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They are at time.com/newsletters and are separate from a paid subscription. ## Video: 'The Opioid Diaries': A Discussion With Photographer James Nachtwey [Watch (HLS stream): 'The Opioid Diaries': A Discussion With Photographer James Nachtwey](https://cdn.jwplayer.com/manifests/yDE2ELjo.m3u8) (36:25)  _Published 2018-03-07. James Nachtwey discusses "The Opioid Diaries"_ --- Jul 27, 2023 11:36 PM UTC --- ## More From This Series [All Videos](https://time.com/video/) ['The Opioid Diaries': A Discussion With Senator Maggie Hassan](/video/rViH0mSw/) ### 'The Opioid Diaries': A Discussion With Senator Maggie Hassan [Photographer James Nachtwey Accepts Lifetime Achievement Award](/video/fQ839g4B/) ### Photographer James Nachtwey Accepts Lifetime Achievement Award [A Look Back at James Nachtwey's Career](/video/xXdV9cmT/) ### A Look Back at James Nachtwey's Career --- ## Transcript As I traveled across the country working on this story, I had the privilege to meet a lot of remarkable people. And I'd like to begin by thanking everyone who gave me their trust and believed in this project, who opened up their lives and allowed me to document some very personal moments. This presentation is dedicated to all of them and to their struggle. I would also like to thank all the people at Time magazine for the extraordinary level of dedication and hard work that went into publishing The Opioid Diaries. Kiera Edward. Matt Finn. Chrissy D.W. Tara. Keith and everyone else, and a remarkable crew who worked behind the scenes to produce this special issue. I especially want to thank Paul Moakley, who did the research, manage logistics, establish contacts with key people in the field and made videos. He also conducted dozens of interviews. And throughout this talk, I'll be quoting people from those conversations. It's the wish of everyone. The time that this publication creates a heightened level of awareness within our population at large and also among decision makers that the national dialog about this crisis will be advanced in the more effective ways of dealing with it will be initiated. The motivation to work on a story about the opioid epidemic goes back to what motivated me to become a photographer in the first place. The Vietnam War began when I was in high school, and it lasted until I was well out of college. Images of the war were at odds with the rhetoric of our political and military leaders. They showed us what was really happening on the ground and helped galvanize public protest. By the time the war was over, many long years after it had begun, millions of Vietnamese had been killed in over 58,000 American lives had been lost. It was a staggering figure inspired by the powerful social impact of the photographs from Vietnam. When I decided to become a photographer, it was to be a war photographer. 35 years later, I've been involved in photographing many wars and conflicts, as well as critical social issues and global health problems almost exclusively in foreign countries. In 2016, over 64,000 Americans died from drug overdoses, more than died in all of Vietnam, Iraq and Afghanistan combined. 64,000 deaths in a single year, not from wars or natural disasters or plagues caused by lethal microbes, but by people killing themselves by using narcotics. It's hard to believe, as I learned, photographing war as statistics are an abstraction to even begin to understand the reality of the situation. It's necessary to see what's happening to individual people one by one. As a photographer, I knew it was time to revisit my own country. What I discovered is an American nightmare. Paul had identified Dayton, Ohio, as one of the worst hit cities in the country, and we began our journey there. Deputies from the Montgomery County Sheriff's Office are among the first responders on overdose calls. We quickly learned how the use of Narcan, a drug that temporarily counteracts the effects of heroin, saves lives time after time. This is Tasha, mother of two children and a grandmother who died on the front porch of her home and was revived by Narcan. She'd been in jail and in rehab. And last November 9th, she died from an overdose of fentanyl and heroin. She was 38 years old, Shared call overdose for the fourth time this past 4th of July. He'd been injured playing football in high school and at the age of 17, became addicted to prescription painkillers. By the time he was 25, his insurance ran out and he turned to heroin, which was cheaper and easier to get. He lost his job, his apartment, his relationship with the mother of his daughter. And he went to jail for robbing two gas stations. I talked with him a couple of weeks after I made this photograph, and I found him to be very aware and articulate about what had happened to him. I asked him why he continued to take a substance that he