Indiana is grappling with an outbreak of HIV that local health officials say is connected to prescription drug abuse.
Since mid-December, there have been 27 confirmed and 10 preliminary — meaning they need to be confirmed with further testing — HIV-positive cases in the state, according to an announcement from Indiana health officials on Friday. The infections are largely concentrated in the southeast corner of the state, and in all cases, the patients had reported injecting the prescription opioid oxymorphone hydrochloride, known by the brand name Opana. For local health officials, this raises concern about addiction in the area.
“It’s very concerning to me that most of the individuals who have tested HIV positive have only recently contracted the virus,” said State Health Commissioner Jerome Adams in a statement released Feb. 25 about the HIV outbreak. “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.”
Opana comes in either injection or pill form and contains the active ingredient oxymorphone. The opioid painkiller is usually prescribed to treat back pain or pain related to cancer or osteoarthritis. It’s also more potent per milligram than OxyContin, another commonly prescribed and abused opioid painkiller.
Opana’s manufacturer, Endo Pharmaceuticals, did not respond to requests for comment.
In response to reported cases of Opana misuse and abuse, Endo Pharmaceuticals reformulated the pill in 2012. The company made the pill difficult to crush and made it so that it took on a sticky feel when combined with liquid.
Nabarun Dasgupta, an epidemiologist who studies the abuse of prescription painkillers, told The Huffington Post that this abuse-avoidance strategy may have led some people to turn to riskier methods of taking the drug, such as injecting it. He said he was not surprised to learn that Opana has been linked to the spread of HIV.
“If the pills are harder to crush and inject, the amount of active ingredient in each preparation will be lower, and the nasty [fillers] will be be greater,” Dasgupta, who is the chief data scientist at public health data company Epidemico, wrote in an email. “So, to achieve the same high or stave off withdrawal, there has to be more injection events. More events are more opportunities for HIV and hepatitis transmission.”