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April 21, 2016

PAW Weekly Update

    

                                          
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SAMHSA
           
SAMHSA Prescription Drug Abuse Weekly Update
         
         
WEEKLY
           
UPDATE
         
                             
          Issue 170  |  April 21, 2016          
   
                                                               
                                                                                                                                                                       
                                                                                                                   
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.        
            
                                                                                                                                                                     
Index                            
Featured                            
Journal Articles and Reports                            
Professional Opinion and Policy                            
Professional Development                            
National                            
Marijuana                            
International                            
Northeast/Mid-Atlantic News                            
South News                            
Midwest News                            
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Upcoming Conferences and Workshops                                                         
                       

  Featured

J.L. McCauley, J.M. Hyer, V.R. Ramakrishnan. R. Leite, C.L. Melvin, R.B. Fillingim, C. Frick, and K.T. Brady. 2016. “Dental Opioid Prescribing and Multiple Opioid Prescriptions Among Dental Patients: Administrative Data from the South Carolina Prescription Drug Monitoring Program.” Journal of the American Dental Association, doi:10.1016/j.adaj.2016.02.017.                        

A review of South Carolina prescription drug monitoring program data on all patients prescribed at least one opioid by a dentist during 2012–13 included 653,650 opioid prescriptions. Virtually all were initial dental prescriptions for immediate-release opioids. Hydrocodone (76.1 percent) and oxycodone (12.2 percent) combination products were most frequently dispensed. People under age 21 received 11.2 percent of the opioids. Of the patients, 31 percent had a history of multiple concurrent opioid prescriptions within 180 days, including 25 percent within 90 days and 17 percent within 30 days.                        

Read more:                        
http://www.sciencedirect.com/science/article/pii/S000281771630201X                                                 

Pennsylvania OKs Medical Marijuana                        
Pittsburgh’s Action News 4                        
April 13, 2016                        

Pennsylvania’s governor has signed legislation making the state the 24th to legalize medical marijuana. The law sets standards for tracking plants, certifying physicians and licensing growers, dispensaries and physicians. Patients could take marijuana in pill, oil, vapor or liquid form but would not be able to legally obtain marijuana to smoke or to grow their own. The law’s list of 17 qualifying conditions includes cancer, epilepsy, autism, Parkinson’s disease, posttraumatic stress disorder, sickle cell anemia, multiple sclerosis, AIDS, and glaucoma.                        

Read More:                        
http://www.wtae.com/news/final-votes-may-be-close-on-medical-marijuana-bill/38972378                      
               
               

Journal Articles and Reports

D. Ciccarone, G.J. Unick, J. Cohen, S.G. Mars, and D. Rosenblum. 2016. “Nationwide Increase in Hospitalizations for Heroin-Related Soft Tissue Infections: Associations with Structural Market Conditions” Drug & Alcohol Dependence, doi:http://dx.doi.org/10.1016/j.drugalcdep.2016.04.009.                

U.S. hospital admissions rates for heroin-injection-related skin and soft tissue infections rose from 4 per 100,000 in 1993 to 9 per 100,000 in 2010, according to Healthcare Cost and Utilization Project nationwide inpatient sample data. Regressions that added heroin price and purity data from the U.S. Drug Enforcement Administration found that each $100 increase in yearly heroin price per gram-pure was associated with a 3 percent decrease in the rate of admissions. Western cities, where Mexican-sourced “black tar” heroin predominates, had twice the infection rate of eastern cities where Colombian-sourced powder heroin predominates. The author suggest clinical and harm reduction efforts should promote vein health strategies, especially for black-tar heroin users.                

Read more:                
http://www.drugandalcoholdependence.com/article/S0376-8716(16)30036-9/abstract                                 

S.J. Cousins, S.R. Radfar, D. Crèvecoeur-MacPhail, A. Ang, K. Darfler, and R.A. Rawson. 2016. “Predictors of Continued Use of Extended-Released Naltrexone (XR-NTX) for Opioid-Dependence: An Analysis of Heroin and Non-Heroin Opioid Users in Los Angeles County.” Journal of Substance Abuse Treatment, doi:10.1016/j.jsat.2015.12.004.                

This sub-analysis of data on community provider use of extended-release (28-day) naltrexone to treat opioid addiction combined data from 60 patients followed for 30–60 days after their last dose and 111 patients from an earlier phase that did not track beyond the last dose. Those addicted to prescription opioids had virtually the same dropout pattern as those addicted to heroin, with roughly 40 percent dropping out after only one dose, another 20 percent after taking two, another 20 percent after taking three. At 30-day follow-up, urge-to-use scores were also similar.                

Read more:                
http://www.sciencedirect.com/science/article/pii/S0740547215003141                                  

M.J. Fleury, M. Perreault, G. Grenier, A. Imboua, S. Brochu. 2016. “Implementing Key Strategies for Successful Network Integration in the Quebec Substance-Use Disorders Programme.” International Journal of Integrated Care, doi:10.5334/ijic.2457.                

Focus groups and interviews with 105 stakeholders representing two regions and four local substance use disorder networks in Quebec, Canada, revealed that six types of service integration strategies have been implemented in use disorder networks: 1) coordination/ governance, 2) primary-care consolidation, 3) information and monitoring management, 4) service coordination, 5) clinical evaluation, and 6) training. Important investments have been made in Quebec for training on assessing individuals with substance use disorders, particularly in terms of support for emergency room liaison teams and introduction of standardized clinical evaluation tools. However, development of integration strategies was insufficient to ensure implementation of successful networks.                 

Read more:                
http://www.ijic.org/articles/10.5334/ijic.2457                                 

K.M. Hoffman, S. Trawalter, J.R. Axta, and M.N. Oliver. 2016. Racial Bias in Pain Assessment and Treatment Recommendations, and False Beliefs About Biological Differences Between Blacks and Whites.” Proceedings of the National Academy of Sciences, doi:10.1073/pnas.1516047113.                

