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April 2, 2014


SAMHSA Prescription Drug Abuse Weekly Update
Issue 65  |  April 2, 2014
The Prevention of Prescription Drug Abuse in the Workplace (PAW) TA Center addresses prescription drug abuse—a growing public health problem with increasing burdens on workers, workplaces, and our economy. To subscribe colleagues, family members, or friends to this listserv sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), please click here or send their e-mail addresses to paw@dsgonline.com.
Table of Content Featured Article Journal Articles and Reports News Other State and Local News Other Resources Video Webinar Grant Announcements Take-Back Events and Drop Boxes Save the Dates Upcoming Conferences and Workshops


Public Approval for Driving Limits for 16 Drugs
United Kingdom, Department for Transport
March 27, 2014

The United Kingdom's driving restriction for eight prescription and eight illicit drugs will be effective in fall 2014. Regulated limits are clonazepam (50 µg/L), diazepam (550 µg/L), flunitrazepam (300 µg/L), lorazepam (100 µg/L), methadone (500 µg/L), morphine (80 µg/L), oxazepam (300 µg/L), and temazepam (1000 µg/L). The government is reconsidering proposed amphetamine limits to avoid restricting patients who are taking prescribed attention deficit hyperactivity disorder medication.

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Journal Articles and Reports

E.E. Bonar, R.M. Cunningham, S.T. Chermack, F.C. Blow, K.L. Barry, B.M. Booth, and M.A. Walton. 2014. "Prescription Drug Misuse and Sexual Risk Behaviors Among Adolescents and Emerging Adults." Journal of Studies on Alcohol and Drugs 75:2.

Editor's note: This study replicates the well-known finding that multi-problem youth practice risky sex. In a hospital emergency department, 2,127 sexually active 14- to 20-year-olds (61 percent female) reported on past-year substance use and sexual risk behaviors. Respondents were categorized as no prescription drug misuse (n = 1,705), misuse of one class of prescription drugs (n = 251), misuse of two classes (n = 90), or misuse of three classes (n = 81). Logistic regression controlled for demographics (age, sex, race), alcohol use pattern, and cannabis use. Misuse of one, two, or three classes of prescription drugs was significantly associated with increased odds of inconsistent condom use and substance use before sex; misuse of two or three classes was associated with increased odds of reporting multiple partners.

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M. Gabay. 2014. "Federal Controlled Substances Act: Dispensing Requirements, Electronic Prescriptions, and Fraudulent Prescriptions." Hospital Pharmacy 49(3):244–46, doi:10.1310/hpj4903-244.

This article discusses key components of the Federal Controlled Substances Act, dispensing requirements, electronic controlled substance prescriptions, and fraudulent controlled substance prescriptions. Pharmacists should be aware of criteria that may help them identify controlled substance prescriptions issued for illegitimate medical purposes and criteria for identifying forged prescriptions. Pharmacists can use simple prevention techniques that may significantly reduce controlled substance prescription fraud. These include knowing prescribers and their signatures, being familiar with a prescriber's Drug Enforcement Administration registration number, knowing patients who come to the pharmacy, and checking the date on the controlled substance prescription to ensure it was presented for filling in a reasonable time frame. A pharmacist with doubts about the validity of a controlled substance prescription should contact the prescriber for verification.

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S.L. Huskinson, J.E. Naylor, J.K. Rowlett, and K.B. Freeman. 2014. "Predicting Abuse Potential of Stimulants and Other Dopaminergic Drugs: Overview and Recommendations." Neuropharmacology, doi:10.1016/j.neuropharm.2014.03.009.

Researchers reviewed studies on several central nervous system stimulants, focusing on those with primarily dopaminergic actions, in drug self-administration, drug discrimination, and physical dependence. For drug self-administration and drug discrimination, they distinguished between experiments conducted with rats and nonhuman primates to highlight the common and unique attributes of each model in assessing abuse potential. A review of drug self-administration studies suggests this procedure—although important in predicting abuse potential of dopaminergic compounds—yields many false positives. Researchers suggested that tests to determine how reinforcing a drug is relative to a known drug of abuse may be more predictive of abuse potential than tests yielding a binary, yes-or-no classification. Several false positives also occurred with drug discrimination. For discrimination, the authors recommended following a standard decision-tree approach that defines the drug being tested for abuse potential as the training stimulus. This approach would also allow several known drugs of abuse to be tested for substitution, which could reduce false positives. Finally, the authors reviewed evidence of physical dependence with stimulants and discussed the feasibility of modeling these phenomena in nonhuman animals in a rational and practical fashion.

