The number of recently diagnosed cases of HIV in Indiana has risen to 135, prompting Gov. Mike Pence to extend a needle-exchange program for 30 more days to stem the public health emergency.
Pence's executive order creating the needle exchange overrides state law and Pence's own reservations about such programs. But the conservative Republican said he was doing what state and federal health officials recommended to control the outbreak, which has centered on Scott County in Southeastern Indiana near Louisville, Ky.
“Today, on the recommendations of the Indiana State Department of Health and in consultation with Scott County officials and the Centers for Disease Control, I used my authority as governor to extend the public health emergency in Scott County for an additional 30 days,” Pence said in a news release. “While we've made progress in identifying and treating those affected by this heartbreaking epidemic, the public health emergency continues and so must our efforts to fight it.”
The new number includes 129 confirmed cases and six cases classified as “preliminary positive.” This is up from the 120 confirmed and 10 preliminary cases announced April 17, which was an increase of 24 cases from the week before. Health officials typically see no more than five HIV cases a year among the 23,700 residents of Scott County, Pence noted in the executive order.
The needle exchange operated by the Scott County Health Department is available only to county residents. The 95 visitors to the exchange have received drug counseling, information on mental health resources and thick plastic containers for needle disposal. Visitors' demographic information is recorded, but not their names. So far, 3,111 needles have been brought in and 4,337 have been provided since the exchange opened April 4.
Pence also signed a bill on April 17 that allows individuals to obtain and dispense overdose intervention drugs such as Narcan (or nalaxone).
“Many overdoses happen in the presence of others, and readily available naloxone is a proven method for bystanders and loved ones provide rescue assistance,” Pence said in a news release. “While we diligently work to make headway on our state and nation's opioid abuse epidemic, this bill will help keep Hoosiers alive in order to facilitate seeking treatment and again become healthy and productive members of society.”
Most of the overdose cases have been linked to an opioid painkiller known as Opana, which contains the drug oxymorphone and has been described by the Indiana State Department of Health as “more potent, per milligram, than Oxycontin.”
Strides have been made in stemming Oxycontin abuse, but new research finds that these preventive interventions are only half the battle.
A Journal of American Medical Association Internal Medicine study, posted online April 20, reports that two interventions—the development of “abuse-deterrent” formulations for Oxycontin and discontinuing the sale of propoxyphene (or Darvon) from the U.S. market—led to a 19% reduction in expected opioid dispensing between 2010 and 2012.
The estimated overdose rate also fell by 20%. The study was conducted by researchers at the Harvard Medical School, Boston University School of Medicine and other Boston-area institutions. Previously, individuals abusing Oxycontin could bypass the drug's time-release mechanism by crushing and dissolving it.
The researchers reported, however, that the heroin-overdose rate increased during the same period by 23%.
“Changes imposed through regulatory mandates or voluntary company actions may be a viable approach to stemming prescription abuse,” the researchers concluded. “Regardless of the mediating mechanism, a transition from prescription opioid to heroin abuse has been well documented, and further efforts are needed to improve identification and treatment of these individuals.”
Dr. Hillary Kunins, with the New York Department of Health and Mental Hygiene, wrote in an accompanying editorial that preventive measures should also be coupled with treatment as a two-pronged comprehensive public health approach to opioid abuse.
“Recasting the often-maligned 'doctor-shopper' instead as a patient with a substance-use disorder reminds us that using public health strategies to promote judicious opioid prescribing, including via pharmaceutical market change to reduce overdose risk, needs to be accompanied by similar policy approaches to provide accessible and effective services for people who use drugs,” Kunins wrote.