June’s book of the month was Opium Eater: The New Confessions by Carlyn Zwarenstein. It’s a discussion of opium and the people, especially creatives, who have used it to relieve mental and physical pain, enhance creativity, and more.
Zwarenstein is a writer and journalist based in Toronto. Opium Eater is her first book & a Globe 100 Best Book of 2016. She was kind enough to answer a few of my burning questions as a fellow writer interested in drugs and illness.
In Opium Eater, when discussing people who used opioids, you refer to them as addicts. Would you also consider yourself an addict since publishing the book in 2016? And what is your opinion on person-first language (person with addiction/substance use disorder/etc)?
I can’t consider myself an addict—or a person with opioid use disorder–because I am not, by any existing clinical definition of addiction. I am physically dependent on the opioid tramadol, but as I explain in the book, physical dependence and addiction (loosely defined as persistent use despite negative consequences) are different things and I haven’t ever exhibited the symptoms of opioid use disorder, or addiction to opioids. I take the drug as prescribed and it improves my life. That doesn’t mean I couldn’t exhibit or be diagnosed with opioid use disorder one day if things change, but so far, no, unless obsessive thinking and writing about something makes you addicted to it. But that’s not currently part of anyone’s definition, and opioids remain for me a function-enhancing, essential medication.
In Opium Eater, I try to use language that people understand but I do think carefully about when and how I use a word like ‘addict’ with pejorative and dehumanizing connotations. In journalism I have done on substance use and addiction, I always use person-first language, and if I quote someone who uses terms like ‘junkie’ to describe themselves, I distinguish clearly between the self-description that is every person’s right, and a journalist’s responsibility to be factually accurate and to support people in realizing their human rights, including by not reducing them to a health or social condition, especially a highly-stigmatized one. In Opium Eater, which is more what you’d call creative non-fiction, it’s a little different. I’ve aimed to be more flexible with my language and to use more clinical language when that’s the right context for it, and more colloquial language when that’s called for. Sometimes I use the more offensive terms in an ironic way or because a hard, harsh edge is what I’m after in a given sentence. In the expanded version of that short book that I’m working on right now (to be published by Goose Lane in 2021), I do chart an evolution in my own thinking, in hopes of bringing my readers along with me to not just accept person-first language but to do so in a way that doesn’t simply substitute a sanitized version of currently unpopular language, but that actually puts people’s self-identification and humanity forward at all times. Here’s a sentence from my draft of that book (I’ve just removed the name of the person I’m describing for now):
“None of my friends have ever met a fentanyl addict. X would be like some exotic species if she weren’t so obviously not an ‘addict’ but a person (who plays guitar, writes poetry, and uses drugs). We go back in together.”
I also want to look deeper at the conventional understanding of opioid use disorder because I think that what we call addiction in certain groups of people (especially poor and homeless or marginally-housed people) is actually physical dependence, not addiction, and that in those cases it is the circumstances people are dealing with, not the substance use, that is actually problematic. So although I don’t and couldn’t consider myself an ‘addict’, I think that many people who are shouldn’t be either. That’s part of what I explore in this Opium Eater redux that I’m working on. The book that you are reading now, though, looks more at the blurry line between dependence and addiction, and at their relationship to pain of different kinds.
This article I wrote on why I’m not any better than people who use illicit drugs just because I don’t have opioid use disorder or because my medication is legal and their is not might also be of interest. I want my writing about people who use drugs to convey appreciation, acceptance, respect and love, and I try to choose my language accordingly.
You discuss the way that drugs enhance your life, from easing pain, lifting your depression, and even aiding your writing process. As someone who has taken medication for schizoaffective disorder for over a decade, I struggled with the idea that my medications dulled my creativity and altered the way I experienced life. My emotions and senses felt like they had the volume turned all the way down. But as the years passed, I realized the good my heightened emotions brought to my creative life was not worth the damage they brought to my personal life. What are your thoughts on how drugs can change people, whether good or bad?
Everyone reacts differently to different substances and to different doses of those substances. It is pretty amazing and pretty terrifying that a substance can affect people so strongly. But don’t forget that so can hormones and so can our body’s reaction to what we experience. The way that depression has at various times altered my entire experience of life is far stronger than the clarity and uplift as well as effective pain relief I get from tramadol. Same thing with love. And ongoing pain is incredibly distorting, in a really bad way. Those of us with mental illness often have really difficult choices to make. I took Zoloft and then Prozac over ten years and always felt that they did more for those around me (by making me nicer) than for my own experience. On the other hand it did seem that they saved me in situations of extreme depression. Medications, whether psychoactive or not, are a question of cost versus benefit and the choice depends on our own values, what we can compromise, and what costs we’re willing to accept in hopes of benefit (by taking or by choosing to not take them). I actually have a lot more trouble making that choice with some of the other, non-psychoactive medications I take for my spine condition. It can be really tough to work through trade-offs where you don’t feel good about any of the options.
