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"Drug Users' Hard Lessons Become Tools to Teach Doctors"

The New York Times, March 2006


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."


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Read the full article at The New York Times' website.