Run-around is part of the TBL canon - no question about it . . . 

Identity thievery is a dominant recurring theme. 

As with most shows - the anti-heroes and heroes are gullible to discovery. Red & Dom keeping most of their secrets for over 5 seasons is actually amazing. Most shows would have either been cancelled or full revelations exposed.

But this show cannot run as a simple crime drama. The real identity of many of regular characters is the show driver. Sorry, Uber!

As for Spadeington looking pale & somewhat jaundiced. Two outlooks - 1. He's suffering a legit genetic-derived malfunction and he's afraid it will be passed onto LIzington or 2. James is nearly 60, this is his first series where he's the dominant lead and he also carries a ton of this show's mail. Who wouldn't be tired.

That said - both scenarios fit his character Red Reddington. The pill-popping an open invitation for viewers to speculate.

I was thinking how much nerve it took for Brimley to tell Red - I gotta think deep down you know this, it's like lipstick on a pig.  I am not too sure that there are many people who could get away with saying that. 
 

I had to look up "trayf" (not kosher) to get the full picture, but that was hands-down my favorite scene of the episode. That and his comment about the pain of children disappointing you.