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Indiana Town Struggles To Contain HIV Outbreak Fueled By Drug Abuse


Last spring, the state of Indiana declared an emergency after a major HIV outbreak in the small town of Austin. Drug users there were injecting the painkiller Opana and sharing needles.


At the time, the response was to open a one-stop shop where people could pick up clean needles and information about drug treatment. They could also get health insurance, state IDs and job training. Well, now, one year later, that response has been scaled way back. And the people at the center of this outbreak have been left with very few resources. Our colleague, Kelly McEvers, has the story.

KELLY MCEVERS, BYLINE: Four days a week, this is what happens in Austin, Ind. A little white SUV goes up and down the streets with clean needles and sharps containers where you can throw away old needles.

So you've got people who are expecting you?



COMBS: We have, like, a set schedule that we do, and then we kind of drive around.

MCEVERS: Brittany Combs is a public health nurse for the county.

COMBS: We're just going, like, right down the road for this first one, so...

MCEVERS: She drives up and down the streets of Austin, passing out clean needles.

COMBS: Everybody's going to be outside today.

MCEVERS: This is most of what's left of the one-stop shop - this mobile needle exchange run by Brittany Combs and two other staffers in their spare time. Most days, Brittany Combs does her regular job for eight hours, then she comes out here for two to three more hours and doesn't get paid for it.

COMBS: We're basically volunteering our time, yes.

MCEVERS: I mean, basically, if you stopped caring, like...

COMBS: Oh, it wouldn't - it wouldn't get done. Oh, there's no way. There's no way it would get done.

There's Theresa now.

MCEVERS: We pull up to a house, and two women open the door. One is named Theresa, and the other doesn't want to give her name. They don't want to be identified because they're doing drugs illegally.

COMBS: How are you doing?

UNIDENTIFIED WOMAN #1: Oh, pretty good.

MCEVERS: Brittany writes down how many needles one woman is getting.

COMBS: And you don't share with anybody, right?

UNIDENTIFIED WOMAN #1: Hell no. Hell no.

COMBS: I didn't think so. And you only use them once, right?


COMBS: What have you been using, just Opana?

UNIDENTIFIED WOMAN #1: Yeah, Opana. Opana - anything I can get in me. Can I just get my needle?


MCEVERS: Then, Teresa says she wants to quit using Opana. She says she went to the health department's satellite office in town. There is an addiction clinic there with a doctor who comes once a week. Theresa says she couldn't get an appointment. She says what she really wants is a prescription for Suboxone, a drug that blocks the effects of opioids, like Opana and heroin, and helps with withdrawals.

THERESA: I need, you know, Suboxone to get off the stuff. But I never did get to go see a doctor, so, you know, I just quit.

MCEVERS: She doesn't mean she quit using Opana. She means she quit trying to stop using Opana.

THERESA: I mean, I can't wait. I can't get off of them by myself.

MCEVERS: Brittany Combs, the public health nurse, says this happens a lot. People say they want to stop using drugs, but there aren't very many options. Research has found that medication-assisted treatment through drugs like Suboxone helps people stop abusing other drugs. And it's linked to stopping the spread of infectious diseases.

COMBS: The Suboxone is what most of our people want. They're actually buying it illegally on the street to try to quit themselves. That's how desperate they are.

MCEVERS: But not many doctors are authorized to prescribe Suboxone, and even they are limited in how many prescriptions they can write. Also, many doctors only take cash for Suboxone. Brittany Combs says one patient called around for months looking for a doctor who would prescribe it and take insurance.

COMBS: I have somebody who came in the program, and he's excited. He said, I finally got a Suboxone doctor. He has to go almost to Cincinnati to get his Suboxone. So now he has to get someone to drive him over there in order to get his meds.

MCEVERS: So that is if you're extremely motivated.

COMBS: Extremely motivated and have access to things like car rides, which a lot of these people don't.

MCEVERS: Cincinnati is almost a hundred miles away. That doctor Theresa was talking about - the one who comes once a week - can prescribe Suboxone. But this doctor will only do that after a drug user has completed a 30-day inpatient treatment program. The closest one is the next county over, and the waiting list there is four to six weeks.

JASON MOUNT: There's the old jail there.

MCEVERS: One of the few places you can get help if you're drug user in Austin, Ind., is the county jail, says Jason Mount, the local prosecutor.

MOUNT: Well, in a rural county, what you find is that, you know, the jail is where people await trial, but it's also a mental health facility. It's also a detox facility. It's also a homeless shelter. We don't have any of those resources otherwise, so a lot of those people in the margins - this is where they wind up.

MCEVERS: Most drug users end up detoxing in jail - basically quitting cold turkey. But they can also get hooked up with services, like a nurse, and they can get on that waiting list for inpatient rehab. Plus, officials say, the jail will still soon administer another medication-assisted treatment, Vivitrol. That's a once-a-month shot that blocks the effect of opioids. The state of Indiana has just budgeted an additional $30 million over the next two years to try to get people treatment rather than jail time. But that's earmarked for people with felony convictions.

MOUNT: I would love to see a situation where it would be easier for somebody Scott County, before they ever came in contact with the criminal justice system - to be able to walk in someplace and get themselves into treatment. We're working on those things, and they're getting better. But historically, that's been a real obstacle for us.

MCEVERS: There are people in the county who are applying for grants to train hospital workers to deal with addiction. And they're trying to highlight the stories of people who've been through recovery. Still, Scott County, Ind., is the lowest-ranked county in the state for health outcomes. Officials say it's like a lot of places in Indiana and around the country that are just starting to deal with the opioid epidemic.

SIEGEL: That's our co-host Kelly McEvers. Tomorrow, we'll have the story of one woman in Austin, Ind., and her struggle to stop using Opana.

UNIDENTIFIED WOMAN #2: This time last year, I had a home. I had a car, my house full of furniture, a lot of nice stuff - you know, a big sectional sofa and a glass coffee table and a real heavy cherry dinette set. I had my kids, rings on every finger, you know, money in the bank. And in 12 - less than 12 months - gone.

SIEGEL: That story tomorrow on ALL THINGS CONSIDERED. Transcript provided by NPR, Copyright NPR.

Kelly McEvers is a two-time Peabody Award-winning journalist and former host of NPR's flagship newsmagazine, All Things Considered. She spent much of her career as an international correspondent, reporting from Asia, the former Soviet Union, and the Middle East. She is the creator and host of the acclaimed Embedded podcast, a documentary show that goes to hard places to make sense of the news. She began her career as a newspaper reporter in Chicago.
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