In late 2014, a small town in southwestern Indiana experienced a rather sudden outbreak of HIV infections. A quick rise in HIV diagnoses — from 26 at the beginning of March 2015 to 72 by month’s end — was considered a shock to Austin, Ind., which has a population of only 4,300. New reports show that the number of diagnoses has increased to 190, and health officials believe opioid abuse, along with shared infected needles, are to blame.

Ten people believed to have indirectly fueled the epidemic through their involvement in a drug trade in town were arrested, and Scott County has implemented health and social programs to prevent the disease from spreading further. Namely, local health officials have made it easier for drug users and HIV-positive people to access diagnosis and HIV medications. In addition, a needle exchange program aimed to curb the number of infected needles in circulation was established to provide drug users with clean needles, despite these types of programs originally being banned in Indiana.

Although HIV has been in steady decline since 1997, when antiretroviral therapy (ART) became a common and effective treatment, it has a risk of reappearing in communities that have undercurrents of poverty and drug abuse. Austin’s epidemic may be contained in a tiny area and population, but it’s evidence of what could occur anywhere in America —as the result of opioid and heroin abuse rates having gone up significantly in the U.S. in recent years.

“In Scott County, it’s about looking at those indicators that put [people] at risk for this HIV outbreak,” Dr. Jerome Adams, Indiana’s state health commissioner, told USA Today. “The HIV outbreak is really just a beacon that shined a light on the underlying health factors.”

According to the CDC, more people died from drug overdoses in 2014 than any other year on record — a shocking statistic, considering drug addiction and overdose rates have decreased in Europe in recent decades. The number of drug overdose deaths involving opioids — including prescription painkillers (oxycodone, hydrocodone, methadone, Opana) and heroin — increased fourfold since 1999. And it’s largely driven by more painkiller prescriptions being authorized by doctors, despite a lack of evidence existing that medical necessity for the powerful drugs has increased. “Since 1999, the amount of prescription opioids sold in the U.S. nearly quadrupled, yet there has not been an overall change in the amount of pain that Americans report,” the CDC states.

Opioids can be taken in pill form, but many are injected — creating the foundation for HIV or Hepatitis C outbreaks virtually any place where there is a large population of abusers. Because of this, the small town in Indiana may inform health care workers scrambling to prevent further spread of the disease.