A Physician's Tale: Drugs, sex focus of talk
His introduction was telling enough. Before a packed house on hand to see "A Physician's Tale: Working with Addicts, Prisoners and Commercial Sex Workers" in Diamond 122, Sandy Maisel, professor of government and director of the Goldfarb Center for Public Affairs and Civic Engagement, prefaced the talk to be given by Dr. Josiah D. Rich by emphasizing that Dr. Rich was "a different kind of physician, one that works at the nexus of treating patients with addiction and infectious disease."
What followed was an hour-long talk that covered personal anecdotes from working with drug addicts and HIV patients to reforming syringe legislation in Rhode Island.
Dr. Rich, a professor of medicine and community health at Brown Medical School and an attending physician at the Miriam Hospital in Providence, is an expert in the convergent fields of infectious diseases and drug addiction. In addition to having federal funding for research, prevention and care for substance-using populations, Dr. Rich is a consultant for the American International Health Alliance and the director and co-founder of The Center for Prisoner Health and Human Rights at The Miriam Hospital Immunology Center.
Still, for all his credentials, Dr. Rich remained humble and honest about himself and his work.
"I still don't know what I'm going to be when I grow up," he joked. "But it's a wonderful adventure as a physician. Being a physician is a privilege. You see a slice of life that not everybody sees, and I try to honor that by listening to my patients."
Starting at the beginning, Dr. Rich told his story about working with the Drug Treatment Outreach Program in rough Rhode Island neighborhoods, where he gave free HIV tests. He recalled that experience as being the first time he got a sense of what life was like for a drug addict.
"We live in a culture of addiction and injection drug-users have gone beyond what most people have with addiction," he said. "Somebody has crossed a line when they are injecting, and people get tremendously stigmatized."
Frp, reluctantly taking the job as head director of a sexually transmitted infection (STI) clinic in Providence--a story summed up by the fact that all other candidates did not want the job--to his rise to his current position, Dr. Rich has worked with countless drug addicts crippled by HIV or other diseases and those who inject a range of drugs, from heroin to morphine to cocaine to Vicodin.
"People use up all their resources to inject," he said. "You don't have control over it and people do the most awful things to get it."
With injection comes the use of syringes, which are the main transmission device for infectious STIs such as HIV. Hence, feeling the pull to "go upriver to save the babies"--a reference to treating from the source as opposed to the population already affected--Dr. Rich began a needle exchange program for addicts. He emphasized that the idea came out of harm reduction (those close to addicts want to limit the harm they do to themselves) as well as an understanding of the addict population.
"If you actually get to know someone, not just as 'the addict,' then you establish a personal connection," he said.
Thus, instead of people re-using syringes on an average of six times--as it was in Rhode Island in the mid-'90s due to addicts buying drugs and using syringes provided by the dealer--Dr. Rich's needle exchange program sought to provide clean syringes. Still, as he emphasized, when you gather hundreds of drug addicts together and promise them clean needles, "you have to deliver" to build trust--otherwise it comes off as a sting operation.
As to those who would say that this practice is only furthering drug use among established addicts, Dr. Rich emphasized that it is primarily important to prevent the spread of diseases such as HIV and then to help addicts with their "life-long" illness, as he called it.
"Sticking a needle is not a natural thing," he said. "I've never met anybody who started with syringes. [At the same time,] nobody stops using because they can't access a syringe. You can't stop someone from using drugs by limiting their access to a syringe."
Hence, in Rhode Island, one of only four states where 30 percent of AIDS cases are related to injected drug use and a state in which the possession of a syringe is a federal offense, Dr. Rich sought to decriminalize possession of syringes so as to further advance the spread of clean syringes and reduce the risk of re-using dirty ones at the site of drug deals.
Between the time he began working with politicians on the bill and its successful passing in 2000--which featured "the most compelling testimony I've ever heard," according to one Rhode Island lawmaker--Dr. Rich began a syringe prescription program to prevent HIV infection. He also educated many on how to prevent the spread of disease and how to get tested. The result was a dramatic decrease in the shared syringe rate.
Yet, Dr. Rich has also worked from the inside, studying and helping to lessen the problems caused by incarceration and disease.
"It's another world behind bars," he said. "I've been locked up every week for the past 15 years, which has given me a tremendous vantage point. I'm often asked if I feel threatened [talking with inmates, but] I have never felt threatened in 15 years; in fact it's one of the safest places to be."
Nationwide, incarceration rates have been steadily climbing regardless of whatever goes on in the "outside world."
"It's become disconnected," Rich said, who emphasized that the diseases of mental illness and drug addiction play a major role. Thus, much like his work with decriminalizing syringes, Rich goes to directly help those in need.
"Addiction is a chronic, relapsing condition," he said. "Plenty of people do need to be incarcerated, but a lot of them just need the proper treatment."
"Someone who's downtrodden their whole life still trying to change their life for the better," he added, "is a beautiful thing."