A Vulnerability Assessment Tool for Comprehensive Harm Reduction in Virginia's Opioid Response

Introduction: In 2016, the Centers for Disease Control and Prevention (CDC) identified US counties at increased risk of HIV and/or Hepatitis C outbreaks among persons who inject drugs; eight counties were in Virginia. In response to this finding and the increasing opioid use across the state, Virginia passed legislation (HB 2317) enabling comprehensive harm reduction, including syringe services, in select Virginia counties deemed ‘vulnerable’. We aimed to develop a vulnerability assessment tool for the determination of eligible counties for comprehensive harm reduction and to compare our results to those from the CDC’s assessment.

Methods: Per HB 2317, we used 2015-2016 data to identify 13 indicators for inclusion in Virginia’s assessment tool: HIV diagnoses, Hepatitis C diagnoses among persons aged 18-30 years, fatal overdoses due to heroin/fentanyl, fatal overdoses due to prescription opioids (excluding fentanyl), poverty level, unemployment, opioid prescription volume, buprenorphine prescription volume, emergency room visits for heroin overdose, emergency room visits for prescription opioid overdose, naloxone administrations with positive responses, opioid treatment admissions, and drug-related arrests. Rates or percentages for each indicator were calculated for the state and the 133 Virginia counties. For each indicator, counties received 1 point if their rate or percentage surpassed the state rate or percentage, resulting in a summary score with potential range 0–13. Next, the average of the county summary scores was calculated; counties with a summary score above the average were classified as eligible, while those with a summary score equal to or below average were classified as ineligible. We report the mean, median, and range of county summary scores, the percentage of eligible counties, and the percentage of CDC vulnerable counties identified as eligible with Virginia’s assessment tool.

Results: Among the 133 Virginia counties, the indicator summary score ranged from 0–12 with a mean of 5 and a median of 5. Counties with indicator summary scores ≥6 were considered eligible for comprehensive harm reduction; 65 counties (48.9%) met this eligibility definition. Seven of the eight (87.5%) CDC-defined vulnerable counties were identified as eligible using Virginia’s assessment tool.

Conclusions: Virginia’s assessment tool classified as eligible all but one of CDC’s vulnerable counties, while also addressing all of the required indicators as prescribed by the legislation HB 2317. The tool will be implemented routinely for the prioritization of comprehensive harm reduction among persons who inject drugs in Virginia.