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These findings strongly suggest that the national increase in acute HCV infection is related to the country's opioid epidemic and associated increases in IDU.

Objective A recent HIV outbreak in a rural network of persons who inject drugs (PWID) underscored the intersection of the expanding epidemics of opioid abuse, injection drug use (IDU), and associated increases in hepatitis C virus (HCV) infections. We sought to identify U.S. communities especially vulnerable to rapid spread of IDU-associated HIV, if introduced, and new or continuing high rates of HCV infections. Design We conducted a multi-step analysis to identify which indicator variables were highly associated with IDU. We then used these indicator values to calculate vulnerability scores for each county to identify which were most vulnerable. Methods We used confirmed cases of acute HCV infection reported to the National Notifiable Disease Surveillance System, 2012–2013, as a proxy outcome for IDU, and 15 county-level indicators available nationally in Poisson regression models to identify indicators associated with higher county acute HCV infection rates. Using these indicators, we calculated composite index scores to rank each county’s vulnerability. Results A parsimonious set of six indicators were associated with acute HCV infection rates (proxy for IDU): drug overdose deaths, prescription opioid sales, per capita income, white, non-Hispanic race/ethnicity, unemployment, and buprenorphine prescribing potential by waiver. Based on these indicators, we identified 220 counties in 26 states within the 95th percentile of most vulnerable. Conclusions Our analysis highlights U.S. counties potentially vulnerable to HIV and HCV infections among PWID in the context of the national opioid epidemic. State and local health departments will need to further explore vulnerability and target interventions to prevent transmission.

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Deaths from opioid overdoses are increasing in the United States, which may have an impact on the organ donor pool.

Our analysis suggests people injecting POA may be at higher risk for HCV infection than people who inject heroin or other drugs but not POA.