Humanizing The Heroin Epidemic: A Photo Essay

For over a year, Ive been documenting the lives of three long-term drug users Marie, Cheryl and Johnny who are participating in Vancouvers heroin-assisted clinical study and program.

In recent years, heroin use in North America has exploded into an epidemic. At the same time, policymakers and the public have clashed over how to properly treat this public health scourge. Many heroin users receive methadone and other forms of treatment. However, some of the most vulnerable addicts havent responded to medication and detox.

I spent weeks building a rapport and trust with Marie, Cheryl and Johnny, whove all been addicted to heroin for years. Theyve each repeatedly tried detox and methadone and have been unable to stop using heroin.

In a sense, heroin-assisted treatment, a science-based, compassionate approach, is their last resort.

Those involved in the program often users who havent sufficiently responded to other forms of treatment receive pharmacological heroin in a clinical setting. While these programs have long been recognized as scientifically sound and cost-saving in countries like Switzerland, the Netherlands and Denmark, heroin-assisted treatment is only beginning to be offered in North America.

At first, the three subjects allowed me to take photos of them self-injecting their medication at Providence Health Cares Crosstown Clinic in Vancouvers Downtown Eastside. Slowly, over a period of weeks and months, they let me document their lives outside the clinic.

While I hoped to inform the public about heroin-assisted treatment, I also wanted to see if I could create visual counter-narratives to challenge the dominant tropes of drug genre photography.

More than anything, I wanted to represent Marie, Cheryl and Johnny as human beings and show that their drug use didnt define who they were, even though thats how heroin users are usually depicted by documentary and news photographers.

The best way to do this, I realized, was to show them the photographs Id selected and give them the opportunity to respond. I included their words with each photograph in the series.

‘Dark, Seedy, Secret Worlds’

Before beginning my project, I had explored the work of some of the most influential drug genre photographers, and found that most of them have consistently represented heroin users as exotic, primitive and dangerous to society.

There is a tendency in drug photography to attempt to make images of dark, seedy, secret worlds, writes criminologist John Fitzgerald.

This can have the effect of othering the subjects the idea that after looking at these kinds of images, viewers might look at drug users as outcasts.

Larry Clarks 1971 photo work Tulsa is considered an exemplar of documentary photography. Many view the series, which depicts teenagers experimenting with drugs, sexuality and guns, as brutally honest and revealing.

In this photograph from his seminal work Tulsa, photographer Larry Clark eroticizes the risky behavior of teens. Larry Clark, ‘Couple,’ Tulsa, 1971.

Clarks follow-up photo essay, Teenage Lust, published in 1983, also focused on drug users in a voyeuristic, unsettling and erotic way.

The problem with this approach is that it creates sensationalized images, which, in turn, influence the publics thinking and policymakers’ decisions about how to treat drug users.

For Clark the drug user is a modern primitive, writes Fitzgerald. Like the young boys who play with guns and explore their sexuality, Clarks drug users plumb the depths of rapacious desire, so repressed and unexplored in the modern body. Clarks lifework is to bring this primitive desire to light in a liberal artistic adventure.

Clark wasnt the only photographer to represent heroin users this way. Documentary photographer Eugene Richards’ 1994 book Cocaine True, Cocaine Blue focused on cocaine use in three inner-city neighborhoods. The books cover features an extreme close-up of a woman clenching a syringe between her teeth.

The cover photo for Eugene Richards’ Cocaine True, Cocaine Blue dehumanizes the drug user. Eugene Richards, ‘Mariella,’ East New York, New York, 1992

The image is arresting and also influenced the way many other photographers have depicted drug users to this day.

Photojournalists working for news agencies such as AP, Getty Images and The Denver Post have recently followed Richards’ example and composed images of drug users with syringes in their mouths. In most of these photos, the heroin users’ eyes are either partially or completely out of frame or hard to make out in detail.

Its vital that photographers find more balanced ways of representing drug users, instead of reproducing the same types of stigmatizing images that have existed for decades.

Shocking images certainly provoke reactions. But its more important to offer context in order to spark discussions about solutions.

Hearing From The Heroin Users

In my own effort to produce and share balanced and humanizing images and to reduce the possibility of misinterpretation and othering I realized the images on their own couldnt tell the full story. I needed a way to provide context for the viewer.

