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April 2. 2015

PAW Weekly Update

SAMHSA Prescription Drug Abuse Weekly Update
Issue 116  |  April 2, 2015
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 Professional Education Medical Marijuana National News International News Northeast/Mid-Atlantic News South News Midwest News West News Other Resources Upcoming Webinars Grant Announcements Take-Back Events and Drop Boxes Upcoming Conferences and Workshops


HHS Takes Strong Steps to Address Opioid-Drug Related Overdose, Death and Dependence
United States Department of Health and Human Services
March 26, 2015

HHS to Fund More Naloxone Programs to Halt Opioid Deaths
Donna Leinwand Leger, USA Today
March 26, 2015

A targeted initiative aimed at reducing prescription opioid– and heroin-related dependence, overdose, and death will focus on three priority areas: providing training and educational resources to assist health professionals in making informed prescribing decisions, increasing naloxone use, and expanding the use of Medication-Assisted Treatment. The Department of Health and Human Services (HHS) will put more federal funds and efforts behind programs to distribute naloxone, and expand grant programs for states to purchase the drug.

Read more:

When the Prescription Becomes the Problem
Centers for Disease Control and Prevention
March 26, 2015

The Centers for Disease Control and Prevention (CDC), Operation UNITE, and partnering organizations will launch a social media effort at the National Rx Drug Abuse Summit to contribute to the national conversation on prescription drug abuse and overdose. CDC is asking people to submit six-word stories and photos or videos tagged #RXProblem to challenge assumptions about prescription opioids and patient safety.

Read more:

Journal Articles and Reports

American Society of Addiction Medicine. 2015. The ASAM Performance Measures for Addiction Specialist Physicians.

This report establishes benchmarks for addiction-related care. Drafted by a diverse panel of researchers, academicians, and performance measure experts, it describes nine measures that address key areas of concern in healthcare delivery which, when implemented, will have the potential to improve patient and healthcare outcomes. The measures encompass the American Society of Addiction Medicine's (ASAM's) performance standards for assessment and diagnosis, withdrawal management, treatment planning, treatment management, care transitions and care coordination, and continuing care management. This report is part of a multiyear initiative led by ASAM to help standardize processes for evaluation and addiction management among physicians and raise the quality of addiction treatment.

Read more:

J.S. Krause, J.M.R. Clark, and L.L. Saunders. 2015. "Pain Medication Misuse Among Participants with Spinal Cord Injury." Spinal Cord, doi:10.1038/sc.2015.42.

A medical university in the southeastern United States surveyed 919 adult patients with impairment from traumatic spinal cord injury lasting at least 1 year. Patients had reported at least one painful condition and were taking prescription medication for pain. Logistic regression analysis showed age and education level were protective against pain medication misuse, whereas pain intensity, pain interference with functioning, and pain medication use were risk factors. The number of painful days was not significant in the final model. Pain medication misuse was measured by the Pain Medication Questionnaire, with 25.8 percent of participants at or above the cutoff pain score for medication misuse.

Read more:

M.W. McAllister, P. Aaronson, J. Spillane, M. Schreiber, G. Baroso, D. Kraemer, C. Smotherman, and K. Gray–Eurom. 2015. "Impact of Prescription Drug Monitoring Program on Controlled Substance Prescribing in the Emergency Department." The Journal of Emergency Medicine, doi:10.1016/j.ajem.2015.03.036.

Pharmacists in a hospital emergency department began providing prescribers with prescription drug monitoring program (PDMP) data for their patients. Analyzing 710 patient encounters showed the average number of controlled substances prescribed per patient was—if anything—higher after the change. Prescribers reported that PDMP data increased their comfort level when prescribing controlled substances.

Read more:

A.A. Monte, P. Anderson, J.A. Hoppe, R.M. Weinshilboum, V. Vasiliou, and K.J. Heard. 2015. "Accuracy of Electronic Medical Record Medication Reconciliation in Emergency Department Patients." The Journal of Emergency Medicine, doi:10.1016/j.jemermed.2014.12.052.

Electronic medical record (EMR) medication lists tend to be inaccurate. Comparing EMR lists with medication ingestion histories of 502 patients for the 48 hours preceding emergency department visits showed EMR was accurate in only 21.9 percent of cases. EMR prescription lists usually included medications the subject did not report using (78.9 percent of inaccurate lists), and missed non-prescriptions (76.1 percent), vitamins (73.0 percent), supplements (67.3 percent), and herbals (89.1 percent). Neither age (at or older than 65) nor sex predicted accurate EMR history.

Read more:

M.D. Varga and M. Parrish. 2015. "Illicit Use of Prescription Opiates Among Graduate Students." Journal of Evidence-Informed Social Work, doi:10.1080/15433714.2014.889586.

