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April 28, 2016

PAW Weekly Update




SAMHSA Prescription Drug Abuse Weekly Update
          Issue 171  |  April 28, 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.                      
Journal Articles and Reports                            
Professional Development and Editorials                            
Northeast/Mid-Atlantic News                            
South News                            
Midwest News                            
West News                            
Grants Awarded                            
Grant Announcements                            
National Take-Back Initiative                            
Take-Back Events & Drop Boxes                            
Upcoming Conferences and Workshops                                                         


C.S. Davis and D. Car. 2016. “Physician Continuing Education to Reduce Opioid Misuse, Abuse, and Overdose: Many Opportunities, Few Requirements.” Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2016.04.002.                        

Only five states (Conn., Iowa, Md., S.C., and Tenn.) require all physicians to receive opioid-related continuing medical education (CME) as a condition of obtaining or renewing their license to practice medicine, according to a review of state laws codified prior to December 2015. Similar CME requirements in an additional eight states (Del., Ky., Mass., Miss., N.M., Utah, Vt., and W.V.) apply to some or all physicians who are licensed to prescribe or dispense controlled substances (or, in some states, only those who actually prescribe controlled substances). Three states (Fl., Nev., and Okla.) have CME requirements for osteopathic physicians only. Five states (Fla., Ga., Miss., Texas, and Wash.) require some physicians who practice in pain management clinics or with certain patient populations to obtain CME in pain management or controlled substance prescribing. And, three states (Calif., Mass., and Ore.) require physicians to obtain relevant training at least once in their careers, either in addition to or in lieu of CME. The study did not assess if boards of medicine impose similar requirements in other states. In early 2016, the College of Family Physicians of Canada rejected a request that it require its members to take courses on safer opioid prescribing, in part, because it did not want to be in a position of potentially decertifying physicians who did not comply.                        

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Canadian Official Says Marijuana Legislation Coming Next Spring                        
Josh Dehaas, CTVNews                        
April 20, 2016                        

Canada’s health minister has announced that the country will introduce marijuana legalization legislation in spring 2017. The prime minister will not decriminalize the drug while the legislation is being crafted; he supports a legalization solution over decriminalization. Canada finds itself in a gray area in terms of marijuana use in the last year because many people believe the drug has already been decriminalized, and many police stations are unsure of how to proceed in enforcing marijuana laws. As citizens grow frustrated with mixed messages on marijuana from the government, lawmakers hope to find a well-fitting regulatory system.                        

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Movement to Legalize Pot Gains Speed in the Americas                        
Joshua Partlow, Washington Post                        
April 22, 2016                        

Mexico’s president, Enrique Peña Nieto, has announced he will seek approval from his country’s congress to legalize medical marijuana and possession of up to 1 ounce of recreational marijuana for personal use. A senator from Peña Nieto’s ruling Institutional Revolutionary Party said earlier this year that a bill permitting the use of medical marijuana should be approved by May. Last fall, Mexico’s supreme court ruled that a group of activists could legally grow and sell marijuana. Its senate is also considering legislation to create a state-regulated marijuana industry. Mexico’s move is part of a regional pattern. Uruguay has fully legalized marijuana sales. And, many other countries in South and Central America—including Brazil, Chile, Colombia, Costa Rica, Ecuador, and Peru—have made marijuana more available in varying ways, either for medical or recreational use.                        

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Journal Articles and Reports

T.J. Atkinson, A.H. Gulum, and W.G. Forkum. 2016. “The Future of Pain Pharmacy: Driven by Need” DovePress, doi:http://dx.doi.org/10.2147/IPRP.S63824.                

A survey of all 11 accredited pharmacy post-graduate pain and palliative care residency programs found they differ considerably. The majority placed significant emphasis on either acute pain management or palliative care with brief or limited exposure to chronic pain management. Four required 2 months of chronic pain management training. Only two identified chronic pain management as a primary practice setting.                

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J.A. Baker, J. Avorn, R. Levin, and B.T Bateman. 2016. “Opioid Prescribing After Surgical Extraction of Teeth in Medicaid Patients, 2000–2010” Research Letter, Journal of the American Medical Association, doi:10.1001/jama.2015.19058.                

An opioid prescription was filled within 7 days post extraction in 42 percent of the 2.7 million tooth extractions paid by Medicaid between 2000 and 2010. The median prescription was for 120 morphine mg-equivalents, typically 24 5mg doses. The authors believe a combination of nonsteroidal medications and acetaminophen might have provided more effective analgesia for post-extraction pain.                 

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A.S.B. Bohnert, E.E. Bonar, R. Cunningham, M.K. Greenwald, L. Thomas, S. Chermack, F.C. Blow, and M. Walton. 2016. “A Pilot Randomized Clinical Trial of an Intervention to Reduce Overdose Risk Behaviors Among Emergency Department Patients at Risk for Prescription Opioid Overdose.” Drug and Alcohol Dependence, doi:http://dx.doi.org/10.1016/j.drugalcdep.2016.03.018.                

A pilot trial randomly assigned 204 adult, English-speaking emergency department patients who reported prescription opioid misuse in the previous 90 days to either an intervention group, which received a 30 minute motivational interviewing session delivered by a therapist plus educational enhanced usual care, or a comparison group, which received educational enhanced usual care. At 6-month follow up ( with an 87 percent retention rate), patients receiving the motivational interview reported significantly lower levels of overdose risk behaviors (incidence rate ratio [IRR] = 0.72; 40.5 percent reduction in mean vs. 14.7 percent) and lower levels of non-medical opioid use (IRR = 0.81; 50.0 percent reduction in mean vs. 39.5 percent) compared to comparison patients.                 

