AUDIE CORNISH, HOST:
And next, Kelly, you're about to take us into a house in Austin, Ind. And it's in this small town that I know most of us have never really heard of it until this HIV outbreak last year.
KELLY MCEVERS, HOST:
Yeah. It started last spring. More than 20 new HIV cases were being diagnosed each week, and that outbreak was traced to IV drug users who were using this drug called Opana. And I wanted to find out how this happened, so for my new podcast, Embedded, we went to Austin. And we ended up spending time in a house where half a dozen or so people were living. Most of them were addicted to Opana, and a couple of them were HIV-positive.
CORNISH: Right. And we should actually warn listeners. For that reason, there are some pretty detailed descriptions of IV drug use coming up. Here's the story.
MCEVERS: The house is a one-story brick situation on a small street in Austin. Inside, the dishwasher's going, kitchen's pretty clean. And when I get there, one woman is folding another woman's laundry.
That said, the shades are closed, and it seems like they're always closed. The first person who's willing to sit down and talk about Opana is a guy named Jeff. People in the house ask that we only use their first names because what they're doing is illegal.
Jeff served in Iraq with the Army National Guard. He was that guy who stands up in the Humvee and mans the big gun. One day back in 2008, the Humvee had an accident.
JEFF: The Humvee rolled over.
JEFF: Yeah, messed my back up and stuff.
MCEVERS: Jeff hurt his back really bad.
JEFF: Yeah. I was on a walker for about six months.
MCEVERS: He came back to the U.S. He got hooked on prescription pain pills - first Percocet and then Opana. And then he noticed other people around town were doing Opana, too - first getting prescriptions from pain clinics or pill mills, as they're known, and then buying them on the street from dealers. Jeff says the way they did the drug at the time is they would buy a pill or a piece of a pill and then crush it up and snort it.
And they were, like...
JEFF: Snorting them.
MCEVERS: The idea is if you take the pill by mouth, it has a time release, but if you crush it up and snort it, you get all the effects at once. Then in 2012, something happened. The company that makes Opana, Endo Pharmaceuticals, changed the formula of the drug. They put a coating on the pill that made it really hard to crush up. But by this point, Jeff and a lot of other people were already hooked on Opana, doing more and more every day.
JEFF: More and more, and then they reformulated them. And the only way you could really do them is inject them because if you actually swallow them, it - you - they really don't do nothing.
MCEVERS: Jeff and other people said they figured out how to cook up this new version of Opana and inject it. He's been doing that for three years now.
What do you need a day to be right?
JEFF: Probably close to a whole one a day at least.
MCEVERS: Four hits a day but spread out.
JEFF: To help, yeah, with the pain and not withdrawn, and so...
MCEVERS: That's just to sort of be normal.
JEFF: Be normal, yeah. I don't get high anymore. I just keep from being sick and out of pain, actually. I mean, we've actually done a whole pill already today.
MCEVERS: A whole pill costs like 140 bucks on the street.
JEFF: Most people can't come up with $140, $150 at a time, so they just buy a quarter piece or...
MCEVERS: Jeff gets a check every month from the National Guard. I ask him how other people can afford it.
JEFF: A lot of people just get out here and hustle. And then there's people who robs people. I mean, they'll steal their money, or...
CLYDE: Yeah, and if you're a female, you know what you got to do to get it.
MCEVERS: Or if you're a female, the owner of the house, Clyde, says, you know what you have to do to get it. The next person to talk to me about Opana is Joy. A few years ago, she was working as a nurse in a hospital. She posted pictures on Facebook of summer vacations, trick-or-treating with her kids. But she hurt her back at work. She started taking prescription pain pills at first by mouth. Then she snorted them. She knew she was addicted, but she never thought she would inject.
JOY: And I've - I'd never ever would use a needle, never. I'm never going to do that. Never say never, for one thing. But I started using the needle about - it was around the 6th of February. So it's just been...
MCEVERS: A few months.
MCEVERS: That was February of last year.
JOY: I am so ashamed.
JOY: I pack so much shame, and I'm going to cry.
JOY: I pack so much shame from it. I do.
MCEVERS: Joy doesn't share needles. She says she's a nurse and she knows better. I asked Jeff and Joy how they inject a drug that's supposed to have a coating that makes this pill resistant to abuse. Later, Jeff motions for me to come into a bedroom.
JEFF: You want to see how it cook?
MCEVERS: Yeah, sure.
On the dresser, Joy shows me this round, jagged piece of aluminum. It's the bottom of a Coke can.
JOY: All right, so here's our infamous can...
JOY: Which has been used to death.
MCEVERS: Joy puts a tiny white triangle on the piece of aluminum. It's just a piece of a pill of Opana.
JOY: And this little piece right here...
MCEVERS: Is that really a quarter?
JOY: No. That's an eighth.
JOY: That's just a little piece of nothing.
MCEVERS: And then Joy takes a pair of fingernail clippers and clamps them onto the aluminum. And then she takes a lighter and starts heating up the pill from below. Right away, I can start to see this hard, white coating just kind of floating off the piece of the pill.
It looks like plastic.
JOY: A lot of people...
JEFF: (Inaudible) like rubber...
