For 15 years, Dr. Marc Lasher has been hitting the streets of Fresno, Calif., on Saturday mornings in a school bus-turned-medical clinic, collecting used syringes and handing out sterile ones to addicts who need them.
And that's only a piece of it. Lasher and his volunteer staff also provide basic medical care to addicts who visit the bus, and give out referral information for detox and treatment centers in the area.
"Addicts have a very unique set of problems, and need a lot of medical care," said Lasher, who is an addiction specialist and medical director of Aegis methadone clinic. "We act as a portal to the health care system for a population that has fallen off the edge of the world."
Prejudice and shame dissuade many addicts from receiving standard care, Lasher said, and his belief in providing compassionate and respectful care while attempting to curb the transmission of deadly bloodborne illnesses, including HIV and hepatitis C, is enough to keep his mission going, despite the roadblocks that he has experienced in recent days.
While the program is technically illegal because it provides drug paraphernalia to the public, three years ago, Lasher and his crew struck a deal with Fresno government officials that allowed the needle exchange program to receive immunity from drug paraphernalia laws and provide care to addicts who needed it.
They have been able to provide care to addicts largely unbothered by police or government, but two weeks ago, the city officials withdrew their support of the traveling medical clinic.
"It's a philosophical question whether to give someone the tools to continue an illegal behavior," board supervisor Judy Case told the Fresno Bee. "I just think providing needles to addicts is enabling."
Fresno has one of the largest injection drug user populations in the country, Lasher said, and the moral dilemma should not have a place in a decision to prevent HIV and hepatitis C.
"People are dying of HIV and hep C all the time," said Lasher. "We can prevent that from happening. We need to get the morals out of the way and present real health solutions and care about what's happening to these people."
Lasher is now seeking to override city government entirely. Two new bills were presented to California Gov. Jerry Brown's office, and Brown has until Oct. 9 to sign or veto the bills, one of which would allow pharmacists and other medical personnel to hand out a limited amount of syringes without prescription. The other would allow the California Department of Health to administer needle exchange programs when there is a potential public health risk, according to the LA Times.
"There is absolutely no evidence that providing clean needles to addicts encourages use," said Dessa Bergen-Cico, assistant professor of public health at Syracuse University in New York. "On the contrary, such services have been researched and found to be an effective means of engaging addicts with health care and social services, thereby facilitating their entry into drug treatment."
The U.S. is one of a few countries where the availability of sterile syringes is limited, Bergen-Cico said. Needle exchange services are available in Canada and most European countries, including Turkey, where clean needles can be obtained from any pharmacy without a prescription, Bergen-Cico said.
Fresno Needle Exchange Program Defies Law
"It is time for the United States to take a mature position of leadership and examine drug use and drug policies not as a public order issue but as a public health issue," she continued. "The emphasis only on criminality, interdiction and the drug war has blinded politicians in particular to the breadth of solutions for reducing harm and treating addiction."
On any given Saturday, about 10,000 needles are exchanged at the bus, and Lasher and his staff provide care to 100 and 200 patients. The staff collects the used needles, places them in biohazard containers and brings them to a biohazard facility to be destroyed. He said the clients range greatly in socioeconomic status and background.
"Not having a clean needle is not going to stop someone from using if they're an addict," said Lasher. "These people are our children, aunts, tias and tios. There's no ducking from this. This is about saving lives. It's not about religion or morals."
But even if Brown vetoes the bill, Lasher has no plans to discontinue his medical care for addicts in the Fresno area.
"We'll continue to do exactly what we're doing," said Lasher. "People feel comfortable with what we're doing, because they're treated with compassion and respect. For a lot of people, we're their medical home and their doctor and we'll continue to do what we do."