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S.D. Passik. 2014. "Tamper-Resistant Opioid Formulations in the Treatment of Acute Pain." Advances in Therapy 31(3):264–75, doi:10.1007/s12325-014-0099-7.

This article catalogued efforts to balance opioid abuse risks with availability. PubMed literature searches using terms such as "prescription opioid abuse," "abuse-deterrent opioids," and "tamper-resistant opioids" and bibliographies of relevant articles were used to identify relevant sources. Efforts identified included improving assessment of patient risk for drug misuse, abuse, or diversion; funding and encouragement of referral to addiction treatment programs; access to and widespread use of prescription monitoring programs; public knowledge of prescription opioid abuse; proper storage of opioid medications; and development of new formulations designed to resist tampering and deter abuse.

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P.D. Pilkinton and J.C. Pilkinton. 2014. "Prescribing in Prison: Minimizing Psychotropic Drug Diversion in Correctional Practice." Journal of Correctional Health Care 20(2):95–104, doi:10.1177/1078345813518629.

This article provides an introduction to prescription drug use, abuse, and diversion in the correctional setting, including systems issues in prescribing, commonly abused prescription medications, motivation for and detection of prescription drug abuse, and the use of laboratory monitoring.

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Opiate Epidemic Leads Massachusetts Gov. Deval Patrick to Declare Public Health Emergency
The Republican (Massachusetts)
March 27, 2014

The governor of Massachusetts has declared a public health emergency and outlined steps to address opioid addiction, including an immediate ban on Zohydro and the commitment of $20 million to increase drug treatment and recovery services. The ban will last until authorities determine measures are in place to "safeguard against the potential for diversion, overdose, and misuse." Other directives include granting permission for first responders to carry and administer naloxone and a Department of Public Health mandate for physicians and pharmacies to use prescription monitoring to guard against abuse or misuse of prescriptions.

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Prescription Drug Overdose Comp Dispute Goes to Calif. High Court
Business Insurance
March 21, 2014

The California Supreme Court agreed to hear arguments in South Coast Framing Inc. v. Workers' Compensation Appeals Board. In December, the California 4th District Court of Appeal ruled that the death of Brandon Clark, a South Coast employee, was noncompensable. Mr. Clark suffered back, head, neck, and chest injuries when he fell off a roof. His workers' compensation doctor prescribed an antidepressant, as well as Vicodin and Neurontin. Mr. Clark also was prescribed Xanax and Ambien by his personal physician in January 2009 for anxiety and sleep problems. He died the following July from the combined effects of the antidepressant, Neurontin, Xanax, Ambien, and associated early pneumonia. Mr. Clark's wife and children filed for workers' compensation death benefits, contending that his death was a result of his work injury and related medications. A California workers' compensation judge awarded benefits, finding that Mr. Clark's medications contributed to his death. South Coast appealed the decision, arguing that Mr. Clark's workers' compensation prescriptions did not "materially contribute" to his death, based on the testimony of a doctor who said he could not precisely determine how much Mr. Clark's industrial prescriptions were responsible for his overdose. A three-judge panel of the California appeals court unanimously overturned the decision of the workers' compensation judge in December, finding that medical testimony in Mr. Clark's case did not adequately establish the death was caused by his comp prescriptions.

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Drifting Off ... Swimming Australia Bans Sleeping Pills
March 22, 2014

Swimming Australia has banned the use of sleeping pills, including Stilnox. Searches of bags and rooms are authorized, and swimmers caught using the pills will face fines and lengthy suspensions. The ban mirrors the Australian Olympic Committee's initial stance prior to the 2012 London Olympics. Stilnox is not banned under the Australian Sports Anti-Doping Authority or World Anti-Doping Agency code.

