Inside A Small Brick House At The Heart Of Indiana's Opioid Crisis | KUOW News and Information

Inside A Small Brick House At The Heart Of Indiana's Opioid Crisis

Mar 31, 2016
Originally published on April 4, 2016 9:42 am

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.


Episode highlights

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.

Copyright 2017 NPR. To see more, visit http://www.npr.org/.

KELLY MCEVERS, HOST:

I'm Kelly McEvers. And this is EMBEDDED, an NPR podcast where we take a story from the news and go deep.

(SOUNDBITE OF MUSIC)

MCEVERS: And today, we're going to Austin, Ind., a town that, back in the spring of 2015, was all over the news.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED MAN #1: A virus is spreading in Indiana.

UNIDENTIFIED MAN #2: A rural town in Indiana...

UNIDENTIFIED MAN #3: It's in the small town of Austin.

UNIDENTIFIED WOMAN #1: Austin, Ind...

UNIDENTIFIED MAN #3: Austin, Ind. and tries to control an unprecedented outbreak of HIV there.

UNIDENTIFIED WOMAN #2: Linked to dirty needles and intravenous drug use.

UNIDENTIFIED MAN #4: Hooked on a powerful painkiller called Opana.

UNIDENTIFIED MAN #5: Opana is stronger than Oxycontin and easier...

MCEVERS: The opioid crisis in this country has finally led to one of the biggest HIV outbreaks in decades - because people in one small town in Indiana are addicted to a prescription painkiller called Opana and they're sharing needles. A lot of reporters went to cover this story. On CBS, the reporter talked to one of the few people in Austin, Ind., who was willing to go on the record and say he actually uses this drug, Opana.

(SOUNDBITE OF TV SHOW, "CBS EVENING NEWS")

DEAN REYNOLDS: Kevin Polly was diagnosed with HIV seven weeks ago. He has no plans to quit injecting a drug called Opana. He had done it three times today, by 2 this afternoon.

KEVIN POLLY: I'd like to say that I'm going to quit, but probably I'd be lying to you.

REYNOLDS: Did you know sharing needles is risky?

K. POLLY: I think we all knew that. But it was in the back of our minds.

REYNOLDS: Austin, Ind., is a place high unemployment and low...

MCEVERS: It's about a two-minute story and it's pretty interesting. This guy, Kevin Polly, sitting on his front porch, positioned just right for the interview. But the story leaves me with a lot of questions about Kevin Polly and other people who live in this town. Why are people doing this particular drug, Opana? Why are they sharing needles? What is this drug? So along with a producer, I head to Indiana. We want to find this guy, Kevin Polly. We start by driving about an hour and a half south of Indianapolis to Austin, Ind., and into Kevin Polly's neighborhood. Some of the houses do not look very welcoming. Keep out, posted, keep off, private property, no trespassing. Kevin Polly's house is this pretty normal, one story brick situation with a yard. Out on the porch, we meet Kevin's 74-year-old dad, Clyde. Hi.

CLYDE POLLY: Yeah?

MCEVERS: Are you Clyde?

POLLY: Yeah.

MCEVERS: Hey. Clyde says his son, Kevin Polly, the guy from the TV news story, doesn't live here anymore.

POLLY: He's down in that rehab place in Jeffersonville right now.

MCEVERS: Clyde says Kevin went off to rehab about an hour away. And how is that going so far? I mean, you can't - probably can't talk to him, can you when he's doing his...

POLLY: No, you can't talk to him. I don't know if they're going to contact us at all or not. I guess he's all right. They're supposed to be a real good place so...

MCEVERS: Clyde says even though Kevin isn't around anymore, a lot of his friends who do drugs are still around. At least five of Kevin's friends are staying in the house.

POLLY: There's so much more of them right here in this house right now.

MCEVERS: Clyde says most of them are doing this drug that we came here to learn more about.

POLLY: Everyone that's in there right now is probably doing it.

MCEVERS: Opana.

POLLY: They probably - none won't talk to you. But if you could get the whole story out of some of these people, you'd be getting a lot of stuff.

(SOUNDBITE OF MUSIC)

MCEVERS: We do go back the next morning, and we do end up getting a lot of stuff. And just a warning here, we see some people doing some pretty intense things, some of it illegal. And so, because of that, we've agreed that for most people, we're only going to use their first names.

