HBO Producer, Lise King, Talks to us About the “Heroin: Cape Cod, USA” Documentary
Prescription opioid and heroin addiction, overdose and deaths have been serious problems for many years. As the crisis more recently expanded to suburban and urban communities, it has generated significant media and political attention. Documentaries are being developed to raise awareness of the epidemic and its devastating impact on families in a way that is relatable to viewers. A recent example is the HBO documentary “Heroin: Cape Cod, USA,” which offers a graphic portrayal of heroin addiction by following the lives of eight young people addicted to the drug.
The film effectively demonstrates the horrors of heroin addiction and the tragic reality that people are still not receiving the treatments that are known to work by halting the addiction and preventing overdose. Instead, the young people are portrayed as they go through the ineffective system of detoxification, followed by sober houses or attempts to recovery, without the use of ongoing medication, neither of which have scientific evidence of working for people with severe heroin addiction.
What is concerning in its omission from the film is mention of Medication-Assisted Treatment (MAT), which combines longer-term counseling with medications. Methadone, Suboxone (buprenorphine) and Vivitrol (naltrexone) prescribed by a physician are the most effective, potentially lifesaving, treatments for opioid addiction.
MAT can stop people from experiencing the intoxication, craving and withdrawal effects of opioids, reduces drug use and overdose rates and helps retain people in treatment longer – all of these effects are associated with better outcomes. Because the eight people in the film using heroin were not being maintained on MAT, the message that people can and do recover from this terrible disease is overshadowed by a sense of hopelessness over the deadly outcomes associated with insufficient treatment.
We had the opportunity to speak to Lise King, Co-Producer of the film, who shared her valuable insights on what it was like to work on the “Heroin: Cape, Cod USA” documentary and answer questions about treatment.
What made you want to work on such a profound film like this?
The opportunity came by chance. A colleague emailed me saying that there was an immediate need to help on a film in Massachusetts. When I found out what it was, I realized that the project was a great fit because its goal was to use media as a platform for positive social change and justice. Previously, I had obtained my Master’s in Public Policy and Public Administration at the Kennedy School of Government at Harvard University and worked in media, film and publishing my entire adult career. I also accepted a fellowship at the Carr Center for Human Rights Policy and was involved in an ethnographic film-making program, where I learned from some of the best documentary film makers. This particular opportunity to work on the heroin documentary seemed perfect.
While working on this project, I became deeply embedded in the lives of the people in the film. I have addiction and recovery in my family so it was a subject I was familiar with, although not opioid addiction in particular.
You followed and filmed numerous addicted persons in the film over an extended period of time. How did you get them to participate in this? Were they paid?
We don’t do “pay to play” in documentary work – that’s just journalistic ethics. I think they looked at it as a way for them to provide service by sharing their story in a really profound way. That was the hardest part of making the film…finding people who fit all of our criteria and who would be relatable to viewers – where someone watching the film would think, “that could be my kid or my classmate.” We set the parameters up front and were very candid about what the reality of being in a documentary released on HBO actually means. We made sure to communicate that the film would be seen by millions of people including the participants’ families, neighbors, friends and employers. We didn’t want participants who were incapable of giving informed consent.
Was it challenging working with such young people who you knew might end up dying from an overdose?
Yes. I’ve never seen anyone shoot up before and it was very difficult to watch and be in their private space as an observer and as a mother of a 23-year-old, which I didn’t disclose because I didn’t want them to look at me as a mom figure. But, our job is not to intervene; it’s to document what’s going on. Although, we were trained to use Narcan, the drug that reverses an opioid overdose, and of course we would have used it if needed.
What happened to me is interesting because there was a moment where it was no longer shocking for me to watch these kids shoot up heroin – I became desensitized to it. And I think this speaks to how something seen as an outlier activity can become normalized within a community.
The film refers several times to treatment approaches (detoxification, short term inpatient rehab and sober houses) and portrays what the research shows – that these are ineffective forms of treatment for people with severe opioid addiction. Why was no mention made of MAT (methadone, buprenorphine and naltrexone), which are considered best medical practices?
As much as possible we were just trying to observe and present honest portraits of the people in the film. We were looking at particular people with heroin addiction, not the whole picture of heroin addiction. Therefore, some aspects of addiction and recovery weren't in the film if it wasn't part of the experience of the people we were following. During the filming, one of the participants was using Vivitrol while taking numerous amounts of other drugs.
There has been significant mention in the media that the opioid problem became an epidemic worthy of political attention once it started killing white kids and when the victims were black, the problem was ignored or criminalized. Have you received any criticism for the film’s specific focus on white kids in Cape Cod?
No, I have not heard that criticism applied to our film. I’ve read about that subject and heard people talk about it in general, but not towards our film.
It was interesting to see and hear the parents in the support group. Why do you think it was important to include their take on addiction?
The parents are part of the story. They were an integral part of our exploration process and very generous in letting us come to their support groups and talk to them. With the age group of the kids in the film in particular, the parents were involved and taking an active role and found a really important way to deal with the trauma in their lives though the parents support group.
Michelle Conley, MIPH
Michelle is a Communications and Digital Manager at Center on Addiction