“The New Opioid Novel” explores a collection of contemporary US fiction published in the 2010s that tackles the current opioid crisis. Differentiating these new opioid novels from earlier opioid literature, opioid memoirs, and other contemporary drug literature, this essay identifies three distinct modalities of the new opioid novel, paying particular attention to the ways these texts think through the causality of the opioid epidemic. First, some texts (novels from Julie Bunton, Brian Allen Carr, Cheryl Reed, and Jennifer Weiner), which read like detective fiction, take an epistemological approach, framing opioid use as a problem or mystery to be solved. A second set of texts pursues a more ontological approach. These novels (Nico Walker's Cherry and Michael Henson's Maggie Boylan and Tommy Perdue), which read like existential fiction, sidestep the problem of causality to imagine opioids as just another part of the world we've all been thrown into. Finally, a more phenomenologically oriented set of texts (Carter Sickels's The Evening Hour and Robert Gipe's Trampoline and Weedeater) works past the problem of our ontological thrownness to explore new ways of living with and within the opioid epidemic. These three categories provide a heuristic framework for approaching other new opioid novels not treated here.