The Best American Essays 2017

by Leslie Jamison

  You complain of ceaseless fatigue, a haze in your head. You list your medications: lithium, Topamax, prazosin, Thorazine, lorazepam, also methadone, more I am forgetting, they are always changing. Frankly I am astonished at, worried by, the number of medications you are taking. The lithium concerns me most. I know that it has dangerous side effects. I know that it is used in batteries. Never once does it occur to me that you seem all right because of the meds and not despite them. You are impressionable and take what I say seriously. The only people you talk to are social workers, counselors, medical doctors, psychiatrists, and you do not seek to inform yourself about your own condition. You are not a skeptic. You do not read. You trust what others tell you. The source is of no relevance.

  Within weeks—or is it months?—your behavior seems to me more erratic. You are quick to anger. You demand things of me in your text messages. Usually money. I put fifty dollars’ worth of minutes on your phone; the next day you’ve run out, ask for more. Three, four times in a week, you run out of minutes. I tell you it’s too expensive to be using the phone in this way, and who are you talking to all of a sudden in any case? You say it is your friend Lenny. He is agoraphobic, you add. He rarely leaves the house. By now you think that I am trying to control you, to do you harm, and you begin making accusations. I get you a better phone plan, and for a few weeks, we do not speak.

  Later you explain that you adjusted the dosage of your lithium without first telling your doctor. That was you in a manic phase.

  I know better now.

  Mostly we talk about your daughter, Sophie. She is twenty-one now and the mother of a boy, eighteen months. The father is a young naval officer with whom she has parted ways, but his parents take care of the baby often. You have not seen or spoken to Sophie since long before her son was born. She wants nothing to do with you. You have tried phoning her, you tell me, but she will not take your calls.

  You know of her whereabouts, though, because you are in touch with the naval officer’s parents. You call them regularly, hear the latest on Sophie and the baby. They must empathize with you, perceive good intentions. One day they allow you to visit when Sophie is not around. You meet your grandson and you are ecstatic. You talk about it for weeks.

  Then one day you phone and they say they will no longer take your calls. They ask you not to call again, hang up.

  I am optimistic. This phase will pass; Sophie will come to see that you have changed. I think I know you will be reunited.

  We like eating at B&H Dairy and return there often. Today I bring you Tompkins Square Park, a recent book of black-and-white photographs by Q. Sakamaki. In 1986 Sakamaki moved from Osaka, Japan, to the East Village. Throughout the 1980s and ’90s, he documented the park and its surrounding streets, then a gathering place for the city’s marginalized and homeless and a stronghold of the antigentrification movement.

  We turn the pages, examine the pictures. I ask you what it was like. You tell me about when you loitered outside an abandoned building turned shooting gallery, waiting in line to buy your next fix. Police officers approached you, but you were neither questioned nor arrested. Instead, they emptied your pockets, took your money. They took everyone’s money. Then they left.

  It is difficult to know whether your memory is reliable, whether you can be relied on. But I have no reason not to believe you.

  Today is a good day for you. You get new teeth. You are more confident.

  July 2013. My eye lands on a headline in the New York Times: “Heroin in New England, More Abundant and Deadly.” I can’t recall the last time I saw heroin in the news. Media coverage of drug use had shifted, or so it seemed to me, to meth.

  Officials in Maine, New Hampshire, and Vermont, from “quaint fishing villages” to “the interior of the Great North Woods,” are reporting an “alarming comeback” of “one of the most addictive drugs in the world.” What’s remarkable about the story, according to its authors, is where the comeback is taking place: not in urban centers, but in the smaller cities and rural towns of New England. Experts offer observations. A police captain in Rutland, Vermont, states that heroin is the department’s “biggest problem right now.” A doctor, an addiction specialist, says, “It’s easier to get heroin in some of these places than it is to get a UPS delivery.”

