1. When writing about this topic or even when thinking about writing about this topic, was there any moment of hesitation for you? Was there something that you thought you shouldn’t talk about, but forced yourself to anyway?
That’s a reasonable question! There is a lot of stuff in the book I probably should have hesitated to include. For instance, that I admit to ever having used drugs recreationally or taken any pill that wasn’t prescribed to me could, if a doctor who treats me read it, put my pain management at risk. I admit to having made decisions, such as dating David, my main romantic interest in the book, that I knew when I made them would likely hurt me later. Or that, the first time I got my own Vicodin prescription, I thought Oh, this could be fun for me (which seems kind of funny now since that was exactly the point at which drugs stopped being fun)—anything like that not only makes me seem like a bad patient but could also undermine the reader’s sense of me as a sympathetic character or someone who deserves narcotics for her pain. Those stories complicate the narratives we tell ourselves about drug use and addiction and pain management, which makes the book important but also can make it kind of a hard sell: people who know only the opioid narrative they’ve read in newspapers and heard from the government or TV shows might not know how to approach a book that doesn’t fit with our discourses around addiction or even illness.
So, I knew I was kind of going out on a limb. But I really didn’t hesitate about anything. The story is too important to not tell fully and honestly, and I’m not sure why I would have written it if I didn’t want to be honest or wasn’t willing to make myself vulnerable—even to real-world consequences. I think readers can tell when you’re hiding from them, and I have to trust the reader to do a lot of interpretive work, so I need to earn their trust. I hope that my disclosures encourage readers to think harder about how we enact our ideas about addiction and whether the bright lines and neat distinctions we draw around “the patient” and “the junkie” are really all that clear cut in practice. And, as a reader, I’m more invested and more willing to do that interpretive work if I know the author is being completely, nakedly honest with me. I also didn’t want to be the angel patient or the poor naive girl who gets abused by an evil man and takes no pleasure in any part of that relationship or, worse, goes into a doctor’s office and gets a prescription and finds herself accidentally addicted. (And I’m not addicted; I’m dependent on opioids. My use enables my functioning—on an appropriate dose, I can have a job and write and leave the house—rather than hindering it, as in colloquial definitions of addiction when someone keeps using a substance despite the harm it causes.) Those are exactly the narrative frames I want to disrupt, and I can’t do that if I’m hiding “bad behavior” for any reason.
But I rarely hesitate when I’m writing. I don’t have that kind of self-protective filter that would make me go I don’t know if I want this in the world. If I’m going to write from my experience, I don’t feel like I have a right to be precious about what I include and how I might come across. That doesn’t serve the work or me as a writer/narrator/character and certainly not the reader. Especially not in this book.
2. Despite the levity of your tone in some places, you discuss some pretty heavy things. Were there a lot of things that were difficult to write about? Did you find yourself needing to take a break often?
I mean, it’s a pretty dark version of levity! Usually, when I make a sarcastic aside or kind of joke about something, it’s because I’m pissed about it or want to emphasize some absurdity in whatever I’m writing about. So, I guess that is a type of break taking. Because I really didn’t take physical breaks. I’d write for six or eight hours without stopping for more than a playlist change or a handful of cereal or to wait for a pill to kick in. I just wrote and wrote and wrote, and that was all I wanted to do.
In so many areas of my life, I have to shut up about pain and pills and doctors and studies that show I’m right that the opioid crisis did not originate in doctors’ offices and the government and media narrative is wrong. Or, when I’m in a doctor’s office or a professional setting (or talking to my mom), I have to tell little lies about my relationship with David or, in the former case, never mention that I know that side of drug doing. But, when I was writing, I could focus on these things that most people don’t want to hear about in regular life or that I don’t get to talk about as much, so writing it was almost more like the break for me. The page was the place where I didn’t have to compartmentalize or fake or minimize anything.
3. I’m curious about the structure of this piece. The structure is very clever—my favorite is the essay “Product Warning”—how did you decide on these structures? How did you come up with the idea of the Manhattan map?
Oh, “Product Warning” is my favorite structurally, too! I wrote that one largely because I had made this medicine cabinet in Matthew Vollmer’s creative nonfiction workshop. He had us make 3D objects that incorporated writing for our final projects, and I bought an old medicine cabinet on eBay and narrated my drug history in it, mostly with short essays folded into pill bottles or bags of fake coke or the empty Suboxone packets I kept finding in my purse. There are two essays in Codependence that are shaped like motel keys, and they come basically straight from the keys I made for the medicine cabinet. But the pill bottles had really detailed labels that worked via this code that I guess someone else might have been able to figure out (they were dated, and the dates mattered either for chronology or because the refill date or a lack of one told you something about how I used that drug or about my and David’s relationship—David introduced me to drugs, so of course he had to be in it; I printed out his best mug shot so people could see why I was attracted to him!), but it was mostly a way of coding stuff for myself. I really loved the pill bottle format and how much story I could tell in such a small space, and I wanted to figure out how to get what I’d made onto a 2D page. “Product Warning” was my first major attempt to do that. I took one of the information sheets that always come with my oxycodone prescriptions and used it as a template. I wanted the subheadings (“Uses,” “Side Effects,” “Interactions,” “Overdose”) to relate to whatever part of the David story I was telling with that drug—like, the part of the story in the “Side Effects” section usually complicates the main conflict, the story under “Interactions” usually involves other people or outside influences, “Overdose” usually depicts some kind of an end—even though it’s not necessarily an obvious interpretation of the term in the subheading or a one-to-one kind of similarity. That one was really fun and a lot like a puzzle, which is part of what I like about using received forms: they’re generative because you have to figure out how to fit your story into the shape,
So, a lot of those decisions came from the medicine cabinet—and sometimes the decision was This needs to go in a braided essay because, in those, I had more room to spread out in my thinking or could take a second look at something I’d already written about in an experimental essay. The form had to add something to or fit really well with the content; I didn’t want it to feel like a gimmick.
