Heroin for the Holidays

HBO documentary provides inside look at modern users.



Heroin: Cape Cod, USA. HBO. Monday, December 28, 9 p.m.

When journalists report about heroin, their efforts almost inevitably suffer from the same problem. For short, we'll call it the Halsted Omission.

William Halsted was one of the founders of Johns Hopkins Hospital. He's often credited as the inventor of modern surgery for his pioneering use of anesthesia and sterilized operating rooms. During his distinguished 45-year career, he was among the first American surgeons to perform a blood transfusion, remove a gall bladder or do a mastectomy. He was also, for more than three decades, addicted to morphine, a close chemical cousin of heroin, which impaired his professional and personal lives so little that only his closest associates knew about it.

If you didn't think such a thing was possible, it's not your fault. If there's a form of journalism that suffers from endemic selection bias, it's drug stories. Heroin users who manage to adapt their lives to their addictions, or vice versa, never get mentioned in news accounts or documentaries. Neither do those who try heroin, don't like it, and quit immediately; or those who chip occasionally without falling into real addiction. In the stylebook of drug journalism, "heroin user" means "dead or dysfunctional." Those exist, of course, but they are not the whole story.

The invisible fingerprints of the Halsted Omission are all over Steven Okazaki's new HBO documentary Heroin: Cape Cod, USA, an otherwise (mostly) meritorious exploration of one little corner of the expanding heroin demimonde.

As the documentary notes, the United States is a bull market for heroin right now. Heroin users increased by half between 2002 and 2012, and heroin overdose deaths grew six-fold between 2001 and 2014. Cape Cod, for all its quaint fishing villages and picturesque lighthouses, isn't immune.

Okazaki's crews followed eight young addicts for several months. His access was startling; they buy and sell drugs and even shoot up on camera. (Heroin: Cape Cod is definitely not for the needle-averse.) The result is an unusually intimate documentary that busts some myths even though it protects others.

The addicts are kids in their early 20s, mostly from middle-class homes with loving parents. Almost without exception, they refuse to blame sociological trauma for their drug use.

"I didn't do drugs growing up because i was depressed or I was sexually abused or because i have issues," says one. "I did drugs 'cause they were fun."

That, as much as physiological dependence, is why so many of them have been in and out of so many rehab programs with so little success. "I miss, like, the chaos of running around, copping dope, selling dope. … robbing people, running from the cops," says one, at least temporarily clean after emerging from detox. "My life is so boring now."

Practically everything in Heroin: Cape Cod gives lie to the myth that big government expenditures for treatment can stamp out drug use just as they did measles and whooping cough. The addicts talk about the traditional scramble to score drugs just before entering a program—"everybody gets high before they go to detox, that's what you do" —and after leaving—"every time I'd get out of detox, I'd go get high." (Not that criminalization works, either; one young woman describes the constant parade of dealers through her life: "One would get arrested and another would take up right where he left off.") Barely in their 20s, many of them have already cycled through rehab and re-addiction half a dozen times, punctuated with the occasional arrest.

As for drug education, it only seems to have made them curious. One recalls, in the aftermath of a serious auto accident, being cautioned by a doctor to be careful with the opioid pain relievers he was being prescribed. "'Don't scrape off the coating, don't crush it, don't abuse it in anyway," he recounts the warnings. "Who in their right mind wouldn't be [thinking], 'Okay, if I do this, what's it gonna do to me?'"

That young man, like several in the documentary, turned to heroin after becoming addicted to opioid painkillers like oxycodone following an auto accident. You don't have to accept Heroin: Cape Cod's wild-eyed and unsourced claim that "80 percent of heroin users started with prescription pain killers" to acknowledge that oxy and other popular opiate pain-killers are gateway drugs for heroin.

But just as Heroin: Cape Cod, wittingly or not, provides a wealth of evidence that neither the prohibition nor medical models of the drug war work very well against heroin, it seems to me the real lesson it imparts on oxy is that the federal crackdown on pill mills has backfired in an ugly way.

As pills get more difficult and more expensive to obtain, their users are switching to the far less reliable heroin market, where dosages differ from dealer to dealer and nobody has any idea what kind of stuff has been used to cut the drug. The hazards of dose miscalculation increase exponentially for an inexperienced user who's taking other drugs that can lethally magnify the effect of heroin, a phenomenon known as potentiation that's well-known to researchers if not pillhead rookies experimenting with their first syringes.

