The first step for the assessments was to identify the key outcomes of interest and potential indicators for use – factors either predictive of or associated with the outcomes of interest. The primary outcomes for the assessments were opioid overdoses (fatal and/or non-fatal) and bloodborne infections from unsterile IDU, such as hepatitis C (HCV) infections. Many jurisdictions used county-level indicators from the Van Handel et al. analysis, particularly drug overdose deaths, prescription opioid sales, per capita income, unemployment, and buprenorphine prescribing potential by waiver . In many cases, states already had these indicators available, such as drug overdose deaths from state vital statistics programs. Jurisdictions also explored indicators included in the Rickles et al. analysis  and other state specific factors of interest such as the percentage of the population with a disability.
When selecting indicators, analysts were advised to focus on one or two indicators per topic area, unless needs of program partners or specific areas suggested otherwise. For example, the American Community Survey (ACS) indicators of unemployment (among those age 16+) or per capita income are likely sufficient to address economics factors, unless there is a need to examine unemployment among specific populations. Likewise, the Drug Enforcement Agency (DEA) Arcos, IQVIA Xponent, and prescription drug monitoring program (PDMP) data all measure opioid prescriptions. If your jurisdiction or department already has a standard indicator to measure opioid prescriptions, you should use that indicator.
The select indicators often used in the assessments including topics and sources are described in Table 1. Jurisdictions that used statistical methods tested additional indicators, such as measures of years of potential life lost (YPLL), urban/rural classification, and access to vehicles.
|Buprenorphine Prescription Waivers||SAMHSA||Buprenorphine Prescribing Potential by Waiver per 10K Persons|
|Crime||Uniform Crime Reporting Data||County-Level Detailed Arrest and Offense Data|
|Demographics||American Community Survey||S1901 – Income in the Past 12 Months, detailed information on per capita income|
|Demographics||American Community Survey||S2301 – Employment Status, detailed information on unemployment|
|Demographics||American Community Survey||S2701 – Selected Characteristics of Health Insurance Coverage by Age, detailed information on health insurance coverage|
|Mortality||CDC Wonder||Drug Overdose Mortality – Per 100,000 Population, Underlying Cause|
|Population||American Community Survey||S0101 – Age and Sex|
|Prescriptions||IQVIA Xponent||Per capita prescriptions (per 100 residents) for opioids|