Cape Cod: America’s Heroin Hot Spot

In Steven Okazaki’s new documentary, he explores the heroin epidemic hitting one East Coast town.


I received an advanced viewing of HBO’s latest documentary Heroin: Cape Cod, nervous to hit play.

The best comparison I can make to the experience would be watching a car hit a brick wall. I knew exactly where the story was headed, yet I was drawn to the horror of the journey. I was left searching for answers. I was wondering who, if anyone, would walk away a survivor. I felt angry. I felt sad. I felt frustrated with the subjects of the film. As one subject spoke in an ethereal, detached voice comparing shooting up to Christmas, I caught myself yelling at the screen.

In 1999, television viewers curled up in their living rooms across the United States to watch a documentary on a subject that, at the time, seemed both foreign and terrifying. The film Black Tar Heroin: The Dark End of the Street was the story of five young addicts living on the streets of San Francisco. I was one of them.

Over the course of 74 minutes, viewers saw the progression deeper into the world of addiction. It was a glimpse into the struggles faced by the subjects: incarceration, prostitution, trauma, and HIV. One of HBO’s highest rated documentaries, the film is regarded by many as the definitive work on the subject of heroin addiction. It is shown in universities, jails, and treatment centers as the ultimate cautionary tale. With a second life on YouTube, BTH has racked up millions more views since 2012.

Steven Okazaki, the Academy Award winning filmmaker behind BTH, is back with his new film. While the area has the public reputation as a sleepy vacation town, it has the private label of “Cape Nod.”

It has been 18 years since I concluded my portion of the film. I can sit cuddled up to one of my children as I reflect on those last few moments. I was staring past my feet. They were bruised from injecting on both the tops and the soles in the tiny unremarkable veins I used as a last resort. I was on a dirty bed in a dirty room in a pay-by-the-day hotel with the bloodstains left by others peppering those walls. It was another holiday season in a long series of disappointing years for my loved ones. If there is such a thing as “rock bottom,” I certainly had achieved it in the two years the camera followed me.

Once the filming ended, it wasn’t long before I was arrested and my recovery process began outside of the prying lens Steven Okazaki used to peer into my daily existence.

When I watched Heroin: Cape Cod I felt my face become warm and wet with tears as I heard the parents of children with heroin addiction tell their stories. It made me wonder how my own parents must have felt. I thought about how much times had changed when I saw the characters tie their arm off for injection with an iPhone cord. Obtaining heroin was an effort in my using years. These subjects discuss heroin coming to their doorsteps.

One immediate criticism of the film is that heroin only becomes an epidemic when it happens to white people. While this may be true, the film provides a window into the life of subjects that will seem familiar to those who have been recently touched by addiction. The subjects describe being “bored” or completely unaware that prescription drugs would lead them to a place where they are searching for a vein in their neck.

As an observer, I had many questions. I wanted to ask Okazaki more about the film. I found his film to be visually stunning and emotionally draining. I felt particularly drawn to the honesty of one of the subjects who had incredible insight into her own condition—but as I learned her fate before the closing credits, I realized that with heroin it becomes impossible to know who will make it. In addition, I wanted to know his thoughts on what makes his film different from the recent rush of drug related documentaries flooding cable channels.

I have received calls, messages, and been stopped hundreds of times over the years by people that think Black Tar Heroin is the definitive documentary of heroin addiction. What made you decide to revisit this topic?

It’s been nearly 20 years since I filmed Black Tar Heroin in San Francisco. I think we went deeper into the young addict’s life than any other film and it’s still very relevant, but we still just scratched the surface. It was bad then, truly horrible, but it was confined to a few neighborhoods in a few cities. Now it’s everywhere. The big factor, of course, is that opiates are so much more prevalent. They’re in most American homes’ medicine cabinets—Vicodin, Percocet, Oxycodone, Hydrocodone, etc. Eighty percent of heroin addicts started with prescription painkillers. I felt like it was clearly time to take another look at the subject and this film provided an opportunity to look at a different population in a different setting.

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What were the main differences and similarities between these subjects and what we hear about in the broader heroin “epidemic”?

In Black Tar Heroin, many of the kids were drawn to the mystique of the drug. They saw themselves as outsiders, rebels, they’d read William Burroughs’s Junky, were into Kurt Cobain. They liked the idea of doing a drug that other kids were afraid of. And they were mostly hustling to sustain their habits. With Heroin: Cape Cod, a lot of the subjects were just looking for a good high. Alcohol and marijuana wasn’t doing it for them anymore so they moved on to OxyContin, then heroin. In Cape Cod, heroin is cheap, easy to find, and potent. The kids are bored, have limited opportunities, and are looking for a good high, a way to escape. I understand that part, but the life that comes with it is so terrible, so demeaning.

I don’t know what makes something an epidemic, but a lot of kids are dying; 1,400 overdose deaths in Massachusetts last year is a seriously scary number.

I was really struck by the bravery of the parents who allowed themselves to be part of the film. My own mother suffered in silence as she wondered on a daily basis if today would be the day she would get that call saying I had died from my addiction. How did you recruit the parents who chose to become involved in the film?

The parents of addicts group in the film was extraordinary. I heard that there was a parents’ support group in Cape Cod which meets every Monday, except on holidays. So, on a Columbus Day, since they weren’t having their usual meeting, I asked if they would have a special meeting 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. But we ran out of chairs. Everybody showed up, open and eager to talk. They didn’t have to be convinced. They’re tired of hiding their child’s addiction, feeling lonely and ostracized. They need to share their stories, they want to get the word out and try to help each other. So 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.

When you are filming, is it hard stay objective when you are witnessing acts that may lead to the demise of your subject?

I have a job. When filming anything, I try to be neutral and non-judgmental, so the subjects will feel comfortable to say and do what they feel. These kids are going to shoot up whether we’re there or not, and they can overdose anytime. I’ve had to revive addicts from unconsciousness, no heartbeat. It’s scary. I put the camera down, try to revive them, call 911. We carried Narcan in the camera bag, just in case. After awhile I realized we should leave the Narcan with them since they’re in more danger when the crew’s not around.

We’re in and out of their lives for a few brief moments. If they’re serious about getting clean we’ll try to help them, take them to detox, cameras running or not.

Writer’s Note: I vaguely remember one of the people working on the film taking me to the methadone clinic to sign up. I didn’t stay in treatment there. When I was sent, Steven came to visit me in my rehabilitation program. He brought me a chocolate cake that I still remember 17 years later.

Black Tar Heroin seems to have spawned a set of similar docu-series around the issues of addiction. Does the narrative happen organically or is it constructed in light of the progression of the events while you are filming?

I hate films with a pre-prescribed agenda, where you know what the filmmaker wants you to feel and care about in the first few minutes. That’s propaganda or a long form documentary commercial. I have no interest in that kind of filmmaking, which is what dominates the field. I try to find compelling people that I like being around for endless hours and let the stories evolve. Often, especially with this subject, nothing happens for days. You wait for someone to show up at the Dunkin’ Donuts parking lot, freezing cold, for hours, then go back to the hotel with nothing. But, if you’re open and lucky, somebody will say something surprising and beautiful. Or something unexpected happens like the party scene in the film or when Colie and Shan go to the detox and have a fight. You think, “Finally, we have a film.” You have to have those moments to make a good film.

What insight do you feel viewers will gain about heroin use and abuse from the film?

I started the film will one simple goal, just to humanize the subject. When Marissa says, “I could be your daughter,” I feel like that’s what the film is about. But 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.