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P. Dietz, M. Souka, and A.G. Franke. 2016. “Pharmacological Neuroenhancement in the Field of Economics—Poll Results from an Online Survey.” Frontiers in Psychology, doi:10.3389/fpsyg.2016.00520.                

Among a convenience sample of 1,021 readers of Handelsblatt, a leading German business daily, 19 percent reported lifetime use of illicit or prescription drugs for neuro-enhancement.. Reasons and situations that predicted neuro-enhancement with illicit and prescription drugs were “curiosity,” “to enhance mood,” “for a confident appearance,” “stress/pressure to perform,” and “deadline pressure.” Another 62 percent of respondents reported lifetime use of herbal or over-the-counter drugs (e.g., No-Doz) for neuro-enhancement.                 

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N.E. Hagemeier, A. Alamian, M.M. Murawski, H. Flippin, E.J. Hagy, and R.P. Pack. 2016. “Correlates of Prescription Opioid Legitimacy Judgments Among Community Pharmacists.” Substance Abuse and Misuse, doi:10.3109/10826084.2015.1135952.                

Pharmacists were less likely to think prescription opioid use by their clientele was legitimate if the pharmacists were (1) female, (2) practiced in a chain or independent practice rather than a supermarket, (3) feared employer disciplinary action if prescription legitimacy were questioned, and (4) were confident in their ability to detect prescription opioid abuse, according to a survey of Tennessee pharmacists. The survey, mailed to 2,000 pharmacists in October and November 2012, had a 40 percent response rate and 624 usable responses from community pharmacists.                 

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D.A. Lewis, J.N. Park, L. Vail, M. Sine, C. Welsh, and S.G. Sherman. 2016. “Evaluation of the Overdose Education and Naloxone Distribution Program of the Baltimore Student Harm Reduction Coalition.” American Journal of Public Health doi:10.2105/AJPH.2016.303141.                

During an 8-month pilot, the Baltimore Student Harm Reduction Coalition, Maryland’s first community-based training program tied to third-party naloxone prescription, distributed 250 free naloxone kits. Three overdose reversals were reported to the program. Pre-post and follow-up surveys showed trainings increased self-efficacy around overdose prevention and response, with increases persisting 12 months after the training.                

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L.A. Marsch, S.K. Moore, J.T. Borodovsky, R. Solhkhah, G.J. Badger, S. Semino, K. Jarrett, K.D. Condon, K. Rossettie, P. Vincent, N. Hajizadeh, and E. Ducat. 2016. “A Randomized Controlled Trial of Buprenorphine Taper Duration Among Opioid-Dependent Adolescents and Young Adults.” Addiction, doi:10.1111/add.13363.                

People who received a 56-day buprenorphine taper had a significantly higher percentage of opioid-negative scheduled urine tests than people who received a 28-day buprenorphine taper (35 percent versus 17 percent), according to a small, double-blind, placebo-controlled trial in two hospital-based research clinics in New York City that randomized 53 DSM–IV opioid-dependent people ages 16–24 between 2005 and 2010. They also were retained in treatment significantly longer (37.5 days versus 26.4 days). A daily attendance requirement was associated with decreased abstinence and shorter retention compared with a 2–3 times weekly attendance requirement, independent of taper duration.                

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A. Mohammad, J. Busse, R.N. Shub, and A. Sarkar. 2016. “Long-Term Suboxone Maintenance Therapy for Opioid Use Disorder: 2 Case Reports.” Open Journal of Psychiatry, doi:http://dx.doi.org/10.4236/ojpsych.2016.62023.                

Suboxone (buprenorphine) was shown to be a viable, long-term treatment option for severe opioid addiction in two case studies of individuals who maintained sobriety for 11 years with the use of Suboxone maintenance therapy.                 

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S.C. Mudumbai, E.M. Oliva, E.T. Lewis, J. Trafton, D. Posner, E.R. Mariano, R.S. Stafford, T. Wagner, and J.D. Clark. 2016. “Time-to-Cessation of Postoperative Opioids: A Population-Level Analysis of the Veterans Affairs Health Care System.” Pain Medicine, doi:10.1093/pm/pnw015 pnw015.                

Among all 64,391 Veterans Health Administration (VHA) patients who underwent inpatient surgery in 2011 and received at least one opioid prescription within 90 days of discharge, 60 percent received preoperative opioids: tramadol (7.5 percent), short-acting acute/intermittent (24.1 percent), short-acting chronic (17.5 percent), and long-acting (5.2 percent). Defining cessation as 90 consecutive, opioid-free days, for patients opioid-free preoperatively, median time-to-cessation postoperatively was 15 days. The short-duration acute/intermittent cohort had greater risk for prolonged time-to-cessation than those opioid-free (Hazard Ratio [HR] = 2.0), but lower risk than those taking tramadol only (HR = 3.0), short-acting chronic (HR = 9.1), or long-acting opioids (HR = 9.1). Diagnoses of chronic pain, prior illicit drug use, or affective disorders were weaker positive predictors of longer time to cessation.                

