The CDC looked at drug use rates and hepatitis C infection reports in Kentucky, West Virginia, Virginia and Tennessee. The results were pretty disturbing, if not surprising. From 2006 to 2012, the region saw a 364 percent increase in reports of acute hepatitis C infection among people age 12 to 29, with the rural rate more than twice the urban rate. (Rural, or "non-urban" in CDC parlance, was defined as a town of less than 50,000).
Among the people who were asked about risk factors for infection, 73 percent said they had used intravenous drugs, mainly heroin or prescription opioids. The number of young people admitted for drug treatment who said they had injected any kind of opioid during the six year period rose by 12.6 percent. The study notes reports of similar findings in Wisconsin, Massachusetts and upstate New York, so this is not isolated to Appalachia.
While this kind of comparison can't prove cause and effect, heroin and opioid use is soaring in the United States. "The number of admitted patients who report injecting suggests that the increase in acute [hepatitis C] infections
in central Appalachia is highly correlated with the region’s epidemic of prescription opioid abuse and facilitated by an upsurge in the number of persons who inject drugs in these four states," the study concludes.