It might not matter to the addicts anyway. The Halsted Omission aside, there are clearly some users who fall so profoundly into the grip of heroin that even the fear of death is no deterrent. Several of them are front and center in Heroin: Cape Cod, one young woman who confesses to getting high in a hospital parking lot moments after being released from emergency-room treatment for an overdose. Says another, briefly clean again: "I'm a good girl. I don't know why I do this to myself." Not long after the interview, she did it to herself for the last time, dying of an overdose at 23. The cops couldn't save her; rehab couldn't save her. Maybe a repeal of a prohibition policy that keeps drugs overpriced and unnecessarily dangerous and prevents them being taken in a secure environment could have. And maybe someday we'll have a documentary on heroin that raises that question.

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  1. You know who else habitually used heroin and ran a perfectly successful private detecting operation with his good friend and chronicler Dr. John Watson?

      1. No. Okay, maybe I was a bit obtuse, the guy I’m thinking of lived in london, wore a deerstalker hat, smoked one of those big bowled loopy pipes, liked the words “afoot” and “indubitably.”

        1. sounds like hitler to me

        2. Mr Peabody? He owned a orphan also.

          1. Or commander McBragg ?

            1. Peter Lorre? Alma Rubens?

        3. Margaret Thatcher?

          1. Jack the Ripper?

    1. Ya, and my friend Clark and his friend fight aliens and other evil doers in their off hours…. Me thinks using a fictional character to support an argument is rather silly,,,, and I should know, I am a member of the Baker Street Irregulars…

      1. The New Orleans band?

    2. That was cocaine

  2. Yet another reason why small doses of Naloxone, or Narcan, ought to be available over the counter, without a prescription. It effectively reverses the negative effect of heroine or opiods on the respiratory system and is the only sensible public health policy that can be implemented. This is what politicians should be talking about openly, that and clean needle exchanges. Now, please.

    1. Would these exchanges be subsidized? Why not just make hypodermics non-prescription?

      1. Good point. Buying clean needles without a prescription, I’m all for it.

        1. This makes too much sense, and it doesn’t support building a bureaucracy of public sector union workers and their massive pensions. It’ll never fly.

        2. Countries in the Americas with tired of the AIDS epidemic sell needles over the counter. Baptist and Methodist politicians love the AIDS epidemic as an excuse to demonize gays. They are real quiet about Hepatitis C outbreaks everywhere clean needles are banned. Brazil has a socialized medical system that looks like pictures of nationalsocialist death camps. It would be mass suicide for them to ban clean needles, so they are as legal as they used to be in the US before Nixon’s GOP took office.

        3. You don’t need a prescription to buy clean needles/syringes. I buy disposable syringes in boxes of 100. I raise livestock.

          Sheesh. City kids.

      2. They were non-prescription. In 1968 you could walk into a drugstore and buy sterile needles, cheap. Then government officials decided sacrifice and altruism would by better served by prohibition, Hepatitis C outbreaks and an AIDS epidemic.

        1. They’re non-prescription again. I think NJ was the last state to repeal its prescription law on syringes & needles, over a decade ago.

    2. sensible public health policy
      Beep! Oxymoron alert.

      “We just need a few more common sense gun drug control regulations.”

  3. From anecdotal evidence I believe that only some people are susceptible to physical addiction. What percentage this might be, I have no idea. But if it’s true, then the war on drugs is even more ridiculous.

    1. It’s pretty well accepted that there is such a thing as an addictive personality. This is probably why some people can do cocaine or heroin and stop whenever they want. It also explains why others can become obsessed with video games, pornography, and food – and I don’t mean that these things become major hobbies for people; I mean that they stop at nothing to obtain these things and let their finances, health, and relationships go to shit because they only care about their “addiction”.

      As is just about always the case, a one-size-fits-all government mandate fails to work as (allegedly) intended.

      1. I was once late for class due to an ill-timed yank fest. Do I have a problem…?

        1. Depends on the class.

        2. Depends I guess on if this frequently effects you life…. Can you live without your “yank”, does it effect your day to day life negatively? Are you unable to hold a job because of your “yank”? Have you resorted to crime or prostitution to support your yank?