A University of Virginia survey of 222 white medical students and residents who were native English speakers born in the United States asked participants to read two mock medical cases (a kidney stone and an ankle fracture and make pain ratings (scale: 0 = no pain to 10 = worst possible pain) and medication recommendations (dummy coded for accuracy: 1 = accurate, 0 = inaccurate) for each. Each student’s cases randomly assigned one patient as white and the other as black, as well as randomizing the order of the two cases. Neither mean pain ratings nor medication recommendation accuracy varied significantly or sizably race. The students also rated the accuracy of 15 statements about biological differences between blacks and whites, 11 of them false. Students who answered those questions inaccurately had a higher probability of answering the pain questions inaccurately, underestimating pain levels of blacks and under-prescribing in accordance with that underestimate. [Editor’s note: Some media coverage has exaggerated the findings of this study, mischaracterizing the nature of the incorrect responses about biological differences.]                

Read more:                
http://www.pnas.org/content/early/2016/03/30/1516047113.abstract                 
http://www.medscape.com/viewarticle/861435                                 

D. Madah-Amiri, T. Clausen, and P. Lobmaier. 2016. “Utilizing a Train-the-Trainer Model for Multi-Site Naloxone Distribution Programs.” Drug & Alcohol Dependence, doi:http://dx.doi.org/10.1016/j.drugalcdep.2016.04.007.                

In Norway, during 41 workshops, 511 staff at medical facilities were shown how to train recipients of naloxone kits. Surveys of 54 workshop participants found knowledge scores improved significantly, attitude scores improved, and most staff found the training useful and intended to distribute naloxone to their clients.                

Read more:                
http://www.drugandalcoholdependence.com/article/S0376-8716(16)30034-5/abstract                                  

R.K. McHugh, R.D. Weiss, M. Cornelius, M.O. Martel, R.N. Jamison, and R.R. Edwards. 2016. “Distress Intolerance and Prescription Opioid Misuse Among Patients with Chronic Pain.” Journal of Pain, doi:10.1016/j.jpain.2016.03.004.                

Among a convenience sample of 51 chronic back or neck pain patients prescribed long-term opioid analgesics, 60 percent misused their opioids. Distress intolerance—the perceived or actual inability to manage negative emotional and somatic states—was associated with a slightly elevated risk of opioid misuse (odds ratio = 1.1). This association remained after controlling for pain severity and negative affect. Distress intolerance can be modified with treatment.                

Read more:                
http://www.jpain.org/article/S1526-5900(16)30001-3/abstract                                 

J. Mennis and D.J. Stahler. 2016. “Racial and Ethnic Disparities in Outpatient Substance Use Disorder Treatment Episode Completion for Different Substances. Journal of Substance Abuse Treatment, doi:10.1016/j.jsat.2015.12.007.                

Racial disparities in outpatient treatment episode completion vary by substance, according to an urban sample of 416,224 outpatient treatment discharges from the 2011 U.S. Treatment Episode Dataset-Discharge (TEDS-D) data set. African-American patients are less likely to complete episode treatment than Caucasian patients for all substances; the largest disparities are for alcohol and methamphetamines. Caucasian patients are more likely to complete treatment than Hispanic patients for heroin and marijuana. This could highlight the need for culturally appropriate treatment programs.                 

Read more:                
http://www.sciencedirect.com/science/article/pii/S0740547215003177                                  

H.J. Mosher, K.K. Richardson, and B.C. Lund. 2016. “The 1-Year Treatment Course of New Opioid Recipients in Veterans Health Administration.” Pain Medicine, doi:10.1093/pm/pnw058.                

Veterans Health Administration pharmacy users who received a new prescription for an opioid preceded by a year with no opioid prescribed totaled 373,900 in 2004 and 525,500 in 2011. Among those users, 20.4 percent started long-term opioid therapy in 2004 as did 18.3 percent in 2011. Hydrocodone and tramadol increased as a proportion of initial opioids prescribed. Median days initially supplied decreased from 30 to 20 days. The percentage of new opioid prescriptions that were for 7 days or fewer rose from 20.9 percent to 27.9 percent. The proportion of new recipients who started long-term opioid therapy varied widely by medical center in 2004, but the proportions tended to equalize over time.                 

Read more:                
http://painmedicine.oxfordjournals.org/content/early/2016/04/05/pm.pnw058                                 

Z. Samaan, L. Naji, B. Dennis, M. Bawor, C. Plater, G. Pare, A. Worster, M. Varenbut, J. Daiter, D. Marsh, L. Thabane, and D. Desai. 2016. “A Prospective Study to Investigate Predictors of Relapse Among Patients with Opioid Use Disorder Treated with Methadone.” Substance Abuse: Research and Treatment, doi:10.4137/SART.S37030.                

Among 233 methadone-maintenance treatment patients in southern Ontario, Canada, who had been on maintenance for at least 3 months and an average of 52 months, participants remained abstinent for an average of 99 days during 6 months of follow-up (including urine testing). Multivariate analysis showed relapse risk was higher for patients with a history of injecting drug use behavior (hazard ratio [HR] = 2.26), illicit benzodiazepine consumption (HR = 1.07), older age at onset of opioid abuse (HR = 1.10). Relapse risk declined with patient age (HR = 0.93).                

Read more:                
http://www.la-press.com/a-prospective-study-to-investigate-predictors-of-relapse-among-patient-article-a5525                  
               

Professional Opinion and Policy

T.C. Green and M. Doe-Simkins. 2016. “Opioid Overdose and Naloxone: The Antidote to an Epidemic?” Drug & Alcohol Dependence, doi:http://dx.doi.org/10.1016/j.drugalcdep.2016.03.024.                

Naloxone is effective at reversing an opioid overdose when administered by professionals and laypeople. The biases and barriers to allowing laypeople to administer naloxone are decreasing as policies locally and federally are changing. The authors point out that guidelines differ about delivering naloxone before or after resuscitative measures, with little research informing the decision. Also needed is research about how well the drug works when fentanyl and other drugs are mixed with opioids, as well as treatment protocols for extended-release formulations that can remain in the body well beyond naloxone’s relatively short half-life.                 