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Trouble Falling Asleep? Prescription Sleeping Pills Are Popular, Tempting—and Risky
The Washington Post
March 24, 2014

In a study published last year, the Centers for Disease Control and Prevention reported that about 8 million adults turn to prescription sleeping pills for help each month. Gregg Jacobs, an insomnia specialist at the University of Massachusetts Medical School's Sleep Disorders Center, warns these medications all have flaws. Ambien, Lunesta, and Sonata, also known as Z-drugs, can have short-term side effects such as hangovers, amnesia, abnormal behavior, and abuse and addiction. Long-term effects include dependence, tolerance, and risk of early death. Jacobs says Z-drugs may also cause daytime confusion, memory problems, and falls among elderly people. The American Geriatric Society recently discouraged use of Z-drugs for more than 90 days.

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Darren Sharper Case Spotlights Sleep Drug's Dark Side
USA Today
March 26, 2014

This article discusses a criminal case against Darren Sharper, a former National Football League (NFL) player who used Ambien to rape women. In January 2012, Sharper filed a workers' compensation claim that described health problems he suffered over 14 NFL seasons. After his doctor prescribed Ambien, Sharper used the drug frequently, taking 70 pills in 65 days through mid-January of 2014. Investigators say he also slipped the drug into women's drinks, rendering them unconscious so he could rape them. On January 17, Sharper had 20 Ambien pills in his possession when Los Angeles police arrested him on suspicion of two rapes. Sharper has been indicted for two other rapes in Arizona and is the subject of investigations in Louisiana, Nevada, and Florida. He has pleaded not guilty in Los Angeles and will remain jailed, pending a hearing on April 15.

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Under Fire, Zohydro Maker Touts Drug Safety Board
The Washington Post
March 26, 2014

This article discusses the launch of an oversight board for Zohydro that will try to prevent the drug's abuse. Zogenix's president and director told the Associated Press that the outside group of seven medical, addiction, and law enforcement specialists will be able to spot early signs of misuse, using data from sources that include prescribing statistics, addiction center reports, and law enforcement records. Critics say Zohydro will add to the epidemic of opioid drug abuse and question whether the panel will be truly independent from the company. Five of seven experts on the board have previously received consulting payments from the company, at least two physicians on the panel have served as consultants and paid speakers for other drug companies, and all panel members will be compensated for quarterly meetings to review Zohydro data. The company claims it is educating doctors and compensating sales representatives based on educational goals rather than drug sales targets. Experts say such multipronged safety plans have not curbed the rising number of fatal overdoses, and evidence is lacking that the "safe-use board" will ensure Zohydro is used appropriately.

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Heroin Is Spreading in America's Suburbs: Here's Why
Alaska Dispatch
March 23, 2014

This article rehashes the links between prescription pain relievers and heroin use.

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Prescription Drug Abuse a Workplace Concern
Canadian Occupational Safety Magazine
March 26, 2014

At Safety Services Nova Scotia's 32nd Annual Workplace Safety Conference, Nadine Wentzell reported that prescription drug abuse is a significant problem in the Canadian workforce. Wentzell said Canadian organizations are seeing the effects of opioid abuse in the form of turnover, absenteeism, lost productivity, and more accidents. People with an addiction will do everything they can to mask it in the workplace, but there are signs: uneasiness, yawning, runny nose, tears, nausea, and vomiting. Employers should develop a culture in which employees with substance abuse problems are encouraged to self-report without facing repercussions.

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Addicts Seek Prescription Heroin to Keep Them off Illegal Street Drugs
The Province
March 26, 2014

Five drug addicts asked a Vancouver judge to issue an injunction against the federal government that would allow them access to prescription heroin until the court hears their case. Their lawyer, Joseph Arvay, told a judge the group was part of a clinical trial that provided them with pharmaceutical-grade heroin until last year. When they left the study, they applied for and were granted special access permits from Health Canada to receive the prescription drug, diacetylmorphine. Arvay argued that the federal government is infringing on provincial jurisdiction over health care by removing the treatment option of prescribed heroin. Federal Health Minister Rona Ambrose responded by announcing immediate changes to prevent Health Canada from approving prescription heroin under the program. In court documents, federal government lawyers argued the special access program was not meant to operate as an alternative to clinical trials or comprehensive drug reviews, but for short-term access and emergency needs.

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Other State and Local News

Bill Adds Prescriptions to Oklahoma Trafficking Law
Tulsa World (Oklahoma)
March 26, 2014

The Senate Appropriations Committee approved a bill that defines morphine, oxycodone, hydrocodone, and benzodiazepine possession above quantity thresholds as trafficking offenses. A conviction would result in a minimum sentence of 10 years for a first offense and up to life without parole for a third offense.

