Hektoen International

A Journal of Medical Humanities

New opioid epidemic: another long day’s journey

Carol Levine
New York, New York, United States


Papaver somniferum  (opium poppy)
D. G. J. M. Bois (1896-97)

Edmund Tyrone, age 23 (August 1912, New London, Connecticut)

“It’s pretty hard to take at times, having a dope fiend for a mother!”
From Long Day’s Journey into Night by Eugene O’Neill, Act III1


Alexis Lightle, age 17 (December 2017, Chillicothe, Ohio)

“My dad was on pills and opiates and mum was into heroin…My dad died of an accidental overdose. I remember my brother telling me it’s not going to be ok, it’s never going to be ok, but we’re going to pretend it’s ok.”2


America is in the grip of an opioid epidemic once again, fueled by misleading information about the addictive qualities of opioids. And yet again the epidemic is taking a toll not only on the men and women who become addicted but also on their families, especially their children. There are certainly differences between the opioid epidemic of the late nineteenth and early twentieth centuries and the one we confront today, such as the growth of powerful marketing campaigns, but the similarities are compelling.

Rarely in the history of medicine has a fictional character come to represent an entire generation of people with a disorder of any kind. But, as David T. Courtwright points out in his history of opiate addiction in America, “Mary Tyrone in Eugene O’Neill’s autobiographical play, Long Day’s Journey into Night, exemplified the characteristics of this generation of addicts: female, outwardly respectable, long-suffering – and thoroughly addicted to morphine.”3 He contrasts her status with the emergence in the 1920s and 1930s of a new group of addicts – lower-class, predominantly male, non-white or immigrant – people who were already considered suspect. Distrust of this new generation, he argues, led to social stigma and criminalization. That legacy continues in the current epidemic.

While Courtwright’s description captures historical changes in public policies toward addiction, it minimizes the social stigma and despair that the Mary Tyrones of the earlier period both experienced and passed on to their families. Eugene O’Neill and his brother James, as well as their father, also James, a once-famous actor, found solace in another common addiction – alcoholism.


The beginnings of addiction

Besides the four Tyrones in Long Day’s Journey into Night, there is only one other character – Cathleen, a servant. But doctors past and present play a major role offstage. Mary Tyrone says to her husband, “I was so healthy before Edmund [O’Neill’s counterpart in the play] was born…. Even traveling with you season after season, with week after week of one-night stands, in trains without Pullmans, in dirty rooms of filthy hotels, eating bad food, bearing children in hotel rooms. I still kept healthy. But bearing Edmund was the last straw. I was so sick afterwards, and that ignorant quack of a cheap-hotel doctor – All he knew was I was in pain. It was easy for him to stop the pain.” Mary’s complaint, echoed throughout the play, is not just about the doctor: she blames James, a wealthy landowner, for failing to make her a proper home and for being stingy in providing for his family.

Mary’s distrust of doctors extends to Doctor Hardy, the local doctor whose diagnosis of Edmund’s cough and fever are anxiously awaited in the play. She refuses to believe that there is anything seriously wrong with Edmund but uses his illness as an excuse for her nervousness. The family recognizes but does not acknowledge these signs of a relapse. The family learns that Edmund has consumption and will have to go to a sanitarium to recover. But which one? Edmund is upset to learn that his father wants to send him to a state-run sanitarium because it is cheaper than a private facility. (This incident is based on O’Neill’s own experience as a tuberculosis patient in his twenties).

Mary says, “I know all about Doctor Hardy, Heaven knows I ought to after all these years…When you’re in agony and half insane, he sits and holds your hand and delivers sermons on will power! He deliberately humiliates you! He makes you beg and plead!  He treats you like a criminal.”

The Doctor Hardys of the early twentieth century did not look to science for guidance, nor were they constrained by drug regulations. Physicians wanted to help their patients who complained of pain, anxiety, and a host of other problems; and an injection of morphine, introduced on the Civil War battlefields, seemed to do the trick – until it became, literally, a habit. This opioid epidemic was addressed by the federal Pure Food and Drug Act of 1906 and anti-narcotic legislation that followed. It did not mean the end of drug use, however, as epidemics of cocaine and heroin took hold in the 1930s. But in these later periods the primary source was not the medical profession but illegal drug suppliers.

Andrew Kolodny, co-director of the Opioid Policy Research at Brandeis University, dates the onset of the current opioid epidemic to 1996, when Oxycontin was introduced, followed by a barrage of industry-funded messages to physicians and professional societies. These messages blithely but mistakenly claimed that opioids are safe and effective for chronic pain and did not lead to addiction.4 State governments are currently suing these drug companies for their misleading promotional activities.5 The populations first and most seriously affected were white, rural, and poor; addiction and overdoses are by no means limited to these groups, however.

