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Project Lazarus: Community-Based Overdose Prevention in Rural North Carolina

Authors

  • Su Albert MD, MPH,

    1. Project Lazarus, Moravian Falls, North Carolina
    2. Wilkes County Health Department, Wilkesboro, North Carolina
    3. Northwest Community Care Network, Winston-Salem, North Carolina
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  • Fred W. Brason II Chaplain,

    Corresponding author
    1. Northwest Community Care Network, Winston-Salem, North Carolina
    2. Wilkes Healthy Carolinians Council, Wilkesboro, North Carolina
      Fred W. Brason II, Chaplain, Project Lazarus, P.O. Box 261, Moravian Falls, NC 28654, USA. Tel: 336-667-8100; Fax: 866-400-9915;
      E-mail: fbrason@projectlazarus.org.
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  • Catherine K. Sanford MSPH,

    1. Project Lazarus, Moravian Falls, North Carolina
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  • Nabarun Dasgupta MPH,

    1. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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  • Jim Graham,

    1. Northwest Community Care Network, Winston-Salem, North Carolina
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  • Beth Lovette MPH

    1. Wilkes County Health Department, Wilkesboro, North Carolina
    2. Northwest Community Care Network, Winston-Salem, North Carolina
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Fred W. Brason II, Chaplain, Project Lazarus, P.O. Box 261, Moravian Falls, NC 28654, USA. Tel: 336-667-8100; Fax: 866-400-9915;
E-mail: fbrason@projectlazarus.org.

Abstract

Background.  In response to some of the highest drug overdose death rates in the country, Project Lazarus developed a community-based overdose prevention program in Western North Carolina. The Wilkes County unintentional poisoning mortality rate was quadruple that of the state's in 2009 and due almost exclusively to prescription opioid pain relievers, including fentanyl, hydrocodone, methadone, and oxycodone. The program is ongoing.

Methods.  The overdose prevention program involves five components: community activation and coalition building; monitoring and surveillance data; prevention of overdoses; use of rescue medication for reversing overdoses by community members; and evaluating project components. Principal efforts include education of primary care providers in managing chronic pain and safe opioid prescribing, largely through the creation of a tool kit and face-to-face meetings.

Results.  Preliminary unadjusted data for Wilkes County revealed that the overdose death rate dropped from 46.6 per 100,000 in 2009 to 29.0 per 100,000 in 2010. There was a decrease in the number of victims who received prescriptions for the substance implicated in their fatal overdose from a Wilkes County physician; in 2008, 82% of overdose decedents received a prescription for an opioid analgesic from a Wilkes prescriber compared with 10% in 2010.

Conclusions.  While the results from this community-based program are preliminary, the number and nature of prescription opioid overdose deaths in Wilkes County changed during the intervention. Further evaluation is required to understand the localized effect of the intervention and its potential for replication in other areas.

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