Health Officials Investigate an Injectable Painkiller Possibly at the Heart of an HIV Outbreak in Southern Indiana

A fast-spreading HIV outbreak is wreaking havoc in Indiana and a new form of injectable painkiller could be causing some of the risky behavior leading to spread of the virus.

According to Time, federal regulators from the U.S. Food and Drug Administration (FDA) told Endo Pharmaceuticals in May 2013 that a new form of its widely used prescription pain pill Opana could be driving drug addicts to inject the drug intravenously or snort it. The new version of Opana was introduced by Endo in 2012. The company said the pill was designed to be abuse deterrent. A previous version of the painkiller was easily crushed and snorted or dissolved and injected, but the new version had a special coating that supposedly made abusing it more difficult. The drug maker took the previous version off the market and asked the FDA to rule that it had been unsafe, thus preventing other drug manufacturers from introducing generic versions of the pill.

The FDA rejected Endo’s request, saying even though Opana’s new coating made it more challenging to crush and snort, the agency found that “it may be easier to prepare OPR for injection.” Federal health regulators worried about “the troubling possibility that the reformulation may be shifting a non-trivial amount of Opana ER abuse from snorting to even more dangerous abuse by intravenous or subcutaneous injection.”

The HIV outbreak in southern Indiana has exploded from eight cases in January to 166 as of June. Officials from the U.S. Centers for Disease Control and Prevention (CDC) and local officials in Scott County said 96 percent of the patients they interviewed said they were injecting Opana, according to an April CDC  alert obtained by Time.

Officials in Scott County told Time that drug abusers found they could cook down the abuse deterrent coating on the pills and dissolve and prepare it for injection. Opana has become a favorite over heroin, despite it being more expensive and having a shorter effect. Some Scott County addicts admit to shooting up more than 20 times a day. They shoot up and transmit HIV to each other.

Endo, based in Pennsylvania, denies Opana is at the heart of the HIV outbreak in Indiana and has suggested generic versions of the pill without the “abuse deterrent” coating might be to blame. But Scott County Sheriff Dan McClain refutes the idea. “I’ve got an evidence room full of Opana over there right now, and I don’t have any generic forms of that pill that are being purchased off the street,” McClain told Time in April.

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