BALTIMORE, MD, USA - MAY 19, 2011 :
Shooting up before going on stage is a requirement; Alex says she can't dance without being high. Alex works at a strip club in Baltimore in order to pay for her habit; the money is fast and always in cash. She has been warned by the club managers several times that if she doesn't clean up her act, she will be fired.
Heroin is a huge industry in Baltimore, as it is in many post-industrial towns and cities in the United States. It has seen a huge resurgence in popularity over the last decade, due in great measure to the availability of prescription opioids like oxycontin, which is often a gateway drug.
According to the Centers for Disease Control, in 2002, 100 people per 100,000 were addicted to heroin but that number had doubled by 2013. Rates of addiction in the Northeastern United States have increased dramatically, only slightly outpaced by addiction rates in the Midwest, with the highest addiction increases being reported amongst 18-25-year-olds. The rate of heroin-related overdose deaths increased 286 percent between 2002 and 2013.
This photograph was unposed and undirected by the photographer.