As abusers of prescription painkillers turn to injection drugs, experts worry the opioid epidemic could result in HIV outbreaks across the United States.
“People will escalate their use from taking pills to snorting to then injecting to try to maintain the same level of relief from the drug before,” said Elaine Martin, director of HIV prevention for the Virginia Department of Health.
The Centers for Disease Control and Prevention said the rise in injection drug use in the U.S. is a reason Hepatitis C (HCV) cases have increased by 294 percent from 2010 to 2015.
“When we see Hepatitis C going up, we are concerned that two or three years later those HIV cases could follow," Martin said.
A small town in Indiana had an HIV outbreak linked to injection drug use in 2015, and by 2016 had nearly 200 HIV cases.
“After the incident in Indiana with that HIV outbreak, across an entire county we have an understanding that Hepatitis C is the precursor that you look for before you look for a kind of local HIV epidemics. This can be really indicative of areas of high needle sharing," said Shayla Schlossenberg, manager at HIPS, a free clinic in Washington, D.C.
The CDC said safe injection equipment is a large component in stopping the spread of infection, and more needle exchange programs are now popping up across the country.
“With what happened in Indiana, it was kind of a wake-up call to many states saying this could happen if you don’t have the right services and things available," Martin said.
Martin said most needle exchange programs are located near metropolitan areas, but because the CDC said areas hit hardest by new HCV infections are typically rural areas, she hopes to see more programs in those areas.
"That it could happen in a rural area very quickly in a place that didn’t have a lot of disease was really concerning," Martin said.
Now, 220 counties across 26 states have been identified as vulnerable to HCV and HIV outbreaks, according to the Journal of Acquired Immune Deficiency Syndromes.
Most of these counties are located in West Virginia, Kentucky and Tennessee, and many do not have easy access to needle exchange programs.
Eight of these vulnerable counties are located in Virginia, and in July the state legalized needle exchange programs.
“There is a huge body of research, over 30 years of evidence, showing that syringe services to reduce new cases of HIV and Hepatitis C,” Martin said.
But six months after the law was passed, Martin said there have been no applications submitted to start a program.
The application process is not simple. Clinics or organizations need to law enforcement and local community support, and have to secure private funding for the needles and other drug related supplies, Martin said.
“We do have federal funds that can support all the parts of comprehensive harm reduction except for the needles themselves. So, we can pay for equipment and staffing and rent and mobile outreach and testing and all those other components,” Martin said.
Health Brigade, a free clinic in Richmond, Virginia, hopes to submit an application in 2018.
“Health Brigade does work with a number of folks who struggle to make ends meet. Folks who are under-insured or uninsured, and because we can offer opportunities to reduce the spread of Hep C and HIV, we can help reduce the incidence of infection," said Ari Laoch, Health Brigade mental health and substance abuse counselor.
Until an exchange program opens in Virginia, injection drug users have access to free, clean needles if they are willing to drive. Schlossenberg said the needle exchange program at HIPS has many visitors from outside the district.
“We see folks from Maryland, Virginia, West Virginia and sometimes farther. I've done big exchanges for people from North Carolina, honestly. We see people from all over," Schlossenberg said.
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