(SOUNDBITE OF MUSIC)

MCEVERS: Another thing we should say - even though this story is about HIV, not everyone you're going to hear is HIV-positive. And not everyone you're going to hear is from Austin, Ind. It's just where they've ended up. So the next morning, we show up on the front porch and Clyde lets us inside. The dishwasher's going. The kitchen's pretty clean. This one woman is folding another women's laundry. One thing, though - the shades are closed. And it seems like they're always closed. So we're in the living room. And the center of activity is this L-shaped couch. A lot of people are milling around, getting Kool-Aid in these big, Styrofoam cups. And the first person who's willing to sit down and talk is a guy named Jeff (ph). And Jeff starts telling me right away how powerful Opana is and how withdrawing from it makes you really, really sick.

JEFF: Yeah. The withdraw is unbearable.

MCEVERS: What does it feel like?

JEFF: It's like having a flu but 10 times...

MCEVERS: Oh, my God.

JEFF: ...Intense. You get diarrhea. You puke. And it's - it's awful.

MCEVERS: Here's Jeff's story. He served in Iraq with the Army National Guard. He was that guy who stands up in the Humvee and mans the big gun. One day back in 2008, the Humvee had an accident.

JEFF: The Humvee rolled over.

MCEVERS: Oh.

JEFF: Yeah, messed my back up and stuff.

MCEVERS: Jeff hurt his back really bad.

JEFF: Yeah, I was on a walker for about six months.

MCEVERS: He came back to the U.S. and then basically got hooked on pain pills.

JEFF: They had me on Percocets while I was there, so yeah.

MCEVERS: That's the starting point.

JEFF: Yeah. That's where it got started (laughter).

MCEVERS: And then what?

JEFF: Then they moved me up to Opanas. She - the doctor said we've got this new - you ought to try it. It will probably help with the pain better. She said Opanas and...

MCEVERS: Had you ever heard of it before?

JEFF: No. I never had. Nobody around here had.

MCEVERS: Nobody had heard of it at first. But then, slowly, Jeff started noticing that other people were taking Opana. And then how did - how were other people getting them?

JEFF: They was going to the doctor's.

MCEVERS: Yeah. So they know about it. They were, like, oh. They were like hey, it's pretty good.

JEFF: They knew there's a new one, yeah, and started going to pain clinics and...

MCEVERS: And saying my back hurts.

JEFF: Yeah.

MCEVERS: Wink wink.

JEFF: Yeah.

MCEVERS: Is that how it works?

JEFF: Yeah. I tried - I tried this new pill, and it's Opana. They'd write it out for them.

MCEVERS: And now - are there still people that will do that? Or is it harder and harder?

JEFF: It's harder to do, yeah.

MCEVERS: It's harder now because the police and the feds are cracking down on these doctors who prescribe pills for cash, and they call them pill mills. Did you keep getting prescriptions or did that stop at some point?

JEFF: It stopped, yeah. And then I started buying on the street, so...

MCEVERS: Buying them on the street meant getting them from dealers who get them from bigger cities like Louisville or Detroit. Jeff says the way they did the drug at the time is they would by a pill or a piece of a pill and crush it up. And they were, like...

JEFF: They were snorting them.

MCEVERS: They'd snort it just like people do with other drugs like OxyContin. And the idea is this, like, if you take the pill by mouth, it has a time release. But if you crush it up and snort it, you get all the effects at once. Then, in 2012, something happened. To stop people from snorting this drug, the company that makes Opana changed the formula. They made it pretty hard to crush up. And even if you do manage to crush it up and snort it, it turns into this thick, gooey gel that just gets stuck in your nose. But by this point, Jeff and a lot of other people were already hooked on Opana, doing more and more every day.

JEFF: More, more - and then they reformulated them. The only way you could really do them is inject them because you actually swallowed them, it - you really don't do nothing.

MCEVERS: Jeff and other people say they figured out how to cook up this new version of Opana and inject it. He's been doing that for three years now. So then how - what do you need a day to be right?

JEFF: Just depends. Usually - what? - probably close to a whole one a day at least.

MCEVERS: Four hits a day, but spread out.

JEFF: To help - yeah - with the pain and not withdraw and so...

MCEVERS: Right. That's just to sort of be normal.

JEFF: Be normal - I don't get high anymore. I just keep from being sick and out of pain, actually. I mean, we've actually done a whole pill already today.