The multitude of meanings in a photograph makes it risky, arguably even irresponsible, to trust raw images of marginalization, suffering, and addiction to an often judgmental public, write Philippe Bourgois and Jeffrey Schonberg in their 2009 book Righteous Dopefiend. Letting a picture speak its thousand words can results in a thousand deceptions.

After selecting my final images, I showed them to Marie, Cheryl and Johnny. I wanted to know if they thought the photos accurately represented them, if they thought anything was missing and what they would have done differently if they had taken the photos themselves.

Many of their responses were positive. They thought that in most of the images, Id accurately represented them. And they had important suggestions. Most of all, they wanted to be seen in the photos as more than just drug users.

Ive included their most telling comments alongside each of the photos in this story.


When Marie was a girl, she dreamed of becoming a professional dancer and auditioned for the National Ballet School of Canada. Aaron Goodman, Author provided

A needle in my arm is only ten percent of who I am. The other parts are going to the park and playing, having fun outside and watching children play. Being as much a part of as I can be in the community. Im not just some dirty, mistrusting, drug addict from the skid row.

Marie self-injects her medication at Providence Healthcares Crosstown Clinic in Vancouver. Aaron Goodman

I dont have to be in alleys [injecting heroin] anymore, like I used to be. Im in a safe environment, no risk of getting or transmitting any infections, and my health is taken care of.

Marie crosses Vancouver by bus with her cat to try to find her mother, whom she hasnt seen in two years. Aaron Goodman, Author provided

Im caring for my pet whom Ive have taken on the busIm not selfish. I dont just think of me and my addiction. That was me, on the bus, going to see my Mom. I was going overnight so I had to take my cat with me. Theres more to my life than addiction Like my cat. Like my family. Like taking time out to remember where and who I truly am. And where I come from.

Maries cat tried to escape from its carrier bag several times during the trip. Aaron Goodman, Author provided

People looking at this photo might possibly see that Im being cruel. Which is not what I want them to see. I wasnt trying to hurt her. She looks very scared and sad there. She looks alone. And I dont like that because shes not. I wasnt trying to hurt her. I wanted her to meet my mom.

Marie approaches an apartment building where she thinks her mother may live. She hasnt seen her mother in over two years. Aaron Goodman, Author provided

People seeing this photo could think anything. They could think that Im going to see a drug dealer, they could think basically whatever they want, but thats not what it is. I was going to see my Mom. [I wish viewers could see] my face, the smile on my face that Im happy to see her. The excitement that I had because it was the first time I had seen her in a while.

Marie searches for her mothers name on an apartment intercom system. Aaron Goodman, Author provided

I look confused, maybe a little freaked out or something. I dont like [the photo]. I wish it werent so close up. Maybe its a harsh truth, I dont know.

Marie relaxes in her room in Vancouvers Downtown Eastside. Aaron Goodman, Author provided

People seeing this photo might see somebody whos happy, somebody who isnt so dark or depressedsomebody whos carefree and playful, and likes to enjoy herself. I do that all the time. Im always like that With a smile on my face, I try to always be happy. Which is really hard sometimes but yeah Its me.


A nurse treats Johnny at Vancouvers Crosstown Clinic before he self-injects his medication. Aaron Goodman, Author provided

I would like it if maybe theyd let me comb my hair, instead of looking like a real hardcore junkie here. I didnt realize my hair looked so bad when I take my shirt off.

The reason why I take my shirt off is because I muscle the dope, I dont IV it, because the reason why I do the dope is different from why a lot of other people do it. They do it to get high, I do it to help with some pain issues I have. I dont want people thinking, You know, these guys are going in there taking our tax dollars and doing heroin and getting high, look at them. You know, theyre nothing but detriments to society. Well, Ill tell ya, its saving my life.

Tattoos on Johnnys back. Aaron Goodman, Author provided

I have a love for animals, especially cats. I had a cat in my life for the last year-and-a-halfwell, no, the last eight months. And the more time I spent with humans, the more I love my cat.

Im not much on being a show off, thats why I put [the Siberian tiger tattoo] on my back Its something Ive always wanted to doand I managed to do that.

