POINTED DISPUTE

Fresno Doctor Backs Needle Exchange Without Joining Trade.

It's an hour before drug users can get clean syringes at a needle
exchange in south Fresno, but a line of people begins to form as soon
as Dr. Marc Lasher pulls around the corner behind the wheel of a
green and gold bus.

There are always patients waiting for the doctor. "I'm always doing
something. There's no time I sit here twiddling my thumbs," Lasher
says at the end of a recent sweltering Saturday inside the bus that
serves as the Fresno Free Medical Clinic.

Lasher doesn't provide needles, but volunteers his time to provide
medical care near the needle exchanges.

In the past five hours, he has taught a drug addict the basics of
cardiopulmonary resuscitation and how to give medication to stop a
drug overdose. He has administered shots for hepatitis, referred a
man to a detoxification program, applied an ice pack to a black eye,
handed out antibiotics to a half-dozen men with infections and lanced
a wrist abscess.

This is the 10th year Lasher has provided free medical care to drug
users who show up each week to exchange dirty needles for sterile ones.

Little has changed in a decade. The Fresno Needle Exchange continues
to distribute needles and remains the subject of political debate in
Fresno County. And Lasher, who isn't a member of the needle exchange
- -- but is its biggest public advocate -- continues to lobby for a
legal exchange while practicing street medicine within arm's length
of an illegal operation.

"This is the war on drugs. This is the front line," Lasher says.

Lasher believes it would be easier to fight drug abuse if Fresno had
a legal needle distribution system.

A legal exchange could receive grants from private foundations and
use the money for services, such as an abuse counselor, he says.
Exchange volunteers also would not be in danger of arrest for
participating in the illegal distribution of needles.

Lasher is not part of the program and not subject to the threat, but
he sympathizes with those who are. Lasher helps a volunteer learn how
to give a hepatitis shot. For 10 years, Lasher has provided free care
to drug users who show up for the exchange.

It's no secret where the illegal exchange occurs in Fresno. It's down
the street from the California Highway Patrol offices at West and
Hedges avenues, but police look the other way. Volunteers hand out
4,000 to 5,000 clean hypodermic kits within an hour's time each
Saturday. The exchange has been in operation for the past 12 years.

Says Lasher: "We're not trying to hide somewhere. We want it out in
the open and dealt with as a community health issue."

Lasher continues to provide medical care to all who need it, hours
after the needle exchange packs up and leaves.

Before Lasher began offering free medical care, exchange co-founder
Jean Rodriguez says, she would take drug addicts to the emergency room herself.

Lasher's interest in the needle exchange began when he found dirty
needles in the alley behind his home and in abandoned homes in his
neighborhood near downtown Fresno.

He started the free clinic in 1996 while working as a family practice
intern at University Medical Center. He carried medical supplies in
the back of a Geo Metro and later in a van. He bought the 1964 Fowler
School bus about four years ago with a $2,000 donation from the
family of a deceased elderly patient at his Chinatown Family Practice
on F Street.

He has spent years trying to convince Fresno County to authorize a
needle exchange. State law allows counties or cities to approve
exchanges, and about 35 to 40 programs are in operation statewide.

Lasher argues needle exchanges reduce the spread of infectious
diseases from contaminated needles.

According to a county health department report, 81% of illegal drug
users in the county are infected with hepatitis C, and 34% of county
residents living with the virus that causes AIDS admit to injecting drugs.

Lasher has both personal and professional concerns about infections
being spread by dirty needles. In January, he nicked one of his hands
with a scalpel used to treat patients.

He was not overly worried about the cut when it happened. The knife
went through several layers of cloth before cutting him. Tests for
the AIDS virus and hepatitis C were negative.

The reason he mentions the accident, he says: "It shows how our lives
are interlinked between the people I treat here and what happens to
them and what happens to those of us in the rest of the community."

Lasher began his campaign to get a legal needle exchange in Fresno
County in 2002.

He had gained political and community action skills protesting the
Vietnam War in the late 1960s while attending college in New York,
and in the past 20 years learned organizing skills participating in
movements to unite farmworkers and prisoners in California. Thus far,
he hasn't been able to persuade supervisors to approve a legal needle exchange.

Supervisor Susan Anderson pushed for an exchange at a heated board
meeting on May 23. Supervisors Henry R. Perea and Judy Case said they
couldn't support a program unless it included substance abuse
treatment. Supervisor Bob Waterston said the city of Fresno should
share the cost.

Supervisors ordered Dr. Edward Moreno, the county's health officer,
to meet with city officials on a possible joint effort. Moreno said
last week he has not set a date to present information.

City Council President Jerry Duncan said last week that a needle
exchange is a public-health issue that typically is a responsibility
of the county; besides, he says, he is not a supporter of needle
exchanges. "I just think it encourages more drug use," he says. "If
people don't want to get hepatitis, just quit using drugs."

Lasher says kicking a drug habit isn't easy. "Addiction is a monster"
that people with drug habits wrestle with daily, he says. "It has its
talons in them."

Government leaders see only one dimension of a drug user, he says.
"They're dehumanizing them into just a drug addict chasing a bag.
That's not it. There's much more to it than that, and we can't just
throw them out based on that."

Almost every Saturday, heroin, methamphetamine and cocaine addicts
attend a detoxification orientation class he offers. Some are
successful at quitting. Others are not.

Until the addict is able to stop using drugs, a clean needle is the
best treatment, Lasher says.

At a recent needle exchange, three people waited for Lasher to park
the bus. A man leaned against a wood staff to steady himself, a thin
young woman clutched her stomach and a woman rubbed arms dotted with red welts.

The man needed a prescription for insulin, the woman a cream for her
skin condition. The young woman wanted information about drug
detoxification for OxyContin, a narcotic painkiller with withdrawal
symptoms as intense as those from heroin.

Lasher treated the young woman first, handing her a list of places
she could go for help.

She didn't know the drug was highly addictive when she began abusing
it five months ago, she says, declining to give her name. She decided
to start treatment the following Monday at the doctor's Chinatown
family practice.

"She's doing excellent," Lasher says of the woman's treatment.

On a searing hot afternoon at the needle exchange last week, Lasher
rushed from detoxification orientation to overdose prevention classes
to immunizations before seeing patients.

A 54-year-old Fresno heroin user met Lasher under the shade of a tree
to talk about options for his addiction.The man, who did not give his
name, says he had been a licensed vocational nurse. He began using
heroin four years ago to dull pain in his spine. He was ready to
stop. "It's not where I want to be," he says. "The side effects are
too much. Plus the cost -- 60 to 100 bucks a day."

He came to see Lasher because the doctor had treated him for a couple
of abscesses at puncture sites where he had injected heroin. Lasher
is a caring man, the man says. "I don't know what drives him, but
he's here almost every week."

The Fresno Free Medical Clinic is more than a hobby for Lasher, says
Dr. John Zweifler, who taught Lasher at UMC and occasionally helps at
the free clinic. "The fact that Marc has done this for years without
any reimbursement is truly amazing," Zweifler says.

Lasher's wife, Chanah Cossman, a certified nurse midwife who works at
the Chinatown office, says the free clinic is Lasher's shabbat, the
Jewish sabbath, which is from Friday sundown to Saturday sundown.

Lasher told Cossman the Saturday afternoons spent at the clinic were
not work. And he wanted to be there.

Whether the needle distribution remains an illegal venture or the
county and city decide to approve a legal exchange, Lasher says he
will continue to treat drug users from his bus.

"I'm their doctor," he says. "They're my patients."