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About
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The people behind Community Care — and how we are improving health services in our state
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A community-based infrastructure to target patients and populations in need
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Quality
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Center- Informatics Center Overview
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Population Management
Durham Chronic Pain Collaborative
Project of Duke Medical Center and Durham Community Health Network
Go to the site
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.
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 (see graph below), 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.