Two Great Songs About Opiates

They always tell writers to write what they know. I guess that’s why there are a whole lot of rock songs about addictive substances. Without giving it too much thought, I can rattle off a list of songs about cocaine (Eric Clapton, The Grateful Dead), LSD (The Beatles), cannabis (Peter Tosh), and alcohol (pretty much all of country music). My favorite songs, however, are about heroin.

As the opiate crisis made clear, there is nothing cool about heroin. Opiates themselves, however, are pretty interesting. We secrete endogenous opioids that bind to the same receptors as the pharmacologic versions. Humans have probably been taking opiates for over 7000 years. The effects of opiates are remarkably diverse. They are pain relievers that cause sedation; they can be used to suppress cough or treat constipation; they induce euphoria but also depress respiration. They are addictive, leading to tolerance, withdrawal symptoms, and continued use despite negative consequences.

I have prescribed innumerable grams of opiates. I’ve written for morphine, fentanyl, hydromorphone, codeine, methadone, hydrocodone, and oxycodone. I have prescribed them to be taken orally, intravenously, subcutaneously, intrathecaly, and intramuscularly.

Personally, I’ve had only one memorable experience with opiates. One night in 1999, I made an amazing dinner: penne with a tomato sauce, heavy cream, and Italian sausage. Around midnight, I woke up with horrible, wave-like abdominal pain. After rolling around in bed for an hour, I woke Sarah, who said, “You look terrible, let’s go to the ER.”1[i]

After writhing around on a gurney for about 15 minutes, I was given 2 mg of IV hydromorphone, Dilaudid. The pain, maybe the worst I had ever experienced, disappeared. The relief was followed by a pleasant warmth and euphoria. I remember thinking, “Huh, now I understand why people use heroin. If I didn’t have a job, I’d be back tomorrow to get more of this stuff.”

That’s a long way of saying that the world is awash in opiates, which are effective for myriad indications and are addictive. If you were a rock star of a certain time, they might have been something you could write about. It probably says something that two notable songs were recorded within a couple of years of each other.

Heroin

The Velvet Underground and Nico is an album awash in drug references. I’m Waiting for the Man is about buying drugs. Run Run Run is about the craziness associated with scoring and using. Heroin is just about the experience of using. After you’ve listened to the album once, you realize that even the first song, Sunday Morning, probably describes the morning after a Saturday night rave.

You can’t imagine where you are headed when Heroin starts with Lou Reed’s beautiful lead and Sterling Morrison’s atmospheric rhythm guitar. The star of the song, though, is Maureen Tucker’s drum. (I am pretty sure it is just one drum.) There is no way not to hear this as a pulse, throbbing away. Sometimes slow and regular, sometimes fibrillating irregularly, and sometimes throttling forward, hammering, tachycardic. You can feel the trip peaking and receding.

I find the lyrics appropriately bleak, hopeless, and depressing. They’re about abandoning a purposeful life, escaping. The second verse probably best summarizes the mood.

I have made big decision
I’m gonna try to nullify my life
‘Cause when the blood begins to flow
When it shoots up the dropper’s neck
When I’m closing in on death
You can’t help me, not you guys
Or all you sweet girls with all your sweet talk
You can all go take a walk
And I guess I just don’t know
And I guess that I just don’t know

You can’t not mention John Cale’s droning electric viola. I am not sure when this comes in, probably during the third verse. By the 5-minute mark, the beautiful noise takes over. I love songs that pitch melody against noise to beautiful effect. Heroin is one of the best. There are two memorable quotations about the Velvet’s first record. Brian Eno said, “I think everyone who bought one of those 30,000 copies started a band!’ Someone else (Jim DeRogatis, maybe) said that every song on the record birthed a genre. I hear shoegazer and peak Sonic Youth in the last two minutes of this song. If you are listening to Heroin from the beginning, you’re in a trance by now. If you walk into the room at this point, you’re likely to scream, “Turn this shit off!”

Sister Morphine

While Heroin is inarguably about illicit drug use, Sister Morphine might live more in my accustomed realm. The song begins:

Here I lie in my hospital bed

Tell me, sister morphine, when are you coming ‘round again

Oh, and I don’t think I can wait that long

Oh, you see that I’m not that strong

Yet, this song is certainly not just about the medicinal, therapeutic uses of opiates. The second stanza suggests an overdose, a doctor without a face, and the need to score. Then there is the fact that, by the end of the song, sister morphine has been joined by cousin cocaine. I sometimes wonder if this is the greatest song ever about drug-seeking behavior, as we refer to it with hushed voices, in the hallway, on rounds.

I am a pushover for any song that builds slowly. Sister Morphine begins with a perfect Keith Richards acoustic guitar. Played loud, the steel strings resonate, and you can hear a hand hit the body of the instrument.

Mick’s voice joins only about 15 seconds later. There are many things that separate a good lead singer, the person you appreciate at some local club, from icons. The likes of Jagger, Bowie, and Jenny Lewis are true performers. Mick is at his best on Sister Morphine, totally inhabiting a character.

For the second verse, Ry Cooder joins the mix on slide guitar. Slide always adds atmosphere; here, it is haunting. Guitar parts weave in and out with one another on the best Stones’ songs. Here, Richards accomplishes the magic with Cooder. Bill Wyman’s bass joins in at the end of this second verse

There’s an instrumental break before the third verse, when the band is completed with the percussion: Charlie Watts on drums and Jack Nitzsche on piano. The piano on this track is so cool. It starts out distorted and then becomes sharper and more recognizable as the song progresses. (Cooder and Nitzsche were on the original Marianne Faithfull version of Sister Morphine.)

For what it’s worth, the third verse is my favorite. Jagger goes all in on the delivery, and the acoustic picks up a little swing.

Honorable Mentions

In order to do my usual nerdy “playlist included”, I’ve got to add a few honorable mentions. There’s Marianne Faithfull’s original version of Sister Morphine. There is Ambulance, a 2022 Wilco song, which is probably more an ode to an opioid antagonist (naloxone/Narcan) than to an opiate. And, finally, Torn and Frayed from Exile on Mainstreet. This one includes the stanza that clearly inspired the 2017 Anupam Jena NEJM study.

Joe’s got a cough, sounds kind of rough

Yeah, and the codeine to fix it

Doctor prescribes drug store supplies

Who’s gonna help him to kick it?

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