When you think of Cape Cod, Massachusetts, you probably associate it with picturesque summer vacations — not rampant heroin addiction. But 85 percent of the crimes on Cape Cod today are opiate related, and that's just the tip of the iceberg.
In fact, Cape Cod is a microcosm of what's going on across the country. Between 2007 and 2013, the number of heroin users in the United States nearly doubled, and it's currently growing at a faster rate than any other drug — including meth and cocaine, according to the Substance Abuse and Mental Health Services Administration.
Not to mention today's heroin addict looks a lot less like a character from The Wire and more like someone from Desperate Housewives: Opiate abuse has increased the most among the demographics you'd least expect, including women, people with high incomes, and people with private insurance.
Why? According to a May 2015 study published in JAMA Psychiatry, it's got a lot to do with prescription opioid painkillers; heroin becomes an unexpectedly appealing option to someone addicted to prescription painkillers because it's cheaper and more potent.
This becomes all too clear in "Heroin: Cape Cod, USA," a documentary about eight young heroin addicts living on the seemingly idyllic vacation destination, which debuted on HBO in December 2015.
One of the women featured in the film took us through her terrifying relationship with the highly addictive drug that took over her life.
Jessica's Story: Accident to Addiction
"I think the U.S. knows that the northeast has a big problem with heroin, but I don't know if they know how bad it is on Cape Cod," Jessica says.
About three years ago, when Jessica was 18, she was hit by a drunk driver and severely injured. She was grateful to be alive, but was devastated when she learned the crash left her with 250 stitches in her face. "My face was all lacerated," she remembers. "I really didn't want the world to see me."
Jessica didn't leave her mother's house for the next six months. She had been working as a preschool teacher and attending college for early childhood education, but her career came to a halt after the accident. She stayed home, suffering from ongoing pain and depression — and armed with prescriptions for opioid painkillers Percocet and Dilaudid.
"I would take one pill, then two. I had started out taking 30 milligrams a day and within a month, I was taking 600."
The high she felt on the painkillers was as if she had discovered a missing piece of herself.
"It's hard to describe to people who don't understand, but it's like filling a hole," she says. "You want to feel complete everyday, so you will take the drugs each day, but then your tolerance gets bigger, so you have to take more."
After a while, Jessica says, getting high becomes a basic necessity. She likens sobriety to feeling naked: "You'll do whatever it takes to get clothes because you can't go out into the world naked," she says. "And eventually, people like me turn to heroin because it's cheaper — and we need that clothing."
Heroin offers the same type of rush as opioid painkillers but for a fraction of the cost, which is why Jessica switched over to "dope." But with no money to her name (by this time she had quit her job and failed out of school), she sold her laptop, iPad, and beloved guitars, stole from her mother, robbed strangers, and even slept with a few people to support her habit.
"I was just hoping one day I would wake up from this nightmare, but it didn't exactly happen like that," she says.
On the Road to Recovery
Then, last year, Jessica was approached by a friend who told her that Academy Award-winning director Steven Okazaki was looking to feature someone just like her — a young adult living in Cape Cod who is addicted to heroin — in an HBO documentary. She agreed to be in the film with the hope of raising awareness about the crisis that is heroin addiction.
"Not enough people believe it's a disease," she says. "It doesn't discriminate. There's no walk of life it hasn't touched. There are millions of people out there who are going through the same thing that happened to me. I just wanted as much coverage on it as possible. And if I had to sacrifice my life story for it, that's fine."
But the documentary might have been a blessing in disguise for Jessica. While she was still using during production of the documentary, Jessica is proud to report she has been heroin-free since September 12 and attends regular group therapy sessions as well as therapy with a counselor. She hopes to attend cosmetology school — "Especially after my accident and all of the scars on my face, my absolute dream is to help people feel beautiful" — and to maintain her sobriety.
"Someone in the film had said, 'In your lowest low, there's a trap door underneath,'" Jessica remembers. "Two people from this documentary have died. I don't know what can happen to me. I don't know what the future holds if I continue to use, so I want to stay clean."
A Spotlight on Addiction
"My goal with this film — and pretty much any film I do — is to give a subject that people are weary of, that makes them a bit uncomfortable, and give it a human face," says Okazaki, who has created two previous HBO documentaries about addiction called Black Tar Heroin and Rehab. "Maybe they'll consider what the issue is, think about the actual people who are going through it, and see that they're really just like you or your own kids."
He's also hoping people get a better understanding of how serious and widespread this problem is. "The whole thing about heroin is that everybody is vulnerable, from the kid who comes from a really rough background to someone from a privileged background," he says. "Opiates are in nearly every medicine cabinet in America right now… We are over-prescribed. I think people see [opiate painkillers] as this positive thing, which it can be. But it does have this other downside and really dangerous aspect."
The documentary is full of poignant moments, but one stands out to Okazaki: "To me, the most striking thing in the film is when one of the young girls says, 'Don't disrespect me. I could be your daughter,'" he says. "I'm struck by her pride and her defiance by saying, 'Don't label me.'"
Okazaki, who says the young adults featured in this documentary took "an act of faith," hopes their stories will inspire viewers to raise awareness and take action. "Maybe there will be some empathy, maybe there will be some change in our attitudes, and maybe there will be some help."
"Heroin: Cape Cod, USA" debuted in December 2015 exclusively on HBO. Check the HBO schedule for additional play dates. The documentary is also available on HBO NOW and HBO GO.