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Pain Pill Abuse May be Contributing to Indiana HIV Outbreak

Jun 11, 2015

The newest formulation of the prescription pain pill Opana could be contributing to an HIV outbreak in Indiana.

In May 2013, Food and Drug Administration (FDA) regulators warned Endo Pharmaceuticals that the new form of its widely used prescription pain pill Opana (oxymorphone) could be driving abusers to inject the drug intravenously instead of snorting it, Time magazine reports. Addicts who share needles when injecting drugs can transmit HIV to each other.

An HIV outbreak in southern Indiana has ballooned from eight cases in January to 166 as of early June. The Centers for Disease Control and Prevention (CDC) and health officials in Scott County say the outbreak is the result of addicts dissolving and injecting Opana. Scott County is the center of the outbreak. The CDC said 96 percent of those who tested positive for HIV and who were interviewed said they were injecting Opana. The CDC issued a health alert in April, Time reports. CBS News reports that the state of Indiana has set up a needle exchange to help reduce the sharing of possibly contaminated needles among addicts.

In 2012, Endo introduced a version of Opana that it said was designed to be abuse deterrent. The previous version of the drug could easily be crushed and snorted or dissolved and injected, but the new version has a coating to make it more difficult to misuse the drug in these ways, according to Time. Endo pulled the previous version from the market and asked the FDA to rule that it had been unsafe. An "unsafe" ruling would have meant that other drug makers could not introduce generic versions of Opana. The FDA denied Endo's request, rejecting the claim that the new coating could help deter abuse. The FDA found that while the new formulation makes it harder to crush and snort Opana, "it may be easier to prepare [the drug] for injection," raising "the troubling possibility" that the reformulation may be shifting Opana abuse "from snorting to even more dangerous abuse by intravenous or subcutaneous injection."

Officials in Scott County say abusers discovered they could cook down the abuse deterrent version of the pill, dissolving it and preparing it for injection. Officials say addicts prefer Opana to heroin, even though it is more expensive, and the high doesn't last as long, according to Time. Addicts in Scott County have transmitted HIV to each other by sharing needles as they shoot up, creating an HIV crisis in the county of about 24,000 residents.

Pennsylvania-based Endo specializes in pain medications. The company, earned $1.16 billion in revenue from Opana from 2008-2012. Endo has denied that Opana is at fault in the HIV outbreak and has suggested that generic versions of the drug that do not have the "abuse deterrent" coating might be to blame. But Scott County Sheriff Dan McClain says, "I've got an evidence room full of Opana over there right now, and I don't have any generic forms of that pill," according to Time.

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