Project Lazarus: A Community-based Response to Prescription Opioid Diversion and Overdose

Background: Project Lazarus is a community-based education and intervention program based in western North Carolina that intends to reduce deaths among patients and non-patients at increased risk of abusing or misusing prescription opioid medication and dying from an accidental poisoning (unintentional drug overdose).

Methods: The five-step model includes: 1) community knowledge and coalition, 2) surveillance, 3) drug abuse/misuse prevention (including better pain management), 4) naloxone rescue medication and Treatment, 5) evaluation. Information will be presented on how a coalition was created and maintained, and evaluations will be presented using public health surveillance data (mortality, electronic prescription dispensing data, and hospital emergency department visits).

Results: The combined efforts in one rural community have led to decreases in diversion; the sources of drugs involved in overdose deaths have shifted to outside of the program area. The number of emergency department visits involving problematic prescription opioid users has decreased, with corresponding financial savings. However, there has been limited impact on mortality from prescription opioids, indicating that supply side reduction alone is not sufficient for preventing overdose deaths. Ongoing assessment of the program's acceptability, data quality, community penetration, timeliness, and efficiency will also be presented.

Conclusions: While law enforcement and financial outcomes, such as reducing diversion, have been achieved, a corresponding decrease in overdose deaths was not achieved. In response to this observation, drug users will be provided with an antidote to reverse overdoses. Community engagement for overdose prevention is possible, however, harm and demand reduction strategies must be enacted alongside supply reduction.