The Centers for Disease Control and Prevention warns that the U.S. epidemic of opioid abuse could lead to more severe outbreaks of HIV and hepatitis C nationally, much like the outbreak now seen in Indiana. A health advisory the agency released Friday outlines steps that state health departments and medical providers should take to minimize the risk of that happening.
A public health emergency has been in effect in southern Indiana's Scott County since late March. According to the Indiana State Department of Health, 142 people have been diagnosed with HIV since December. Prior to the outbreak, the rural county hadn't recorded more than five cases of HIV in a given year, and in many years it recorded none.
Indiana's current HIV outbreak has been linked to the intravenous injection of oxymorphone, an oral painkiller sold under the brand name Opana. Abuse of the prescription opioid has been a common problem in southern Indiana for years and has affected many communities across the U.S.
A CDC report, released at a press conference Friday, shows that 85 percent of patients newly diagnosed with HIV in Scott County also have hepatitis C, which can be hugely expensive to treat.
The report also indicates that 75 percent of the infected patients are men, and about 25 percent of infected women are commercial sex workers.
Entire families are sometimes using the prescription opioids, the report notes — "with as many as three generations of a family and multiple community members injecting together."
The Indiana State Department of Health says it has developed a multipronged plan for dealing with the current outbreak. It includes a public education campaign, a facility that offers immunizations, and programs that connect patients with addiction treatment centers and job training.
Right now, that approach also includes a controversial needle exchange program, which has reportedly distributed thousands of needles to more than 80 injection drug users. The exchange program became possible when Indiana Gov. Mike Pence temporarily suspended an Indiana law that bans needle exchange programs. Some politicians have called for the ban to be lifted permanently. Neighboring Kentucky approved the use of needle exchange programs last month.
In addition to the recent HIV and hepatitis C outbreaks in Indiana, CDC data have shown a 150 percent increase across four years nationally in new hepatitis C infections. Hepatitis C infections often increase among users of injected drugs; the CDC is asking states to take a closer look at their own health data, to help identify communities that could be at risk for unrecognized clusters of hepatitis and HIV infections.
ROBERT SIEGEL, HOST:
The Centers for Disease Control and Prevention is warning today that an HIV outbreak in Indiana could be a harbinger of similar outbreaks around the country. The state now has nearly 140 cases of HIV confirmed. The bulk of those are in Scott County and are linked to injected drug abuse. Just ahead, a conversation with Indiana's state health commissioner. But first, NPR's Anders Kelto reports on today's federal warning.
ANDERS KELTO, BYLINE: Jonathan Mermin, the director of the CDC's Center for HIV and AIDS, says the root of the problem is prescription painkillers.
JONATHAN MERMIN: The overprescribing of these powerful drugs has created a national epidemic of drug abuse and overdose.
KELTO: It's not just in Indiana. In many parts of the country, he says, people are injecting themselves with prescription opioids, and injection drug use has caused an unprecedented rise in cases of hepatitis C, a virus that can be spread from people sharing needles.
MERMIN: New CDC data on viral hepatitis show 150 percent increase during the four-year period between 2010 and 2013.
KELTO: Hepatitis C can cause liver damage and is even deadly if it isn't treated. And HIV, the virus that causes AIDS, spreads the same way. So the CDC is worried that outbreaks of HIV might follow outbreaks of hepatitis, just like in Indiana. The agency has now issued what it's calling a national health advisory. Basically, it's telling doctors and health departments to take a number of steps to stop outbreaks from developing. Doctors need to stop overprescribing the prescription painkillers people are abusing. They need to screen more people for HIV and the hepatitis C virus, or HCV.
MERMIN: To help identify communities that could be at high risk for unrecognized clusters of HCV and HIV infections.
KELTO: That way they can detect outbreaks early. And the agency recommends offering clean needles to people who are addicted. The CDC is also asking state health agencies to make sure addiction and counseling services are available and to track and report new cases of HIV and hepatitis, so the disease doesn't spread.
MERMIN: The situation in Indiana should serve as a warning that we cannot let down our guard against these deadly infections.
KELTO: Because just like in Indiana, Mermin says, they can come back and spread quickly. Anders Kelto, NPR News, Washington. Transcript provided by NPR, Copyright NPR.