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 funding from the National Center for Injury Prevention and Control (NCIPC), launched activities within the Jurisdictional Recovery domain, funding 41 state and the District of Columbia health departments to develop and disseminate jurisdiction-level vulnerability assessments (JVAs). These projects built on the methods established in the National Vulnerability Assessment conducted in 2016 by Van Handel et al. 
These assessments identified sub-regional areas at high risk for opioid overdoses and/or areas at high risk for bloodborne infections associated with non-sterile IDU. The assessment findings continue to be used to develop plans that strategically allocate prevention and intervention services to maximally reduce the life-threatening complications of the national opioid crisis. Key stakeholders and other health district officials are using the vulnerability assessments to address gaps in prevention, intervention, and distribution of resources including naloxone distribution, substance use disorder treatment, and linkage to care for HIV and viral hepatitis. 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.
CSTE was well positioned to provide technical assistance for two reasons: 1) CSTE serves as the professional home for almost 2,000 epidemiologists representing all 50 states, many territories and many local and tribal jurisdictions; 2) CSTE routinely provides professional development to the epidemiologic workforce through communities of practice and workgroups, toolkits, webinars and an annual conference. This toolkit reflects the CSTE mission to:
- Promote effective use of epidemiologic data to guide public health practice and improve health,
- Support effective public health surveillance and epidemiologic practice through training, capacity development, and peer consultation, and
- Develop standards for practice.
The purpose of this specific toolkit is to provide guidance, tools, and examples of state vulnerability assessments for epidemiologists and other public health professionals planning to conduct or update 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 states in response to challenges and questions that arose during the conduct of their projects.
This toolkit provides guidance on:
- Indicator identification
- Data collection and exploration
- Assessment approaches including the composite index scores, statistical modeling, and spatial epidemiologic analyses
- Identifying prevention gaps
- Using assessment findings to address prevention gaps and intervention considerations
- Collaboration, communication, and dissemination examples
- Communication resources/tools
CSTE Jurisdictional Vulnerability Assessment Toolkit 05/xx/2021. Toolkit Background and Introduction. Retrieved from [web link].
Acknowledgement Statement: “This product was developed by CSTE, Thought Bridge, LLC and Tsuro Consulting with subject matter support and review from CDC/NCHHSTP. The vulnerability assessment project and the associated toolkit was funded through CDC’s National Center for Injury Prevention and Control, Cooperative Agreement Number 1NU1ROT000018-01-00. The findings are those of the consultants and do not necessarily represent the views of the Centers for Disease Control and Prevention.”