A survey e-mailed to 5,000 graduate students at a Southeastern university yielded 1,033 responses. Of respondents, 19.7 percent had misused prescription opiates, with 6.6 percent reporting past-year misuse. Most misused to self-medicate. Compared to nonusers, misusers were 75 percent less likely to use marijuana, 79 percent less likely to use cocaine, and 75 percent less likely to use Ecstasy.

Read more:

Professional Education

M.E. Schatman and L.R. Webster. 2015. "The Health Insurance Industry: Perpetuating the Opioid Crisis Through Policies of Cost-Containment and Profitability." Journal of Pain 2015(8):153–58, doi:10.2147/JPR.S83368.

This commentary argues that in the interests of cost containment and profitability, the health insurance industry contributed to America's opioid crisis. For example, private and public insurers designated methadone as a first-line drug for chronic pain, based only upon its extremely low cost. It urges the government to require health insurance carriers (including Medicare and Medicaid) to cover tamper-resistant opioid formulations.

Read more:


Seeking Facts on Medical Marijuana
The New York Times
March 23, 2015

Medical marijuana has been legal in Canada for 16 years. A 2010 pilot study of 23 patients split into four arms found a 9.4 percent daily THC level over 2 months was superior to placebo for its effect on pain. Claudia Dreifus interviewed Dr. Mark Ware, director of the Canadian Consortium for the Investigation of Cannabinoids. "I think the time has come for us as a global community to agree on what we want to know and then go get it," said Ware. "And our patients need to move away from self-experimenting with substances and derivatives we don't know about, and move to a situation where we know what they are using and where we can better help them."

Read more:


VA Officials Say They'll Work to Mend Flaws in Narcotic Prescription Computer Program
Dana Ferguson, StarTribune
March 26, 2015

Department of Veterans Affairs (VA) officials are trying to curb narcotic overprescribing practices at VA hospitals. The agency is launching computer programs aimed at tracking opioid prescriptions across the VA system, but in 29 states, that software does not work with similar state-run programs. This makes it easy for some patients to get prescriptions from both VA and other doctors.

Read more:

Amid Crisis, States Expand Access to Opioid Rescue Drug
Laura Unger, USA Today
March 25, 2015

Thirty states and the District of Columbia have enacted laws or developed pilot programs to widen naloxone access.

Read more:


Two Die on Blood Tribe Reserve from Probable Overdose of 'Extremely Potent' Fentanyl; 16 Dead Since August
Reid Southwick, Postmedia News
March 23, 2015

Fentanyl abuse on the Blood Tribe reserve in southern Alberta has become so dire that local health officials are looking for a facility to house a makeshift detox center. The reserve has seen 16 confirmed fatal fentanyl overdoses since late August. Authorities set up a 24-hour hotline to help users cope with addictions.

Read more:

Pharmaceutical Drug Overdoses Reach Record Levels with Doctors Unable to Monitor Prescriptions
March 22, 2015

The Victorian coroner reported that prescription drug overdoses increased for the 6th year in a row in 2014, reaching record levels. Among 314 overdose deaths, 42 percent were caused solely by prescription drugs. The remainder involved alcohol and drug combinations.

Read more:

Northeast/Mid-Atlantic News

N.J. Assembly Advances Bills on Atlantic City, Prescription Drug Abuse, Medical Marijuana
Dustin Racioppi, The Record
March 26, 2015

The New Jersey Assembly passed a bill that would require pharmacy permit holders to use the state's prescription drug monitoring program and submit information every 7 days. The Assembly also approved measures to revise the state's medical marijuana program. They would add post-traumatic stress disorder to the list of medical conditions qualifying a patient's participation in the program, and allow treatment centers to transfer excess inventory of seeds, seedlings, paraphernalia, plants, and packaged marijuana to other authorized centers. All measures head to the Senate.

Read more:

New Effort to Curb Opioid Abuse Clears Legislative Hurdle
Daniela Altimari, Hartford Courant
March 25, 2015

The Connecticut Public Health Committee approved House Bill 6856, which would require medical practitioners to check a patient's record in the prescription drug monitoring program database before prescribing more than 3 days' worth of narcotic pain medication. The bill allows pharmacists to dispense naloxone and requires physicians, dentists, and other medical providers who dispense narcotic pain relievers to complete a continuing education program on pain management and opioids.

Read more:

Five Md. Students Overdose on Prescription Drugs at High School
Catherine Hawley, WMAR
March 25, 2015

Five students at a western Maryland high school were rushed to the hospital after overdosing on prescription drugs. They became ill from taking Ambien and Adderall provided by a 15-year-old student. Charges are expected to be filed against the teen.

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Wallingford Police Chief: Not Enough Evidence to Equip Officers with Narcan
Eric Vo, Record-Journal
March 26, 2015

The Wallingford, Conn., police chief says there is a lack of information to support equipping officers with Narcan. The town's ambulances carry the drug.

