Editor’s Note: Today’s post comes from contributing editor Bob Beach. Beach is a Ph.D. candidate in history at the University of Albany, SUNY.
The National Football League (NFL) has a pain management problem. It also has a marijuana problem. The league currently regulates marijuana use among its players as part of its Policy and Program on Substances of Abuse. Revised in 2018, the program tests players for marijuana (and other “substances of abuse”) once every year during a set time (during the offseason).
The threshold to trigger a positive test is a relatively small 35 nanograms of THC per milliliter. To get a sense of how much that is relative to common testing thresholds, one source suggests that, “following a single marijuana use, THC is unlikely to be detected in the urine beyond 3 days at the 50 ng/ml cut-off level and beyond 7 days for the 20 ng/mL cutoff level.” If a player fails a test, they face fines, suspensions, and more frequent and random testing.
Often touted more as an “intelligence test” than a drug test, at least for marijuana (are players smart enough to stop smoking weed prior to the testing window?), the program still ensnares new players every season, including David Irving, who recently quit football live on Instagram while smoking weed, following a failed drug test which triggered an indefinite suspension by the league.
Amy Long is the author of Codependence: Essays(Cleveland State University Poetry Center 2019) and a founding member of the Points editorial board. She has worked for drug policy reform and free speech advocacy groups in California, D.C., and New York; as a bookseller at Bookpeople in Austin, TX; and as an English instructor at Virginia Tech and Northwest Florida State College. Her essays have appeared in Best American Experimental Writing 2015, Ninth Letter, Hayden’s Ferry Review, and elsewhere, including as a Notable Essay in Best American Essays 2018. Codependence is her first book.
Two nuns and a penguin approach you at a bar, and you tell them you’re a writer. When they ask what you write about, how do you answer?
“Myself. I find myself inherently interest–sorry, I’m maybe having a Topamax flashback. You’re sure that penguin’s really here?” And then I’d probably ask the bartender for a cup of water, down a Klonopin, and run like mad out of there.
Points is primarily a blog for drug and alcohol historians. What do you think this audience would find most interesting about your work?
The juxtaposition of medicinal and recreational opioid use would probably most interest drug historians, as would the descriptions of “doctor shopping” in 2003 versus 2012 and 2015. All the events in Codependence take place prior to implementation of the 2016 CDC guideline, and it’s harder now to find doctors who are willing to write opioids in doses high enough to actually control serious pain. My ex-boyfriend David, a major figure in the book, was a master doctor shopper back when it was still easy to get opioids from a doctor for any relatively believable pain complaint, and I doubt even he could get them now. I don’t give him credit for much, but watching him trick doctors into writing him pain pills taught me how to act in pain management offices and is likely a major reason I’m still able to treat my intractable headaches with opioids in today’s restrictive climate. It’s not that I’m lying; I wish I were! But he taught me how to present myself and that presentation matters.
I also hope literary historians like reading a drug memoir that doesn’t end in recovery or tie up in a neat bow. Feminist historians interested in relationships similar to the one I was in as an older teenager and college student might find something interesting about the emotionally abusive, codependent dynamic David and I share.
Scholars interested in gender disparities in medicine will hopefully appreciate reading about my experience as a pain patient with a “women’s problem.” I experiment with non-opioid headache medications, too, and depict my use of illicit drugs such as marijuana and LSD, which should interest historians who study medicine and pharmacology. I was also an early Suboxone adopter (at one point in the book, I get off opioids entirely and stay off for a year, but I go back to them after I get dependent on Advil–Advil!), and I write a good bit about how quitting alcohol (it’s a migraine trigger) affects my social life, so there’s something for everyone!
Mostly, though, I’m writing about opioids and other drugs, pain, addiction, dependence, recovery, and mental health in ways that I’ve never seen represented in literature, so the essays work as a sort of case studies in what it’s been like to rely on opioids during the past 15-plus years.
What led you to write about drugs and alcohol in the first place?
I started Codependence in my MFA program. I always knew that I wanted to put these two kinds of drug-related experiences in conversation with each other, but I thought I’d write it as a novel until I took a creative nonfiction workshop with Matthew Vollmer in my second semester. That class totally changed the way I think about writing and even just being a person. I narrated my drug history in a medicine cabinet as my final project (if you’re ever at Virginia Tech, ask Matthew if you can see it; he’s its executor!) and used that as an outline for my thesis, which turned into this book. But drugs have been a big part of my life since I was 18, so I was always going to address it in some way. To me, Codependence is the book I had to write in order to ever write anything else. But my writing will probably always involve drugs in some way. I mean, I take three drugs right when I wake up; they’re hard to ignore!
