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On Opium: Pain, Pleasure, and Other Matters of Substance
A groundbreaking meditation on pain, painkillers, and dependence from a prescription opioid user.
Her writing has been described as "measured," "sensuous," and "compelling." In 2016, Carlyn Zwarenstein’s short narrative on pain made the Globe and Mail’s Top 100 Books. Now, she returns with a seductive dive into opioids and the nature of dependence.
North Americans are the world’s most prolific users of opioid painkillers. In On Opium, Zwarenstein describes her own use of opioid-inspired medicines to cope with a painful disease. Evoking both Thomas De Quincey and Frida Kahlo, she travels from the decadence of recreational drug use in past eras to the misery and privation of the overdose crisis today.
Speaking with users of prescribed morphine, illicit fentanyl, and smoked opium, Zwarenstein investigates uncomfortable questions about why people use substances and when substance use becomes addiction. And she exposes causes of drug-related harms: the debilitating effects of poverty, isolation, and trauma; the role of race, class, and gender in addressing pain; and a system of prohibition that has converted age-old medicines into taboo substances.
Through all of this, Zwarenstein finds hope. Drawing on solidarity between illicit drug users and people in pain; in a wise understanding of what humans need to be well; and in radical drug policies like legalization and safe supply, she lays out a vision of a world where suffering is no longer lauded, and opioids are no longer demonized.
Her writing has been described as "measured," "sensuous," and "compelling." In 2016, Carlyn Zwarenstein’s short narrative on pain made the Globe and Mail’s Top 100 Books. Now, she returns with a seductive dive into opioids and the nature of dependence.
North Americans are the world’s most prolific users of opioid painkillers. In On Opium, Zwarenstein describes her own use of opioid-inspired medicines to cope with a painful disease. Evoking both Thomas De Quincey and Frida Kahlo, she travels from the decadence of recreational drug use in past eras to the misery and privation of the overdose crisis today.
Speaking with users of prescribed morphine, illicit fentanyl, and smoked opium, Zwarenstein investigates uncomfortable questions about why people use substances and when substance use becomes addiction. And she exposes causes of drug-related harms: the debilitating effects of poverty, isolation, and trauma; the role of race, class, and gender in addressing pain; and a system of prohibition that has converted age-old medicines into taboo substances.
Through all of this, Zwarenstein finds hope. Drawing on solidarity between illicit drug users and people in pain; in a wise understanding of what humans need to be well; and in radical drug policies like legalization and safe supply, she lays out a vision of a world where suffering is no longer lauded, and opioids are no longer demonized.
364 pages, Paperback
Published September 14, 2021
9 people are currently reading
121 people want to read
About the author
Carlyn Zwarenstein
2 books24 followersNEW: Sign up for Carlyn's newsletter about literature and experience, LIVE MORE LIVES, at https://carlynzwaren.substack.com
Toronto author & journalist Carlyn Zwarenstein writes distinctly stylish, emotionally intense and politically daring non-fiction, fiction, and poetry. Her writing has been described as "intoxicating", "sensuous and compelling", and "rage-inducing". Her latest book, On Opium: Pain, Pleasure, and Other Matters of Substance (Goose Lane, 2021 with audiobook from ECW press, 2022), tackles the overdose crisis, chronic pain, capitalism, and Romantic literature among other subjects, blending journalism, science writing, literary biography, memoir and social commentary. On Opium expands on the short memoir, Opium Eater: The New Confessions (2016), a Globe & Mail Best Book of 2016, shortlisted for the Science Writers and Communicators of Canada's 2016 general audience book award. Zwarenstein's books and articles are taught on university courses in English literature, social work, and literatures of addiction. Follow her on Twitter @CarlynZwaren.
Toronto author & journalist Carlyn Zwarenstein writes distinctly stylish, emotionally intense and politically daring non-fiction, fiction, and poetry. Her writing has been described as "intoxicating", "sensuous and compelling", and "rage-inducing". Her latest book, On Opium: Pain, Pleasure, and Other Matters of Substance (Goose Lane, 2021 with audiobook from ECW press, 2022), tackles the overdose crisis, chronic pain, capitalism, and Romantic literature among other subjects, blending journalism, science writing, literary biography, memoir and social commentary. On Opium expands on the short memoir, Opium Eater: The New Confessions (2016), a Globe & Mail Best Book of 2016, shortlisted for the Science Writers and Communicators of Canada's 2016 general audience book award. Zwarenstein's books and articles are taught on university courses in English literature, social work, and literatures of addiction. Follow her on Twitter @CarlynZwaren.