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State: Pain Meds Contributing to Workers' Comp Costs
Alaska Journal of Commerce
March 27, 2014

Alaska officials and legislators are concerned with overprescription of opiates and other controlled substances for pain management in the workers' compensation program. House Bill 370 would put a 30-day limit on long-term opioid prescriptions and allow employers to require drug testing of workers' compensation claimants prescribed opioids for more than 90 days.

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Study Buddies: Adderall at the UA
The Arizona Daily Wildcat
March 24, 2014

This article discusses Adderall abuse among college students at the University of Arizona (UA). The reporter talks to a student who has an Adderall prescription and sells his pills on campus. In the 2013 Health and Wellness Survey conducted by Campus Health, 6.6 percent of UA students admitted to using Adderall or similar attention deficit hyperactivity disorder (ADHD) medications without a prescription in the past 30 days; 13 percent said they had used it in the past year. Campus Health only dispenses ADHD medications when students have a valid prescription.

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Vaporizing Marijuana and 'Skittling' Are Latest Drug Trends for Harford Teens
The Baltimore Sun (Maryland)
March 25, 2014

The county's Office of Drug Control Policy said vaporizing marijuana in e-cigarettes and "skittling" are some of the latest drug trends among teenagers in Harford County, Maryland. Teens are taking tobacco out of electronic cigarettes and replacing it with marijuana, making it difficult for parents to detect the odor. Teens are also hosting pharming parties where they mix a bunch of different pills into a bowl (called skittling or trail mix) and consume them in random handfuls.

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Anne Arundel Co. Police Will Begin Carrying 'Narcan' to Treat Heroin Overdoses
CBS Baltimore (Maryland)
March 24, 2014

Anne Arundel County police will carry Narcan by the end of April. They made the change in response to heroin overdose statistics (85 in 2014, 12 of them fatal).

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Abuse of Prescription Pills Among Greek and Non-Greek Georgia College Students:
Presentation for the 17th Annual Student Research Conference

Scott York
April 4, 2014

Using data collected with an anonymous Victimization Survey, this study will assess whether fraternity/sorority membership affects the rate of illicit prescription drug abuse among Georgia College students.

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Lancaster Coroner: Prescription Drug Abuse an 'Epidemic,' Caused 46 Deaths Here in 2013
Lancaster News (Pennsylvania)
March 23, 2014

Dr. Stephen Diamantoni, the Lancaster County coroner and family doctor, says 46 people died last year from prescription drug-related overdoses—three times more than heroin-caused fatalities.

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Senate Passes Hannon Legislation to Increase Access to Naloxone
Long Island Exchange (New York)
March 27, 2014

New York has passed Senate Bill 6477-B, which will increase access to naloxone. The bill will allow authorized healthcare professionals to issue non-patient specific orders to certified training programs and pharmacies, which can distribute naloxone kits and instructions.

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RI Overdose Deaths Rise to 69 for 2014; Illicit Drugs and Fentanyl Key Factors
Providence Journal (Rhode Island)
March 21, 2014

The Office of the State Medical Examiner reported that unintentional overdose deaths in 2014 rose to 69. Forty-one of the 65 victims tested were positive for fentanyl, but only two had valid prescriptions, and many involved nonpharmaceutical fentanyl mixed with heroin. In each of the previous 3 years, about half of overdose deaths were blamed solely on prescription drugs. So far in 2014, only 14 percent of confirmed cases were solely prescription drugs.

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Three Lives Saved on Staten Island with Overdose Reversing Drug, Health Commissioner Says
Staten Island Advance (New York)
March 27, 2014

Staten Island police have saved three lives using naloxone. Two overdosed and were treated at their homes. The third was treated at a gas station.

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Other Resources

Drug Overdose in the United States: Fact Sheet
Centers for Disease Control and Prevention
February 10, 2014

This fact sheet provides an overview of illicit and pharmaceutical drug overdoses. It includes a discussion of the problem, the most common drugs involved in an overdose, the costs, and risk factors.