How would you describe the way that drugs function in your work, whether in terms of thematic concerns or the choices you make about how to craft a narrative? Do you think there are things that you wouldn’t be able to explore as successfully if drugs weren’t in your writing arsenal?
Nearly every decision I made had something to do with drugs. I needed a way to wrap a coming-of-age story into one about a druggy relationship and a medical memoir without using chronology to connect the dots. There’s no way I could have left drugs out of the book. But I spent a lot of time thinking about how I’d use them. Codependence is an essay collection, but it’s also a non-linear memoir or memoir in essays; the essays touch on different parts of or events from my life, but they create a distinct arc when you read all of them together, so I had to decide when it was right to introduce certain elements. For example, the first essay centers on me telling my mom that I’m back on opioids, and the second kind of sums up my relationship with David, but neither refers to the events depicted in the other, and readers have to figure out as they go how those two strands connect. I didn’t want to spell it out, and there’s a degree to which I don’t know what it means that I used to take drugs for fun, and now I take them to treat chronic pain either, so building a sort of puzzle-like, incantatory narrative structure made up of essays that might not always seem related puts the reader in a position similar to mine, which is the other thing I most wanted to do: trap the audience in my body, my head, my pain so that the book mirrors both chronic pain and addiction and hopefully builds in some empathy (I know, I’m really great at selling this: “Let me trap you in my pain!”).
About half the essays use received forms (I’ve seen them called hermit-crab essays, but I call them “formally inventive”) such as a map or a series of glossary entries. One of my favorites is a set of six prescription-informatic-like essays that tell the story of my and David’s relationship. After I wrote it, a friend said, “You’ve found your form! You could write the whole book like that,” but I thought writing about drugs in a drug-label format would be too on the nose. I included the glossary in part because I wanted to catalog all the migraine and headache medications I’ve tried, but I also thought readers might need actual definitions of some things, especially since I can’t assume that all my readers have had the prodigious drug experiences I’ve had! So, decisions about how to write about drugs played an important role in shaping the narrative, its structure, and the meanings it can make.
What do you personally find most interesting about how drugs work in your writing, and where do you see that interest leading you in future projects?
Mostly, I like that I blur the boundaries around medicinal and recreational drug use or abuse, and I’m interested in stories that don’t really resolve at the book’s end. In my next project, I’d like drugs to take something of a back seat to other themes, but I know what I want to write next, and I can’t do it without writing about drugs again! And I like writing about drugs. Maybe what most interests me is looking at how to live in a drug-dependent body without letting drugs structure every interaction, every thought, every relationship, even though there is a way in which they have to for me.
BONUS QUESTION: Let’s hope [oh, we hope!] Codependence gets made into a major motion picture. What song do you fantasize about hearing as the credits roll?
Raymond Raposa, whose band is Castanets, and I are going on tour together this fall (we launch the book at Pete’s Candy Store in Brooklyn on Sept. 14!), but I started thinking of that song as my “credits song” for a long time, way before I knew Ray and I were doing the tour (I have been thinking about this answer for literal years!). It just really captures the feelings and themes of the last essay and of the book as a whole. It’s evocative and paints this kind of bleak but beautiful picture in a way that’s similar to what the book does.
On January 20 – inauguration day – the HBO news talk show Real Time with Bill Maher aired its fifteenth season premier. Unsurprisingly, Donald Trump was the topic of the hour. After Maher and his panel of pundits concluded their discussion, the host delivered an editorial monologue analyzing Trump’s electoral victory and offered a provocative comparison:
“Here on inauguration day, in the spirit of new beginnings, liberals have to stop calling Trump voters rubes and simpletons and instead reach out and feel their pain, the pain they insist we didn’t see. And there is ample evidence for that pain. Did you know that of the fourteen states with the highest painkiller prescriptions per person, they all went for Trump? Trump won eighty percent of the states that have the biggest heroin problem… So let’s stop calling Trump voters idiots and fools and call them what they are: fucking drug addicts!” Continue reading →
I first met Anita in the Boston jail where she was doing time for passing bad checks related to a prescription opioid addiction. She had first been introduced to opioids after giving birth to her first child several years earlier. “I was prescribed percs [percocets] for pain related to the delivery,” Anita explained. “I just remember taking them and being high and cleaning … I took four or five at a time.” Anita’s drug use spiraled out of control, as her physiological tolerance to the opioids increased and she needed to buy more and more pills to get the same effect. One day, Anita’s dealer offered her heroin, and off she went.
