Outcasts: Exploring Documentary Photography and Photo-Elicitation with Longterm Heroin Users

When Providence Healthcare won a legal challenge in May 2014 at British Columbia's Supreme Court to prescribe medically supervised heroin to two hundred and two of Vancouver's most severely addicted drug users, a firestorm lit up online. Many called it a positive step for harm reduction that would help keep addicts from engaging in crime and using potentially lethal street drugs. Others said it was shameful that taxpayers would be funding a program for drug users who "contribute nothing to society," according to one individual. Many had even more scathing things to say about heroin users. While heroin-assisted treatment programs have long been recognized as scientifically sound and cost-saving in countries across Europe such as the United Kingdom, Switzerland, the Netherlands, and Denmark, this is the first time one has been offered outside of a clinical study in North America. Realizing how deeply divided the public was about heroin-assisted treatment, I suspected it was due to a lack of information. I wondered if documentary photography could play a role in educating people about compassionate, science-based treatment for drug users. I began planning a photo documentary project that I hoped would help humanize some of the long-term heroin users taking part in the Study to Assess Longer-term Opioid Medication Effectiveness (SALOME). My intention was to help foster empathy toward vulnerable drug users and allow people to come to their own conclusions about heroin-assisted treatment. The scale of the heroin addiction Across Canada, as many as ninety thousand people (1) are addicted to heroin, according to Providence Healthcare. The New York Times has reported on a heroin "epidemic" sweeping across the United States. (2) Thousands of heroin users receive methadone and other forms of treatment. However, for some of the most chronic and vulnerable addicts, nothing has worked. "Ninety percent of the refractory people- the people who've tried the treatments and haven't benefited from them, haven't been retained in care-need another option." Dr. Scott MacDonald, lead physician at Providence Healthcare's Crosstown Clinic, told me. "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." (3) "Dark, seedy, secret worlds" 1 began to explore the work of some of the most influential documentary photographers who have focused on heroin users in recent decades. What 1 learned is that most of them have consistently represented heroin users as exotic, primitive, dangerous to society, and essentially as outcasts. "There is a tendency in drug photography to attempt to make images of dark, seedy, secret worlds," writes drug policy expert John Fitzgerald. "This can have the effect of Othering the subject, or making them different through eroticizing or exoticizing them." (4) Many viewed Larry Clark's 1971 photo work Tulsa, about young people experimenting with drugs, sexuality and guns, as brutally honest and revealing. Clark's follow up photo-essay, Teenage Lust., published in 1983, also focuses on drug users in a voyeuristic, unsettling, and erotic way. "For Clark, the drug user is a modern primitive," writes Fitzgerald. "Like the young boys who play with guns and explore their sexuality, Clark's drug users plumb the depths of rapacious desire, so repressed and unexplored in the modern body. Clark's lifework is to bring this primitive desire to light in a liberal artistic venture." (5) Clark wasn't alone in his style of representing heroin users. Documentary photographer Eugene Richard's 1991 book Cocaine True, Cocaine Blue focused on cocaine culture in three inner-city neighborhoods. Its cover features an extreme close-up of a woman clenching a syringe between her teeth. Not only is the image unsettling, it has influenced the way many other photographers have depicted drug users to this day. …