knew could be fatal. Every time he used it, I asked him if it was because he had given up on life, and he told me he had not given up that life. And the people he was close to meant a lot to him. But in his own words, heroin grabs a hold of you and it won't let go. You have to have it. You don't just hurt yourself. You're hurting everybody else around you that cares about you, that loves you. The selfishness of addiction takes over. It turned me into somebody I never thought I would be. Roger McLaren, age 61, is so lost to addiction. He's been known to overdose several times in a single day as Montgomery County Sheriff Phil Palmer explained. The epidemic has changed our job drastically. We've become more of a service provider. We're doing Narcan to save them, and we drive them to the treatment center. We become more compassionate. This man overdosed on a drug known as Flocka, which contains heroin and causes delirium and wildfires, vocal spasms. He was so out of control, the deputies were at a loss about what to do and could only watch over him while they waited for the ambulance crew to arrive at a trailer park out in the countryside. Deputy Jim Guisewite saved a man with a dose of Narcan. Sure, a plumber describes the demands that are being put on emergency medical teams. There's times when every medic in the city is tied up on an overdose. Then we have to call in, call in mutual aid from other cities. So we're tied up on overdoses. And your grandmother has a heart attack and she has to wait five more minutes because another city medic to come and save her. Every overdose has an impact on many other people. The man's partner was left stunned and afraid. A man was found dead on the 4th of July from an overdose of carfentanil and crack cocaine. Sergeant David Stats, who described his reaction. You can only see so much that particular day. I hate to say it, but it's another call. It's just another overdose. It's not that I don't care. It's not that at all. It just become mind numbing. Emergency medical personnel work for a long time, trying to revive Christopher Shaw from a fentanyl overdose. But he didn't make it. Tina Shaw told us about her son. He was getting his life in order. He had plans. He was looking toward the future. I just don't understand. I don't know if he was just tired of fighting it. It's a horrible, horrible thing for parents to go through, according to Sheriff Plummer. Fentanyl is a synthetic substance made in super labs in China and Mexico. It's so much more addicting than heroin, it's easier to produce. Our addicts don't want heroin. They're now wanting fentanyl and carfentanil, which is very, very powerful and addicting. And the problem is, it's killing people. Shiela Jones waited in her kitchen as first responders tried to save her boyfriend who had overdosed in the next room. Dr. Kent Harshbarger, the chief coroner from Dayton, described the epidemic as a mass medical fatality event analogous to a plane crash or a large terrorist attack, only in slow motion. The epidemic poses a huge challenge for law enforcement. This woman was taken into custody by Detective Keith Saunders for possession of 27 fentanyl capsules. But arresting individual users or small scale sellers doesn't make a dent in the overall influx of drugs. Sheriff Plummer describes the dynamics of the problem in Dayton. We have 70 and 75. The crossroads of America. So the heroin is coming directly from Mexico to Dayton nonstop. Then they can head Interstate 70, which runs east west. So it can go to Chicago. It can go to New York. We're now what you call a source city. This is where people come to get it. A photograph of an arrest for heroin possession. Extensive work by undercover deputies in a sting operation resulted in the arrest of a local distributor. But Sheriff Plummer describes the frustration involved even in a big arrest. We've had tremendous drug busts here, and we haven't affected the price. $1. We haven't affected the supply at all. Overdoses go down for a few days, then it will spike back up because more product come in. Undercover police in Huntington, West Virginia, also worked a sting operation and a SWAT team staged a successful raid against a drug distributor. Several suspects were taken into custody, into your armory in New Mexico. A great majority of the inmates in the county detention center are in for drug offenses, including Adrian Redwine, because a former guard in that same jail put his generator. Fire chief of Huntington, West Virginia, points out locking them up isn't the answer. People who go to jail with no services for their problem, 93% of them recidivists. Holly Atkins was an inmate in the county jail in Dayton, going through detox the hard way. She's an accountant with her own office, the mother of five children and a grandmother. And describing the pain of detox. She said it's like glass in