This new novel from Canadian author Vincent Lam hit super close to home as a former harm reduction worker in a safe injection site. I have seen the ways in which opiates tear peoples lives apart and the ways in which the powers in society truly could care less.

It can be a hopeless feeling but telling these stories is so important and Lam did it with grace.

Thank you to the publisher and netgalley for the arc.

Wow, what an amazing look at the current state of Opioid addiction in our country from a very personal perspective of an addictions doctor and a struggling patient and at the same time takes a deep dive into the sometimes murky world of drug trials from a business point of view.

Thanks to NetGalley for an advanced copy of this book to review.

I really wanted to like this book as the author is Canadian. It covers a lot of information regarding the opioid crisis and what is being tried to help those who have addictions. I was interested in the story at first and tried to be engaged with the characters but I found the writing a bit too dry to maintain interest. The story felt more like a clinical report to me and I was not able to finish the novel.

I think it’s very admirable that Dr. Lam has written this book because he is dealing with a very contemporary and very
disturbing phenomena. The descriptions of substance abuse are harrowing and I don’t think they will be easy to read for every reader. There are pages where the principle characters injest multiple drugs on one page-it’s very rough to read about. And Vincent Lam graphically and extremely sympathetically describes the agony of trying to withdraw from illegal street drugs such as fentenayl,opium and heroin. It is unbelieveable to read how hooked people get to this stuff and how much it destroys people’s lives.

Having said this I had two major difficulties with the plot. The relationship between Chen,the primary addiction care giver and his main client-Claire struck me as being overly intimate and unprofessional. I won’t include all of the extra-matters Chen does for his client,which are excessive and beyond the reign of a normal doctor patient relationship. If any doctor took as much care towards one client- there are numerous instances in the no plot where Dr. Chen extends himself in his treatment which is completely beyond belief,then most of the patients would never get treated because drs. would have no other time for them.
I could never understand why Chen is called Chen by everyone-including his friends. Does he not have a first name?
There is also a great deal of details about the scientific attempts to treat addiction dependency. I don’t have a scientific mind or interest so those were excessive for me,although I’m sure other readers will find these discussions fascinating.
Finally the disgraced Dr. Fitzgerald made no sense to me as a character. Toward the end of the book his house on the ravine is full of drug addicts strung out on all of the furniture. Is this legal or ethical?
Overall On the Ravine accomplishes what I don’t know other fiction has done recently. There is no glorification of addiction here,no cure as Chen frequently says,just a means to relieve some of the pain of withdrawal by using other forms of medication. I think this is a novel a lot of Canadians are going to want to read,full of very disturbing issues that readers are going to need to face. I congratulate Vincent Lam for accomplishing this and for not holding back the horror of substance abuse. I just felt the relationship between Chen and Claire was overly-done. I can see this becoming a very popular and important read. The book brings home the message that drug addicts are not people somewhere out there-they are often talented respected people who live in our communities and have tragically become addicted to extremely dangerous substances.

The opioid crisis is real and Vincent Lam brings it to us, the readers, in all of its deadly light. Chen is an opioid doctor who strives to help his patients come clean. He’s also involved with a mega company to bring forth a solution to the addicts if they participate in a survey. I found the book disjointed with the letters written to a student interwoven in the story. And the whole survey panel unfortunately left me bored. Claire, the violinist, left me wishing she’d get clean. Her character was a highlight in the book.
Unfortunately, this book didn’t grab me. I’m not blind to the horrors of the opioid crisis but I have to say I was disappointed in this read. By the looks of other reviewers I’m in the minority.
Thank you to NetGalley and the publisher for my eARC .

Thank you to NetGalley, Penguin Random House Canada and Knopf Canada for the arc in exchange for an honest review.

I’m a big fan of Vincent Lam’s work. I still think about the ending of The Headmaster’s Wager, years after reading it. In this book, we revisit two of the characters from Lam’s Giller Prize winning piece, Bloodletting and Miraculous Cures. However, there’s no absolute need to re-read Bloodletting in order to appreciate this book.

Dr. Chen and his friend/ colleague Fitzgerald are battling the opioid crisis in Toronto in two distinctly different ways.

