‘Heroin(e)’ director Elaine McMillon Sheldon wants to change the way we understand addiction

Having grown up in West Virginia, journalist and documentarian Elaine McMillon Sheldon had long been witness to the cycle of addiction when she began work on her Oscar-nominated short documentary Heroin(e).

Set in the town of Huntington, West Virginia, the film chronicles the work of three women — first responder Jan Rader, drug court judge Patricia Keller and concerned citizen Necia Freeman — as they attempt to save lives in a community where the overdose rate is 10 times the national average.

In an interview with Mic, Sheldon shared her thoughts on where the dialogue surrounding addiction can take us next — and how, regardless of whether she wins an Oscar on March 4, she’s trying to raise awareness around the recovery solutions being pioneered in Huntington.

(Editor’s note: This interview has been edited and condensed for clarity.)

Mic: The opioid problem is so widespread in West Virginia. I know you’re originally from the state, but what made you want to focus on Huntington in particular?

Elaine McMillion Sheldon: The interesting thing about Huntington is that even though these headlines are all over the nation, all over the state, they were making their data and statistics surrounding overdoses very public. I was interested in their approach, because they were one of the first needle exchange and harm reduction programs within the state. They just seemed to be doing a lot of things in a very forward-thinking way that I wasn’t seeing in other parts of the state. That doesn’t mean that they weren’t there, just that I acknowledged how open they were about it.

Because addiction is surrounded by stigma, because a lot of communities still don’t want to talk about their own problems, I was just really impressed with how they were facing it. We started by interviewing people from the mayor’s drug control policy force. Jan Rader was actually on that board; that’s how we met Jan. After that, Jan introduced us to so many people around Huntington doing incredible work.

The story of Jan, the first responder, is incredibly compelling. How do you think she represents the grassroots struggle that’s happening in these hard-hit communities?

EMS: I think Jan and Patricia Keller and Necia Freeman all represent what seems so hard for us to attain, which is this inner resilience — not turning our backs on a situation that seems insurmountable. They all represent this idea that we can find within ourselves the ability to help one another, and to not run from a problem but go straight towards it. They don’t exempt themselves from the problem no matter how big it is, and I think that is something I really admire. They represent that in the different fields that they’re in, in the criminal justice system and the first responder community and just within. Necia ... anyone can be a Necia Freeman.

Anybody can go out and help people. It’s time and it’s love. So the goal was to show the professions of women across the different strata of society, and then through seeing how they help people in their own way, people would see the film and maybe in some way relate to these women and what they’re doing, and maybe see how they could help in their own communities.

What is the importance of continuing to pay attention to working-class communities like Huntington, even as we see the opioid epidemic increasingly labeled a “white-collar issue”?

EMS: Addiction can hit anyone, there’s no class, race or gender barrier to addiction. So to say that any one form of substance is relegated to just one class of society is just false, and so I think we have to look at all communities — wealthy communities, working-class communities — and see how we’re all coping with it. I mean, what’s happening in Huntington, West Virginia, even though it’s the same substance — fentanyl, heroin, opiates — is going to require a different response than maybe what’s happening in Portland, Oregon.

I think that it’s important that we learn from one another, and certainly being from Appalachia and having that be sort of the backdrop for all of this, the fact that drug distribution companies dumped so many pills into these small towns like Huntington ... I think for a long time America didn’t even know what was happening. I think it’s important that we look at Huntington because they’ve been dealing with it for a while ... It’s hit peak awareness, I think, in that community. The response will be different, the statistics will maybe be different [in other communities], but it’s all relatable on what we’re fighting, and what we’re fighting is society’s stigma and callousness towards addiction.

We saw just across state lines in Ohio it being proposed that they only respond three times to someone overdosing and the fourth time they won’t administer Narcan — that was a proposed idea. So I think it’s just important that, it doesn’t matter if it’s Huntington working class or if it’s in Connecticut, there’s so many similarities in how we approach this.

