mirror up his nose because he was trying to see his brain. Later, another young man is brought in after being found crushed under 2 tons of books (he and his father were part of a moving team that were clearing a library that was closing). By the time his father discovered him, his son was going into shock, with toxins being released into his bloodstream. In the hospital he goes into kidney failure, respiratory failure and then cardiac arrest. He cannot be saved. The father grieves and blames himself.
The medical questions
Do addictions to painkillers worsen with time, requiring larger doses and different kinds of medications? What are the potential complications from an object wedged into the nasal passage? How does being trapped under a heavy pile of books lead to organ failure and death?
Addictions to opioid painkillers, such as morphine and Percocet (Jackie's main drug), do get worse over time, says Jim Adams, associate professor of pharmacology at USC. As the addict builds up tolerance, he or she must take larger doses to get the same euphoria, or "brain reward," a process involving the neurotransmitter dopamine. The brain's own opioids — endorphins and enkephalins — shut down, making the addict more dependent on a drug-delivered "fix." Addicts frequently combine their opioids with other drugs and with alcohol, says Dr. Ben Honigman, chair of emergency medicine at the University of Colorado School of Medicine in Aurora.