![]() ![]() 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). Between 19, opioid mortality increased 486% to over 11 per 100,000 (Injury and Epidemiology Surveillance Unit, Injury and Violence Prevention Branch, Division of Public Health, North Carolina Department of Health and Human Services, 2015). 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.ĭeaths from opioid overdose began increasing in North Carolina (NC) in the late 1990s (Web-based Injury Statistics Query and Reporting System (WISQARS), 2005). These results are consistent with previous findings of limited impact of PL strategies on overdose morbidity and mortality. Implementation of PL strategies did not appreciably reduce opioid dispensing and did not increase buprenorphine utilization. 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). None of the other PL strategies were associated with reduced prescribing of opioid analgesics. In adjusted models, diversion control efforts were positively associated with increased dispensing of opioid analgesics (IRR: 1.06 95% CI: 1.03, 1.09). Incidence Rate Ratios were estimated with adjusted GEE Poisson regression models of all seven PL strategies. Outcomes were PDMP-derived counts of opioid prescriptions and buprenorphine patients. Exposure data sources comprised process surveys, training records, Prescription Drug Monitoring Program (PDMP) data, and methadone treatment program quality data. 74 of 100 counties implemented the intervention. The intervention period was March 2013–December 2014. Observational interrupted time series analysis of 100 counties over 2009–2014 ( n = 7200 county-months) in North Carolina. Buprenorphine is often used in connection with medication assisted treatment (MAT) for opioid dependence. We examined the association between PL implementation and 1) overall dispensing rate of opioid analgesics, and 2) utilization of buprenorphine. 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. ![]() PL was originally developed in Wilkes County, NC. 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. Project Lazarus (PL) is a seven-strategy, community-coalition-based intervention designed to reduce opioid overdose and dependence. ![]()
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