Project Lazarus

Description

Project Lazarus addresses drug overdose deaths, with a focus on prescription drug overdoses. Its four-component overdose prevention program was initiated in Wilkes County, North Carolina, but has since been expanded statewide.

Objective(s)

To raise awareness of prescription drug abuse, address dangerous prescribing practices, and increase community efficacy to address prescription drug abuse and reduce overdose deaths

Typical Elements

Project Lazarus is a prevention model comprising four components, each of which is intended to work in conjunction with the others (Project Lazarus, n.d.a):

  • The first component is community activation and coalition building (Albert et al., 2011, p. 77). Coalitions can include representatives from organizations identified as important to health promotion—including health departments, schools, governmental agencies, hospitals, primary care clinical practices, churches, and newspapers—who together engage in prevention activities, for example:

    • Holding a town hall meeting focusing on overdose deaths
    • Creating special task forces to examine topics relevant to overdose deaths (such as prescribing rates)
    • Developing community leadership
    • Gathering input for an educational toolkit
    • Holding community training events that raise awareness of overdose deaths (Community Care of North Carolina [CCNC], n.d.)
    • Developing social marketing media campaigns
    • Creating school education events, such as classroom-based education, or pledge cards
  • The second component, monitoring and epidemiological surveillance (Albert et al., 2011), involves gathering and analyzing various types of data to describe and characterize overdose deaths occurring in the community, for example:
    • The number of emergency department (ED) visits for substance abuse and accidental poisonings
    • The amount of controlled substances dispensed to outpatients
    • The number of “fatal accidental poisonings” (Albert et al., 2011, p. S80)
    • Vital statistics from the state health agency
      • Note: For example, Project Lazarus determined that overdose deaths in Wilkes County were due “almost exclusively to prescription opioid pain relievers” (Albert et al., 2011, p. S77).
  • The third component, prescriber, patient, and law enforcement training and education (Albert et al., 2011), includes activities such as the following:
    • Developing an educational tool kit for prescribers and patients, including, for example, pain management guidelines, opioid risk assessment tools, universal precautions for opioid prescribing, a sample patient-prescriber agreement, defensive prescription writing materials, patient education materials, and information on screening, brief intervention, and referral to treatment (Albert et al., 2011, p. S81)
    • Providing individual education and training to prescribers on pain management and overdose prevention
    • Supporting continuing medical education on pain management and overdose prevention
    • Informing prescribers about actions the state medical board can take against prescribers who violate state regulations
    • Inspecting local pain clinics
    • Promoting use of Prescription Drug Monitoring Programs (PDMPs)
      • Note: PDMPs can have different names by state—for example, North Carolina’s is called the Controlled Substance Reporting System.
    • Modifying hospital ED policy on dispensing opioids (such as mandating PDMP use and limiting the amount of opioids that can be dispensed at one time)
    • Holding medication takeback events and establishing permanent medication disposal sites
    • Training specialized drug diversion law enforcement officers
    • Mandating the use of patient-prescriber agreements when pain medications are prescribed
    • Creating support groups for patients with chronic pain
    • Assigning ED case managers to patients with chronic pain
  • The fourth component, overdose reversal medication (Albert et al., 2011), encourages the establishment of procedures that enhance naloxone access to populations at risk of overdose (Harm Reduction Coalition, n.d.), for example:
    • Training prescribers to identify patients at risk of an overdose
    • Asking at-risk patients to participate in the initiative
    • Showing participating patients a 20-minute video that “covers patient responsibilities in pain management, storage, and disposal of opioid medications, recognizing and responding to an opioid overdose, and options for substance abuse treatment” (Harm Reduction Coalition, n.d., p. 1)
    • Giving participating patients a prescription for a free naloxone kit
    • Supporting efforts to expand the capacity of inpatient detox programs, for example, securing funding for additional beds at existing programs, increasing awareness of existing programs, and establishing new programs

Populations

Prescribers, patients at risk of overdose, community members

Outcomes

In Wilkes County, North Carolina, Project Lazarus has been linked to the following outcomes (Albert et al., 2011; Project Lazarus, n.d.b):

  • A 69% reduction in the overdose mortality rate from 2009 to 2011
  • A reduction (from 82% in 2009 to 0% in 2011) in the percentage of overdose patients whose death was caused by a prescription issued by a prescriber operating in the county
  • A 15% reduction in the number of ED visits for overdoses or substance abuse from 2009 to 2010
    • Note: Statewide, North Carolina saw a 6.9% increase in the number of ED visits for overdoses or substance abuse.
  • A percentage of prescribers who registered with the state PDMP, as of 2010, that is almost three times higher than the statewide average (70% and 26%, respectively) (CCNC, n.d.)

Guidelines

Project Lazarus [Website]

Acknowledged by

Office of National Drug Control Policy. A Public Health Approach to Overdose Prevention: Director’s Remarks at Project Lazarus, Wilkes County, North Carolina. 

References

Albert, S., Brason II, F. W., Sanford, C. K., Dasgupta, N., Graham, J., & Lovette, B. (2011). Project Lazarus: Community-based overdose prevention in rural North Carolina. Pain Medicine, 12, S77–S85. Retrieved from http://prescribetoprevent.org/wp-content/uploads/2012/11/pm2011albert.pdf

Community Care of North Carolina. (n.d.). Project Lazarus: A community-wide response to managing pain. Retrieved from https://www.slideserve.com/rivka/project-lazarus-a-community-wide-response-to-managing-pain

Harm Reduction Coalition. (n.d.). Project Lazarus: Case study. Retrieved from http://harmreduction.org/issues/overdose-prevention/tools-best-practices/naloxone-program-case-studies/project-lazarus/

Project Lazarus. (n.d.a). The Project Lazarus model. Retrieved from https://www.projectlazarus.org/the-model

Project Lazarus. (n.d.b). Project Lazarus results for Wilkes County. Retrieved from http://projectlazarus.com/project-lazarus-results-wilkes-county