Ethnographers and historians of drug use are all too familiar with stories that resemble Anita’s. As an anthropologist who studies prisons and addiction treatment, I find it relatively easy to point the finger at doctors for their professional complicity in “epidemics” of opioid addiction.
But as a medical student in my final year, destined to start residency in July in an internal medicine-primary care program, I also worry I won’t be able to refuse prescriptions for opioids for patients presenting to me in distress and pain.
Historians of medicine and drug use have detailed how physicians—whether they wanted to or not—became central to the distribution and administration of opioids in the United States. In the wake of the Harrison Narcotics Act, addicts had to obtain prescriptions for their drugs, and so-called “dope doctors” would provide them for cash. The alternative to the dope doctor was the street druggist, the so-called “pusher.”
Laudanum (image via Science & Society Picture Library/Getty Images)
Doctors and opiates have a long, complex history. In the era of magical formulations, Dr. Thomas Syndenham compounded laudanum by mixing “two ounces of opium and one ounce of saffron dissolved in a pint of Canary or sherry wine” with a “drachm of cinnamon powder and of cloves powder,” as historian Richard Davenport-Hines noted in his history of the subject. At the time, opiates (plus or minus alcohol) were among the few medicines that were actually effective pain relievers (working at the μ pain receptors in the brain). They were instrumental in bolstering the medical profession’s emerging reputation for dispensing effective interventions rather than simply bearing witness to suffering. Indeed, enterprising pharmacists and doctors alike created their own patented formulations of various narcotics marketed as cure-alls– a mix of magic, profiteering, and chemistry.
I didn’t keep up with my drug-related news over the holidays. I didn’t check Facebook or read any blogs. My mother was in town, and I was playing tourist. What could possibly happen, anyway, I thought, with legislators on holiday and courts out of session? Apparently, a lot.
Ed. Note–This post originally appeared on August 1. We removed it briefly while pursuing an opportunity to speak with Rep. Bachmann about the questions posed below. Unfortunately, the Bachmann camp did not respond to our query. We welcome readers’ insights into the candidate’s stances on these issues and urge fellow bloggers and mainstream journalists to ask Bachmann about her approach to drug policy – and pain management praxis in particular – if given the chance.
Tucker Carlson: Trouble-Maker
Points has been investigating the regulation and increasing criminalization of opioid pain medications in the U.S. with posts like Siobhan Reynolds‘ on DEA meddling in pain management practices, Joe Spillane‘s on historical accounts of law enforcement interference in medicine, and Kenneth Tunnell‘s look at the first OxyContin scare. Conservative political news site the Daily Caller (run by formerly bow-tied pundit Tucker Carlson) alleged in late July that Republican presidential candidate Michele Bachmann takes “all sorts of pills” to deal with “incapacitating” migraines. Since narcotic pain relievers are one of several tools in many a migraineur’s survival kit (as well as that of at least one president), that story got us thinking about how the congresswoman’s experience with chronic pain might affect her approach to drug policy. The response to the allegations also illuminates the way in which media discourses work to reproduce normative representations of gender and power, even when media commentators attempt to upend those discourses.
In her final guest post for Points, Siobhan Reynolds asserts that the oft-repeated claim that the War on Drugs has failed should be reassessed from the point of view of those who profit from its outcomes. Looked at from that perspective, Reynolds sees opiate regulation as central to the drug war’s astonishing success.
