The opioid crisis is the worst addiction epidemic in American history. Drug overdoses kill more than 64,000 people per year, and the nation’s life expectancy has fallen for two years in a row. But there is a key part of the story that statistics can’t tell. Over the last year, photographer James Nachtwey set out to document the opioid crisis in America through the people on its front lines. Alongside TIME’s deputy director of photography, Paul Moakley, the pair traveled the country gathering stories from users, families, first responders and others at the heart of the epidemic. Here, Nachtwey’s images are paired with quotes from Moakley’s interviews, which have been edited. The voices are a mix of people in the photos and others who are connected to them. The Opioid Diaries is a visual record of a national emergency—and it demands our urgent attention.
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Graphic content could be disturbing to some readers
Bobby Lee, 45, injecting a friend inside his van in San Francisco on Jan. 30. Lee says he’s been an addict since he was 17
Chad Colwell, 32, being revived by EMS workers after overdosing in his truck in Miamisburg, Ohio, on July 4, 2017. He says this, his fourth overdose, led him to seek treatment
‘Heroin grabs ahold of you, and it won’t let go. It turned me into somebody I never thought I would be.’
Cheryl Schmidtchen, 67, being consoled at the funeral for her granddaughter Michaela Gingras in Manchester, N.H., on Sept. 17, 2017. Gingras, a heroin user, was 24
‘After Michaela died, I saw it clear as day. They’re not only destroying themselves, they’re destroying us.’
A woman, who goes by Jen, struggling to inject herself in the freezing cold in Boston on Jan. 14
A man, who goes by Dave, huddling against the cold as he injects in Boston on Jan. 13
‘We get into detox, they spin-dry you. And then it’s so overcrowded you can’t go onto the next step, even if you want to.’
John, 49, preparing to inject in the bathroom of a restaurant in Boston on Jan. 12
I am an addict
I had a career in sales in the automobile business. I was making a lot of money, upwards of $100,000 a year. Then I started up with the OxyContins. It’s an amazing feeling, that warm hug from Jesus. It started as a once-in-a-while thing. But I began telling myself, “Well, if I can feel this good on Friday and Saturday, why shouldn’t I feel this good on Tuesday and Wednesday?” And then the price started going up, and all of a sudden they’re $80 a pill. At this point, I’ve got a six- or seven-pills-a-day habit. I wouldn’t get out of bed without one. I always knew about heroin, but it was a line I didn’t want to cross. But, you know, the ship had already sailed. An opiate’s an opiate’s an opiate. I’m not trying to die, contrary to people’s belief. I’m not trying to kill myself. I’m just an addict. — John, an active user in Massachusetts
Two men sharing drugs under a truck in Boston on Jan. 14
Billy, 31, right, preparing to use drugs in Boston on Jan. 14
Two women, one of whom goes by Pangea, right, openly using on the street in San Francisco on Jan. 26
‘I’m getting older. I see less and less of the future I want for myself and more and more of this taking over.’
Drug users in the South of Market neighborhood of San Francisco, photographed on Feb. 1
A homeless grandmother, next to a shopping cart full of her belongings, injecting in Boston on Jan. 14
A man, high and stumbling in the parking lot of a convenience store in Boston, on Jan. 13
A woman sleeping beneath a highway underpass in Boston, on Jan. 13
Rachel Hoffman, who says she was six months pregnant when this photo was taken in Dayton, Ohio, on July 2, 2017. After prematurely giving birth, she lost custody of her newborn girl. Hoffman, 35, says she is now in recovery
‘I want my daughter. I shouldn’t have used with her. But I was too late.’
Roger McLearran, 61, being transferred from a bedsheet to a stretcher after overdosing in his sister’s Dayton, Ohio, home on July 2, 2017
A man, center, known in his Miamisburg, Ohio, neighborhood as “Bike Mike.” Police said he appeared to be having a drug-induced episode on July 4, 2017
Dorothy Onikute, 33, a deputy sheriff with the Rio Arriba County sheriff’s office, responding to an overdose call on Feb. 4, on the side of the road in Alcalde, N.M.
‘This sort of thing happens so often, it’s sad to say it’s on to the next once they are out of our care.’
Gust Andrew Teague II, 42, a deputy sheriff in Montgomery County, Ohio, handcuffing two unidentified men suspected of drug possession in Dayton on June 29, 2017
I am an officer
You kind of become cold to seeing somebody overdose. As an officer, you bury it away. A lot of us do that. That’s how we cope. It becomes easy to talk about the drug and not talk about the person, to say, “Yeah, just another one.” But seeing the families that are affected, their loved ones, actually seeing them on the scene, trying to care for their loved ones or friends. To see that, to see the children involved, the heartache, it’s overwhelming. You also learn not to give up. So I talk to everybody out here. They might not want to talk to me, but I’m talking to them. I just don’t brush by them. They’re a human being. A lot of things are lost in the world today, and humanity is one of them. — Walter Bender, a deputy sheriff in Montgomery County, Ohio
Law enforcement arresting an unidentified man in Montgomery County in Dayton, Ohio, on July 25, 2017
Rocky Johnson, far left, a captain with the Huntington, W.Va. police department talking with a suspect on Jan. 22
Kent Saunders, left, a detective with the Montgomery County sheriff’s office speaking with an unidentified woman arrested for drug possession in Dayton, Ohio, on June 30, 2017
Tasha Taguacta, being revived after overdosing on the front porch of her home in Dayton, Ohio, on June 29, 2017. Taguacta, who later said she wanted to recover for her kids, died on Nov. 9, 2017, from an accidental overdose of fentanyl, acetylfentanyl and heroin. She was 38
‘They want me to be clean. I want to be clean. It’s just wanting and doing is so foreign.’
