Indiana HIV outbreak linked to prescription drug abuse

LOUISVILLE, Ky. — A quickly spreading outbreak of HIV in southeastern Indiana is being linked to injection of the powerful painkiller Opana — raising concern among health officials across the region and nation as they face an epidemic of prescription drug abuse.

Indiana state health officials said Wednesday that they have confirmed 26 cases, and four more preliminary cases, since mid-December, most linked to Opana injection and a few spread through sexual transmission. Officials said this is the largest HIV outbreak the state has ever experienced in one region.

"Addicts use and misuse needles," said Karyn Hascal, president of The Healing Place in Louisville, which serves Southern Indiana addicts. "When you have injectable drugs like prescription pills and other narcotics being abused as much as they have been, (Hepatitis) C and HIV are soon to follow. ... I knew that HIV and Hep C would come back."

That's a concern nationally as well. Officials at the U.S. Centers for Disease Control and Prevention say injection drug use is a well-known route of transmission for blood-borne infections such as HIV, and injection drug users represent 8 percent of new HIV infections each year and 15 percent of those living with HIV, which causes AIDS.

Jerome Adams, Indiana state health commissioner, said he's especially concerned because most of the residents who tested positive for HIV just recently contracted the virus and may spread it to others.

"Because prescription drug abuse is at the heart of this outbreak, we are not only working to identify, contact and test individuals who may have been exposed, but also to connect community members to resources for substance abuse treatment and recovery," Adams said.

Prescription drug abuse has skyrocketed in the past two decades in Indiana, Kentucky and across the nation. Nationally, public health officials said, someone dies of a prescription drug overdose every 25 minutes. The CDC said drug overdoses were the leading cause of injury death in 2012, causing more deaths among 25-to-64-year-olds than motor vehicle crashes.

Drug overdoses kill about 1,000 people a year in Kentucky and about the same number in Indiana. And according to the U.S. Substance Abuse and Mental Health Services Administration, 5.68% of Hoosiers and 4.48% of Kentuckians used prescription painkillers nonmedically in 2010-11, the latest year for which statistics are available.

Brandon Holman of Louisville, a recovering Opana and heroin addict who has been at the Healing Place for three months, said he sometimes used to worry about contracting HIV, "but at the time I was just maintaining a drug habit," and spent most of his energy on getting the drugs he craved. Holman, 24, said he never contracted a blood-borne disease, and "I consider myself real blessed."

Holman said he shot up Opana between 2009 and 2011, when it was relatively easy to find, crush and shoot up. But in late 2011, the U.S. Food and Drug Administration approved a new, crush-resistant formulation of Opana ER, an opioid containing oxymorphone. Two years later, the FDA rejected a petition by Opana drugmaker Endo Pharmaceuticals, clearing the way for generic versions of the original formulation to be approved and marketed.

FDA officials argue that the generic product is a useful therapy for pain if used correctly, and that abuse-deterrent properties don't make an opioid impossible to abuse.

"While there is an increased ability of the reformulated 'abuse deterrent' version of Opana ER to resist crushing relative to the original formulation, study data show that the reformulated version's extended-release features can be compromised when subjected to other forms of manipulation, such as cutting, grinding, or chewing, followed by swallowing," FDA officials said in a statement. "Development of abuse-deterrent technologies is a priority for FDA, and we strongly encourage companies to continue innovating in this area. However, abuse-deterrent science is still in the early stages. ..."

Meanwhile, Indiana health officials are warning people to take measures to stay safe by not injecting drugs, sharing or re-using needles, engaging in unprotected sex or having sex with commercial sex workers. They are also encouraging people to get tested for HIV and seek help if they are struggling with substance abuse.

Holman, the recovering addict, suggested people may want to visit needle exchange programs, where they can get clean needles in exchange for dirty ones — and seek treatment for their substance abuse. If someone does contract HIV, he said it shouldn't be viewed as a death sentence. He said he learned that from a friend who contracted HIV through drug use and is now keeping it under control with medications.

"I'm grateful I didn't pick (HIV) up," he said. "But for those who have it, there's still hope."

Ungar also reports for The (Louisville, Ky.) Courier-Journal