Johnny collects cans at a Vancouver food court. Aaron Goodman, Author provided

In this photo Im trying not to break the law and grab some bottles and cash them in. So I can basically eat and have food. Whats missing is the security guards who usually hassle me. And, they have no reason to because Im not hurting or stealing from them.

Im also helping the environment because 80 percent of these bottles end up going to the landfill or the garbage. Its not good for our ecosystem.

At this point in my life, I feel like I could come home at night and look in the mirror and not feel guilt or shame for what I was doing out there. Because Im not stealing from anybody or hurting anybody.

Johnny collects cans at a Vancouver food court. Aaron Goodman, Author provided

People looking at this photo will see a fella who looks very intense. He looks tired. Hes out trying to make an honest dollar. Hes not proud of what hes doing. But hes doing what he has to, in order to survive. At the point where Im at in my life, I think its a 100 percent accurate description of where my life is at. You can see the weariness, the life, the trials and tribulations Ive been through.

Johnny shops in a store where he used to shoplift before starting heroin-assisted treatment. Aaron Goodman, Author provided

I used to go into the shops and shoplift. I shoplifted quite a bit of food from this shop to feed my drug addictions, and thats one thing you dont see in this picture right now. I came and stole from this place and yet, a year later, Im welcome to come in that store because I made an immense change and do not steal in there now. I come in and buy food like any other individual, and it makes me so proud to be able to do that.

Johnny pauses in front of a tourist shop in Vancouvers Gastown neighborhood where he used to shoplift to support his heroin addiction. Aaron Goodman, Author provided

You can see the intenseness in my face. It looks like Im thinking deep about something and its just a feeling of gratitude of being happy and being alive I hope people get out of this photograph that its never too late. And what Ive been through in my life. We always have a chance as long as we stay positive in the moment. Live in the moment.

Jade figurines in a window of a tourist shop in Vancouvers Gastown neighborhood. Aaron Goodman, Author provided

These are some nice carvings. If you look close enough, done in jade. Very nice done little pieces and very expensive little pieces.

This photo represents a point in my life when I needed money to do dope. These were the things I would steal to feed my drug addiction. And they were small enough, and easy enough to steal that I would do it. And I had no problem doing it. I never once got caught stealing and grabbing these pieces of ornaments. I would go into the store and take about five minutes. Five minutes of work would keep me unsick for approximately two or three days.


Cheryl returns to an alley in Vancouvers Downtown Eastside where she lived for several years. Aaron Goodman, Author provided

People viewing this photo might see some young girl, downtown, in a back alley. Looks like its a rough alley. A young girl, maybe shes strung out, or maybe shes determined to find drugs or who knows what they see in this photo. They just see a young girl smiling and looking down the alley.

Yeah, it shows all of me. I just hope the people see me in this photo that Im a striving, struggling drug addict. That Im trying to better my life.

Cheryl self-injects her medication at Providence Healthcares Crosstown Clinic in Vancouver. Aaron Goodman, Author provided

I want to show the people that this place is where we get our injections for our heroin opiate program, just show them that we need these places so heroin addicts can get off the streets. Heroin can be contaminated with many different poisons out there that can severely give us infections, because they put hog dewormer in the heroin on the streets. The clinical heroin here, theres no bad chemicals or poisons in the drug. It helps us through the day, takes our aches and pains away, everything that heroin used to do.

In other places of the world, they had this study and its helped them, thats why they brought it to Canada, here to [British Columbia]. And for us, the people who are in it, were so lucky and should be so grateful to have such a great program.

Cheryl cries in the yard of a church where her fathers funeral was held. Aaron Goodman, Author provided

I hope the people see through this documentary all the points, all the emotions and desires, needs, and wants that we need, that you can help us down the road be able to successfully show our governments that people need the extra bit of help because we cant do it on our own.

Cheryl prepares to use drugs in in her apartment in Vancouvers Downtown Eastside. Aaron Goodman, Author provided

We need for you people to see that were not stereotyped monsters. Were people just like you, just with an addiction. Something that we do a little bit more than others When you look at this, take it with a grain of salt, because it could be your own daughter, it could be your own son out there doing exactly what Im doing, but they had the door closed.

A drug addicts world is not just the drugs, its how they get them, what you gotta do to get them. Sex trade, you know. Stealing, killing, whatever it might take just to get that extra dollar to get that extra fix so you can feel numb for the rest of the day. Not necessarily its always that, but in my life, I just want you to know that Im struggling and I need that extra help.