Read more:                
http://www.drugandalcoholdependence.com/article/S0376-8716(16)30011-4/abstract                 

Professional Development

M.E. Hale, D. Moe, M. Bond, M. Gasior, and R. Malamut. 2016. “Abuse-Deterrent Formulations of Prescription Opioid Analgesics in the Management of Chronic Noncancer Pain.” Pain Management, doi:10.2217/pmt-2015-0005.                

Read more:                
http://www.futuremedicine.com/doi/full/10.2217/pmt-2015-0005                                 

L. Manchikanti, A.M. Kaye, and A.D. Kaye. 2016. “Current State of Opioid Therapy and Abuse.” Current Pain and Headache Reports.                

Read more:                
http://link.springer.com/article/10.1007/s11916-016-0564-x                
               

National

State Attorneys General Call for Federal Action to Aid in Battle Against Opiate, Heroin Abuse                
Sara J. Ketchum, Daily Press                
April 15, 2016                

Thirty-three state attorneys general are calling on the federal government to close a loophole that keeps methadone clinics from reporting their dispensing data to state prescription drug monitoring programs. Closing the loophole would allow prescribers to avoid dispensing opioids to people also receiving treatment for opioid addiction.                

Read More:                
http://www.dailypress.com/health/dp-nws-herring-methodone-prescription-monitoring-20160414-story.html                                 

House Republicans Playing Politics with Pain Relievers—Say Some Senate Republicans                
Karoun Demirjian, Washington Post                
April 13, 2016                

House Majority Leader Kevin McCarthy (R-Calif.) has said that the House would not consider a Senate bill to combat heroin and opioid abuse. The Senate bill overwhelmingly survived a test vote last month. Some Senate Republicans fear the House leadership may be stalling to let members take a turn in the spotlight on a widely popular issue. And, they fear the House’s decision to start from scratch instead of picking up the Senate bill may upset a near-perfect opportunity to get something done. Only a few months remain to pass meaningful legislation before Congress effectively disbands for the election season.                

Read More:                
https://www.washingtonpost.com/news/powerpost/wp/2016/04/13/some-fear-house-playing-politics-with-painkiller-bills                                 

How Obamacare Is Fueling America’s Opioid Epidemic                
Sean Gregory, Time                
April 13, 2016                

To reward quality care, the Centers for Medicare and Medicaid Services (CMS) annually allocates $1.5 billion in Medicare payments to hospitals based on criteria that include patient ¬satisfaction surveys. Among the questions: “During this hospital stay, how often did the hospital staff do everything they could to help you with your pain?” And: “How often was your pain well controlled?” The advocacy group Physicians for Responsible Opioid Prescribing wrote CMS, asking them to stop using these surveys questions. They believe the questions unintentionally encourage the over-prescription of opioids. They also wrote the Joint Commission, urging changes in their accreditation standards around pain management. Others are concerned that new prescribing guidelines and emergency department protocols, which can deny opioids to individuals displaying drug seeking behavior, will lower CMS survey scores and hurt hospitals financially. In October, the Department of Health and Human Services announced it would review how the survey influences pain treatment and opioid prescribing.                

Read More:                
http://time.com/4292290/how-obamacare-is-fueling-americas-opioid-epidemic                                                  

                                                                                   
Related: Health Officials Call for Less Aggressive Treatment of Pain                    
Jeanne Whalen, Wall Street Journal                    
April 13, 2016                    
http://www.wsj.com/articles/health-officials-call-for-less-aggressive-treatment-of-pain-1460576556                    
                                
The Fed’s New ‘War on Drugs’: Obama Proposes $1.1 Billion to Expand Care for Opioid Addicts                
Melinda Carstensen, Fox News Health                
April 14, 2016                

This article reviews selected studies and legislative proposals about opioid overdose, then reports on an interview with Melinda Campopiano, M.D., medical officer at SAMHSA who prescribes opioids and treats patients who have become addicted to them. Dr. Campopiano said when she was in medical school in the 1990s, professors taught students using the sickest patients. That approach may have skewed the risk–benefit factor for stronger drugs like opioids versus over-the-counter pain medications. An assumption at the time that pain was undertreated in America overall led many doctors to readily prescribe opioids. Campopiano added overprescribing of opioids also emerged from a well-intentioned effort to standardize care in response to evidence that pain in minorities was being undertreated—a bias that data suggest still affects minority and less wealthy patients today. That systematic approach persisted through the 1990s and 2000s and was accompanied by a push from the federal government for doctors to better address their patients’ pain. Big Pharma’s campaign in those decades downplayed the risks of long-term opioid misuse and encouraged use.                 

Read More:                
http://www.foxnews.com/health/2016/04/14/feds-new-war-on-drugs-obama-proposes-1-1-billion-to-expand-care-for-opioid-addicts.html                                 

New Federal Bill to Allow Partial-Fill of Opioid Rx                
Practical Pain Management                
April 13, 2016                

Legislation, the Reducing Unused Medications Act, recently introduced in Congress would allow pharmacists to partially fill prescriptions for opioids at the request of patients or doctors. The legislation is intended to reduce leftover opioids stored in homes.                                 

Read More:                
http://www.practicalpainmanagement.com/resources/news-and-research/new-federal-bill-allow-partial-fill-opioid-rx                

FDA to Review Remoxy New Drug Application for Pain Management                
Lea Eslava-Kim, MPR                
April 13, 2016                

The FDA has accepted for review a new drug application for Remoxy, an extended-release form of oxycodone that uses Oradur abuse-deterrent technology.                                 

Read More:                
http://www.empr.com/drugs-in-the-pipeline/fda-to-review-remoxy-nda-for-pain-management/article/489587                                 

The Stunning Spread of the Opioid and Heroin Epidemic, in One Map                
German Lopez, Vox                
April 9, 2016                

Socrata, a provider of data software solutions, has published maps that contextualize how far and wide the opioid epidemic has spread, showing the rate of drug overdose deaths by county in 2004 and 2014. As the maps show, it is not just that overdose deaths increased as a result of the opioid crisis; these deaths spread to all parts of the country.                