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Professional Development and Editorials

D. Dowell, T. Haegerich, and R. Chou. 2016. “CDC Guideline for Prescribing Opioids for Chronic Pain–United States, 2016.” Journal of the American Medical Association, doi:10.1001/jama.2016.1464.                

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Opioid Abuse Could Be Costing Employers as Much as $8 Billion Annually                
Join Together Staff                
April 20, 2016                

The average healthcare cost per employee who abuses opioids is $19,450 and just $10,853 per employee who does not abuse opioids, according to an analysis of data by benefits firm Castlight Health. The findings are based on data covering almost 1 million workers who used Castlight’s benefits platform between 2011 and 2015.                

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New Law Aims to Ensure Access to Medication While Curbing Abuse                
Rachel Balick, Pharmacy Today                
April 21, 2016                

President Barack Obama on April 19 signed the Ensuring Patient Access and Effective Drug Enforcement Act, which requires, among other things, the Secretary of Health and Human Services to submit a report to Congress by April 2017 that identifies (1) obstacles to legitimate patient access to controlled substances; (2) issues with diversion of controlled substances; (3) how collaboration between Federal, State, local, and tribal law enforcement agencies and the pharmaceutical industry can benefit patients and prevent diversion and abuse of controlled substances; (4) the availability of medical education, training opportunities, and comprehensive clinical guidance for pain management and opioid prescribing, and any gaps that should be addressed; (5) beneficial enhancements to State prescription drug monitoring programs, including enhancements to require comprehensive prescriber input and to expand access to the programs for appropriate authorized users; and (6) steps to improve reporting requirements so that the public and Congress have more information regarding prescription opioids, such as the volume and formulation of prescription opioids prescribed annually, the dispensing of such prescription opioids, and outliers and trends within large data sets.                 

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American Society of Addiction Medicine President Discusses Buprenorphine Access                
Celia Vimont, Partnership for Drug-Free Kids                
April 20, 2016                

Under current regulations, doctors who are certified to prescribe buprenorphine (sold as Suboxone) are allowed to write prescriptions for up to 30 patients initially. After 1 year, they can request authorization to prescribe up to a maximum of 100 patients. The U.S. Department of Health and Human Services has proposed doubling the current patient limit for qualified doctors who prescribe buprenorphine.                

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The Future of Prescription Bottles; End of Opioid Crisis?                
Matt O’Connor, Hospitals and Health Networks                
April 20, 2016                

A device from Intent Solutions called TAD, which stands for “take as directed,” seeks to control prescription drug misuse by only allowing a patient to access their pills during the times their doctor directed. TAD houses a portable dispenser that contains a disposable vial attached to a preprogrammed reusable electronic device. TAD notifies a patient when to take a pill, scans their fingerprint, and then dispenses the pill and sends data to an accompanying app and a database.                

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PillDrill Medication Tracking System Reminds Patients When to Take Medications                
Michael Brown, TechHive                
April 19, 2016                

PillDrill, a new high-tech pill box, reminds patients to take medications on time, tracks medication usage, and provides a feature to track how a patient is feeling in response to medication therapies. The device, which is about the size of a smart phone, connects to WiFi and is adaptable to the diverse needs of different types of patients.                

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Breakthrough Wireless Pill Organizers to Make Tracking and Taking Medication Easier                
PN Newswire                
April 20, 2016                

Medisafe and TimerCap have released two Bluetooth-enabled devices to help patients better manage their medication regimens: iCap, which is a cap that fits most standard prescription pill bottles dispensed in the United States, and iSort, a weekly pill organizer for people who take multiple medications or more complex regimens.                

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Prime Therapeutics Releases Studies on Efforts to Reduce Opioid Abuse, Misuse                
Denise Lecher, PRNewswire                
April 19, 2016                

Prime Therapetics presented two unpublished studies at the Academy of Managed Care Pharmacy’s recent annual meeting. The first study reviewed 2013–14 U.S. data from 9.2 million continuously enrolled, commercially insured members and identified 34,775 with concurrent prescriptions for opioids, antianxiety/sedative hypnotics, and muscle relaxants (what the study calls triple-threat medications). Among this group, 23 percent had more than 30 consecutive days of overlap, 40 percent had four or more prescribers associated with their triple-threat medications, and 16 percent used four or more pharmacies to obtain their triple-threat medications. Those with more days of triple-threat overlap in 2013 had more emergency department visits and higher total costs of care in 2014, possibly because they had worse health problems that required more providers and prescriptions. The second study, a pilot program, showed the company’s point-of-sale alert system helped pharmacists identify Medicare members who might be at risk of opioid misuse or misuse disorders. The alert identified members using more than 100 mg. of morphine-equivalent-dose per day for at least 60 consecutive days, and using three or more prescribers and three or more pharmacies to get their opioids. The system flags at lower usage than the existing Medicare overutilization monitoring system.                 

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Joint Commission Says Its Pain-Management Standards Didn’t Fuel Opioid Epidemic                
Steven Ross Johnson, Modern Healthcare                
April 19, 2016                

The Joint Commission is defending its requirement that healthcare providers assess and treat pain after a letter from 60 state health department, professional medical organization and patient advocacy group leaders requesting it to reconsider the standards. David Baker, M.D., The Joint Commission’s executive vice president of healthcare quality evaluation, responded, saying criticism of its standards is based on a number of “misconceptions,” including that they call for pain to be treated as a vital sign.                