But the map was a little different. I’d tried to write about my anxiety around my prescriptions and the ways that informal rules or actual regulations affect my life as a pain patient, and it always ended up feeling too much like the essay really was the thing it pretended to be, if that makes sense (I tried for a long time to get a “doctor-shopping guide” to work, but it turned into a literal how-to guide for getting a doctor to write opioids, and I couldn’t get a story to nest in it). I’d borrowed from Matthew this anthology, Where You Are (edited by Anna Gerber and Britt Iversen), that is kind of like a box set; you open it and pull out all these different map essays. I got the idea to do a map essay from that and narrowed it down to the pharmacies where I took my prescriptions when I lived in New York. That way, I could get in all the anxiety stuff and the problems with doctors and pharmacists, and it had a built-in story because I had to get from one to the other to the other and had a reason for visiting each one and stories to go with that. But I couldn’t figure out how to draw the map! I went ahead and wrote a draft and sent it to Silas Breaux, a really talented printmaker I’m lucky to have known since middle school whose work engages a lot with territory and geography. I told him it was his map and to make whatever he wanted. I love what he did with it. The symbols he uses to show what each pharmacy means for me are so smart, and his aesthetic decisions give the essay a texture it wouldn’t have if it were just made of words (or if I’d used the shitty maps I drew!).
4. Did writing Codependence help you understand things differently, or realize something you hadn’t noticed before?
Yes, but I think a lot more about what I realized or noticed in editing. I was so lucky when I was in grad school in Virginia and, before that, in New York. I had doctors who cared about me as a person and believed not only in my pain but that I deserved to have it managed the way I wanted it managed. All of the events in the book take place before 2016, when the CDC put out a new guideline for primary care doctors to help them figure out appropriate opioid dosing for patients in acute pain who’d never taken opioids before, and it was supposed to be voluntary. It’s not legally binding, and it was not supposed to apply to patients on stable doses or whose pain is chronic, but—and this always happens with regulations designed to reduce initial opioid prescriptions—doctors, the DEA, insurance companies, legislators, and pharmacies have used the guideline, respectively, as a reason to limit patients’ opioid intake or taper them down to the guideline’s ceiling dose, identify doctors who “overprescribe,” punish doctors who write doses over the guideline’s ceiling (one insurance company reduces all payments to a doctor who writes even one patient more than a certain number of milligrams per day; so, if my doctor wrote me what I took in Virginia, which was not an excessive dose but is now over the CDC recommendation, it would cut all of its payments to him—even if he saw someone for a totally non-opioid reason—by 10%), codify those limits into laws, or refuse to fill a prescription that’s over the guideline dose. I moved right after the guideline was published, and ever since then, my pain management has been substandard. I feel dumb for ever complaining about anything that happened pre-2016. It’s so much worse now. Patients are being forced off opioids entirely because doctors don’t want to deal with it or make themselves targets. We did pretty light editing on the book, and it was harder on me than actually writing the book because, when I wrote the book, I had good pain management, and now I’m in pain all the time because my doctor won’t adjust my dose, and I’ve needed an adjustment for nearly two years. So, I realized in a different way how vital a good doctor and an adequate opioid dose is to me as a writer and a person who wants to have a life and that I had been so lucky to have the ones I did when I did.
5. Is there anything you’re currently working on? Do you have any future plans?
I have a plan, but I’ve finished about two essays since I finished the book in 2017, which is paltry; I wrote all of the essays in Codependence within two years. But it’s hard to write when you have pain in your head all the time, and looking at a computer screen damns you to days of worsened pain. So, I’m still mostly in the planning stages. If I get to write, it’s a good day. But, really, my future plans are all about getting to a place where I can write for about six hours about five days a week, which I can’t do now. I worry that it will mean my career stalls out before it fully starts. But my plan is to center the next book on relationships and let pain take a little break from its center-stage role in my writing. If that’s possible. I can’t write anything that doesn’t have some relationship to pain. I also want to write a 33 1/3 on Taylor Swift’s reputation (2017) not because it’s her best album but because it’s a good gateway to all the most interesting parts of her career and persona and fanbase. It would be nice to have a writing project that got me away from me but still obsessed me, and if you want me to talk for an hour straight, ask me about opioids or my book or Taylor Swift gossip.
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Amy Long is the author of Codependence, selected by Brian Blanchfield as the winner of the CSU Poetry Center’s 2018 Essay Collection Competition. She holds an MFA in creative writing from Virginia Tech and a master’s degree in women’s studies from the University of Florida. Her work has appeared in Best American Experimental Writing 2015, Hayden's Ferry Review, Ninth Letter, and elsewhere. She serves as a contributing editor at the drug history blog Points.
Leyna Bohning is a second-year NEOMFA fiction writer at Cleveland State University and has had her works published in various corners of the universe. She received her BFA in Creative Writing from The University of the Arts in Philadelphia where she was the co-Editor for Underground Pool and an intern for The American Poetry Review. When she’s not writing she’s teaching herself Korean, listening to Paramore, or doing color-by-numbers.