Read More:                
http://www.vox.com/2016/4/9/11392856/opioid-heroin-epidemic-map                                 

Older Adults’ Health Often at Risk from Too Many Medications, Including Opioids                
Celia Vimont, Partnership for Drug-Free Kids                
April 13, 2016                

An estimated 10,000 people per day turn 65 in the United States. The growing population of older adults who are taking many medications prescribed by different doctors, combined with the growing opioid epidemic, is contributing to the increasing problem of drug misuse among the elderly. Harry Haroutunian, M.D., suggests how children and caregivers of older adults can recognize drug misuse, how they can differentiate it from signs of normal aging, and what they can do about it.                

Read More:                
http://www.drugfree.org/join-together/older-adults-health-often-risk-many-medications-including-opioids/?utm_source=Stay+Informed+-+latest+tips%2C+resources+and+news&utm
_campaign=72de240f1b-JT_Daily_News_Older_Adults_Health_Often_4_13_2016
&utm_medium=email&utm_term=0_34168a2307-72de240f1b-224293653
                                                 

Can a Smart Pill Dispenser Curb Prescription Drug Overdoses?                
John Bonazzo, Observer                
April 8, 2016                

MedicaSafe has patented a smart tamper-resistant pill dispenser that requires patients to enter a passcode to access medication. When a doctor prescribes a medication under the MedicaSafe system, it is packaged in a dispenser with a unique ID. Patients must enter a code to get pills, and over each 24-hour period, the MedicaSafe will provide only the daily dose of medication set out in the prescription. The device locks if the patient tries to take extra pills.                

Read more:                
http://observer.com/2016/04/can-a-smart-pill-dispenser-curb-prescription-drug-overdoses                                 

Of Pills and Planes: Flight Grounded After Students Found with Drugs                
Ken Chang, The Review                
April 12, 2016                

A chartered airplane full of Delaware college students bound for the Bahamas on spring break was diverted to Orlando, Fla., after students were caught snorting Adderall in the airplane bathroom. FBI agents detained for questioning those passengers allegedly involved, according to a witness.                

Read More:                
http://udreview.com/of-pills-and-planes-flight-grounded-after-students-found-snorting-adderall-on-board/                
                 

Marijuana

California Town to Appeal Medical Marijuana Debate to State’s Supreme Court                  
Liset Marquez, Inland Valley Daily Bulletin                  
April 13, 2016                  

An appeals court in California has sided with the California Cannabis Coalition, finding that the city of Upland, Calif., is obligated to hold a special election that could allow three medical marijuana dispensaries because the necessary signatures were gathered to get the initiative on the ballot. City officials will appeal the decision to the state supreme court. They also made the rare request of asking the supreme court to unpublish the appeals court’s opinion due to its possible consequences.                  

Read More:                  
http://www.dailybulletin.com/government-and-politics/20160413/upland-to-appeal-medical-marijuana-debate-to-the-supreme-court                                     

Native American Church Can’t Use Pot, Judges Say                  
Cathy Bussewitz, Associated Press                  
April 6, 2016                  

A federal court has ruled that a church for Native Americans in Hawaii should not be excused from federal marijuana laws despite the group’s claim that ingesting cannabis is part of their sacred sacrament. The court said the church did not present enough evidence about the details of its religion. While the federal government will allow the church to use the hallucinogenic drug peyote in religious ceremonies, marijuana will remain illegal.                   

Read more:                  
http://www.usnews.com/news/us/articles/2016-04-06/court-native-american-church-not-excused-from-cannabis-laws                                     

Ex-NFL Players Rally Behind Medical Marijuana                  
Abby Haglag, Daily Beast                  
April 14, 2016                  

Thirty former NFL players have teamed up with a cannabis company in California to test medical marijuana as a treatment for chronic pain and depression. The move comes in the wake of increasing reports on the physical and mental anguish retired football players face, including the potentially debilitating brain disease chronic traumatic encephalopathy. A 2007 study published by the American College of Sports Medicine found half of retired professional football players struggle with chronic pain. A 2013 study found that 40 percent suffer from some level of depression.                  

Read More:                  
http://www.thedailybeast.com/articles/2016/04/14/ex-nfl-players-rally-behind-medical-marijuana.html                                     

Menstrual Cramps Considered for Medical Marijuana Treatment in New Jersey                  
Associated Press                  
April 8, 2016                  

Lawmakers in New Jersey are considering legislation that would loosen the state’s strict medical marijuana law to allow women to get marijuana-based products to ease menstrual cramps. Other states have not formally extended their laws to include menstrual cramps as an eligible ailment.                  

Read more:                  
http://www.courierpostonline.com/story/news/2016/04/08/menstrual-cramps-medical-marijuana-treatment/82798570                                     

Pharmacists Should Be on Front Lines of Medical Marijuana, say Canadian Pharmacists                  
David Salazar, Drug Store News                  
April 8, 2016                  

The Canadian Pharmacists Association is calling for pharmacists to be on the front lines of patient management and dispensing of medical marijuana. Its director, Phil Emberley, said the medication expertise brought forward by pharmacists should play a critical role in the management and monitoring of marijuana, just for other medications. This position marks a reversal for the organization, which had opposed involving pharmacists due to the unproven efficacy of medical marijuana and increased risk for pharmacy thefts.                  

Read more:                  
http://www.drugstorenews.com/article/cpha-pharmacists-should-be-front-lines-medical-marijuana                                     

Three Military Veterans Explain What Weed Does for Their Posttraumatic Stress                  
Tobias Coughlin-Bogue                  
April 13, 2016                  

In Santa Cruz, Calif., an organization distributes free marijuana to veterans. Many claim it is useful in treating the symptoms of posttraumatic stress disorder.                  

Read More:                  
http://www.thestranger.com/weed/2016/04/13/23950860/three-military-veterans-explain-what-weed-does-for-their-ptsd                                     

Bill Would Broaden Medical Marijuana Access, Expand Production                  
Kevin Litten, NOLA.com                  
April 8, 2016                  

A Louisiana state representative has introduced a bill that would significantly expand the scope of medical marijuana in Louisiana and speed efforts to begin growing and dispensing the drug.                  

