Arizona O’Neill’s debut graphic novel draws on father’s overdose — and a decision that haunts her

Montreal author and illustrator Arizona O’Neill’s father had struggled with addiction for her whole life — and much of his — before a fentanyl overdose took him at 41. She was 21.

She received a call from a hospital one day in the summer of 2015 to say he’d had an accident and was on life support and that she had to come. As his next of kin, the decision about whether to donate his organs was hers.

She was raised by her mother, award-winning Montreal writer Heather O’Neill. Arizona and her father were never close. “We were estranged because of the addiction,” she said. His death was the most intimate we had ever been.”

She was seated in a conference room in a Toronto hospital with four or five doctors — “a little bit like a Mafia,” O’Neill, 31, said in an interview.

“They told me he was brain dead and then immediately went into their pitch. They have a routine to get the signature. … I was, ‘There is no chance that he will come back?’

“There is something cold about the process — especially since there was no acknowledgment of how he died.”

Cover illustration of Opioids & Organs (Drawn & Quarterly), by Arizona O’Neill.

Questions lingered: What had been done to save him? When had he relapsed? What were his last words?

Yet she felt pressured — felt she “had no choice but to sign those papers to take him off life support and to donate his organs.”

Donating organs from people who die of a fentanyl overdose is a widely accepted medical practice; most of the deaths result from a lack of oxygen to the brain; other organs, like the heart, liver and kidneys, are healthy and viable for transplant.

Still, “when you are making any person’s final decisions, you are definitely going to second-guess yourself,” O’Neill said. And she came to feel guilty about her decision to donate her father’s organs to a society that did not value him during his lifetime — “a society that does not care about addicts.”

All illustrations from Opioids & Organs (Drawn & Quarterly), by Arizona O’Neill.

Her father’s death marked the first time she’d had to deal with such intense grief, O’Neill said. And that grief “had an intense effect on my personality.” As she re-visited her decision, she said she became “obsessed” with the idea of parts of her father “alive and out there in pieces.

“I had a conscious feeling of multiple voices in my head,” she said. “My inner monologues became really loud.”

News reports linking the increase in opioid-related overdose deaths to a rise in available organ donors gained traction between 2016 and 2018, O’Neill said. More than 50,000 Canadians have died from opioid-related overdoses since 2016.

Although it was reported on, “it did not create a stir” in the news cycle, she said. “If it doesn’t pique interest, it doesn’t get clicks and we move past it.

“It occurred to me that that’s a lot of organs — and that is what threw me into working on the book. That is when I set off on this journey.”

What O’Neill learned is addressed in her powerful debut graphic novel, Opioids & Organs (Drawn & Quarterly, 371 pages, $35, publication date May 19), a thoughtful, imaginative and beautifully drawn work that weaves her own story with scientific history as it explores her father’s death, medical advances (including some questionable ones) which made organ transplantation possible, organ donation and society’s attitudes toward addiction. It’s dark and sobering in places but lighter in others — even uplifting.

“It’s almost how I would tell the story at a dinner party,” she said. “One of my processes is telling my friends and family certain aspects and seeing what they react to the most.”

She spent a few years doing research and, before even coming up with a plot, had “a master list of anecdotes and was looking for a way to connect them,” explained O’Neill, who has a bachelor’s degree in film production. Only after writing a script did she illustrate the story. “I find film and comics very closely related in my head,” she said.

Her illustration work includes Nelly Arcan’s L’Enfant dans le miroir and Valentine in Montreal by Heather O’Neill. Her comics have appeared in such publications as Hazlitt, Exclaim! and Canadian Geographic and she has created animated videos for outlets including the CBC.

“Arizona” is a character in the story who uses the first-person voice. The graphic novel uses only dialogue. She said she wanted to stay away from narration — blocks of text used to explain things because, to her, it “would have felt a bit stilted and preachy.”

Arizona is accompanied on her at-times-surreal journey — it takes her down a literal rabbit hole at one point, for instance — by a yellow lizard named Izzy, who represents her “anxieties and toxic obsessive traits,” and by Frankie, who “represents my vulnerabilities,” she said.

