SILVER SPRING, MD, USA - JAN 12, 2014 :
Alex eats strawberry and banana crepes at a local IHOP in Silver Spring, Maryland, with other recovering addicts after attending a meeting. Alex rarely ate when in the deepest throes of addiction; loss of appetite is a common side effect of opioid addiction. At her thinnest, she weighed less than 100 pounds (45 kg).
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.