HIV Outbreak Linked to Opana Injections
We’ve been hearing about the rise of opioid abuse and prescription pain reliever overdose deaths. Now this deadly behavior is resulting in an unintended consequence: HIV outbreak
For the 20 somethings that are now the heaviest users of opioids and heroin, they haven’t heard the same lessons that older generations have learned about the dangers of sharing needles.
Recently, the Indiana Department of Public Health announced an HIV outbreak in Southeastern Indiana linked to injection of the prescription painkiller Opana. Since mid-December, 142 have tested positive for HIV, with 136 confirmed cases and six more with preliminary positive test results. While the majority of cases were found among injectors, some are attributed to sexual transmission. This is a huge number of cases for an area in rural Indiana that has a population of only a few thousand people.
Rural areas in Indiana, Kentucky, Ohio and West Virginia are among the highest at risk. Many family members, across generations, live in the same house and will use the drugs together which has led to more needle sharing, which spreads infection.
This is the first documented HIV outbreak in the United States associated with injection of a prescription painkiller. Over the past 20 years, HIV rates associated with injection drug use have declined and so has hepatitis C infections. However, both are now on the rise again in Indiana. Health advocates have been sounding the alarm that if hepatitis C is spreading among injectors, HIV won’t be far behind. Unfortunately we’re now seeing that prediction come true.
Some now say that we are in phase two of America’s opioid epidemic. “The first phase, from the late ‘90s up through a few years ago, was characterized by a dramatic rise in the use and misuse of prescription painkillers. These drugs were heavily marketed, heavily prescribed, and readily available — resulting in skyrocketing rates of opioid dependence and overdose. But heroin use was largely stable, and injection of opioids was uncommon”, says Daniel Raymond, Policy Director, Harm Reduction Coalition.
Raymond goes on to report that “in this second phase, the prescription opioid overdose epidemic has morphed into a full-fledged opioid epidemic, with rising drug injection and heroin use. As more opioid users transitioned to injection, hepatitis C spread quickly through syringes and injection equipment shared within social networks. CDC estimates that between 2010 and 2012, new hepatitis C infections rose 75%, to about 23,000 new cases a year. Like HIV, hepatitis C is a blood-borne virus, but tends to spread more quickly among social networks of drug injectors through shared syringes and injection equipment.”
Opioid overdoses have leveled off in recent years due in part to controlling the supply of prescription opioids by developing prescribing guidelines, establishing monitoring programs and setting up “take-back days” where people bring their unused prescriptions back to the pharmacy for disposal.
However, demand of opioids is on the rise. According to the CDC, there has been a 150% increase in hepatitis C between 2010 and 2013 – the majority of the increase believed to be from injection drug abusers.
Another reason that HIV and Hepatitis C have spread so rapidly is the nature of the drug itself. “Opana, as the prescription opioid is known, needs to be injected more than once a day. Users have reported injecting it four to 10 times a day to stay under its influence. When people start to feel the drug wear off after about four hours, they begin to feel sick and go into withdrawal. Often they’ll turn to an injecting partner in the same house who will share their needle and their drug to give the person relief from these symptoms”, says Dr. Joan Duwve, chief medical consultant with the Indiana State Department of Health.
Opana also requires a larger-gauge needle that exposes users to more blood, which increases the risk of infection.
“The situation in Indiana should serve as a warning not to let our guard down. This is a powerful reminder that HIV and other infectious diseases can gain ground at any time, unless you remain vigilant,” say Jonathan Mermin, MD, MPH, and the Director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP)
Sources: CDC, CNN, and Harm Reduction.org