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Displaying 1 - 11 of 11 reviews
May 26, 2022
I bought this book because I am interested in what the title promised. If it had been entitled, "Opium: Pain, Pleasure and Other Matters of Substance Examined Politically, from a Leftwing Point of View", I would not have wasted my money. The politics were really hammered home. White privilege, Black victims, White supremacism, Capitalism, Patriarchy, Trump, Hamas, Gaza and Black Panthers et al. "Heroin is a tool of white supremacism," is kind of key to this book.
I read books on all those subjects. I choose them because I am interested in the subject matter. I chose this one because my ex-bf's son died of heroin possibly spiked with fentanyl. My ex-bf has never been able to really understand the addiction or anything much about how his son arrived at his death. So I read books to find out.
The author, who is Canadian and writes about Trump, does not mention Trudeau even once. Is he doing everything right as far as drug issues in Canada are concerned? So why not write about them if they are so admirable? Or is it his leftwing credentials that give him a free pass?
The author writes at length about Mexico but does not once mention that China is their major source of fentanyl, chemical constituents of opioids and methamphetamine. China, in fact, is not mentioned in the book which seems to be a strange exclusion.
Why are Blacks always portrayed as victims? My family are Black and the ones who live in the US are extremely successful - professors, bank managers, actuaries, architects, IT people, managers etc. but no, they are Black, got to be victims. Sometimes this can get really upsetting. This is not to negate the many issues that Blacks face, but it does negate their success and to some extent, their self-determination.
__________
Reading notes, mostly a rant
Stop blaming manufacturers and advertisers for the over-prescription of legal opiods. There was a recent book blaming the Sacklers for the state of addiction in the US. The Sackler corporation characterised by the author of this book as 'sly Jews' was guilty of many things, but not of people's addiction.
The guilty ones were the doctors and the pharmacists, but primarily the doctors. They got financial incentives to prescribe these drugs, so they did. But they did not get blamed. But they are the gatekeepers to the drug. Without their prescription their would be much less drug problems in the US. And the pharmacists, they know which doctors are giving out the largest no. of prescriptions for opiods and can see the addicts coming in to fulfil them. There should be some sort of reporting agencies.
And China, major supplier of Fentanyl analogues never gets a mention. Just the Sacklers.
__________
I've just learned something. Opioids do not affect thinking like weed or alcohol. They affect mood, they take away pain, mental and physical, and may make you drowsy but not necessarily. I didn't know that!
I read books on all those subjects. I choose them because I am interested in the subject matter. I chose this one because my ex-bf's son died of heroin possibly spiked with fentanyl. My ex-bf has never been able to really understand the addiction or anything much about how his son arrived at his death. So I read books to find out.
The author, who is Canadian and writes about Trump, does not mention Trudeau even once. Is he doing everything right as far as drug issues in Canada are concerned? So why not write about them if they are so admirable? Or is it his leftwing credentials that give him a free pass?
There is a level of admiration I actually have for China because their basic dictatorship is allowing them to actually turn their economy around on a dime…having a dictatorship where you can do whatever you wanted, that I find quite interesting.Canada is China's second largest trading partner. China is also the world's major supplier of Fentanyl and of the precursor chemicals used to make it. China's human rights abuses are so great, that for a politician to actually speak out admiringly is really an example of how the media give certain people, certain political attitudes a free pass.
The author writes at length about Mexico but does not once mention that China is their major source of fentanyl, chemical constituents of opioids and methamphetamine. China, in fact, is not mentioned in the book which seems to be a strange exclusion.
Why are Blacks always portrayed as victims? My family are Black and the ones who live in the US are extremely successful - professors, bank managers, actuaries, architects, IT people, managers etc. but no, they are Black, got to be victims. Sometimes this can get really upsetting. This is not to negate the many issues that Blacks face, but it does negate their success and to some extent, their self-determination.
__________
Reading notes, mostly a rant
Stop blaming manufacturers and advertisers for the over-prescription of legal opiods. There was a recent book blaming the Sacklers for the state of addiction in the US. The Sackler corporation characterised by the author of this book as 'sly Jews' was guilty of many things, but not of people's addiction.
