August 24, 2017
As the United States opioid crisis intensifies, a doctoral student from the UNC Gillings School of Global Public Health has evaluated the statewide rollout of “Project Lazarus,” an opioid overdose intervention program in North Carolina. Communities that have used Project Lazarus strategies have seen a modest decrease in opioid-related deaths.
As a centralized intervention, Project Lazarus is comprised of a set of “bottom up” overdose prevention strategies – meant to be implemented by community-based coalitions – and a set of “top down” efforts to change health-care policies and prescriber behaviors at the system level.
It is part of a nationwide response, co-led by the White House Office of National Drug Control Policy and the Centers for Disease Control and Prevention, to the fact that opioid overdose deaths in the U.S. increased 200 percent between 2000 and 2014. In North Carolina, the overdose death rate increased 14.5 percent from 2014 to 2015 alone, and is now the leading cause of injury death in the state.
Apostolos Alexandridis, doctoral student of epidemiology at the Gillings School and graduate research assistant at UNC’s Injury Prevention Research Center, was first author of an article on the evaluation findings. Titled “A Statewide Evaluation of Seven Strategies to Reduce Opioid Overdose in North Carolina,” the article was published online August 23 by Injury Prevention.
“The Project Lazarus intervention model comprises seven supply, demand and harm reduction strategies,” Alexandridis explained. “County-level coalitions were invited to select and implement the strategies they considered appropriate for their communities. Our study model aimed to determine which of the seven strategies most effectively reduced opioid overdose.”
The strategies ranged from community education that promotes public awareness of opioid overdose to programs that remove unused medications from the community through take-back events and drop-boxes. The evaluation – which compared data from the pre-intervention period of January 2009 to February 2013 with data from the intervention window between March 2013 and December 2014 – found that two strategies in particular were most successful.
These were: 1. health-care provider education on pain management and addiction and 2. emergency department policies limiting opioid prescribing and encouraging regular Prescription Drug Monitoring Program checks for patients. These strategies had a positive impact on mortality (with nine and three percent fewer deaths from overdose, respectively), but also were linked with a slight increase in emergency department visits related to overdose.
“A modest increase in emergency department visits isn’t a bad thing!” Alexandridis said. “It means more people experiencing an overdose are getting to care centers in time.”
Alexandridis also noted that the study was challenging to conduct because of the many distinct health data systems that had to be aggregated, including death records, addiction treatment data and prescription drug monitoring data. He echoed other researchers and government agencies in highlighting the need for quality, linkable data.
In addition to improving data systems, the co-authors called for further research to create more evidence around opioid overdose interventions.
“Some of the seven Project Lazarus strategies, such as harm reduction or addiction treatment expansion, may be seen initially as ‘non-starters’ in a community,” said Nabarun Dasgupta, PhD, a co-author and research scientist at the Injury Research Prevention Center. “One of our goals is developing a body of evidence that helps communities recognize that those ‘non-starters’ might be just what they need.”
Stephen Marshall, PhD, professor of epidemiology at UNC Gillings and director of the Injury Prevention Research Center, also was a co-author of the evaluation.
“This study is especially important because it helps empower community coalitions to fight the opioid problem, which is now one of the top 10 causes of death in our country,” he said. “There are no quick fixes here. We are 15 years into this epidemic, and it may take a similar amount of time to fully address the problem. What this study shows is that well-supported community coalitions are integral to helping Americans heal this terrible wound.”
Other co-authors from the University of North Carolina at Chapel Hill Injury Prevention Research Center included Agnieszka McCort, MA, program manager of the Prescription Overdose Prevention Program, Christopher Ringwalt, DrPH, program area lead for prescription drug overdose, and Catherine Sanford, MSPH, injury epidemiologist.