Arizona O’Neill’s newest work – the full-length graphic novel Opioids and Organs – emerged from a need to channel a family tragedy, a personal obsession, and almost a decade of research into what would become a compelling 380-page tome.

Out next week from the Montreal artist, filmmaker, and bookseller’s hometown publisher Drawn & Quarterly, the book is a deeply idiosyncratic, lushly illustrated deep-dive into the history and contemporary reality of organ transplants, and how the need for healthy organs from typically younger donors intersects in disturbing ways with Canada’s opioid crisis. 

The narrative begins in 2015 with the death of O’Neill’s father from an overdose: she draws herself in a hospital office, where, as next-of-kin, she is given a palpably short amount of time to make decisions about the fate of her dad’s healthy organs. Though these “donations” help extend the lives of others, they sent O’Neill on a distressing, macabre odyssey of cultural history, politics, and body-horror. By 2020, as opioid-related deaths in Canada had started to rise, O’Neill’s obsession with organ transplants got her thinking about how many of the bodies of the dead would be re-purposed for other patients, and how addiction- and overdose-related deaths fed into a system of organ harvesting, whereby the loss of so-called less valuable lives fed an organ industry that served so-called worthy patients. 

“That’s when [my] research really started, to see if my intuition was correct: that there was a surplus of organs during this time,” O’Neill says. “And I was correct! It had been reported on in 2018 and it didn’t create any stir. But for me, it was a shocking revelation.”

Working outward from her personal grief and this disturbing realization, the book traces a circuitous history of organ transplants, including more than 200 years of science, pseudo-science, and science fiction that have re-shaped how we think about life and death. 

“I just became very obsessed with organ transplants. And it was coming out in all of my art forms, every time I would do a painting or an installation piece,” O’Neill says. “[This book] really allowed me to capture the haunting (effects) organ transplantation had on my grief….That scene at the beginning where I’m manically drawing all these hearts is real. I was drawing the hearts anyway. So I had to channel it into a real project, and not just a mental decline.”

The result is a challenging graphic memoir that belies a mountain of research, which took O’Neill from McGill University’s collection of preserved organs to Harvard, then to Marsh’s Library in Dublin, and eventually to the Louvre and the catacombs of Paris, each locale revealing a piece of a cultural – and intimately personal – puzzle. O’Neill is clear about the value of this experiential approach to research. “I had written a tentative ending that was actually very pessimistic, very nihilistic. So I went to Paris hoping that maybe…there would be some revelation there. I was really putting a lot of trust in Paris!” she says. “I just knew that I needed to really see death. There was a version of this book that could have ended with me being like ‘My God, I’m going to die and I can’t handle it. Mortality! What are we going to do?’ But no, I went down [into the Paris catacombs] and it was such a beautiful experience. I had such clarity when I was under the ground with all the bones.”

After that trip, she went home and rewrote the book’s ending, which became more of a rumination than a call to action, despite the clear political issues she raises. As it turns out, there aren’t simple answers, and Opioids and Organs concludes with a satisfying ambiguity that reflects the complexity of its intersecting topics.

For all that the book is grounded in sombre, at times chilling, realities, O’Neill’s visual and narrative styles are surprisingly ebullient. Surreal and gothic-horror-inflected landscapes flow into each other as Arizona the character guides readers from point to point across continents, centuries, and a dense network of cultural allusions. Taut linework is softened by a carefully curated watercolour palette of pastel hues, reflecting tension between the hardness of material reality and the malleability of our attitudes, thoughts, and beliefs. (Opioids is hand-pencilled and -inked, though O’Neill was encouraged by her editor to learn digital colouring for this project — a suggestion she was thankful for after 10 months of drawing.)

D&Q publisher Peggy Burns says there was no question that O’Neill’s book belongs in the Drawn & Quarterly catalogue.

“Arizona really captures the macabre spirit of Montreal,” Burns explains. “In the hands of other authors, this could have been a very dry, chronological memoir. In Arizona’s hands, she tells a serious story, close to heart, while unabashedly leaning into her wild passions, auteur influences, and chimerical elements.” 

That lean-in to the personal and idiosyncratic is the most fascinating aspect of Opioids and Organs. O’Neill references and celebrates a vast range of personally significant art and literature that connects her insights with our collective intellectual history. Cameos from works that include Dracula, Géricault’s “The Raft of the Medusa,” and Alice in Wonderland abound. And while this eclecticism is inherently delightful (often in welcome contrast to the subject matter), it is also a functional part of O’Neill’s narrative structure. 

This is most clearly realized in the two fictional characters who accompany O’Neill for most of the book: Frankie and Izzy. Frankie is Frankenstein’s monster – perhaps an obvious literary touchpoint for thinking about organ-harvesting. Izzy, meanwhile, is a small yellow gecko whose origins are more opaque and who speaks the book’s ominous opening line: “I advise against proceeding.”

That line was inspired by The Monster at the End of This Book, the 1971 Sesame Street Golden Book by Jon Stone and Michael Smollin, starring Grover. “It was one of my favorite books as a kid – just the idea that the character is trying to stop you from reading,” O’Neill says. “It’s kind of like: Why are we doing this? Stop! Those keep-it-to-yourself comments, self-doubt comments…Izzy is just that nagging voice in my head.” 

As a child, O’Neill had a yellow and black plastic lizard that she carried around via a string attached to a small ring on her finger. “My mom was like, ‘So what are you gonna do? You’re just gonna walk this lizard around?’ And that’s exactly what I did. And I felt so cool about it. So, there’s always been a lizard with me.”

It’s these childhood back-stories that illuminate the uneven pairing of the tiny yellow lizard and the lumbering Frankie. O’Neill remembers the striking popular image of the innocent but powerful Frankenstein figure paired with a fragile, drowning girl, an image that has resonated with her since childhood.

“It’s me…I’m the little girl, and Frankenstein is my protector,” O’Neill says. “Frankenstein has always been with me. It was kind of my bedtime story when I was a kid, just because my mother [writer Heather O’Neill] loved Mary Shelley so much. So that’s how [Frankie] started to represent my sensitive side in the book.” 

For O’Neill, her grief felt loud, and its vocal insistence melded with these key childhood images on the page. “I started to really feel as though I had voices in my head that were very, very loud. I started to really see my inner thoughts as characters,” she says. “There was a little angel and a little demon on my shoulders, and my grief found itself somewhere in the middle. I knew that I wanted characters to personify these different voices in my head.” 

The knotty network of passions and influences animates this meta-memoir. As Arizona’s mother – the character – counsels her, in a scene depicting the research behind that very scene itself (!): “Turn your fixations into art!” Opioids and Organs does exactly that, charting a personal obsession, elaborated to the point that it resonates meaningfully with our collective experience of humanity, death, and life. 

Detail from Opioids & Organs by Arizona O’Neill (Drawn & Quarterly); Arizona O’Neill (Julie Artacho).