Data Summary: Vulnerable Areas for Infectious Diseases in Persons Who Inject Drugs

At a glance

A deadly consequence of the opioid crisis is increased incidence of blood-borne infections, including hepatitis B virus and hepatitis C, HIV, and bacteria that cause heart infections (endocarditis). The use of contaminated injection drug equipment is a primary transmission route for both HIV and hepatitis C. Increasing injection drug use has placed new populations, including young people, at risk.

A woman with a large tattoo interacts with a syringe services provider.

What CDC is doing

CDC’s infectious disease programs work to implement evidence-based drug prevention in school and community settings, and to stop the spread of infectious diseases like HIV and hepatitis C among people who inject drugs. Access to comprehensive prevention services is essential for all persons who inject drugs. Syringe services programs reduce syringe sharing and can help provide access to prevention and treatment services for HIV and other blood-borne diseases, such as hepatitis C and hepatitis B. Below are a summary of CDC resources on infectious disease and injection drug use.

Vulnerabilities assessments

Identifying jurisdictions with increased risk of infectious disease among people who inject drugs

The United States is currently facing an urgent crisis involving misuse of opioids, such as heroin, fentanyl, and prescription opioids, as well as other drugs, such as methamphetamines and cocaine. Opioid-related overdose deaths were six times as high in 2019 as they were in 1999, and infectious diseases, including viral hepatitis and methicillin-resistant Staphylococcus aureus (MRSA), have dramatically increased as a result of this crisis.

Disease outbreaks among people who use drugs have devastating effects in communities for illness, suffering and costs associated with treatment and care.

  • Since 2015, there have been multiple HIV outbreaks associated with injection drug use; 11% of all people with an HIV diagnosis in 2018 reported injection drug use. The average lifetime HIV-related medical cost for one person with HIV is $510,000.
  • A nationwide outbreak of hepatitis A, primarily among people who use drugs and/or people experiencing homelessness, has spread across the United States since 2016, with 37,691 cases affecting more than 35 states as of February 5, 2021. More than 60% of cases have resulted in hospitalization, and 354 people have died. These outbreaks have resulted in illness and loss of life nationwide, as well as an estimated financial toll of at least $367 million in hospital costs alone.
  • Rates of invasive MRSA associated with injection drug use more than doubled from 2010–2018 in the sites monitored by the Emerging Infections Program. Nationwide, hospitalization due to injection drug use-related infections (not including viral hepatitis and HIV) — such as endocarditis, MRSA, and other bacterial and fungal infections — cost over $700 million in 2012 alone.

Vulnerable counties and jurisdictions experiencing or at-risk of outbreaks‎

Vulnerability to rapid dissemination of HIV/HCV infection among persons who inject drugs and jurisdictions determined to be experiencing or at-risk of significant increases in hepatitis infection or an HIV outbreak due to injection drug use following CDC consultation.

Vulnerable counties state assessments‎

In 2018, CDC released emergency funding in response to the opioid overdose epidemic and launched activities to directly fund 41 states and the District of Columbia to develop and disseminate jurisdiction-level vulnerability assessments (JVAs).