MCEVERS: When he says we've done a whole pill already today, I don't know exactly who we is. But I do know from what Jeff tells me that one pill costs, like, $140 on the street.

JEFF: Most people can't come up with a $140 - $150 at times, so they just buy a quarter piece or...

MCEVERS: So I asked Jeff - I mean, why not just do heroin? It's a lot cheaper, and it's what a lot of other people around this area are doing. He says Opana is just better - and stronger. And it's what's around. Jeff gets a check every month from the National Guard. I ask him how other people can afford it.

JEFF: A lot of people ready to get out here and hustle. And there's people that robs people. I mean, they'll steal their money or...

POLLY: Yeah. If you're a female, you know what you have to do to get it.

MCEVERS: Or if you're a female, the owner of the house Clyde says, you know what you have to do to get it.

(SOUNDBITE OF MUSIC)

MCEVERS: OK. So by this point in the day, we know some stuff about this drug Opana. And the first stuff isn't surprising, right? It's really strong, really addictive. At first people were getting it through doctors and prescriptions, and later they started getting it on the street from dealers. But we also know that one reason people inject this drug is because the company that makes it, Endo Pharmaceuticals, reformulated the drug to make it harder to crush. That reformulation did stop people from snorting Opana. But then many people just switched to injecting. We actually did a lot of reporting on this, and we found it wasn't just happening in Austin. A study co-authored by one of the company's own scientists found there's evidence it was happening in other parts of the country, too. Endo Pharmaceuticals declined several of our requests for an interview. In a statement, they said, in part, we are dedicated to providing quality medications to treat the millions of patients diagnosed with chronic pain and to addressing opioid abuse. But experts say the company might also have been motivated by money. Having a label that says your drug is abuse-deterrent is a selling point for doctors. Reformulating, those experts say, can also help block competition from generic drug makers. In an affidavit filed in federal court, an Endo executive said allowing generics into the marketplace would decrease annual sales of Opana by about $135 million.

(SOUNDBITE OF MUSIC)

MCEVERS: All right. So we're still at the house. It's the middle of the day. And still, I want to understand how doing Opana works. I mean, how do they inject this drug that's supposed to be resistant to abuse? Eventually, this woman Joy (ph) says to me...

JOY: I'll have something for you in just a moment. OK? Just one moment (laughter).

MCEVERS: Sure. I'll have something for you in just one moment. Joy used to work as a nurse at a hospital. She used to post pictures on Facebook of summer vacations, trick-or-treating with her kids. She says she first started taking prescription pain pills back in 2006. Her back would hurt after long hours at work. She eventually had back surgery, recovered, went back to work. And then this one day, somebody called a code. That means one of the patients was having an emergency.

JOY: And I ran from one end of the building to the other, thinking I was going to have to try to save someone's life. And I get back there, and the old geezer had just slid off the bed.

MCEVERS: So she picked the man up.

JOY: Once my adrenaline, you know, had worn off, I realized that I was in bad shape.

MCEVERS: She knew she'd hurt her back again - really bad. She kept taking prescription pain pills, then she got hooked. At one point, her prescription ran out, so she started buying pills on the street. But still, she was taking the pills by mouth. At the time, she says, she never thought she would inject.

JOY: And I never, ever would use a needle - never. I'm never going to do that. Never say never, for one thing. But I started using the needle about - it was around, like, the 6 of February. So it's just been...

MCEVERS: A few months.

JOY: Yeah. And I'm so ashamed. I pack so much shame. And I'm going to cry.

MCEVERS: No.

JOY: I pack so much shame from it, I do.

MCEVERS: Joy doesn't share needles. She says she's a nurse, and she knows better. And so a few minutes after she had told me she'd have something for me in a moment, Joy disappears into a back bedroom. I had seen her go in there once before with Jeff. They acted like they were helping a sick friend. But I figured they were shooting up. So they left that door open this time. They're cleaning off the dresser. Jeff walks out of the bedroom, looks at me and motions for me to come in. OK.

JEFF: You want to see how it's cooked?

MCEVERS: Yeah, sure. So I walk into the bedroom. Jeff and Joy are in there. And we close the door. And Joy shows me this round, jagged piece of aluminum. It's the bottom of a Coke can.

JOY: So here's the infamous can...

MCEVERS: OK.

JOY: ...Which has been used to death.

MCEVERS: Joy puts a tiny, white triangle on the aluminum. It's just a piece of a pill of Opana. They say they just cut it with scissors.

