The United States is in the midst of an opioid crisis. Devastating consequences of the opioid epidemic include increases in opioid misuse and related overdoses, as well as the rising incidence of bloodborne infections from non-sterile injection drug use (IDU), such as HIV and viral hepatitis. In 2018, the Centers for Disease Control and Prevention (CDC) released emergency funding in response to the current opioid overdose crisis. The National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), with funds from the National Center for Injury Prevention and Control (NCIPC), launched activities within the Jurisdictional Recovery domain, directly funding 41 state and the District of Columbia to develop and disseminate jurisdiction-level vulnerability assessments (JVAs). These assessments identified sub-regional areas at high risk for opioid overdoses and/or bloodborne infections associated with non-sterile IDU. To support jurisdictions in conducting their assessments, CDC also funded the Council for State and Territorial Epidemiologists (CSTE) to provide technical assistance as well as develop a toolkit of resources for jurisdictions planning to conduct or update their own assessments in the future.
Below we present the six main steps applied by jurisdictions for conducting JVAs to identify sub-regional areas at high risk for opioid overdose or bloodborne infections from non-sterile IDU use in order to develop and initiate implementation of plans to address prevention and intervention needs.
- Indicator Identification
The first step was to identify and prioritize indicators associated with the outcomes of interest, such as overdose deaths or new hepatitis C (HCV) infections. Indicators should be available at the sub-regional level (e.g., county, ZIP code) and be timely. Core indicators used by states included: socio-economic indicators – employment status, poverty status, income, and health insurance coverage; opioid-related indicators – drug overdose mortality, opioid prescriptions, buprenorphine prescribing potential by waiver, drug-related arrests; and infectious disease indicators – acute HCV rate, endocarditis hospitalizations. The Indicator Identification section of the toolkit provides guidance on identifying outcomes of interest and selecting indicators.
- Data Collection and Exploration
- Developing the Assessment: Overview of the Three Primary Assessment Approaches
- Identifying Prevention Gaps
- Developing Plan to Address Gaps
- Collaboration, Communication, and Dissemination Strategies
This toolkit provides guidance, tools, and examples of state vulnerability assessments for epidemiologists and other public health professionals seeking to assess their jurisdictions’ vulnerability for opioid overdoses and bloodborne infections associated with non-sterile IDU. The guidance presented in this toolkit reflects the technical assistance delivered to grantees in response to challenges and questions that arose during the conduct of their projects.
Several states have released their assessment findings and plans online. These resources can be found at: