Project Lazarus in the Huffington Post

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In a nice article in the Huffington Post, Project Lazarus, located in Wilkes County, NC, was highlighted as an example of how a community can take action to prevent drug overdose deaths. Please check it out at: http://www.huffingtonpost.com/2014/03/05/project-lazarus_n_4889620.html?1394071210

Many people think Project Lazarus provides naloxone kits to reverse overdoses, and this is true, but they do much more than that. Project Lazarus has sponsored educational programs for doctors to learn to be more cautious when prescribing opioids, has sponsored medication take back days where old prescription meds can safely be disposed, and has worked with agencies and organizations across North Carolina and the nation to better inform doctors, law enforcement, and elected officials about what works to prevent drug overdose deaths.

Project Lazarus helped pass a Good Samaritan law North Carolina (see my post of April 20, 2013). Under this new law, a person who calls 911 to save another person’s life – or their own – won’t be prosecuted for minor drug possession, since they were trying to do the right thing and save a life by calling 911.

The Huffington Post article describes how the opioid overdose death rate has been falling in Wilkes County, while the overdose death rate in other parts of the country has been steadily rising. They credit Project Lazarus for this reduction in overdose deaths.

While I’m sure Project Lazarus has played a huge role in reducing overdose deaths not only in Wilkes County and the state of North Carolina, other factors have helped. Being an opioid addiction treatment provider, of course I believe availability of addiction treatment reduced deaths too.

Project Lazarus also supported the opening of an opioid treatment program in 2011, Mountain Health Solutions. Started by Dr. Elizabeth Stanton, this program initially offered only buprenorphine. As it grew, it became obvious some patients needed methadone treatment, so option became available by late 2011. Mountain Health Solutions was eventually purchased by CRC Health in 2012, and has continued to grow. Located in a small town, we have nearly four hundred patients.

I am honored to be the medical director at this program. It’s one on the best programs I’ve seen, and we work hard to keep improving our quality of care. Our program has done outreach -particularly in the medical community- to try to reduce the stigma of medication-assisted treatment. If you read my blog, you know this can be both a joy and a challenge.

Initially, Project Lazarus paid for an intranasal naloxone kit for every patient entering our opioid treatment program. Now since our patient census has risen, Project Lazarus still pays half of the $50 cost of the kits. The opioid treatment program pays the other half, out of a $33 admission charge for new patients. I feel lucky to be able to partner with Project Lazarus, as I’ve seen these kits save lives.

I know of four occasions when a naloxone kit saved a person’s life. Three of these four times, that person saved wasn’t even in treatment for opioid addiction.

Most recently, a parent used a kit to reverse an opioid overdose in a child who accidently ingested the parent’s medication. The parent called 911 and while waiting for EMS to arrive, used one of the two vials in the kit. The child partially woke, and started breathing better. Then EMS arrived and took the child to the hospital. This child survived a potentially fatal overdose and is back to normal with no lasting damage, thanks in part to that naloxone kit and a parent who knew how to use it.

Naloxone kits can be obtained much more cheaply, but contain Narcan vials, a more dilute form of naloxone that is meant to be injected. Those kits, which cost a few dollars, contain a syringe and needle instead of the Project Lazarus kit for nasal administration. Trying to inject naloxone into a vein is technically much more difficult than spraying the more concentrated form of naloxone up into the nose.

And unfortunately, a kit containing a needle and syringe would meet resistance from the public. I can imagine all sorts of angry phone calls to our opioid treatment program: “My son came to you people to get off the needle and you GAVE him a needle and syringe??” Politically, the public would more likely oppose distribution of a naloxone kit with a needle than a kit for intranasal use.

Fifty dollars for an intranasal naloxone kit to save a life is a pittance in the overall picture. Some insurance companies will cover these kits, as will Medicaid, but most of our patients have no insurance. They pay for their buprenorphine/methadone treatment out of their own pocket. Fifty dollars is a big sum for these patients.

I am blessed to work for an opioid treatment program that gets financial help from Project Lazarus for these kits. And I am very blessed to work for a for-profit company, CRC Health, which is willing to bear half the cost of the kits, since this comes out of their profits. Most opioid treatment programs do charge patients an admission fee, but unlike Mountain Health Solutions, don’t put that money towards buying a naloxone kits for their patients.

This is an example of the success that can happen when agencies work together toward a common goal.

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8 responses to this post.

  1. Posted by Sean McKinnon on March 9, 2014 at 9:22 pm

    I think it’s a great idea to give patients naloxone kits. I am going to start advocating for my program to do this too. Maybe I can suggest they contact you at your program for some information? I am a patient of a CSAC clinic in New England.

    Reply

  2. Posted by Carlos on March 16, 2014 at 6:43 pm

    North Carolina has the North Carolina Harm Reduction Coalition that have been very involved with this project. Which this was all over the the United STates. Unless we are alive we can not recover.
    The project have been around for a while. I was at the Triangle in NC during the Southern Harm Reduction Conference back about 4 years ago and they have already been talking about this project.

    I believe New Mexico was the first state involve. They use an inhalant that was place in the nose and acted similarly like the inhalants for Asma

    Reply

  3. Posted by Carlos on March 16, 2014 at 7:05 pm

    I know this can be rather long. But here is a timely articleGeorgia Residents Say
    from NC about Georgia.