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Doctors, States Fight Over Data Checking Prescription Drug Monitoring Programs                
David Pittman, POLITICO Morning eHealth                
April 18, 2016                

Doctors rarely use prescription drug monitoring programs—only 14 percent nationally according to one study last year—so state lawmakers are trying to mandate that prescribers check them before issuing certain drugs. But, state doctor groups and the American Medical Association (AMA) are against most mandates. “We need them to be better and easier to use so that it’s natural and not mandated,” said AMA President Steven Stack.                

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As Opioid Epidemic Worsens, Rethinking How Doctors Are Taught to Treat Pain                
Christopher Booker, Saskia de Melker, and Melanie Saltzman, PBS News Hour                
April 17, 2016                 

This video is a report of how pain management has changed over the past 40 years to include more prescribing of opioids. (Video included = 9:27 minutes)                                  

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A. Bradford and W.D. Bradford. 2016. “The Impact of Medical Marijuana Legalization on Prescription Medication Use and Costs in Medicare Part D.” Working Paper, University of Georgia.                  

Using data on all prescriptions filled by Medicare Part D enrollees from 2010 to 2013, this study examines whether prescriptions for drugs used to treat conditions that can be treated with medical marijuana declined in states that implemented medical marijuana laws. As states implemented laws, the number of prescriptions for competing drugs fell significantly saving an estimated $153 million per year.                  

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A.L. Bretteville-Jensen. 2016. “Expected Lessons from the U.S. Experience with Alternative Cannabis Policy Regimes.” Addiction, doi:10.1111/add.13368.                  

The author reports that many countries are eager to understand the multiple impacts of marijuana legalization. She approaches legalization as a non-binary policy issue and urges policymakers to also consider the continuum of legalization when drawing conclusions.                   

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U.S. Health Officials Respond to Senators’ Queries About Marijuana Research                  
Washington Post                  
April 4, 2016  

The U.S. Secretary of Health and Human Services has answered a series of questions posed by a group of senators in a December 21, 2015, letter about the availability and use of marijuana for research purposes. The most potent product the federal government offers to researchers contains 7.4 percent tetrahydrocannabinol and 0.21 percent cannabidiol—far lower than concentrations in some state-legalized products. The letter discusses the volume of marijuana supplied for research, barriers to supply, efforts to expedite provision to researchers, improvements planned and challenges in federal data collection about medical marijuana use, and federal efforts to medical marijuana research.                  

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Physicians Form Group Promoting Legalization and Regulation of Marijuana                  
Join Together Staff                  
April 19, 2016                  

More than 50 prominent physicians, including a former U.S. surgeon general and Center for Substance Abuse Treatment director, have banded together to promote the legalization and regulation of marijuana. The group, Doctors for Cannabis Regulation, endorses legalization of marijuana for adult recreational use. It argues that marijuana is far less harmful for adults than alcohol and tobacco.                   

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Advocates in Maine Push to Let Patients Use Marijuana to Treat Opiate Addiction                  
Gillian Graham, Portland Press Herald                  
April 18, 2016                  

Maine will become the first state to formally consider using medical marijuana to treat opioid addictions when caregivers and patients formally ask for the extension of Maine’s law. Research suggests that cannabinoids might prevent people from building up a tolerance to opioids, so they could take fewer strong pain relievers. Some also claim marijuana is a viable treatment for opioid withdrawal symptoms, such as nausea, diarrhea, muscle spasms, insomnia, and anxiety.                   

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Massachusetts Marijuana Legalization Ballot Question Explained                  
Allison Manning and Adam Vaccaro, boston.com                  
April 20, 2016                  

The authors answer questions about the ballot initiative in Massachusetts to legalize recreational marijuana. Voters in the commonwealth will likely decide on the initiative in November.                  

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Regulating Marijuana in California                  
Patrick Murphy and John Carnevale, Public Policy Institute of California                  
April, 2016                  

Voters in California in November will decide whether the state should legalize recreational marijuana. This report discusses the policy implications, primarily regulatory issues, of legal recreational use in the state.                  

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Doctor: If Ohio Legalizes Medical Marijuana, Prescription Options Should Be Broad                  
Jim Siegel, Columbus Dispatch                  
April 21, 2016                  

The Ohio State Medical Association is opposing efforts to legalize the use of medical marijuana in the state until more clinical research is performed and the FDA approves the drug for medical uses. However, in the event legislation passes, the association is concerned about limiting the conditions for which it can be prescribed. Members believe that given the lack of research, any restrictions lack a sound basis, so restrictions only prevent future research that needs to be performed to better understand the medicinal efficacy of marijuana.                  

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Nations’ Widely Varying Approach to Drug Policy on Display at UN Conference                  
Join Together Staff, Partnership for Drug-Free Kids                  
April 21, 2016                  

Several country officials, speaking at the recent UN General Assembly’s special session on drug control, indicated that nations’ drug policies are all over the map. For example, Jamaica has decriminalized possession of small amounts of marijuana, while Cuba opposes legalizing drugs or declaring them harmless. Canada’s health minister announced her government’s plans to introduce a measure next spring to legalize marijuana. And, Indonesia’s ambassadors called for a zero-tolerance approach to suppress and eliminate illegal drugs. Indonesia and Iran impose the death penalty on drug traffickers.                  