JOY: And this little piece right here.

MCEVERS: Is that really a quarter?

JOY: No, that's an eighth.

MCEVERS: Sorry.

JOY: That's just a little piece of nothing.

MCEVERS: Yep (laughter).

JOY: A little piece of nothing.

MCEVERS: And then, Joy takes a pair of fingernail clippers and clamps them onto the aluminum. And she takes a lighter and starts heating up the pill from below. Right away, I can start to see this hard, white coating kind of float off the piece of the pill. It looks like plastic.

JOY: A lot of people...

JEFF: Yeah. It looks like rubber.

MCEVERS: This is the coating that the drug company put on the pill to keep people from crushing it up and snorting it. And Joy says the idea at this point is to cook the pill until it gets to be the color of whiskey.

JOY: What do you think Jeffrey (ph)? Toast the top a little bit there now?

JEFF: Yeah.

MCEVERS: Joy puts water into a syringe, squirts water into the cooker and then the water and the pill start to form this gel. And the hard, white coating just floats away.

JOY: Now you see the coating of all that mess laying in there still?

MCEVERS: Yeah. All that white junk? Do you get rid of the coating, or do you just not?

(CROSSTALK)

MCEVERS: Oh, the filter filters that out, got you. And that's a piece of a cigarette filter, yeah? Joy puts that cigarette filter right into the liquid. And then Joy, Jeff and this other guy who's been sitting on the bed who didn't want us to use his name - they each take turns with their own needle, sticking it into the filter and then pulling that liquid through. And the idea is that the filter will keep the white coating out of the needle. They're really precise about who gets how much. And it all depends on how much money you put on it. So the guy on the bed put the least amount of money down on this pill, so he only gets a little bit. He raises his sleeve and - about four inches of one of his veins is this really dark purple color. And on the top is a sore. So he takes the needle and he injects it into the sore. He asks me if I mind. I don't mind if you don't mind. But he can't get a vein. So he takes the needle out and takes his hand and sandwiches it between his two legs and, like, crosses his legs really tight so the veins in his hand will pop out. There's a bunch of little red marks on his hand where he looks like he's has shot before, and he sticks the needle into one of those. Joy and Jeff have both turned their backs - to me while they're doing their hits. And then it just gets really, really quiet. After about five minutes, they wrap up all the gear and hide it and then come out into the living room, sit down. Back out on the couch, Joy nods off for a minute and makes herself a bologna sandwich. And then she starts to tell me she has plans to move out of the house one day and get into her own apartment. And, she says, she's made an appointment with a doctor who can do an outpatient detox program for her, which includes prescribing this drug called Suboxone. It's kind of like methadone, helps you with the pain and helps with withdrawals. So I asked Joy - what made you make that appointment?

JOY: Because this is not...

MCEVERS: She starts looking in her purse for her appointment book.

JOY: This is not for me (laughter). This is not what I'm - you know, 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, my - you know, I don't want something to have control over me.

MCEVERS: Yeah.

JOY: Yeah. It's the 13th.

(SOUNDBITE OF MUSIC)

MCEVERS: The appointment is for the 13th. That's about three weeks away.

(SOUNDBITE OF MUSIC)

MCEVERS: We'll be right back after this break.

(SOUNDBITE OF MUSIC)

MCEVERS: So we're still at the house. It's a little bit later in the afternoon, and the next person to talk to us about using Opana is this guy, Devin. Do you have a few seconds? What's different about Devin is that he didn't start doing Opana because of an injury or a prescription. He says he got into Opana because people around him were doing it. So people were just hanging out. It looked like fun. You just got into it, too? I mean, is that how it works?

DEVIN: I mean, it didn't look like fun. But, you know, peer pressure - you got 20 people in and out all day long, look like they was having a good time.

MCEVERS: And the other thing that's different about Devin is that he does share needles. That's because, for a long time, it was really hard to get a clean needle. Up until last year, needle exchanges were illegal everywhere in Indiana, and you could be arrested for carrying a needle. For a while, Devin says, you could just go to Wal-Mart and say you were a diabetic and get a needle. Devin says sometimes, pill dealers would sell clean needles. Most of the time, people just don't want to spend the extra money on a needle. They want to save it for the next fix.

DEVIN: Ain't nobody got it uncontrolled.

