Jane, a recovering drug addict and lifelong Vigo County resident, is alive and well today. Her decades-long nightmare, which included numerous instances of sharing needles with friends to inject ground-up pills or meth into her body to satisfy her cravings, could have ended differently. Tragically.
As she watches the unfolding drama in southeastern Indiana’s Scott County, where 145 people have been diagnosed with HIV in recent months, Jane recalls the risks to which she subjected herself for years and feels empathy for those involved.
“Why I don’t have hepatitis or HIV, I do not know,” Jane said solemnly. “I have so many friends with hepatitis.”
At the heart of the HIV epidemic, the largest in the state’s history, is the dirty little secret of drug abuse — repeated sharing of contaminated needles. HIV, the virus that if left untreated can cause AIDS, can also be spread by unprotected sex with an infected partner or by a blood transfusion. But state health officials stress that the enormity of the HIV outbreak can be traced directly to the practice of sharing syringes when injecting drugs.
Rational people recoil in disgust at the notion of knowingly using a contaminated syringe. But drug addicts are not rational people. They know the risks, but they do not care.
“Why do people use dirty needles?” Jane asked and answered. “Well, they’re ready to get high. You’re sitting there and your friends are doing it, and you’re not going to say, ‘wait until I go to [the pharmacy] and get a clean needle.’ They won’t wait.”
Those who work with drug addicts understand all too well the problem Jane describes. They see it frequently.
“As one’s addiction progresses, their inhibitions, beliefs and values are compromised in order to experience the euphoria,” said Paul Southwick, director of Vigo County’s Drug and Alcohol Program. “Addiction will make individuals engage in behaviors they would normally not do in a sober and clean state of mind.”
Syringes used by addicts aren’t terribly expensive, about $1 each when bought in multi-needle packages. Nor are they difficult to acquire. But there are enough obstacles that drug users will resort to sharing used, dirty needles rather than obtaining fresh, clean ones. That phenomenon is what created the public health crisis in Scott County that officials worry could spread to other parts of the state.
Indiana law does not allow needle-exchange programs for drug addicts as a strategy for battling the spread of disease from contaminated needles. But the current crisis prompted Gov. Mike Pence last month to approve and extend an emergency needle-exchange program in Scott County. And the Indiana General Assembly last week passed a law to allow for limited needle-exchange programs in the future in emergency situations such as that which now exists.
Public health officials and medical professionals believe needle-exchange programs work to prevent the spread of disease. In addition to serious infections such as HIV or hepatitis-C, contaminated needles can transmit sexually transmitted and other diseases. Even while health officials understand why some politicians and police might object to needle exchanges because the practice enables the drug user, they insist the spread of disease is a greater issue than denying addicts a reliable avenue toward safety and, possibly, treatment.
Jane is not her real name. She agreed to share her story with the guarantee of anonymity in hopes of helping people better understand problems associated with addiction and how it leads people into reckless, unhealthy and unsafe behavior. As a convicted felon and recovering addict, she hopes to spare her family any more pain.
In a 90-minute interview with the Tribune-Star late last week, Jane slowly — and at times tearfully — peeled back the layers of her life to explain what happened to her during years of drug abuse.
When she started injecting drugs to get high about three decades ago, she said it was pretty easy to get hypodermic needles. A person could just walk into a pharmacy, show identification, sign a register, and pay for them.
That is still the case today in Indiana for people who do not have a prescription for syringes.
People hesitant to go into a pharmacy may have learned to just sneak one or two from a diabetic family member, she said. Or if a clean needle is not available, and the drug craving is uncontrollable, a user will just share a needle with friends.
“At the time, you’re not thinking it is dirty,” Jane said of needles being shared. “It’s ‘you’re my friend.’ There were so many people who didn’t care. They just wanted to get high.”
Jane is embarrassed by her past, but is trying to muster courage for the future. She now tries to help others affected by addiction — speaking encouragement to people in prison, jails, groups and even in churches.
“There are many of us recovering addicts in Vigo County,” she said. “I am just one of those many blessed individuals. Twelve-step programs, church and support groups work if an individual is ready.”
She said she talks with others about her experience so she won’t forget the pain she caused her family and children.
“I was very young,” she said of starting her drug usage as a teen. It eventually escalated.
“I knew someone who did it,” she said of IV drug use. “And I knew if I did it the first time, I would be lost to it.”
By the time she was in her mid 20s, she found herself pregnant. She knew she should stop using drugs for the health of her child. But she was lost.
“That’s the thing. I get it. ... I just could not stop,” Jane said.
Drug users don’t have just one needle, she said. They will use one multiple times until it becomes dull and can no longer puncture a vein. Then they pick up another needle to use.
She knew needle-sharing just once could kill her, but she told herself that she “cleaned it out real good” by flushing the syringe with water. Her friends trusted “nurse Jane” to pass out the clean needles, she said.
The process of IV drug use is basically the same no matter the drug, she said. If a person uses prescription narcotics such as oxycontin or other opioids, each pill is crushed into a fine powder. It is then mixed with water into a solution, heated to better dissolve the drug, and then drawn into the syringe for injection. Oxycontin is called “hillbilly heroin” because its high is similar to heroin, which is also an opioid. A similar syringe process occurs for cocaine or methamphetamine.
Heroin, which can be injected intravenously, has been growing in popularity in the Wabash Valley as pharmaceutical changes to oxycontin have made it harder to grind into powder form, authorities say. That means the demand for syringes is increasing as well.