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Bipartisan Push for Medical Marijuana                  
Charles Boothe, Registered Harrold                  
April 16, 2016                  

The ranks of legislators who support medical marijuana legalization at the federal level continue to grow. A bipartisan group of legislators recently sent a letter to President Obama, urging him to facilitate medical research on marijuana. Morgan Griffith (R-Va.), one of the letter’s signers, is motivated toward increasing understanding of how the drug works and what quantities provide the best results.                  

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Legalizing Marijuana Will Mean Nothing in Vancouver, Canada                  
Brian Hutchinson, National Post                  
April 20, 2016                   

Marijuana as a recreational drug is illegal in Canada, but the laws do not really apply any more—at least not on the west coast, where pot can be bought almost everywhere, city-regulated stores included. Vancouver’s mayor insists on calling the shops “medical marijuana dispensaries,” but all that is required of a person wanting pot are a quick referral and note from any compliant naturopath. Vancouver’s annual April 20 marijuana celebration has become a massive, open-air marijuana market and rally. The city does not require an event permit despite an anticipated crowd of 25,000–50,000. And, though the event is not sanctioned, officials look the other way, with taxpayers footing overtime bills for police, firefighters and paramedics. A recent survey showed 68 percent of Canadians say marijuana should be made legal, 64 percent say legalization will do more good than harm in the long run, and 41 percent would like to see marijuana legalized but tightly controlled by government.                   

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Weed and the Canadian Workplace                  
Andrew Ebejer, Plant                  
April 21, 2016                  

Legal or not, the worry for employers remains the same: how to manage the use of marijuana in the workplace, particularly in manufacturing where employees operate heavy and automated machinery and impairment can have fatal consequences. Existing testing methods do not assess in-the-moment impairment which is of primary concern for workplaces. Under Ontario’s Occupational Health and Safety Act an employer has an obligation to take every reasonable precaution to protect the health and safety of workers. This includes identifying hazards that may result from an employee working while under the influence of medical marijuana.                   

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Medical Marijuana and the Workplace                  
Marliss Silver Sweeny, Corporate Council                  
April 19, 2016                  

Navigating the issue of marijuana and the workplace can be hazy as states legalize the drug for medical or recreation use. Hardline legal protections for employers remain in place.                  

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Up in Smoke—Are Employers Required to Accommodate Medical Marijuana Use?                  
Ivo Becica, Obermayer Rebmann Maxwell & Hippel LLP                  
April 20, 2016                  

Most recent laws legalizing marijuana use have been geared toward removing criminal penalties for users and do not fully address workplace issues posed by medical marijuana. Some laws are starting to specify employer requirements. For example, Pennsylvania’s medical marijuana law says employers may not discriminate against employees because of their status as a medical marijuana card holder. In most states, employers with zero-tolerance drug use policies can refuse to hire or terminate employees who fail a drug test for marijuana—with or without medical authorization.                  

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Weed’s Worldwide Impact on the Workplace                  
Tony Fiore, Kegler Brown Hill & Ritter                  
April 20, 2016                  

A team of legal experts around the world examined marijuana laws in their countries and reported on how employers deal with drugs in the workplace. The information was collapsed into a categorized world map. While many countries have decriminalized varying degrees of possession, the drug remains widely illegal for medical and recreational uses.                   

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Fed’s Reclassification of Pot Could Usher in New Era of Medical Marijuana Research                  
David Noonan, Scientific American                  
April 15, 2016                  

Because the U.S. Drug Enforcement Administration (DEA) classifies marijuana as a Schedule I drug, the application process to use the substance in research is extensive and the time it takes to receive approval often interferes with the experiments themselves. If the DEA chooses to move forward with rescheduling marijuana, which it is reportedly considering, scientists say that research opportunities will be enhanced, such as the option to perform large double-blind experiments.                   

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The Science Behind the U.S. Drug Enforcement Administration’s Long War on Marijuana                  
David Downs, Scientific American                  
April 19, 2016                  

The U.S. Drug Enforcement Administration’s decision to consider rescheduling marijuana could rest on evidence of medicinal uses of the drug. As it stands, marijuana is a Schedule I drug, one with no medical application and high potential for abuse. The debate on the medical efficacy of marijuana continues to heat up with experts arguing both sides. The history behind scheduling of marijuana dates back many decades, and provides a fascinating mix between politics and science.                  

Read More:                  

Eleven Bids Made for Kent, Sussex Counties’ (Del.) Marijuana Dispensaries                  
Jeff Mordock, News Journal                  
April 19, 2016                  

When Delaware legalized medical marijuana nearly 5 years ago, each of its three counties was required to have a dispensary by 2013. However, the only dispensary in operation to serve the state’s more than 700 medical marijuana cardholders is in New Castle County, quite a distance from residents in Kent and Sussex counties. Now, 11 bids have been received to open dispensaries in Sussex and Kent counties. Applicants paid a $5,000 application fee, and winners will have to pay a licensing fee of $40,000.                  

Read More:                  

Phoenix Limits Medical-Marijuana Industry in Case of Pot Legalization for Arizona                  
Brenna Goth, The Republic                  
April 21, 2016                  

New medical marijuana facilities will lose some options of where they can locate in Phoenix, under stricter rules approved by the city council. Dispensaries, as well as cultivation and infusion businesses, will have to find sites farther away from residential areas, places of worship, daycare centers, homeless shelters, and youth community centers than previously required. The changes moved swiftly as Phoenix prepares for possible legalization of recreational marijuana through a statewide voter initiative.                  

