Abstract
BackgroundProject Lazarus (PL) is a seven-strategy, community-coalition-based intervention designed to reduce opioid overdose and dependence. The seven strategies include: community education, provider education, hospital emergency department policy change, diversion control, support programs for patients with pain, naloxone policies, and addiction treatment expansion. PL was originally developed in Wilkes County, NC. It was made available to all counties in North Carolina starting in March 2013 with funding of up to $34,400 per county per year. We examined the association between PL implementation and 1) overall dispensing rate of opioid analgesics, and 2) utilization of buprenorphine. Buprenorphine is often used in connection with medication assisted treatment (MAT) for opioid dependence.MethodsObservational interrupted time series analysis of 100 counties over 2009–2014 (n = 7200 county-months) in North Carolina. The intervention period was March 2013–December 2014. 74 of 100 counties implemented the intervention. Exposure data sources comprised process surveys, training records, Prescription Drug Monitoring Program (PDMP) data, and methadone treatment program quality data. Outcomes were PDMP-derived counts of opioid prescriptions and buprenorphine patients. Incidence Rate Ratios were estimated with adjusted GEE Poisson regression models of all seven PL strategies.ResultsIn adjusted models, diversion control efforts were positively associated with increased dispensing of opioid analgesics (IRR: 1.06; 95% CI: 1.03, 1.09). None of the other PL strategies were associated with reduced prescribing of opioid analgesics. Support programs for patients with pain were associated with a non-significant decrease in buprenorphine utilization (IRR: 0.93; 95% CI: 0.85, 1.02), but addiction treatment expansion efforts were associated with no change in buprenorphine utilization (IRR: 0.98; 95% CI: 0.91, 1.06).ConclusionsImplementation of PL strategies did not appreciably reduce opioid dispensing and did not increase buprenorphine utilization. These results are consistent with previous findings of limited impact of PL strategies on overdose morbidity and mortality. Future studies should analyze the uptake of MAT using a more expansive view of institutional barriers, treating community coalition activity around MAT as an effect modifier.
Highlights
Project Lazarus (PL) is a seven-strategy, community-coalition-based intervention designed to reduce opioid overdose and dependence
Opioid analgesic dispensing In univariate models, we found weak associations between the adoption of PL strategies and the rate of opioid analgesics (OA) prescription dispensing (Table 2)
medication assisted treatment (MAT) expansion was associated with a 16% increase in OA dispensing (IRR: 1.16; 95% CI: 1.11, 1.20), and Diversion Control efforts were associated with a 15% increase (IRR: 1.15; 95% CI: 1.12, 1.17) in OA dispensing
Summary
Project Lazarus (PL) is a seven-strategy, community-coalition-based intervention designed to reduce opioid overdose and dependence. Deaths from opioid overdose began increasing in North Carolina (NC) in the late 1990s (Web-based Injury Statistics Query and Reporting System (WISQARS), 2005). Opioid overdose has become the leading cause of unintentional injury death in the state, and involves prescription opioid analgesics (OA) as well as illicitly manufactured heroin and fentanyl (State Center for Health Statistics, 2015). Addressing this epidemic has become a leading priority for the NC Department of Health and Human Services (NC DHHS), which has promoted supply, demand, and harm reduction strategies (North Carolina Department of Health and Human Services, 2017). Formulations of buprenorphine indicated for MAT are often used to reduce the risk of opioid abuse in patients receiving high doses of full-agonist opioids
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