  Most of the heroin reaching New England originates in Colombia and comes over the U.S.-Mexico border. Between 2005 and 2011 the number of seizures jumped sixfold—presumably in part because of increased border security—but plenty of heroin still got through. In May 2013 six people were arrested in connection with a $3.3 million heroin ring in Springfield and Holyoke, Massachusetts.

  The article describes two addicts in particular, both young women. They sell sex for drug money. One overdosed and died after injecting some very pure heroin. The addiction specialist tells us that he is “treating 21-, 22-year-old pregnant women with intravenous heroin addiction.” The lone man identified is the companion of one of the women. Beyond his name and age, nothing about him or his circumstances is mentioned. All three are white.

  I stop when I read, “Maine is the first state that has limited access to specific medications, including buprenorphine and methadone.” I open a new tab, search for what the writers mean by the vague phrase “has limited access to.” Earlier that year, the state enacted legislation to limit how long recovering addicts could stay on methadone, or similar drug-replacement therapies, before they had to start paying out of pocket. Medicaid patients will receive coverage for a maximum of two years. I know that for some people, like you, this is not enough time.

  Moving to the United States from Canada was, for me, eight years earlier, an easy enough transition. Much is shared between the two countries, and the culture shock was minimal. Yet even after all this time, I still find that certain ideas I’d taken for granted throughout adolescence and early adulthood—ideas about what a good society tries to make available for its citizens—are here not to be taken for granted at all.

  At the Bowery shelter you are a model resident. You participate in group. You see a counselor. You follow the methadone program. You are friendly with others. It is on account of this that you are recommended for Section 8 housing, and before long you are moved into a two-hundred-square-foot studio with a single bed, a private bathroom, a tiny kitchen. The facility, a four-story building, is designated for people living with psychiatric disabilities. Your share of the rent is $260. You are also responsible for your own utilities. These are subsidized based on your income.

  For a time you find yourself in a vexing predicament. The state has deemed you “unfit to work.” But each of your applications for disability benefits is denied. It is not at all clear how you are meant to survive.

  November 2013. The front page of the Saturday paper features a story on buprenorphine under the headline “Addiction Treatment with a Dark Side.” Buprenorphine is an opioid used for maintenance therapy like methadone, but is available by prescription. This is new. Since the 1970s, methadone has been distributed through clinics. People participating in methadone programs must go to the clinic at least once a week, and in some cases every day. This is obstructive, even oppressive. A similar drug that can be had by prescription seems like an improvement. But doctors must receive federal certification to be able to prescribe buprenorphine. Federal law limits how many patients a physician can help with the drug at one time. This means that only people with good insurance, or the ability to pay high fees out of pocket, can access it. “The rich man’s methadone,” the article calls it.

  But this—the part that interests me—isn’t what the article is about. The article is about how the drug gets “diverted, misused and abused”; how, since 2003, the drug has led to 420 deaths. (By comparison, there are more than 15,500 deaths from opioid overdose each year.) The article is not about the drug’s demonstrated efficacy at helping people with opioid dependencies that negatively impact their lives. Or about how restricted access to the drug is likely contributing to its div
ersion and misuse in the first place. Studies report that at least some people are self-treating their dependencies and withdrawal symptoms. I read elsewhere that medication-assisted treatment with an opioid agonist, such as buprenorphine, is the most effective treatment available for opioid dependencies.

  This is what you tell me: From the time you were young, you possessed an antiauthoritarian streak. This disposition did not emerge from any particular maltreatment, by family members, say, or teachers; it was your natural orientation toward the world. You were enthralled by the neighborhood kids who attracted trouble even as you yourself did not act out. You desired proximity to danger and rebelliousness. Unlike your brother, you attempted to differentiate yourself from your family not by transcending your class, but by assuming a posture of nonconformity. You liked drugs because you weren’t supposed to like them. For a long time—more than a decade—you were able to manage your use, to keep it, for the most part, recreational.

  One time your father found your needle and other supplies for shooting up. He was furious. You wouldn’t hear it. When he died years later his heart was still broken.

