Heroin Town review: Louis Theroux loves misery’s company

Louis Theroux’s interview technique is blunt and relentless, like a terse interrogation designed to coax an exact confession. “Do you have a job?” he asks one young woman, who does not. “Do you use?” he asks. She does. “What did you first take? Where did you get them from? Why?” The questions come like jabs, designed not to hurt or taunt, but to mainline on her misfortune, as though Theroux is searching for a vein.

Filmed in Huntington, West Virginia, the epicentre of the US opioid crisis, and given a title as unwieldy as its presenter, Louis Theroux: Dark States - Heroin Town (BBC Two, Sunday, 9pm) does not flinch when it sees a needle reach the skin. At one point Theroux regards a rock of heroin. "It's so nothing," he says, but he has always had an eye for compulsive television.

Throughout his career, as stalker of America’s abundant weirdness or the low-hanging fruit of curdling celebrity, Theroux’s sincerity has often been in doubt. With a canny nose for ridiculous situations, and the fixed expression of a perplexed Vulcan, he has a capacity to titillate and moralise in the same breath. “There’s nothing I could say that would persuade you not to do that?” Theroux says, sliding down to sit on the floor beside Cotilia, a remarkably unguarded young addict. There is only the trace of a question. The camera doesn’t flinch as the needle breaks her skin – the second time we watch someone shoot up in the episode and not the last.

It isn’t difficult to put a lens on the heroin epidemic in America. Theroux meets most of his participants through a needle-exchange programme, many of whom tell dismayingly similar stories of chronic pain. First is the accident – a common phenomenon in a former industrial town like Huntington – then the high-strength pain medication, then the cut-off, then the cheap illegal alternative.

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Theroux works on the ground level, staying close to the users – “We are talking to people who are active in their addiction,” he says to one recovering addict, now a religious proselytiser. That certainly gives a human face to an epidemic that could otherwise pass by in numbing statistics. In Huntington, one in four adults are addicts, one in 10 babies are born dependent on an opiate, and the fatal overdose rate is 13 times the national average. But it dwells on conspicuous miseries of the desperate and impoverished rather than expanding its scope to look at broader failures: the addictive pharmaceutical products, the struggling emergency services, the contested provisions of American health care.

It’s telling that we get little from one emergency responder, with frank insights into the crisis, other than Theroux asking her of an overdose, “Could he have died right there?” (Another dark consideration is whether, if he had, the programme would have shown it.)

In this awful situation misery is like heroin: cheap, plentiful and easily available. Theroux risks becoming addicted to the stuff.