Cheryl gets ready for a date in her apartment in Vancouver’s Downtown Eastside. Q: “What do you think people on the outside see in this photo?” A: “They see a young girl, me, Cheryl, putting on her lipstick, smiling, getting all dolled up for the night on the town or whatever she’s doing that afternoon or evening.”

Heroin Users Help Us See Photos Of Addiction Differently

After a year taking photos of three long-term heroin users, I turned to them to help interpret the images

by Aaron Goodman


This is the first in a series of three articles that share the results of a project in which I photographed three long-term heroin users — Cheryl, Johnny and Marie — and asked each to interpret my photos.

Read Part Two: Johnny’s Story. Read Part Three: Marie’s Story


A HEROIN epidemic is spreading across North America. In Canada, as many as 90,000 people are addicted to heroin. Thousands are prescribed oral methadone, but for some of the most chronic and vulnerable drug users who don’t sufficiently respond to it, other treatments are needed.

Vancouver is the first city in North America to provide heroin-assisted treatment to 120 heroin users who exited the Study to Assess Longer-Term Opioid Medication Effectiveness (SALOME), a clinical study that looked at ways of treating people addicted to the drug.

“Heroin-assisted treatment works. It gets people into care, and that’s what’s important to me, that’s what’s important for their health and what’s important for our society,” said Dr. Scott MacDonald, physician lead at Providence Health Care in Vancouver.

Canada’s former Conservative government cut off Providence Health Care physicians’ rights to offer heroin-assisted treatment. In late 2013, Providence and five SALOME patients took their battle to British Columbia’s Supreme Court where they won the right to continue to access the treatment.

“It’s our moral responsibility to provide for some of these folks who are the most ill, sick, marginalized in our society,” says MacDonald. “We have an ethical responsibility to help them and by helping them society will get better.”

Exploring a new approach to photography: A beautiful, generative failure

If the public and policy makers are divided about heroin-assisted treatment, a lack of information certainly won’t help. I wanted to see if a collaborative photography project would create a new type of imagery. I wondered if new imagery could spur new attitudes.

For over a year, I worked with Cheryl, Marie and Johnny — three long-term heroin users taking part in the SALOME clinical trial. They’ve each repeatedly tried methadone and other treatments and have been unable to stop using drugs but they say heroin-assisted treatment saved their lives.

For decades, documentary photographers such as Larry Clark, Eugene Richards, and Lincoln Clarkes, who took over 300 portraits of female heroin users in Vancouver’s Downtown Eastside from 1997 to 2001, as well as countless photojournalists around the world, have represented heroin users as exotic, primitive, and dangerous to society.

Photo: Larry Clark

“There is a tendency in drug photography to attempt to make images of dark, seedy, secret worlds,” writes sociologist and cultural theorist Stuart Hall. “This can have the effect of Othering the subject, or making them different through eroticizing or exorcising them.”

I wanted to see if I could create photographs that could humanize drug users and, in turn, help viewers come to their own conclusions about heroin-assisted treatment. Easier said than done. Two of the subjects of my story spent much of their time acquiring and using illicit drugs and didn’t take part in many other activities. I tried to represent them in the least stigmatizing ways possible, and while curating the final photos for the project, I deliberately left out many images that could be seen as the most exoticizing or harmful. At the same time, I couldn’t ignore the reality of their lives. In the end, I realize, some of my photos, on their own (without excerpts from interviews I conducted with the subjects, as outlined below) replicate some of the elements that I am critical of in other photographers’ images of heroin users.

(While two of the subjects continued to use illicit drugs, it doesn’t mean heroin-assisted treatment isn’t effective. They said they likely weren’t receiving the right medication or high enough doses during the double-blind study, but said the clinical trial had allowed them to significantly reduce their illicit drug use.)

Hearing from the heroin users

If there’s one thing I learned, it’s that images on their own are unable to communicate the full depth, complexity and humanity of drug users’ — or anyone’s — lives. From the outset of the project, I intended to pair the images with excerpts from interviews with the drug users.

“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 about heroin injectors and crack smokers in San Francisco. “Letting a picture speak its thousand words can results in a thousand deceptions. For this reason, we insist that without our text much of the meaning of the photographs we present could be lost or distorted.”

I wanted viewers to know about the challenges the drug users face but I wasn’t deluded enough to think that my photographs alone could, or would do that. Photographs spur interpretation. That much is unavoidable, so I decided to be proactive about the interpretation — and the text that accompanied my published images — and asked Cheryl, Marie and Johnny to reflect upon my images. I asked them if each photograph accurately represented their lives. And I asked them what they thought I could have done differently.

