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THE THIRTEENTH STEP
Mary G. Barry, MD
Louisville Medicine Editor
[email protected]
A
s of April 17, the HIV epidemic
in Scott County, IN (just to the
northwest of Clark County, along
1-65) had hit 130 cases.
Like other internists of my generation,
I have lost hundreds of patients to HIV,
most but not all while training in the Emory
system in Atlanta. Some were older, and a
few had acquired HIV from therapeutic
transfusion, but most were under 50, gay,
and impossible to save with any weapon
we had then. The plague decimated entire
communities of friends and lovers in every
American city and town.
Eventually, through painstaking research
and with an abiding personal commitment
to drug development and treatment from
both patients and physicians, we have turned
HIV into a chronic, expensive illness. HIV
extracts a punishing toll of co-morbidities
from both the virus and the side effects of
treatment. But patients can live with this
infection for years now. The question is,
why do people still put themselves at risk?
And the answer to that is denial, and drugs.
The Scott County epidemic has been linked
to shared needles, from shooting up heroin
and Opana, and as the case rate skyrocketed
this spring, Gov. Pence agreed to a needle-sharing program which in its first weeks
distributed 5300 needles from the “one stop
shop” community program hastily set up
in Austin, IN. The program provides free
HIV testing, necessary vaccinations, and
information about prevention, medical referrals, and substance abuse, along with help
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LOUISVILLE MEDICINE
enrolling in the Healthy Indiana insurance
plan. Law enforcement has no presence at
the clinic; it is only for helping the addicts.
Reporters all over the country have for
the past few years been chronicling every
surrounding state’s rise in heroin abuse,
heroin OD deaths, the number of babies
born addicted, the woefully inadequate state
sponsored facilities for treatment, the enormous cost of privately paid treatment, and
the pain for all involved. How has heroin attacked us here in the innards of the nation?
First, it became harder to get huge amounts
of prescription opioids, as states shut down
drug mills and required strict monitoring
of prescribers and patients. Heroin thus
filled the gap, particularly Mexican black tar
heroin. Heroin expert Mr. Sam Quinones
in the New York Times of April 19 reported
on the novel and incredibly successful distribution networks from Mexico, pioneered
in the 90s by the Xalisco Boys, entrepreneurs and dealers to the middle and upper
classes. All you need to do to get heroin
delivered to your door is to call the advertised number, and a presentable person will
bring it to you - but not if you live in what
is perceived as a Latino or African American neighborhood, for the Xalisco Boys
have designed this as a business preying on
the drug-hungry, not as a gang enterprise
where guns and killing reign. They have
fanned out everywhere away from the big
city gang-controlled trade, into “small town
America” and throughout the heartland
and the West. Mexican heroin accounts for
at least 2/3 of the current national supply.
The Scott County sheriff ’s office arrested
three people on April 3 with $150,000 worth
of black tar heroin; over 100,000 doses of
heroin were seized in drug raids in March
in Indianapolis from a group with ties from
Indiana to Arizona; on April 17 a major
drug sweep after months of undercover
work netted dozens of arrests.
Still, thanks to criminal initiative and the
laws of supply and demand, anybody who
finds the right number to call - but without
having to stand on a street corner or visit
a dangerous place - can be shooting up in
under an hour. They can be dead minutes
later. Black tar heroin is roughly 70 percent
pure and extremely potent. The addict who
relapses and is no longer tolerant, the newbie, and the daily user all have very high
risks of death. In Northern KY alone, heroin
overdose ER visits increased by 670 percent
from 2011-2014.
In late March our legislature passed the
Good Samaritan law,