Jefferson Township Fire Dept. EMT Rhonda Hughes aids a man who overdosed in Dayton, Ohio, on July 23, 2017
Deputy David Statzer, right, 48, a sergeant with the Montgomery County sheriff’s office, responding to an overdose call at a Dayton, Ohio motel on July 4, 2017. The man died of an accidental carfentanil and cocaine overdose
‘That morning, it’s numb. You can only see so much. I’ve been on the street since basically right after the epidemic started. I hate to say this, but it became commonplace.’
Shilah Jones, 41, minutes after her boyfriend’s overdose in her Dayton, Ohio home on July 3, 2017
Christopher Short, who died from an accidental fentanyl overdose in Dayton, Ohio, on July 23, 2017. He was 29
Kayla Rauck, 29, experiencing withdrawal symptoms in a holding cell at the Kenton County Detention Center on Dec. 8 2017, in Covington, Ky.
Gary White, standing in the Kenton County Detention Center in Covington, Ky., on Dec. 8, 2017. He is part of a voluntary rehabilitation program for inmates at the jail
‘The universe hit me. I wanted to fight. I wanted to cry. I need to hold myself accountable. I’m hoping that this time, I make it.’
I am a counselor
I had to come to terms with the shame and guilt surrounding the wreckage of my past. The lives I had impacted, the wasted time. In recovery I realized that I can use the most disgraceful, embarrassing moments in my past to empathize with other men that are coming through the program. It was almost magical—the shame became something that I could use. My past has become one of my most valuable assets in helping people today. It really does take an army to strengthen our communities, to support men and women that are re-entering society. It’s not just what we do within these walls. This is something that takes months, even years. But we can solve this. The conversations are finally shifting from problem-centered to solution-based. — Jason Merrick, director of inmate addiction services at the Kenton County Detention Center in Covington, Ky.
Holly, detoxing in the Montgomery County Jail in Dayton, Ohio, on July 3, 2017
Seth Dial, 33, being removed from drug court by police in Cabell County, W.Va., on Jan. 22. He had relapsed without telling his probation officer. The judge in his case says he has since made progress in his recovery
Kathleen Lakos, 56, becoming emotional at her first support group meeting for parents of children with addictions, in Derry, N.H., on Feb. 14
‘At the meeting, we’re told that we need to try to get back to our lives. It’s easier said than done.’
Fabian Pacheco, 17, attending Sunday service at the Lighthouse in Chimayo, N.M., on Feb. 4. His mother died of an overdose in 2015, and his father, who also battled addiction, has been in and out of jail. Beth Pacheco, 60, his paternal grandmother, became his legal guardian and later took in three other grandchildren
Billy Merrifield, 43, a captain with the Rio Arriba sheriff’s office in New Mexico, visiting the grave of his daughter, Brandi, on Feb. 4. She died from a heroin overdose at 22
‘It never gets easier. Because that void will always be there. Our children are supposed to bury us; we’re not supposed to bury them.’
Jennifer Mosher, 33, had been using drugs when she found out she was four months pregnant. She eventually went on methadone. Mosher gave birth to a baby girl at Lawrence General Hospital in Lawrence, Mass., on Jan. 10. Her daughter, Brayleigh, is now healthy
What I saw
by James Nachtwey
Like most people, I’d heard about the opioid epidemic. It was especially hard to get my mind around a statistic from 2016: almost as many deaths from drug overdoses as in all of America’s recent wars combined. But numbers are an abstraction. I had no idea what it looked like on the ground. The only way to make real sense of it, I told my editors, was to see what happens to individual human beings, one by one.
Photography can cut through abstractions and rhetoric to help us understand complex issues on a human level. Never is photography more essential than in moments of crisis. To witness people suffering is difficult. To make a photograph of that suffering is even harder. The challenge is to remain open to very powerful emotions and, rather than shutting down, channel them into the images. It is crucial to see with a sense of compassion and to comprehend that just because people are suffering does not mean they lack dignity.
Over the past 35 years, my work as a photojournalist has taken me to other countries to document wars, uprisings, natural disasters and global health crises. In revisiting my own country I discovered a national nightmare. But the people living through it aren’t deviants. They are ordinary citizens, our neighbors, our family members. I don’t think I met one user whom I would consider to be a bad person. No one wants to be an addict.
I also saw signs of hope, particularly from the people who are dealing with the crisis at the street level. Some of them are former users who have lifted themselves up and are using their experience to help others. They are refusing to allow our country to be defined by this problem. Instead, they are helping us define ourselves by finding solutions. We must join them.