  I have difficulty reconciling all this with what else you have told me of your past. I know that you worked for the police as a 911 dispatcher. You were good at your job, liked and respected, and soon you found yourself in a supervisory position. You enjoyed the night shift, especially, and for a long stretch the Bronx was your district. The position is notoriously stressful, but you were sharp, capable, levelheaded, and you excelled.

  You were fired when your fidelity to heroin was stronger than it was to your job.

  You love your new apartment, can’t believe your good fortune. When I stop to consider it, neither can I.

  Sometimes I imagine what you will do with your time. I picture you as a volunteer—with other people who use drugs, maybe, or at a food kitchen or shelter. I feel certain that you will want to do this, that you will do something good, in the way that others did good for you. That maybe we will do something good together. Once, when I am volunteering on American Thanksgiving, I invite you to come along. I know that you have nowhere else to go. You tell me you’d prefer to stay home. A few months later, I make the suggestion once more. Again you decline.

  Later I come to recognize this as my own bizarre fantasy, a projection of my savior complex, perhaps. I laugh, not for the first time, at the naïveté of my younger self.

  December 2013. Two articles command my attention. The first, a few weeks old, is about a radical clinical trial in Canada comparing the effectiveness of diacetylmorphine—prescription heroin—and the oral painkiller hydromorphone, i.e., Dilaudid, in treating severe heroin dependency in people for whom other therapies have failed. An earlier study in Canada had demonstrated that both diacetylmorphine and hydromorphone are better than methadone at improving the health and quality of life of longtime opiate users. An unexpected finding was that many participants couldn’t tell the difference between the effects of diacetylmorphine and hydromorphone. But the sample group receiving hydromorphone wasn’t large enough to draw scientifically valid conclusions. So the study investigators created a new trial to test this finding. If hydromorphone were to be found as effective as diacetylmorphine, it could mean offering people the benefits of prescription heroin without the legal barriers and associated stigma. The study results have yet to be published.

  Larry Love, sixty-two, a longtime dependent: “My health and well-being improved vastly” during the trial. Love’s doctor applied to Health Canada for permission to continue prescribing heroin to Love and twenty other patients after their year in the trial was up. The applications were approved, although renewal was required after ninety days. The federal health minister responded by creating new regulations to prevent such approvals. He insisted Ottawa would not “give illicit drugs to drug addicts.” Love, four additional patients, and the health-care center that runs the hospital that oversaw the trial are suing the government in turn. The doctor who submitted the applications, Scott MacDonald: “As a human being, as a Canadian, as a doctor, I want to be able to offer this treatment to the people who need it . . . It is effective, it is safe, and it works . . . I do not know what they are thinking.”

  The second is an editorial about a Canadian bill that, if passed, would set new guidelines for opening supervised-injection facilities. Like syringe-distribution programs, supervised-injection facilities act as a frontline service for people who use drugs intravenously, giving out sterile needles and other paraphernalia. But they go one step further: users may bring in drugs procured elsewhere and inject them under the watchful eye of trained nurses. Staff members offer instruction on safer technique (“Wash your hands,” “Remove the tourniquet before pushing the plunger,” “Insert the needle bevel up”) and monitor for overdose, which they counteract with naloxone. They do not directly administer injections.

  The new law would erect application hurdles so onerous it would effectively prevent the establishment of any new sites. The columnist attacks the government for acting on ideological rather than scientific grounds. “Supervised injection sites are places where horrible things take place.” I cringe a little. “The fact is, however, that these activities are even more horrifying when they take place in the streets, and strict prohibition has never been even remotely successful.”

  There is, I know, only one such facility in all of North America. It’s called Insite, and it’s in Vancouver.

