(Updated May 11)
A federal agency recommended steering the $100 million Congress appropriated for rural counties to battle the opioid epidemic to those dealing with high rates of hepatitis C infection and HIV/AIDS instead.
The Health Resources and Services Administration will award 75 available grants as part of the Rural Communities Opioids Response Program, selecting counties considered "being at risk" from the Centers for Disease Control and Prevention's recommendations. The CDC prioritized counties based on confirmed acute hepatitis C infection rates rather than opioid overdose rates, according to emails obtained by Modern Healthcare.
In its April statement, HRSA said it would award up to $200,000 to grant applicants so they could develop plans for opioid abuse prevention, treatment and recovery to reduce overdoses in rural areas.
However, the CDC's highlighted counties are not those "most at risk for overdose or with the highest rate of opioid overdose but rather those with highest risk of an injection drug use related infectious disease outbreak," a CDC official wrote in one email.
The CDC's metrics excluded some states battling the highest rates of opioid deaths, including New Mexico, New Hampshire and Florida. Other states with equally high rates, such as Nevada and Pennsylvania, have only a few counties flagged even though they are heavily rural.
Kentucky, Tennessee, West Virginia and Missouri hold the most counties recommended for funding. These states face the same high opioid overdose death rates as excluded states like New Mexico and New Hampshire. But counties in other states with significantly lower death rates, such as Kansas and Georgia, also made CDC's priority list.
A separate email from an a different CDC official acknowledged that the agency focused on hepatitis C and HIV rates. The email states that officials used a "vulnerability analysis" from 2016 that followed the Indiana HIV/AIDS/hepatitis C outbreak in Scott County, Ind., "with the goal of identifying U.S. communities potentially vulnerable to rapid spread of HIV, if introduced, and new or continuing high rates of (hepatitis C) infections among persons who inject drugs."
Ultimately, confirmed acute hepatitis C infection rates were used as the key indicator for flagging vulnerable counties because of the lack of a "county-level measure of injection drug use," the CDC official wrote.
A HRSA spokesperson said Congress' authorization of the money references these 220 counties highlighted by the CDC, and that HRSA "agrees with the logic of using the (2016) report because it is a good proxy for risk." The spokesperson also said hepatitis C was just one indicator among others that included drug-overdose deaths, per capita income, unemployment and buprenorphine prescribing.
"Based on these indicators, we identified 220 counties in 26 states within the 95th percentile of most vulnerable," the spokesperson said, noting that the funding is not limited to those counties but that other high-risk regions could be considered. So far, the agency hasn't released guidance on designations of areas for being at high risk.
Congress is entrenched in opioid legislation that lawmakers hope to pass as a comprehensive package this year. The House Energy and Commerce Committee is finishing its final markups of bills this week. The Senate health committee has passed a package of its own.
The spending omnibus set aside significant money to help states curb the opioid epidemic, including an additional $1 billion in state grants.
This story has been updated to clarify that funding opportunities under these grants are not limited to the prioritized counties.