Pain and Strong Endeavours

Carlyn Zwarenstein felt the first signs of ankylosing spondylitis, a rare type of arthritis, at the age of twenty-eight. An aspiring writer and young mother in Toronto, she was devastated by the sudden onset of disease and its resulting pain. The chronic inflammation that began at the base of her spine gradually moved upward, making it nearly impossible for her to find comfort, whether sitting, standing, or lying down. “The muscles at the front of my neck are as short and tight as steel cables,” she wrote about the experience. “A dull burn at the back of my neck radiates down to my tailbone. My lower back feels unstable, an oddly unbearable sensation, as if my spinal column were inadequate to support the rest of me.”

After enduring two years of violent side effects from anti-inflammatory medicine, she asked her rheumatologist to give her something different — something that could ­better moderate the pain. She was then handed a prescription for tramadol, an opioid. When Zwarenstein realized the drug’s chemical origins, “I thought that meant I was going to die.”

In fact, the opioids gave her a new chance at life. In 2016, after a decade of living with AS, Zwarenstein published Opium Eater: The New Confessions, a 110-page essay about her relationship with the medication, its history, and its appeal (Charlotte Brontë, Bram Stoker, Franz Kafka, Frida Kahlo, and Frédéric Chopin were apparently fond of it). That book was refreshingly open about the possible benefits of drug use, even in the midst of the opioid crisis, which was just starting to make headlines. (“Of course, of course, yes of course: drugs are more likely to be detrimental than improving to literature or art,” Zwarenstein wrote at the time. “And yet, some undeniably beautiful and passionate work arose from that drowsy hour — and its release from pain.”) Despite its controversial topic, the slim volume found great success: it was a finalist for a Science Writers & Communicators of Canada Book Award and named a Globe and Mail Top 100 Book.

In the five years since, Zwarenstein’s writing career has blossomed, and drugs have become her journalistic beat — in the context of not only pain treatment but also public health, policy making, mental health, poverty, and social ­justice. Zwarenstein’s latest book, On Opium, brings together this recent reporting while updating readers on the author’s attempts to temper her AS symptoms. It begins with a full reprint of the 2016 essay, which is followed by around 250 pages of new material.

Zwarenstein didn’t update Opium Eater for its publication here, and that makes the essay an interesting artifact when contrasted with the more recent content. A clear evolution in her writing style and tone betrays how her life — as well as the way she thinks about it — has changed in the intervening years. “Opioid” and “addiction,” for example, felt like controversial words not too long ago; part of her first book’s sell was that someone had dared say something positive about drug use. Now, however, Zwarenstein is so used to talking about her subject that the shock factor is gone. She’s past the stage of convincing people to entertain the idea of opioids; she wants to tackle the gritty details with us. What does it really mean to be addicted, for instance, and how should we think of those who are?

Having spent the past few years reporting on drugs, Zwarenstein is more familiar with the nuanced sociopolitical issues involved, and, just as importantly, she has met and spoken with dozens more sources, including doctors, researchers, and “fellow opium users.” Among the people she encountered in her research — on social media, in online forums, in homeless shelters — she has found a “new, delicately built community of allies against the war on drugs.” Many of the individuals she quotes she also calls new friends. As she explains to Joe, a Torontonian who was prescribed OxyContin for back pain and then “languished” on anti-addiction medication for years, “You are not my source, you are not my story. You are my friend and the friendship comes first.” She tells Joe this, and then she tells her readers about the conversation, which is a refreshingly transparent way to go about reporting on such sensitive issues.

On Opium is part memoir, part journalism, which situates it somewhere between Anna Mehler Paperny’s Hello I Want to Die Please Fix Me, from 2019, and Michael Pollan’s How to Change Your Mind, from 2018. The three books also share a progressive vision: mental health is complicated and poorly treated, they tell us, and drugs, which are often unfairly vilified and underappreciated, hold great healing potential.

Zwarenstein’s writing touches on controversy and personal trauma just enough to intrigue the typical reader, without going so deep that it would make people uncomfortable. But her structure is not as formulaic (nor as tidy) as one might expect. Yes, she covers the expected topics: she describes in detail what being on opium feels like; she travels around the world to attend conferences and admire the creations of famous opium-consuming artists; and she interviews activists and harm reduction workers. All the while, she refuses to conform to the standard non-fiction format, which demands one overarching message that the reader can easily grasp. What Zwarenstein sees — and does not want to oversimplify — is that drug production and consumption, pain, public health, homelessness, mental health, discrimination, and ­capitalism are inseparable. She writes from within the ­fabric of it all, without restricting herself to the artificial segmentation of just one topic.

As a result, the trail can be hard to follow: Zwarenstein often jumps from one idea or story to another, leaving the reader in suspense about the conclusion of one line of argument until it returns ten pages later. In reading On Opium, I began to feel that whatever I might be wondering about Zwarenstein’s words in the moment she had probably thought of five times already, overthought, and then included as a sentence in the next paragraph. It can be befuddling to engage with an account so enthusiastically nuanced. On the other hand, it can also be enlightening: rarely have I felt so trusted as a reader. Zwarenstein is disarmingly transparent about her process, casual in her tone, and honest about her limitations. “My understanding of the harms and effects of substance use,” she writes at one point, “is actually very poor.” At times, the book feels like a diary more than anything else — but a diary full of sophisticated opinions and interesting experiences.

Despite its resistance to being easily summarized, it is possible to draw at least one overarching conclusion from On Opium. Through her personal experiences and interviews with others, Zwarenstein convincingly implies that no matter how hard we try, we cannot distinguish clearly between pain that is physical, pain that is psychological, and pain that is social, such as intergenerational trauma. Pain is the result of myriad factors, and treating it (perhaps with medication, perhaps not) requires creativity and care. In the end, drugs are simply a side concern — just one possible way to relieve suffering. What we should all be thinking of more, Zwarenstein seems to be saying, is suffering itself, and how we can help ourselves and others surmount it.