Can you take medication on Survivor?

Any medication that Survivor contestants need is kept in an off-camera container at each tribe's camp. That medical box contains production-provided necessities such as sunscreen and contact lens solution, and an individual bag or container for each contestant's approved personal effects.

realityblurred.com - Jackson's exit, and Survivor's problem with prescription medication

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The most unsettling part of Survivor 42’s mostly great season premiere was the exit of Jackson Fox, a 48-year-old healthcare worker. He was ejected from the game because of medication he’d been taking, and didn’t disclose to the show until the day before filming began.

I was particularly unsettled by the way this happened. Why not pull him from the game before it started, and replace him with an alternate? Did they let him start playing just to use him for his story, only to pull him from the game after creating a moment of drama?

In post-exit interviews, Jackson has shared more details about what happened, which included him saying that he’s “glad they pulled me” out of the game. But he also said the show’s doctor told him “okay, we can do this” when he said he was going off of lithium. Jackson also revealed that Survivor did have an alternate player on location, as they have in the past—but that person left the day before the game began. “There was an alternate, but the alternate left that day,” he told Parade. “[I]t was my fault. I take full responsibility for just not being responsible with it, honestly.” I appreciate his honesty now and on-camera, which helps to de-stigmatize use of pharmaceuticals to improve mental health. But this has been a reminder that Survivor, CBS’s cornerstone reality competition, has a problem with prescription medication.

What happened in Survivor’s past

Fourteen years ago this week, Survivor Micronesia: Fans vs. Favorites episode seven showed Kathy Sleckman quitting on day 19. The Wikipedia summary of the episode says “the constant rain, poor camp conditions, and feeling of missing her family was too much for Kathy to bear and she decided to quit.”

The Survivor Wiki page for the episode goes into more detail:

The next day Kathy is still feeling depressed, which is much worse when she no longer feels connected to her family. Kathy finally reaches her breaking point and decides to quit the game. Kathy profusely apologizes to her tribe for letting them down, but the tribe is more concerned with Kathy feeling better, rather than being disappointed with her for quitting. Despite the loss of one of their tribe members, the game still continues for everybody left. What actually happened was Kathy was going through withdrawal from Zoloft. Kathy did a Reddit AMA where she discussed this in detail, saying the side effects made her imagine things about her family, and actually consider cutting off a finger just to be removed from Survivor. Kathy explained that she had a conversation with Jeff Probst in which he was first upset about her quitting, but: …after I told him that I wanted to chop off my finger to get out on a medical, and that I lied about being on Zoloft for 3 years, and just quit taking it, he mellowed out tremendously. Also the fact that my tribe was sticking up for me (I had told them that no matter how much I wanted to get voted off, I just didn’t have it in me to throw a challenge) Jeff thought it was very gutsy to tell the truth, and not come up with some lame ass excuse.

Kathy also shared this:

Had I known then, what I know now, I would have just kept taking the zoloft and took it with me. The night before the game starts, you get to talk to medical. They ask if you are taking anything that might have come up since when they tell you that you made the show and being on the island. My back had gone out and I got steroid shots 5 days before we left, and they gave me an anti-inflammatory and a muscle relaxer. They told me I couldn’t take it on the show as it would be an unfair advantage to have a pain killer etc. I think if I would have told them ‘Oh, by the way, I take a zoloft everyday too’ they would have let me bring them in my med bag, knowing that you can’t just cold turkey something like that. However, they keep threatening you that they have an alternate just sitting in a hotel room on the island just waiting to take your place. I don’t know if that was true. This seems to be the core problem: a lack of clear information even for people who are playing the game.

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Kathy reiterated this in an interview with Rob Cesternino, whose summary of the conversation says “Kathy thinks that if she had told the producers that she was on Zoloft she wouldn’t have gotten cast on the show.”

Even if that’s incorrect, why do players or applicants have the perception that their medication might be a problem—especially for mental health medication?

What Survivor says

Survivor does not have publicly documented policies about prescription medication. But the show does have a contract and set of rules that the players sign long before they arrive on location, and those are clear. The Survivor rule book explicitly says players “may be disqualified and ejected” for, among other things, “withholding of medical information or symptoms from the production medical team”; the Survivor cast contract has similar language about medical disclosures. What is clear is that Survivor players are allowed to take prescription medication during filming. Back in 2004, Gael Fashingbauer Cooper, who co-wrote a reality TV Q&A column with me for msnbc.com, asked CBS about this, and reported that “CBS spokeswoman Colleen Sullivan says that any contestant who needs regular doses of a prescribed medication get that too, of course.” We have had contestants with controlled asthma, high cholesterol and high blood pressure (using medications and monitored by our medical staff). (Years later, Cohen was fired after admitting cocaine use and acquiring prescription medication improperly.) Any medication that Survivor contestants need is kept in an off-camera container at each tribe’s camp. That medical box contains production-provided necessities such as sunscreen and contact lens solution, and an individual bag or container for each contestant’s approved personal effects.

So if prescription medication is okay, why did Jackson have to leave?

