This incredibly timely book is an engaging way to delve into the issue of toxic drug supply and addictions treatment. As we follow an addictions doctor through his work we feel his empathy and frustration, his hope and his burnout. This is mirrored by the experience of a new patient and the thinking and actions that bring her to this point in her life.

In this middle of a toxic drug crisis, this book lets us engage with the lived experience of people at the centre of the news stories. It should be a must read for anyone who wants to better understand the issues (and enjoy a book that’s hard to put down!)

Although this type of book is not my typical go-to genre, I enjoyed Vincent’s writing and storytelling. Personally, I preferred the female POV more than the male, as the male’s was very detailed and full of medical jargon, but that’s a testament to Vincent’s educational background & lived experiences as a doctor and definitely a ME problem. With that being said, if you’re interested in the book and the subject matter, audiobook was a better way for me to absorb this story.

This book was truly eye-opening into the fentanyl crisis and I learned a lot about how gruelling the recovery process really is and why it’s not so cut and dry.

If you’ve had the pleasure of reading Bloodletting & Miraculous Cures, you may recognize some familiar faces in On the Ravine. Though this time, the book isn’t about Chen and Fitz and their complicated and messy “friendship”. No, the focus now is on a more experienced Chen and one of his patients, Claire, a gifted violinist who is struggling with an opioid addiction and who is the true protagonist of On the Ravine.

By giving us the point of view of both patient and physician, Lam is able to allow readers to look at addiction in more than one way. With Claire’s chapters, we get to see how she ended up with an addiction to drugs and how it was a seemingly mundane start and a series of small unfortunate events that lead to her downward spiral. I appreciated how the portrayal wasn’t overly dramatized. While it’s true that we get to see the highs and lows of her addiction, at the end of the day it is shown that the reason Claire continues to go back to the drugs is because in addition to the relief they provide her from pain, she believes they make her the best musician and version of herself. Her trajectory is messy and nonlinear, which adds to the authenticity of the story. As for the chapters from Chen’s side, we get to understand his decisions a bit better. This is important because while his continual overstepping of professional boundaries when it comes to Claire can be unnerving and uncomfortable, getting to know his past helps the readers better understand his actions. Of course, it doesn’t justify his behaviour...

Let me start by saying that the premise of the book is important - so many people in North America are dying from a poisoned drug supply and it is affecting all walks of life. Literature that highlights these 'real life' stories of trauma and tragedy are an important way of knowledge sharing with the general public. For this reason, I had high expectations for this novel, but was ultimately let down due to tropes of substance use and misinformation.

As a disclaimer, I study Public Health and I am well versed in research and evidence on substance use interventions. For the average reader, the story is palpable and they may not be as critical as I am; however, I was disappointed in the way that some interventions were portrayed in the book. For example, the main character is reluctant to support a safer supply of drugs (lots of evidence that this is successful in real life) and emphasizes the importance of treatment and clinical trials. While this may work for some people, it does not work for all. My concern is that some readers may see that the novel is written by a medical doctor and take the information inside to heart as medical guidance. Secondly, the novel is very physician-centered. While I understand that it is meant to be written from the main character's perspective, it leaves out the reality of the many other people working to make our communities safer and healthier, including community groups, families and even other allied health professionals.

This book is well written and enjoyable if read with a critical eye; however, I think more clarity is needed so as not to conflate the author's credentials and writing as the 'gospel' on substance use.

Thank you to Netgalley for the ARC. This is a great novel, even though it is really heavy content (opiod crisis). I greatly appreciate that it is written by a doctor--the knowledge, care, and ethics shine through along with the blurring lines. I believed both Chen and Claire could exist.

Dr Chen runs a clinic for drug addicts. He’s used to people arriving at different stages of their addictions and for different reasons, and for some of them to suddenly disappear, while others learns to manage their conditions. He’s noticed the rapidly rising numbers of people addicted to fentanyl and other opiates. He also takes solace in the evenings from his difficult job by listening to a violinist at a nearby restaurant.

Claire is this violinist; she injured her shoulder some time ago, and during her painful and frustrating recovery, became addicted to opiates, and has graduated to injecting fentanyl and heroin. She decides to visit Dr. Chen's clinic when her life begins spiralling out of control.

Claire desperately wants an end to her addiction, and everything that goes with it: the highs, the lows, the physiological and mental effects of her addiction, and her increasingly precarious employment and financial situations.

When a representative of a pharmaceutical company comes to Chen with a possible drug which can terminate the cycle of addiction, Chen convinces Claire to participate, leading to unforeseen and tragic circumstances.

This is a quiet novel; Vincent Lam's prose is simple, but also wonderful at creating atmosphere. The content is tough at times to get through, mainly because the real life situation of a huge number of people addicted to opiates, and so lives ruined.

It's clear Vincent Lam's professional experience working with drug addicts informed this novel, which so well describes the complicated situation facing society when so many are suffering from opiod addictions. There are no easy solutions, and while I felt some despair while reading, I liked the somewhat ambivalent ending of this well crafted, deeply sympathetic novel.