“We are starting to see more and more heroin in the area, and a lot of the time, heroin use is associated with intravenous drug use,” said Detective Steve Lockard of the Vigo County Drug Task Force. “When we encounter heroin use around here, 60 to 70 percent of the time, there’s needles present as well.”
When police enter a scene where heroin has been used, it’s not uncommon to find needles scattered around, he said. Officers are trained to safely collect the needles and put them into special containers for safe disposal.
As for needle exchanges, the veteran drug task force officer said that it is his personal feeling and the general consensus of the task force that needle exchanges are a good thing.
“It doesn’t stop the usage, but it stops the spread of disease,” Lockard said.
Jane agrees. For safety’s sake, she believes they make sense. “I think Scott County has it right,” she said. “I think we better start trying to prevent an outbreak rather than try to punish it out of people.”
Without the ready availability of syringes, the demand falls on pharmacies, or even to online distributors.
Pharmacies that sell syringes to people without a prescription are supposed to record the purchaser’s identification information. Pharmacies also have the right to refuse to sell the product to a customer.
Pharmacist Ashok Patel of Hoosiers Prescription Shop on South Seventh Street said he occasionally encounters customers without a prescription seeking to purchase syringes. If the person is not a client and has no prescription, Patel said he declines to sell syringes to that person.
“I check to see if they are taking insulin or another prescription, and if not, then I won’t sell to them,” he said. “We have a responsibility to the public health.”
Pharmacists at other area locations say their establishments also use caution and discretion when selling syringes. A pharmacist at JR Pharmacy on Poplar Street in Terre Haute said needle purchasers must show identification and sign a log book. Prescriptions are preferred, but he sometimes will call a customer’s physician if no prescription is available to confirm the need.
Despite the best efforts of pharmacies, needles find their way into the hands of drug abusers. That’s when the potential for unsafe use or sharing occurs.
Lynn Hostetler at Lynn’s Pharmacy in Brazil said a syringe is intended for one-time use. But the needles are designed to be sharp to eliminate pain during injection, so they can usually be used multiple times. After about five uses, however, Hostetler said they will become dull and bend, creating pain for the user.
While Vigo County is not seeing any dramatic rise in HIV cases, it is considered a high-risk county because of the number of current diagnosed cases of HIV and the incidence of hepatitis-C.
Vigo County had 11 new HIV cases reported in 2014, according to the Indiana State Department of Health. The total number of people in Vigo County living with HIV, including those diagnosed in other states, was listed at 274 as of the end of 2014.
In the first four months of 2015, fewer than five new HIV cases have been reported for the county, state health officials said. When the number is less than five, a specific count will not be given to protect identity. Methods of transmission are also not released.
Vigo County has reported a range of seven to 16 new HIV cases each year from 2011 to 2014. The average for those four years is 12 new HIV cases reported annually.
To combat the rapid spread of HIV in Scott County, authorities in local, state and federal health agencies set up a community outreach center. Services offered include access to state-issued ID cards, birth certificates, job counseling and local training, enrollment in HIP 2.0 insurance, HIV testing, HIV care coordination, substance abuse referrals, and vaccinations against tetanus, hepatitis A and B.
As of May 1, the number of HIV cases in the southeastern Indiana outbreak had reached 145.
The Scott County Health Department operates the outreach center, but the emergency needle-exchange program approved by the governor is for Scott County residents only. Participants are counseled about their drug use. They are also given new needles based upon their drug use for a week. And they are given thick plastic containers for safe disposal of used needles.
The center has had an estimated 7,106 needles brought in — both for the exchange program and some by community members disposing of used needles. The total number of needles provided was 7,912.
Paul Southwick, director of the Vigo County Alcohol and Drug Program, says counselors he works with believe that IV drug use and needle sharing is “very under-reported” by their clients when they go through an initial assessment with the local program.
“Denial is central to addiction and oftentimes IV users [as well as other addicts/alcoholics] are not willing to be honest, admit to a problem, and get help for the problem,” Southwick explained. “The individuals we work with are referred from the courts for pretrial supervision or a condition of probation and that adds another reason to not be truthful out of fear of consequences whether real or imagined.”
Addicts will go to extreme measures to continue and conceal their use of the drug, he said. Some will inject in areas not visible, such as their toes.
“We have seen cases where IV users wear only long sleeves to conceal needle tracks on the arms,” he said. “Wearing long sleeves might seem normal attire for certain seasons but odd during the heat of the summer.”
Now in her mid 40s, Jane laments her longtime drug abuse.
“Meth was what destroyed my life. Meth use took away my children, my family and my freedom,” she said. “It’s been a long road back to what most people call ‘normal’.”
More often than not, Jane said, she used a safe syringe when she started injecting drugs. She would make up stories when she went into a pharmacy about buying the syringes for a visiting friend or relative.
“I was very much a closet user — for a long time — until the end of my journey, and then I didn’t care.” she said.
Her drug abuse eventually landed her in prison, and that is what got her off drugs. Once back in society, it wasn’t easy. But with lots of support, she persists. And she tries to use her story to give hope to others.
Southwick calls Jane “a shining example of someone who was in the depths of addiction but was able to overcome. She was able to overcome through the help of others, which seems to be a key element in one’s recovery.”
And he says there are others in the community just like Jane.
“I can’t change the whole system, the whole world,” Jane said, “but if I help one person, and that person helps one person, that’s how it’s supposed to be done.