A nurse treats Johnny at Vancouver’s Crosstown Clinic before he self-injects his medication. © Aaron Goodman, Author provided For over a year, I’ve been documenting the lives of three long-term drug users – Marie, Cheryl, and Johnny – who are participating in Vancouver’s heroin-assisted clinical study and program.

In recent years, heroin use in North America has exploded into an “epidemic.”

At the same time, policymakers and the public have clashed over how to properly treat this public health scourge.

Many heroin users receive methadone and other forms of treatment. However, some of the most vulnerable addicts haven’t responded to medication and detox.

I spent weeks building a rapport and trust with Marie, Cheryl, and Johnny, who’ve all been addicted to heroin for years. They’ve each repeatedly tried detox and methadone and have been unable to stop using heroin.

In a sense, heroin-assisted treatment, a science-based, compassionate approach, is their last resort.

Those involved in the program – often users who haven’t sufficiently responded to other forms of treatment – receive pharmacological heroin in a clinical setting. While these programs have long been recognized as scientifically sound and cost-saving in countries like Switzerland, the Netherlands and Denmark, heroin-assisted treatment is only beginning to be offered in North America.

At first, the three subjects allowed me to take photos of them self-injecting their medication at Providence Health Care’s Crosstown Clinic in Vancouver’s Downtown Eastside. Slowly, over a period of weeks and months, they let me document their lives outside the clinic.

While I hoped to inform the public about heroin-assisted treatment, I also wanted to see if I could create visual counter-narratives to challenge the dominant tropes of drug genre photography.

More than anything, I wanted to represent Marie, Cheryl and Johnny as human beings – and show that their drug use didn’t define who they were, even though that’s how heroin users are usually depicted by documentary and news photographers.

The best way to do this, I realized, was to show them the photographs I’d selected and give them the opportunity to respond. I included their words with each photograph in the series.

‘Dark, seedy, secret worlds’

Before beginning my project, I had explored the work of some of the most influential drug genre photographers, and found that most of them have consistently represented heroin users as exotic, primitive and dangerous to society.

“There is a tendency in drug photography to attempt to make images of dark, seedy, secret worlds,” writes criminologist John Fitzgerald.

This can have the effect of “othering” the subjects – the idea that after looking at these kinds of images, viewers might look at drug users as outcasts.

Larry Clark’s 1971 photo work “Tulsa” is considered an exemplar of documentary photography. Many view the series, which depicts teenagers experimenting with drugs, sexuality and guns, as brutally honest and revealing.

Clark’s follow-up photo essay, “Teenage Lust,” published in 1983, also focused on drug users in a voyeuristic, unsettling, and erotic way.

The problem with this approach is that it creates sensationalized images, which, in turn, influence the public’s thinking and policymakers' decisions about how to treat drug users.

“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 adventure.”

Clark wasn’t the only photographer to represent heroin users this way. Documentary photographer Eugene Richards' 1994 book Cocaine True, Cocaine Blue focused on cocaine use in three inner-city neighborhoods. The book’s cover features an extreme close-up of a woman clenching a syringe between her teeth.

The image is arresting and also influenced the way many other photographers have depicted drug users to this day.

Photojournalists working for news agencies such as AP, Getty Images andThe Denver Post have recently followed Richards' example and composed images of drug users with syringes in their mouths. In most of these photos, the heroin users' eyes are either partially or completely out of frame or hard to make out in detail.

It’s vital that photographers find more balanced ways of representing drug users, instead of reproducing the same types of stigmatizing images that have existed for decades.

Shocking images certainly provoke reactions. But it’s more important to offer context in order to spark discussions about solutions.

Hearing from the heroin users

In my own effort to produce and share balanced and humanizing images – and to reduce the possibility of misinterpretation and “othering” – I realized the images on their own couldn’t tell the full story. I needed a way to provide context for the viewer.

“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. “Letting a picture speak its thousand words can results in a thousand deceptions.”

After selecting my final images, I showed them to Marie, Cheryl and Johnny. I wanted to know if they thought the photos accurately represented them, if they thought anything was missing and what they would have done differently if they had taken the photos themselves.

Many of their responses were positive. They thought that in most of the images, I’d accurately represented them. And they had important suggestions. Most of all, they wanted to be seen in the photos as more than just drug users.

I’ve included their most telling comments alongside each of the photos in this story.