Read More:                  

New England’s Opioid Abuse Epidemic Stalls Marijuana Legalization Efforts                  
The Join Together Staff                  
April 20, 2016                  

Efforts to legalize marijuana in New England are stalling in the face of the region’s opioid epidemic. Vermont’s senate approved a bill to create a regulated market for recreational marijuana, but the house stripped the bill of the sections that would allow legalization. Currently, it only contains a provision that would permit home cultivation and legalized possession of small amounts of marijuana.                  

Read More:                  

Cape Cod (Mass.) Medical Marijuana Dispensaries Expect Green Light by Fall                  
Christine Legere, Cape Cod Times                  
April 21, 2016                  

Many dispensary proposals in Massachusetts’s Cape Cod area have been working through the state approval process and are likely to open by mid fall 2016. A dispensary in Mashpee likely will be the first on the Cape to open its doors, with a planned startup in early October. Massachusetts voters legalized medical marijuana through a 2012 ballot initiative. To date, only six dispensaries from a pool of 185 applications have received approval to open.                   

Read More:                  

Does Marijuana Make You Stupid?                  
Stephanie Pappas, Live Science                  
April 22, 2016                   

Research is mixed as to whether marijuana causes declines in intelligence and functioning over time. Human brain scan studies suggest that pot may be linked to anatomical brain changes, such as shrinking of the amygdala—a brain region that processes emotion, reward and fear.                  

Read more:                  


Vancouver (Canada) Prescriptions for Addicts Gain Attention as Heroin and Opioid Use Rises                
Dan Levin, New York Times                
April 21, 2016                

Vancouver’s (Canada) Crosstown Clinic treats 110 chronic addicts with prescriptions for diacetylmorphine hydrochloride (DMH), the active ingredient in heroin, as heroin maintenance treatment. The program has been successful at keeping addicts out of jail and away from hospital emergency departments. Supporters are seeking to expand it across Canada. Prescription programs like Crosstown’s, which is for addicts for whom replacement drugs like methadone do not seem to help, have been available for years in Britain, Denmark, Germany, the Netherlands, and Switzerland. All of these countries have reported significant decreases in drug abuse, crime, and disease. This treatment is not a legal option in the United States, where DHM is a Schedule I drug.                 

Read more:                

Canada’s Shift on Tamper-Resistant Opioids a Bitter Pill to Swallow for U.S. Coalition                
Jim Bronskill, Canadian Press                
April 20, 2016                

The U.S. Abuse Deterrence Coalition, which is led by pharmaceutical companies, has accused Health Canada of abandoning its leadership in the global fight against prescription opioid abuse by failing to enact strict new regulations. Canadian health officials concluded that insisting on tamper-resistance for products containing oxycodone before they can be sold in Canada would not have had the intended health and safety effects.                

Read more:                

Health Canada to Explore National Plan to Deal with Opioid Abuse                
Karen Howlett and Grant Robertson, Globe and Mail                
April 18, 2016                

The office of Canada’s health minister is working on a range of options to address the country’s opioid abuse epidemic, including setting up a national surveillance system to monitor drug overdoses. The minister has asked bureaucrats to address gaps in the system that make it difficult for frontline workers to respond to the opioid crisis. Illicit fentanyl is rapidly moving east from British Columbia and Alberta, where overdoses linked to the drug claimed 418 lives in 2015. British Columbia declared a public health emergency last week—a move that allows officials to collect real-time data on overdoses.                

Read more:                

Northeast/Mid-Atlantic News

Heroin, Opioid Crisis: Pennsylvania Making Progress                
Davin Jergensen, Evening Sun                
April 18, 2016                 

Speaking at the American Medical Association Alliance’s recent northeast regional meeting, Pennsylvania’s physician general described ways the commonwealth is working to address its heroin and opioid abuse epidemic. Prevention efforts include working on guidelines for medical students to get more education on opioids, establishing guidelines for prescribing for many specialties, distributing naloxone, developing guidelines on what happens to people who are administered naloxone, prescription takeback boxes, and use of the new prescription drug monitoring program in the fall.                 

Read more:                

Legislation in Pennsylvania Aimed at Stopping Opioid Epidemic                
J.D. Prose, Herald-Standard                
April 19, 2016                

Pennsylvania state legislators have proposed a bill to create a subcommittee on drug abuse within the House Health Committee. The subcommittee would ensure that state agencies are coordinating efforts to combat the crisis and offering consistent practices and messages on treatment and prevention; confirm that the prescription drug monitoring program is fully operational and working with neighboring states; develop strategies to work with schools on drug education and early intervention; formulate ways to educate medical and pharmaceutical professionals on the dangers of overprescribing and over-dispensing opioids; and review the effectiveness of addiction treatment programs.                 

Read more:                

W.Va. Attorney General Applauds Neighboring State’s Expanded Rx Drug Database                
Office of the West Virginia Attorney General                
April 20, 2016                

West Virginia’s attorney general has said he applauds Pennsylvania’s expansion of its prescription drug monitoring program (PDMP) and strongly encouraged state leaders to take the necessary steps to join a national database. Legislation increased the types of prescription drugs tracked by the monitoring program and expanded access to its database, including to doctors and pharmacists. He also congratulated members of Pennsylvania’s Achieving Better Care by Monitoring All Prescriptions Board and urged them to expedite full integration into the National Association of Boards of Pharmacy’s PDMP, InterConnect.                 