The guilty ones were the doctors and the pharmacists, but primarily the doctors. They got financial incentives to prescribe these drugs, so they did. But they did not get blamed. But they are the gatekeepers to the drug. Without their prescription their would be much less drug problems in the US. And the pharmacists, they know which doctors are giving out the largest no. of prescriptions for opiods and can see the addicts coming in to fulfil them. There should be some sort of reporting agencies.
And China, major supplier of Fentanyl analogues never gets a mention. Just the Sacklers.
__________
I've just learned something. Opioids do not affect thinking like weed or alcohol. They affect mood, they take away pain, mental and physical, and may make you drowsy but not necessarily. I didn't know that!
December 12, 2021
This is a great read for anyone who is curious about the connections and nuances of the current opioid poisoning crisis in Canada and how ideas like decriminalization, stigma and safe supply work. It brings together the chronic pain community and the drug user community and shows how the desires and goals of each are two sides of the same coin. Well written and so timely!
August 21, 2022
Someone once asked me for recommendations of drug texts that were on the theory of drugs. Were I to have be asked that now, I would say with absolute certainty, "On Opium". Carlyn Zwarenstein is a true woman of letters, and excellent at her craft. Through her experiences with tramadol, her love (or maybe fascination is a better word) of de Quincey & her ability to weave threads between the worlds of pain patients and people who use non-prescribed opioids, Zwarenstein creates a true drug user text. There are lots of works looking at the overdose crisis, lots of works looking at the structural violence that shapes the lives of people who use drugs, but we have fewer and fewer texts that focus on what a life is when it comes to becoming-with drugs. Those are all important works, but what has drawn me to engage with this work quite a bit is the ways that it entangles both the functionality of opioids with pleasure - both in this case both shape & facilitate the exploration of, "what a body can do" (to quote Dutch philosopher Baruch Spinoza via Gilles Deleuze, who like Zwarenstein is a fan of Antonin Artaud).
The author describes their experiences as a disabled person (they have ankylosing spondylitis or "AS" a spine disease), and the ways that tramadol have made capable certain things she would be unable to do otherwise. She can go to Venice, engage with fine art, tramadol takes away the pain of AS, exercise, in essence: live her life. But it's not just about pain management, but also, pleasure/enjoyment, and the ways in which both of these things are entangled. If you read through this text (both my review but also the authors book) and thought that it glorified opioids you'd be incredibly mistaken. What makes this a true drug user text is that it shows the complexity of opioids and the way/why people use them.
The author never glorifies drugs, the text is always aware that they have risks (and they're well described); they also have possibilities - this is true in her own story as well as through her analysis of de Quincey & through sharing the story of Meg, who is a person who uses illicit fentanyl, in part (from my understanding) to deal with the traumatic experience of almost having lost her mom at such a young age & believing her mom had died for several years growing up. Meg is never reduced to either her of these things. It is really clear in the genuine care and camaraderie these two have with each other. Meg and Carlyn both share a love of literature, they're both talented authors. One is on the dividing line of legitimate prescription, the other is not. Both use opiates to treat the pain - yet they're never framed as a panacea.
I have some minor quibbles here and there about the drug prohibiton history, but that is more of my nitpicky academic tendencies, and they honestly don't draw away from the text, even as a nitpicky academic (these mostly include things like, coca was prohibited pre-1961, prohibition being "US-led" is more complicated than that, things like that).
I don't know if I've done justice to the text in anyway here - but I think that's because there is a lot to think about with it, lots of different lines of thought within it.
The author describes their experiences as a disabled person (they have ankylosing spondylitis or "AS" a spine disease), and the ways that tramadol have made capable certain things she would be unable to do otherwise. She can go to Venice, engage with fine art, tramadol takes away the pain of AS, exercise, in essence: live her life. But it's not just about pain management, but also, pleasure/enjoyment, and the ways in which both of these things are entangled. If you read through this text (both my review but also the authors book) and thought that it glorified opioids you'd be incredibly mistaken. What makes this a true drug user text is that it shows the complexity of opioids and the way/why people use them.
The author never glorifies drugs, the text is always aware that they have risks (and they're well described); they also have possibilities - this is true in her own story as well as through her analysis of de Quincey & through sharing the story of Meg, who is a person who uses illicit fentanyl, in part (from my understanding) to deal with the traumatic experience of almost having lost her mom at such a young age & believing her mom had died for several years growing up. Meg is never reduced to either her of these things. It is really clear in the genuine care and camaraderie these two have with each other. Meg and Carlyn both share a love of literature, they're both talented authors. One is on the dividing line of legitimate prescription, the other is not. Both use opiates to treat the pain - yet they're never framed as a panacea.
