How Pain Medication Misuse Led to an HIV Outbreak
Most people’s perceptions of injection drug use and rising rates of infectious diseases involve images of broken needles in an inner city. But the year isn’t 1985 and we’re not just talking about people injecting illegal drugs, like heroin. Thirty years later, a relatively unknown prescribed opioid called Opana has hit hard in rural America, particularly in Indiana, and its misuse is reigniting concerns about a new HIV outbreak.
What is Opana?
Opana is an extended release painkiller that comes in pill form, but can be crushed and converted to an injectable liquid. Its use increased a few years ago, when the widely misused prescription painkiller OxyContin was changed to a tamper resistant pill. Injecting Opana or any opioid for that matter — whether heroin or OxyContin — increases the likelihood of contracting blood-borne diseases such as HIV and hepatitis C.
And that is exactly what we’re witnessing in the Midwest.
The recent HIV outbreak in Scott County, IN not only sheds light on the troubling opioid epidemic in the state, but also challenges the misconception that HIV is strictly an urban disease. To date, nearly 100 people have been diagnosed with HIV in an area that normally only sees five new infections a year — and most of these new infections have been linked to injection drug use. Fueled by the rampant over-prescription of opioid medications and the lack of a clean needle exchange program, the small county of 24,000 is facing one of the worst public health emergencies in its history.
The problem with over-prescription
In 2012, Indiana doctors prescribed opioid pain relievers at the ninth highest rate in the country, contributing to the risk of opioid dependence in the area. Over-prescribing potentially addictive drugs creates opportunities for people to become dependent on their prescribed medication or to sell their unneeded prescribed pills or share them with drug misusers. Over-prescription floods the illegal drug trade with an excessive amount of narcotics.
Opana’s misuse typically involves injecting the drug, often with shared or old needles, which increases the risk of spreading disease. The Indiana county has already seen a rise in hepatitis C cases and is now experiencing an outbreak of new HIV infections. Expanding availability of and access to needle exchange programs is one of the most effective methods of reducing HIV and hepatitis C transmission. This is because needle exchange programs allow injection drug users to exchange potentially contaminated used needles for clean ones.
Indiana Gov. Mike Pence, who has opposed needle exchange programs in the past, recently sanctioned a lift on the needle exchange ban — but only for 30 days. Although the governor’s decision is a step in the right direction, it does not address the larger issue of over-prescription or high demand for addictive drugs. Indiana’s public health response needs to reevaluate how it can implement new health-focused laws and programs to prevent over-prescription and drug misuse and to offer comprehensive and effective treatment to those with addiction.
Compared to other states, Indiana does not have the highest rate of over-prescription, nor is it the only state without a needle exchange program. And without the best preventive measures, this type of outbreak, which ravaged the country just three decades ago, is still possible in any state and in any type of area – urban, suburban or rural.
The current situation in Indiana serves as an urgent reminder that government officials need to enact comprehensive public health measures that anticipate changes in drug availability, and promote interventions that prevent misuse and reduce harm, while providing effective treatment for those with addiction. A proactive approach has a greater chance of protecting the public’s health than enacting partial and temporary measures that just respond to the latest emergency.
Adetutu Adekoya, MA
Adetutu Adekoya is a Research Associate at CASAColumbia