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Delahunt Helps Start Group Aimed at Immigrants Fighting Addiction
Patrick Ronan, The Patriot Ledger
March 23, 2015

Former U.S. Representative William Delahunt is helping to launch a Massachusetts organization that will assist immigrants battling opiate addiction. Asians, Hispanics, and Russians are among the local immigrant populations struggling with prescription opioids and heroin.

Read more:

South News

Fentanyl an Emerging Health and Public Safety Threat in Mississippi
Office of the Attorney General, State of Mississippi
March 26, 2015

Mississippi Attorney General Jim Hood and the Bureau of Narcotics director warned dealers are lacing heroin with fentanyl to make the drug more potent. Such a combination can be deadly for those who regularly use heroin. Atty. Gen. Hood stressed the importance of seeking immediate professional help when individuals suspect a loved one is hooked on a prescription drug.

Read more:

Heroin in Alabama: Fighting Heroin Abuse and Overdose Deaths
Rachel Osier Lindley, WBHM
March 23, 2015

Last year, heroin-related deaths more than doubled in Jefferson County, Ala. WBHM explores the problem in its series "Heroin in Alabama," interviewing schools, law enforcement, courts, and others about their strategies to fight heroin abuse and curb overdose deaths. (Includes audio)

Read more:

Prescription Drug Abuse Among 12th Graders in Chesterfield Higher Than National Average
March 25, 2015

According to the executive director of the SAFE substance abuse coalition, prescription narcotic abuse among 12th graders in Chesterfield, Va., is higher than the national average. Police are asking parents to dispose of medications to help combat this problem. (Includes video: 1:41 minutes)

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Bigger Cities Are at a Higher Risk of Doctor Shopping
Avery Anderson, Big Country
March 24, 2015

In small towns like Anson, Texas, few drug stores see customers "doctor shopping." Pharmacists have good relationships with doctors and know their customers. Bigger towns such as Abilene are at higher risk of attracting doctor shoppers. As a prevention measure, doctors are being issued individually numbered prescription pads for strong narcotics. (Includes video: 2:46 minutes)

Read more:

Midwest News

'Balanced Approach' to Counter State's Heroin Epidemic Approved by Legislature
March 25, 2015

Senate Bill 192 passed the Kentucky Senate and moved to the governor for signing. The bill will immediately infuse Kentucky's addiction treatment system with $10 million, followed by $24 million annually from money saved in prior judicial reforms. It will allow heroin users to exchange dirty needles for clean ones at the state's regional health departments. The bill also lets first responders administer naloxone and includes a Good Samaritan provision that shields heroin addicts from being prosecuted if they report an overdose. It creates a new crime—importing heroin into the state with intent to distribute or sell—punishable by up to 10 years in prison.

Read more:

Indiana Calls in CDC to Help with HIV Outbreak
South Bend Tribune
March 20, 2015

Opana (oxymorphone hydrochloride) is a tablet that some abusers crush and inject. Injectors sharing needles can spread HIV. The Indiana State Department of Health brought in a medical team from the Centers for Disease Control and Prevention to try to contain an HIV outbreak, largely linked to Opana, with 55 confirmed cases and 13 other preliminary positive cases. The team will help staff with follow-up contacts of HIV-positive individuals and data analysis. The health department has created a public awareness campaign, "You Are Not Alone," which provides information on drug abuse, safe sex, needle disposal, and HIV testing and treatment.

Read more:

Local Doctors Pushing to Make Abuse-Deterrent Drugs Indiana Standard
Jessica Schmidt, WFIE
March 25, 2015

Indiana doctors are advocating for more access to abuse-deterrent drugs to prevent prescription abuse. Many insurers refuse to pay for abuse-deterrent formula medications because of their higher price. (Includes video: 1:36 minutes)

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Nashville Seeks Answers for Spike in Overdose Deaths
Tom Wilemon, The Tennessean
March 26, 2015

In Nashville, Tenn., four apparent heroin overdose deaths occurred over a 3-day period. Authorities are investigating whether the heroin had been cut with fentanyl.

Read more:

West News

San Francisco May Be First Major U.S. City with a Drug-Take Back Program
Ed Silverman, The Wall Street Journal
March 25, 2015

San Francisco, Calif., approved an ordinance that would require drug makers to fund and administer a citywide take-back program—the first major city in the United States to do so. The ordinance awaits Mayor Edwin Lee's signature.

Read more:

Prescription Drug Monitoring Bill Passes Oklahoma Committee
The Oklahoman
March 23, 2015

The Senate Committee on Health and Human Services approved prescription drug monitoring program (PDMP) legislation and sent it to the Oklahoma Senate for a vote. The bill requires healthcare providers to consult the PDMP before prescribing or refilling opiates and other narcotics.

