Of course, there is another approach to dealing with addiction (beyond prohibition, which never works): instead of treating it, you indulge it, and give the addicted person what they want, in a safe environment. Her inevitable regressions, her cheesy rationalizations for reusing, her betrayals of everyone for money and dope, her harrowing flirtations with overdose and death, just to feel high again – Lam recreates the entire roller coaster in intimate detail, and leaves his reader shivering next to Claire, as hungry for his prose as the violinist is for her beloved but evermore adulterated “down,” the street name for heroin.

Claire has the gumption to sign up at Chen’s clinic, but then needs bigger and faster highs to feel confident enough (of her own talent) to play the violin at her freest and most artful. Lam manages a small miracle in On the Ravine: he turns the dreary sameness of addiction, as well as its impenetrable bureaucracies, into a compelling narrative: “Pills prescribed, pills bought, pills snorted, heroin snorted, heroin in needles …” Chen’s parlous obsession with his favourite patient, Claire – a talented violinist addicted first to oxycontin, then to heroin, then to everything – is a one-step-forward-two-steps-back map of the stuttering progress and (almost) inevitable backsliding of addiction. We tell ourselves addiction is failure because we don’t want to admit how porous the membrane between addiction and health can be, how frequently and inexplicably smart and talented people fall through to the inferno of bottomless need below. “The camps were all around him,” Chen observes, pedalling through the city’s wild subsurface ravines: “they were easy to miss but plain to see if you looked.” Most of us don’t want to look. His bike routes are extensive and detailed (anyone who rides in Toronto will recognize them) – Lam’s way of telling us addiction is everywhere, afflicting the homeless and the wealthy alike. When he isn’t writing prescriptions for methadone and being a soft touch, fronting patients money, Chen roams the city on his bike, handing out naloxone overdose kits to pharmacies and the homeless. Caring, he points out, doesn’t save lives: diagnosis and treatment do. As Chen advises his favourite patient in the book, a “cure” takes at least two years.Ĭhen is a principled, evidence-addicted scientist with a penchant for caring too much about the people he treats. Some patients refer to “bupe” and methadone as “liquid handcuffs” because, while they soften the craving, they maintain addiction. Methadone and buprenorphine, which are slow-acting opioids, replace heroin and oxycodone and their pals and theoretically make withdrawal less devastating, granting patients time and space to re-establish their lives. On the Ravine, his third work of fiction, picks up the story of two of them, Chen and Fitzgerald, both of whom have devoted their subsequent careers to opioid addiction, albeit in very different ways.Ĭhen runs a clinic that prescribes opioid agonist therapies.

When he isn’t writing, Lam is a Toronto doctor (he graduated from medical school in 1999, and has worked in both emergency and addiction medicine): his first book of short stories, Bloodletting & Miraculous Cures, which won the Giller Prize in 2006, followed the lives of four medical students as they became physicians.

Vincent Lam battles these unanswerable questions in his new novel, On the Ravine. Why are people drawn to opiates, to the repetitive agony of failing to find painless oblivion? What causes that longing? Is it genetic, or learned and chosen? How much can you blame an addicted person for the chaos they cause? Are some people simply less equipped to endure the unavoidable pain of being human? The numbers raise questions as old as addiction, an ancient human problem.

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