I noticed there’s that one scene where Jan is in the firehouse, when the one fireman is grilling her on, “OK, so do we need to administer the Narcan? Are we legally obligated?” Is that debate something you tried to touch on at all?

EMS: Yeah, I mean, I think that’s the reality of not just the fire department but of the medical community. There’s still a lot of skepticism around, “Are we helping?” I understand that the compassion fatigue of those on the front lines, it’s very real; they are responding to the same people over and over and they’re not seeing any of those people get help. So I think that showing that is not a judgement on that man questioning, but actually it’s a really important way to show the compassion fatigue. And I think the biggest thing I learned is that we have to take care of the people who are taking [care] of the other people, you know? We’re focusing on getting people out of the cycle of addiction, which is a very important goal, but in that process we have a blind side on what’s happening with first responders, so it’s just important to show that.

That guy’s potentially being made an example of for that callousness or compassion fatigue, but he has his own story and his own experiences. There’s some people who are really appalled by that and there’s other people who have watched that and told me, “I agreed with him, and by the end of it I had sort of changed my mind.” I think it’s important to show both sides of that coin and that conversation.

The film clocks in at just under 40 minutes. Which elements felt the most important for you to show, and were there any narratives you felt like you had to leave out for time?

EMS: We are releasing this film at a moment when people like yourselves and many other people in the media are covering this topic, so we’re really lucky to be adding to the conversation. You know, this film is not the “opioid epidemic 101” film. We really set out to make a film about people and their daily struggles, their ups and downs, and so we structured the film around scenes of these women interacting with these people that they’re on the ground with. We didn’t wanna put a lot of statistics in the film, we didn’t go with the background of distribution companies and pills, all those things that I think the media’s actually doing really well.

When I look at the landscape and how it’s being covered, I think that on an educational level I’m really impressed with what the media’s doing to educate about what’s happening. What we felt that we could add to it would be more personal, more intimate, and literally just see what it looks like on the front lines from a first responder point of view, from a criminal justice point of view and from basically a volunteer point of view. It was important to us that the visuals we were creating weren’t ones that further increase stigma or further isolate Americans.

When the film ends, you’re trying to end on a high note with the graduations from drug court, and then we’re interrupted by Jan getting an overdose call. What is the symbolism of that moment, and what do you think it says about the state of the opioid crisis in America?

EMS: Well, the ending was really important for us. I mean, the ending of any film about an issue that’s ongoing is really important, and as a filmmaker, documentarian, journalist, I don’t think it’s helpful to wrap things up in a pretend bow and be deceitful that everything’s fixed — you know, “These three women have fixed everything.” Because the fact is, today, Jan Rader’s probably going on an overdose call right now. We wanted to paint the reality that yes, this is ongoing, and yes, we don’t have all the answers yet, and yes, we don’t have all the resources to fix this, but these women are going to keep working, and you and your community have all these women and you should look to [support them].

What are some of the big misconceptions around opioids do you see being reported in American media, and how do you hope your film will correct those?

EMS: For me, we’re talking about the opioid crisis right now and certainly that’s what the film is focusing on, but to me it’s a bigger issue of addiction and isolation and the role society plays in the stigma of addiction.

Our society has unfortunately decided that addiction is [essentially] a moral failure, and we’ve seen that in communities of color where in the past they have been given no rehabilitation options. They’ve simply been locked up for their addictions when this is a health crisis. I think there’s just a lot of work to be done to understand addiction, to understand things such as childhood trauma, to understand the impacts of environment on people’s ability to change their lives.

I see the people in long-term recovery as the solution-makers — they are the people who are going to have the answers, to help get more people into long-term recovery. I just think that when you talk to some people and they hear, “Well, my niece went to rehab and she relapsed,” we have to better understand the fact that this is brain chemistry we’re talking about, and it takes a long time for people to rebuild their lives. And it’s not like rehab fixes people overnight and they’re good to go; we have to totally change the way we understand addiction and recovery and make it a part of our society.

Heroin(e) is available to stream on Netflix.