February 27th, 2016

HIV outbreak associated with poor white rural folk and injected opioids


All kinds of things pop up here.

"A "very ballpark figure" is that between 400 and 500 people were injecting drugs, mainly oxymorphone (Opana) but also oxycodone and methadone, Brooks said. Many were sharing injection equipment and injecting drugs frequently."

This is in a tiny town, Austin, Indiana -- less than 4500 population. So like, 10% of the population is shooting up.

"As of Feb. 1, 188 people in the area had been diagnosed with HIV in less than 15 months. At the end, HIV prevalence ... for Austin it was 4.6%, he said."

So about half the people who were injecting drugs wound up with HIV. That seems weird. Doesn't that seem weird? What, were these people sharing needles? Yes! Yes they were. Why the fuck were they sharing needles?

One of the issues was the sheer number of times a day people were injecting:

"The first was the combination of poverty and high costs for the drugs. To cope, many people took to "shaving" their pills to get small amounts of drug -- just enough to have an effect -- but injecting as often as 15 times a day."

So, because the pills were expensive, they were tapering them out. Yikes. Okay, sure, but why reuse needles?

"The state, which had previously forbidden needle exchanges, changed the law to allow them in emergencies, a decision that helped tamp down the outbreak, Brooks said. Whether such a program would have helped to prevent the outbreak isn't clear, he told MedPage Today."

Brooks, here, is being diplomatic. Because if you take Brooks at his word, he's totally full of shit. Thus, he's being diplomatic. The state's ban on needle exchanges/access to clean needles basically ensured an enormous, ongoing cost to the state for HIV treatment for a couple hundred people who, in any sensible world, never would have gotten it.

All that said, that's not even my real point. My real point is that we are treating the illegal opioid epidemic separate from the prescription drug abuse epidemic, separate from HIV transmission. _IT'S ALL THE SAME THING_. With Hep C tossed in for good measure. Should we be surveilling for Hep C? Sure! Should we be ensuring access to clean needles? Oh, hell yeah! But mostly, we need to start treating all these problems as facets of the same underlying problem.

Sure, it manifests as poverty, unemployment, etc. But really, these are people who have complex, unmet needs in our society. They are likely actually somewhat resistant to help, even when it is offered, because the cognitive frameworks of effective help violate the way they are accustomed to imagining reality. That is not an excuse for governance to be aggravating the problem with _needle exchange bans_. We need to start by getting rid of bad laws that get in the way, but we can't stop there. We have got to get meaningful assistance to bring marginalized peoples -- poor and white or whatever -- back into the mainstream of US society.

Because this is a tragic waste.