Reformulated Opioid Painkiller Opana ER Contributed to HIV Outbreak in Indiana

When the prescription opioid painkiller Opana ER was reformulated in 2012 to make it more difficult to crush and snort, the change led many people to abuse the drug by injection. The resulting increase in shared needles led to a spike in cases of HIV, according to NPR.

Shared needles can also transmit hepatitis C, the article notes.

Opana ER pills, when swallowed, release their painkilling ingredient over 12 hours. When crushed and snorted, the drug was released all at once. Endo Pharmaceuticals, which makes Opana, reformulated the pills with a coating that makes it more difficult to crush or dissolve. But people who abused Opana found they could remove the pill’s hard coating and inject the drug.

In March 2015, Indiana Governor Mike Pence declared a public health emergency as the state battled an outbreak of HIV linked to intravenous use of Opana. He authorized a short-term program in Scott County to exchange used needles for sterile ones, to reduce the risk of contaminated needles being shared. Since early 2015, 190 people in Scott County have tested positive for HIV.

In May 2013, the Food and Drug Administration (FDA) denied a request from Endo to block generic forms of the drug. Endo argued its newer tamper-resistant formula was more difficult to abuse than the original version of the drug, and asked that the agency not approve generic forms of the earlier version. The FDA decided that since the original Opana had not been withdrawn for reasons of safety or effectiveness, generic forms of the painkiller could continue to be approved and marketed.

The FDA also said the newer Opana ER could still be abused, and might be more easily injected than the original formulation.