(Cleveland, OH: Cleveland State University Poetry Center, 2019)
The Centers for Disease Control and Prevention (CDC)’s website is chock-a-block with opioid overdose statistics. From 1999-2017, nearly 400,000 people have died from an overdose involving opioids. There is a tendency (among a certain type of person) to be dismissive about deaths from overdose. A common misperception reserves overdoses for people whose addiction is the result of poor choices: the initial poor choice to experiment with a substance, the subsequent poor choices to continue consuming said substance despite negative consequences, and the final poor choice to succumb to dysfunction — unemployment, homelessness — and a predictable death.
But even the sterile CDC website points at a more complex issue. It explains that the rise in opioid deaths began with a surge in opioid prescriptions in the 1990s. These drugs were prescribed by licensed medical practitioners to legitimate patients experiencing moderate to severe pain with diagnosable causes: broken bones, dental surgery, osteoarthritis, or pain control during cancer treatment. It is wrong to assume that these prescriptions are based on sound science; there is little to no evidence that prescription painkillers like Vicodin or OxyContin are effective in the long-term. There is plenty of evidence, however, that almost a quarter of patients receiving opioids for the treatment of a chronic condition will become physically dependent or addicted.
Read it again: 25% of people who take their medication as prescribed are at risk of addiction, overdose, and death. This is not an outcome reserved for any specific type of person.
It is important, I think, to keep in mind the context of the current opioid epidemic and any biases we hold toward people experiencing addiction while reading Codependence, Amy Long’s ambitious new essay collection. Codependence is a memoir of opioid addiction and (failed? or failing?) prescription pain management and Long is, perhaps, the best possible person to represent addiction’s lack of specificity.
Long is cerebral and creative, holding both an MFA in creative writing from Virginia Tech and a Master’s degree in women’s studies from the University of Florida. She is also a chronic pain patient who has been unable to find an adequate treatment for migraines that have increased in frequency and intensity over the years. Long, too, has used drugs recreationally and struggles to move past an unhealthy romantic relationship with a man, David, who supports her destructive tendencies implicitly and explicitly through his own addiction. She fits no particular “drug addiction” motif: her journey is insulate, fully her own.
Codependence is tricky to navigate; Long does not represent herself as a reliable narrator and the essays are not organized linearly. From what I gather, Long appeared to be a typical high schooler — a little awkward, unable to appreciate her own coolness, and riddled with self-doubt. Although anxiety and intense headaches were already a part of her life, it was not until meeting David at a mall that Long’s life pivoted. She writes in “Initiation”:
Of course I was susceptible to someone four years older who knew how to make a girl like me feel special. David had dealt in girls like me his entire life. Girls like the girl I was then are all over the Florida Panhandle. Populous as the fish that dad and I used to catch in the Choctawatchee Bay. We are girls who swim hesitantly toward sin, shifting shape in the same easy way a rainbow trout’s scales change color in the sun. David’s hook slipped right under my skin, and I only noticed because it felt so good in that empty space.
Girls like Long are everywhere in high school. But, as the book progresses, we learn that Long may be different. Her self-doubt is the tip of a massive iceberg: she is clinically depressed, possibly bi-polar. As she writes in another essay, “Comedown”: “I have this memory of myself crying in the shower; I must have been eleven or twelve. I’d stand under the running water and just fucking bawl.” These symptoms were not recognized for what they were by either Long’s family or doctors and, without intervention, she found herself susceptible to David and the drugs he offered. Back to “Initiation”:
It took so little for me to change everything about myself. A bit of attention from an attractive guy, and I threw away years of order and spiritual cleanliness. I wasn’t one of those kids who just never got the chance to do drugs. I could have done them. […] I remember standing beside Taylor’s teal locker at Destin Middle School while she told me about the first time she did cocaine. I thought she was disgusting. […] I thought Who would do that to themselves as Taylor described the speedy thrill she got from rubbing coke on her gums. I thought Chelsea and Rebecca were stupid. I hated the way they acted when they got stoned, the condescending pleasure they took in being fucked up around people who weren’t. I was never going to do drugs. Not ever. And then I did.
