Thread by @haroldpollack

Wow the FBI really blew this whole opioid episode. (1/)

No--not the Federal Bureau of Investigation—the Dick Wolf TV reboot: The FBI, Season 4 episode 7, which I watched last night seeking mindless entertainment (2/)

The FBI's main character, Special Agent Maggie Bell, has a sister Erin. Erin has a pill problem+was in rehab. Erin+Maggie discuss recent events.
“There was an issue at Hancock Hills Treatment Center. “What kind of issue?” “The kind where they tell you to get the hell out.” (3/)

“Did you relapse?”“Not really” “More of a yes or no question.” After some back-+forth, Maggie pulls out that Erin violated Hancock’s rules by drinking off-campus. “Just because I had an issue with pills doesn’t mean I can’t drink. It’s not like alcohol is my problem.” (4/)

Erin’s offense was so grave that there's apparently no reason for any follow-up outpatient or harm reduction care. Maggle informs Erin, in a tone clearly intended to be didactict for the viewer: “I’m not an expert, but the counselors said that recovery is *all or nothing.*” (5/)

Erin guiltily acknowledges: “Yeah. That’s what they kept telling me.” Out of the goodness of her heart, Maggie lets her sister stay with her, anyway. Special agent that she is, she has her doorman keeping tabs on whether she’s leaving the apartment or having someone over. (6/)

The show-writers subtly and not-so-subtly embrace a tough-love approach throughout. Erin indeed renews her pill use, has a drug dealer come to the house-- captured by the high-tech surveillance cam. Maggie tells her partner: “I don’t know if I can trust what she says to me.” (7/)

Defying the common sense of every TV FBI agent who should know that there’s only ten minutes left in the show, Maggie answers her personal cell while on stakeout--in a plotline when her colleagues are obviously building up for a shoot-out chase scene with the main suspect. (8/)

(Meanwhile, another opioid user ODs+gets Narcan after getting high while he’s supposed to be dropping off ransom to the villain who kidnapped his child.) Maggie finds out that that Erin OD'd. Distracted, Maggie misses key radio call that the suspect is making a run for it (9/).

This causes serious TV-drama complications. The suspect almost escapes. Maggie goes to the hospital to see Erin. In the waiting room, Maggie tells her grizzled FBI senior colleague, Jubal Valentine: “She’s unconscious. Doctors are worried about the effects of fentanyl.” (10/)

Valentine responds w/a knowing+damning nod: “Fentanyl.” He goes on: “That officer who was shot…If that bullet were two inches to the left, he’d be dead+you’d be out of a job.” Maggie tells him through heavy tears+even heavier drama-music: “I don’t know how to manage this.” (11/)

Valentine responds: “When I was still drinking, I can say…the people who thought they were helping me the most…weren’t. You have some hard choices to make. Cause what happened yesterday…It cannot happen again.” Maggie then goes into Erin’s room. (12/)

Laying in bed, Erin apologizes: “I’m sorry Maggie. I’m just going through a rough patch.”“You flatlined. You were this close to death. That’s not a rough patch. Erin, this is why you have to be going to meetings. This is why you need a sponsor....” (13/)

Meaningful background music is playing--signaling to us that Maggie’s keeping it real+speaking truth.
“I can’t be your fallback anymore. I can’t be in your life like this,” she tells Erin. “What does that mean?”
“I don’t think we should see each other, for awhile.” (14)

“I need you, Maggie,” Erin says tearfully.Maggie responds—even louder and more meaningful music is playing:“I need you, too. I need you to be sober, Erin.” “I love you,” Maggie says. Sad music is playing, as she walks out of the room. Erin is crying, too. Credits roll. (15/)

The message is clear: Maggie did the hard but necessary thing—for Erin’s own good, and for her own good, too. (16/)

So much is wrong in this misleading disaster. People w/ opioid use disorders are presented as deeply damaged, in need of tough-love, when what they actually need most are proper services, empathy, and continuity of care. (17)

Erin didn’t need to be kicked out of treatment or cast adrift until she hit bottom. Hitting bottom doesn't help people be more socially functional or to cease their drug use. Nor is it necessary to be cruel to maintain proper boundaries when a loved-one lives with addiction (18/)

Even within this make-believe TV world, Erin's OD was rather predictable. Erin needed follow-up care, evidence-based outpatient medication OUD treatment, not an inpatient rehab that apparently didn’t offer MOUD or help when she felt short of their abstinence standard (19/)

Recovery is certainly not all or nothing. Most people with addiction disorders have some continued use on their trajectory to recovery, even if the ultimate goal includes no use of street drugs. That's part of the journey. (20)

No one expects popcorn TV to distinguish naloxone from naltrexone or whatever. But pop culture matters. When Life Goes On humanely depicts a young man w/intellectual disability, that matters. When 13 Reasons Why presents an unsafe plot about youth suicide—that matters, too (21/)

It matters to get things right, especially in the midst of an overdose epidemic that took 100,000 lives last year, when it’s incredibly easy to present a more evidence-based, humane depiction of this horrible epidemic. (22)

So many overdose deaths can be prevented through harm reduction services, improved access to naloxone (Narcan), and to medication opioid use disorder treatment (MOUD). (23/)

We must honor the humanity of everyone, including people who use drugs. Casting a hospitalized patient adrift after she's suffered near-fatal OD won't help. It’s not cruel to be kind, kind to be cruel, in that moment. We shouldn't give people reason to believe that it is (24/24)