DRUG USERS' HARD LESSONS BECOME TOOLS TO TEACH DOCTORS

Marlana Reed and Geraldine Westcott were huddled in the corridor of a
hospital in the Bronx one recent morning, wrangling over who would be
in charge of heroin and who should cover crack. After agreeing, they
entered the conference room and sat at the head of a long table.

Five first-year doctors on the other side focused the attentive
stares they seemed to have honed in medical school.

"I know you all know about drugs through the books," said Ms. Reed,
whose face, prone to girlish grins, belies her 48 years. "But we're
here to tell you the real deal from the street."

So began the seminar.

In the Albert Einstein College of Medicine's residency program at
Montefiore Medical Center, substance abuse training may include
lessons from those with firsthand experience. Since January, three
pairs of patients, called Peer Educators, have come monthly from
among five methadone clinics in the Bronx to lead 90-minute courses
for internal medicine interns through a program called Project Grow
(Giving Resources and Options to Women).

"In med school, we get the chemical mechanisms of what drugs do to
the body and how to treat it," said an intern, Dr. Svetlana
Korenfeld. "You can read about drug abuse, but if you've never seen
it the way it really is, you won't recognize it."

Dr. Hillary Kunins, Grow's founder, and Dr. Melissa Stein, who
coordinates the interns' substance abuse education, also attend the
sessions to add information from a physician's standpoint. But the
Peer Educators provide nuances that statistics and medical jargon
miss. For instance, in a recent seminar, Dr. Kunins mentioned that
crack smokers face an increased risk of hepatitis C from sharing pipes.

Ms. Westcott explained: "Say if you're in a hurry to get that hit.
The glass might pop and you cut the skin, or you burn your mouth
because the stem is too short."

A crack binge, she added, often results in scorches on smokers'
thumbs, from use of cheap lighters.

One intern, Dr. Alexander Han, said he was clueless about such things
- -- despite having treated many substance abusers in his first months
of practice. "When I look back, they definitely did have a lot of
skin chafing," he said. "I wasn't too sure what it was, and so I let
it be. Burn marks in the mouth? I'd never thought to look for that."

In 2000, Dr. Kunins began directing a methadone clinic in the Bronx
and fretted that though her patients were at risk for health problems
like H.I.V., they often avoided medical care besides their once-a-day
methadone stop. A few years later, she founded Grow, offering H.I.V.
risk-reduction education, counseling and escorts to doctor's
appointments. She knew, however, that the patients still faced a
medical culture that speaks a different language than they do and is
not well equipped to serve them. With Dr. Stein's help, she began
organizing seminars to bring women from Grow to instruct interns so
they can better understand drug-related health issues.

The course material strays from the curriculum the doctors have seen
before. The Peer Educators lecture and field questions on street
lingo, how to find and use drugs, and what being high and withdrawal
are like. "How long does crack last?" asked Dr. Christina Tseng, an intern.

"That first hit is tremendous," Ms. Westcott said. "After that, you
just chasing it until the money is gone."

Dr. Tseng wondered what a doctor could have done to help them stop using.

"Don't be judgmental, because a drug user figures everybody's
watching anyway," Ms. Reed said, adding that users are not likely to
ask for help outright. "You gotta kind of read in between."

In many of Ms. Reed's seminars, she explains how heroin can be bought
in abandoned buildings. "There are these holes in the wall, and you
put your hand in the hole and they put the stuff in your hand," she
said. "The last time I put my hand in that wall, somebody put cuffs
on it from the other side."

In more than 20 years of using drugs, Ms. Reed said she experienced
incredible highs. But memories of the lows -- including being
arrested and fearing for her baby after using drugs during pregnancy
- -- will not go away even though she has not used heroin for more than
a decade..

Now, she gains satisfaction from her tumultuous history by sharing
valuable information with doctors who have spent many of their years
in classrooms.

"It makes me feel good to know something they don't," Ms. Reed said.
"Today, that is my high."

According to Dr. Kunins, Grow's main purpose is to give these women
the tools to care for their own health. "But they have this
expertise, and if they can transmit that to the doctors," she said,
"then we can improve the system."

Dr. Kunins and Dr. Stein say what distinguishes their program from
similar ones that connect drug users with clinicians is that these
women assume the role of expert.

"We don't present the participants as patients, we present them as
teachers," Dr. Stein said. "They often don't share personal
experience very much. It's a different dynamic than the testimonial model."

Grow provides its Peer Educators with a $20 stipend and
transportation to seminars. The interns are getting a deal, too, said
Dr. Richard Saitz, the president of the Association for Medical
Education and Research in Substance Abuse.

"Learning factual information from someone who is an expert on their
own disease would be something that they will remember for a long
time," Dr. Saitz said from his office at Boston University, where he
works to raise substance abuse awareness among health professionals.

Not only is this kind of training rare, Dr. Saitz said, but substance
abuse training for residents is also lacking over all. He cited a
broad, government-financed survey, published in 2000, with more than
1,200 residency program directors responding. Only 56 percent
required substance abuse training of any kind.

Dr. Saitz believes that number is too low. "There's no word for
educational malpractice," he said, "but to not train people in drug
abuse when you're training them for H.I.V. or Hep C reduction is ridiculous."

And that is where Ms. Reed and Ms. Westcott are making a mark.
"Unless the patient was specifically admitted for overdose or
withdrawal," Dr. Han said after the seminar, "I would usually just
ask routinely, 'Do you smoke, use alcohol or drugs?' and then move
on. Now I think we know a lot more questions to ask."

Ms. Reed said that she hoped her students would use their new skills
with care. After all, she said with a grin, "If I go to a doctor and
they have more street knowledge than I do, I might feel a little
shaky about that doctor."