title: Project Lazarus: community-based overdose prevention in rural North Carolina.
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.
authors.affiliation: Project Lazarus, Moravian Falls, North Carolina 28654, USA.
authors.forename: Su
authors.initials: S
authors.lastname: Albert
authors.forename: Fred W
authors.initials: FW
authors.lastname: Brason
authors.forename: Catherine K
authors.initials: CK
authors.lastname: Sanford
authors.forename: Nabarun
authors.initials: N
authors.lastname: Dasgupta
authors.forename: Jim
authors.initials: J
authors.lastname: Graham
authors.forename: Beth
authors.initials: B
authors.lastname: Lovette
mesh_terms: D000701:Analgesics, Opioid / Q000506:poisoning*; D062787:Drug Overdose / Q000401:mortality* / Q000517:prevention & control*; D006801:Humans; D008691:Methadone / Q000506:poisoning; D009270:Naloxone / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use; D009657:North Carolina; D010353:Patient Education as Topic; D055553:Prescription Drugs / Q000506:poisoning*; D012307:Risk Factors; D012424:Rural Population; D012946:Social Welfare
chemical_list: D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D055553:Prescription Drugs; D009270:Naloxone; D008691:Methadone