your bones. Sure. Plummer explained the current situation in lockup. We have a cell full of 30 inmates shaking and shivering under their covers because they're withdrawing and detoxing in jail. It's sad that we treat people that way. We're treating this wrong as a community, as a country. We're better than this. An alternative to incarceration has been developed in Huntington, West Virginia. It's called drug court. In the words of generator. It's a treatment court where there's intensive supervision group and individualized therapy, where they're helped given social services to deal with all the issues they have. There's less than a 10% recidivism rate. Greg Howard, the chief judge, described what was happening to South Dale during a hearing. He relapsed and didn't tell anybody and got caught by a drug screened. That's a dishonest relapse. And that's why we put him in jail. I think I gave him 48 or 70, 72 hours to get his head on. Right. We've already made the conscious decision that these are people we want to rehabilitate, not just punish their people. We're trying to get back into the community to be productive citizens. Another promising rehabilitation program has been developed at the Kenton County Detention Center in Covington, Kentucky, by Jason Merrick, a former heroin addict who went on to earn a bachelor's than a master's degree. He describes his own recovery process this way. I spent many years in active addiction before I was able to accept and find help. 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. That was a struggle until I began to really understand that there was a way to take that and mold it into a tool that could be used to help other people. I'm one of the lucky ones. I was able to make it out alive. I thought it was time to see the epidemic from the point of view of drug users themselves. We began in the south end of Boston, where we met John, who was homeless but who once had a successful career as a salesman, making upwards of $100,000 a year. He was intelligent, articulate, sociable, the very likable person who committed petty crimes to support his addiction. He'd been in jail and had recently gone through a rehab program. But when he tried to go to the next step in recovery and find a place in a halfway house, there was no room. He ended up staying in a shelter where conditions were so miserable, he resumed using drugs. He was injecting heroin in the bathroom of his restaurant. On the second day of his relapse. Heroin addiction is so powerful that if only dirty needles are available, then that's what people will use. Harm reduction organizations such as a hope collect used needles and distribute clean ones to prevent outbreaks of AIDS and hepatitis. This is a man named Dave. On a bitter cold night. Directly across the street from a homeless shelter. He had to use drugs and refer to the manor venue communicating with me. He was open, direct and unapologetic about who he is. He was glad we were working on a story about heroin addiction and he wanted to be part of it. Our guide and mentor in Boston was Sarah Macken, director of Harm Reduction services for the Boston Public Health Commission and the head of A Hope. She earned a master's degree in public health and has more than a decade of experience in her field. The outreach program she founded currently serves over 3000 7000 people. Her willingness to take us under her wing and show us her world really helped establish trust with the people she's working with. For Sarah. Harm reduction is more than a humane and practical strategy. It's a philosophy, in her words. How do we take drug use out of the shadows and into the light and start treating it like the chronic illness that it is? You can't deny someone lifesaving interventions because they won't stop using drugs. When someone comes back with a positive tox scan, it shouldn't be an opportunity to reject them from the health care system. That's when people die. If someone's injecting and using a clean needle, that's a positive change. They're not hanging their head in shame. They're coming back and they're asking for help. Harm reduction embraces recovery, even though harm reduction is sanctioned by the city. At the shelter, needles were confiscated. The staff has a reputation for being disrespectful, and many homeless people would rather fend for themselves even in the cold, than stay in the shelter. We wanted to see how the epidemic is affecting the western part of the country. So we traveled to San Francisco and New Mexico. The streets of the Tenderloin and South Market districts were filled with homeless people. The number of drug users shooting up in plain sight right on the sidewalk came as a surprise. In Boston, people use drugs with at least a pretense of trying to hide it. In San Francisco, it was right out in the open. When the project began, I thought trying to