On Opium: Pain, Pleasure, and Other Matters of Substance by Carlyn Zwarenstein

Part memoir, part history, part policy examination, and part roadmap for the future, On Opium: Pain, Pleasure, and Other Matters of Substance by Carlyn Zwarenstein is captivating, rage-inducing, and most important of all, helpful. Zwarenstein is a regular user of opioids, a fact she explains at the beginning of the book, explaining her chronic illness and pain, her sometimes difficult relationship with opioids and getting her life back, and the use of opioids by writers in the past. This first part was originally published in a slightly different form as Opium Eater: The New Confessions. What struck me most in this first section was Zwarenstein’s careful examination of her own substance use, a use which would be considered more “legitimate” by many, and how she aligns it with those “less legitimate” uses. This compassion and immediate breakdown of the line that exists between those dubbed addicts of illicit drugs, and those who begin by using prescribed opioids to treat a condition. Zwarenstein, while examining her own use, a use she admits helps her function, but also – she likes the feeling. How does that, then, make her “different” than those who use illicit drugs? In the subsequent parts of the book, she explores the history of substance use, the creation of stronger and stronger opioids, the opioid crisis, and the very personal stories of those caught in the midst of this maelstrom: substance users from all walks, prescribers, researchers, and the programs which actually work.

“Detailing the relationships she built through her research, Zwarenstein offers a blend of anecdote and evidence to pave the way for the real meat of her book, a radical solution to substance use: decriminalization and managed use programs.”

Zwarenstein demands that we stop looking at substance use through narrow windows. If someone is using a substance, whether it’s prescribed or not, they are trying to treat themselves so they can function. Detailing the relationships she built through her research, Zwarenstein offers a blend of anecdote and evidence to pave the way for the real meat of her book, a radical solution to substance use: decriminalization and managed use programs, perhaps assisted with medication that can alleviate symptoms of opiate withdrawal and the like. She refers to the mountain of evidence that indicates demonizing substance users is ineffective and punitive, as well as the pervasive idea that the only way to manage addiction is to quit the substance entirely, a practice which is not realistic for many. Some people can become clean, some require maintenance therapy with methadone, buprenorphine, or other drugs, and others would do better in managed use programs or access to safe supply. Continuing to criminalize substance use is criminalizing poverty, trauma, and marginalized populations. Zwarenstein is matter-of-fact in her examination of the social determinants of health, as her work and some of her interviewees in this book were unhoused people, who rightfully point out the many issues with many of the supports provided to them requiring them to abstain from substance use. How do you ask someone to give up the drug which is keeping them alive, in order to receive services? Zwarenstein is adamant that because her substance use is prescribed, she is white and middle-class, that hers is considered acceptable while others’ is not.

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In my professional life, I engage with a lot of research on substance use and the efficacy of harm reduction, which has sealed my support for harm reduction strategies. Even so, I found this revelatory, with its comprehensive blend of story, history, and investigation. This takes the work being done across North America and packages it up for everyone from the layperson to the lawmaker to read and digest. In On Opium, Zwarenstein challenges us to imagine a world in which we toss out our antiquated, actively harmful ideas about substance use, stop thinking of addicts versus “legitimate” users, and embrace harm reduction in a meaningful way, with decriminalization and safe supply. CBC Books listed this as one of the fall’s must-read nonfiction books, and I agree. I absolutely recommend this book: its compassion, accessibility, readability, radical proposal, and examination of privilege will leave you the tools to demand better.


ABOUT THE AUTHOR

Carlyn Zwarenstein is a writer based in Toronto. Her writing has appeared in the Guardian, the Toronto Star, and Vice. She is also the author of Opium Eater: The New Confessions.

  • Publisher ‏ : ‎ Goose Lane Editions (Sept. 14 2021)
  • Language ‏ : ‎ English
  • Paperback ‏ : ‎ 368 pages
  • ISBN-10 ‏ : ‎ 1773101811
  • ISBN-13 ‏ : ‎ 978-1773101811

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Alison Manley bounced around the Maritimes before landing in Miramichi, NB, where she works as a hospital librarian. She has an honours BA in political science and English from St. Francis Xavier University, and a Master of Library and Information Studies from Dalhousie University. When she's not reading biomedical research for her work, she likes reading poetry, contemporary and historical fiction, and personal essays. Noted for a love of bright colours (and lipstick), you can find her wandering the banks of the Miramichi River with a book and a paintbrush.

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