MCEVERS: So people would reuse their own needles and share needles with each other, like, hundreds of times, Devin says. He says sometimes, the needle gets so dull you have to sharpen it. I had assumed everybody knew not to share needles after the AIDS epidemic in the '80s and '90s. I guess I was wrong. Devin says people just didn't think about the fact that a dirty needle could give you HIV.

DEVIN: We didn't know that there was HIV epidemic going around at the time. That's why we really wasn't too concerned about sharing. We didn't think that we was going to get HIV.

MCEVERS: Now nearly 200 people in this town of more than 4,000 people have tested positive for HIV. Devin changes the subject when I ask him about that. Devin has three kids with a woman named Samantha. She's used Opana, too. The kids were taken away and now live in a foster home.

DEVIN: I mean, I really don't want to talk about my kids.

MCEVERS: That's fine.

DEVIN: It's just too hard for me.

MCEVERS: He doesn't want to talk about the kids. But he will say that in order to get them back, he has to be clean. The mother of the kids, Samantha, she's already clean because she's in jail. She was arrested on prostitution charges and pleaded guilty. Devin says she gets out in a few days.

DEVIN: I've got to change my ways right now - in the next week before she gets out because she's been sober and clean for five or six months now. And she's not wanting to come back here to this place, so...

MCEVERS: She gets it that - she's, like, I can't - she knows that if she comes here that it'll be - it'll be an influence. So you're going to try to get clean before she comes out?

DEVIN: Yeah. I mean, yeah. I'll try to - us both be clean together and try to start over.

(SOUNDBITE OF PHONE RINGING)

DEVIN: This is Samantha right now in jail.

MCEVERS: Oh, OK. Go ahead.

(SOUNDBITE OF PHONE CALL)

RECORDED VOICE: From...

SAMANTHA: It's Samantha.

RECORDED VOICE: ...An inmate at the Scott County Detention Center.

(SOUNDBITE OF KEYPRESS TONES)

RECORDED VOICE: Your call has been accepted.

DEVIN: Hello?

MCEVERS: Devin walks off to talk to Samantha. Then, a little bit later, there's some kind of drama out in front of the house. Some people pull up in a truck. There's a bunch of yelling. Everybody runs out of the house. Some fight outside, Jesus. I start to realize it's a pattern. Right after everybody shoots up, they're mellow. But then, when the drug starts to wear off, people start to withdraw and need another fix, there's drama. I've seen the cycle, like, three times already.

JEFF: I don't want to argue.

MCEVERS: This time Devin and Jeff - remember, he's the guy who was hurt in Iraq - are fighting over 40 bucks. Everybody's in the living room now. Jeff says he doesn't want to argue anymore. Devin chases him out the door.

DEVIN: I ain't about to argue neither. I'm done arguing. I'm ready to start busting some [expletive] heads, buddy. I'm tired of [expletive] arguing, Jeff.

MCEVERS: I decide it's probably time to leave. That's enough for one day.

(SOUNDBITE OF MUSIC)

MCEVERS: A week later, I go back to the house. Even though I had talked to people about their drug use, I still wanted to talk about HIV. Hello? Plus, I want to see how everyone is doing and if anything's changed. A lot has. Some people who were staying in the house before are gone. It seems like new people are staying there now. So they all took off, huh?

POLLY: Yeah.

MCEVERS: And walking up on the front porch, it looks like something really bad has happened to the front door - like it's has been kicked a lot. But Clyde, the owner of the house, is still here. He lets me in and tells me what happened.

POLLY: Since you've been here, somebody attacked my door and busted it up.

MCEVERS: I saw it. When I came in, I was, like - what is that?

POLLY: And he pulled - had a knife on me out on the porch.

MCEVERS: On you?

POLLY: On me.

MCEVERS: Why?

POLLY: Claimed somebody ripped him off.

MCEVERS: Clyde says the guy with the knife was coming after someone he thought owed him money. And right as I'm talking to Clyde, Devin - remember, he's the guy with the girlfriend in jail - comes out of the back bedroom. He's with three women. One of them is this young, dark-haired gal. Are you Samantha? Nice to meet you. Welcome back. It's Samantha, Devin's girlfriend, the mother of his three kids. She just got out of jail. And I'm thinking, wait a minute you guys. What about the plan? I thought the plan was to get away from the house when Samantha got out of jail. I start to ask them about it, but then - everybody's running around, grabbing purses and keys, and they tell me they have to leave really quickly and take Samantha to an appointment with her probation officer.