Thank you to Netgalley and to Penguin Random House Canada for this ARC in exchange for my review.

A captivating, devastating, and gritty novel that serves as a heartfelt call to action to address the opioid epidemic. I was hooked into the world of Chen (Addictions Treatment Physician) and Claire (Patient of Chen, and professional Violinist battling an opioid addiction).

We often hear stories of addiction from the POV of the person afflicted, or the friends/family impacted, but this was a unique novel about addiction written from the POV of the physician treating the addiction. Chen is a compassionate doctor who cares deeply and is challenged by boundaries of keeping his work and personal life separate - a theme that anyone in the helping professions can attest to!

I learned so much in terms of medical responses & treatments to addiction, as well as the world of pharmaceutical companies, trials/research for treatment options. This book is very technical but not pretentious. The story posed many thought-provoking questions in response to the opioid epidemic. Between government, pharma, doctors: Who is helping? HOW do we help recovery? Who is culpable? The answers you’ll find are mostly grey and up to your own interpretation.

It’s essential for me that books written about addictions are trauma-informed, non-stigmatizing and non-judgmental in order to portray circumstances accurately and with compassion. This book was all of these things, which I appreciated. Truthful, heartbreaking, and compassionate. You can tell that the author, who is a doctor himself, practices with empathy and care. I appreciated his perspective and hearing about Claire’s unravelling into addiction as well!

I fully recommend this novel, which is out Feb 28! Thank you @netgalley and @knopfca for the ARC.

Another excellent story from a master storyteller. Dealing with a difficult subject matter of opioid addiction, Lam provides both a doctor's and patient's first hand accounts of an addiction journey. At times it was so uncomfortable to read, leaving me alternating fearing for the patient's lives and frustrated at their continued detrimental actions. Lam provides a beautiful understanding of compassion and alternate treatment options for those in these difficult crossroads in their lives. Well worth the read but be prepared to be uncomfortable in the telling.

I have long been hoping for a Vincent Lam follow-up to his first novel and was excited to be reunited with Chen and Fitzgerald in this timely and eloquent novel. Lam's work is is suitably contemporary and makes the reader face difficult situations that are of the real world, not the imaginary one. I applaud him for that, because often in our daily lives, we avoid seeing these difficulties unless it is a necessity to our circumstances. Through the eyes of Dr. Chen, we are able to see the complex problems of the medical world, and in this case, the world of drug addiction and pharmaceuticals. Lam's prose is both precise and lyrical, depending on his focus. Toronto is depicted realistically, with the beautiful and the ugly side by side.

I highly recommend On the Ravine, both for its wonderful prose and well drawn characters and for its thought -provoking take on the issue of illnesses and treatments.

Many thanks to NetGalley and Penguin Random House Canada for an ARC in exchange for an honest review.

On The Ravine is a down in the trenches story of the struggle of substance abuse treatment as told through the lens of Dr. Chen, a physician who runs a drug addiction clinic and Claire, a violinist who is seeking treatment for her addiction. It is a depiction of the challenges of the addictions practice environment from the viewpoint of the physician as well as the patient seeking treatment. It contains themes relating to treating an illness/condition vs the whole person, the limitations of pharmaceutical management of an illness, as well as the impact of belief systems on the effectiveness of treatment.

This novel, while fiction, was an eye-opening read for me as I have limited experience with drug addiction. Even though I found it very difficult to read at times, I persisted because I became more invested in the characters. Overall, I appreciated (and would recommend) the book because it challenged my perceptions of drug addiction/treatment.

This would be a great read for a book club, as I feel it will definitely spark lots of animated discussion regarding substance abuse.

Have you ever had the experience of deeply disliking an actor, because the character they play is such a dick (think: Alan Rickman or the kid who plays Joffrey in GoT)? Then recognizing that the strength of your dislike for the character is a testament to how talented the actor is.

That's kind of where I'm at with this book. It was tough to read at times with it's unflinching look at opioid abuse and withdrawal. I wanted to criticize the novel for being unnecessarily long, like did we really have to see a character get clean --> back slide --> get clean -->rationalize using again --> get clean -->almost OD, repeated again and again? But if I'm being fair, the answer is yes. Yes we did have to witness that endless cycle, because that's what drug addiction and abuse is like.

Everything that makes this novel tough to read is a credit to the writing. Take that as you will, and don't expect a feel good romp.

Thank you to #NetGalley for the ARC

I really wanted to love this book! The topic is near and dear to my heart and I thought it would be a bit different than it was.

The parts that kept me reading were really good but then the next chapter would lose me so completely. I also thought the little interludes between the chapters, where Dr. Chen was writing to his former student, were unnecessary. I didn't feel like they added to the story at all.

The technical execution of this book is exactly what you'd expect from a Giller Prize-winning author; it builds in anxiety and tension throughout and all along the way, you're thinking to yourself 'how can this end?' and 'why do I feel so nauseous?' This book spares no details on addiction and the opioid crisis in Canada. Prepare to really root for Claire and have your heart broken repeatedly. Torontonians will recognize Chen's bike routes and encampments, and will hopefully be reminded that we are still in the midst of a crisis across this country. On the Ravine does a brilliant job of telling a story rooted in a harsh reality, and hopefully readers take it to heart (even if it's hard to make it past the first few chapters due to the weight of it all.)

