Dan, age 33, woke up one late summer Saturday in Fresno with pain in his left buttock.
Dan is tall and dresses neatly in long shorts, and from looking at him, I didn’t guess that he was in pain, or that he had an intravenous drug habit. On the previous Tuesday, he’d gone to the jail on a warrant, but when the jail’s nurse saw the red abscess – the cause of the pain – she instructed the wardens to release him and give him a ticket instead.
For three days, the infection continued to grow. Although he has health insurance and was going to a methadone clinic daily, Dan did not go to the emergency room.
A 2004 study found Fresno had the highest rate of IV drug use in the country – more than New York or Miami – and nearly three times the national average. Last year, just after the deputy police chief was caught trafficking in opiates in a federal sting, the district attorney announced that Fresno’s drug problem was getting worse, with heroin available at every high school. The secondary impacts of widespread IV drug use are reflected in high rates of HIV, AIDS and a current syphilis outbreak.
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Lesser known is the problem of abscesses, which for IV drug users are a slow-motion car crash. Once users start injecting drugs, abscesses can become part of their lives, with sometimes fatal consequences if they’re not treated promptly.
Caused by bacteria or fungi from skin, needles, or adulterated drugs, these infections are most likely to affect longer-term users, like Dan, who can no longer access veins and instead inject under the skin or deep into their muscles. Abscesses are difficult to treat because they are resistant to antibiotics, and they seem to affect 22 to 65 percent of IV users.
While other cities have taken steps to reduce the harm of IV drugs – by allowing users to buy needles at pharmacies, and operating targeted public health clinics – Fresno’s pharmacies do not sell needles. So local users rely on a web of stalwart volunteers at the Fresno Needle Exchange and the associated clinic.
It was this volunteer system to which Dan turned to deal with his infection. On Saturday afternoon he went to the Fresno Free Medical Clinic, which is held for two hours a week in a yellow-and-green 1963 school bus parked in a cul-de-sac next to the needle exchange.
For the past 21 years, the clinic has been staffed by Dr. Marc Lasher, a wiry man with a large supply of disposable scalpels. Joining him was Shahram Aghaei, a pre-med graduate of Fresno State, in safety glasses and latex gloves. They have the treatment of abscesses down to a routine – part surgery, part comedy sketch, part opportunity to talk users into treatment for their addiction.
The temperature outside was 113 degrees; the temperature inside was upwards of that. Lasher took a look at the abscess, bright red and the size of a tangerine, offered corny jokes and said he’d need to open it up to drain it. Dan looked relieved. The infection was so large that his hip had begun to ache. I asked him why he hadn’t gone to the ER and he said the medical staff there isn’t as good at the procedure as Lasher.
The doctor injected a local anesthetic and picked up the scalpel, said “now this won’t hurt me a bit,” and made an incision longer than an inch. Dan remained stoic while the doctor extracted an enormous amount of pus from the abscess, perhaps equivalent to a cup, and showed it to him in a small surgical tray.
“This could have killed you,” he said.
Lasher then squirted the cavity with saline rinse.
Every Saturday, Lasher treats two to five abscesses, depending on what’s adulterated the street drugs that week. When IV drug users go to ERs for treatment, the cost can be considerable. Lasher’s clinic survives on goodwill and the occasional $5,000 donation to cover two years of supplies. It’s probably saving the city of Fresno (not to mention the clinic at the jail) a lot of money.
Lasher wrapped up his treatment with a gentle question: “You’re not really getting high anymore, are you?” Dan agreed. He was spending $100 a day mainly to avoid the sickness of detoxing.
“That’s a lot of money,” Lasher observed. “You’re a slave to the cartels. You have better things to do than be a pawn.”
Dan promised to take treatment more seriously and perhaps come to the methadone clinic where Lasher works during the week.
What Dan wanted was heartbreakingly normal: “I want to be able to get up in the morning, dose (methadone) and go to work.”