Population Management

Overdose Prevention materials

Opioid Overdose Prevention Toolkit

Free SAMHSA Toolkit for first responders, providers, and those recovering from opioid overdose.

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Durham Chronic Pain Collaborative

Project of Duke Medical Center and Durham Community Health Network

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Coverage of Project Lazarus

Fox 8 WGHP (Greensboro/High Point) October 27, 2012

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Media Coverage

WSPA Coverage of Project Lazarus

Local news coverage of Polk County event

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CME/CNE activities designed to help safely and effectively manage patients with chronic pain, when appropriate, with opioid analgesics.

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Prescribe to Prevent Site

Information on prescribing and dispensing naloxone

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AMA Online Learning Center

AMA Pain Management Modules

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TIP 54: Managing Chronic Pain in Adults With or in Recovery From Substance Use Disorders

Equips clinicians with practical guidance and tools for treating chronic pain in adults with a history of substance abuse.

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AMDG Opioid Dosing

The Agency Medical Directors' Group of Washington State has gathered informational materials for opioid dosing.

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ICSI Chronic Pain Guidelines

Institute for Clinical Systems Improvement Assessment and Management of Chronic Pain

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NC County-Level Overdose Data

Tables are based on county of residence by county and include years 1999-2013.

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Adopting Naloxone Standing Orders

Toolkit for NC Local Health Departments

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Project Lazarus

A community-wide response to managing pain

Surveys show that the management of chronic pain is a top concern among primary care doctors, who along with internists and dentists write the majority of scripts for painkillers. Roughly 20 percent of prescribers prescribe 80 percent of all prescription painkillers.

The number of prescriptions being written is truly staggering.  According to the CDC, enough prescription painkillers were prescribed in 2010 to medicate every American adult around-the-clock for an entire month!   A recent report by the Institute of Medicine suggests that the U.S may be spending as much as $635 billion annually to treat chronic pain and that long-term pain impacts more patients in the U.S. than heart disease, cancer and diabetes combined.

In an unfortunate corollary, this flood of narcotics is fueling what can only be called an epidemic of prescription drug overdoses. Such deaths rose five-fold between 1990 and 2007, reaching unprecedented levels. In addition to the threat of overdose, inappropriate use of painkillers has been associated with HIV, hepatitis and worsening mental health. Individuals abusing painkillers tax busy hospital emergency departments and can lead doctors to order unnecessary imaging and diagnostic tests. The inappropriate use of pain medications significantly impacts the entire community.

Project Lazarus seeks to address these challenges through a broad partnership that includes CCNC, the North Carolina Hospital Association, local hospitals and emergency departments, local health departments, primary care doctors, faith-based programs and law enforcement. CCNC is providing financial support and tapping into CCNC’s local networks – professionals who are expert in local conditions and resources for treatment.

Project Lazarus Toolkits

To assist partners in the initiative, CCNC has developed a series of toolkits aimed at providing information and resources to key players in chronic pain treatment:  care managers, emergency room physicians and primary care providers.  Kits are being distributed to Pain Initiative Coordinators in each of CCNC's 14 local networks.  These documents can also be downloaded in PDF form via the links on the right side of this page.

Project Lazarus Training

Project Lazarus is conducting both clinical training and community training sessions.

  • Clinical training is aimed at providing guidance to clinicians and prescribers on the medical assessment and treatment of chronic pain and the use of opioids. Attendees include care managers, primary care physicians and emergency room physicians and dentists. (CME credit is available for most training sessions.) To register for clinical training opportunities in your area, please go to the Project Lazarus Training site.
  • Community training broadens awareness of unintentional poisonings and chronic pain issues, and bolsters community involvement in prevention and early intervention. Attendees include a broad range of community partners including law enforcement, public health, schools, hospitals and faith based organizations. To register for community training, please contact Fred Brason II.

Background:  The Wilkes County Experience

CCNC's statewide program is modeled on a highly successful overdose prevention program pioneered in Wilkes County, North Carolina. The program began with a series of public meetings organized by the Wilkes County Health Department to heighten community awareness of the county’s exceptionally high rate of mortalities attributable to overdoses of prescribed opioid pain relievers. In 2008, Project Lazarus, a secular, non-profit drug overdose prevention program, was formed to develop and disseminate a set of strategic action plans for the community and tool kits and medical training for local medical care providers to address opioid misuse and abuse.

An evaluation published by members of the Project Lazarus study team found that the implementation of their program in  Wilkes County generated a 47% reduction in the overdose death rate from 2009 to 2010. More recent data show that the overdose death rate in Wilkes County decreased by 69% between 2009 and 2011, from 46.0 to 14.4 per 100,000 per year, even as the level of opioid prescribing remained above the state average. Substance abuse-related ED admissions dropped by 15.3% from 2008 to 2010, in marked contrast to an increase in such admissions statewide of 6.9% over this period. Most remarkably, in 2011 not a single prescription overdose decedent received a fatal prescription from a Wilkes County prescriber, down from 82% in 2008. As of 2010, 70% of the county’s prescribers were registered with the State’s prescription drug monitoring program, compared to a statewide average of only 26%.

Data from Wilkes County suggest that the Project Lazarus had an impact within two years of its initiation, and that strong effects were apparent by the third year. It is hoped that the impact of the statewide Project Lazarus effort will be evident even earlier, as Project Lazarus' first year was devoted to developing an organizational infrastructure and intervention techniques, which have now been refined and provided to project participants in manual form (see Toolkits at right). CCNC case managers are already working with ED staff to coordinate care for chronic pain patients and facilitate referrals for appropriate treatment of the underlying causes of chronic pain.

Project Lazarus is a community-wide response to a problem that is devastating communities all across the nation. Click here to see more information about the Project Lazarus Training grant received from The Kate B. Reynolds Trust.

Office-Based Urine Drug Screening*

Dr. Paul Martin is Board Certified in Family Medicine, Addiction Medicine, and Occupational Medicine. In this two-part module, he explains the options available for monitoring patients who are prescribed controlled substances in an outpatient setting. The first module discusses the latest standards of care, the types of tests available, and when to utilize confirmation testing. In the second module, he explains how to select the proper UDS panel, understanding drug metabolites, and recognizing adulterated specimens.


*The project described in these videos was supported by Grant Number 1C1CMS331019-01-00 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.