Sudden Death

Needle-exchange pioneer John Watters' interrupted journey

CSF psychologist John Watters was something of a hero to people who didn't even know his name. His scholarship on injecting drug users (IDUs) changed -- maybe even saved -- many of their lives.

As chief of the Urban Health Study (UHS), the 47-year-old researcher studied needle users in what Marlon Perkins would have called their natural habitat. He pioneered the "bleach and teach" method, encouraging drug users to disinfect their syringes, and wrote or co-authored several medical papers that demonstrated how needle exchange programs slow the spread of HIV, including a 1994 landmark study published in the Journal of the American Medical Association. As a loyal partisan of the "harm reduction" movement, Watters argued that drug use should first be treated as a public health problem rather than a criminal one.

Watters' harm-reduction campaign came to an end on Nov. 20, when he was found dead in his Glen Park cottage by the mother of his child, Lesley Iura, who had been dispatched to check up on him after he failed to fly into New York City as promised. Watters was discovered lying face down on a couch with small amounts of blood coming from his nose and mouth. A preliminary coroner's report said, "Found on a cutting board on the kitchen table were a[n insulin] syringe containing a clear liquid, a spoon with a dried white powder on it, a glass of water, and small pieces of cotton with blood on them." There were also "empty wine bottles and prescription containers" and "apparent needle marks in the right antecubital fossa [the crook of the forearm]."

The suddenness and circumstances of Watters' death led the Coroner's Office to investigate it as a possible drug overdose -- and sent shock waves through AIDS prevention and harm-reduction circles.

"John's sense of ethics and intolerance for bureaucracy and bureaucrats was certainly my standard ... and the yardstick by which I measure my colleagues," says Moher Downing, a friend of 10 years who educates mothers about HIV transmission to their babies. "Having John die is, for us in AIDS, kind of like having Jerry Garcia die."

Former Bay Times reporter Tim Kingston calls Watters' death a "tremendous loss to the community. Everyone just keeled over from this. It's like the harm-reduction movement lost a -- he would prefer the term 'patriarch.' "

"He really looked at the large picture and was really at the leading edge of looking at many important public health problems," says Alan Lifson, an associate professor at the University of Minnesota who had worked with Watters for seven years. "I think he's really been a leader in many fields of epidemiology."

But Watters' death left several questions. Did the energetic and professionally driven professor run afoul of illegal drugs? Or was there a simpler explanation, such as a heart attack or a prescription-drug overdose, which friends and colleagues favor?

The San Francisco Coroner's Office will not determine the official cause of death for another four to six weeks, until thorough toxicology tests are completed. Meanwhile, sadness and speculation fills the air.

This much is known: A close friend of Watters expected him to arrive on an 11 p.m., Nov. 20 flight in New York. When Watters didn't show by 1 a.m., the friend learned from the airline that he hadn't even boarded the flight. The friend had spoken with Watters at 4:30 a.m. (Eastern time) on Nov. 20, at which time he planned to make the flight. (When she called again at 6:30 a.m., she got no answer.)

The friend called Lesley Iura and ask her to check on Watters; entering through the unlocked front door, Iura found the doctor's body and called emergency services. The officials examined Watters, searched the premises, and wrote out a receipt for his street clothes. A police officer took five Polaroids of the scene, and a coroner removed Watters' body for autopsy.

No suicide note was found, and no friend or colleague contacted could cite a motive for suicide. The highly regarded professor was working on seven different papers with Alex Kral, not to mention a letter on hepatitis transmission which was being reviewed for publication by the Journal of the American Medical Association. The UHS was about to receive additional grants -- one came in the day before his memorial service -- and Watters was about to start studying a new population of IDUs in the Bayview-Hunters Point district, "something John had been looking forward to for 10 years now," Kral says.

Watters was a national player; his obituary appeared in the Examiner, the New York Times, and the Washington Post, and also spawned a Chronicle story. Most of the obits acknowledged that the death was being investigated as a "possible drug overdose," but the Chronicle's Sabin Russell directly implied that Watters was using illegal drugs.

Noting the fact that Watters studied IDUs and died in a room containing prescription drugs and "paraphernalia" in it, Sabin's Nov. 23 story drew this conclusion: "Colleagues at UCSF said they were shocked by the news. Although Watters devoted much of his work to the problems of drug users, they said, they did not know that he was a user himself."

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