Indiana is dealing with an incredible HIV outbreak, centralized in Scott County. The HIV outbreak has been directly tied to needle use for opiate drug users. The Governor has called it a public health crisis, and while normally an opponent to needle exchanges, he is allowing for a 30-day needle exchange to curb the outbreak of HIV.
To give you a sense of the numbers, typically Scott County will see about five new cases of HIV in a year. They saw 26 new cases between mid-December and the beginning of March, and the count is up to 72 cases as of March 26.
The cause of the cases has been traced to intravenous drug use of a liquid form of Opana, a prescription painkiller. Doctors in the area report that the drug addiction problem, like many other places in the US, has been going on for at least the last ten years, with increasing incidences of other blood-borne diseases from needle sharing and deaths due to overdose.
Scott County is struggling against poverty as well as addiction. However, opiate drug addiction is a problem that is spanning all demographics across the US. My article in Salvo Issue 31 looks at nationwide statistics of opiate drug addiction from both prescription pain medicine and heroin use and the underlying causes.
Typically, people start with prescription pain medicines. It can even be from their own prescription that they obtained legitimately for a hurt back or a tooth extraction or any number of reasons that physicians dole out prescriptions for hydrocodone. One guy, mentioned in my article, got hooked on fentanyl after receiving it as an anesthetic for a colonoscopy. He was already abusing alcohol and other substances in an effort to cope with depression over a break-up. Fentanyl, indeed, served as a pain reliever in more ways than one.
Not everyone becomes addicted to opiate drugs when they take pain medicines, but with chronic use, many people do become addicted. And, unfortunately, it is a very difficult addiction to break. Once you’ve tickled those paths in your brain, the tracks that usually take naturally produced endorphins (named for endogenous morphine), you wear a neurological path that is VERY difficult to undo. Unlike endorphins, which our bodies administer through a sophisticated regulatory process that ensures you are receiving the right amounts, opiate drugs stand in as stronger, more potent endorphin replacements.
On a short-term, temporary basis, opiate drugs, like hydrocodone, are supposed to decrease pain, and many of them, when in pill form, are time-released. When our bodies experience pain, endorphins help to quell the effects; however, the endorphins are not enough for injury or sickness, so people take pain medicine. Sometimes people will experience some physical withdrawal symptoms when they stop taking pain medicine if they have been taking them for a while, but physical withdrawal does not necessarily mean the person is addicted. Even physical tolerance is not the full picture of addiction. Addiction has to do with seeking out a high, and in an effort to do so, the person becomes consumed with overcoming physical tolerance to the point that he or she may grind pills and take them intravenously or turn to heroin which is cheaper and sometimes easier to obtain. Scott County is seeing the effects of people sharing needles for opiate drug use.
My article gets into both the neuroscience as well as the cultural and psychological factors that lead to addiction. Suffice it to say that one of the problems is accessibility to a substance that is too potent and too addictive to be administered for trivial reasons (such as tooth aches or minor aches and pains).
Prior to 1990, opioids were not typically prescribed as painkillers except for cancer patients. But in 1990, that all changed. Doctors wanted a solution to patients’ chronic pain, patients were desperate for relief, and big pharma was ready to profit from the situation. Fast forward to now. The CDC reports that in 2014, physicians wrote 259 million painkiller prescriptions in a single year, the equivalent of one bottle of pills per American. They have seen a four-fold increase in overdose deaths since 2000.
At the end of the Washington Post article reporting on Scott County’s crisis, Dr. William Cooke points out that this issue is not unique to Scott County, Indiana. They are the canary in the coal mine.