Read more:                  
http://www.nola.com/politics/index.ssf/2016/04/medical_marijuana_expansion_le.html                                     

What’s Allowed in Ohio’s Medical Marijuana Plan?                  
Jessie Balmert, Cincinnati.com                  
April 13, 2016                  

A group of Ohio lawmakers have announced a plan to provide patients with medical marijuana by 2018. The proposal would allow Ohioans age 18 and older to buy edible marijuana, patches, plant material, and oils with their doctor’s recommendation. A commission would create rules regarding marijuana production within a year after the law passed.                  

Read More:                  
http://www.cincinnati.com/story/news/politics/2016/04/13/lawmakers-plan-tackle-medical-marijuana/82938422                                     

Colorado Schools Slow to Allow Medical Marijuana, Lawmakers Want a Change                  
Bente Birkeland, KUNC                  
April 13, 2016                  

Colorado schools may soon be forced to allow students to use medical marijuana in a non-smokeable form while on school grounds. It is already allowed under state law, but no districts have created access policies, leaving many families frustrated. A bill under consideration would require all school districts to allow parents or caregivers to administer medical marijuana on school grounds.                  

Read More:                  
http://www.kunc.org/post/colorado-schools-have-been-slow-allow-medical-marijuana-lawmakers-want-change#stream/0                                     

Medical Marijuana Creates Different Challenges for Employers                  
Brad Allis, Tucson Local Media                  
April 13, 2016                  

Arizona legalized medical marijuana a few years ago, but employers are still adjusting to how the law affects their workplace policies. Marijuana, even for medical use, is still illegal under federal law. There are more than 77,000 qualified patients with medical marijuana cards in the state. The average age of cardholders is 44 for men and 48 for women. The top reason for use is severe and chronic pain.                  

Read more:                  
http://www.tucsonlocalmedia.com/news/article_a28cd6e2-00d4-11e6-bf4a-23fb24c76279.html                                                        

Massachusetts Politicians Form Bipartisan Anti-Marijuana Legalization Coalition                  
CBS Boston                  
April 14, 2016                  

Massachusetts’s governor, Boston’s mayor, state legislators, and healthcare professionals have formed a coalition to oppose a ballot question that would legalize marijuana in the commonwealth. The coalition warns of the harm legalization would cause to young people, citing a 20 percent rise in teen marijuana use in Colorado after the drug was legalized.                  

Read More:                  
http://boston.cbslocal.com/2016/04/14/anti-marijuana-legalization-committee-massachusetts-charlie-baker-marty-walsh-robert-deleo                                                        

What to Do if Your Employee Asks to Use Medicinal Marijuana at Work                  
Howard Levitt, Financial Post                  
April 13, 2016                  

Although employers are not permitted to ask invasive health questions when an employee requests permission to use medical marijuana in the workplace, employers have several options if they are interested in keeping a drug-free workplace. The author suggests five actions to consider: accommodation, investigation, disclosure, request for information from a physician, and protection of the company’s reputation.                  

Read More:                  
http://business.financialpost.com/executive/careers/what-to-do-if-your-employee-asks-to-use-medicinal-marijuana-at-work                                     

Medical Marijuana Advocates Fight New York Roadblocks                  
Jon Campbell, Democrat and Chronicle                  
April 12, 2016                  

Advocates for medical marijuana recently traveled to New York’s capital to push lawmakers to loosen the state’s new law concerning medical use. New York's medical marijuana program only allows physicians—no other healthcare professional with prescribing privileges—to prescribe non-smokeable marijuana and for a limited list of conditions.                  

Read more:                  
http://www.democratandchronicle.com/story/news/politics/blogs/vote-up/2016/04/12/medical-marijuana-advocates-fight-ny-roadblocks/82954278/                 
               

International

Canada: Abuse Deterrent Opioids Too Expensive                
Pat Anson, Pain News Network                
April 12, 2016                

While the FDA is promoting the development of more opioid pain medication with abuse-deterrent formulas, Canadian health officials are saying the drugs are too expensive and will have little to no effect in the fight against opioid abuse and addiction. Health Canada last week rejected a proposed regulation that would require all medications containing oxycodone to have tamper-resistant properties. According to the Healthcare Bluebook, a Web site that estimates the market price of medications, the fair price for a 60-day supply of OxyContin 20mg in southern California is $352. A 60-day generic version of oxycodone—without abuse deterrence—retails for $138.                

Read more:                
http://www.painnewsnetwork.org/stories/2016/4/12/canada-abuse-deterrent-opioids-too-expensive                                 

Healthcare System Flaws Hindering Ontario’s (Canada) Response to Fentanyl Crisis                
Karen Howlett and Andrea Woo, Globe and Mail                
April 10, 2016                

A surge in overdose deaths in Ontario, Canada, linked to illicit fentanyl is exposing gaps at every level of the healthcare system, leaving frontline workers who are responsible for monitoring drug use ill-equipped to respond to the crisis. Fentanyl was developed as a prescription pain reliever but gained popularity as a street drug after OxyContin was removed from the market in Canada in 2012. Fentanyl is up to 100 times more toxic than morphine—the equivalent of two grains of salt can kill a healthy adult.                

Read more:                
http://www.theglobeandmail.com/news/investigations/health-care-system-flaws-indering-ontarios-response-to-fentanyl-crisis/article29582102                                 

Doctor Flagged Six Years Before Drug Charges                
The Chronicle Herald                
April 13, 2016                

A Canadian doctor charged with trafficking opioids was flagged four times between 2010 and 2016 for questionable prescribing practices, according to search warrants filed in the case. She was charged in late February with trafficking 50,000 opioids.                

Read more:                
http://thechronicleherald.ca/novascotia/1356720-doctor-flagged-six-years-before-drug-charges                
               

Northeast/Mid-Atlantic News

Pennsylvania Governor: Make Life-Saving Medication Available at Schools                
Marc Levy, The Daily Item                
April 12, 2016                

Pennsylvania’s governor recently announced his state has started the application process for 642 public high schools to obtain a free two-dose carton of the heroin antidote naloxone. Pennsylvania is the first state to implement what may serve as a model program. In partnership with Pennsylvania-based pharmaceutical company Adapt Pharma, the program will increase statewide access to naloxone.                

