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West Virginia Study Details Promising Method for Estimating Rural Intravenous Drug Use


Researchers release a new tool to help rural communities understand the resources needed to combat the opioid epidemic   

A study published today in the American Journal of Public Health estimates that 1,857 people injected drugs in the last six months in Cabell County, W.Va., a rural county with a population of 94,958. This estimate is based on an innovative survey technique that public health officials can now use in their own rural communities to address the opioid epidemic.

The study was led by researchers at the Johns Hopkins Bloomberg School of Public Health in collaboration with the Cabell-Huntington Health Department.

For their study, the researchers surveyed the population of people who inject drugs to understand their drug use and needs for essential public health services, including drug treatment and overdose prevention resources. Using these data, the study team was able to quantify the size and characteristics of the population of people who inject drugs. The study also found that most people who inject drugs in the county are white (83.4 percent), male (59.5 percent) and under age 40 (70.9 percent). Many reported injecting heroin (82.0 percent), crystal methamphetamine (71.0 percent) and fentanyl (56.3 percent) in the past six months.

“By understanding the size and characteristics of the populations in need, rural communities can tailor response strategies and begin turning the tide on the opioid crisis,” says lead researcher Sean Allen, DrPH, assistant scientist in the Bloomberg School’s Department of Health, Behavior and Society. “This research demonstrates that rural communities can leverage innovative population-estimation methods to better understand population-level needs for services among people who inject drugs,” adds Allen.  

Home to Huntington, W.Va., Cabell County has been particularly hard hit by the opioid epidemic; it saw 1,831 overdoses in 2017, and 152 were fatal.

This new data will allow public health officials, particularly those in rural areas, to appropriately scale their services, the researchers say. Michael Kilkenny, MD, physician director of the Cabell-Huntington Health Department, was the health department study lead. The Department has a comprehensive harm-reduction program that provides overdose prevention resources, drug treatment referrals and sterile injection equipment.

Details about the project, including a toolkit for public health officials to use in the field and an interactive demonstration tool of the study’s method, are available at

“Estimating the Number of People Who Inject Drugs in A Rural County in Appalachia” was written by Sean T. Allen, Allison O’Rourke, Rebecca Hamilton White, Kristin E. Schneider, Michael Kilkenny, and Susan G. Sherman.

The research was funded by the Bloomberg American Health Initiative (

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