It’s interesting to see how Dr. Chen, a licensed medical doctor - a professional - takes such a personal interest in his patients of addictions medicine. He keeps photos, in his phone, of patients who have died from drug-related causes, waking in the middle of the night to scroll through them again and again, wondering what he could have done differently, trying to fit the puzzle pieces together.

Fitzgerald, on the other hand, now stripped of his license, is a bit detached from the scene, objectively doling out clean drugs to users, to keep them from dying from the unknowns out there.

Both men had started an addictions clinic, now run by Dr. Chen, and a clinical trial company that runs trials for pharmaceutical drugs that have the potential to offer some kind of reprieve to the addicted.

The character that links Chen, Fitzgerald, the clinic and the clinical trial company is Claire, a talented violinist who is first exposed to opioids in Germany where she falls down some stairs, injuring her shoulder, while she is there for a key performance for a scholarship. The drugs are miraculous. They allow her to continue her passion, her life’s work. It’s the innocent first step of the downward spiral.

We follow Claire, through Chen’s eyes as her doctor, as addiction changes her life and the lives of those around her.

What the novel did for me was to show me a clear progression of how addiction takes hold and drags one under. We hear it all the time: soccer moms, college students, executives… the least likely candidates for addiction are becoming addicted and losing everything. How and why does it happen? Is it that easy? We think we’re all able to withstand addiction. “That would never be me!” “Only weak people become addicts.” The reality is, maybe we’re one dislocated shoulder away from a very steep and slippery slope.

In Chen and Fitzgerald I saw two sides of one doctor. The side that wants to personally take care of his patients, to be involved and responsible. Also the side that does what needs to be done - prevent them from dying and that’s enough. Can both sides co-exist in one doctor? It’s a stretch and, I imagine, a struggle.

I loved this novel, not for its difficult subject matter, but because it showed me how truly complicated addiction is, how quickly it can happen and how incredibly difficult it would be to extract oneself from this disease. It was enlightening, as Dr. Lam works in addictions medicine and writes from deep knowledge and experience.

Aside from the story, the prose is gorgeous. Lam paints a vivid picture of the city, the people and their struggles, with words and imagery almost set to music. Just a beautiful read.

Highly recommended.

Thank you to NetGalley and Penguin Random House Canada for providing a copy of this book in exchange for an honest review. On the Ravine by Vincent Lam follows Doctor Chen with appearances from Fitzgerald who readers may remember from the Giller Prize Winning, Bloodletting & Miraculous Cures. This book can be difficult at times, but overall paints a compassionate picture of drug addiction and the helpers who work on the front-lines trying to help to spite all of the obstacles that the opioid crisis poses.

The story centres around Dr. Chen and his patient Claire, a gifted violinist, who becomes addicted to opiates through a series of events that sees her drug use and seeking escalate. She is not the picture most will have of a “junkie” and that is what makes this story all the more compelling and important. Though constantly trying to ride a precarious line of what she is willing and not willing to do for her next fix, Claire seeks out the help of Dr. Chen at his Swan Clinic in hopes of a miraculous cure. Dr. Chen keeps a photo album on his phone of his lost patients who haunt him, those he last sees in the morgue as they lose their fight with addiction. Throughout this story, he stays hopeful that Claire will not be added to his gallery. Fitz has lost his medical licence and continues to “help” addicts at his house that backs onto a ravine in questionable ways to ensure their drug supply is as safe as possible.

As Claire finds success with Dr. Chen’s regimens and struggles with the constant pull of the high, she relapses in spite of her best efforts. In the background, the drug scene is slowly infiltrated with the introduction of fentanyl and carfentanil resulting in increased deaths. Chen constantly worries about Claire and goes to extreme lengths to help her blurring patient/doctor boundaries. Dr. Chen and Fitz are involved with medical trials paying addicts to participate and are responsible for recruiting patients. Dr. Chen questions the new research trials using psychedelics which has promising results, but risks seem to be ignored leading to deadly consequences. This book is fascinating, informative, and helps provide perspectives of what brings people to addiction and the lengths helpers will go for a successful story. This book has stayed with me, and has helped put both sides of the story of addiction into perspective.

