What It’s Like to Take Opioids for Pain
"First physical pain recedes, and then emotional pain. I was depressed, and now I am not." An excerpt from Carlyn Zwarenstein's <i>Opium Eater: The New Confessions.</i>
North America is in the grip of an opiate epidemic that now kills more people than car crashes. But despite all the overdose and addiction risks, opioids are still the most prescribed treatment for chronic long-term pain. When Toronto author Carlyn Zwarenstein was diagnosed with an inflammatory spine disease, the young mom cautiously turned to the synthetic opioid tramadol to keep her life and family together. In a new memoir, she confronts the drug's risks and taboos—including the psychotropic effects explored by famed opium eater Thomas de Quincey. The following is an excerpt from Opium Eater: The New Confessions, out this month from Nonvella.
As a girl, I loved the Sherlock Holmes stories, and read and reread Arthur Conan Doyle's erotically measured lines about the famous seven percent solution of cocaine:
Sherlock Holmes took his bottle from the corner of the mantelpiece and his hypodermic syringe from its neat morocco case. With his long, white, nervous fingers he adjusted the delicate needle, and rolled back his left shirt-cuff. For some little time his eyes rested thoughtfully upon the sinewy forearm and wrist all dotted and scarred with innumerable puncture-marks. Finally he thrust the sharp point home, pressed down the tiny piston, and sank back into the velvet-lined arm-chair with a long sigh of satisfaction.
Like him, I enjoy the waiting. Once I have decided that today is going to be a tramadol day, and I've given myself a deadline before which I absolutely will not cave in and take it, my experience of pain is transformed. Rather than grinding and hopeless, it feels charged, electric. The difficulty I have standing up (or sitting down) begins to feel noble. The constant, miserable, and exhausting stretching I do to relieve pain and stiffness in my joints acquires a warm-up quality.
I am already removed one degree from my own experience and it is a little more observable, a little more interesting. I know that in a little while, after some sore but delicious anticipation, it will melt away in an exquisitely gradual, perceptible way. And then I will feel expansive and happy. The hours ahead are no longer to be endured but rather to be savoured, and this knowledge invigorates me, refocusing my day.
Then there is the actual taking of the drug. If you don't get a high from whatever medicine you take, I suppose it is just a medicine. Nobody craves Tylenol or ibuprofen or Lipitor. If, however, the drug you are taking is really, in your own mind, a drug, all the preparation involved is part of a lovely ritual of anticipation. It has a sort of a pleasant glow of association. Do this, feel that. A lifelong non-smoker, a cautious adolescent, and the most sober adult at any party, I have nevertheless been fascinated by intoxication, addiction, and altered mental states for as long as I can remember.
I don't think that anyone I know has known that about me.
The flame that licks the spoon. The tightening of the rubber strap and the clinical flicking of a tube with the nails of index finger and thumb. The way you hold the cigarette, even, stretching out your fingers, touching your lips as you inhale. It's all a very private romance.
Unfortunately for my sense of occasion and aesthetics, all I do is swallow a medium-sized yellowish pill, chasing it with some water or—more sensibly, given the drowsiness it induces—coffee.
Over the past eight years I have regularly been asked to rate various aspects of my pain—along with fatigue and resulting psychological distress—according to those one-to-ten scales. (On one such scale—there are many—ten represents unbearable, unimaginable suffering, the sort that would quickly cause one to black out; one represents no pain: "feeling perfectly normal.") It's a frustrating exercise. Both mental and physical pain are difficult to quantify.
They are best expressed in metaphors: the dark hole, the cliff, the vise, the hot poker, the black dogs. Or in ambiguous phrases evoking the senses: heavy, fine and needle-like, wide or very bright. Loud and metallic. Electric. Soft and creeping. Or more like concrete, like lead, like spiders.
Pain studies could be like wine connoisseurship: "It started with a bouquet of creeping unease, then a full, bloody, vigorous sensation followed by a lingering ache."
So I write this, again, under the influence.
It's a release that I've earned through the sheer effort of waiting for it all day. At last I take the pill, and I begin to focus intently on the pain in my neck and down my back—waiting for the magic moment when it begins to melt away. I watch, feel, and wait. Minutes pass. Is it gone? I think I feel it leave. But no. The pain is still there.
Then, as it always does, at almost exactly the one-hour mark, something shifts. The ropey muscles of the neck that pull my head forward, the tight muscles around my hips, mid-back, and sacroiliac joints (in an X-ray you can see the erosion)—they all seem to loosen at last. I sigh audibly, letting my shoulders fall. I stand up straighter. Gravity stops pounding me into submission. All at once, I seem able to inhale more oxygen than usual. That breath is rich and deep. I'm also breathing more slowly than usual.
I close my eyes almost unconsciously. When I let them close, just for a moment, there's a pleasant weight on my eyelids, as if I were falling into a dreamless, restorative sleep. At the same time I seem to float, perhaps on a pool raft drifting on saltwater waves, with a sort of inner buoyancy. It is wonderful.
I could stay in it forever, like those Victorian gentlemen found after days by worried families—prostrate upon a back-alley opium den couch, obscured in a cloud of stale smoke.
But I open my eyes after a moment because in the infinite peace and wisdom now upon me—right now—I also see my goal: to write, to create, clearly and without stress.
First physical pain recedes, and then emotional pain. I was depressed, and now I am not.
Nothing is hazy or distorted or vague. There is no drunkenness, no lack of balance or blurring. I can once again see all the little worries and big angsts in my life from a bearable distance. And now, taken a little out of myself, I can also see and feel compassion for other people's struggles, am interested once again in their stories. For these few hours I have regained the essential human characteristic of someone who is well and flourishing: a healthy curiosity about everything that is not me.
Not least, the thread of thought I want to track down and record in writing plays out smoothly and I can follow it. Peaceful, concentrated work is the best opioid side effect of all.
I close my eyes again. There are endless variations in the texture of good feelings that keep me here, happily working at my desk. Every time I close my eyes—every time I inhale, deeply, then exhale—these feelings are intensified. This eye-closing, this looking within: it's a subtle action which, over a group dinner or in a café, I've sometimes caught friends catching, to my shame.
But then, why should I feel ashamed?
I've since learned, on online forums where drug users and abusers share their experiences, that this is called "nodding" or "nodding out." The term is also used simply to describe sleeping or the sleepiness associated with the drug—and more generally "being on the nod" is long-used slang for a calm and dreamy opioid high. "Nod" is the Hebrew root of the word for "to wander." The term may refer to the involuntary dropping of the chin into a literal nod, but it carries, too, associations with the Biblical land of Nod and all manner of remixed cultural notions: wandering, desires, creativity, sleep, dreams.
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