photograph people using drugs would cause suspicion and hostility. But as I've experienced in Boston, if I approach people with respect, took the time to introduce myself and explain the project. When I asked permission to photograph, people were open and respectful in return. Almost everyone wanted to participate. By and large, I was impressed by their intelligence and their ability to articulate what was happening to them instead of hiding from the camera. People thanked me for doing the story. I met Pandya, who was bright, charming, charismatic and deeply troubled. She spoke candidly about what she was going through. I'm getting older. I see less and less of the future I want for myself and more and more of this taking over people that don't ever experience a thing. Think you could just quit? You can't just quit. I was born a drug addict. This happened to me in the womb. The deeper I got into the story, the relationship between drug users and their children, both born and as yet unborn, emerged as a tragic subtext. In the midst of getting high, this young woman began to tell me about her children, how they'd been taken away from her. And how much you want wanted to try to get them back. Mary Howard, the founder and executive director of Homeless Youth Alliance, became our guide. She's a former drug user and homeless runaway for the past 19 years, has dedicated herself to addressing the needs of young street people. She explained how her organization operates in the philosophy behind it. It's very much about meeting people in the moment, accepting them in that moment, and building relationships. If someone wants an individual appointment with a therapist or a psychiatrist, we can schedule that right there on the street. In the evenings we do the syringe access program. We have a doctor who provides medical care. We now have a Suboxone clinic, methadone, referrals, HIV testing. It's it's not just about the needles. It's about the connection. This is Bobby Lee helping a friend get high. He's a fully functioning addict who holds on a job and lives in a camper that he parks on the streets. Mary, how continued? It's about giving people a place to feel accepted as they are. I enable people to take care of themselves, to reduce harm in their own lives, to reduce harm in the community, to have a life of value, to have the steam as a person. We fear what we don't know. If we take the stigma and the bias out of something early on. The story goes very differently. Now every community can say it's me. It's in my community. From San Francisco, I traveled to Rio or Reba County in northern New Mexico, which has the highest overdose rate in the state and more than five times the national average. Sheriff's Deputy Dorothy on A to responded to an overdose call outside the village of Ella called a the sheriff's office in Rio. Reba has been hard hit by the epidemic. A captain's daughter, the sergeant's stepson, and the sister of a deputy all died from drug overdoses. The ways in which opioids have affected children and the ways in which children have affected members of their families is at the heart of this crisis. Because heroin addiction is both insidious and unnatural, it's difficult to comprehend. It demolishes people's will on a fundamental level. It can override even the most primal human instincts, the natural sense of maternal protectiveness, even self-preservation, can be completely overpowered by the influence of narcotics. Rachel Hoffman from Dayton was 35 years old and six months pregnant when this picture was made. She is also the mother of three sons who she was not able to raise herself. On July 19, she gave birth to a girl. Immediately afterwards, Rachel fled the hospital, leaving her daughter behind and returned to the street to resume her life as an addict. She was arrested for violating probation and spent 49 days in jail where she went through detox, started working with the counselor, and is now in group therapy. Her daughter was with the foster family for Rachel. Rachel is allowed to visit her once a week in hopes eventually to regain custody. When asked what she would like people to understand by seeing her at her worst, she says, I've been down a lot in my life, and I started believing that about myself. I still do in a way, for what I did to my baby. I know I was better than that and that something controlled me that I shouldn't let control me. But now I hear positive things in me, and I'm starting to believe that now. Life's a struggle, but you can overcome it if you believe and have faith. You really can. Don't lose the fire. This is Rachel. Three weeks ago, Kayla Ross was enjoying detox as an inmate at the Kenton County Detention Center in Covington, Kentucky. For the fourth time in purely physical terms. Addiction attacks people from two sides. The compulsion to keep using drugs is caused by the