Read more:                
http://www.dailyitem.com/news/wolf-make-life-saving-medication-available-at-schools/article_4543c88e-00d3-11e6-9473-bb2a8619a969.html                                  

Medical Offices in Princeton Abusing Drug Drop Box, New Jersey Police Say                
Keith Brown, NJ.com                
April 13, 2016                

The prescription drug drop box at Princeton police headquarters has been a success—a bit too successful, in fact. The bin, which is the size of a U.S. Postal Service collection box, has been filled to the brim on occasion. So, the Princeton police checked the video surveillance and realized local medical offices were dumping their expired prescription drugs. These medical facilities are being advised to cease and desist with this practice immediately.                

Read more:                
http://www.nj.com/mercer/index.ssf/2016/04/princeton_police_to_doctors_offices_stop_it_stop_i.html                                  

Opioid Prescription Debate: Grappling with Pain and the Law in New Hampshire                
Mark Hayward, New Hampshire Union Leader                
April 9, 2016                

The New Hampshire Board of Medicine has preliminarily approved rules for physicians when prescribing opioids. The final proposal still must be reviewed and approved by the Joint Legislative Committee on Administrative Rules then formally adopted by the Board of Medicine.                 

Read more:                
http://www.unionleader.com/Opioid-prescription-debate:-Grappling-with-pain-and-the-law                                 

Maryland Officials Discuss Opioid Epidemic                
Mike Davis, MyEasternShoreMD                
April 13, 2016                

Medical and behavioral health practitioners and law enforcement officials met at Anne Arundel Medical Center in Annapolis, Md., on April 8 to discuss the growing issue of opioid addiction throughout Maryland and how to best serve those in need.                 

Read more:                
http://www.myeasternshoremd.com/news/queen_annes_county/article_e6cec8af-3f5e-5473-904d-86fa28d58ad5.html                 
               

 South News

Guidelines for Virginia Hospital Emergency Departments Take Aim at Opioid Abuse                
Amy Trent, News & Advance                
April 12, 2016                

Emergency departments across Virginia have received guidelines on how they can help curb the state’s growing opioid abuse epidemic. The 14-point guidelines, which encourage doctors to avoid prescribing opioids and give patients no more than a 3-day supply in extreme cases, were endorsed by the Virginia Hospital & Health Care Association along with the Virginia College of Emergency Physicians. The guidelines aim to address the more than 900 overdose deaths in Virginia in 2013, the majority—more than 500—related to prescription opioids.                

Read more:                
http://www.newsadvance.com/news/local/rules-take-aim-at-opioid-abuse-state-hospital-association-releases/article_56e1a9b8-3e5f-52d2-9b2f-597732fe9838.html                                  

Fighting Prescription Drug Abuse Gets a Little Easier for Florida Providers, Pharmacists                
Martin Dix and Sheryl D. Rosen, JDSupra Business Advisor                
April DD, 2016                

Beginning July 1, 2016, designees working on behalf of Florida pharmacists and prescribers will be authorized to check the prescription drug monitoring program database and submit reports.                 

Read more:                
http://www.newsadvance.com/news/local/rules-take-aim-at-opioid-abuse-state-hospital-association-releases/article_56e1a9b8-3e5f-52d2-9b2f-597732fe9838.htmlhttp://www.jdsupra.com/legalnews/fighting-prescription-drug-abuse-gets-a-74929/                                 

Commentary: Texas Needs an Open Prescription for Life-Saving Naloxone                
Mark Kinzly and Charles Thibodeaux, Austin American-Statesman                
April 8, 2016                

Texas’s legislature las year passed a bill that allows greater access to naloxone, but the Texas Health and Human Services Commission and the Texas Medical Association have not implemented the law by getting an open prescription in place. This opinion piece calls for the organizations to act.                 

Read more:                
http://www.mystatesman.com/news/news/opinion/commentary-texas-needs-an-open-prescription-for-li/nq2SC                                 

West Virginia Doctor Investigated for Deaths in Opioid Epidemic                
Jim Axelrod and Ashley Velie, CBS News                
April 13, 2016                

A West Virginia physician has written more than 40,000 prescriptions for oxycodone in the last 2 years. Nearly 100 percent of his patients get prescriptions for oxycodone. In the last 2 years, three of the doctor’s patients died after overdosing on a cocktail of pills—including oxycodone—prescribed by him along with pills prescribed by other physicians.                

Read more:                
http://www.cbsnews.com/news/west-virginia-doctor-michael-kostenko-investigated-for-deaths-in-opioid-painkiller-epidemic                                 

North Carolina Campaign Warns of Danger in Medicine Cabinet                
Beth De Bona, The Times-News                
April 9, 2016                

HopeRx, a community-based prescription drug abuse initiative funded by a SAMHSA grant, is working to spread awareness of the dangers of medication getting into the hands of teens with the “Lock Your Meds” campaign. One in six teens in North Carolina reported that they have taken a prescription medication not prescribed to them. The SAMHSA grant also funded the recent “We Are Hope” campaign that spread awareness to local middle and high school students about substance abuse and misuse.                

Read more:                
http://www.blueridgenow.com/article/20160409/news/160409842                
               

Midwest News

Ohio Governor Seeks Tighter Controls on Prescription Drugs                
Alan Johnson, Columbus Dispatch                
April 13, 2016                

Ohio will limit prescriptions of narcotic pain pills to 90 days, improving access to medication-assisted drug treatment, and tightening pharmacy licensing requirements. Its governor is proposing mandatory licensing for facilities treating at least 30 patients with buprenorphine, as well as making naloxone available to homeless shelters, halfway houses, and schools. Also proposed were required registration of 42,000 pharmacy technicians; invalidating an opiate prescription unused after 30 days; enacting oversight by the pharmacy board for sole private practitioners who dispense pain relievers; and waiving the requirement that clinics that provide methadone be certified in Ohio for at least 2 years before doing business.                