        3. Where are your hands, right now?

    2. I understand that there was a survey done on Vietnam veterans who did opiates while in Vietnam. IIRC almost 90% quit cold turkey without a problem once they left Vietnam.

      On the other hand, I know that I have a generally addictive personality. Stuff I get into often becomes a pattern and then a habit. I’m careful about alcohol consumption and don’t trust myself with other drugs – but I don’t project this aspect of myself on to other people unless they identify themselves as having a similar issue.

    3. Bullshit. Opiates destroy bodily functions that take a long time to painfully regenerate. Things that imitate opiates, like barbiturates, are also poisonous and addictive. But nobody ever got addicted to or overdosed on hemp or acid. It takes a double handful of mescalin to be as poisonous as chugging two gallons of water. Addictive is a medical term the prohibitionist judicial system is trying to apply to Twinkies, Barbie dolls and anything a spoiled brat holds its breath to demand. Claims that an allegation is accepted or discredited are confessions of ignorance, dishonesty or both.

    4. its about twenty percent i believe. of those who try it, so people who wanna try heroin are already being selected for. i imagine it’s significantly lower in the general population (if 20% of people who were prescribed opiates got addicted we probably would have stopped using them some time ago)

  4. Google pay 97$ per hour my last pay check was $8500 working 1o hours a week online. My younger brother friend has been averaging 12k for months now and he works about 22 hours a week. I cant believe how easy it was once I tried it out.
    This is wha- I do…… ?????? http://www.buzznews99.com

    1. You sell heroin, don’t you?

  5. “Maybe a repeal of a prohibition policy” could save them, yes. People die from ‘heroin addiction’ not because they have a brain disease but usually because they are depressed and intentionally try to kill themselves. There is a huge epidemic of intentional suicide by all means, and it’s kind of ridiculous to insist that heroin (or drugs) are an exception to this rule. This is why ‘rehab’ actually contributes to the epidemic – by making people confess they are ‘powerless to heroin’. And then the ‘old-timers’ often abuse and exploit the newcomers and bully to suicide. As for surgeons, heroin dependency was common, but if you think about it, it makes sense. Cutting people open and often making horrible mistakes, especially in the early years, would take its toll on one’s conscience. Many physicians succumbed to their dependency.

    1. Wrong. Heroin causes sudden death in overdoses, and the governments that want it expensive enough to generate bribes make quality control iffy to the folks who can’t find safer stuff to fool with. It’s been decades since I read this stuff, but even De Quincy can be found on Gutenberg.org for free and describes withdrawal.

      1. WRONG. Heroin generally causes slow death from falling asleep and slowly stopping breathing. It is not ‘sudden’. This is why naloxone is effective. Also most people die from a combination of meds/alcohol, not heroin alone. And people DO NOT die of withdrawal. That is a dangerous and stupid fallacy. In fact heroin withdrawal is harmless with the exception of being in jail when it happens, which kills a handful of people annually generally because they are not adequately hydrated.

  6. Decriminalizing is a good idea; not so sure about again letting corporations entangled with governments sell the stuff in coin-operated machines and get us into another World War. The stuff is acetylmorphine, morphine treated with acetic anhydride. Heroin is Bayer’s brand name just as Aspirin is a brand name for acetylsalicylic acid. I do recommend a copy of “Drugs and The Mind,” by Robert M. De Ropp, M.D. which was a survival guide in the 60s Haight. It explains in detail how opiate withdrawal sickness operates after overuse has atrophied the body’s natural mechanisms. Nobody healthy wants the stuff if ANYTHING else can be had, so decriminalizing and legalizing pot, mushrooms, cacti, woodrose, catha, coca, hoasca and their extracts promptly offers alternatives that are not addictive if the term “addictive” is to have any real meaning.

  7. Google pay 97$ per hour my last pay check was $8500 working 1o hours a week online. My younger brother friend has been averaging 12k for months now and he works about 22 hours a week. I cant believe how easy it was once I tried it out.
    This is wha- I do…… ?????? http://www.buzznews99.com

    1. Now, see, that is something I could get addicted to!

  8. Some, okay, *many* people seem to think that a “responsible drug user” is an oxymoron. The real contradiction is why people think that drug addiction can’t be helped but that the legal threat of criminal punishment will somehow stop drug addicts from using.

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