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April 3, 2013

SAMHSA Prevention of Prescription Drug Abuse in the Workplace Listserv

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April 3, 2013 (PDF version)
Featured Article

J.R. Webb, M.A. Valasek, and C.S. North. 2013. "Prevalence of Stimulant Use in a Sample of U.S. Medical Students." Annals of Clinical Psychiatry 25(1):27-32.

Yale University researchers used a cross-sectional survey to measure the prevalence and demographic correlates of prescription stimulant use among third-year students at a medical school. One fourth of 144 respondents reported they had been offered stimulant medications without a prescription while in medical school. Lifetime prevalence of stimulant use was 20 percent and prevalence of use during medical school was 15 percent. By comparison, 6.9 percent of all college students report stimulant use. More white medical students (32 percent) than Asian students (7 percent) reported stimulant use. Nine percent of respondents reported an attention deficit hyperactivity disorder (ADHD) diagnosis; those diagnosed were more than 30 times likelier to have used stimulants compared to those without a diagnosis. Of those who had taken stimulants, 83 percent reported using them specifically for cognitive performance enhancement, such as studying better and staying awake longer while on clinical duties. We caution readers that data from the medical school surveyed may not be representative of the situation elsewhere. This study needs replication. The authors concluded: "Medical students eventually will become the prescribing doctors who dispense these medications, and their personal experience with stimulant use may affect future prescribing trends for children diagnosed with ADHD and students experiencing academic difficulties for other reasons."

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Journal Articles
E.G. Benotscha, R. Zimmerman, L. Cathers, S. McNulty, J. Pierce, T. Heck, P.B. Perrina, and D. Snipes. 2013. "Nonmedical Use of Prescription Drugs, Polysubstance Use, and Mental Health in Transgender Adults." Drug and Alcohol Dependence.

Researchers recruited 155 transgender adults in the Mid-Atlantic region to complete anonymous, self-administered surveys assessing demographic information, nonmedical use of prescription drugs (NMUPD) and other substance use, nonmedical use of hormones, psychosocial factors, and psychiatric symptoms. Overall, 26.5 percent of participants reported lifetime NMUPD, with the most commonly reported nonmedically used medications being prescription analgesics (23.9 percent), anxiolytics (17.4 percent), stimulants (13.5 percent), and sedatives (8.4 percent). Nonmedical use of hormones was also frequently reported (30.3 percent). Participants reporting NMUPD were likelier to report use of illicit drugs. NMUPD was associated with lower self-esteem, more gender identity-based discrimination, and more self-reported symptoms of anxiety, depression, and somatic distress. Psychiatric symptoms remained statistically associated with NMUPD after controlling for demographic factors and other substance use.

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E. Frauger, C. Moracchini, R. Le Boisselier, D. Braunstein, X. Thirion, and J. Micallef. 2013. "OPPIDUM Surveillance Program: 20 Years of Information on Drug Abuse in France." Fundamental and Clinical Pharmacology. doi:10.1111/fcp.12024.

This article describes the Observation of Illegal Drugs and Misuse of Psychotropic Medications (OPPIDUM), a French drug abuse surveillance system, and demonstrates the system's ability to effectively provide interesting data on drug abuse to health authorities and physicians. The OPPIDUM is an annual, cross-sectional survey that anonymously collects information on drug abuse and dependence in patients recruited in specialized care centers dedicated to drug dependence. From 1990 to 2010, 50,734 patients were included in the survey with descriptions of 102,631 psychoactive substance consumptions. These data outlined emergent behaviors such as misuse of buprenorphine by intravenous or nasal administration. The system has helped assess abuse of emergent drugs such as clonazepam and methylphenidate and detected the decrease of flunitrazepam abuse following implementation of regulatory measures.

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J. Kim, I. Sanghwan, H. Choi, and L. Sooyeun. 2013. "Illegal Use of Benzodiazepines and/or Zolpidem Proved by Hair Analysis." Journal of Forensic Sciences 58(2):548-51. doi:10.1111/1556-4029.12034.

In this study, 18 cases involving illegal use of benzodiazepines and/or zolpidem were proved by hair analysis. The drugs were extracted from the hair samples using methanol and analyzed using liquid chromatography and mass spectrometry. Cases were classified according to their history: five pertained to illegal use among medical staff, eight resulted from inappropriate or illegal distribution, and five related to drug-facilitated crimes. Among the 18 cases, zolpidem was identified in eight, alprazolam in seven, diazepam in six, and clonazepam in four.