  It is a fall evening and we are on our way to a movie. We pass a small group of Chabad men on the street. It is Sukkot and they are trying to identify secular Jews by sight, inviting them to perform the ritual with the date-tree fronds (lulav) and lemonlike fruit (etrog), shaking them together three times in six different directions. They have a small truck nearby (the Sukkahmobile). You tell me how a Chabad man befriended you once, how you almost became religious. He wanted to help you, and you had no one else. You went to dinners at his house. He would call to ask how you were. You say that he and his family were some of the kindest people you had ever met. But you couldn’t stick with it, and one day you stopped responding.

  I take you to see Ballast, that film of austere, understated realism about a drifter boy and a grieving man in the Mississippi Delta. It’s more about tone than narrative, and I am moved by the beauty and sadness of its barren landscapes. I worry that you are bored, you nod in and out; but afterward you tell me how much you liked it. I decide I will take you to movies often.

  Within weeks of Philip Seymour Hoffman’s death, a surfeit of reporting:

  Why Heroin Is Spreading in America’s Suburbs

  How Did Idyllic Vermont Become America’s Heroin Capital?

  New England Town Ripped Apart by Heroin

  Today’s Heroin Addict Is Young, White and Suburban

  Heroin’s New Hometown: On Staten Island, Rising Tide of Heroin Takes Hold

  When Heroin Use Hit the Suburbs, Everything Changed

  Heroin in the Suburbs: A Rising Trend in Teens

  Heroin Reaching into the Suburbs

  Heroin Scourge Overtakes a “Quaint” Vermont Town

  Heroin-Gone-Wild in Central New York Causes Jumps in Overdoses, Deaths

  Actor’s Heroin Death Underscores Scourge Closer to Home

  Heroin Scourge Begs for Answers

  New Wisconsin Laws Fight Scourge of Heroin

  The Scourge of Heroin Addiction

  Heroin Scourge Cuts Across Cultural and Economic Barriers

  Colombian, Mexican Cartels Drive LI Heroin Scourge

  Senate Task Force Hears from Rockland on Heroin Scourge

  Report Shows Heroin Use Reaching Epidemic Proportions in NH

  America’s Heroin Epidemic: A St. Louis Story

  Heroin: Has Virginia Reached an Epidemic?

  United States in the Grips of a Heroin Epidemic

  Cheap, Plentiful, Deadly: Police See Heroin “Epidemic” in Region

  How Staten Island Is Fighting a Raging Heroin and Prescription-Pi
ll Epidemic

  A Call to Arms on a Vermont Heroin Epidemic

  Fighting Back Against the Heroin Epidemic

  Ohio Struggles with “Epidemic” of Heroin Overdoses

  Cuomo Adds 100 Officers to Units Fighting Heroin

  Governors Unite to Fight Heroin in New England

  Police Struggle to Fight America’s Growing Heroin Epidemic

  DuPage Officials Suggest Laws to Fight Heroin

  Taunton Launches Plan to Fight Heroin After Dozens of Overdoses

  There are many more I don’t write down.

  Your disability application is finally approved. You will receive monthly Social Security payments of $780. You are also entitled to the disability that has accrued from the time of your first denied application, which, because it was several years ago, now amounts to several thousand dollars.

  There is one condition, however. The state has decided that, given your history, you are unfit to oversee your own finances. You will need someone who can demonstrate gainful employment, preferably a family member, to tend to the money on your behalf.

  On a winter morning, early, I take the bus from Prospect Heights to the Social Security office in Bushwick. We have an appointment but we wait a long time. I sign where I am asked to. I attest to my reliability. I assume responsibility.

  Soon after I set up a bank account where I am your “representative payee.” Your money is deposited to it on the first of each month. From this account I pay your rent, your utilities. We meet every week or two, for food, for a movie, but always so that I can provide you with cash for provisions.

  This works for a while.

  On the phone one day you tell me you hurt your arm, a man on the street walked right into you, knocked you down to the ground. When I call a few days later to see how you are feeling, you tell me how strange it is, nearly every guy you pass on the street is eyeing you as if he wants to start a fight. These men, they are always brushing up against you on purpose.