Read more:                
http://www.dispatch.com/content/stories/local/2016/04/12/kasich-seeks-tighter-controls-on-prescription-drugs.html                                  

Michigan Representative: Coming Together to Combat the Heroin Epidemic                
Rep. Tim Walberg, LenConnect.com                
April 8, 2016                

According to Rep. Tim Walberg (R-Mich.), the Office of National Drug Control Policy has added Michigan to its list of high-intensity drug trafficking areas, which will bring additional resources to the state.                

Read more:                
http://www.lenconnect.com/article/20160408/OPINION/160409119                                 

Wisconsin Legislators Combat Addiction Epidemic                
royalpurplenews.com                
April 12, 2016                

In 2015, 255 people died from drug overdoses in Wisconsin, a 53-percent increase from 2012. The governor recently signed a series of bills—part of the Heroin Opioid Prevention and Education (HOPE) agenda—intended to reduce heroin and opioid abuse in Wisconsin.                

Read more:                
http://royalpurplenews.com/state-legislators-combat-addiction-epidemic                                 

How One Ohio Jail Treats Addicts                
Terry DiMio, Cincinnati.com                
April 8, 2016                

Seventy inmates of the Kenton County (Ohio) Detention Center are part of an evidence-based addiction treatment program that is seeing impressive results. Of 176 inmates who completed treatment at the jail so far, only 10 have re-offended.                

Read more:                
http://www.cincinnati.com/story/news/2016/04/08/how-one-jail-treats-addicts/82512064                                 

Missouri Politician Cites Privacy in Blocking Prescription Drug Monitoring Program                
Join Together Staff, Drug Free                
April 13, 2016                

In Missouri, the only state without a prescription drug monitoring program, state senator Rob Schaaf is blocking approval of the program because he thinks it represents an invasion of privacy.                

Read more:                
http://www.drugfree.org/join-together/missouri-politician-cites-privacy-blocking-prescription-drug-monitoring-program                
               

West News

Why California Doctors Shouldn’t Have Their Own Secret Programs to Fight Addiction                
Michael Hiltzik, Los Angeles Times                
April 8, 2016                

Legislation in California, which would reestablish a separate substance abuse program for physicians and keep this information confidential from the Medical Board and a physician’s patients, was scheduled for a committee hearing on April 18. The California Medical Association supports restoring the program, which was abolished in 2008. The bill could set the stage for awarding a lucrative state contract to a treatment program co-founded by the association.                

Read more:                
http://www.latimes.com/business/hiltzik/la-fi-hiltzik-diversion-20160407-snap-htmlstory.html                                 

Hawaii Drug Treatment Centers See Opiate Addictions Soar                
Jim Mendoza, Hawaii News Now                
April 11, 2016                

Hawaii substance abuse treatment centers are seeing an alarming increase in people addicted to pain medications. Seven percent of adults treated at Hina Mauka treatment facilities on the island of O‘ahu admit to being addicted to opiates. A few years ago it was less than 1 percent. (Video included = 1:58 minutes)                

Read more:                
http://www.hawaiinewsnow.com/story/31697370/opiate-addiction-alarmingly-high                                  

Four Indicted in Colorado After Patients Die from Illegal Prescription Drugs                
Victoria Sanchez, KUSA Channel 9                
April 12, 2016                

A former Parker, Colo., doctor, office manager, and two pharmacists have been arrested and charged with conspiracy and illegal distribution of prescription drugs that resulted in patients’ deaths. (Video included = 1:40 minutes)                

Read more:                
http://www.9news.com/news/crime/4-indicted-after-patients-die-from-illegal-prescription-drugs/129614130                                  

Join the Pledge to End Prescription Drug Abuse in Montana                
Stefanie Ponte, ABC/Fox Montana                
April 13, 2016                

Montana Attorney General Tim Fox has pledged to start a conversation in communities on safe disposal and use of prescription drugs, adding that many cases of abuse start with people sharing their medications. (Video included = 0:58 minutes)                

Read more:                
http://www.9news.com/news/crime/4-indicted-after-patients-die-from-illegal-prescription-drugs/129614130http://www.kfbb.com/story/31716246/join-the-pledge-to-end-prescription-drug-abuse-in-montana                 
               

Other Resources

Slideshow: Medical Marijuana                
WebMD                

This resource has an overview of what medical marijuana is, which medical symptoms and conditions it is used to treat, how it impacts the body, and how it is ingested.                                 

Read more:                
http://www.webmd.com/brain/ss/slideshow-medical-marijuana?ecd=wnl_wmh_041316&ctr=wnl-wmh-041316_nsl-ld-stry_img&mb=hnoTiuCzFUom3DvggMSUNeHnVev1imbCHRMIDbuI8u4%3d                                 

Heroin and Other Opioids from Understanding to Action                
Partnership for Drug-Free Kids                

The Partnership for Drug-Free Kids formally launched its new education initiative “Heroin and Other Opioids: From Understanding to Action” in early April. The program includes two versions of a presentation that can be given by local law enforcement and their community partners, one version to target community mobilization and the other for parent education. The centerpiece is a 1.5 minute film riven by a powerful story and supported with 3-D animation and statistics to illustrate the devastation of the epidemic to communities across America.                

