You previously explored the heroin epidemic in 1999 with Black Tar Heroin: The Dark End of the Street. Why is it an important topic for you?
Steven Okazaki: I just happened onto the subject. In 1995, during the AIDS-HIV epidemic in San Francisco, I met two young heroin addicts living between floors in an abandoned hotel. They were knocked around by life, fucked over by adults, but they were remarkably resourceful and resilient, and still capable of laughing over a comic book. I immediately wanted to make a film with them, but I went slowly. I volunteered at a needle exchange; handed out clean socks and pizza; talked to addicts; got to know the scene; and then started filming.
People don?t understand addiction, and addicts are treated as lower life forms by society. You see the stories about heroin in the news and it feels distant and abstract. The viewer feels safe, like it?ll never happen to them. I hate that. As Marissa in [Heroin: Cape Cod] says, ?I could be your daughter."
What are the differences you've noticed in the 20-year span between films?
The biggest difference is that nearly everyone has opiates in their medicine cabinet: Vicodin, Percocet, Oxycodone, Hydrocodone. Doctors overprescribe them and people get addicted. Eighty percent of heroin addicts started with prescription drugs.
The prescription pills cost a lot -- sometimes $40 a pill -- and heroin is a cheap, potent and accessible alternative. Heroin used to be confined to a few neighborhoods in a few cities. Now it?s everywhere. You don?t have to go to a sketchy neighborhood to get it. You can send a text and have it delivered.
Twenty years ago, the addicts I followed were mostly hustling to maintain their habit so they wouldn?t be sick. The kids in Heroin: Cape Cod are looking to get high. Alcohol and marijuana isn?t doing it for them anymore; they move up to prescription opiates then heroin. They go to detox, get clean for a few days, then use again. They?re not into William Burroughs; they don?t care about Kurt Cobain -- they just want to get high and block out whatever pain they?re feeling.
Companies have been trying to commercialize opiates for more than a century. A scientist at Merck invented the product in the late 1800s and in the early 1900s, Bayer gave it the name "Heroin" and tried to give it away free to children! In various forms, opiates have been marketed to women for depression or ?women?s ills.? They?ve finally succeeded.
You mentioned how alcohol and marijuana isn't doing it for kids. Heroin is a problem in the rural town where I grew up, despite it being the one drug considered untouchable when I was a teen. What's changed?
Along with the huge upswing in the use and abuse of prescription painkillers, there?s also been a social/cultural change encouraged by the pharmaceutical companies and the medical profession, on how society views both physical and emotional pain. It's something not to be endured, but erased. So when you have a surgical operation the anesthesiologist medicates you for the pain and also gives you amnesia so you?ll also be spared the memory of pain. The message is that the elimination of pain, like the elimination of hunger, is an attribute of civilized society. When I was a kid, you got Novocain, then aspirin and maybe an ice pack for a toothache. Now you can get an opiate. Let?s assume the doctors mean well, but maybe we need to reconsider some of this.
Was it a challenge to work with young people who were at risk of killing themselves -- some of whom died while making the film?
Two of the young women in the film, Marissa and Arianna, died from overdoses during the time we were making the film, but not while we were filming. I don?t know if they were alone or with someone who was too fucked up to help them. They were both bright, caring and beautiful. People loved them, but the drug was stronger.
The film features eight addicts. They?re all different. Their reasons for becoming addicts are deeply personal. You don?t know who?s going to survive, who?s going to get clean, who?s going to die. It?s scary. I don?t have high ideas about getting them to quit after the people who love them have failed. We?re in their lives for a brief moment in time. I don?t promise anything but to portray them as honestly as I can. I ask them how it?s going, what they?re thinking. If they?re thinking about going to detox, we?ll take them, with or without the camera on. Maybe being in the film will be a part of their motivation for getting clean. Maybe it won?t. Minimally, maybe seeing the film will help somebody else.
Why include the parents of addicts in the film?
I heard that there was a parents' support group in Cape Cod which meets every Monday, except on holidays. On a Columbus Day, when they weren't having their usual meeting, I asked if they would have a special one for us, in front of the cameras. Twenty to 30 people show up for the regular meetings, so I hoped to get five or six for the filming -- we ran out of chairs. Everybody showed up, open and eager to talk. They're tired of hiding their child's addiction, of feeling lonely and ostracized. They need to share their stories, and they want to get the word out and try to help each other. That was really moving, how frank they were about what it's like to be the parent of an addict, someone they love and can't seem to help.
Most of the addicts in the film are/were close to their parents. They talk to them regularly and, in some cases, the parents are enabling their habits. It?s dramatic, compelling, and important to see how they?re affected by their child?s addiction.
In your opinion, what would best help in the fight against heroin?
It?s really complicated. I?m a filmmaker, not an expert, but it seems to me that the prescription opiates are too plentiful and easy to abuse. They?re sitting in the medicine cabinet and you can crush them, then smoke them, sniff them or shoot them up. Pharma Pharmaceuticals was forced to make Oxycontin tamper-proof by turning it into a gel tablet that can?t be smoked, sniffed or shot up. Their sales immediately dropped. Why can?t they do that to all the opiates? What would that cost? A few cents a tablet for a $15 billion a year business?
I spoke with Sheriff Cummings of Barnstable County (Mass.) and he talked about the need to develop school education programs similar to what was done with cigarette smoking. I think he?s right if the material is smart and doesn?t simplify the issue or demonize the users. It?s a good idea to reach kids very early. I also think it?s a mistake to totally de-criminalize drugs, but put them in long-term recovery programs instead of jail.