Beginning with Cheryl’s story below, I will share (in three-parts) the responses given to me by the three heroin users with whom I collaborated. Their most informative and compelling comments accompany the photos.

I do not consider the project a total success; I believe there are limits to what we can learn from heroin users from photographs and (even lightly-mediated) texts. However, I believe there is value in sharing the process and outcome. Sharing failures can be generative. The ways in which this project fell short may be foreseen and successfully negotiated in others’ future projects.

Others may be inclined to support drug users so they can take and curate their own photos. It’s worth noting that I facilitated a digital storytelling workshop for ten SALOME participants in which they took all their own photos, wrote and audio recorded scripts, and used digital video editing software to create short multimedia stories about their lives. Marie and Johnny, two of the subjects of the photo documentary, also took part in the workshop. Their stories and others’ can be viewed here: www.storyturns.org/harmreduction

We can only benefit by hearing from those who are suffering and at the centre of this public health issue. That’s what this project was ultimately about.


PART ONE: CHERYL’S STORY

Cheryl returns to an alley in Vancouver’s Downtown Eastside where she lived for several years.

Aaron: What do you think people on the outside see in this photo?

Cheryl: They see some young girl, downtown, in a back alley. Looks like it’s a rough alley. A young girl, maybe she’s strung out, or maybe she’s 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.

Aaron: Do you think this photo accurately represents you?

Cheryl: It represents me for what they see in the photo, yeah. Yeah, it shows all of me.

Aaron: Is there any other information you want people to know? What do you hope people get out of this photograph and what do you want to show?

Cheryl: Nothing. I just hope the people see me in this photo, as well the rest of the photos in the documentary, that I’m a striving, struggling drug addict. That I’m trying to better my life.

Cheryl self-injects her medication at Providence Healthcare’s Crosstown Clinic in Vancouver.

Aaron: What do you think people on the outside see in this photo?

Cheryl: They see a young girl in a room, must be a place they can do safe injections. There’s probably nurses, doctors around to see, to be there for support or just for the side help this girl might need. It shows that she’s using probably clinical drugs because it looks a facility that is well kept. There’s glass windows, person behind there with a computer, watching her making sure she’s safe, and she’s to tend to anything if needed, they’d be right there for her.

Aaron: Do you think this photo accurately represents you?

Cheryl: Yeah, it does, it shows my facial expression. It shows what I’m doing at that time, injecting a needle into my hip. I’m still in addict behavior and still in this program, still getting help for my addiction.

Aaron: Is there any other information you want people to know? What do you hope people get out of this photograph and what do you want to show?

Cheryl: 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 which is 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, there’s 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 it’s helped them, that’s why they brought to Canada, here to B.C. And for us, the people who are in it, we’re so lucky and should be so grateful to have such a great program, and I hope that the people see that this place is needed and they speak out for the yes for having other programs open up like these, because we definitely need them and they save lives. They saved my life. Thank you on that one.

Cheryl cries in the yard of a church in Vancouver’s Downtown Eastside where her father’s funeral was held.

Aaron: Is there any other information you would like people to know? What do you hope people get out of this photograph and what do you want to show?

Cheryl: I don’t have anything else to show in this picture. I hope the people see it for who I am, and you know, trying to be a recovering drug addict. In my journey in my life today, I’m going through a heroin program to better my life and I just want the people to know that they need opiate programs for heroin addicts more, just so they can save the people who are out there, still struggling on the streets.

And 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 can’t do it on our own.

Cheryl prepares to use drugs in in her apartment in Vancouver’s Downtown Eastside.

Aaron: What do you think people on the outside see in this photo?

Cheryl: Possibly me lighting my lighter to see what’s in my needle. Maybe she is heating it up, doing a shake and bake, heating up the heroin so it all dissolves. Could be quite possibly, or she’s looking to see if she has a vein on her hand to inject it into. Not sure what the picture really states.

Aaron: Do you think this photo accurately represents you?

Cheryl: Yeah. It shows my emotions that day, how I felt what I’m doing. It accurately represents me at the time, at that place.

Aaron: Is there any other information you want people to know? What do you hope people get out of this photograph and what do you want to show?

Cheryl: I just want to show people that, you know, I’m a drug addict. I’m a recovering addict. This program I’m on is a great program. It’s helped me in many, many angles. I just hope you see that this documentary brings light into your lives to show that there are addicts out there in the world that need a little bit more help.

We need for you people to see that we’re not stereotyped monsters. We’re people just like you, just with an addiction. Something that we do a little bit more than others. I just want you to know that, you know. 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 I’m doing, but they had the door closed because you guys look down on it, so they don’t want to share that with you.

