Can you make use of a ServletOutputStream object from within a JSP page?

No. You are supposed to make use of only a JSPWriter object (given to you in the form of the implicit object out) for replying to clients. A JSPWriter can be viewed as a buffered version of the stream object returned by response.getWriter(), although from an implementational perspective, it is not. A page author can always disable the default buffering for any page using a page directive as:
<%@ page buffer="none" %>