As heroin addiction rates continue to hit record highs across America, a new report from the Robert Wood Johnson Foundation is pointing to another facet of the drug epidemic, with new stats suggesting that up to 28 U.S. states are not prepared for outbreaks of hepatitis C virus (HCV), hepatitis B virus (HBV) or HIV related to injection drug use, Medical Daily reports.

Titled “Outbreaks: Protecting Americans from Infectious Diseases” and co-published with Trust for America’s Health, the study ranks Idaho, Kansas, Michigan, Ohio, Oregon, Oklahoma and Utah as the least prepared states in the country for detecting, diagnosing and responding to blood-borne disease outbreaks. Delaware, Kentucky, Maine, New York and Virginia were found to be the best prepared.

Authors of the report point to the fact that heroin use has more than doubled in the United States over the past decade. They also write that 2013 saw nearly 30,000 new hep C cases, most commonly among young, white, non-urban injection drug users (IDUs) who may have become addicted to opioids through prescription drug use.

New findings further projected that for every IDU with hep C, 20 additional people would get the virus, primarily via shared needles or injecting equipment, before it was detected or treated.

“The best offense to fighting infectious diseases is a strong and steady defense,” write the study authors, pointing to an increased need for testing, diagnosis and treatment for all three diseases—especially among injection drug users—to help stem the tide of new cases.