The Professional Patient

I grew up in the Beaches, on a wide street with big houses and sprawling lawns. My father was the assistant manager at a lumberyard, and my mother stayed home to take care of me. My mother and I had a tight bond and spent our days together, doing crafts and watching movies. But, as I got older, I started to notice some strange changes in her behaviour.

My mother would disappear into her bedroom for days at a time, and her mood would fluctuate rapidly, from upbeat and happy to morose and flat. What I had thought were eccentricities turned out to be clinically diagnosed OCD, depression and anxiety. She self-medicated with clonazepam and cannabis, often to excess.

As her son, I felt duty-bound to help her. I’d watch her for signs of sadness and ask her constantly whether she was happy. Even though she assured me she was, her actions—locking herself in her room, spending days in bed—told a different story. I decided that, if I really wanted to help my mother, I needed to understand exactly what she was going through. I believed that, if I tried these substances myself, I’d discover why she took them and how she could stop. So, in 2004, at the age of 14, I started destroying my life. Looking back, my rationale is nonsense, but I was young, scared and desperate to save my mother. Plus, I was struggling too: I had started to have panic attacks, and a doctor had diagnosed my anxiety and depression.

I’m not sure whether I inherited my mother’s mental disorders or developed them by growing up in similar circumstances. But, when I smoked weed for the first time, I felt my breathing relax and an ease settle into my body. It was such a relief. I hadn’t even realized I’d been in so much pain. Smoking quickly became an everyday habit. I would lift a little weed from my mother’s stash and smoke it alone in my bedroom.

As I began to smoke more, my periods of sobriety were marked by increasingly severe depression and anxiety. I continued to have panic attacks and was unable to leave the house, and I became dependent on weed to manage my symptoms. By 2006, my drug use was no longer just an experiment—it was my life. Despite my parents’ pleas, I dropped out of high school in Grade 10. I made up my own curriculum composed of books about human suffering, including Osamu Dazai’s No Longer Human and the poetry of Georg Trakl. They made me feel less alone.

Despite her own struggles, my mother never left my side. She sat with me all day as I suffered in silence, letting me know she was there. She tried to get me professional help and accompanied me to endless appointments with doctors, psychiatrists and social workers. I was prescribed antidepressants, but they didn’t help—I was still addicted to weed, which dampened the effects of the drugs.

In 2010, when I was 20, a friend of the girl I was dating connected me to a dealer who sold OxyContin. At that point, I was willing to try anything. At first, the OxyContin felt like a magical answer to all of my problems. Then, the following year, there was an OxyContin drought; I couldn’t find it anywhere. I went into an excruciating withdrawal that lasted weeks beyond the usual period of three or four days, so I went to see a doctor. She said there was nothing she could do to alleviate my symptoms, which included a fever, nausea and sleeplessness, and she told me to go back on the drugs. But she wouldn’t prescribe them to me and suggested that I obtain them illegally.

I went to see another provider, who told me that I was “too smart and well put together” to be addicted to drugs and refused to acknowledge my problem. So I showed up to our next appointment looking dishevelled, saying that I needed an OxyContin prescription to tide me over until rehab—a lie—so that I wouldn’t have to buy drugs off the street. She seemed to register the difference in my appearance and wrote me a prescription for morphine, a similarly effective painkiller. This tactic, called croaking—pretending to need drugs for reasons deemed legitimate by the system—would soon become my go-to for obtaining prescription drugs.

My anxiety and depression faded away while I was under the effects of the morphine, and I got a job as a salesman for a printing agency on Bay Street. I travelled around the downtown core, peddling printing contracts while snorting crushed pills in the bathroom. By then, I was living in a rooming house on Euclid Avenue, and my mother and I had grown distant as my drug use surpassed hers. She and my father were scared and worried.

Later that year, I left that job, and with nothing to fill my days, I became a full-time drug user. In addition to OxyContin, I was addicted to weed, clonazepam, heroin, cocaine and alcohol. When I couldn’t get my drugs of choice, I took whatever I could get my hands on. I used alone, in the stairwells of high-rises and coffee shop bathrooms. I kept wearing the suit and tie from my Bay Street days so I wouldn’t look like what I thought of as a typical drug user.

By 2013, I was emaciated and oscillating between panic attacks and a depression so severe that I often couldn’t get out of bed. I funded my drug use with a combination of ODSP payments and begging my parents for cash. Desperate and unsure of what to do, I started going to the hospital several times a week to try to get some help. I insisted to anyone who would listen that my addiction was the result of my poor mental health, but the hospital would treat only one condition at a time. If I wanted mental health treatment, in other words, I’d need to quit the drugs on my own—an impossibility. So, instead, I’d spend 12 hours in the ER receiving intervals of diazepam, to ease my painful withdrawal symptoms, before being sent home with crisis hotline pamphlets. I was turned away from receiving any real, lasting treatment for my addiction so many times that it felt like I had some type of unique, incurable disease. It seemed like the only way to stop being sick was to die.

In the ER, I noticed that those who screamed the loudest were treated first. But, in contrast to the people chugging pills from prescription bottles or walking around with disconnected tubes hanging from their bodies, I was quiet and mild-mannered. I didn’t look or act as desperate as I felt. I remembered the first time I had croaked, pretending to be someone I wasn’t to get what I needed, and how well it had worked.