Read more:

Barrasso to Hold Drug Hearing on Wind River Indian Reservation
Jackson Hole News and Guide
March 25, 2015

Wyoming Senator John Barrasso will hold a congressional field hearing on the Wind River Indian Reservation to explore how drugs are harming Native American communities.

Read more:

Other Resources

CADCA Launches New, User-Friendly Website
Community Anti-Drug Coalitions of America
March 23, 2015

The Community Anti-Drug Coalitions of America (CADCA) has launched a new website. Features include coalition success stories and tools that make it easy for organizations to partner with CADCA. One part of the site is devoted to resources and allows users to search through a vast library by drug or resource type.

Read more:

Upcoming Webinars

ONDCP Webinar on Synthetic Drugs
Office of National Drug Control Policy (ONDCP)
Date and time: April 8, 2015, 1 to 2 p.m. EST


Grant Announcements

Rx Safes Engages Grant Writer to Support a National Shift in Efforts to Curb Prescription Drug Abuse
March 25, 2015

Rx Safes Inc. announced its grant writer will assist nonprofit organizations in identifying and obtaining funds to purchase units of Rx DrugSAFE. The writer will also help organizations with outcome evaluation plans.

Read more:

RFP: Prescription Monitoring Program
State of South Carolina
Bid date and time: April 9, 2015, 2:30 p.m.

Drug-Free Communities Mentoring Program
Substance Abuse and Mental Health Services Administration
Deadline: April 14, 2015

Translational Avant-Garde Award for Development of Medication to Treat Substance Use Disorders
National Institutes of Health
Deadline: April 15, 2015

Comprehensive Media Campaign for Prescription Drug Abuse
State of Montana
Bid date and time: April 27, 2015, 2 p.m.

This project aims to provide comprehensive media and communication services.

Read more:

Prescription Drug Overdose Prevention for States
Centers for Disease Control and Prevention
Deadline: May 8, 2015

Take-Back Events and Drop Boxes

Prescription Drug Take-Back Scheduled for April 11
TriCities.com (Virginia)
March 24, 2015

Garden Spot Village Drug Take-Back Service: Public May Dispose of Unwanted Medications on Campus April 18
The Berks-Mont News (Pennsylvania)
March 25, 2015

Nearly 1 Million Pounds of Unused Drugs Collected
Star News (North Carolina)
March 25, 2015

Sheriff's Dept. Hosts County's First Medicine Drop Box
Davie County Enterprise Record (North Carolina)
March 19, 2015

NHRMC Holds Medication Disposal Event
WWAY (North Carolina)
March 21, 2015

Prescription Boxes Installed to Curb Drug Abuse
The Daily Tar Heel (North Carolina)
March 24, 2015

Prescription Drug Disposal Box Available in Grand County
Ski-Hi Daily News (Colorado)
March 24, 2015

Drug Disposal Program Keeps Pace with Increasing Prescription Abuse
F.S. Abderholden, Chicago Tribune (Illinois)
March 26, 2015

GLWACH Provides 'Medsafe' Boxes for Used Meds Disposal
John Brooks, Guidon (Missouri)
March 25, 2015

Buena Vista Now Accepting Unwanted Meds
Daniel J. Kov, Vineland Daily Journal (New Jersey)
March 24, 2015

Canal, Winchester Holds Prescription Drug Collection Day
Lancaster Eagle-Gazette (Ohio)
March 25, 2015

Prescription Drug Boxes Installed Around Milwaukee to Curb Drug Use
Bridget Shanahan, WTMJ (Wisconsin)
March 25, 2015

Police in Chippewa County Collect Unused Prescription Drugs Saturday
Kaitlyn Riley, WQOW (Wisconsin)
March 21, 2015

Upcoming Conferences and Workshops

National Rx Drug Abuse Summit
April 6–9, 2015
Atlanta, Georgia

48th Annual Communicating Nursing Research Conference—Equity and Access: Nursing Research, Practice, and Education
Western Institute of Nursing
April 22–25, 2015
Albuquerque, New Mexico

Training: Engaging Youth in Rx Drug Abuse Prevention
Health Resources in Action and Blake Works
May 7–8, 2015
Boston, Massachusetts

Register: http://events.r20.constantcontact.com/register/event?oeidk=a07eai0x62oca5f692b&llr=jcwvq5cab

Pharmacy Diversion Awareness Conferences
Drug Enforcement Administration, Office of Diversion Control
May 30–31, 2015: Norfolk, Virginia
June 27–28, 2015: Oklahoma City, Oklahoma

Fourth Annual Generation Rx University Conference for Collegiate Prevention and Recovery
The Ohio State University College of Pharmacy
August 4–6, 2015
Columbus, Ohio

University of Michigan Injury Center Prescription Drug Overdose Summit
University of Michigan Injury Center
November 9, 2015
Ann Arbor, Michigan
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.