Prevention on the streets: A needle exchange and free medical clinic run by a DO

Marc Lasher, DO, has devoted his career to preventing the spread of diseases from injection drugs and treating those with addiction.

On Saturdays, he runs the Fresno Free Medical Clinic in Fresno, California. The clinic treats the medical needs of people who use injection drugs in a 1960s bus that has been remodeled to serve as a mobile medical unit. At the clinic, people can see a volunteer physician for medical care, including getting an abscess drained, instead of going to the emergency room. An abscess is a common complication of injection drug use. When they’re ready, patients can also learn about detox programs.

“People are very appreciative that someone is willing and wants to see them,” Dr. Lasher says.

20,000 needles a week

The clinic also operates a needle exchange program, where people can trade in used needles for sterile ones. There are about 400 needle exchange programs in operation in the U.S., Puerto Rico and the U.S. Virgin Islands, according to the North America Syringe Exchange Network. A review of 15 studies analyzing needle-syringe exchange programs found that they were associated with decreases in the spread of HIV and hepatitis C.

About 20,000 needles are exchanged weekly at Dr. Lasher’s clinic.

When he’s not running a free clinic, Dr. Lasher is an addiction medicine specialist at Aegis Medical System, where he sees patients with addictions to substances such as methadone, alcohol, and methamphetamine.

Dr. Lasher became interested in needle exchange programs in medical school. Inspired by a lecture he heard from a community activist, he visited a needle exchange program in East Los Angeles. He watched people turn in used needles for clean ones as a way to prevent the spread of diseases like hepatitis C and HIV, as police drove by the program on occasion. He remembers the environment as respectful.

“The people running it understood that these people were there for help,” Dr. Lasher says.

His passion for working with people with addiction continued during his family medicine and community medicine training at the University of California San Francisco-Fresno.

Changing attitudes about addiction

Historically, some health care professionals have had negative attitudes toward people who use injection drugs. This has led to worse outcomes for this population.

In residency, Dr. Lasher remembers that health care staff would refer to someone with a drug addiction as a GOMER, an acronym that stood for “Get’em out of my ER.”

Many emergency rooms don’t offer addiction treatment or buprenorphine for people who have withdrawal symptoms.

“I’ve seen abscesses being opened in the ER and they don’t give the person Lidocaine to anesthetize the pain of it being drained. There are some basic common myths about addiction that people have to deal with,” Dr. Lasher says.

Dr. Lasher’s Saturday clinic is different. He describes it as user-friendly. He says many people will bypass their local emergency rooms and come to the mobile unit for medical care instead.

“No one is going to beat them over their heads to change their ways,” Dr. Lasher says. “We try to get people to reflect by asking questions such as, ‘Are you interested in changing what you’re doing?’ or ‘Do you see where it’s gotten you?’”

The cost of infectious diseases

Besides draining abscesses, the clinic also provides prescriptions for medications such as naloxone for opioid overdoses and buprenorphine.

In one study, after people received buprenorphine, they were more likely to enter formal addiction treatment.

Keeping people safe when they’re using prevents the community from paying for hepatitis C treatment later, says Dr. Lasher.

An estimated $6.5 billion in 2011 was spent to treat people with the virus, according to an article in Hepatology.

Despite the negative consequences of their actions, many of the people he treats or gives sterile needles to will use again.

“We know when we drain someone’s abscess in our mobile unit, despite all the pain and this unpleasant experience, they’re going to use again that night,” Dr. Lasher says.

When patients are ready to enter a recovery program, Dr. Lasher can refer them to see him at his regular practice. He’s trusted in the community. Many times he’ll see patients at his clinic who remind him that he treated them on a Saturday.

“I’ll see them on Saturday and then two days later they’ll see me again to continue treatment,” Dr. Lasher says.

Further reading:

5 things to know about naloxone, the opioid overdose reversal drug

Combatting the opioid epidemic: One student’s innovative approach in Idaho

Treating opioid addiction shouldn’t leave physicians, patients feeling criminal