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H. Matusow, S.L. Dickman, J.D. Rich, C. Fong, D.M. Dumont, C. Hardin, D. Marlowe, and A. Rosenblum. 2013. "Medication Assisted Treatment in U.S. Drug Courts: Results From a Nationwide Survey of Availability, Barriers and Attitudes." Journal of Substance Abuse Treatment 44(5):473-80. doi:10.1016/j.jsat.2012.10.004.

Medication-assisted treatment (MAT) is an effective option for addressing opioid addiction. Researchers used an online survey to assess availability, barriers, and need for MAT in drug courts. Ninety-eight percent reported opioid-addicted participants and 47 percent offered agonist medication (56 percent for all MAT including naltrexone). Barriers included cost and court policy. Responses revealed significant uncertainty, especially among courts that did not provide MAT. Political, judicial, and administrative opposition appear to affect MAT's inconsistent use and availability in drug court settings.

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T.L. Mark, J. Dilonardo, R. Vandivort, and K. Miller. 2013. "Psychiatric and Medical Comorbidities, Associated Pain, and Health Care Utilization of Patients Prescribed Buprenorphine." Journal of Substance Abuse Treatment 44(5):481-87. doi:10.1016/j.jsat.2012.11.004.

Researchers used the 2007-09 MarketScan Research Databases to describe comorbidities and healthcare utilization of individuals treated with buprenorphine. Buprenorphine recipients had a high prevalence of comorbidities associated with chronic pain, including back problems (42 percent), connective tissue disease (24-27 percent), and nontraumatic joint disorders (20-23 percent). Approximately 69 percent of recipients filled prescriptions for opioid agonist medications in the 6 months before buprenorphine initiation. Buprenorphine recipients were frequently diagnosed with anxiety (23-42 percent) and mood disorders (39-51 percent), and filled prescriptions for antidepressants (47-56 percent) and benzodiazepines (47-56 percent) at high rates. Only 53-54 percent of patients filling a prescription for buprenorphine had a coded opioid abuse/dependence diagnosis.

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D. Rastegar, H. Kunins, J. Tetrault, A. Walley, and A. Gordon. 2013. "2012 Update in Addiction Medicine for the Generalist." Addiction Science & Clinical Practice 8:6. doi:10.1186/1940-0640-8-6.

This article presents an update on addiction-related medical literature for calendar years 2010-11, focusing on studies with implications for generalist practice. Articles pertain to medical comorbidities and complications, prescription drug misuse among patients with chronic pain, screening and brief interventions, and pharmacotherapy for addiction.

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http://www.ascpjournal.org/content/pdf/1940-0640-8-6.pdf or 

S. Sood, J. Howell, V. Sundararajan, P.W. Angus, and P.J. Gow. 2013. "Paracetamol Overdose in Victoria Remains a Significant Health Care Burden." Journal of Gastroenterology and Hepatology. doi:10.1111/jgh.12196.

Researchers investigated the epidemiology and outcome of over-the-counter paracetamol (acetaminophen) overdoses in Victoria, Australia. The Victorian admitted episode dataset was examined for all patients who had a diagnosis of paracetamol poisoning or paracetamol adverse effect in therapeutic use from July 1, 2000, to June 30, 2007. Data extracted included all ICD-10 codes related to admissions, gender, age range, and cause of death (if applicable). There were 14,662 hospital admissions for paracetamol overdoses over 7 years; 15 percent of cases were accidental overdoses. The overdose rate fell from 46 cases per 100,000 in 2001 to 39 cases per 100,000 in 2006. Most overdoses occurred among women (71 percent). Seventy-eight percent of cases involved patients between 15 and 50 years of age. Complications and mortality were relatively uncommon, with 26 deaths directly attributable to paracetamol overdose over the 7-year period. No child under age 15 died.

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P.T. Veliz, C. Boyd, and S.E. McCabe. 2013. "Playing Through Pain: Sports Participation and Nonmedical Use of Opioid Medications Among Adolescents." American Journal of Public Health. doi:10.2105/AJPH.2013.301242.

Researchers assessed nonmedical use of prescription opioids among adolescents who participated in competitive sports. Using data from Monitoring the Future, they discovered adolescent participants in high-injury sports had 50 percent higher odds of nonmedical use than adolescents who did not participate in competitive sports.

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M.A. Yonas, M. Garrettson, A. Gielen, and E.A. Parker. 2013. "Integrating Principles of Community-Based Participatory Research (CBPR) With the Injury Prevention and Control Agenda." Injury Prevention 19:149. doi:10.1136/injuryprev-2013-040788.