Protesters Rail against the Drug War with Puns
Drug policy reformers have rallied for an end to drug prohibition calling it a dismal failure. To my mind, however, in order to understand this thing that has taken on a life all its own and to ultimately change course, if that is possible, one has to stop looking at the drug war as a failure and instead regard it as a spectacular success. There’s no denying that drug war policies and practices have turned physicians against the interests of their patients, been wildly expensive, destroyed the criminal justice
Activists Protest Drug War Over-Incarceration
system, and facilitated the incarceration of people in the United States to a degree that would make Stalin or the Chinese envious. People who value civil liberties above all other social goods undoubtedly consider such developments evidence of failure. But these chilling outcomes do benefit some. A mature view would necessitate that we look at who profits under drug prohibition in order to truly judge what it has become. Continue reading →
In her fourth in a six-post series for Points, Siobhan Reynolds reviews the policies and judicial precedents that leave doctors unwilling to prescribe opioids to patients in pain. Reynolds focuses in particular on how federal control of the medical profession undermines the political structure of the United States and the opportunities for freedom and experimentation federalism provides.
In an earlier blog post I suggested that I would explain the reasons why physicians are loath to treat pain with opioids despite their notedefficacy; I’ve mentioned that medical professionals don’t like to admit that they are afraid to prescribe these medicines, preferring instead dole out far more dangerous non-controlled drugs on the grounds that opioids are “bad” in some special way having nothing to do with their actual utility or safety profile. In this post, I will examine how the profession developed such a seemingly irrational blind spot where opioids are concerned. This blind spot has its roots in the interpretation and enforcement of the Harrison Narcotics Tax Act of 1914 and the more recent Controlled Substances Act (initially passed in 1970).
Years ago, when I sat at my computer in my kitchen in New York City, wondering how in the world it was that doctors simply refused to effectively manage their patients’ pain, I researched the law myself. Continue reading →
In her third guest post for Points, pain relief activist Siobhan Reynolds traces the unraveling of the doctor-(pain)patient relationship under drug prohibition.
Siobhan Reynolds Looks for the Missing Connections Between Doctor and Patient
Perhaps the most disturbing consequence of opium prohibition, and the one least talked about in polite company, is the steady degradation of the doctor/patient relationship that has occurred since prohibition’s inception. In poor countries, where opioids are not at all available, physicians speak truthfully to their patients when they tell them that they have nothing with which to relieve their pain. In countries like the United States, where opioid pain medications are ostensibly legal but where physicians have been intimidated into withholding pain treatment, the doctors feign their impotence. There is certainly a great deal of pain relief to be found in opioid medications, and they are stacked on the pharmacist’s shelves. But physicians in the US are jailed – often arrested by SWAT teams, de-licensed and destroyed financially – for treating pain in a manner inconsistent with the opinions of government lawyers and agents. If you ask the physician who refuses to treat pain with opioids if his fear of official attention is the cause of his failure to serve his patient, you will likely meet with something quite different than such a humble confession. Instead, you will hear about how addictive the opioids are, or the doctor will say that their use should be confined to the care of the terminally ill, when addiction is not a concern. And he will extol the virtues of the anti-inflammatory and of psychiatric drugs. He will talk about the miracle of biofeedback and the importance of a positive outlook on life in the treatment of pain.
All of these responses have their place in the treatment of pain after the pain has been medically controlled. But recommending these adjustments as if they replace the pain relief provided by opioids is like telling a woman whose house is burning that a simple glass of water will fix her problem or a diabetic that he must exercise to earn his insulin. To a person in suicidal levels of pain, this kind of dissembling amounts to psychological and physical abuse. And yet this conversation between doctor and patient is par for the course under drug prohibition. It is a refrain patients hear over and over, until they finally stop searching for relief and eventually give up on living all together.
The fundamental truth that confronts anyone concerned with the quality of the doctor/patient relationship under drug prohibition – namely, that doctors have in essence been turned against the interests of their patients – remains almost entirely unacknowledged by the profession as a whole. Continue reading →
Siobhan Reynolds’ most recent guest post to this blog does an outstanding job of making the case that we (meaning both society writ large and the medical profession more generally) have utterly failed to address problems of chronic pain, and that these failures have a great deal to do with “the context of drug prohibition.” Reynolds observes: “The system-wide denial of humane and effective treatment is covered up by the fear campaign that has been hammering away at our consciousness since the dawn of drug prohibition–a fear campaign masquerading as a public health initiative.”
The phrase “the dawn of drug prohibition” led me to ask myself–just what are the roots of our contemporary struggle to employ opiate analgesics effectively and appropriately, and how deep are they? Here’s a bit of what we, as historians, know about the case of the United States. Continue reading →