Read more:                

South News

Chattanooga (Tenn.) Among Worst U.S. Cities for Opioid Prescription Abuse                
Steve Johnson, Times Free Press                
April 20, 2016                

To combat the opioid abuse epidemic, Tennessee’s senate has passed a bill that would require all pain treatment clinics that prescribe opioids to be licensed by the state’s health department and receive regular inspections.                

Read more:                

Midwest News

Battling Opioid Addiction in Minnesota’s American Indian Communities                
MPR News Staff, MPRnews                
April 19, 2016                

Minnesota’s opioid epidemic continues to hit American Indian communities especially hard. American Indian people have died of opioid overdoses at a rate that’s almost five times higher than Caucasian people in the state. Last week, White Earth Nation reported eight nonfatal opioid overdoses over just 3 days. A leader of the Red Lives Matter movement discussed in an interview why addiction to heroin and opioids is hitting American Indian communities especially hard and what they are doing about it. (Audio included = 7:46 minutes)                

Read more:                

Prescription Drug Database Closer to Becoming Law in Missouri But Obstacles Remain                
Mallory Daily, St. Louis Public Radio                
April 20, 2016                

Missouri’s house has passed a bill that would establish a statewide prescription drug monitoring program. The bill awaits a senate committee vote. However, one senator, who has proposed his own bill that would deny doctors access to the database, has said he will filibuster if the committee’s bill gets to the senate floor for debate, citing privacy concerns. He said he would support the measure if ballot language and a referendum clause were added so that voters could decide on the program.                 

Read more:                

Employees Stealing Drugs from Ohio Pharmacies, Healthcare Facilities                
Ben Sutherly and Holly Zachariah, Columbus Dispatch                
April 17, 2016                

At least 217 healthcare employees in Ohio were implicated in prescription drug theft in 2014. Ohio does not license or register pharmacy technicians, which makes it easy for people to steal medicines and then move to another pharmacy. The article details how an employee was stealing opioids from the Toronto Apothecary. She was fired from the pharmacy, but the pharmacy did not press charges. (Video included = 3:47 minutes)                

Read more:                

West News

Deaths from Powerful Opiate Fentanyl Rise in Los Angeles County                
Joseph Serna, L.A. Times                
April 16, 2016                 

The Los Angeles County’s public health department announced that while fentanyl-related deaths were around 40 a year between 2011 and 2013, they increased about 50 percent to 62 in 2014. That and 51 overdoses, 11 of them fatal, in the Sacramento County area over the last month triggered an alert from the California Department of Public Health.                 

Read more:                

Guest Commentary: California’s Doctors Already Addressing Opioid Abuse                
Arthur Chen, East Bay Times                
April 18, 2016                

California’s physician community is taking the issue of prescription opioid abuse very seriously. In 2013, California physicians supported legislation to pay additional licensing fees to upgrade California’s outdated prescription drug monitoring program. In 2014, the state medical board worked with physicians to develop balanced clinical guidelines that emphasize the complexity of the issue and the need for providers to work together to prescribe pain medications in the safest and most effective manner possible. As a result of these and other efforts, data show that California has the second-lowest number of opioid pain reliever prescriptions per 100 residents in the nation.                

Read more:                


Preventing Youth Marijuana Use: Changing Perceptions of Risk                
Center for the Application of Prevention Technologies                
Thursday, May 19, 2016                 
2 p.m. (ET)                 

Grant Awarded

Northern California Community Health Coalition Gets Grant to Fight Opioid Abuse                
Martin Espinoza, Press Democrat                
April 17, 2016                

The Redwood Community Health Coalition in Sonoma County, Calif., has received a $60,000 grant from the California HealthCare Foundation for a multipronged opioid prevention campaign. The campaign includes developing guidelines for prescribing opioids, expanding access to medication for opioid withdrawal, and making naloxone more readily available.                 

Read more:                

Grant Announcements

Prescription Drug Overdose: Data-Driven Prevention Initiative                
Center for Disease Control and Prevention’s National Center for Injury Prevention and Control                
Due: May 27, 2016                 

Bottle Tracking Program                
National Association of Drug Diversion Investigators                
Due: None Specified                

 National Take-Back Initiative

National Prescription Drug Take-Back Day                
Drug Enforcement Administration                
Saturday, April 30, 2016                
10 a.m.–2 p.m.                

The Opioid Epidemic: Nurses Can Help                
Daria L. Waszak, Advance Healthcare Network                
April 19, 2016                 

Take-Back Events & Drop Boxes

Walla Wall (Wash.) Prescription Drug Disposal Set for April 30                
Union Bulletin                
April 17, 2016                 
Victoria (Texas) Medication Disposal Day Planned for April 30                
Jennifer Sourdellia, Victoria Advocate                
April 17, 2016                 
Free Disposal of Prescription Drugs April 30 Across Whatcom County (Wash.)                
Bellingham Herald                
April 17, 2016                 

Ogdensburg (N.Y.) Police Holding Prescription Drug Take-Back Day April 30                
Watertown Daily Times                
April 17, 2016                 

National Pharmaceutical Drug Take Back Day Will Be April 30 in SeaTac (Wash.)                
Scott Schaefer, SeaTac Blog                
April 17, 2016                 