When it became apparent that people were overdosing and dying at alarming rates, limits on prescriptions were instituted. But by then other drugs – heroin, fentanyl, and combinations – were widely available as street drugs. As an unintended consequence, patients with chronic pain are finding it difficult to obtain appropriate medications from their doctors.


Women in the two epidemics

Middle-class women like Mary Tyrone who were addicted to opioids were sheltered by their families and protected from society’s disapproval. Prostitutes were seen as the main female drug abusers. Treatment options typically addressed men’s problems – holding jobs, restoring self-esteem linked to masculinity, and mending relationships with family. Women’s issues, such as domestic abuse, poor parenting skills, and gendered social expectations about motherhood, were not often included in treatment plans.6

In the current epidemic, women – particularly pregnant women – are singled out for harsh assessments. Newborns born to women who are using drugs or who are in treatment but undergoing Medication Assisted Treatment, may experience Neonatal Abstinence Syndrome, a severe but treatable withdrawal syndrome. New mothers may not be allowed to bond with their infants, although this practice is beginning to change. Drug-using women, even those in treatment, may lose custody of their children. The impact on older children, who experience constant stress and who sometimes become caregivers for their parents or young siblings, is only now beginning to be recognized and incorporated into prevention and treatment programs.


The legacy of Long Day’s Journey into Night

O’Neill’s play has long been considered a masterpiece but with little relevance for our times. Yet the play’s depiction of the ways in which denial, avoidance, and lying become the normal means of communication in a family affected by substance abuse are as telling today as they were in 1912, when the play is set, or in the 1950s, when O’Neill finally made good on his promise to tell the whole story.

Who will tell this new opioid story in literature and song? The first efforts are coming, not surprisingly, from Appalachia, where the epidemic has taken the heaviest toll. William Brewer, a young prize-winning poet, paints vivid pictures of pain and loss. In “Oxyana, West Virginia,” he writes, “Where once was faith,/ there are sirens: red lights spinning/door to door, a record twenty-four/ in one day, all the bodies/ at the morgue filled with light.”7 And Marcus Oglesby, leader of his band Creek Don’t Rise, sings the blues in “White Coat Man,”

“Things in the holler, they ain’t the same,
People in the holler can’t stand the pain.
Used to owe it to the company store,
Now the white coat man’s gonna own your soul.” 8



  1. Eugene O’Neill, Long Day’s Journey Into Night, 2nd ed. (New Haven, CT: Yale University Press, 1989). All further quotations from the play are from this edition.
  2. Alexis Lightle, “Heroin’s Children: My Life Inside the US Opioid Crisis,” Aljazeera, Dec. 26, 2017, available at https://www.aljazeera.com/indepth/features/heroin-children-life-opioid-crisis-171030083501156.html
  3. David T. Courtwrght, Dark Paradise (Cambridge, MA: Harvard University Press, rev. ed., 2001, p. 1, 
  4. http://www.khi.org/assets/uploads/news/14781/dr._kolodnys_presentation_-_kansas_8.29.17.pdf
  5. Barry Meier, “Origins of an Epidemic: Purdue Pharma Knew Its Opioids Were Widely Abused,” New York Times, May 29, 2018. Available at: https://www.nytimes.com/2018/05/29/health/purdue-opioids-oxycontin.html.
  6. Nancy D. Campbell and Elizabeth Ettorre, Gendering Addiction: The Politics of Substance Abuse Treatment in a Neurochemical World (New York: Palgrave Macmillan, 2011).
  7. William Brewer, “Oxyana, West Virginia,” in I Know Your Kind: Poems (Minneapolis: Milkweed Editions, 2017), pp. 2-3.  Brewer notes that “Oxyana is the nickname given to the town of Ocean, West Virginia, after becoming a capital of OxyContin abuse.”
  8. PBS Newshour, October 27, 2017, https://www.pbs.org/newshour/arts/listen-this-blues-song-tells-the-story-of-the-opioid-crisis-and-the-white-coat-men-who-started-it.
  9. Papaver somniferum L. (Opium Poppy) drawn by D. G. J. M. Bois.  From E. Step and D. Bois, Favourite Flowers of Garden and Greenhouse, vol. 1 (1896-97).Contributed by Missouri Botanical Garden, St. Louis, to www.plantillustrations.org,  Illustration courtesy New York Botanical Garden Library.



CAROL LEVINE, MA, directs the United Hospital Fund’s Families & Health Care Project in New York City and is co-director of UHF’s project on the opioid epidemic and its impact on children and families. She is editor of Living in the Land of Limbo: Fiction and Poetry about Family Caregiving (Vanderbilt University Press, 2012). She received a MacArthur Fellowship in 2003 for her work in AIDS policy and ethics.


Spring 2018  |  Sections  |  Literary Essays

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