Observational studyInjury prevention : journal of the International Society for Child and Adolescent Injury Prevention2018
A statewide evaluation of seven strategies to reduce opioid overdose in North Carolina.
Observational study in Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
25 citing papers in PubMed, 4 syntheses or guidelines pooled it, 40 citations in OpenAlex.
- How do naloxone-based interventions work to reduce overdose deaths: a realist review.Harm reduction journal · 2022Pooled it
- Association between supportive interventions and healthcare utilization and outcomes in patients on long-term prescribed opioid therapy presenting to acute healthcare settings: a systematic review and meta-analysis.BMC emergency medicine · 2021Pooled it
- Evidence for state, community and systems-level prevention strategies to address the opioid crisis.Drug and alcohol dependence · 2019Pooled it
- A Rapid Review of the Impact of Systems-Level Policies and Interventions on Population-Level Outcomes Related to the Opioid Epidemic, United States and Canada, 2014-2018.Public health reports (Washington, D.C. : 1974)Pooled it
- Fentanyl purity and overdose decline: A reexamination of geographic trends.Science advances · 2026Article
- Fentanyl Purity and Overdose Decline: A Reexamination of Geographic Trends.medRxiv : the preprint server for health sciences · 2026Article
- Quality indicators for opioid stewardship interventions in hospital inpatient and emergency departments: a systematic review.Pain reports · 2025Review
- A systematic review of macro-, meso, and micro-level harm reduction interventions addressing the U.S. opioid overdose epidemic.Drugs (Abingdon, England) · 2025Article
- Leveraging Policy Changes Made in Response to COVID-19 to Advance Telehealth and Novel Treatment Approaches for People Who Use Opioids: Qualitative Perspectives From Two Rural North Carolina Counties.North Carolina medical journal · 2023Article
- Article
- Supporting community overdose response planning in Ontario, Canada: Findings from a situational assessment.BMC public health · 2022Article
- Retrospective analysis of patterns of opioid overdose and interventions delivered at a tertiary hospital emergency department: impact of COVID-19.BMC emergency medicine · 2022Article
- Implementation of a New Hampshire community-initiated response to the opioid crisis: A mixed-methods process evaluation of Safe Station.The International journal on drug policy · 2021Article
- Implementing harm reduction in non-urban communities affected by opioids and polysubstance use: A qualitative study exploring challenges and mitigating strategies.The International journal on drug policy · 2021Article
- Community engagement to implement evidence-based practices in the HEALing communities study.Drug and alcohol dependence · 2020Article
- Article
- Touchpoints - Opportunities to predict and prevent opioid overdose: A cohort study.Drug and alcohol dependence · 2019Article
- 'Communities are attempting to tackle the crisis': a scoping review on community plans to prevent and reduce opioid-related harms.BMJ open · 2019Article
- Association between harm reduction strategies and healthcare utilization in patients on long-term prescribed opioid therapy presenting to acute healthcare settings: a protocol for a systematic review and meta-analysis.Systematic reviews · 2019Article
- Army and Navy ECHO Pain Telementoring Improves Clinician Opioid Prescribing for Military Patients: an Observational Cohort Study.Journal of general internal medicine · 2019Observational
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundIn response to increasing opioid overdoses, US prevention efforts have focused on prescriber education and supply, demand and harm reduction strategies. Limited evidence informs which interventions are effective. We evaluated Project Lazarus, a centralised statewide intervention designed to prevent opioid overdose.
methodsObservational intervention study of seven strategies. 74 of 100 North Carolina counties implemented the intervention. Dichotomous variables were constructed for each strategy by county-month. Exposure data were: process logs, surveys, addiction treatment interviews, prescription drug monitoring data. Outcomes were: unintentional and undetermined opioid overdose deaths, overdose-related emergency department (ED) visits. Interrupted time-series Poisson regression was used to estimate rates during preintervention (2009-2012) and intervention periods (2013-2014). Adjusted IRR controlled for prescriptions, county health status and time trends. Time-lagged regression models considered delayed impact (0-6 months).
resultsIn adjusted immediate-impact models, provider education was associated with lower overdose mortality (IRR 0.91; 95% CI 0.81 to 1.02) but little change in overdose-related ED visits. Policies to limit ED opioid dispensing were associated with lower mortality (IRR 0.97; 95% CI 0.87 to 1.07), but higher ED visits (IRR 1.06; 95% CI 1.01 to 1.12). Expansions of medication-assisted treatment (MAT) were associated with increased mortality (IRR 1.22; 95% CI 1.08 to 1.37) but lower ED visits in time-lagged models.
conclusionsProvider education related to pain management and addiction treatment, and ED policies limiting opioid dispensing showed modest immediate reductions in mortality. MAT expansions showed beneficial effects in reducing ED-related overdose visits in time-lagged models, despite an unexpected adverse association with mortality.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.