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April 7, 2016

PAW Weekly Update

    

                                          
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SAMHSA
           
SAMHSA Prescription Drug Abuse Weekly Update
         
         
WEEKLY
           
UPDATE
         
                             
          Issue 168  |  April 7, 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 Development                            
National                            
Marijuana                            
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Featured

 N.D. Volkow and A.T. McLellan. 2016. “Opioid Abuse in Chronic Pain—Misconceptions and Mitigation Strategies.” New England Journal of Medicine, doi:10.1056/NEJMra1507771.                        

This review by the director of the National Institute on Drug Abuse and former deputy director of the Office of National Drug Control Policy addresses common misconceptions about the abuse-related risks of opioid analgesics and highlights strategies to minimize those risks. It does not provide prescribing guidelines. Rather, it focuses on the pharmacologic properties of opioids that underlie both their therapeutic and abuse-producing effects and on ways pharmacology can help to correct common clinical misconceptions that interfere with proper prescription and monitoring of opioids for management of chronic pain. According to the authors, no single or simple change in prescribing behavior can be expected to alleviate all risks of opioid diversion, overdose, and addiction while properly managing pain. Risks of diversion are best mitigated by the full participation of all prescribers in prescription drug monitoring programs that rapidly update their data. Recommended overdose mitigation strategies include an overdose risk assessment and urine drug screening before prescription or refill of opioids; increased education of the patients and their families about overdose risks; use of an opioid treatment agreement; caution in prescribing high opioid doses or long-acting opioids; frequent clinical follow-up; and, potentially, a prescription for and instruction in the use of naloxone.                         

Read more:                        
http://www.nejm.org/doi/full/10.1056/NEJMra1507771                       
               
               

Journal Articles and Reports

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:10.1016/j.drugalcdep.2016.03.018.                

In a Michigan emergency department pilot study, 204 adult English-speaking patients who reported prescription opioid misuse during the prior 3 months received educationally enhanced usual care, with half randomly assigned to an added 30-minute motivational interview with a therapist. Six-month follow-up with 87 percent of the patients found greater declines in the motivational interview group than the usual care group in overdose risk behaviors (40.5 percent vs. 39.5 percent) and non-medical opioid use (50.0 percent vs. 39.5 percent).                

Read more:                
http://www.drugandalcoholdependence.com/article/S0376-8716(16)30005-9/abstract                                  

G. Cochran, J.L. Bacci, T. Ylioja, V. Hruschak, S. Miller, A.L. Seybert, and R. Tarter. 2016. “Prescription Opioid Use: Patient Characteristics and Misuse in Community Pharmacy.” Journal of the American Pharmacists Association, doi:10.1016/j.japh.2016.02.012.                

Researchers between September 2014 and June 2015 screened a convenience sample of 333 adult patients (71 percent of those approached) at two urban and two rural community pharmacies in southwestern Pennsylvania, using a battery of pain, posttraumatic stress disorder (PTSD), opioid misuse, and substance misuse instruments. Nearly the entire sample reported pain above and general health below national norms. Fifteen percent had misused prescription drugs, with 19 percent of them misusing hydrocodone and 21 percent misusing morphine. In multivariate regression, odds of misuse were higher for patients with positive screens for illicit drug use (adjusted odds ratio [AOR] = 8.1), PTSD (AOR = 5.9), or depression (AOR = 2.4).                

Read more:                
http://www.japha.org/article/S1544-3191(16)00123-0/abstract                                  

A.D. Furlan, S. Hassan, I.M. Famiyeh, W. Wang, and J. Dhanju. 2016. “Long-Term Opioid Use After Discharge From Inpatient Musculoskeletal Rehabilitation.” Journal of Rehabilitative Medicine (preview), doi:10.2340/16501977-2080.                

From October 2011 to September 2013, staff at the Toronto Rehabilitation Institute’s musculoskeletal program recruited 64 opioid-naive patients with no history of chronic pain who were discharged with prescribed opioids for pain management. Mean patient age was 71. Telephone follow-up with half of the patients at 6 months post-discharge found nine (28 percent of those contacted) were still taking prescribed opioids. Patients who were still using opioids had higher scores at discharge on the Opioid Risk Tool than patients who were not.                 

Read more:                
http://www.medicaljournals.se/jrm/content/?doi=10.2340/16501977-2080                                 

C. Hildebran, G. Leichtling, J.M. Irvine, D.J. Cohen, S.E. Hallvik, and R.A. Deyo. 2016. “Clinical Styles and Practice Policies: Influence on Communication with Patients Regarding Worrisome Prescription Drug Monitoring Program Data.” Pain Medicine, doi:10.1093/pm/pnw019.                

