Evaluation of a community-based initiative to prevent opioid overdose

描述（由申请人提供）：由于处方阿片类镇痛药的医疗和非医疗使用，意外中毒导致的死亡率正在迅速上升。Lazarus项目是为了应对北卡罗来纳州滥用阿片类镇痛药的流行而创建的，是一项新的基于社区的药物过量预防计划，旨在减少阿片类镇痛药的供应，需求，转移和风险，同时促进慢性疼痛的最佳治疗。一项初步疗效研究表明，在减少阿片类药物误用和滥用导致的死亡方面具有显著效果，而不会对阿片类镇痛剂处方产生不利影响。现在被称为拉撒路项目/慢性疼痛倡议（PL/CPI），拉撒路项目正在与北卡罗来纳州的医疗补助管理局合作，将这一倡议扩大到该州的所有县。干预的目标是降低与阿片类镇痛药相关的风险，同时保持适当的获得这些药物以控制慢性疼痛。我们建议进行一项为期两年的有效性研究，以测试这种全州范围内的社区为基础的倡议：1。增加供应商的注册率和与国家处方监测计划的协商， 受控物质报告系统（CSRS）; 2.通过增加接受阿片类药物依赖医疗辅助治疗（MAT）的人数，改善药物滥用治疗的可及性; 3.使用独特的基于全州人口的艾德监测系统，降低因阿片类药物过量而导致的每月县级药物相关急诊（艾德）就诊率;以及4.与县级年度年龄调整的阿片类药物相关意外中毒死亡率下降有关。 只要NC的医疗补助计划和几个基金会已经为PL/CPI的实施提供了充分的支持，这项自然准实验研究将实现实质性的效率，从而将我们向CDC要求的资源限制在进行评估所需的资源上。构成PL/CPI的高度创新的基于社区的阿片类药物中毒预防战略值得评估，如果发现有效，则应在全国范围内复制，以应对全国处方药过量的爆炸性流行。 公共卫生相关性：在过去的10年里，美国因滥用和误用阿片类镇痛药而死亡的人数几乎翻了一番，2004年至2009年期间，美国与麻醉性镇痛药有关的艾德就诊率上升了155%。目前每天约有9000例处方阿片类药物滥用病例，截至2009年，其对社会的总成本估计为560亿美元，其中250亿美元由医疗保健系统承担。这项拟议的研究将评估在全国范围内首次实施基于社区和提供者的阿片类药物过量预防计划。

DESCRIPTION (provided by applicant): Rates of mortality attributable to unintentional poisoning are rising rapidly as a consequence of both the medical and non-medical use of prescribed opioid analgesics. Project Lazarus, which was created to respond to North Carolina's epidemic of abuse of opioid analgesics, is a novel community-based drug overdose prevention program designed to reduce the supply of, demand for, diversion of and risks associated with opioid analgesics, while promoting the optimal treatment of chronic pain. A preliminary efficacy study has demonstrated dramatic effects on decreases in deaths attributable to opioid misuse and abuse without adversely affecting prescriptions for opioid analgesics. Now called the Project Lazarus/Chronic Pain Initiative (PL/CPI), Project Lazarus is collaborating with NC's Medicaid Authority to expand this initiative to all counties in the State. The goal of the intervention is to reduce the risks associated with opioid analgesics while maintaining appropriate access to these medications for control of chronic pain. We propose a two year effectiveness study to test whether this statewide community- based initiative: 1. increases providers' rates of registry and consultation with the State's prescription monitoring program, the Controlled Substances Reporting System (CSRS); 2. improves access to substance abuse treatment by increasing the number of individuals who receive medically-assisted treatment (MAT) for opioid dependence; 3. decreases monthly county-level drug-related emergency department (ED) visit rates attributable to opioid overdoses, using a unique statewide population-based ED surveillance system; and 4. is associated with a reduction in annual county-level age-adjusted opioid-related unintentional poisoning mortality rates. Substantial efficiencies in this natural quasi-experimental study will be achieved insofar as full support for the implementation of the PL/CPI is already available from NC's Medicaid Program and several foundations, thus limiting the resources we are requesting of the CDC to those that are required to conduct the evaluation itself. The highly innovative community-based opioid poisoning prevention strategies that constitute the PL/CPI are deserving of an evaluation and, if found to be effective, of replication across the country to respond to the nation' exploding epidemic of prescription drug overdose. PUBLIC HEALTH RELEVANCE: Deaths due to the abuse and misuse of opioid analgesics have nearly doubled in the U.S. in the last past 10 years, and the U.S. rates of ED visits related to narcotic analgesics rose by 155% between 2004 and 2009. There are now about 9000 daily cases of prescription opioid abuse, and their total costs to society as of 2009 were estimated at $56 billion, of which $25 billion were borne by the health care system. The proposed study would evaluate the first statewide implementation of a community and provider based opioid overdose prevention initiative in the nation.