Project Lazarus Focus on Preventing Overdoses in Children: Presentation to Child Fatality Task Force, August 29, 2011 Catherine (Kay) Sanford, msph Slides available upon request from www.projectlazarus.org. Prepared August 2011 1
Project Lazarus - Mission Statement Project Lazarus believes that communities are ultimately responsible for their own health and that every drug overdose is preventable. We are a secular, non-profit organization that provides technical assistance to community groups and clinicians throughout North Carolina and beyond. Using experience, data, and compassion, we empower communities and individuals to prevent drug overdoses and meet the needs of those living with chronic pain. Reducing supply, demand, diversion and harm. Slides available upon request from www.projectlazarus.org. Prepared August 2011 2
Project Lazarus Model for a Community-Based Drug Overdose Prevention Program 2. Epidemiologic Monitoring 5. Program Evaluation: process and outcomes 1. Community knowledge; Coalition building 3. Prevention: Chronic Pain Initiative 4.Rescue: Project Lazarus Slides available upon request from www.projectlazarus.org. Prepared August 2011 3
LOCUS OF COMMUNITY INTERVENTIONS* Society Environmental Situation Economic Conditions Employment Opportunities Peers Religion Individual Physical Psychological Social Spiritual School Community Social Structures Prejudices Family * Adapted from Carl Leukefeld, University of Kentucky July 2006 Slides available upon request from www.projectlazarus.org. Prepared August 2011 4
Project Lazarus: Step 1.Community Knowledge and Coalition Building Data Collection Community Assessment Community Awareness Community Coalition Building Strategic and Action Planning Implementation Evaluation Slides available upon request from www.projectlazarus.org. Prepared August 2011 5
Project Lazarus: Step 2. Epidemiologic Monitoring FATAL OVERDOSES NC SCHS--Death Certificates, OCME- ME investigations NON-FATAL OVERDOSES NC DETECT ED data NC Poison Control poison calls NC SCHS - hospital data CCNC- Medicaid data AVAILABILITY OF PRESCRIBED OPIOIDS DMH/DD/SAS -- NC Controlled Substances Reporting System (CSRS) data NC SCHS-State Center for Health Statistics; OCME-Office of the Chief Medical Examiner; NCDETECT North Carolina Disease Event Tracking and Epidemiologic Collection Tool; CPC-Carolina Poison Center; CCNC-community Care of North Carolina state s Medicaid Authority; CSRS-Controlled Substances Reporting System; Division of Mental Health/ Developmental Disabilities/Substance Abuse Services. 6 Slides available upon request from www.projectlazarus.org. Prepared August 2011
Project Lazarus. Step 3. Prevention Replicate Wilkes Chronic Pain Initiative in all NC counties. Change ED opioid prescribing policies for chronic pain upon discharge. Conduct drug prevention programs in schools, faith community, juvenile justice system, all community sectors. Advocate for (more) Substance Abuse treatment facilities in Wilkes, Western counties, and state. Slides available upon request from www.projectlazarus.org. Prepared August 2011 7
Community Education Slides available upon request from www.projectlazarus.org. Prepared August 2011 8
Slides available upon request from www.projectlazarus.org. Prepared August 2011 9
The four cardinal rules to prescription drug safety TAKE CORRECTLY. STORE SECURELY. DISPOSE PROPERLY. NEVER SHARE. Slides available upon request from www.projectlazarus.org. Prepared August 2011 10
Project Lazarus: Step 4. Naloxone Rescue Pain Diagnosis Opioid prescription Identify high risk patient Prescribe naloxone Substance Abuse Treatment Prescribe naloxone 1. 2. 3. Watch Video Get naloxone kit Re-watch video Discuss OD plan Clinic Pharmacy Home Slides available upon request from www.projectlazarus.org. Prepared August 2011 11
Project Lazarus: Step 5. Program Evaluation Process Evaluation Evaluate Chronic Pain Initiative Monitor opioid prescribing policy changes in ED Assess availability/use of Buprenorphine and other substance abuse treatment Monitor willingness of family or peers to use naloxone rescue kits in community. Assess frequency of use of overdose plan template by Project Lazarus kit recipients. Outcome Evaluation Changes in unintentional poisoning mortality. Changes in ED or hospital treatment of substance abuse and unintentional poisonings. Changes in prescribing patterns of controlled substances by local MDs. Changes in patterns of where victims of fatal overdoses obtained their prescribed opioids within 6 months of death. Slides available upon request from www.projectlazarus.org. Prepared August 2011 12
Mortality rates per 100,000 population Unintentional and undetermined intent poisonings mortality rates: US, NC, Wilkes 2003-2011* 50 45 40 41.6 46 35 30 25 20 15 10 5 23.9 8.2 8.58.2 6.7 7.1 28.3 26.9 24.5 10.4 10.5 10.8 11.5 11 9.2 9.9 8 27 7 U.S. N.C. Wilkes Co. Linear (U.S.) Linear (N.C.) 0 2003 2004 2005 2006 2007 2008 2009 2010 2011 *2003-2009 rates from SCHS-acquired 9/2010; 2010-2011rates based on provisional OCME data from Wilkes Co. Health Dept. Slides available upon request from www.projectlazarus.org. Prepared August 2011 13
How to contact us Fred Wells Brason II: fbrason@projectlazarus.org Kay Sanford: kay.sanford@gmail.com Nab Dasgupta: nab@unc.edu Su Albert: salbert@wilkescounty.net PROJECT LAZARUS www.projectlazarus.org 336.667.8100 Slides available upon request from www.projectlazarus.org. Prepared August 2011 14