Located in the Blue Ridge Mountains of North
Carolina, Wilkes County is in the heart of a culture that
lives in close-knit community that commonly shares their
traditions and personal belongings, including
self-medication practices and prescription drugs. This,
among other reasons, has opened the door for substance
abuse of opioids such as oxycodone, hydrocodone, fentanyl
In 2007, Wilkes County experienced an average of 28.3
deaths per 100,000 people from unintentional drug
poisoning. In 2009, the county's rates rose to be four
times higher than other North Carolina counties (46.6 vs.
11.0 per 100,000 population). Deaths were mainly due to
overdoses of opioids, pain relief medications that are
used for both medical and recreational purposes.
County Health Department, along with other local
organizations, responded to this problem by starting an
opioid overdose prevention program called Project Lazarus.
Though it began in North Carolina, it has since spread to
24 states as well as other military and tribal groups.
Project Lazarus empowers communities and individuals to
do the following:
Prevent prescription medication overdoses
Present responsible pain management practices
Promote substance abuse treatment and support
General community partners have included law enforcement,
schools, hospitals, faith based organizations, human
service agencies, behavioral and public health
organizations, and substance abuse treatment
Project Lazarus is supported by a number of sponsors and
grant funds and individuals, including:
Training and technical assistance to community
groups, coalitions, and clinicians
Lazarus Recovery Services is a program of Project
Lazarus that provides North Carolina Certified Peer
Specialists to lead recovery support efforts.
In-person trainings and continuing medical education
that offer guidance to providers in the primary care,
emergency, and care management settings; as well as
provides information on community coalition building
Pill Drop medication disposal program and other
community-based diversion control initiatives
Treatment and recovery resources and assistance on
Harm reduction through access to naloxone,
an antidote for opioid and heroin overdose. This naloxone
training video was created by Project Lazarus:
Since Project Lazarus began the program in Wilkes County:
The rate of overdose-related deaths has been reduced
A greater percentage of prescribing physicians have
utilized pain agreements and a prescription monitoring
There has been a 26% reduction in emergency
department visits related to substance use/abuse within
North Carolina counties that have implemented and
embedded the Project Lazarus model
Unintentional overdose deaths in Wilkes County have
decreased by 69% from 2009-2011 and are continuing their
Awards and Recognition:
Project Lazarus has received an endorsement from the
White House Office of National Drug Control Policy as
well as recognition through multiple awards.
In 2015, the Pennsylvania Office of Rural
Health awarded the Project Bald Eagle of Lycoming
County, Pennsylvania the 2015 Rural Health Program of the
Year award. Project Bald Eagle is a replication of
In 2012, the Robert Wood Johnson Foundation Community
Health Leader Award was given to Project Lazarus Founder
Fred Wells Brason II.
Research, publications, and interviews relating to
Strategies for Addressing Opioid Use Disorder in
Rural Areas, Health Payer Intelligence, 2019.
Co-Founder of Project Lazarus Fred Wells Brason II
speaks to the opioid crisis in Appalachia in this
interview (mp3 file) conducted by Carlyle Ellis on
October 25th, 2017 in Moravian Falls, North Carolina.
Lessons learned from a grassroots collaboration focused
on overdose prevention, Practical Playbook Success
Brason II, F., Roe, C., & Dasgupta, N. (2013).
Project Lazarus: an innovative community response to
prescription drug overdose. North Carolina Medical
Journal, 74(3), 259-261.
U.S. Department of Health and Human Services (HHS),
Office of the Assistant Secretary for Health, and the
Office of HIV/AIDS and Infectious Disease Policy (OHAIDP)
by Altarum Institute. (2013). Hepatitis C Virus
Infection in Young Persons Who Inject Drugs.
Albert S, Brason FW II, Sanford CK, Dasgupta N, &
Graham J, Lovette B. (2011) Project Lazarus:
community-based overdose prevention in rural North
Carolina. Pain Medicine.
Albert, S., Brason II, F., Dasgupta, N., & Sanford,
C. (2010). Opioid drug overdoses: a prescription for harm
and potential for prevention. American Journal of
Lifestyle Medicine, 4(1), 32-37.
Social determinants to addiction, including
unemployment rates, poverty, trauma, and depression
Lack of public transportation in rural areas
Patient access to providers and treatment for pain
Depending on location, state-by-state laws may impact
protections and access to naloxone.
Project Lazarus operates through the following
organizational structure designed to be replicated in any
The steering committee is the group
of liaisons that sustains the ongoing work of Project
Stakeholders are the decision makers from key
sectors that assign resources,
personnel, and finances to the project.
The coalition is formed by
stakeholders who designate a variety of people from each
sector to be involved in Project Lazarus.
The community is the aim of the
project's educational and serving efforts.
Project Lazarus outlines
activities through training and technical assistance
that are made to be replicated in other communities.
The Project Lazarus Model, a more specific form of their
health model, has 3 core components (the hub) that
must always be present, and seven methods (the spokes)
which are adapted based on the speciﬁc needs of a
Please contact the models and innovations contact directly for the most complete and current information
about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The
programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural
community should consider whether a particular project or approach is a good match for their community’s
needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep
in mind that changes to the program design may impact results.