    ‘Enough. We Want Naloxone Access and 911 Good Samaritan Laws.’

    In 2011 Georgia resident, Robin Elliott, lost her son, Zack, to a heroin overdose. He was 21 years old.

    “I miss Zack every minute of every day,” says his mother. “He started using heroin at 18 [years old] and started trying to get clean at 19. He spent more time clean and sober in the last two years of his life than he did using, but unfortunately he didn’t succeed in his efforts to beat the drug.”

    Georgia loses over 1000 people a year to accidental drug overdose, everyone from elderly pain patients who mix up prescriptions to young people like Zack who struggle with addiction. In an effort to combat the loss of life, the Georgia general assembly is considering a comprehensive overdose prevention bill next week in the Senate. House bill 965 (HB965), or the Medical Amnesty Bill, protects people seeking medical assistance for a drug overdose from criminal prosecution for possession of personal amounts of drugs or paraphernalia. In addition, HB965 just added a second provision, which was formally known as HB966, or the Naloxone Access Bill. This provision would expand access to a medication that reverses the effects of opiate overdoses. Naloxone has been utilized by paramedics for decades to prevent deaths from overdose and can be used safely and effectively by lay persons as well, such as by the friend or parent of someone who is overdosing. HB965 has already passed the House, just made it out of the Senate Heath Committee and will be moving into Senate Rules Committee and then the Senate floor.

    “Passing these bills can save lives by removing major barriers to medical intervention,” explains Laurie Fugitt, a nurse who has advocated for the bill since 2012. “No one should be forced to choose between saving a friend’s life and avoiding arrest.”

    Advocates have worked tirelessly to convince lawmakers to make the right choice and help save thousands of lives in Georgia. And for most of them, it’s personal. Laurie has seven friends who lost children to opioid overdose because no one called 911 or had naloxone on hand.

    “I started investigating the availability of naloxone to friends and family of at-risk individuals,” she says. “I discovered that in 17 other states, naloxone access laws are drastically reducing deaths from overdose. So I thought, why not Georgia?”

    Georgians can show support for HB965 by contacting their state senators to let them know that you are a registered voter in their district who supports these bills. To find your representative and Senator, visit http://www.georgiaoverdoseprevention.org and click “Contact Your Legislator”. It takes only a minute to fill in your home address and the senator & representative for the district you live in appears with their contact information.

    “If you want to help, call or write to your legislators and let them know that you support the bills,” says Robin. “It would be great if you can personalize the letters based on people you know who are currently using, in recovery or who lost the battle. Also, post to social media and ask others to do the same. Nothing speaks louder than ‘I live in your district and I vote.’”

    Zack had many friends who were opiates users too. No longer using drugs, they are now graduating college, getting married, and having children. To Robin, this highlights the importance of preserving the life of each and every person.

    “My war cry is ‘if they are alive, there is still hope,’ she says. “That’s why these bills are so important. They save lives so people can live long enough to have a chance at long term recovery.”

    NCHRC // PO BOX 13761, Durham, NC, 27709 // 336-543-8050 // http://www.nchrc.org

    Reply

  4. Posted by Carlos on March 16, 2014 at 7:22 pm

    And here is one that most of us may not want to talk about. Part of the reason I have problems with the 12 Step facilitation treatment (if you can call lit treatment, they make a lot of claims for which they have no evidence). My problem is that they know the relapse rate is high. And if they would have let me know that the hepatitis virus was much more resiliences than the AIDs virus. Today I might not have it. there is a lot of stuff they should talk about that hey do not.

    I always thought that treatment was all about health. Not about what treatment staff believes and biases. They kept saying is MY TREATMENT. But I did not see any of me around.

    The facility is theirs, the food is theirs, is their treatment “hypothesis” and modalities. They write treatment plans without asking me what I want, they write “treatment notes” and I do not know what is in them. They even have this things call STAFFING or CASE Conferences from which the patient is band. In fact not many patients know when they happen (if they know that they happen at all), hell we do not know what they say about the patient, At these staffing they make life changing decisions and the patient have not input. They are luck if they get any news about them. Because some times the staff start acting toward the patient without knowing what is going on.

    Then they have the gall to tell me that it is MY TREATMENT. I don’t know what planet they live in.

    Efforts to Crack Down on Prescription Drug Abuse Drive Users to Heroin?

    http://www.thefix.com/content/do-efforts-crack-down-prescription-drug-abuse-drive-users-heroin

    Reply

  5. Posted by Carlos on March 16, 2014 at 7:24 pm

    Here is more about reviving over dose persons. They say that the police is about protecting us. Not if you are a junky.

    Police Carry Special Drug to Reverse Heroin Overdoses

    http://www.usatoday.com/story/news/nation/2014/01/30/police-use-narcan-to-reverse-heroin-overdoses/5063587/

    Reply

  6. Posted by Robert Childs on March 25, 2014 at 12:40 pm

    Please note that community based injectable naloxone is injected into the muscle, not the vein. This is extremely easy to do.

    We also know from NCHRC training the majority of NC opioid treatment programs across the state that they are very supportive of syringe based naloxone kits. The opioid treatment program’s community and local law enforcement in large part support this as well, because it saves their families and friends lives in a cost effective, sustainable manner.

    Reply

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