Is the book worth reading? I certainly think so, but there are some triggering topics covered throughout. This is a story about the dark elements of addiction, something that while fiction tries to touch on avoids some of the worst parts.

I love that Chen is a flawed man. We see that he has a big heart and he wants to help people, but that doesn't mean he's always going to do the "right" thing. Sometimes, he puts too much of himself into a situation. His bond with Claire can sometimes cross the line as he desperately finds a way to save her and others.

I didn't connect too much to Claire, but I think that's just because I haven't lived her experiences. She has her ups and downs, and that's expected. At least she is a fleshed-out character. Lam doesn't shy away with adding in flaws to people, and we are all human with flaws, after all.

It is a gripping novel. There are some slow parts to it, such as getting into the third part of the story, but it's worth getting through to see everything come together.

This story takes place in Toronto Canada where Dr. Chen runs a clinic called The Swan. His patients are drug addicts and Dr. Chen prescribes methadone or buprenorphine to handle withdrawal symptoms. He is also a consulting doctor for drug trials. Claire is a violinist who got addicted to opiates after suffering a shoulder injury and eventually graduated to injecting heroin and fentanyl. In the hopes of getting a handle on her addiction she attends Dr. Chen's clinic. There's also another storyline running which involves Dr. Chen's colleague Dr. Fitzgerald who has his own addiction to alcohol and can no longer practise medicine. He seems to be running a safe injection site out of his large crumbling home on the ravine. I guess it's necessary to read Dr. Lam's previous book to get the entire background on these characters.

I found myself much more immersed in this novel than I expected; as a matter of fact it had me more enthralled than almost anything else I've read recently. As I was reading the first 25 pages or so I wondered what I had gotten myself into; the content was a bit dry. But then we got into Claire's story and I was totally engrossed and had trouble putting it down. The events are related by Dr. Chen and Claire separately, interspersed with letters written by Dr. Chen "to a student of medicine" who is never really identified but through these lettters we eventually learn her connection to the doctor. This book is definitely timely what with the opioid crisis pretty much everywhere. I don't have first-hand, or even second-hand, experience with drug users but the characters and stories seem very authentic and I'd assume Dr. Lam is drawing on his professional experience. Incredibly well written and heartbreaking. The ending leaves you hanging but I think it's appropriate in this case; kind of hope for the best but suspect the worst.

Trigger Warning: This story deals with intravenous drug use with graphic descriptions of the process and the consequences. It might be difficult to read if you're squeamish or in recovery.

This was an ARC and there wasn't a lot of formatting, not even chapter breaks, so I did get slightly confused at times. Hopefully the published version will be a bit easier to follow.

My wholehearted thanks to Penguin Random House Canada via Netgalley for the opportunity to read an advance copy of this excellent novel. All opinions expressed are my own.
Publication Date: February 28, 2023

A very raw look at the drug crisis that Toronto and Canada faces. I loved that I could identify every location in the background but I also hated that I could so completely relate to the people in those places. I see it every day and the story telling was very real and made me think of those people I see. It makes me connect with the fact that this is a human problem and more help absolutely needs to be done.

Thank you Netgalley for this arc

If you’re Canadian and follow Canadian writing, you will need no introduction to Vincent Lam. He’s a very respected writer who astounded me by winning the Scotiabank Giller Prize for his first book, the 2006 short story collection Bloodletting & Miraculous Cures. It is rare for a first-time author to win such a prestigious award, and to do with a collection of stories — which typically don’t attain the same readership numbers and acclaim that novels do. After that feat, he published his first novel, The Headmaster’s Wager, in 2012, which was met with warm applause. Thus, if you can do the math, it has taken about a little more than a decade between that novel and his latest, On the Ravine, so you can say that Lam is not a prolific writer. The reason is that he’s an addictions physician living in Toronto, Canada, and God only knows how busy doctors can be — I have to wonder how he finds the time to write and do it so well. Well, On the Ravine draws upon his experience working in the addictions field and also recycles a character or two from Bloodletting & Miraculous Cures. One feels that this is a deeply personal book and one that is tough to read as it was to write because Lam infuses his troubled characters with deep humanity and watching them stumble can be, at times, heartbreaking.