I have some minor quibbles here and there about the drug prohibiton history, but that is more of my nitpicky academic tendencies, and they honestly don't draw away from the text, even as a nitpicky academic (these mostly include things like, coca was prohibited pre-1961, prohibition being "US-led" is more complicated than that, things like that).
I don't know if I've done justice to the text in anyway here - but I think that's because there is a lot to think about with it, lots of different lines of thought within it.
August 5, 2025
I rated this book a 3 out of 5, because that is my personal rating. It is nearly a 4 out of 5. If I was a beginner to this topic, then I would have rated it higher and it likely would have had more of a profound impact on me.
However, I felt the first part of the book was kind of all over the place. In the first part, the next paragraph I would be reading was often barely related to what I was just previously reading. I also felt that the section about vertigo really wasn't relevant. Additionally, at times it felt like I was reading someone's journal, so I didn't love that artistic choice. Occasionally, the book felt repetitive.
Positive things: The book does an excellent job of illuminating the human condition of someone experiencing chronic pain and people who use drugs. It does an excellent job of describing the social determinants of health and discussing the large structures of power that determine policies in our Canadian society. It highlights how unfair and disastrous these policies have been for many groups of people, and how these policies regarding substance use are often rooted in moralistic ideologies than evidence-informed, human-dignity based, and scientific reasons.
Unfortunately, I am quite well versed in this topic (I work in the field), so it didn't add anything new for me. I hope that it reaches a broader audience than myself.
However, I felt the first part of the book was kind of all over the place. In the first part, the next paragraph I would be reading was often barely related to what I was just previously reading. I also felt that the section about vertigo really wasn't relevant. Additionally, at times it felt like I was reading someone's journal, so I didn't love that artistic choice. Occasionally, the book felt repetitive.
Positive things: The book does an excellent job of illuminating the human condition of someone experiencing chronic pain and people who use drugs. It does an excellent job of describing the social determinants of health and discussing the large structures of power that determine policies in our Canadian society. It highlights how unfair and disastrous these policies have been for many groups of people, and how these policies regarding substance use are often rooted in moralistic ideologies than evidence-informed, human-dignity based, and scientific reasons.
Unfortunately, I am quite well versed in this topic (I work in the field), so it didn't add anything new for me. I hope that it reaches a broader audience than myself.
April 14, 2022
Opioid use is an epidemic in North America, killing thousands of people each year, with millions more using them on a regular basis. A user of prescribed opioids to deal with a chronic condition, Carlyn Zwarenstein is able to write from a position of authority due to her first hand experience. She does not limit the book to her own experiences, though. She reaches out to many other opioid experts and users to add their experiences to the book as well. Some use street drugs daily; some are leading recovery sessions at local centers, and some are doctors who provide legal prescriptions to their patients. These stories are all interwoven with history on opioids, a look into why people use them, the effects on users and those around them, an analysis into how the crisis rose to the level where it is today, and what could be done to ameliorate the crisis.
The threads of this book were beautifully woven together to provide a book that is both informative and compelling. I highly recommend it to anyone who wants to know more about opioids, our current crisis, and where we go from here. Christine Horne did a wonderful job narrating the audiobook.
Many thanks to NetGalley for providing me an audio ARC of this book.
The threads of this book were beautifully woven together to provide a book that is both informative and compelling. I highly recommend it to anyone who wants to know more about opioids, our current crisis, and where we go from here. Christine Horne did a wonderful job narrating the audiobook.
Many thanks to NetGalley for providing me an audio ARC of this book.
January 19, 2024
An interesting read overall, particularly in discussing and analyzing our current approach to opioid use and addiction. As Zwarenstein proposes, perhaps an effective solution towards resolving the opioid crisis lies in recognizing that opioid use itself is not inherently harmful. Moreover, that abstinence-only approach itself can be counterproductive. The harm stems from the legal and societal barriers imposed on opioid users. Likewise, by providing users with a steady access to a clean and accessible opioid source, many of the issues associated with opioid usage diminish.
I'm curious to see how this proposed solution will work in reality. In British Columbia for example, all "hard" drugs are decriminalized- including cocaine, heroin, and meth since 2023. However, cities such as Vancouver and Victoria have seen a marked increase in drug abuse and its' associated problems.
