By Shari Hicks
There is a nationwide prescription drug abuse epidemic, and the current outbreak of HIV and hepatitis C in rural southeastern Indiana is a notable symptom. Policy makers, pharmaceutical companies, insurers, and other stakeholders must do more to reduce the misuse and abuse of controlled substances. As a certified pharmacy technician and board member for the Center for Lawful Access and Abuse Deterrence (CLAAD), a national prescription drug abuse reduction coalition, I would like to draw attention to some important facts as we work together to stem the outbreak.
In March, Indiana public health officials declared a public health emergency related to the outbreak of HIV and hepatitis C. Policy makers have since implemented a public awareness campaign, authorized syringe exchanges, and instituted measures to provide comprehensive medical care and substance abuse counseling and treatment for individuals affected. Unfortunately, the demand for addiction treatment has exceeded our local capacity and will only continue to grow unless we address the sources of drug use.
As of August 3, 2015, 175 HIV and an estimated 125 hepatitis C infections have been reported in southeastern Indiana, involving a population that the Centers for Disease Control and Prevention (CDC) notes has historically been at low risk for HIV and in which HIV “spread rapidly within a large network of persons who injected prescription opioids.” The CDC reported that the most frequently abused drug among the recently infected population is extended release oxymorphone that has not been redesigned to resist tampering for the purposes of abuse. The magnitude of the outbreak recently prompted CDC Director Tom Frieden to compare the per-capita rate of HIV infections in Austin, in Scott County, to that of countries in sub-Saharan Africa. And most recently, on July 30, Clark County Commissioners held a public hearing and voted to accept the declaration of an HIV epidemic in order to allow for greater resources to address the crisis.
All opioids come with the risk of addiction, abuse, and misuse even at recommended doses. Despite these risks, opioids continue to be prescribed for a very important reason: these medications can also deliver life changing benefits, allowing up to 100 million Americans who have persistent pain to lead healthy, productive lives. The ability to tamper with opioids to heighten their effects, however, can have serious implications. Death from overdose, of course, is the most tragic. And as we have seen here in Indiana, sharing syringes to inject tampered-with opioids can lead to transmission of HIV and hepatitis C.
This is a preventable outcome. There are seven extended release oxymorphone products available in the U.S. Only one has been reformulated to be more difficult and less rewarding to abuse. Following the introduction of abuse-deterrent oxycodone and the subsequent withdrawal of the generic, non-abuse-deterrent product from the market, the number of overdoses from these drugs dropped by 20 percent. It is inexcusable that there are not more abuse-deterrent products available. Drug manufacturers must develop new, abuse-deterrent formulations of their opioid products. Health insurers must cover abuse-deterrent formulations, despite the fact that their prices will be higher until generic manufacturers do their part and convert their products. Legislators in Indianapolis and in Washington, D.C. must create incentives for drug manufacturers and health insurers to do the right thing to improve the safety of these tragically abused medications. With the recent passing of World Hepatitis Day, celebrated annually on July 28, we must remember that countless lives hang in the balance.
Shari Hicks, CPhT, resides in Indianapolis and is a certified pharmacy technician. Ms. Hicks serves on the Center for Lawful Access and Abuse Deterrence Board of Directors.
Published in The Seymour Tribune on September 4, 2015.