At the heart of On the Ravine is the doctor-patient relationship between an addictions physician named Chen and a promising young classical violinist named Claire. As the novel progresses, they develop more of a platonic friendship with Chen desperately doing everything in his power to keep Claire clean — even if that sometimes involves administering tough love, though sometimes letting Claire be herself. Claire’s struggles begin as a music student overseas in Europe when she is prescribed painkillers to deal with a shoulder injury she attained that caused problems for her violin playing. Back in Toronto, she goes on to become addicted to first heroin and then fentanyl. She struggles to recover, though she frequently slips, and hopes to both stay alive and keep alive her passion for playing music. The main problem in her life is her sister, the cleverly named Molly (which is slang for ecstasy on the streets), who is her enabler and keeps her hooked on the junk. Woven into this narrative are a couple of subplots: one involving a former doctor who has lost his licence because he supplies clean drugs and needles to his “clients” in his once upscale home in the tony Rosedale neighbourhood of Toronto. The other subplot involves an experimental drug dubbed “Memorex” that could help cure addicts of their addictions being pushed for drug trials on humans.

The big selling point of this book is the human interactions between characters and the struggles they endure to recover from their vices. In an author’s note that precedes the novel, Lam talks about On the Ravine as being a novel about desire: the desire to stay clean, the desire to keep using, the desire to make music, and the desire to help other people. To that, the novel is successful in showing that the road to recovery is not always easy, especially when drugs such as methadone are prescribed to help addicts withdraw from their illicit substances. It’s a fine balance, this novel says, trying to keep addicts on their prescriptions while balancing their addictions and wants for more of the thing that could kill them. Lam offers no handholding here: he’s very clinical about the language he uses and readers without a knowledge of the narcotics subculture may very well get slightly lost. However, in doing so, he is perhaps offering a commentary about how dispassionate the doctor-patient relationship can sometimes be, and also offers a sneak peek into the politics of getting new drugs that can help addicts recover in pharmacies.

On the Ravine shows Lam to be an exceptionally talented writer, one who has matured since his last novel. I found The Headmaster’s Wager to be a great novel about the Vietnam War, but my recollection of it is that it had multiple endings and was perhaps a little long — the product of the book being that difficult first novel to write. I’m probably wrong in offering that assessment because the whole point of that book was to show how difficult it is to escape from countries where violence and oppression are a day-to-day reality and the importance of having socially progressive countries such as Canada as havens to those trying to escape. Thus, the overlength was perhaps a means to an end. Still, On the Ravine shows Lam’s growing command of the novel and his ability to weave various strands of thought and plots together. It is a predictable tale, but then it is not. You know there are going to be tragedies, but you are caught off-guard as to who these tragedies occur. And with tragedy comes loss. If anything, On the Ravine shows that there’s a cost in dealing with the human side of the opioid crisis.

Still, this is a hopeful book — one that suggests that it may be possible to live something of a normal life even if you are troubled by the spectre of addiction. All in all, while On the Ravine has its blemishes — I wanted to know more of Molly and Claire’s backstory as siblings, which may have explained why they were so susceptible to abusing street drugs — it is a crucial Canadian text about a serious problem facing society. On the Ravine offers no easy fixes, per se, even when “cures” seem to work. But that’s what makes it so captivating, and it offers a springboard for discussions in group contexts about a problem that isn’t going to magically disappear and probably requires a degree of tough talk to reveal the extent of the problem and what to do about it. To that end, On the Ravine is another feather in the remarkable writing cap of Vincent Lam — even more so given the extended length of time we must wait for the output of his second chosen career.

*disclaimer: this is my own opinion. Arc from netgalley**

This book was interesting. However, maybe not my cup of tea.

This is a very thought-provoking and insightful book. Lam's writing is captivating and the subject matter could not be more timely. I expect this book will be a Giller contender.

Thank you to NetGalley and the publisher for this RAC in exchange for an honest review.