undeniable evil craving produced in the receptors of the human brain by the morphine molecule. That craving is then amplified by the fear of the prolonged, intense pain of withdrawal. Kayla tried to put it into words. My stomach hurts, my legs hurt, my blood pressure is up. I'm dehydrated. One minute you're hot, the next your cold, vomiting, diarrhea, cold sweats. Sometimes I feel like I could just crawl out of my skin. She talked about the background of her addiction. My mom was a crack addict, and my dad was an alcoholic. When my sister passed away in 2013, I started doing cocaine and smoking crack and my husband was smoking it with me. When they took our kids from us, we started to do heroin. We didn't no longer care. We didn't feel anything. We were just numb to the world. Her parents addiction had an effect on her, and her addiction is having an effect on her own children. I had three beautiful kids, and they were great kids, really well mannered. They did good in school. They had everything they wanted. We had a good family bond. I lost everything to this drug. I let it take my home, my husband, everything that I loved. It sucked everything right out of me. Thinking about her future, she understands what she's up against. I was clean for three months. Got out in the same day. I got high. I want to live a good life. Do right. Get my own place, my kids, and be worth something. It's not going to be easy. I don't know where I'm going to go. I don't have a plan right now. I'm useless. Pretty much useless to myself. The 25 year old daughter of Kathleen and John Lucas is addicted to heroin. Homeless, refuses treatment and has abandoned her five year old daughter. Kathleen was attending her first support group meeting in Derry, New Hampshire, for parents with children who are addicts in her own words. You walk through every day thinking about your daughter, wondering if she's safe, wondering if you're going to get a phone call from the jail, the morgue. It's crazy living day to day like that. We're lost. We're at a loss of what to do. We were looking for support. It's nice to know you're not alone. The story of the Pacheco family of Espanola, New Mexico, is an example of how, more than anything else, people need each other. And depend upon each other in order to deal with the devastation caused by the epidemic. The young man on the right, Fabian Pacheco, 17, lost his mother to an overdose in 2015. His father has been continually in and out of jail. So Beth Pacheco, his paternal grandmother, became his legal guardian and later became the foster mother for three other grandchildren. Love and guidance from his grandmother helped Fabian come to terms with his problems. There's more to life than just having parents who are on drugs. Your life doesn't stop there. I wouldn't trade my life for the communication and the relationship I have with my grandma for anything. He's developed strong opinions about drugs. I remember seeing how far my dad fell. With my friends, I've explained to them. I don't need pity. Keep your life together. Don't let drugs be a part of it. They literally kill and destroy and terror part and loop. They aren't in any of my interests. Mrs. Pacheco insisted that the family go to church every Sunday at the Lighthouse, and it has a positive influence on Fabian. You lay down your problems. You feel good about yourself. You don't feel judged. I have a whole congregation behind me. Mrs. Pacheco. Mrs. Pacheco was part of a grandparents support group and finds comfort, as she says, Just to know that I'm not alone in this. I'm not the only one with addicted children because it can be overwhelming at times. We can't do it alone. We need the support of other people and not be afraid to ask for help. Cheryl Minchin is consoled by her grandson at the funeral of her granddaughter Mckeller. Growing this Gingras When she was ten, McKayla shattered her arm in the trampoline accident. By age 17, after multiple surgeries, she was still in a lot of pain, but her doctors said there was nothing more they could do to help her. So she looked for ways to deal with pain on her own and eventually became a heroin addict. She had a relationship with the drug dealer who committed a double homicide and then killed her because she was a witness. Her mother, Justine Gannon, had a career as a registered nurse and currently works for the New Hampshire State Government. She has a grasp of why the dynamic of drug addiction can be difficult for people to understand that rewires your brain to live and want and need in a different way than what a normal person in society would need. Justine talked about her daughter's death. I thought I knew what was going on with my kids, and I thought I had it under control. I had nothing under control. She wanted her father's love and her mother's time, and she got it either. That kills me a little