This article discusses the use of community-based participatory research (CBPR) to successfully address the injury prevention and control agenda. CBPR equitably involves community partners in the research process and recognizes the unique strengths each party brings to understanding and addressing the issue. Many communities have had success with the CBPR approach. For example, Project Lazarus, a prescription drug overdose prevention program in rural North Carolina, was initiated and developed by a pastor in partnership with many stakeholders, including university and state-based epidemiologists. Evaluation of the communitywide effort to improve chronic pain treatment and reduce overdoses showed dramatic reductions in overdose deaths without reducing availability of pain medications. These findings prompted the state's Medicaid authority to implement the intervention model statewide. The pastor and other community coalition stakeholders partnered with the University of North Carolina Injury Prevention Research Center to obtain funding and design a statewide evaluation.

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News and Reports

Tennessee Doctors Required to Check Database Before Writing Prescription
March 19, 2013

The Tennessee Health Department now requires doctors to use the state's substance controlled monitoring database so they can see when and where a person was last prescribed medications. Officials believe this will help reduce prescription misuse and abuse. In 2011, more than 1,000 people died from drug overdoses in Tennessee.

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Assembly of First Nations Supports National Strategy on Prescription Drug Abuse, Inclusive of First Nations
Digital Journal
March 27, 2013

Assembly of First Nations National Chief Shawn A-in-chut Atleo supports the national strategy launched by the Canadian Centre on Substance Abuse (CCSA) for responding to prescription drug abuse. CCSA considered the needs of First Nations' rural, remote, and isolated communities in developing a strategy promoting the importance of First Nation culture, knowledge, and healing practices--all of which the communities have used along with Western medicine to successfully address the prescription drug crisis in Ontario's First Nation communities.

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Hy-Vee Accepting Omahans' Unused Medications for Disposal
Livewell Nebraska
March 28, 2013

Hy-Vee grocery stores in Omaha, Nebraska, are now accepting unused or expired prescription medications, including narcotics, depressants, and stimulants. The pharmacy will seal and send them to a disposal site for incineration.

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DEA Official Backs Tighter Rules on Narcotic Painkillers
Los Angeles Times
March 26, 2013

A letter from the Director of the Drug Enforcement Administration's (DEA's) Office of Diversion Control urged the Food and Drug Administration to impose stricter rules for the way pharmaceutical companies market narcotic pain medications such as OxyContin and Vicodin to physicians. The DEA is concerned about potential public health risks resulting from abuse of opioid drug products.

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Teen Athletes and Performance-Enhancing Drugs: A Lose-Lose Situation
March 25, 2013

The author, a medical doctor, encourages parents to talk to their children about doping with a prohibited substance or other banned method to improve athletic performance. This article describes the use of steroids, growth hormones, erythropoietin, transfusion, and gene therapy.

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More Than 12 Million Doses of Prescription Drugs Collected in NC During Operation Medicine Drop Last Week
High Country Press
March 28, 2013

More than 250 prescription drug take-back events took place throughout North Carolina during Operation Medicine Drop, and more than 12 million doses of prescription and over-the-counter drugs were collected, breaking previous records. Organizers saw a large increase in the collection of fentanyl patches. The most interesting turned-in items were hydrocodone and morphine prescribed in 1958.

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Putting the Lid on Prescription Drug Abuse
National Education Association Health Information Network
March 27, 2013

This blog post discusses prescription drug abuse resources for keeping children safe while home on spring and summer breaks.

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Is Your Boss an Alcoholic or an Addict?
Fox News
March 23, 2013

The author, a clinical director at a rehab center in the Hamptons, discusses addiction among white collar executives who mix alcohol and pain relievers such as Xanax and Vicodin throughout their workday. This article describes signs employees should look for and what they can do to get their bosses help.

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New York Doctor Charged as Head of $10 Million Oxycodone Ring
ABC News
March 28, 2013

This article and video (2:11 minutes) focus on a doctor who illegally wrote oxycodone pill prescriptions for patients in New York, New Jersey, and Pennsylvania. Between September 2011 and February 2013, New Jersey pharmacies dispensed nearly 500,000 pills of oxycodone based on thousands of prescriptions originating from the doctor's office. By contrast, New York pharmacies dispensed approximately 75,000 pills based on approximately 600 similar prescriptions between August 2009 and January 2013.

