Replication of Project Lazarus comprehensive community based model to reduce opioid medication overdoses among active duty soldiers determined to be at risk within select US military bases by implementing the naloxone rescue component as Standard Operating Procedure

Improvements in battlefield protection and evacuation have led to higher survival rates after combat injury during OIF/OEF than in previous military actions. A higher survival rate has resulted in the need for expanded management strategies for pain resulting from battlefield injuries, specifically blast injuries. Chronic pain is a common occurrence among combat-injured soldiers, as well as a common co-morbid condition in soldiers suffering from post-traumatic stress disorder (PTSD) and/or traumatic brain injuries (TBI). The Military Traumatic Brain Injury (TBI) Task Force (2007) reported that 30% of those treated for combat injuries have TBI, and many more exhibit subclinical TBI symptoms. TBI, PTSD and chronic pain are inseparable conditions that must be managed simultaneously.

The effectiveness of opioid treatment for chronic pain in this population is an area of active research further complicating clinical practice. Opioid treatment is not without risks, and the active duty population has elevated risk factors for experiencing chronic pain as well as prescription opioid addiction, abuse, misuse, overdose, and death compared to their civilian counterparts.

Currently, there are few public health initiatives to address the epidemic of fatal overdoses from prescription drugs. Operation OpioidSafe of Ft Bragg, NC is based upon work conducted by the traditional community-based public health intervention by Project Lazarus of Wilkes County, NC. The most novel aspect of the program is the provision of rescue medication (naloxone) as a safety net for those who use opioids and are not willing or capable of responding to efforts to prevent opioid overdose and abuse.