bit every day. Your daughter died of an overdose. I was prepared for that hit. I wasn't prepared for her to be. For her to be brutally murdered the way she was. Was trying to get clean when she died. She said I want to get better. I don't want to look like this anymore. She did detox, and she didn't want me to know because she wanted to surprise me. Captain Billy Mary Field, a Rio rebel, visited the grave of his daughter, who died a year ago from a drug overdose at age 22. Many people I spoke with, especially in law enforcement, find it difficult to accept drug addiction as a disease. They try to apply rules of logic and discipline to a substance whose very nature creates a void in which people's capacities for logic and discipline are replaced by an overpowering physical craving. Through years of experience dealing with the population hard hit by drug use and by seeing what happened to his own daughter, Captain Mary Fields, comprehension of addiction changed. I've always been the type to tell people I don't feel sorry for none of you that do drugs because nobody forces you. Nobody holds you to the ground. I had to learn. Little by little, I learned. This is truly sick. This is a disease. Once they use it, they have to have it to survive. They get major withdrawals in jail. They come out clean. And I've seen a lot of them. A lot of them. And they go right back to it. Talking to my daughter, she says, Dad, I'm sick with it and I don't know how to fight it. I don't know how to beat it. She says, The high that you get, all your problems kind of go away. Any pain and suffering you may feel it's gone. Captain Mary Field talked about his own suffering and the toll his daughter's death has had on him. When it comes to your own child, he will never get easy. Matter of fact, I think it's gotten worse. That void will always be there. Our children are supposed to bury us, not us. Bury them. Children die addicted and children are born addicted. Jennifer. Marsha first tried marijuana when she was 12, then moved on to acid, ecstasy, alcohol and eventually prescription painkillers. She was addicted to opioids by the time she was 26. And when pills came, became hard to get, she turned to heroin. She's now 33. On January 10th, she gave birth to a girl named Briley. On the day before her daughter was born, she talked about her sense of guilt. She's going to be born addicted. It takes about 48 hours for the withdrawals to start. If medication is needed, the doctors will give her neonatal morphine to know that I'm having a baby and she's going to have to feel withdrawal because of my choices, knowing that she's going to feel pain because of my actions is horrible. The kindness of strangers doesn't begin to describe the extraordinary generosity of Lydia and Jim O'Leary, who over the years have taken over 100 people, often addicts, into their home and invited them to become part of their family along with their three children. Jennifer and Bradley have found a refuge there. Jennifer has remained on methadone therapy and it's decided to try to overcome that addiction as well. Praeli has successfully gone through the period of withdrawals and is now healthy in the midst of this crisis. I saw a lot of tragedy, broken lives, broken families, and on many level, a society that needs serious mending. Where I saw reason to feel encouragement about the opioid crisis in particular, but in a larger sense about the resilience and vitality of our nation. This was personified by the outstanding individuals I encountered who emerged the grassroots from within their own communities and responded to this emergency to fight an uphill battle with compassion and clarity of purpose, with empathy, organizational skill, original thinking, selflessness, energy, leadership, and total commitment. People like Sarah McCann, Jan Rader, Jason Merrick, Phil Plummer, Mary Liddy, and Jim O'Leary, to name only a few. Not nearly enough vision or support or coming from above light and inspiration or emanating from the ground level. Hope does not come easy. It's not something that is given to us. It's something that must be earned. And if our country can continue to produce such strong, bright thinking, people hope will continue to exist. ```json {"@context":"https://schema.org","@type":"VideoObject","name":"'The Opioid Diaries': A Discussion With Photographer James Nachtwey","description":"James Nachtwey discusses \"The Opioid Diaries\"","thumbnailUrl":"https://cdn.jwplayer.com/v2/media/yDE2ELjo/poster.jpg?width=720","uploadDate":"2018-03-07T02:34:27.000Z","contentUrl":"https://cdn.jwplayer.com/manifests/yDE2ELjo.m3u8","embedUrl":"https://time.com/video/yDE2ELjo/","duration":"PT36M25S","potentialAction":{"@type":"SeekToAction","target":"https://time.com/video/yDE2ELjo/?jw_start={seek_to_second_number}","startOffset-input":"required name=seek_to_second_number"}} ```