"I go right here," said Linda, pointing between two knuckles. Her whole hand was swollen. "Can I hit it myself?"
Greg Scott knows that junkies are their own best "vein experts," so he said she could.
Linda wrapped a tourniquet around her arm just under the elbow, shook out her hand, then jabbed herself hard with a needle. Scott, wearing turquoise latex gloves, held a plastic vial connected to the needle by a thin tube and waited for blood. A few minutes later the vial was still empty. "I don't see anything yet," he said.
On this recent Wednesday evening Scott and Linda were sitting on folding chairs in the back of the Chicago Recovery Alliance's needle-exchange van. The deal was that if Linda could produce blood Scott would give her $10.
Linda is a black 45-year-old heroin addict who's been shooting up since she was 15. Scott is a white 35-year-old sociology professor on sabbatical from DePaul University. Last year he took phlebotomy training and learned to administer vaccinations and give shots to treat anaphylactic shock in preparation for a study on a hepatitis B vaccine, which is what led him to Linda.
The hepatitis B virus attacks the liver. Symptoms include jaundice, fatigue, and vomiting. IV drug users are at high risk for the disease, which is transmitted through blood and other body fluids and can be spread by sharing needles, cookers, and cotton filters--60 to 80 percent of users have been infected. After recovering from an HBV infection, people usually have a natural immunity to the virus, but to curtail the spread of the disease, the Centers for Disease Control recommend vaccines for people in high-risk categories. Scott says the rate of vaccination for IV drug users and transient populations, who often "feel stigmatized and judged and tend not to trust traditional doctors," is generally pretty low.
Standard medical practice is to give hepatitis B vaccines in three doses--two a month apart and the third five months later. "Ninety-five percent of the time that'll make you fully safe and protected against hepatitis B," Scott says. "But it's that waiting period--we lose a lot of people. They don't finish up, they don't get that third shot. If you don't get that third shot you're not fully protected. So what I'm going to do is I'm going to try to figure out if we can give people the shots in two months."
Scott says several studies have already shown the shorter schedule is nearly as effective in creating antibodies to HBV as the standard one. A 1995 study at an STD clinic in Madrid also showed that people on the shorter schedule were three times as likely to come back for their third shot.
In early 2001 a professor at Yale's public health school enlisted Scott to help reproduce the Madrid study on a larger scale and in multiple locations, though exclusively with IV drug users. Scott's study is funded by the National Institute on Drug Abuse, which pays him or one of two researchers he's employed to travel with the needle exchange's outreach van six days a week. Over the course of the three-year study Scott hopes to enroll about 400 IV drug users in the Chicago area. The plan is to vaccinate half of them on the two-month schedule and half on the six, then compare the results with those of simultaneous studies in Hartford, Connecticut, and Saint Petersburg, Russia.
Scott says the data they collect will have implications not only for medical protocol but for public health policy. He interviews the participants during each visit and says he's already collected "a shitload of data on needle use, social relationships, sexual behavior, hepatitis knowledge, and psychosocial indicators of health and well-being." He thinks the information will be useful in related studies, including one he's decided to do on overdosing. "Conventional wisdom is never shoot alone," he says, "because nobody's there to see you. But people who shoot alone tend not to overdose. They're also less likely to contract communicable diseases."
Scott's also trying to find out whether it makes sense to pay drug users to take care of themselves. "The question is," he says, "is it cheaper from a public health perspective to pay people to come in and get vaccinated than to allow them to go unvaccinated and then check themselves into a hospital with a bad case of chronic hepatitis B or hepatitis A?" (The hepatitis B vaccine he's using also protects against hepatitis A, which is spread through contact with an infected person's fecal matter.)
If Linda's blood shows she's never been exposed to or been vaccinated against HBV, she'll be eligible to participate in the study. If she qualifies she'll get the free vaccination and $50 spread out over four more visits.
But first Scott had to collect some of her blood. After several minutes of staring at the needle between her knuckles he said, "I don't think we're going to get much out of this."
Linda pulled the needle out of her hand and suggested tapping another vein. "I got one in my leg," she said, pushing up a pant leg. A dozen or so dark dime-size scars, likely the result of abscesses, dotted her left calf and shin. Her skin was dry and cracked, and her leg was swollen.
Scott dabbed the area she chose with an alcohol swab, but then Linda pressed down on the spot with her hand before going in with a new needle, pushing into her vein any germs she'd had on her fingers.
"There you go--now you've got a hit," Scott said, looking at the vial in his hand. He encouraged her as she pushed the needle in farther: "Real slow, real steady. You've got a good register. It's still going."
But after an initial spurt collected in the bottom of the vial, the flow nearly stopped. She gently repositioned the needle.
"There you go," he said.
For a few minutes they sat there, hopeful.
"Still dropping?" she eventually asked.
"Yeah, it's still dropping," he replied. "Drop by drop."
Several minutes later he said, "That's about all we can do here."
She looked concerned. She gestured toward the blood in the vial. "Is that enough?"
He said he didn't think so. "Got any veins up in your arm?"
She said they were "burned."
"When you go to the doctor, where do they take blood?" he asked.
She looked at him like he was crazy. "I don't go to the doctor."
He noticed a darker skin tone on the underside of her right arm, which he knew meant scarred, constricted veins. But he thought he saw one that might work.
"That's wore out," she said, before telling him he could try it anyway.
He gently cleaned the spot on her arm with another swab. In the course of his research he'd stuck needles into people's hands, arms, groins, and, on one occasion, the breast of an addict who was seven months pregnant.
Sticking needles into the veins of people likely to have communicable diseases doesn't seem particularly dangerous to Scott anymore. A few days earlier an ex-con he's studying for another research project had led him through a rival gang's territory, nearly walked him into the path of a shooting, and temporarily ditched him at a prostitute's apartment.
As Scott pushed the needle in, Linda turned her head away and winced. The arm was a bust.
Linda said she could draw a good amount of blood if she could collect it at home. "It'll be mine," she said. "I can promise you that." She said she would just sit in the tub and take it real slow.
"I can't let you do that," Scott said.
He could see she didn't want to quit, so he suggested trying her right leg. It had as many abscess scars as the left.
She chose a spot, smacked it four times, then took a new needle from Scott. After waiting for several minutes without much to show for it, he said, "Let's go with what we got." The vial of blood from her other leg had just under two milliliters, the amount the lab needed. "We'll see if the lab can make that work."
Linda stood up, put on her watch, and initialed a form. Scott handed her a crisp $10 bill.
"I'm going to get me some cigarettes with this ten bucks," she told him.
They agreed it was hard earned. Scott laughed and said, "That's gonna be one good cigarette."
Art accompanying story in printed newspaper (not available in this archive): photo/Yvette Marie Dostatni.