I needed to take a bit of time after finishing On the Ravine before writing my review. Although this book is fiction, the topic of addiction is a difficult one and to read about the Claire as she tries overcome her opioid addiction was hard.

Although this is a follow up book to Vincent Lam's first, it is not necessary to read before On the Ravine as Lam does a great job of developing the two main characters, one who is in the first book, Dr. Chen a doctor at a clinic that does drugs trials and Claire who we meet is one of his patients trying to get clean. The descriptions of drug use and how addiction works were at times hard to read as you just want to tell them to stop using, which I know doesn't work.

I know I'm going to be in the minority, but I wasn't a huge fan of the book. It took awhile to get into and I did enjoy some of it, even it Dr. Chen's involvement in Claire's life is a bit far fetched. The ending also seems to wrap up pretty fast, for a book with such a drawn out beginning.

Thank you to NetGalley, Penguin Random House Canada and Knopf Canada for the advanced copy in exchange for my honest review.

I received a complimentary copy of this book. Opinions expressed in this review are completely my own.

ON THE RAVINE, was a hard book to read. The writing and story are fantastic and easy to get lost in. It also does not need the reader to have read it's predecessor Bloodletting and Miraculous Cures to understand this one. I already have it on hold at the library though.

It's a hard read for anyone who has a loved one battling opioid addiction. It brought me back to overdose calls from hospitals and the hell it puts the family through. He's currently 3 years sober and he did it cold turkey. How I'll never know, but I'm so thankful.

This story is important, even though it is fictional. People need to open their eyes to the reality that is opioid addiction. It could happen to anyone and the more people are exposed to informative the more they may care.

Extremely moving. I loved the continued exploration of characters from his first work of fiction - Chen and Fitzgerald, who remained close friends, and have devoted themselves to the treatment of opioid addiction, each in a very different way. Interspersing chapters with ‘letters to a student of medicine’, his past protégée, also affected by the beast of addiction that Chen had taken his oath to treat.

Claire is a violinist; she feels at one with her music, taking flight in its melody, free in its movement. But now she rises and falls with the opioids in her system, becoming increasingly reckless. After two overdoses in twenty-four hours, she sits in the blue light of her computer, searching a notice board for recommendations: my doctor saved my life; my doctor is just another dealer. And then another message catches her attention, about Chen’s clinic: be a guinea pig—why not get paid to take it?

When Claire’s life intersects with Chen’s, the doctor is drawn ever more deeply into the complexities of the doctor-patient relationship, the implication and meaning of his intention to treat. Chen must confront just how far he would go to save a life.

Combining the depth of his experience as a physician with the brilliance of his literary talent, Vincent Lam creates a world electric in its precision, radiant in its detail. On the Ravine is a gripping novel of profound emotional force, a soaring achievement from a singular voice in Canadian fiction.

Vincent Lam is a powerful writer who understands his subjects very well. The people he writes about become very real to the reader. As such I would recommend that you read this book.

This book gave me a much better understanding of how a person becomes a drug addict and how hard it is to stop. Claire had good reasons to stop so she could play her violin but honestly felt she was a better player when she was a little high. Some of the characters around her were good for her, Dr. Chin, others like her sister Molly were a bad influence. Very powerful book.

Heartbreaking and thoughtfully written, I was pleasantly surprised to find the characters well written. Very easy to become attached to the main characters. The writing of the book overall could have used another final edit I think, but didn’t detract too much from the story itself. But as a healthcare worker, and coming from a family knowing all to well what addiction looks like, this was a good read, heartbreakingly hopeful and bleak and wistful all at once. Leaves a lot of “if only”.

I rate it as 4 stars, because there were a few points at the very beginning and then again at about 80% of the way through where the content and timeline sort of jump around, and particularly at the end seemed a bit rushed. But I will likely read the first from this author as well, which I hadn’t heard about until receiving this copy.

On the Ravine is the follow-up to the award-winning book Bloodletting & Miraculous Cures. The story continues with Fitz and Chen, two of the med students who, upon graduating, set up an addiction clinic to help people struggling with heroin and opioids. They also work with pharmaceutical companies to develop alternative treatments.

Chen is committed to his patients and goes above and beyond to help them, even if it means pushing the boundaries of his own values and ethics. The story follows his relationship with a talented violinist who is addicted to opioids prescribed for her shoulder injury. Meanwhile, Fitz takes a more unorthodox approach to addiction, which contrasts with Chen's methods. Despite their differing approaches, their close friendship shows just how challenging it is to help and protect people with addiction.

The story is emotional and at times raw, and has some heartbreaking moments, but it ultimately ends on a positive note. Lam's background in addictions medicine is evident throughout the novel, making it feel realistic and believable. Overall, On the Ravine is a powerful story that sheds light on the complexities of addiction and the challenges of helping those who suffer from it.

Thank you to Alfred A. Knopf Canada and NetGalley, for providing an early copy for review.