I enjoyed that this book was very raw and poignant. I found the topical nature somewhat upsetting and the tone quite dry but I thought it was a strong follow up to Bloodletting and Miraculous Cures.

[arc review]
Thank you to NetGalley, Penguin Random House Canada, and Knopf Canada for providing an arc in exchange for an honest review.
On the Ravine releases February 28, 2023

<i>“Even if we make the withdrawal go away, we can’t take away the memory of the high.”</i>

This title features two characters from Vincent Lam’s <i>Bloodletting & Miraculous Cures</i> — Chen and Fitzgerald. These are both standalone novels, and while it’s not necessary to read <i>Bloodletting & Miraculous Cures</i> in order to understand <i>On the Ravine</i>, it would provide more character background.

CW: opioid addiction, racial slurs

This entire novel is heavily centered around opioids, addiction, addiction clinics, and drug trials. There are many descriptive in-depth scenes about drug use, including needle injections, pill use, highs, withdrawal symptoms, and overdoses. Please keep this in mind to gauge whether or not you’re in the proper headspace to handle content surrounding these topics.

The two main characters here are Claire and Chen, with some sparse input from Fitzgerald (but he mainly takes a backseat here).
Claire is a violinist who has a serious opioid addiction that originally stemmed from an injury.
Chen often frequents the restaurant that Claire plays at, and eventually progresses to being her doctor. He tries so adamantly to help her with her addiction but there is an endless cycle for seeking a high.

There are also letters scattered throughout between Chen and a former student of his, although the student is never named.

I’m no stranger to the adverse struggles of addiction, and I’ve seen it first hand for years in the DTES (Vancouver). I think Lam definitely used his experience and knowledge in the medical field to his advantage. However, with that being said, I did find it difficult to focus solely on this book, and often times found myself reaching for my phone or literally anything else. The narrative was a bit lengthy in the beginning and maybe could have cut down on some repetition.

I’m also so confused, because having read <i>Bloodletting & Miraculous Cures</i>, I was expecting to see a mention of Ming (who Chen apparently married), but there was zero instances of this. Instead, he was comingling with some woman named Bella?! It’s like I went from A to C, and B got lost in a blackhole.

This book will stay with me for a long time. I live in an area with several safe use houses. Almost every day I see someone who chose not to use under supervision. It is sad to watch as they show signs of withdrawl, or perhaps something else as they don't want to use under supervision.

This drug epidemic is certainly a human issue, but it is so easy sometimes to forget that these are people who made bad decisions. Who are addicted and no longer have a choice to make decisions. Vincent Lam breaks that barrier and forces us to see addicts as the people they were before addiction. The people they could be without addiction.

And that is a powerful message.

Vincent Lam - the winner of Canada’s biggest literary award the Giller Prize - returns with a gripping exploration of the opioid crisis. Like his previous book, ‘Bloodletting and other miraculous cures’ Lam mines his background as a physician to create compelling literature. ‘On the Ravine’ is the novel only Lam could write. It’s both a thrilling page turner and guidebook to the inner-life of physicians. It won’t be a surprise if this ends up on the short-list for the giller prize.

This was very well done, very engaging with lots of detail about the current toxic drug crisis and a main character working in an addiction clinic and another viewpoint character who is having troubles with her substance abuse disorder. There's also some suspense in it and a set of interspersed letters to a former student...the prose and the shape of the novel are great. Good local colour for Toronto too. I thought this one was even better than Bloodletting & Miraculous Cures.

I received an ARC of On the Ravine from NetGalley in return for a fair review.

Vincent Lam's collection of stories about a group of medical students in Toronto, Bloodletting & Miraculous Cures was a Giller Prize winning and hugely popular book published in 2005. I came to know it very well as I taught it in a grade 11 University English course a couple of years after its publication.

On the Ravine picks up the story of two of the med students, Fitz and Chen, who have developed a practice in addictions, a clinic to help those trying to get off heroin and opioids and a highly respected cooperation with pharmaceutical companies to develop new alternatives to the standard methadone and buprenorphine. Chen works tirelessly to help all his patients, sometimes finding himself in situations that challenge his values and medical ethics. His relationship with a very talented violinist addicted to opioids, first prescribed because of a shoulder injury, is a powerful thread throughout the story. Fitz's less orthodox attitude to addicts is a foil to Chen's mostly 'by the book' methods and their continued friendship allows the reader to see how fine the lines are within an often hopeless quest to help and protect those with addiction illness.

