Energizing the Community to Reduce Drug Overdoses: The Project Lazarus Model

Background: In response to one of the country's highest mortality rates from drug overdoses, Wilkes County, North Carolina developed Project Lazarus, a prevention program based on three premises: 1) communities are ultimately responsible for their own health, and 2) while programs need public health steps, 3) they must also have a safety net that includes supply, demand, diversion and harm reduction. Methods: Starting in 2007, Project Lazarus created an iterative model for preventing prescription opioid overdose deaths: 1) community activation and coalition building, 2) epidemiologic monitoring using surveillance data, 3) prevention of overdoses, 4) use of rescue medication and education for reversing overdoses by community members, and 5) program evaluation. Community advisory boards play the central role in intervention development and implementation. Results: The Wilkes overdose death rate dropped from 46.6 per 100,000 in 2009 to 28.5. In 2010 emergency care for substance abuse and accidental poisonings decreased 13%. Currently, more than 70% of controlled substance prescribing clinicians are registered to use the state's prescription monitoring program. The matching of medical examiner investigations to the state's prescription monitoring registry indicated that the number of victims who received prescriptions for the opioid implicated in their fatal overdose from a Wilkes County physician decreased from 82% in 2008 to 10% in 2010. Conclusions: After 3 years, Project Lazarus has begun to reduce the burden of opioid overdose mortality. However, public health programs must openly acknowledge the difficulties in changing behavior and set realistic time frames for intervention to take effect.