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Real Estate Agent Charged With Stealing Prescription Drugs
The Daytona Beach News-Journal
March 23, 2013

This brief article discusses the arrest of a real estate agent caught stealing prescription medications from her client's home.

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Massachusetts Medical Society Testifies in Opposition to Proposed Regulations of Prescription Monitoring Program
Massachusetts Medical Society
March 22, 2013

The Massachusetts Medical Society testified before the Department of Public Health in opposition to proposed regulations for a prescription monitoring program--raising objections and suggesting changes that would establish an effective and efficient program.

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Ind. Police Battle Prescription Drug Abuse
The Atlanta Journal-Constitution
March 29, 2013

Police in Columbus, Indiana, use four initiatives to decrease prescription drug theft and abuse: 1) The Indiana Scheduled Prescription Electronic Collection and Tracking program--a secure online database that includes reports showing patients, doctors, and drug amounts prescribed by physicians in various states; 2) Periodic workshops with doctors, nurses, nursing homes, and pharmacy managers to share information about ongoing investigations and trends in drug street sales; 3) A full-time drug diversion investigator; and 4) A theft medication affidavit system to make it more difficult for people to lie about prescription medications being stolen from their homes or businesses.

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Injury, Death by Poison Happens All Too Many Times
McCook Daily Gazette
March 19, 2013

This article provides a brief overview of poisoning statistics: who poisoning affects and how often and what people can do to stay safe.

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Poll: Kentucky Oblivious to Drug Situation
March 20, 2013

In a phone poll conducted by the University of Cincinnati Institute for Policy Research, about 44 percent of 1,680 respondents correctly identified the leading cause of Kentucky's unintentional deaths as unintentional drug poisoning and overdose. Only 41 percent of Northern Kentucky respondents correctly answered the question. In Eastern Kentucky, where prescription drug abuse is most prevalent, most respondents correctly said unintentional drug poisoning and overdose were responsible for killing more people than traffic accidents.

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DEA Targets FedEx, UPS in Online-Pharmacy Probe
Orlando Sentinel
March 26, 2013

FedEx and UPS disclosed that they are targets of a federal investigation related to packages shipped from online pharmacies. The Drug Enforcement Administration will not confirm its engagement in the probe; however, it has been cracking down on online pharmacies suspected of illegal activity that use mail and shipping companies for deliveries.

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RxISK Asks: Are Prescription Drugs Causing Suicides?
PR Web
March 25, 2013

This press release announces a new video interview with Dr. David Healy, co-founder of RxISK.org. Dr. Healy explains how prescription medication use can lead to suicide and what can be done to address the problem. RxISK.org is a free, independent Web site for researching and reporting prescription drug side effects.

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Misuse and Abuse of ADHD Meds Among College Students: Updated Review of a Growing Concern
Sharp Brains
March 26, 2013

The author, a child clinical psychologist, provides a summary of the research on nonmedical use and misuse of attention deficit hyperactivity disorder medications. Addressing nonmedical use of stimulant medication, the article discusses use frequency, sources of medications, user characteristics, motivation for use, consequences, and diversion.

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Prescription Drug Abuse Strategy Targets Governments, Health Practitioners
The Vancouver Sun
March 27, 2013

Canadian officials announced a new 10-year national strategy to tackle the prescription drug abuse crisis. It would overhaul legislation so doctors and pharmacists could no longer prescribe pain relievers indiscriminately. The strategy urges governments and regulators to set up a pan-Canadian surveillance system that tracks prescription drug abuse patterns to the regional level. It also recommends provinces establish prescription monitoring programs within 2 years and engage with regulators to clamp down on high-risk prescribing and dispensing practices. The plan would increase policing resources so law enforcement could raise awareness and promote safe storage of properly used drugs.

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FDA Advisers Recommend Approval of Titan Pharma's Opioid Dependence Drug
March 21, 2013

U.S. Food and Drug Administration advisers voted 10 to 4, with one abstention, that Probuphine (a long-acting, subdermal implant formulation of buprenorphine) should be approved based on the safety, effectiveness, and risk-benefit profile shown in clinical studies. Probuphine is surgically implanted under upper-arm skin during a 10 to 15-minute office procedure. It is effective for about 6 months.

