"Heroin(e)" is a powerful film that follows the stories of three women in Huntington, West Virginia, who are battling the opioid crisis on its front lines. Drug addiction is so common in Huntington, the “overdose capital of America,” that it’s weaved into the fabric of everyday life. In one scene, paramedics work to revive an overdose victim at a convenience store while people step around the commotion and move along the checkout line as if nothing is happening.

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Fire Chief Jan Rader is the first responder who carries not only the film, but also the weight of the crisis in her community as she works to save as many people as possible and get addicts into long-term recovery. Judge Patricia Keller is part mother-hen, part school principal, doling out encouragement and discipline with equal compassion. Necia Freeman, a volunteer with a local church group, drives around at night providing food, shelter and help to those teetering on the edge.

Opioid overdoses are now the leading cause of death for Americans under 50, having killed 64,000 Americans in 2016, a 17 percent increase from the previous year. President Trump had promised to designate the crisis a “national emergency,” which would have prompted more federal dollars to help. Instead, he recently declared it a “public health emergency,” to the consternation of his critics.

I spoke with filmmaker Elaine McMillon Sheldon, who co-produced "Heroin(e)" with the Center for Investigative Reporting, and Chief Jan Rader about the growing epidemic, treatment options and making the film.

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Titi Yu: Chief Rader, what did you think about the president’s announcement and how do you think it will affect your work as a first responder?

Jan Rader: Well, I guess we will see. In my mind it’s a good first step and I hope it’s backed up with more to come. Certainly opening up telemedicine in the rural communities is a help, because we do have a lack of providers. Bringing in [federal grant funds to target those with opioid addictions, part of Trump’s declaration] is going to help that, but it’s going to take further steps to deal with this epidemic.

TY: From your perspective, what does that look like? Is it more money?

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JR: It’s such a complex issue. We’ll just take probably anything. But in our area, the No. 1 issue is that we have a bottleneck at detox. In Cabell County, with a population of 96,000 people, we only have eight detox beds. That’s important, because people have to go into detox before they go into recovery.

The other problem is that the eight detox beds we do have are not medically assisted, and we desperately need them to be. It’s almost inhumane because if they don’t die from detoxing off of opiates, they wish they were dead. So if we had medically assisted detox we’d have a lot more people willing to detox and get into long-term care.

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Elaine McMillon Sheldon: And also Naloxone right, Jan?

JR: Oh yes, we use any and all Naloxone donations that we get. That’s where I would hope that Big Pharma would step up to the plate. You have to be alive in order to get into long-term care. Naloxone’s key to keeping people alive.

TY: So tell me more about Naloxone; what does it do?

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JR: Opioids latch onto receptors in the brain that actually suppress the respiratory system. And if you stop breathing, or you’re not breathing sufficiently for five to six minutes, then you’re brain dead. Then the heart stops working. It’s critical to get to people as quickly as possible when they overdose. What Naloxone does is it knocks the opiate off those receptors so they start breathing again. That is key, and sometimes [people] wake up instantaneously.

TY: How expensive is Naloxone?

JR: You know, my department is quite poor. So for me to carry Narcan [the brand name for Naloxone], I have to accept donations. If we don’t have Narcan, we provide rescue breathing until Cabell County EMS arrives. For a nasal dose, you’re talking about $50 a dose. We had Evzio [a naloxone auto-injector], and those are [as much as $4,500] a box and there are two doses in the box.

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The good thing about our area is that not only did our health department start applying grants so first responders can carry Naloxone, but they were also handing out free Naloxone to friends and families of those suffering from substance use disorder. Over 1,100 lives have been saved without intervention from first responders. For parents with an adult child that’s suffering from substance abuse disorder, they at least can sleep a little better at night knowing that they have a reversal drug to give to their own child if they overdose. So I think we need to continue to supply as much Naloxone to the general public as we possibly can.

TY: So Elaine, what prompted you to want to make this film?

EMS: You can’t live in West Virginia and not know that this problem has been impacting us for many years. Today, because of the headlines, everybody knows what’s going on here. But we’ve been experiencing this crisis since the ’90s, with the pill mill and then with heroin. I grew up in Logan, West Virginia, where right down the street a so-called doctor from another state set up shop in a cinder block building with no furniture, and had a woman just sitting there with a full bag of prescriptions, handing them out, day after day.

So this is part of growing up here. You knew it was happening. Once I got to high school and then college, it started taking classmates from me. We started seeing more people either dying or imprisoned for felonies such as robberies, to get drugs. Some of my friends have had their children taken away from them and put in the foster-care system. I didn’t want to speak about this subject for a long time because the majority of the media focuses on the bleak and dire circumstances of an addict. I don’t have it in me to put that kind of suffering on screen. I wanted to produce something that would hopefully guide us forward.

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When I met Jan, Patricia and Necia, I found them very inspiring. They make Huntington a part of the West Virginia that we should be proud of, a leader in the state. The film was a chance to not only highlight the women doing this work but also what the average citizen can do to help save a person’s life or to help make change. I think we need more stories like these today.

