evidence: The dozens of cases, described as an epidemic, are centered in Scott County, about a half-hour north of Louisville with a population of about 25,000. Indiana Governor Mike Pence declared a public health emergency there in March after dozens of cases of HIV were discovered. An outbreak of HIV may seem odd in such a remote part of the country, but it’s been fueled by growing heroin and drug use in rural counties like this one. A number of Midwestern states have struggled with a recent uptick in drug and needle use, and Indiana specifically has seen an increase in the use of a powerful painkiller called Opana, which can be altered and injected. The number of deaths related to opioids like Opana rose from 200 a year in 2002 to 700 in 2012, according to the Indiana State Department of Health. [...] Read next: At Least 120 Now Infected In Indiana HIV Outbreak