Bright Spot: Project Nazarus/Naloxone
Photo by Obi Onyeador on Unsplash
This bright spot was originally published in the 100 Million Healthier Lives Change Library and is brought to you through partnership with 100 Million Healthier Lives and the Institute for Healthcare Improvement.
The Project Lazarus public health model is based on the premise that drug overdose deaths are preventable and that all communities are ultimately responsible for their own health. The model components:
- Community activation and coalition building
- Monitoring and epidemiologic surveillance
- Prevention of overdoses through medical education and other means
- Use of rescue medication to reverse overdoses by community members
- Evaluation of project components.
The last four steps operate in a cyclical manner, with community advisory boards playing the central role in developing and designing each aspect of the intervention.
Naloxone (also called Narcan) is the antidote that reverses an opioid overdose. It has been used in ambulances and hospitals for decades to reverse overdose. It's legal and has been approved by the Food and Drug Administration (FDA). It works by neutralizing the opioids in a patient's system and helping them breathe again. Naloxone only works if a person has opioids in their system; the medication doesn't work on other drugs. Subjects can't get high from it and it is safe for nearly everyone. It has been used in programs all over the world to effectively reverse opioid overdoses.
Naloxone is also an important tool for empowering communities to protect their health. Reviving an overdose victim can be a very powerful motivator to help people change their behaviors.
The Centers for Disease Control and Prevention (CDC) reports more than non-medical bystanders!
Costs will vary by community and size of program. Actual cost of Naloxone kits is very low ranging from $5.00 - $12.00 per kit depending on method of administration.
Key Steps for Implementation
These are suggested steps for implementing a naloxone intervention in your community community organization and activation
- Town hall meetings
- Specialized task forces
- Build community-based leadership
- Coalition building
- Managing Chronic Pain toolkit assembled
Prescriber education and behavior
- One-on-one prescriber education on pain management (academic detailing)
- Continuing medical education sessions on pain management
- Licensing actions against criminal prescribing
- Promotion of Controlled Substance Reporting System (CSRS)
Supply reduction and diversion control
- Hospital ED opioid dispensing policy modified (e.g., limits on amount dispensed at once, required check of CSRS for hospital ED admissions)
- Unused medication take-back events by sheriff and police departments, with support from DEA and SBI
- Fixed medicine disposal sites at law-enforcement offices
- Hiring and training of drug diversion specialized law-enforcement officers
Pain patient services and drug safety
- Medicaid policy change: mandatory use of patient-prescriber agreements and pharmacy home
- Support groups for pain patients
- ED case manager for Medicaid beneficiaries with chronic pain
- Vetting of local pain clinics and facilitation of specialized pain clinic referrals
Drug treatment and demand reduction
- Drug detox program
- Negotiation and support for opening of satellite office-based drug treatment clinic (buprenorphine)
- Naloxone prescription
- Drug user education on overdose prevention and response
Reversal of unintentional poisoning due to opioid misuse community-based prevention education
- School-based education, including "Never Share" pledge cards
- Red Ribbon campaign - warnings not to share attached to dispensed prescription packages
- Billboard containing message against sharing medications
- Presentations at colleges, community forums, civic organizations, churches, etc.
- Radio and newspaper spots
Our experience has shown us that the central role of the community advisory boards cannot be emphasized enough. In general the boards are made up of clinicians, parents, health officials, faith community representatives, school and college officials, law enforcement, and others. They dictate the specific mix of overdose prevention interventions for their local area. Our national presence gives us access to resources that coalitions would not be aware of, and our practical experience helps us guide the formation and sustainable development of these groups.
Naloxone is a prescription medication. Visit your doctor to get a prescription. Medicaid, Medicare, and most health insurance covers it. If your doctor isn't familiar with naloxone, then direct them to PrescribeToPrevent.org or print out these few pages that explain how to prescribe it. Project Lazarus provides naloxone for FREE through Brame Huie Pharmacy in North Wilkesboro (Wilkes County, NC).
Outcome measures include overdoes statics, reports of overdose reversals, and the use of substance abuse treatment resources.
Process measures include acceptability, policy changes, and data quality.