Drug Drop Box Moved at Fond du Lac (Wisc.) Police Dept.                
Fond du Lac Reporter                
April 17, 2016                 

Medication Take-Back Disposal Event Announced for East Montgomery County (Texas)                
The Observer                
April 16, 2016                 
Hanover Township (N.J.) Will Take Part in Drug Take-Back Day                
Jacob Seibel, Citizens’ Voice                
April 16, 2016                 
Northland Area (Mo.) Agencies Encourage Safe Rx Disposal on Take-Back Day April 30                
Excelsior Springs Standard                
April 19, 2016                 

Sussex County (N.J.) Residents Urged to Spring Clean Medicine Cabinets                
Sparta Independent                
April 18, 2016                 
Hancock County (Ill.) Law Enforcement Taking Back Unwanted Prescription Drugs                
Daily Gate City                
April 18, 2016                 
New York Counties Plan April 30 Drug Take-Back Day                
Mike Hibbard, Finger Lakes Times                
April 17, 2016                 

Artesia (N.M.) Police Department to Host Drug Take-Back Days                
Artesia Daily Press                
April 17, 2016                 

Pewaukee (Wisc.) Police Dept. to Host Prescription Drug Take-Back Initiative                
Lake Country Now                
April 19, 2016                 

Kingston Township (Penn.) Residents Urged to Rid Homes of Unused Drugs on April 30                
Eileen Godin, Times Leader                
April 18, 2016                 

Tift County (Ga.)Take-Back Initiative to Be Held on April 30                
Angye Morrison, The Tifton Gazette                
April 19, 2016                 

Ridgefield (Conn.) to Hold Drive-Through Prescription Drug Take Back                
Wendy Ann Mitchell, Ridgefield Patch                
April 19, 2016                 

Drug Take-Back Event This Saturday at Hy-Vee in Carroll (Iowa)                
CBC Online                
April 19, 2016                 
Henrico County (Va.) Police, DEA Team Up for Rx Drug Take-Back Event April 30                
Trevor Dickerson, RVA News                
April 19, 2016                 

Pensacola (Fla.) Residents Urged to Dispose of Prescription Drugs Safely                
Pensacola News Journal                
April 20, 2016                 
Over 200 lbs. of Medications Collected from Initiative in Arkansas                
Arkansas Matters                
April 19, 2016                 

Dickinson County (Iowa) Area Agencies Announce Drug Take-Back Events                
Dickinson County News                
April 19, 2016                 

Illinois State’s Attorney Teams Up with Coroner and Sheriff for Medicine Disposal Event                
Advantage News                
April 20, 2016                 

Oskaloosa (Iowa) Disposal Day for Old Medications to Be Held                
Angie Holland, Oskaloosa Herald                
April 20, 2016                 

Attleboro (Mass.) Area Police Departments Conducting Drug Disposal Day                
The Sun Chronicle                
April 20, 2016                 

Upstate New York Police Agencies Will Participate in Drug Take-Back Event                
Jeff Murray, Star Gazette                
April 20, 2016                 

Drug Take-Back Event Set for April 29 in Unity (Maine)                
April 20, 2016                 

Laredo (Texas) Announces Drug Take-Back Proclamation                
Juan Rodriguez, KGNS                
April 20, 2016                 

Mission Viejo (Calif.) Participates in National Prescription Drug Take-Back Day                
Jamie Wilkins, Mission Viejo Patch                
April 20, 2016                 

Edwardsville (Ill.) Police Dept. to Take Back Unwanted Prescriptions April 30                
Dan Brannan, Riverbender                
April 20, 2016                 

Upcoming Opportunities for Wayne (Penn.) Community to Dispose of Prescriptions                
PR Newswire                
April 21, 2016                 

Williamsburg (Va.) Police to Dispose of Medications                
Virginia Gazette                
April 21, 2016                 
San Bernardino County (Calif.) Residents Urged to Participate in Take-Back Day                
Gina Gonzalez, Fontana Herald News                
April 21, 2016                 

New Jersey Take-Back Day Gets Unused Drugs Out of Medicine Cabinets                
Erin Delmore, NJTV News                
April 21, 2016                 
Bowling Green (Ohio) Police to Hold Drug Take-Back Event                
April 21, 2016                 

Cedar Rapids (Iowa) Police to Participate in Drug Take-Back Event                
Lee Hermiston, The Gazette                
April 20, 2016                 

Drug Take-Back Events to Be Held Across Bristol (Va.) Area On April 30                
Lurah Spell, Bristol Herald Courier                
April 21, 2016                 

Sealy (Texas) Police To Round Up Unwanted Prescription Drugs                
Sealy News                
April 21, 2016                 
Cincinnati Law Enforcement Agencies Host National Drug Take-Back Day                
Austin Fast, WPCO Cincinnati                
April 21, 2016                 

Upcoming Conferences and Workshops

Medical Marijuana Seminar                
Private Motor Truck Council of Canada                
May 3, 2016                
Alberta, Canada                

24th Annual Meeting                
Society for Prevention Research                
May 31–June 3, 2016                
San Francisco, Calif.                

2016 Annual Conference                
International Health Facility Diversion Association                
September 13–14, 2016                
Duke Energy Convention Center                
Cincinnati, Ohio                 


29th Annual National Prevention Network Conference                
National Prevention Network                
September 13–15, 2016                
Buffalo, N.Y.                

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.