UNIDENTIFIED WOMAN #3: We've got to get her there. We'll see you in a bit, yeah.

MCEVERS: After they pull out of the driveway, Clyde says he doesn't think they're going to a probation officer. He thinks they're going out to buy pills. Either way, they're gone for about an hour. Then they get back, and there's a bunch of running around again, and everybody goes into the back bedroom. And after they come out, everybody's a lot more mellow.

DEVIN: You can come and talk with us in here if you want to.

MCEVERS: And Devin comes to get me. So I go into the back bedroom. It's really clean. The bed is made. Devin and Samantha are sitting on top of the bed. And right in front of them is this - what looks like a kids coloring book. It's open to a page that has hearts and cupcakes and, I mean, it looks like Samantha's been coloring in it with red and purple markers. Samantha and Devin's pupils are these tiny black dots inside their big, blue eyes. And Samantha is scratching herself like crazy. But still, Devin is telling me that they've got a plan to quit using Opana. He says the next day, they're going to go sign up for Medicaid and try to get into rehab.

DEVIN: So we're going to see what we can do about getting in there, just to get up out of here.

MCEVERS: I wonder what the wait - do you know what the waiting time is like for the rehab place?

DEVIN: It's usually four to six weeks.

SAMANTHA: Six to eight.

DEVIN: Six to eight weeks.

MCEVERS: But they're putting you guys at the front of the list?

SAMANTHA: Anybody that - that tests positive or whatever.

MCEVERS: Gets to go to the front of the list. OK.

SAMANTHA: They said that you'll probably get in within a week.

MCEVERS: And you tested, right?

SAMANTHA: Yeah.

MCEVERS: Yeah. And did you? Have you taken the test yet?

DEVIN: Yeah.

MCEVERS: And you're positive, too? If you didn't totally hear that, they both said they have tested positive for HIV. Neither one of them has been to see a doctor. I mean, have they talked to you about, like, what kind of medicine you're going to have to take and all that stuff? Have you started taking any medicine?

DEVIN: It's pretty stupid, but I've been waiting on her to get out. I didn't - I didn't want to be going and getting help and her still being in jail, not getting no kind of treatment. I been waiting on her. So we can go do it together.

MCEVERS: You guys will do it together. Do you know - has anybody even told you, like, what kind of medicine you have to take for HIV? Because, like - it's not a death sentence anymore. I mean, it's - if you take medicine, you can be fine, especially if you're young like you guys. Are you scared?

DEVIN: I mean, a little bit.

MCEVERS: Are you?

SAMANTHA: I mean, yes.

MCEVERS: Is it easier to just not think about it?

SAMANTHA: Yeah, pretty much.

MCEVERS: I try to change the subject, ask Samantha about detoxing in jail. She just gives me one-word answers. So I ask about the kids. They show me pictures - an 8-year-old, a 6-year-old, a 4-year-old. Oh my God, they're so cute. The kids are in a foster home now. Devin and Samantha say the only way to get them back is to get clean and get jobs. I tell them they don't have to say the right thing just because I'm asking. I have thought about getting clean, Samantha says. It's going to be really hard, Devin says. All right, I'll stop by tomorrow. See you, thanks.

(SOUNDBITE OF MUSIC)

MCEVERS: The next day, I go back to the house to see if they went to sign up for Medicaid and get into rehab. They're not here, Clyde says. They didn't go. So I come back a couple more times that day, and they're either gone or they're in that back bedroom with the door closed, saying they don't want to talk to anybody. Clyde says Samantha came out of jail with some extra cash left over from her bond. He says he thinks she used the money to splurge on pills. Another thing we know is that after you've been clean for a while, it's a much stronger high.

(SOUNDBITE OF MUSIC)

MCEVERS: Every time I go back to the house, it seems darker and dirtier than before. Or maybe I'm just getting sadder each time, realizing Devin and Samantha are probably not going to stick to the plan.

(SOUNDBITE OF MUSIC)

MCEVERS: So even though they are both addicts and both HIV-positive, Devin and Samantha, at this point, have still not seen a doctor. There's only one full-time doctor in their town. His name is Will Cooke. Cooke didn't want me to record at his office because he doesn't want to reveal his patients' identities. So I meet him in a Cracker Barrel parking lot a few towns over.

WILL COOKE: Yeah, I grew up in this area here.

MCEVERS: And I have to say, meeting him is the one time I feel like there's any chance for people in Austin, Ind.