Once, around this time, I woke up freezing cold in the psychiatric unit, where I had been admitted for self-harm, and politely asked a nurse for a blanket. She gave me a dirty look and walked away. Feeling helpless, I lashed out, calling her an asshole, and she begrudgingly gave me a bedsheet. This reinforced the idea that I needed to act out in order to get what I wanted. If I played the game, I thought, the system would play along. I stopped showering, exaggerated my tremors and blabbered incoherently in the grips of withdrawal, making my problems as apparent as if they were etched into my skin. As I suspected, I was seen more quickly by specialists and given higher doses of diazepam.

I learned that it wasn’t enough to simply want help. I needed to fit the healthcare system’s idea of what a person who needed help looked like. Providers weren’t interviewing me as a person but as a list of ‘yes’ or ‘no’ items, and I hadn’t been checking the right boxes. Repeatedly, they would note that I had an apartment and access to food, was wearing clean clothes and wasn’t bleeding out, so they would turn me away. It seemed like my problems were invisible to them.

In 2015, when I came across croaking—an early 20th century term for manipulating a provider into writing you a prescription—in a William Burroughs novel, I realized that it was the name for what I had been doing, and it gave me an idea. I considered the treatment I wanted—opiates for my depression and anxiety—and came up with a story about injuring my back while moving furniture. I told the doctor exactly what they needed to hear, throwing out key phrases they needed to fill out their charts, like “unable to work or shop for groceries,” “dependent on family members,” and anything else to demonstrate that, because of the pain, I was unable to function. I had rehearsed the script ahead of time, preparing for the performance.

The doctor wrote me a prescription for Percocet, and it sustained me for around a year. I croaked for refills by telling the doctor, at our regular checkups, that my condition wasn’t improving. The Percocet alleviated my depression, and I got a job stocking shelves at a clothing store. I felt like I’d conned my way into becoming a functioning member of society.

I wasn’t proud of my behaviour, but I had found myself with two undesirable options: I could continue lying and self-medicating for my depression with prescription drugs, which would eliminate the possibility of mental health treatment. Or I could fall back into heroin, which would alleviate my depression and leave me eligible for mental health treatment for my drug problem. My heroin addiction was only marginally less unbearable than my depression, so I decided that croaking for opiates was my best bet.

The practice of croaking has been around for a long time, just below the surface of any doctor’s office or hospital. It’s hard to know exactly how much it happens because of its covert nature, but with drug use skyrocketing during the pandemic, it isn’t hard to imagine that croaking has increased along with it. And it’s not just the stereotypical drug user living on the street who’s doing it—it could be the middle-class mother who injured her back and is now dependent on pain medication to get through the day. The current system will be vulnerable to croaking as long as it fails to address the mental health issues underlying substance use disorders.

On many occasions, I went to walk-in clinics and hospital ERs and tried to croak but was unsuccessful. The providers either didn’t buy my act, had blanket policies against prescribing narcotics or offered not-habit-forming alternative medications that didn’t help my mental health. It was a constant effort to get the drugs I wanted, and it only got harder.

By 27, I had limited my substance use to alcohol because croaking was no longer working and it was too exhausting to track down drug dealers. I lived alone in a bachelor apartment paid for by my parents, completely cut off from everyone in my life. I’d wake up with painful chest convulsions that felt like violent hiccups. If I went 30 minutes without a drink, I felt like I was going to die. I had long stopped caring if I lost my teeth or got cirrhosis. Each morning, I’d take a cab to the liquor store a few blocks away because I was too wobbly to walk. I had hit rock bottom.

I went to the hospital, where a caseworker referred me to a detox centre. I didn’t want to stay, because my withdrawal symptoms were unbearable, but my caseworker, Jay, sat me down and said, “Take a good mental picture of this place, because this is where what you’re doing will land you again and again.” I realized that his bluntness was what real help looked like. I couldn’t avoid the reality of my situation. My only options were death or finding a purpose among the living. I chose to live.

After four days of intense withdrawal, my condition started improving. After seven days, I was well enough to leave the detox centre. I stayed in touch with Jay, who suggested that I become a peer support worker, somebody who uses their experience with mental illness and addiction to support others who are struggling. It seemed like a way to make something good out of my struggle, to make it mean something, so that it wasn’t just a wasted youth.

I went to peer training sessions and got a placement at a shelter in downtown Toronto. I’ve since worked at safe injection sites, recovery colleges and street health clinics all over the city, using my experience to build trust with people who don’t have a lot of faith in the health care system and connect them with resources. I act as an advocate for my clients—as a missing link between patients and providers. I try to help people over the systemic gaps that I fell through and that so many others do. The work gives me a sense of purpose and helps with my own recovery.

My mother passed away from cancer in May 2020. We’d started to rebuild our relationship, but it was difficult with her deteriorating health. My peer support work allows me to help others in the way that she helped me. My mother taught me that, when every bridge has been burned and there’s nowhere left to turn, all you can do is be with somebody. She taught me that there is no right or wrong, good or bad—only people—and to always leave the door open.