There is currently a federal funding ban on needle exchange programs, which is why it took a state of emergency to get one approved in Indiana. Many legislators still view needle exchange as counterintuitive. But needle exchange reduces HIV and HCV. 3

“The needle exchange program can be an opportunity for substance abuse health services. Each touchpoint is an opportunity we need to capitalize on. If we use these touchpoints for harm reduction and not stigmatization, we can start to change the direction of the epidemic,” said Duwve.

“Medication-assisted therapy – substituting a drug like methadone or Vivitrol – can be a tough sell in Indiana. But statistics show that this type of therapy works better for recovery from opioid abuse. We need to do a better job of educating the public about these programs,” said Adams.

Lessons for Primary Care

For primary care providers, the CDC recommends: 

  • Test all your patients with HIV for HCV and all your patients with HCV for HIV.
  • Report all newly diagnosed cases to your state health department.
  • Make sure patients diagnosed and being treated are in compliance with treatment.
  • Test all contacts of these patients who may have shared needles or had unprotected sex.
  • Encourage needle exchange, medication-assisted substance abuse treatment, and counseling.
  • When considering opioids for pain control, discuss all the risks and benefits. Keep in mind that there is very little evidence to support opioid use for chronic pain.

“Primary care doctors should not delegate the prescription of opioids to their nurse practitioners or physician assistants. All providers need to ask about high-risk behaviors. Testing for HIV and HCV should be presented as an assertive recommendation. Each encounter is an opportunity to teach and test. We can turn the tide a little bit with each encounter,” said Adams.

Medically reviewed by: Pat F. Bass III, MD, MS, MPH      

References

1.     Centers for Disease Control and Prevention, CDC Health Advisory, Outbreak of Recent HIV and HCV Infections among Persons Who Inject Drugs. 

2.     The Hill, CDC sounds alarm over Indiana HIV outbreak

3.     Harm Reduction Coalition, Injecting Opana: Indiana’s HIV Outbreak and America’s Opioid Epidemic