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Making the Opioid Epidemic Visible

A new Netflix documentary offers a ground-level look at the crisis engulfing one West Virginia town—through the eyes of the women working to save it.

Rebecca Kiger/Netflix

Reading about the opioid epidemic feels like navigating an outbreak of numbers. Fifty-nine thousand to 65,000: people who died from overdose last year. Sixteen percent: the increase in American opioid deaths from 2014 to 2015. Seven hundred and eighty million: the quantity of hydrocodone and oxycodone pills shipped to West Virginia from drug wholesalers. Fifty-eight: people who died of overdoses from January to June this year in Cabell County, West Virginia, alone. These are the facts we know, and they are each about as useful as a flashlight in a fog. They illuminate a single area, but the problem is the fog.

Heroin(e), a short Netflix documentary set in Huntingon, West Virginia, attempts to give us a clearer view of the opioid crisis. It tells us how one community lives under the combined weight of political negligence and corporate greed, offering a cross-section glimpse of this story’s various strata. It is shot with great sensitivity, alternating between stark realism and an accompany sense of the surreal; the street lights blur like magic in one sequence, making it all the more jarring when first responders try to save a passed-out woman in a bluntly lit Sheetz. The first sounds you hear in Heroin(e) are sirens, a warning: This is an emergency. In 39 minutes of film, it’s an emergency Huntington mostly confronts on its own.

There are three protagonists: a drug court judge, a fire department chief, and a street missionary—all women. These women have steady hands and clear eyes, and they understand the odds against them. “It’s sad when you can drive around this city and say, ‘Oh, somebody died there, somebody died there,’ but that’s the reality of this area,” fire chief Jan Rader says, pointing at houses from the window of her ambulance. At one, she slows to a stop. “This white house right there, we had two deaths in 2015.” It’s a small house with peeling paint; its windows betray no movement.

“When you add hopelessness and unemployment and lack of education on top of all that, it’s kind of like a recipe for disaster,” she says. “I feel like we’ve lost a couple generations, not just one generation.”

West Virginia is not a populous state, nor a rich one. It is the only state that sits entirely within the service area of the Appalachian Regional Commission, which was established by the federal government in the 1960s to address the region’s chronic poverty. And it is associated, to its own detriment, with coal. But as stereotypes go, coal now shares space with other malevolents. Say “West Virginia,” and people think Donald Trump and opioids. The crisis struck West Virginia with particular force. There have been so many overdose deaths that the state exhausted its indigent burial fund five months before the end of this fiscal year. In response, the president it voted for went back on his campaign promise to declare the crisis a “national emergency,” which would have automatically allocated federal funds to fight it.

Politicians are notably absent in Heroin(e). This is not a film about Trump, or even about the state’s own crony politics. That is not an error by filmmaker Elaine McMillion-Sheldon, herself a West Virginia resident. It simply mirrors reality: Politicians have been absent, and continue to be so. As a result, the efforts to fight the epidemic have been piecemeal. Rader manages to score a supply of Narcan for her first responders, but they aren’t required by law to administer the drug, even though it’s frequently the only emergency measure that can prevent overdose deaths. There’s also resistance to using Narcan in principle: Narcan will only encourage addicts to stay hooked, or so the reasoning goes.

But as Rader points out, addicts can hardly get help if they’re dead. Keeping Huntington’s residents alive is also a pressing concern for Cabell County Judge Patricia Keller, who provides over drug court. At times, Keller seems more like a counselor than a judge. “Did you really relapse?” she asks one man; he confirms, and she nods slightly. “Tell me about it,” she urges. Keller speaks to the people in her courtroom as if they are just that—people, not problems or corpses-in-waiting. When participants complete the rehabilitation program and graduate, the joy is palpable. But her work is emotionally taxing, just as it for Rader and for Heroin(e)’s third protagonist, a real estate agent named Necia Freeman.

Freeman is also a kind of missionary: She runs the Brown Bags Ministry, which distributes free food and hygiene products to sex workers on Huntington’s streets. Her politics run conservative—she initially placed a Christian tract in each brown bag meal. In Huntington, however, the church is one of the only sources of help for addicts. Churches run shelters and missions and give out food; without them, living people would otherwise be dead. Freeman patrols the streets of Huntington in her minivan, handing out food while urging women to take shelter for the night. When they graduate from the drug court program, she is there to celebrate.

Heroin(e) doesn’t just make visible the work of rescuing a community. It asks us to consider who does the rescuing. And in Sheldon’s film, it’s women. All over the world, the work of maintaining poor communities typically falls to women, and they often carry this burden in silence, without complaint. Heroin(e) disturbs that custom. If Huntington survives, it will be because of its women—and because those who live outside the state of West Virginia pay them the attention they deserve. The problem is obscurity; the solution is visibility.

The way we talk about drugs and the people who use them are part of the problem. Language becomes a way to deploy whatever stereotype we want to apply to a given population. During the crack epidemic, we talked about crack babies and welfare queens, while white pundits said the problem was culture. Now, for poor whites in the opioid epidemic, we often revert to the language of class. They’re white trash, garbage people in a garbage place. At times the invisibility of Appalachia even seems reinforced by its geography. When I was a child across the border in Virginia, I thought the mountains could swallow us and no one would know. Who would ask where we’d gone, or wonder when we’d return? We would have to dig ourselves out.

Heroin(e) demands better from the world outside those mountains. It does not let anyone distance themselves. It presents addicts and rescuers in the same frame, with the same respect. It asks you to see.