Up to 142 users of the prescribed opioid Opana have tested positive in rural Indiana for infections of the human immunodeficiency virus, also known as HIV. State health officials, the Centers for Disease Control and Prevention (CDC) and Indiana University are collaborating to control the “severe outbreak.”

Confirmed cases hit 136 and another six show preliminary positives in rural Jackson and Scott counties. The population of the entire area is only a few thousand people.

The outbreak was first noticed in mid-December in Scott County. The state announced a public health emergency for that county in March.

The director of the CDC’s HIV prevention unit, Dr. Jonathan Mermin, says many of the infected are younger people “who weren’t around in the ’80s and ’90s when HIV was at its peak.” The dangers of sharing needles were better known at that time. Needle exchanges have been shown to restrain new infections and Indiana’s governor, Mike Pence, extended a 30-day needle exchange program another 30 days on Tuesday.

Dr. Joan Duwve with the Department of Health in Indiana explained how members of multi-generational households in Ohio River communities (as well as in West Virginia and Kentucky) will engage in drug use together “as a community activity” and share needles. There “is not a lot to do” in these areas, she said.

Indiana University is operating a clinic for testing and treatment, with thirty-three people having visited so far. Volunteers from that school are going door to door in an attempt to educate people about the risks of sharing needles.

Oxymorphone (commercially known as Opana) requires injections more than once a day and this partially explains the fast rise in HIV infections. The effects of the drug wear off after about four hours when symptoms of withdrawal kick in. Also, a larger-gauge needles is required for oxymorphone, increasing users infection risk as they are exposed to more blood. Some residents using Opana say they inject the drug four to 10 times a day.