I just hope that you have a better perspective on what a heroin addict’s life or what the person does in order to get their drugs, or whatever they’re doing in their drug addict lives. That we can get better help for addicts, and our world would be a safer, more serene place, because it wasn’t such a war on the hatred of drug addicts, and the war on drugs, the war on safer places to inject, and having safer places for addicts to go so they feel less harm coming their way because they go through many different things.

A drug addict’s world is not just the drugs, it’s 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 it’s always that, but in my life, I just want you to know that I’m struggling and I need that extra help.

I’m asking for that outside help, to look at these pictures and see what I went through my little struggle, my little journey and how you could better my journey, by helping other heroin addicts better their lives and help themselves.

And for you people to not see it as a bad thing. See it as a good thing to help the less fortunate, to give us a chance, cause we’re all equal people down here. So thank you.

Cheryl paints her nails before a court appearance about a sexual assault she experienced.

Aaron: What do you think people on the outside see in this photo?

Cheryl: I think the people 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 don’t know. She’s really studying on her fingernails, I don’t know what’s she’s thinking but it looks like there isn’t much left of the nail polish in that bottle. I don’t know what the people see in that photo. I am just on the outside in the rain. I’m content. I’m puffing on my cigarette though.

Aaron: Do you think this photo accurately represents you?

Cheryl: It represents me fully because it’s my face. There’s my face, my facial expression, what I’m doing in action, I’m standing up outdoors. Yep, I guess it represents me in that photo, yes.

Aaron: How would you have liked me to take photo differently and why? What’s missing?

Cheryl: There’s nothing missing. The photo seems accurate. There’s nothing I would change about it. There’s nothing wrong about and there’s nothing I would put more into it. It’s a good photo.

Cheryl paints her nails before a court appearance about a sexual assault she experienced.

Aaron: What do you think people on the outside see in this photo?

Cheryl: Well, now they see that I have a band aid on my hand. She might have a cut on her hand, that’s why she’s having difficulties painting her fingernails and getting that nail polish out of the jar. I don’t know.

Aaron: Could you imagine a different photograph that would help people understand your life?

Cheryl: I’m sure there’s hundreds of photos that could show my life different. But my life today is a recovering heroin addict. I’m just looking for the support and the people to see that us junkies or heroin addicts aren’t mass monsters and bad creations of our parents doing wrong. It’s our own choice to do drugs.

I just wish that there’d be better places out there to help heroin addicts get by better in their lives without being stereotyped or judgement or cussed or criticized. We’re all the same out there. We all have different wants and needs in our lives. I want to be, one day, clean of heroin and other drugs, and say thank to the SALOME project who had helped me in my journey so far, get to this point in my life. I’m doing so much better.

I’m 124 pounds. I used weigh 97 pounds.. There’s 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 that won’t and that’s all that my voice could tell you. So yes, thank you for this photo.

Cheryl self-injects drugs in her apartment in Vancouver’s Downtown Eastside.

Aaron: What do you think people on the outside see in this photo?

Cheryl: 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, that’s a pretty dangerous site to be injecting, even to be showing. But that’s the reality of that picture. It’s me being all strung out on dope, trying to get that shot into me, and it’s filled with blood and I’m trying to plug it into my vein cause I need that drug that’s in there so I can get off and get high, numb whatever pain I’m going through in that moment.

Aaron: Do you think this photo accurately represents you?

Cheryl: It accurately represents me at that time in that photo, yes. I was all fucked up on drugs that day, yeah. It shows my emotion, my fear, my determination.

Aaron: How would you have liked me to take photo differently and why? What is missing?

Cheryl: Maybe a little bit more light. Other than that, it just grabs it just the way it is. You can see everything.

Aaron: More light where and why, please?

Cheryl: On the left side of the mirror, and the right side of me, on the outside of the mirror, just to show a little bit color in the middle of the picture. That’s about it. It would highlight my face and around my hair, and lighten the darkness at the elbow, right where my hand is injecting it. Just to show it’s hard to inject into your neck like that. Just to show the picture more.

Aaron: It would help people see what more?

Cheryl: 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 I’m doing that to myself. I don’t know.



This project was supported by a Katalyst Grant at Kwantlen Polytechnic University in Surrey, B.C. where Aaron is a faculty member in Journalism and Communication Studies.

Aaron Goodman is a photographer, multimedia producer, documentary maker and instructor based in Vancouver, B.C. and Montreal, QC. Connect with Aaron on Twitter and LinkedIn.