JOY: That's what...
MCEVERS: This is the coating that the drug company put on the pill to keep people from crushing it up and snorting it.
JOY: What do you think, Jeffrey? Toast the top a little bit there now.
MCEVERS: Joy puts water into a syringe, squirts water into the cooker. Then the water and the pill start to form this gel, and the heart, white coating separates and floats away.
JOY: Now you see the coating of - all that mess laying in there still?
MCEVERS: Yeah, all that white junk. Do you get rid of the coating, or do you just not...
JOY: That's what the filter's for...
MCEVERS: The filter...
JOY: ...Under - yeah.
MCEVERS: Oh, the filter filters that out - gotcha.
MCEVERS: And that's a piece of a cigarette filter, yeah?
And Joy puts that cigarette filter right into the liquid, and they Joy, Jeff and another guy each take turns with their needles, sticking it into the filter and pulling the liquid through. Joy and Jeff turn their backs to me while they inject. And then it just gets really, really quiet.
The next person in the house to talk to me about using Opana is a guy named Devon. And what's different about Devin is that he didn't start doing Opana because of an injury or a prescription. He says he got into Opana because people around him were doing it.
People were just hanging out. It looked like fun. You just got into it, too. I mean, is that how it works?
DEVIN: It didn't look like fun, but you know, peer pressure - and you got 20 people in and out all day long - looked like they was having a good time.
MCEVERS: And the other thing that's different about Devin is that he has shared needles. Up until last year, needle exchanges were illegal everywhere in Indiana, and you could be arrested for carrying a needle. So Devon says people would reuse needles and share needles, like, hundreds of times. Devin says the needle would get so dull you'd have to sharpen it. And he says people didn't think about what could happen.
DEVIN: We didn't know that there was HIV epidemic going around at the time. That's why we really wasn't too concerned about sharing. We didn't think that we was going to get HIV.
MCEVERS: Now nearly 200 people in this town of about 4,500 people have tested positive for HIV. Devon has three kids with a woman named Samantha. She has used Opana, too. The kids have been taken away and now live in a foster home. Samantha had been arrested and pleaded guilty to prostitution charges. A few days after she gets out of jail, I am back at the house, and Devon and Samantha tell me I can come and talk to them in a back bedroom.
DEVIN: We're going to go...
MCEVERS: When I get there, they're sitting on the bed with what looks like a kids coloring book open to a page with hearts and cupcakes. Their pupils are these tiny, black dots inside their big, blue eyes. Samantha's scratching herself like crazy. But still, they say they've got a plan to quit using Opana, to sign up for state health insurance, go to rehab, get jobs, get their kids back. The nearest inpatient rehab is in the next county, and there's a waiting list.
DEVIN: It's usually four to six weeks.
SAMANTHA: Six to eight.
DEVIN: Six to eight Weeks.
MCEVERS: Thing is, Devin and Samantha say they have both tested positive for HIV. And at this point, neither of them has seen a doctor. There is only one full-time doctor in their town.
WILL COOKE: Yeah, I opened my practice in September of 2004.
MCEVERS: His name is Will Cooke. I meet up with him a few days later. He says there's still a lot of stigma in this part of Indiana about drug use and HIV.
COOKE: When somebody walks in my doors with HIV, I hug them. I think that's important.
MCEVERS: I asks him if he thinks he can help people like Devin and Samantha.
COOKE: Some people go through a fatalism, you know?
MCEVERS: That's where I think - that's where I think they're at, yeah.
COOKE: Yeah, I'm dead anyway; what - why does it matter? You know, when they come in and they're scared and they're crying and you're just giving them a hug and holding their hand and letting them know that we're there, they just don't even know how to respond to that. They don't trust it. What's the catch?
MCEVERS: So Cooke says his staff's going door to door, trying to stay in touch with people, remind them about their appointments, get them to come in. But he says there's still a lot of people who haven't even been tested for HIV.
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MCEVERS: Later, I find out Samantha actually did go to see Dr. Cooke. After that, she went back to jail for violating a no-contact order. She eventually pleaded guilty, got out on probation and went to rehab. Devin has left the house. He says he's got a job and is trying to stay clean. Since we met her, Joy, the nurse, went to jail, too. She pleaded guilty to a drug charge and now lives with her parents. And since we did this reporting, we have not been able to reach Jeff, the Iraq War vet.
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MCEVERS: The thing is, Jeff, Joy, Devin and Samantha's brain chemistry has been changed by their addiction. Researchers say they are different people because they've used this drug. Studies show quitting a drug like Opana is nearly impossible unless you use what's called medication-assisted treatment like Suboxone, methadone or other drugs.
Expecting Devin and Samantha to just quite on their own isn't fair. That's what I was doing while I was reporting this story, and now I realize it's how a lot of people think about addicts - just quit; fix yourself. But people in Austin, Ind., people in those bedrooms with the shades closed, people who think they're dead anyway - it's a lot more complicated than that.
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MCEVERS: You can hear a longer version of this story on my new podcast. It's called Embedded.
CORNISH: And on this program tomorrow, we'll hear about the decision by Endo Pharmaceuticals to reformulate the drug Opana. Transcript provided by NPR, Copyright NPR.