In the war against drugs, whenever one problem appears to be solved, another is created. To curtail addictions caused by prescription opiates, prices were increased and the regulations and requirements for doctors’ prescription writing was tightened. As a result, drugs like oxycodone were harder to get. With the legalization of marijuana for medicinal uses marijuana prices dropped. As a result of these changes, Mexican cartels needed to find another drug to resolve their economic woes and power struggles. Heroin, the cheaper opiate that unlike marijuana is addictive, filled their drug profit vacuum and insured a new generation of addicts would crave their product.
Heroin: Cape Cod, USA directed by Steven Okazaki is an amazing cinema-verite investigation of the epidemic that is currently overtaking communities in the nation with the specific ground zero focus on Cape Cod, Mass. as a disastrous epicenter of heroin addiction and overdosing deaths. This is an incredible must see film for its authenticity, immersive cinematography and candid expose of the lives of 8 addicted twenty-somethings with additional commentary by other heroin users who have relapsed or are in the valley of detox attempting to rehab. The film elucidates the unfortunate facts and figures behind the epidemic which has led to an explosion in crime rates, addictions, skyrocketing health care costs, deteriorating lives and worst of all, deaths.
Threaded throughout, Okazaki reveals the sociological and economic co-dependency of addicts, medical practitioners, the healthcare industry, and pharmaceutical companies. Specifically, the drug companies and doctors are in the forefront; they have mainstreamed the cultural psyche into accepting opiates as the reasonable alternative for pain “management.” This has led to an unfortunate result. Oftentimes, after clients finish their prescriptions, they are addicted. As addicts they search for more opiates or go through painful withdrawal. To continue pain “management” some users convert to the cheaper drug heroin.
Heroin lasts longer than prescription opiates and yields a bigger bang for the cheaper buck which is why there have been so many conversions from opiate prescriptions to heroin. Sadly addicts end up fighting a personal war on two fronts: they have to mitigate the physical pain and the emotional and psychological humiliation of their never-ending addiction. This morphing process from prescription opiates to heroin turns a tidy profit not only for the cartels but for doctors and pharmaceutical companies ($15 billion for opiate prescriptions). The final social costs are $55 billion in lost productivity, criminal justice, and healthcare expenses.
Using clips of interviews with eight individual heroin users, three men and five women, as well as interviews with pharmacist Lauren Heroux-Camirand, EMR technicians from Hyannes Fire and Rescue, Dr. Craig Cornwall, Chief of Emergency Medicine at Cape Cod Hospital, “Parents Supporting Parents of Cape Cod” and others, the director presents an authentic and shocking portrait of how individuals become addicted, why they stay addicted, why rehab is mostly ineffectual, and why death by overdose has quadrupled since the early 2000s. With each interview we come to understand how heroin users spend their days in the repetitive, boring, obsessive daily routine scrambling to get the money by any means necessary, whether it be through prostitution or stealing from family, friends, or strangers as they create opportunities out of desperation to effect their highs. With the money, they score from their supplier, they shoot up, are sated, then are forced to repeat the same enslaved behaviors day after day or attempt detox, an impossibility.
The filmmaker has done a brilliant job in gaining the trust of the users so that they are anxious to confide their poignant stories which clarify that anyone at any time can be converted into an addict. This is not something that only can impact those who are characterless or ignorant. All of us can identify with the filmmaker’s portrait of human weakness, because Okazaki keeps the fundamental emotional elements real and stark. The interviews are mythic. Each user is reflected in all of us and what is happening to them and what has happened to them is both frightening and maddening.
One user, Daniel, like most users interviewed comes from a middle class family on the Cape. He is an expert at what heroin has done to his life and personhood: it has destroyed his soul because he cannot stop. He has good intentions but the siren call of heroin overwhelms him and he is not “done.” Daniel, expresses it as going into the abyss: each time he believes he has hit “bottom,” it is just a “trap door” into a lower place.
Melissa, a twenty-something with children refers to heroin as “the love of her life.” She and others attempt detox, but cannot go over the divide into health. Each of the users maintain it is impossible to stay in detox and though individuals from the outside looking in judge them thinking it is easy to stop, they just “don’t understand” how the body and the mind crave heroin to the point that they want it “forever” and will “push everyone out of the way to get high.” For a user, true friends don’t exist. The user is alone.
The filmmaker selects themes which play out amongst all of the users and then cuts to hard facts from the doctor and pharmacist to explain what addicts go through and why so many users overdose. Of those individuals who eventually seek out heroin, 80% first become addicted to opiate prescriptions because of surgeries, car accidents, chronic diseases, or other pain events. Though the pharmacist Heroux-Camirand directly states that opiates should not be prescribed for moderate pain, many doctors write prescriptions when they should not. This occurs on a level that 44 people in the United States each day overdose on prescription painkillers and die, as reported by the CDC. With heroin users who have been converted from initial opiate prescriptions, the number of overdose deaths has exploded.
The filmmaker points out the pattern of opiate drug abuse to heroin overdose/death. Those who overdose are addicts. The addictions mostly result from opiates prescribed by doctors. When the prescriptions are through, users seek heroin as the interviewees discuss in their candid, unabashed comments. The most devastating fact is that each user Okazaki questions does not fear dying of an overdose.
This is because the users’ obsession with heroin is greater than fear of death. In 2014, 1250 died from heroin poisoning in Massachusetts. In other towns across the US, the number of heroin deaths almost tripled between 2010-2013 and the numbers continue to rise. The great tragedy is that the parents of heroin users have been enablers; like the users themselves many are numb to the likelihood that their adult children will overdose. Okazaki shows the tragic result of this.
That so much devastation could occur in a beautiful resort like the Cape is an irony not lost on the audience. Cape Cod stands as a microcosm of what is happening in the nation: on the surface all is well; below the shallows there is despair and tragedy. The documentary is superb in its mandate to open our eyes to this catastrophe of destruction borne out of the medical industrial complex’ sustained determination to increase its revenues. To wantonly make and prescribe what is addictive and potentially death dealing goes beyond the pale.
Okazaki’s efforts in Heroin: Cape Cod, USA are a clarion call toward holding accountable politicians, lobbyists, pharmaceutical companies and doctors in the drug war. Instead of fighting the good fight, they have exacerbated it, whether unwittingly or knowingly. The first step in correcting what is dire is knowing what is happening. Okazaki has done an incredible job of enlightening us with this film.
The HBO documentary Heroin: Cape Cod, USA debuts MONDAY, DEC. 28 (9:00-10:15 p.m. ET/PT), exclusively on HBO.