The Opioid Epidemic as Metaphor

The Opioid Epidemic as Metaphor

[gblockquote source=”Susan Sontag, Illness as Metaphor“]Of course, one cannot think without metaphors. But that does not mean there aren’t some metaphors that we might well abstain from or try to retire. As, of course, all thinking is interpretive. But that does not mean that it isn’t sometimes correct to be “against” interpretation.[/gblockquote]

I watched a lot of drug movies in high school. Maybe it was the clothes, the pulsing soundtracks, or how much I loved a voiceover. It also could have been the incredibly pretty people in these movies. Maybe it was because the Drug Movie as a format involves a type of fantastical world-building absent from many realistic dramas. Films like Trainspotting (1996), Party Monster (2003), Requiem for a Dream (2000), and Drugstore Cowboy (1989) felt magnetic. I saw some of these movies before I had a real understanding of drug addiction, and others after, but I can’t deny that movies about drugs shaped the way I viewed opioids and amphetamines alike. In 1979, Susan Sontag wrote about how the language we use to describe diseases such as tuberculosis and cancer (and the media produced about it) may affect how we think about such illnesses when we or our loved ones are afflicted with them. As the opioid epidemic in the United States worsens, I’ve begun to wonder if the same may be true about media concerning opioids and addictions to them.

In a standout scene from the 1995 film the Basketball Diaries, Jim Carroll, played by a young Leonardo DiCaprio, goes through heroin withdrawals in his neighbor Reggie’s apartment. Covered in sores and bruises, drenched with sweat and drool, Jim writhes against the bed, the wall, and finally against Reggie as he sobs and screams. It is a memorable scene bordering on tragedy porn. A year later, in Danny Boyle’s popular filmic adaptation of Irvine Welsh’s Trainspotting, Iggy Pop’s “Lust For Life” blares as an emaciated Ewan McGregor (playing the character of “Renton”) runs through the streets of Edinburgh dodging traffic and stating “I chose not to choose life: I chose something else. And the reasons? There are no reasons. Who needs reasons when you’ve got heroin?” The two films, both released in the veritable heyday of “Heroin Chic,” may have wildly different tones, but they both establish that individuals addicted to opiates essentially depart the world of the ordinary and live on a separate plane as addicts.

Film poster for Trainspotting — Copyright 1996, Polygram Films.
Film poster for Trainspotting (© Polygram Films).

As cinematic portrayals of opioid use and abuse tend to be this sensational, commonplace opioid usage almost feels as if it doesn’t fit into this pattern of addiction at all. My teens were in the early aughts. The friends I had who took opioids usually weren’t doing heroin, “just” prescription drugs, and the worlds constructed around opioid usage in popular media tended to separate other opiates from heroin itself. However, in the last 15 years, opioid-related deaths have risen over 500%, and it is now more likely for an American to die from an opioid overdose than it is to be killed in a vehicular accident. Having reached a point where the opioid problem in the United States cannot be ignored as an epidemic, media representations of heroin and other opioids are beginning to shift from more individualized stories about decisions and inherent susceptibility to addiction, and towards presenting victims of the opioid epidemic as just that, victims of an epidemic.

In Illness as Metaphor and AIDs and its Metaphors, Susan Sontag states that we all belong to both the “kingdom of the sick” and the “kingdom of the well,” but that the baggage associated with illness makes that dual citizenship difficult.1 Sontag began Illness as Metaphor in 1978 after her own diagnosis with cancer as a way of exploring how the “trappings of metaphor” burden cancer patients and have similarly burdened tuberculosis patients in the past. Diseases like cancer and tuberculosis are viewed as isolating illnesses that seem almost to pick victims at random as they invade previously healthy bodies through no apparent fault of the patient.2 With her work on TB, cancer, and later AIDS, Sontag had success in drawing out many of the metaphors that mystify these diseases, belaboring and “using up” the metaphors so that the diseases can return to being just illnesses.3 As the rate of opioid addiction in the US rises, I have noticed popular portrayals of opioid usage and abuse shifting to depict these issues as illnesses rather than individual moral failings. However, many of these contemporary representations of drug use find themselves in the position of wrestling with the stereotypes about addiction that were so theatrically represented in films past.