I also don’t think that drugs turn people into monsters (there’s a whole monster section in my new book, since this concern comes up surprisingly often!)
About halfway through the book, you mention that opioids are not dangerous unless too high a dose is taken. However, because opioids are less effective over time, isn’t the end result most often that users increase their dose? Besides switching medications, what measures have you taken to make sure that the opioids you take are effective and safe?
Opioids are extremely dangerous for an individual if the dose they take exceeds their individual tolerance level at the time they take them.
Long-term use does result in dependence as well as the separate phenomenon of tolerance. This means that the dose that effectively treats pain may creep up over time. But there certainly are many, many pain patients who have been using the same dose for years, even decades, so escalation doesn’t always happen. Same thing with people who use opioids like methadone or buprenorphine as treatment for opioid use disorder: they can stay on the same dose for a very, very long time. To make them relatively safe (no medication that actually has effects is going to be perfectly safe), you just need to make sure that you don’t exceed your current tolerance level, and that you don’t take them in conjunction with other medications or substances (like alcohol or benzodiazapenes) that can heighten risk of overdose, unless you do so under extremely careful medical care for some really compelling reason.
Rotating opioids or considering the costs and benefits of resorting to a non-opioid medication to help reduce the dose are ways to reduce the impact of tolerance and keep the dose low (especially important for my atypical opioid because unlike others there is actually a ceiling above which seizures become a serious risk). I take the same measures anyone would take with a heavy-duty medication (including acetaminophen)–proper storage, close attention to dose, keeping naloxone in the house (for opioids, not Tylenol!) and making sure my family knows how to use it.
Having access to a prescribed medication isn’t something that everyone has–my situation is so much more stable and reasonable than most people with opioid use disorder who function well on a stable supply of opioids but have trouble accessing a legal and regulated supply. By having a regulated supply of the drug I need, I don’t have to worry about quality issues like unknown dose, contamination with nasty surprises, or problems accessing it. Occasional poor communication between my doctor’s office, the pharmacy and me, and lack of attention to the importance for chronic opioid users of having a continuous supply to prevent withdrawal is probably the most dangerous thing I have experienced so far. Despite my worries about side effects and addiction, in fact the opioid I take has not caused significant side effects for me although I’ve taken it for the better part of a decade now; if I were forced to take a different one I might have a different experience to report. One good way to chart effectiveness is to look at me during the 15 hours of pain coverage I get from the drug and compare that to the rest of the time, although of course it’s possible that you could actually just be treating withdrawal symptoms and thinking that’s your underlying pain condition. In my case though, my spine pain is specific and accompanied by stiffness and very different from withdrawal. Another way is to look at my income tax assessments. My income has risen in tandem with my dose as my doctor and I have worked to find a dose that allows me to return as much as possible to the life I had before developing a degenerative spine disease for which other treatments have been either ineffective or caused terrible side effects.
Do you have any advice for other writers working on a book about how drugs have impacted their life? For instance, are interviews necessary? (This question is entirely self-serving since I’m working on a book about taking prescription medication and dating someone with opioid use disorder!)
I think writers need to think what kind of a book they want to write. The published Opium Eater was a memoir and although I liked adding in a few interviews so that you’re not stuck in my head all the time, it was mostly a book about me and about writers I love. The expanded version coming out next year brings in a lot more journalism, and so I’m turning outward and incorporating many interviews where I quote people. I don’t like the way journalism often sort of pushes writers to do interviews just so you can stick quotes in–it’s much better to write what you think the subject demands and if that includes interviews, then conduct interviews, and if you do that, focus on what people are telling you and take what is useful to you from it, but don’t just interview people in order to get them to say what you wanted to say anyway. That can result in really dull, dead text and boring conclusions. Let the book tell you what it needs as you work on it. There are so many approaches you could use for a book about your experience. I’d recommend reading my friend Amy Long’s gorgeous memoir, Codependence, as she writes very creatively about a similar experience to yours. You can see how she handles the issue of writing about oneself and about someone else, and you can make your own decision on how to approach it in your book. The wonderful thing about writing is that there are no right or wrong approaches–just beautiful executions and unsuccessful executions. I sometimes get overwhelmed by the limitless options available, but that’s also what I love about it. I hope you have fun with it.
About the Interviewer:
Josie Thornhill is a freelance writer and student. She is probably having a panic attack in a fast food restaurant or doing yoga with a cigarette between her teeth. She is working on her first novel. You can learn more about her at her website.