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Drug Abuse in America: The Lethal New Pill Hitting the Street
The Dr. Oz Show
March 26, 2014

Dr. Sanjay Gupta and Dr. Oz weigh in on Zohydro, the newest opioid-based prescription drug feared to be a gateway to heroin. They discuss the drug's potential dangers. (Duration: 5:56 minutes)



Girls and Substance Use: Trends, Challenges, and Opportunities
Tuesday, April 22, 2014
3 p.m. to 4:30 p.m.

Grant Announcements

2014 Prescription Drug Abuse and Misuse Prevention Grant Program
Cardinal Health Foundation
Deadline: April 25, 2014

The Cardinal Health Foundation is inviting nonprofit organizations in 18 U.S. locations and Puerto Rico to apply for grants supporting local efforts to prevent prescription medication abuse and misuse. This program intends to increase awareness of and willingness to openly discuss prescription drug abuse and its consequences, expand knowledge of proper prescription medication disposal, and improve understanding of reducing unlawful access to prescription drugs.

Read more:

FY 14 Harold Rogers Prescription Drug Monitoring Program
Bureau of Justice Assistance—Department of Justice
Deadline: May 6, 2014

Take-Back Events and Drop Boxes

Chatham Borough Police Hold Prescription Drug Take Back
Chatham Patch (New Jersey)
March 25, 2014

Take Back the Drugs: Prescription Drugs Turn-In at PC School of Pharmacy
The Clinton Chronicle (South Carolina)
March 23, 2014

D.A. Unveils New Medication Drop Boxes in Adams County
The Evening Sun (Pennsylvania)
March 26, 2014

UCA Now Has Permanent Place to Drop Off Expired Drugs
Fox 16 (Arkansas)
March 23, 2014

Kanawha County Offers Additional Prescription Drug Drop-Off Option
MetroNews (West Virginia)
March 25, 2014

Madison County Safe Pill Drop Off Helps Dispose of Medications
Oneida Daily Dispatch (New York)
March 22, 2014

Latest Medicine Drop Collects Almost 200,000 Drug Doses
The Pilot (North Carolina)
March 25, 2014

280 Pounds of Medications
The Shawnee News-Star (Oklahoma)
March 26, 2014

Smyrna PD to Take Back Unwanted Prescription Drugs
Smyrna-Vinings Patch (Georgia)
March 26, 2014

Save the Dates

National Take-Back Initiative
Drug Enforcement Administration
April 26, 2014

Sixth Annual American Medicine Chest Challenge
National Day of Awareness and Safe Disposal of Rx and OTC Medicine

American Medicine Chest Challenge
November 8, 2014

Upcoming Conferences and Workshops

Pharmacy Diversion Awareness Conference
U.S. Department of Justice, Drug Enforcement Administration
April 5 and 6, 2014: St. Louis, Missouri, Hilton St. Louis at the Ballpark
June 28 and 29, 2014: Phoenix, Arizona, Renaissance Phoenix Downtown
July 12 and 13, 2014: Philadelphia, Pennsylvania, Sheraton Philadelphia Downtown Hotel
August 2 and 3, 2014: Denver, Colorado, Denver Marriott Tech Center

Eleventh Annual World Health Care Congress
April 7–9, 2014
National Harbor, Maryland

National Rx Drug Abuse Summit
April 22–24, 2014
Atlanta, Georgia

RX for Prevention: Preventing and Responding to Prescription Drug Abuse on Campus
Temple University, Villanova University, U.S. Attorneys' Office, and the Clery Center
June 11, 2014
Philadelphia, Pennsylvania

27th Annual NPN Prevention Research Conference
National Prevention Network
September 15–18, 2014

2014 Harold Rogers PDMP National Meeting
Brandeis University, Prescription Drug Monitoring Program Training and Technical Assistance Center
September 22–24, 2014
Washington, District of Columbia
The Weekly Update is a service provided by the SAMHSA Preventing Prescription Abuse in the Workplace Technical Assistance Center (PAW) to keep the field abreast of recent news and journal articles to assist in forming policy, research, and programs to reduce prescription drug misuse or abuse. Please note, the materials listed are not reflective of SAMHSA's or PAW's viewpoint or opinion and are not assessed for validity, reliability or quality. The Weekly Update should not be considered an endorsement of the findings. Readers are cautioned not to act on the results of single studies, but rather to seek bodies of evidence. Copyright considerations prevent PAW from providing full text of journal articles listed in the Weekly Update.