Fatal Overdose, Acute Viral Hepatitis, and Human Immunodeficiency Virus Attributed to Injection Drug Use, Appalachian Region of the United States, 2000–2023

We documented elevated rates of infectious diseases and fatal drug overdose against a background of increased economic distress in the central Appalachian subregions, especially among working-age adults of reproductive age. Interventions to address social determinants of health and expand access to comprehensive integrated medical and substance use disorder treatment, overdose prevention, and syringe services are critical to control this syndemic.