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Grant Announcement

Harold Rogers Prescription Drug Monitoring Program FY 2013 Competitive Grant Announcement
Deadline: May 2, 2013
Upcoming Webinar

Children's Safety Network Webinar Series on Prescription Drug Abuse Prevention Among Teens and Young Adults: Prescription Drug Abuse and Co-Occurring Psychiatric Disorders in Young Adults
April 9, 2013
2-3 p.m. (EST)

This Webinar will explore available research on rates of comorbidity between prescription drug use and other psychiatric disorders and offer a clinical perspective for working with people ages 18-25. The Webinar aims to help people who work with this age group better understand prevalence of the problem, prescription medications being abused, associated co-occurring disorders, and how to effectively intervene with at-risk young adults.

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Upcoming Conferences and Workshops
Heroin and Prescription Drug Diversion
April 12, 2013
9 a.m.-12:30 p.m.
Milwaukee County Sheriff's Office-Training Academy
9225 South 68th Street
Franklin, Wisconsin

The Milwaukee High Intensity Drug Trafficking Area, Safe & Sound, and 27th Street West Drug Free Coalition are sponsoring a training course on heroin and prescription drug diversion for anti-drug coalition members, community organizers, youth development and school professionals, people who work with older adults, and community- and faith-based organizations. Discussion topics will include types of heroin, history of use, how to identify someone under the influence of an opiate, and available treatment.

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Maryland Workers' Comp Prescription Drug Abuse Summit
April 12, 2013
8:30 a.m.-1 p.m.
Linthicum, Maryland

2013 Symposium for Medical Professionals: Kentucky Medical Communities UNITEd
April 13-June 8, 2013
Various Cities, Kentucky

Drug Enforcement Administration's Sixth National Prescription Drug Take-Back Day
April 27, 2013
10 a.m.-2 p.m.
Various Locations Nationwide

National Prevention Week 2013
May 12-18, 2013
Various Locations Nationwide

Prescription Drug Training
May 23, 2013
8:30 a.m.-4 p.m.
Alvernia University Student Center Seminar Rooms
400 Saint Bernardine Street
Reading, Pennsylvania 19607

This training will provide an overview of the prescription medication abuse epidemic. Signs and symptoms of abuse will be presented with attention to contributing factors, such as the Internet, and how drugs are obtained and used. Treatment and prevention will be highlighted, with a focus on local efforts to address the problem.

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The Generation Rx University Conference for Prescription Drug Abuse Prevention and Recovery
August 7-8, 2013
The Ohio State University Blackwell Inn & Conference Center
2110 Tuttle Park Place
Columbus, Ohio

2013 National Safety Council Congress and Expo
Congress: September 28-October 4, 2013
Expo: September 30-October 2, 2013
McCormick Place (West Building)
Chicago, Illinois
Please e-mail Rekaya Gibson at rgibson@pire.org with questions or comments about the SAMHSA Prevention of Prescption Drug Abuse in the Workplace Listserv.  
About PAW and the Listserv
The PAW TA Center addresses prescription drug abuse--a growing public health problem with increasing burdens on workers, workplaces, and our economy. Prescription drug abuse affects workplace productivity and increases employee absenteeism, employee presenteeism, and workers' compensation claims. On a wider scale, overdose deaths linked to prescription opioids tripled from 1999 to 2006, and prescription drug abuse killed more Americans in 2009 than died that year in auto crashes.
Send your request for PAW technical assistance to PAW-TA@pire.org or contact Rekaya Gibson at 504.261.8107 or Deborah Galvin at 240.276.2721. Requests are subject to SAMHSA approval. You will be notified of the status of your request.
We aim to conduct systematic and inclusive searches of professional journals, leading newspapers and magazines, and federal websites, as well as contributions from listserv subscribers (please e-mail suggestions to rgibson@pire.org). We will send links to articles along with brief descriptions of those articles. As we develop the listserv, however, we hope to add commentary and invite feedback from subscribers. Our goal is to expand the listserv to become a widely used and recognized source of the most current and authoritative information on prescription drug abuse--especially in workplaces.

The "SAMHSA Prevention of Prescription Drug Abuse in the Workplace Listserv" 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 viewpoints or opinions and are not assessed for validity, reliability, or quality. The "SAMHSA Prevention of Prescription Drug Abuse in the Workplace Listserv" 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 journal articles.
The Injury Control Research Center at West Virginia University (WVU-ICRC) archives past Listserv issues at http://www.hsc.wvu.edu/icrc/Pages/SAMHSA-Prevention-of-Prescription-Drug-Abuse-in-th. The partnership efforts of WVU-ICRC are supported by Grant Number 1 R49 CE002109 from the Centers for Disease Control and Prevention (CDC). The contents of the Listserv archive are solely the responsibility of the authors and do not represent the official views of CDC or SAMHSA.

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