Frankie is a tall and sensitive creature who looks to have been assembled from pieces of corpses, much like the monster Dr. Victor Frankenstein assembled in Mary Shelley’s 1818 Gothic novel from bodies fresh from graveyards and body parts from dissecting rooms and slaughterhouses.

“Stolen organs allowed surgeons to make huge medical advancements. These achievements now save lives,” Frankie tells O’Neill.

O’Neill agrees, but nuances the observation: “My issue is who these bodies belonged to,” she writes. “We are still taking organs from groups of people society deems lesser. I learned this the hard way.”

Friends asked whether there wasn’t a kind of silver lining to opioid-overdose deaths, suggesting that good came from them because organs for transplantation became available.

“I fight against this idea that his death had a purpose,” O’Neill writes. “That is the whole narrative of mixed blessings — this idea that there is a silver lining from the opioid crisis, and it makes me uncomfortable.”

“The organ donation industry in Canada makes me uncomfortable. I am hoping that by telling my story, I will be able to make peace with it.”

Her father’s death marked the first time Arizona O’Neill had to deal with such intense grief, she said. Dave Sidaway / Montreal Gazette

She learned in her research how, historically, methods including grave robbing and the purchase of the bodies of dead slaves through an underground market had filled the demand for human cadavers in medical schools for students to learn anatomy through dissections. (Bodies used today are of people who choose to donate their bodies to science.) The schools were allowed to use “unclaimed” bodies from workhouses and hospitals.

She learned about Vladimir Demikhov, a Russian scientist whose extensive work on dogs in the 1940s and 1950s laid the foundation for modern heart transplants. He was also highly controversial for creating two-headed dogs by surgically grafting the head and upper body of puppies onto larger dogs: The longest-surviving two-headed dog lived 29 days.

O’Neill found proof of prejudice in the organ trade: how disparities have historically caused substantial delays in access to kidney transplant for Black patients in the United States, for instance. Four times more likely than white people to develop kidney failure, they are half as likely to be placed on a waiting list for a kidney transplant and more likely to die on the list. In 1968, the donor in the first heart transplant in Virginia was a Black factory worker whose heart was removed without his family’s consent and placed in the chest of a white businessman.

Although overdose deaths in Canada dropped in 2024, according to figures from the Public Health Agency of Canada made public in 2025, the total of 7,146 deaths was still nearly double what it had been before the COVID-19 pandemic. The pandemic exacerbated the crisis, “locking everyone in their homes, with no systems put in place to help those suffering from addiction,” O’Neill said. “All the safe sites and programs were shut down, leaving addicts completely alone.”

If death tolls dropped in much of Canada, Quebec had its highest single-year total ever of drug overdose deaths in 2024, according to the Institut national de santé publique du Québec: 645.

For O’Neill, one overarching goal of Opioids & Organs is that “we need more empathy for people who are suffering from addiction, especially if we are taking so much from them.”

She dedicates Opioids & Organs “to the part of my father still out in the world.”

It’s important “to just be a reminder to everyone that addiction affects all of us and that the epidemic is still happening,” she said.

“It is still quite devastating.”

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AT A GLANCE

On May 12 starting a 7 p.m. at the Drawn & Quarterly bookstore, 176 Bernard St. W., Arizona O’Neill will be in conversation with Montreal fiction writer Neil Smith. Copies of Opioids & Organs will be available for sale.

In Toronto on June 4 at Type Books, 883 Queen St., starting at 7:30 p.m., she will be in conversation with Heather O’Neill, an award-winning Montreal-based novelist and short-story writer — and Arizona’s mother.

Arizona O’Neill will also be appearing at the Montreal Comic Arts Festival, on May 15 to 17, St-Denis St. between Gilford and Roy Sts.; and at the Toronto Comic Arts Festival, on June 6 and 7, Mattamy Athletic Centre, 50 Carleton St. More event details here.

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