What Jackson said

In an exit interview with Parade‘s Mike Bloom, Jackson talked about his conversation with Survivor’s doctor: I’m on the island. I had a couple of doses left. And I wasn’t really thinking anything of it. I got so wrapped up in everything going on, I didn’t want to think about what could actually happen the minute I was off the medication. On the day before starting, I told the doctor, “I’m on lithium. I just got a couple of doses left.” She’s like, “Oh my, okay. Okay, we can do this. We’re just going to watch you very closely for two to three days, and we’ll see how you are.” And I thought, “It’s going to be fine. It’s not a big deal.”

In his interview with EW, he said:

And, of course, they do the medical background. They’re sitting there with you and the doctor, and she goes, “You’re on lithium?” And I was like “Yeah, but I’ve got, like, two doses left,” and she’s like, “Oh boy. So we kinda have to be a little careful with it because of dehydration, and we can’t send blood out to get tested because of COVID. We’ll just see what we can do.” Jackson told Parade that he left lithium off of his initial list of medications because he didn’t expect to be taking it by the time filming began last spring: When they said, “Give your list of medications,” I said, “Well, I’m going to be off of this. So there’s no point putting it there.” I didn’t realize I was getting off of it as fast as I thought it was. I really thought it was not going to be a big deal. It’s literally nothing; I’ve taken so little. And that’s why I decided to be open about it with Jeff. Hindsight 20/20, I’d have been like, “Hey, I’m on lithium. So I’m going to get off this before I get on there.” And I guarantee we probably would have had something set up a little bit better. I’m not a doctor; I should have known better. In multiple interviews, Jackson talked about feeling the effects of dehydration. He admits to only drinking a half of a bottle of water in two days, and as we briefly saw in the episode, he felt dizzy—as perhaps anyone would, never mind the effects of withdrawal from lithium.

The production was monitoring him, as he told EW:

“I noticed at night they were watching me — if I’d get up, what would happen. And a couple times, I admit it, I got up and got dizzy, so I would hang on to the shelter and be like, “Whoa!” And I remember Marya was sitting next to me and she’s like, “Are you good?” I’m like, “I’m good. I think I’m just tired.” You know, we haven’t slept any, we haven’t stopped, we haven’t eaten anything. And I really wasn’t putting it together until the next morning. I felt like, “Hmmm, doesn’t feel very good.”

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While Jackson also said that he’s ultimately “glad they pulled me because it was the safest thing,” he also said that “they did cut out some things in that conversation [with Jeff Probst]. I mean, I was upset because you just want to be there so bad. But I wasn’t mad at him.”

What Survivor’s alumni said

In addition to Kathy, other players have talked about what medication they’ve taken during production—or stopped taking before filming began. Kelley Wentworth created a TikTok video last summer discussing what people do when they get their period during Survivor. She said that, before leaving, she had to submit a bag of hygienic products because “production does not provide products for you.” She said, “I was also on birth control so my birth control was in this bag as well when I submitted it.” Several Survivor players over show’s 42 seasons have quit smoking before competing, some just before production and others months earlier, which puts their bodies into weeks of withdrawal, but they were not pulled from the game. Shane Powers’ nicotine withdrawal was even included as part of Survivor: Panama. Last week, after Survivor 42’s premiere, Max Dawson tweeted a must-read thread about “Survivor’s policy on prescription meds,” focusing on both his experience on Survivor: Worlds Apart and the “misconceptions and half truths about contestants being ‘forced’ to stop taking necessary meds.” Max reveals that, during his season, he took Armodafinil while on Survivor. Drugs.com says it “promotes wakefulness” and “is used to treat excessive sleepiness caused by sleep apnea, narcolepsy, or shift work sleep disorder.” Max calls it “the definition of a Survivor PED,” and PED means performing-enhancing drug. In other words, it helped him in the game, which he admits in the thread, saying, he even used the medication strategically and “banked those pills for challenge days.” How was that allowed? Max wrote, “I had no issues getting my med cleared” by production, and speculated that it was because of he’s a white cis man. “My privilege saw to it that my medical issues were taken seriously by the production. My privilege let me take a PED on Survivor,” he wrote. Players’ health matters more than the game, of course, but it’s unfair that a player was allowed to benefit from medication while others are denied—or just think they’ll be denied.

Max concluded with these three tweets:

Survivor needs a clear, equitable policy on contestants’ necessary medications. No one should be required to stop taking a necessary med to go on a reality show. No one should be disqualified from participating based on a necessary med Most of all, no one should feel compelled to stop taking a necessary med out of fear that their medical status will disqualify them from being on the show. Futute castaways, advocate for yourself during the casting process. If the show turns you down because of a necessary med you take every day, that’s an indication that this show isn’t worth your time. You deserve much better than to feel any stigma. That is exactly what Survivor needs. Even if there already is a clear policy, or a list of permitted and prohibited medications, that should be made public and be included in the casting FAQs. That’s especially true for mental health medication, which has become vital for so many people (including me, as I discovered last year). Without that, Survivor risks perpetuating stigma, discriminating against people who rely on medication, and making its game unfair for everyone.

realityblurred.com - Jackson's exit, and Survivor's problem with prescription medication

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