Read more:                
http://www.drugfree.org/heroin                
               

Webinars

Research into Action Series Webinar                
Community Anti-Drug Coalition                
Thursday, April 21, 2016                 
2 p.m. (ET)                
http://www.cadca.org/resources/register-now-cadcas-next-research-action-webinar-series-1                                  

Preventing Youth Marijuana Use: Changing Perceptions of Risk                
Center for the Application of Prevention Technologies                
Thursday, May 19, 2016                 
2 p.m. (ET)                
https://captconnect.edc.org/event/preventing-youth-marijuana-use-changing-perception-risk                 
               

Grant Announcements

FY 2016 Harold Rogers Prescription Drug Monitoring Program                
Bureau of Justice Assistance                
Due: April 26, 2016                
http://www.grants.gov/web/grants/search-grants.html                 
https://www.bja.gov/funding/PDMP16.pdf                                 

NIDA Challenge: Addiction Research: There’s an App for that                
National Institute on Drug Abuse                
Submission Period begins November 3, 2015, 9 a.m. (ET)                
Submission Period ends April 29, 2016, 11:59 p.m. (ET)                
http://nida.ideascale.com/a/pages/addiction-research-theres-an-app-for-that                                 

Bottle Tracking Program                
National Association of Drug Diversion Investigators                
Due: None Specified                
http://www.naddi.org/aws/NADDI/pt/sp/programs_grants                
http://naddibottletracking.org/law-enforcement                
               

National Take-Back Initiative

National Prescription Drug Take-Back Day                
Drug Enforcement Administration                
Saturday, April 30, 2016                
10:00 a.m. - 2:00 p.m.                
http://www.deadiversion.usdoj.gov/drug_disposal/takeback                
               

Take-Back Events & Drop Boxes

National Prescription Drug Take-Back Day set for April 30 in Maine                
The Ellsworth American                
April 14, 2016                 
http://www.ellsworthamerican.com/maine-news/cops/national-prescription-drug-take-back-day-set-april-30                                 

Green Brook (N.J.) Police to Collect Unwanted Prescription Medications April 30                
TAPinto                
April 14, 2016                 
https://www.tapinto.net/towns/north-plainfield-slash-green-brook-slash-watchung/articles/green-brook-police-department-to-collect-unwanted                                 

Prescription Drug Round-Up April 30th in Washoe County (Nev.)                
KOLO Channel 8                
April 14, 2016                 
http://www.kolotv.com/content/news/Prescription-drug-round-up-April-30th-375782661.html                                  

Rockville (Md.) Drug Take-Back Day 2016: When, Where to Get Rid of Drugs                
Deb Pelt, Rockville Patch                
April 14, 2016                 
http://patch.com/maryland/rockville/drug-take-back-day-2016-when-where-get-rid-drugs-0                                                  

Options to Safely Dispose Unused Prescriptions at Airbase in Fort Lewis (Wash.)                
Capt. Dara Shin, Northwest Guardian                
April 14, 2016                 
http://www.nwguardian.com/2016/04/14/24543_options-to-safely-dispose-unused.html                                 

Drug Take-Back Event Is April 30 in Tullahoma (Tenn.)                
The Tullahoma Tennessee News                
April 15, 2016                 
http://www.tullahomanews.com/drug-take-back-event-is-april-30/                                 

Susquehanna (Penn.) District Attorney Takes Fight Against Pain Relievers to the Streets                
Eric Deabill, PA Homepage                
April 14, 2016                 
http://www.pahomepage.com/news/susquehanna-da-takes-fight-against-painkillers-to-the-streets                                 

Londonderry (N.H.) Police Add 24/7 Drug Take-Back Box                
Eli Okun, Union Leader                
April 13, 2016                 
http://www.unionleader.com/article/20160414/NEWS07/160419676/-1/mobile?template=mobileart                                 

Tipton County (Tenn.) Agencies to Participate in Drug Take-Back Effort                
The Leader                
April 14, 2016                 
http://www.covingtonleader.com/local-agencies-to-participate-in-drug-take-back-effort-cms-4389                                 

Fort Lee (Va.) Drug Take-Back Day Set                
Fort Lee Traveller                
April 14, 2016                 
http://www.ftleetraveller.com/community_life/kenners_corner/drug-take-back-day-set/article_43eae6d6-01b7-11e6-9fe5-e787ee39a225.html                                 

Fairfield (Conn.) Police And U.S. Drug Enforcement Agency Team Up to Take Back Drugs                
Kathy Reakes, Fairfield Daily Voice                
April 14, 2016                 
http://fairfield.dailyvoice.com/police-fire/fairfield-police-and-dea-team-up-to-take-back-drugs/651483/                                 

Wayne (N.J.) Police Will Collect Unwanted Prescription Drugs                
Debra Winters, Wayne Today                
April 14, 2016                 
http://www.northjersey.com/news/public-safety/unwanted-prescription-drugs-will-be-collected-at-town-hall-1.1544562                                 

Brentwood (Tenn.) to Take Part in Prescription Drug Take-Back Day                
Collin Czarnecki, The Tennessean                
April 14, 2016                 
http://www.tennessean.com/story/news/local/williamson/brentwood/2016/04/14/brentwood-take-part-prescription-drug-take-back-day/32583033                                 

Kerrville (Texas) Police Department Offers Drug Disposal                
Community Journal                
April 14, 2016                 
http://www.hccommunityjournal.com/news/article_a3a86284-00d0-11e6-8f5e-63fbd44fbfee.html                
               

Upcoming Conferences and Workshops

Marijuana Summit                
Smart Approaches to Marijuana and New Jersey Prevention Network                
April 28, 2016                
Atlantic City, N.J.                
http://www.njpn.org/summit2016                                  

Medical Marijuana Seminar                
Private Motor Truck Council of Canada                
May 3, 2016                
Alberta, Canada                
http://www.todaystrucking.com/alberta-hosting-spring-talk-on-medical-marijuana-in-trucking                
http://www.pmtc.ca/News.asp?a=view&id=113                                 

24th Annual Meeting                
Society for Prevention Research                
May 31–June 3, 2016                
San Francisco, Calif.                
http://www.preventionresearch.org/2016-annual-meeting                                 

2016 Annual Conference                
International Health Facility Diversion Association                
September 13–14, 2016                
Duke Energy Convention Center                
Cincinnati, Ohio                 
https://ihfda.org/2016-annual-conference/                                 

Register:                
https://www.regonline.com/Register/Checkin.aspx?EventID=1803476                                 

29th Annual National Prevention Network Conference                
National Prevention Network                
September 13–15, 2016                
Buffalo, N.Y.                
http://www.npnconference.org                

Register:                
http://www.npnconference.org/registration                                 

Call for Presentations                
Online Application Deadline: April 18, 2016, 5 p.m.                
         
                                 
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.