Does the solution then lie in the government providing clean and accessible access to these drugs (in addition to permanent housing)? To some extent it seems like a far better solution than anything we've tried so far. Ottawa's MOP (Managed Opioid Program) serves to show that a safe and accessible supply of opioids combined with assisted living facilities can be tremendously positive for users.
I'm curious to see how this proposed solution will work in reality. In British Columbia for example, all "hard" drugs are decriminalized- including cocaine, heroin, and meth since 2023. However, cities such as Vancouver and Victoria have seen a marked increase in drug abuse and its' associated problems.
Does the solution then lie in the government providing clean and accessible access to these drugs (in addition to permanent housing)? To some extent it seems like a far better solution than anything we've tried so far. Ottawa's MOP (Managed Opioid Program) serves to show that a safe and accessible supply of opioids combined with assisted living facilities can be tremendously positive for users.
April 12, 2022
Thank you to NetGalley and Goose Lane Editions for granting me free access to the audiobook recording of On Opium: Pain, Pleasure, and Other Matters of Substance by Carlyn Zwarenstein in exchange for an honest review. Wow. What an extensive look at the opioid epidemic that has plagued North America for the past thirty years. The careful analysis of the opioid crisis from a harm-reduction perspective paired with the narrative of Carlyn's own experience with opioid use made this book both strikingly intellectual and incredibly empathetic. I would highly recommend this book to anyone who would like to learn more about the opioid crisis, but has never been challenged to see the nuances of drug use and addiction. Carlyn bravely fights for justice for those who are most marginalized in the drug using community and poignantly outlines the necessity of harm reduction health care.
May 4, 2022
On Opium in an interesting series of essays discussing the use of opium and other hard drugs, both for recreational and medical/pain relieving purposes. Some sections were eye-opening, such as how the decriminalisation of these drugs, as with the alcohol prohibition in 1920s America, causes unwanted consequences and forces otherwise good people into crime and dangerous street drugs, and how misdemeanours are more heavily prosecuted against minority populations.
Worth a listen, but my criticism is that this comes across as a series of essays, with many of the core points repeated throughout. This is a huge audiobook - 18 hours in total, I felt the narrator was losing interest at some points - and could've easily been edited down to half its length to have a greater punch.
Book supplied by Netgalley for an honest review.
Worth a listen, but my criticism is that this comes across as a series of essays, with many of the core points repeated throughout. This is a huge audiobook - 18 hours in total, I felt the narrator was losing interest at some points - and could've easily been edited down to half its length to have a greater punch.
Book supplied by Netgalley for an honest review.
April 3, 2022
What an informative read!
On Opium is filled with so much information and stories from real people. I feel like we need to start having a reality check when it comes to opioid use and hearing about others experience is just the beginning. There are so many misconceptions out there and I feel like Carlyn was able to address them all.
I recommend this book to any one and everyone, especially those who are looking to do further research on this topic because it is filled with great references.
Thank you to Carlyn Zwarenstein and Bespeak Audio Editions for the audio-digital ARC provided through NetGalley in exchange for an honest review!
On Opium is filled with so much information and stories from real people. I feel like we need to start having a reality check when it comes to opioid use and hearing about others experience is just the beginning. There are so many misconceptions out there and I feel like Carlyn was able to address them all.
I recommend this book to any one and everyone, especially those who are looking to do further research on this topic because it is filled with great references.
Thank you to Carlyn Zwarenstein and Bespeak Audio Editions for the audio-digital ARC provided through NetGalley in exchange for an honest review!
April 18, 2022
Thanks to NetGalley for the audiobook ARC!
On Opium is an exhaustive look at the use of morphine derivatives for both legal and illegal use. It's also rather exhausting. As a pharmacist, I found the in-depth nature of the book to be fascinating and insightful, but I feel like it is probably about twice as long as a member of the general public would remain interested in the subject matter. Which is partly a downfall of the book and a sad commentary on our society's ability to ignore problems that are staring us in the face.
On Opium is an exhaustive look at the use of morphine derivatives for both legal and illegal use. It's also rather exhausting. As a pharmacist, I found the in-depth nature of the book to be fascinating and insightful, but I feel like it is probably about twice as long as a member of the general public would remain interested in the subject matter. Which is partly a downfall of the book and a sad commentary on our society's ability to ignore problems that are staring us in the face.
January 20, 2022
great book for anyone interested in the decriminalization of drugs, specifically with a canadian lens (rare!!). very important book!
Displaying 1 - 11 of 11 reviews