COOKE: When somebody walks in my doors with HIV, I hug them. I'll sit there and hold their hand. I think that's important.

MCEVERS: I ask Dr. Cooke if he can help people like Devin and Samantha. I'm not totally sure he can.

COOKE: You know, at first, most people are scared. You know, you have this new diagnosis. And one of the first things you're going to do is deny it. Some people go through a fatalism, you know...

MCEVERS: That's what I think. That's where I think they're at.

COOKE: Yeah. I'm dead anyway. What - why does it matter? And when they come in and they're scared and they're are crying and you're just - you're giving them a hug and holding their hand and letting them know that we're there. They just don't even know how to respond to that. They don't trust it. What's the catch?

MCEVERS: So Cooke says his staff is going door to door, trying to stay in touch with people, remind them about their appointments, get them to come in. I leave the Cracker Barrel, check out of my hotel and...

(SOUNDBITE OF PHONE RINGING)

MCEVERS: ...Call the house one last time.

SAMANTHA: Hello.

MCEVERS: Hey. Is this Samantha?

SAMANTHA: Yeah.

MCEVERS: Hi, it's Kelly. It's the usual with Samantha - one word answers, not much information. I ask her if she and Devin went to sign up for Medicaid so they could go into rehab, and she says they did. And then she says she's got an appointment in a few days with Dr. Cooke. I really want to believe she will go to that appointment.

(SOUNDBITE OF MUSIC)

MCEVERS: Later, I find out she did go. But then, after that, she went back to jail for violating a protection order. She eventually pleaded guilty, got out on probation and went to rehab. Since we did this reporting last year, Devin has left the house. He recently told me he was on treatment to help him stop using Opana - for a while. He says he has a job and is trying to stay clean. Since we met her, Joy, the nurse, went to jail, too - once on a drug charge and once for violating a home detention order. She pleaded guilty to the drug charge and now lives with her parents. We have not been able to reach Jeff, the Iraq war vet.

(SOUNDBITE OF MUSIC)

MCEVERS: The thing is, Jeff and Joy and Devin and Samantha's brain chemistry has been changed by their addiction. Researchers say they are different people because they've used this drug. Studies show quitting a drug like Opana is nearly impossible unless you use what's called a medication-assisted treatment like methadone or Suboxone. Expecting Devin and Samantha to just quit on their own isn't fair. That's what I was doing while I was reporting this story. And now I realize it's how a lot of people think about addicts - just quit. Fix yourself. But for people in Austin, Ind., people in those bedrooms with the shades closed, people who think they're dead anyway - it's a lot more complicated than that.

(SOUNDBITE OF MUSIC)

MCEVERS: Coming up, we'll tell you where we're going on our next show. But first...

(SOUNDBITE OF MUSIC)

MCEVERS: I want to say a huge thanks to public media reporters Jake Harper of WFYI Side Effects Public Media and Barbara Brosher of WTIU and WFIU. This episode was produced by Tom Dreisbach, Brett Bachman and Chris Benderev and edited by Lisa Pollak, Sean Cole, and Steve Drummond with help from Vikki Valentine, Jeff Rogers and Jason Beaubien. Digital production by Alexander McCall, research help by Will Chase. Original music in this podcast is by Colin Wambsgans. The show is executive produced by me, Chris Turpin and Anya Grundmann. Our project manager is Kasia Podbielski. If you haven't already, please subscribe to this podcast wherever you do that, and please leave a review. If you want to hear a discussion of this episode look for the On Point With Tom Ashbrook podcast or hear that show on your local public radio station, which is also where you can hear more stories by me and the rest of NPR on a show I host called All Things Considered. Stay tuned for next week's episode, where we will try to get embedded with bikers after a shootout in Waco, Texas.

UNIDENTIFIED MAN #6: We went up there to eat lunch. And next thing I know, I heard a shot go off.

UNIDENTIFIED MAN #7: And I hit the ground. And I'm thinking to myself, oh, my God. I'm going to die.

UNIDENTIFIED MAN #6: End of the story is bad things happen.

(SOUNDBITE OF ENGINE REVVING)

UNIDENTIFIED MAN #6: Have gotten y'all gotten on a scooter since you've been here? Do you want to ride?

MCEVERS: Thanks for listening. I'm Kelly McEvers, and we will be back next week. Transcript provided by NPR, Copyright NPR.