Long (as narrator) does not overtly attribute her initial recreational drug use to her fragile emotional state. She implies, rather, that a young woman with a small sense of self is susceptible to the influence of charming men, even if their same behaviors would be classified as “stupid” and “disgusting” if done by Chelsea, Rebecca, or Taylor. I can already hear the objections: Doesn’t this constitute the “poor choice” scenario that I’ve already argued is reductive? Well, sure. It was a poor choice. But it was a poor choice made by a teenager — a kid — re-complicating the whole thing.
I’m unable to locate a single, static thread in Codependence that makes the jump from Long’s recreational opioid use to her quest to find a treatment for her chronic migraines. “A Glossary of Terms: Excerpts From An Encyclopedia of Iatrogenic Opiate Addiction” provides a terrifying account of Long and David’s efforts to obtain drugs, though it is already hard to ascertain whether Long’s addiction is honestly iatrogenic (i.e. caused by her migraine illness). The essay is in some ways quite literally a glossary of drugs: Butalbial with Codeine, Vicodin, Compazine, Oxycodone, Clonidine, Topamax, Propranolol, Verapamil, Vicoprofen… the list continues.
With this essay, Long paints a lucid portrait of a dysfunctional health care system that can apparently neither provide adequate treatment for pain patients or support healthy use of the highly addictive drugs that can sometimes be used to mitigate pain. It’s certainly not a system equipped to support the one in four patients that become physically or otherwise dependent on opioids. After much doctor-hopping, Long finds Paul:
You play the part of Someone Who Needs More. With Paul, your performance elicits the review you hoped it would. “From what you’ve told me,” he says, “I don’t think the hydrocodone is controlling your pain. You haven’t taken Percocet?” he asks. You shake your head even though of course you’ve taken Percocet. It’s not a lie because you’ve never taken Percocet for your headaches. “I’d like to try oxycodone, then,” Paul says. You startle at the suggestion of a stronger drug. […] Paul leans over his prescription pad. You relax into your shitty folding chair, the kind with a thin cushion on its seat and back. You’ve found your doctor.
Paul resurfaces in multiple essays, but it is here that he first demonstrates (to me) that he’s a true menace to the medical profession. Long leaves the appointment happily; she now has prescriptions for oxycodone and Klonopin (a benzodiazepine). Both are highly addictive in and of themselves so it’s troubling that Paul did not pick up on any of Long’s drug-seeking behavior. Worse, Klonopin is associated with accidental overdose when used in tandem with opioids. No one specific person is to blame for Long’s situation, but it’s crushing to read as Paul puts his patient at real, avoidable risk.
The CDC’s website states that “collaboration is essential for success in prevention [of] opioid overdose deaths” and calls on medical personnel, public safety officials, mental health providers, members of the community, and others to work together to better coordinate preventative efforts. But this is simply not the reality in the United States. Here’s Long in “Relapse”:
I’m 30 years old, and every morning I take a blood pressure pill, and anti-anxiety drug, and an opioid. […] I look at my life and wonder if preserving it is worth all this effort. […] I picture the next 30, 40, 50 years and wonder how I will bear them, what shape they’ll take, if I’ll still be able to write and what I’ll do when I can’t; I think about why I want to live. When I tell my mother I’m taking opioids again, I’m telling her how I will.
This, coming from a woman who has spent decades of her life in treatment. The help that has been offered her and patients like her is insufficient. Also insufficient is Long’s attempt to save her own life (or improve its quality) through continued use of opioid medications. But who, after reading Codependence, can judge this decision? Long has already demonstrated the medical community’s utter failure to address patients’ needs in times of crisis, whether that crisis is a health condition like chronic pain or anxiety exacerbating drug dependence or vice versa.
It is imperative that we remember that Long’s memoir is not just a book. It is an account of her real, lived experiences and the most persuasive argument that our healthcare systems, our families, and our communities fail, fail, fail each time we point a finger at a “poor choice” or a “failure of willpower” or even our bad taste in romantic partners. Codependence is a bold and necessary book that, through all it’s excuses, deceptions, and rawness, shines a necessary light on a horrifying problem.
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Lisa Grgas is the Supervising Editor and Associate Poetry Editor at The Literary Review. Her work has appeared in Tin House, Adroit Journal, Luna Luna, Fractal, and elsewhere. She lives in Hoboken, NJ.