TY: There was a scene where Jan says she’s worried about how the younger medics are dealing with the increase in the number of deaths they see every day. I imagine there are moments that must have had a profound impact on you as well.

EMS: I was really conflicted about that. I talked to Jan quite a bit about all the ethical choices around filming someone hitting rock bottom. That is not something we took lightly, and honestly it was quite difficult for me. And if it wasn’t for us focusing our efforts on the first responders including Jan, I don’t know that I could have done that. But I was filming people who were helping save a life and that gave me the motivation to keep on filming. What I’ve seen is nothing compared to what first responders have to deal with day in and day out.

TY: Can you tell us a bit more about the court-appointed drug rehab program?

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JR: Judge Keller, who by trade is a family court judge, is an amazing person. She doesn’t get paid to do drug court; she just does it on her own, pro bono. She really cares about individuals and she’s not willing to give up on people when they screw up. I can’t speak for her, but we have had many conversations on her goals. I look for Judge Keller to do wonderful things as a family-court judge, because if we treat one person, the triggers are still there in the family. But if you treat the whole family, then you really tackle it from a holistic point of view — you’re doing away with the triggers. A lot of people are unsuccessful in long-term treatment because they get better and then they go right back into the same household with the same family members nagging them or not understanding. There’s so much collateral damage and family members need counseling and treatment also, whether they’re using or not. I looked at some models in New England where they do a home health-care model with addiction counseling. They treat people in their homes with their family units and it’s quite successful.

EMS: When we talk about addiction, I think one of things for me is the tremendous brain drain from the state. Young people leave every day and our death rate is higher than our birth rate. But what scares me is that we have such a high population of young people who are addicted. Once they do get clean, it’s really hard for them to return home. I’ve been making a film about four guys going through recovery and the ones that return to the same environment they left didn’t do well.

TY: Jan, in a very emotional scene, you thanked Mickey, an addict, for teaching you more than he would ever know. What did you mean by that and how has doing this work changed your life?

JR: I was very blessed; I grew up in with a family who loved me and provided for me. I never had to want for anything. We weren’t rich, but we always had food in our bellies and clothing and things like that. I was never beaten or mistreated and my parents always gave back to their community. So starting out as a first responder — and I’m an old medic and I went to nursing school — I was never taught anything about what addiction truly is. And there was a lot of ignorance surrounding substance use disorder.

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But Mickey in particular — he’s such a nice guy. My education has come through dealing with the Mickeys of the world and dealing with those with substance use disorder. It’s like there has to be a better way. Why are we treating people poorly? Why are we not embracing them and trying to lift them up? And Mickey, I had him as an overdose case multiple times and he was a very belligerent user. He would get very angry when we would catch him using. And that’s how I knew him. I’d get an overdose call, and when I see Mickey’s address, I would think, “Oh this is gonna be a doozy.”

[Phone rings in the background] We have an overdose right now, just so you know.

Mickey’s a man who started using at age 8. His mom was getting drunk and high and he had no life. All he knew was getting high until he was 34 years old, when he got clean. He’s super intelligent and funny. He let go of all that anger that he had. They always say that drugs kill your brain cells. Well, I can’t imagine how smart he would be or what he would have been able to accomplish had he not suffered like that as a young boy. He was physically and sexually abused when he was growing up. And it’s just like, “How in the world can he be that resilient?” I can’t imagine that I would have survived that. What an amazing person to go through that. And now he’s healthy, he’s happy and he’s involved in his children’s life, which he had never been before. And Mickey teaches us so much about humanity. I mean, who am I to judge? I didn’t take an oath to judge; I took an oath to save lives. I just saw him the other day, happy as he can be. His wife was just diagnosed with cancer for the second time. They were in recovery together and now they are clean together. It’s just a humbling experience to know people like Mickey.

TY: So I guess the question is, and I think you’ve already answered it in a way, but: How do you stay hopeful?

JB: How dare I say that I’ve had a bad day because I’ve seen three overdoses when somebody lost their child or their sister or their wife or husband. How dare I think I had a bad day, you know what I mean? Now if I have a bad day, somebody else always had a worse day. I know not all first responders look at it that way, but maybe someday they’ll connect the dots and realize, “You know what, I don’t have it so bad,” because I really, truly believe that every one of us is just one bad time of our lives away from addiction.

TY: Elaine, do you have thoughts on that as well? About being hopeful, because despite the bleakness of the topic, you made a very hopeful film.

EMS: I think one of the reasons I was drawn to Jan, and the other women too, is trying to understand how they stay hopeful. And I think we give up on people too easily. What I love about what they’re doing here in Huntington is the belief in a second chance and a third chance. It’s really remarkable to see Jan even on a bad day find purpose in what she’s doing. It’s a lesson on being a good person and a good people within humanity take care of each another.

One of the reasons why I think addiction has taken over so many communities is that we’ve lost each other. We live isolated from each other, and our society is at a point where we feel like we don’t need another. I think seeing a crisis like this shows us how much we really do need one another.