The recent Lucas Hedges and Julia Roberts feature Ben Is Back attempts to reckon with the flaws of addiction movies, while at the same time characterizing opioid addiction as a widely spread illness. When Ben, played by Hedges, returns home from rehab early, he doesn’t look like many of the other drug addicts we’ve come to expect from earlier drug films. He’s not gaunt or pretty. Instead, he looks strikingly ordinary. This is a good reflection of how commonplace opioid addiction has become, that even in media it is presented plainly. Like sufferers of other illnesses, Ben has a family, a stepfather, a pharmacist, and a congregation, demonstrating that isolation is not a necessary or even truthful component of addiction. As the movie ambles on and the main action falls, Ben’s mother and the audience are at once exposed to how much Ben’s illness was influenced by the world around him. His addiction, like most, began with a prescription that Ben received when he was 14. Sometimes he got a fix in the form of pills from people at school, sometimes the pharmacist. Other times, he bought heroin. In one scene where his brother puts on a scratchy costume Ben gives him advice by saying, “Bud, the thing about an itch is just don’t scratch.” However, it is achingly apparent to Ben that while a temporary feeling can be overlooked, chronic symptoms of illness like addiction need to be treated and not just “not scratched.”

Official poster for Ben is Back. (Wikimedia)

Ben is Back did not garner as much attention as the splashier heroin movies of the past, but it is a part of a recent pattern that changes the way opioid addiction is presented. Another example of this is in the Lifetime Series (later purchased by Netflix) You. The drama about a serial killer who manages a bookstore is based on a pulp novel of the same name. It is a genre program for the era of “dark” reboots presented in a sleek package that makes binging easy, which is exactly why I watched it. As I watched Penn Badgely skulk around to glossy covers of songs like “I Want You to Want Me,” I was surprised to notice how the show handled subplots about various characters’ addictions to opiates. Their stories varied (an heiress, a hipster jackass, and a mother trapped in an abusive relationship), but their addictions all felt incidental. That is, these characters were not defined by their addictions. Their addictions were a part of their backstory, but not the entire backstory. The series also made references to the anti-overdose medication Naloxone, or Narcan, in multiple episodes. It felt revelatory to me that other characters just had this in their homes or on their person as if it were normal, a necessary precaution. I wouldn’t go so far as to say the show is revolutionary, but it has a large viewership and fanbase, so the fact that it portrays addiction this way matters.

Sontag wrote that “The poor and the rich both get TB and cancer; and not everyone who has TB coughs. But the mythology persists.”4 The popular image of the addict is that of a heroin addict, in part because of the myriad portrayals of heroin use in drug movies and other kinds of media over the last half-century. This is damaging because the connection between prescription opioid abuse and heroin use are so often overlooked. An estimated 80% of heroin users started with prescription medications. The reality is that the opioid epidemic has become a part of everyday life in the United States, although many of us have been conditioned to overlook its more banal traits. The opening of the 2017 documentary Warning: This Drug May Kill You, for example, painted a very different picture than those dramatic drug movies. It began with a montage of horrifying cellphone videos of individuals flopping over or being carried out of public places after an overdose. These are things that happen every day, in cities and in rural areas, on public transit, and in the dressing rooms of shopping malls, as portrayed in Ben is Back. The world of the sick and the world of the well are one and the same, and no matter what the epidemic at hand is, we need to acknowledge this.

Further Reading

The Opioid Diaries,” photographs by James Nachtwey, TIME: Special Report.

P.A.I.N. (Prescription Addiction Intervention Now) homepage.

Margaret Talbot, “The Addicts Next Door,” The New Yorker, May 29, 2017.

Understanding Naloxone,” Harm Reduction Coalition.

Understanding the Epidemic,” US Centers for Disease Control and Prevention.


  1. Sontag, Susan. Illness as Metaphor and AIDS and Its Metaphors, (New York: Doubleday, 1989), 1, 25. Return to text.
  2. Sontag, Susan. Illness as Metaphor and AIDS and Its Metaphors, (New York: Doubleday, 1989), 35. Return to text.
  3. Sontag, Susan. Illness as Metaphor and AIDS and Its Metaphors, (New York: Doubleday, 1989), 139. Return to text.
  4. Sontag, Susan. Illness as Metaphor and AIDS and Its Metaphors, (New York: Doubleday, 1989), 18. Return to text.

Featured image caption: Heroin Withdrawal – What to Expect. (Find Rehab Centers).

Faith Bennett earned her bachelor’s degree in history with a minor in African Studies from the University of Florida in August 2016. She is a graduate student in the PhD Program for American History at UC Davis starting in fall 2019. Her research interests include gender, labor, and the service industry.