261178 Project Lazarus: Community-based Intervention successfully reduces prescription drug overdose deaths

Tuesday, October 30, 2012 : 3:10 PM - 3:30 PM

Nabarun Dasgupta, MPH , Department of Epidemiology, Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, Chapel Hill, NC
Catherine (Kay) Sanford, MSPH , Project Lazarus, Moravian Falls, NC
Fred Brason II, Chaplain , North Carolina Community Care Network, Project Lazarus/Chronic Pain Initiative, Moravian Falls, NC
     
Background: In 2008, Wilkes County had the sixth highest annual unintentional poisoning mortality rate in the country (42.0 per 100,000), attributed to overdoses of prescribed opioid analgesics. Project Lazarus and the Chronic Pain Initiative were formed in response, to simultaneously reduce overdose deaths and encourage optimal treatment for chronic pain.

Methods: Project Lazarus developed strategic action plans targeting risk factors for opioid abuse through local community coalitions. The Chronic Pain Initiative educated doctors on proper pain management and distributed toolkits. Other strategies included law enforcement training, use of the prescription monitoring program (PMP), and more.

Results: The unintentional poisoning mortality rate decreased 69% between 2009 and 2011, from 46.0 to 14.4 per 100,000 per year. Substance abuse- and unintentional poisoning-related ED visits dropped by 15.3% from 2008 to 2010, while the rest of NC increased 6.9%. In 2011 not a single Wilkes County resident who died from an unintentional overdose received a prescription for an opioid analgesic in the six months prior to death from a Wilkes County prescriber, down from 82% in 2008. As of 2010, 70% of prescribers registered to use the PMP, compared to 26% statewide average. Reductions in mortality did not occur at the expense of access to opioids. Among Wilkes residents, 7.5 to 8.0% received an opioid indicated for pain per month from 2008 through 2010, higher than 5.75% state average.

Conclusion: Community-based prescription overdose prevention can lower unintended consequences without jeopardizing access to pain care. The intervention is now being rolled out statewide.

Learning Areas:
Clinical medicine applied in public health
Communication and informatics
Epidemiology
Planning of health education strategies, interventions, and programs
Public health or related public policy
Social and behavioral sciences

Learning Objectives:
1. Define the components of a successful community-based overdose prevention program. 2. Describe the results of Project Lazarus in terms of reductions in overdose deaths and benefits to patients with chronic pain. 3. Identify ways in which the Project Lazarus model can be adapted for replication in your setting.

Keywords: Drug Abuse, Injury Prevention

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am quantitative epidemiologist involved in the study of the medical and nonmedical uses of prescription opioids and heroin, and co-founder of Project Lazarus. I have worked with for diverse groups in public health (clinical practices, nonprofit organizations, state and local health departments, WHO) involved in reducing the adverse consequences of opioid use. My areas of research are in pharmacoepidemiology, opioid overdose, and injection drug use.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4277.0: Policy Level Interventions & Impacts: Alcohol & Other Drugs