Cheryl paints her nails prior to a court appearance for a sexual assault she experienced. Aaron Goodman, Author provided

I think the people will see a young girl having a cigarette out in the rain, painting her fingernails, enjoying the weather. Really studying, Oh, come on, get the last bit of that nail polish out of the bottle. I am just on the outside in the rain. Im content. Im puffing on my cigarette.

Cheryl paints her nails prior to a court appearance for a sexual assault she experienced. Aaron Goodman, Author provided

Well, now people will see that I have a band aid on my hand. They might think she has a cut on her hand, thats why shes having difficulties painting her fingernails and getting that nail polish out of the jar.

Im sure theres hundreds of photos that could show my life different. But my life today is a recovering heroin addict. Im 124 pounds. I used weigh 97 pounds. Theres so many good things, and positive ways of looking at my life. If a picture could show all that emotion in one? That would be great, but it wont and thats all that my voice could tell you.

Cheryl self-injects drugs in her apartment in Vancouvers Downtown Eastside. Aaron Goodman, Author provided

I think that people see a girl looking in the mirror, looking in fear, like what is she doing with the needle in her neck, sticking in her neck, thats a pretty dangerous site to be injecting. But thats the reality of that picture. Its me being all strung out on dope, trying to get that shot into me, and its filled with blood and Im trying to plug it into my vein cause I need that drug thats in there so I can get off and get high, numb whatever pain Im going through in that moment.

I was all fucked up on drugs that day, yeah. It shows my emotion, my fear, my determination. [I wish the photo had] maybe a little bit more light Just to show its hard to inject into your neck like that. Just to show the picture more. To see what kind of struggle it is to inject in your neck. And to show maybe just a little bit more emotion to the people just to show what and why Im doing that to myself.

Postscript: Depicting The Lives Of Users

Throughout the project, Id spoken with the subjects about the purpose of the photo essay to challenge the stereotypes of drug genre photography and to help spread awareness about heroin-assisted treatment.

I often explained to them that their photos would likely be published on the Internet that police, future employers and others could learn they are heroin users. Despite the risks, the three subjects reiterated that they wanted to take part in the project because they, too, wanted to tell others about heroin-assisted treatment.

Id been told that after enrolling in the heroin-assisted treatment study, some participants had reconnected with family members, found stable housing and gotten jobs. I hoped that Id be able to take photos of Marie, Cheryl and Johnny in these types of settings.

However, I quickly learned that this wouldnt be easy. Two of the three subjects didnt engage in many other activities beyond self-injecting at the Crosstown clinic three times a day. Outside the clinic, much of their time was spent acquiring and using drugs.

This meant the moments I was able to capture ended up being far less varied than Id anticipated.

Still, there were revealing moments, like when I managed to photograph Marie traveled across the city by bus to try to find her mother. It was Thanksgiving and she hadnt seen her mother in over two years. I thought these particular photos might help the viewer understand Marie in a new way: even if people werent able to fully understand the depth of Maries suffering or the roots of her addiction, everyone knows what its like to want to spend the holidays with loved ones.

The greatest challenge I faced was determining how to document two of the subjects’ ongoing drug use outside of the heroin-assisted treatment study. I simply couldnt ignore it because it was a major part of their day-to-day lives. Marie and Cheryl told me that since the study was double-blind, they might not have been receiving the right medication or high enough doses to suppress their need to use other drugs. This doesnt mean heroin-assisted treatment doesnt work.

When the time came to choose the final photographs, I deliberately left out images that I suspected could be viewed as the most sensational or degrading.

My photo of Cheryl, lit by a candle and injecting drugs into her neck in front of a mirror in her apartment may not appear any less shocking than other drug genre photographers images of injection scenes.

However, Cheryls own words that accompany the photo provide critical context for the viewer. She explains that she was compelled to buy street drugs and inject into her neck even though she knew the drugs could be contaminated and possibly kill her because she was desperate to do whatever she could to feel well, even if this meant risking her life.

In order to see Cheryl as more than a drug user, the viewer needs to know this.

Aaron Goodman, Faculty, Journalism and Communication Studies, Kwantlen Polytechnic University

Source: Array

Wonder Of Science


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