The Stories We Tell About Opioids

I'm an Associate Professor of English at the University of Nevada, Las Vegas, where I've taught since 1999. In 2002, I woke up with a headache I've had ever since. My primary diagnosis is chronic migraine, though other things are going on: cervicogenic pain, occipital neuralgia, hemicrania continua. In the sixteen years I've spent seeking relief, the only reliable respite from my worst pain episodes are opioids.

I have the misfortune of suffering from chronic pain and depending on an opioid prescription in Nevada, which has enacted some of the most draconian opioid regulations of any state in the union. The same state that named me the Nevada System of Higher Education's best teacher (2013) has come closer than ever to making my condition a crime. Eight weeks ago, I turned students away from office hours and left school early to take my first, and now quarterly, state-mandated drug test ("3254: drug abuse panel 10 w/oxy"). I am under surveillance, under preemptive punishment, not because I've ever abused drugs but because I might—solely because I have standing prescriptions for oxycodone and morphine. To my state, I am not a responsible, high-functioning citizen who's never abused my opioid prescription in the sixteen years I've had one. I am a potential addict, approached not with sympathy but suspicion. In the state of Nevada, having chronic pain is practically a crime. As a result, I long ago lost the ability to distinguish between my fear of uncontrollable pain and fear of being denied the medicine to control it.

Living in pain is work. Real, material labor; and because the overwhelming majority of us who suffer it still endeavor also to do other work in the labor economy—have a job, raise children, or otherwise participate productively in society—opioid medication serves as an essential tool, however limited or imperfect, in getting both jobs done. Opioids, for most responsible, long-term pain patients, do not mark the end of their life as engaged members of the community, but are their lifeline to it. The "war on opioids" tears insensibly at a lifeline that most of us need to fight harder battles—often literal battles, when I think just of the wounded veteran students I teach—battles to remain grounded, sane, and connected in meaningful ways to our world despite pain. Even aside from the galling waste of time and downright cruel extra labor my state is imposing on patients with opioid prescriptions, such as mandatory in-person physician visits for all refills every 30 days, living in pain is a full-time job.

My own head pain, both the daily pain that's sort of always there and the much more severe pain that hits with unpredictable intensity and duration, exacts profound mental and emotional labor. It makes thinking difficult. Migraine disrupts cognition, sleep, mood, memory, and sensory perception. When I must teach or attend meetings in this condition, it's as if conversation is on a seven-second delay. I have difficulty tracking and comprehending what others are saying. I forget the beginning of my own sentence before I get to the end. I forget basic nouns. Sounds are too loud. That painting on the wall, just its arrangement of color and lines, becomes a violent affront to sight. As I often joke to my students, when I'm in full-blown migraine, ironically, I seem like I'm on drugs. Taking the drugs, however, is what allows me to function more or less normally. Rarely does my medication "kill" my pain. It mutes it. My opioid prescription quiets the haywire signal in my brain, everywhere screaming pain, and makes room for something else. For thinking, which is my work, my sense of self. These are not small things.

I specialize in critical theory, studying how meaning gets made and by what forces. I'm interested in how stories are shaped and what we need them to tell us. Yes, the "opioid epidemic" is real, its effects tragic. But the state casts me as an addict whose behavior must...