This story is part of NPR's podcast Embedded, which digs deep into the stories behind the news.
In the spring of 2015, something was unfolding in Austin, Ind.
The town of about 5,000 people became home to one of the biggest HIV outbreaks in decades, with more than 140 diagnosed cases. At the root of the outbreak was a powerful prescription painkiller called Opana.
People figured out how to get around a coating on the pills intended to deter abuse, prepared them for injection and then shared needles to do so.
When news of the HIV infections broke, Kevin Polly was one of the few people in Austin willing to go on the record and say he was using Opana. Polly had contracted HIV, and at the time told a CBS reporter he had no plans to quit injecting the drug.
Clyde Polly, Kevin's 73-year-old father, says his son went to a rehab facility and isn't living in Clyde's one-story brick house anymore. Even though Kevin is gone, Clyde says some of his son's friends who do drugs are still there. Not all of them are HIV positive, and not everyone is from Austin — but most of them are using Opana.
"Everyone that's in there right now has probably done it," he says. "There's about a half-dozen in there. Some of them give me a little money for staying here, help me get by."
NPR's Kelly McEvers went inside the house and spoke to some of those people.
How a nurse became addicted to Opana
A few years ago, Joy was working as a nurse at a hospital. She had been through back surgery, but she recovered and returned to work. One day at the hospital, somebody called a code, indicating one of the patients was having an emergency.
"I ran from one end of the building to the other, thinking I was going to have to try to save someone's life," she says. "And I get back there and the old geezer had just slid off the bed."
Joy picked the man up, but once the adrenaline rush dissipated, she realized she'd injured her back again. She was prescribed painkillers and says she got hooked.
At first she took the pills by mouth, thinking she would never inject. But she broke that promise to herself.
"I pack so much shame from it," she says.
Still, Joy doesn't share needles. She's a nurse and knows better, she says — and she's going to get help for her addiction. In her appointment book, there's an appointment with a doctor she says can prescribe outpatient treatment.
"This is not for me," Joy says. "I don't want to hurt, but I don't want to be dependent. I don't want something like that to have control of my life, my body. I don't want something to have control over me."
Why users are injecting the drug
It used to be that people using Opana could crush a pill and snort it, says Jeff, one of the people in the house. Jeff served in Iraq with the Army National Guard before a Humvee accident injured his back. He says he became addicted to painkillers after his injury.
Snorting the drug instead of taking it by mouth meant avoiding the pill's time release, giving a user all the effects of the drug at once. In 2012, the company that makes Opana changed the formula of the drug to prevent people from snorting it. The company made the pills hard to crush, but at this point, many people were already addicted.
"The only way you could really do them is inject them, because if you actually swallow them, it really don't do nothing," he says.
Jeff says they've figured out how to cook the reformulated version of Opana so it can be injected.
How Opana is injected
"Here's our infamous can, which has been used to death," Joy says.
A round, jagged piece of aluminum — the bottom of a Coke can — sits on the dresser in the back bedroom of the house.
She puts a tiny white triangle on the can. It's an eighth of a pill of Opana that's been cut with scissors.
"That's just a little piece of nothing," she says.
Joy takes a pair of fingernail clippers and clamps them onto the aluminum before flicking a lighter to heat the pill from below. The pill's hard white coating, which the manufacturer put there to prevent people from snorting the drug, begins to separate. Then, Joy says, it's time to toast it, cooking the pill until it turns about the color of whiskey.
She puts water into a syringe and squirts it into the cooker, forming a gel. The coating once covering the drug floats away.
One by one, Joy, Jeff and the other person in the room take turns with their own needles, sticking them into a piece of a cigarette filter used to keep the white coating out of the needle, and pulling the liquid up into the syringe.
As they each take their hits, the room falls quiet.
To hear more of this story, listen to Embedded. Keep up with podcast host Kelly McEvers on Twitter at @kellymcevers, and join the conversation using the hashtag #NPREmbedded. Want to dive deeper? Listen to Kelly's conversation with WBUR's On Point.
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