‘Heroin: Cape Cod, USA’: Systems of Addiction

Pain is costly, and treating it, profitable; Heroin: Cape Cod, USA reveals that 80% of heroin users start with prescription painkillers.

“I also hope that it provides insight into the devastating human toll that the pharmaceutical companies share a huge responsibility for. Knowingly or unknowingly they’ve been trying to commercialize opiates for more than a 100 years, and now they’ve succeeded and people are paying a terrible price”.

Steve Okazaki

“Everybody has an addiction. Everybody has something that they do constantly. Mine just happens to be heroin”. Ryan sits on his bed, upstairs in his childhood home, where his parents still live. He wears a Boston Red Sox cap.

Ryan talks openly about his habit in Heroin: Cape Cod, USA. He has ideas about how addiction works, how it’s a system and how hard it is to stop. He takes Steven Okazaki’s camera along on a night’s journey, selling drugs in order to support his habit. At his house, his mom barely looks up at him as he walks by her, seated on the couch, TV on in the background. You can’t know why they don’t interact, exactly, but the interview scene, as Ryan looks directly into the camera, his face drawn, offers an explanation. “I think that’s why parents are scared”, he observes, calmly, logically, “that their kids are gonna die, and that they’re gonna lose their kids if they kick them out. But if they kicked me out, I’d probably be doing a lot better than I am”.

Ryan can’t know this. But his guess, like so much guessing about addiction, presumes that a different state could be an improvement over the present one. He’s not happy being an addict, Ryan says, and neither is Benjamin nor Jessica nor Marissa, some of the other heroin addicts who appear in the documentary, running now on HBO after a series of festival screenings. Like other stories of addictions, including Okazaki’s own 2000 documentary, Black Tar Heroin: The Dark End of the Street, this one straddles lines, formal and aesthetic, moral and diagnostic. That straddling makes judgment difficult.

Still, of course, you’re inclined to judge. Like the young addicts you see here, like their family members and “running partners”, as Marissa calls those fellow addicts who can never be her friends, you’re immersed in a culture that finds fault in addicts in order to explain them. Members of a parents support group find space to worry, together and out loud. “Our role as a parent is to take care of our children”, one mother says. “With this disease, we can’t. We have tough choices and sometimes with this disease, the outcome is really bad”.

Her son’s judged, she’s judged, as others tend not to see disease, but instead, blame addicts, finding defects and errors. Heroin users must be weak and broken, they must be failures. Their backgrounds must be tragic or dysfunctional, their genetic make-ups must be flawed. They must be unlike you, it’s why you have to guess. It’s also why you should rethink how you come to your judgment.

The film makes this case subtly, even as it allows for a conventional response. You can be horrified and distressed by the many intimate, harrowing, and heartbreaking scenes that show young white people in Cape Cod cooking heroin in bathroom stalls or slipping needles into the backs of their hands and necks. These images are heartbreaking, in part because you know what comes next, in part because, these faces will become thinner and emptier over the course of the movie, even as the streets outside are filled with snow or ice cycles begin to drip near film’s end, signaling a new season that will be the same season. You can be frustrated that the subjects don’t seek treatment or that they relapse when they do try it, that the experience of “rehab” is at once so erratic and so predictable.

If all these patterns are familiar, Heroin Cape Cod, USA poses a few more questions, including what does pain have to do with this? Daniel can’t locate an answer but describes, acutely, the experience when he recalls seeing his parents, “When they give you the ‘We’re disappointed in you’ look. It’s the hardest”, he says, “but at the same time, they don’t get it, they never will. Until you’re an addict, you’ll never understand fully what goes through our heads”.

Addicts wonder what’s in their heads too. Marissa, lovely, at ease with the camera, tries to explain how heroin addiction works for her. “You just become so lost, but I just don’t want to feel that pain, so that’s why I get high”, she says. “Everybody’s like, ‘That’s just an excuse,’ but fuck you. I didn’t want to feel it”. Almost lyrical as she speaks, Marissa talks about her choices, not to get into home invasions, but instead work in strip clubs. She describes her isolation and apparent grasp of what’s at stake. “I don’t know why it doesn’t scare me, I don’t know why. I guess you never think it’s going to happen to you”.

Nicole asks another question: “Why do they have to make a drug that makes you feel good?” She goes on, “Opiates don’t stop the pain, it still hurts, but you’re happy that it hurts”. Her analysis is chilling, in that it both makes so much sense and makes none at all. Most of the interviewees here recall their first encounters with prescription opiates.

Lauren Heroux, a local pharmacist, appears early in the film, setting the context for Nicole’s question. Lauren wears a white lab coat, sits behind a white counter, her interview intercut with close-ups of pills and prescription labels. She lists the opiates doctors overprescribe — vicodin, oxycodone, oxycontin, morphine — even as she describes a terrible dynamic, beginning when doctors believe their patients’ complaints of pain and want to help them.

That pain is costly, and treating it is profitable. The film reveals that 80% of heroin users start with prescription painkillers, that heroin is a cheaper alternative, and that in 2015, pharmaceutical companies’ “revenues for opioid painkillers reached $15 billion”.

That number is astounding. You can wonder why and how individuals become addicts, but you might wonder too how they don’t.

Heroin: Cape Cod, USA is now available on HBO Go and HBO Now.

RATING 8 / 10