One of the fastest-spreading recorded U.S. outbreaks of HIV since the inception of the epidemic is now occurring in southeastern Indiana, and it is being driven by injection drug use—specifically, abuse of the opioid painkiller Opana (oxymorphone). Sadly, this outbreak was preventable, given all that we know about HIV and its links to opioid addiction, yet adequate treatment resources and public health safeguards were not in place. Following the discovery of 11 new HIV cases in Indiana’s rural Scott County in January, positive tests have been reported almost daily, and health investigators are actively locating and testing people who may have shared needles or had sex with those infected.
A significant portion of individuals who are addicted to opioid painkillers may initiate and maintain abstinence with a brief but intensive outpatient detoxification treatment followed by opioid antagonist therapy using naltrexone.
Opioid prescriptions have increased three-fold over the past two decades, and we have seen how this skyrocketing availability of medications has helped create a new drug abusing population, some of whom suffer severe health consequences. More deaths now occur as a result of overdosing on prescription opioids than from all other drug overdoses combined, including heroin and cocaine. The opioid epidemic is tied closely to another epidemic in our country, that of chronic pain—although the ties are very complex.
Combating the epidemic of opioid abuse—including prescription painkillers and, increasingly, heroin—requires a multi-pronged approach that involves reducing drug diversion, expanding delivery of existing treatments (including medication-assisted treatments), and development of new medications for pain that can augment our existing treatment arsenal. But another crucial component we must not forget is that people who abuse or are addicted to opioids need to be kept alive long enough that they can be treated successfully. In this, the drug naloxone has a large potential role to play.
This past weekend Americans were shocked and saddened to learn that one of our greatest actors, Philip Seymour Hoffman, had died at age 46 of an apparent heroin overdose. Hoffman’s death, in the prime of his life and career, is a poignant reminder of some of the harsh realities of a disease that 17.7 million Americans struggle with and that all too often cuts their lives short.