Lam's own professional involvement in the addiction community of Toronto is the authentic voice but the stories are all out in there in the media - the explosion of 'bad' adulterated heroin and cocaine and the rising death toll in opioid addiction. Notwithstanding Chen's dark world, he is a believable light who is not deterred by the low success rate. Lam does not create a medical saint in Chen but a caring, likeable physician whose life is governed by his Hippocratic oath to do "Do No Harm", a strong sense of ethics and a desire to do better.

I was so excited to read On the Ravine by Dr. Vincent Lam after loving Bloodletting and Miraculous Cures many years ago.

I just finished it last night and am still in the process of formulating my thoughts so they may change a bit. My early thoughts are that this was a very good book about a very difficult topic.

In this story, which features two characters from his previous book (but it is not necessary to have read the other one to enjoy this one), we are given a very deep look at drug addiction. Dr. Chen runs a clinic called The Swan where he sees patients each day who are dealing with drug addiction. In addition to putting patients on methadone or Buprenorphine to settle their withdrawal symptoms, he is also a consulting doctor for drug trials. In comes Claire, an aspiring professional violinist. Claire has been using Oxycodone and heroin as an IV drug user and needs assistance in coming off the drugs. This is the beginning of a precarious doctor/patient relationship.

Addiction is a beast that many cannot reckon with. The chemical dependency and increasing tolerance usually results in the person using more drugs, more dangerously and experiencing withdrawal more and more quickly. Harm reduction is the current method used to stabilize patients but doesn’t offer freedom. The role of the doctor in determining just how much of an opioid will have the patient become a functioning person is a difficult balance and it is tested by addicts who will manipulate and lie to obtain their high. Please don’t take this as me judging addicts, this is not so simply the result of a chemical that has taken over the addict’s life.

In the story, Claire fights this battle and tells Dr. Chen that what she wants most is to be able to play her violin and become the music. She wants to reach beyond the formulaic playing of her violin and become immersed in the music. In addition to desperately wanting relief from her addiction, she has a sister who comes to stay with her who is also an addict. As someone who has worked as a youth worker with street addicted youth, we often say “people, places, and things” need to change in order for success.

When Dr. Chen contacts Claire after she has had two overdoses and tells her that he believes she may be suitable for a new drug trial, Claire jumps in with both feet.

Lam has written a story that one must finish to appreciate. The beginning third of the book takes its time in setting up what a drug trial looks like, the decline in an addict-especially with fentanyl out there, and the push and pull of a doctor who works in the field. I am concerned some will find this part of the book a little dry and not continue but I urge you to trust the process.

Dr. Chen is an interesting character on his own with his big heart and wanting to do the best for his patients. He is a hero character with faults and hindsight.

Big pharma and the interests of the players in the field was a little less dramatic and at times a bit lengthy but played a role in the crux of the story.

Thinking about the audience for this book has been with me during the night. This book could be highly triggering for anyone in recovery, or an active user. The processes and terms are very detailed and even the descriptions of dealers, users, drugs, places, and equipment has the potential to activate an addict’s brain to want to use. For those that are interested in the field of addiction or who can manage difficult stories, then I would feel comfortable in recommending this book.

With more and more deadly drugs on the street, this could also be a call to action. I live in Vancouver, Canada and we are currently experiencing overdoses at alarming rates. One of the pushes is to legalize drugs and offer a safe supply. Recent legislation passed has allowed small amounts of drugs to be carried without penalty but that doesn’t stop those drugs from being laced with fentanyl or carfentanil. Safe injection sites are available and drug testing kits and more people are being trained on how to use Nalaxone kits. I would be interested in revisiting this book in ten years and seeing how it fits into reality then.

Thank you to @netgalley and @penguinrandomca for an ARC of On the Ravine. It publishes February 28, 2023.