Semi-structured telephone interviews with 33 clinicians who routinely used Oregon’s prescription drug monitoring program (PDMP) found approaches for communicating about PDMP results ranged from openly sharing, questioning patients without disclosing access to the PDMP, and avoiding the conversation. Clinicians also reported practice policies and procedures that influenced communication with their patients about prescribing and ongoing care, including policies that normalized use of the PDMP with all patients and that facilitated difficult conversations by providing a rationale not to prescribe in certain circumstances.                

Read more:                
http://painmedicine.oxfordjournals.org/content/early/2016/03/22/pm.pnw019.abstract                                  

B.B. Kitch and R.C. Portela. 2016. “Effective Use of Naloxone by Law Enforcement in Response to Multiple Opioid Overdoses.” Prehospital Emergency Care 20(2): 226–9, doi:10.3109/10903127.2015.1076097.                

Pitt County, North Carolina, trained two law enforcement agencies to identify opioid overdose and use naloxone therapy. In a 48-hour period, shortly after introduction of fentanyl into the illicit drug market, officers successfully deployed five doses of naloxone to revive four individuals.                

Read more:                
http://www.tandfonline.com/doi/abs/10.3109/10903127.2015.1076097                                  

S.M. Murphy and D. Polsky. 2016. “Economic Evaluations of Opioid Use Disorder Interventions.” PharmacoEconomics, doi:10.1007/s40273-016-0400-5.                

A systematic review through August 2015 identified 49 articles (six of them reviews) that reported economic evaluation studies of interventions for opioid use disorders. The review agrees with prior reviews that methadone maintenance therapy is an economically advantageous opioid use disorder therapy. The economic literature that compares methadone therapy with other opioid use disorder pharmacotherapies is limited, as is the literature on other forms of therapy.                

Read more:                
http://link.springer.com/article/10.1007/s40273-016-0400-5                                  

C. Tjagvada, S. Skurtveitab, J.G. Bramnessa, L. Gjersingac, M. Gossopad, and T. Clausena. 2016. “Misuse of Prescription Drugs and Overdose Deaths.” Journal of Substance Use, doi:10.3109/14659891.2015.1077280.                

Researchers in Oslo, Norway, investigated prescribing and dispensing patterns between 2006 and 2008 for the 167 drug-overdose deaths with positive post-mortem tests for benzodiazepines or opioids/carisoprodol (strong analgesics). Among 128 deceased with toxicological findings of benzodiazepines only, 28 percent had been dispensed benzodiazepines recently (within 4 weeks prior to death); among 15 with strong analgesics, 33 percent had been dispensed the drugs recently; among 24 involving both benzodiazepines and strong analgesics, half recently had been dispensed the drugs. A third of the deceased had five or more different prescribing physicians of either benzodiazepines or strong analgesics in the year prior to death. Doses of both dispensed benzodiazepines and strong analgesics were higher than recommended. Younger age and residing outside Oslo were associated with dying on drugs that had not been dispensed.                

Read more:                
http://www.tandfonline.com/doi/abs/10.3109/14659891.2015.1077280                                  

T. Winhusen1, J. Theobald, D. Lewis, C. M. Wilder, and M.S. Lyons. 2016. “Development and Initial Testing of a Tailored Telephone Intervention Delivered By Peers to Prevent Recurring Opioid-Overdoses.” Health Education Research 31 (2):146–60, doi:10.1093/her/cyw010.                

In an eight-patient pilot test, peers presented a computer-facilitated, individually tailored telephone intervention designed to prevent recurring opioid-overdoses. Peer interventionists completed 4 hours of training. Recruitment letters were sent to patients treated for opioid-overdose in a hospital emergency department within the prior 8 months. All participants rated the intervention as “very helpful.” Opioid-overdose knowledge rose from 70 percent to 94 percent. Interest in receiving medication-assisted treatment, measured on a 10-point scale, increased from 8.1 to 9.5.                 

Read more:                
http://her.oxfordjournals.org/content/31/2/146.abstract                
               

 Professional Development

M.H. Andreas, E. Rhodes, T. Bourgoise, G.M. Carter, R.S. White, D Indyk, H. Sacks, and R. Rhodes. 2016. “An Ethical Exploration of Barriers to Research on Controlled Drugs.” American Journal of Bioethics, doi:10.1080/15265161.2016.1145282.                

The authors examine the ethical, social, and regulatory barriers that may hinder research on therapeutic potential of certain controversial controlled substances like marijuana, heroin, or ketamine. Hazards for individuals and society and potential adverse effects on communities may be good reasons for limiting access and justify careful monitoring of these substances. Overly strict regulations, fear of legal consequences, stigma associated with misuse and populations using illicit drugs, and lack of funding may, however, limit research on their therapeutic potential. Ethical concerns pertinent to research with illicit and addictive substances include participant recruitment that unduly induces risk of adverse events and addiction, informed consent, therapeutic misconception, and risk to participants, researchers, and institutions. The authors propose an empirical research agenda to provide an evidentiary basis for ethical reasoning. A series of open peer commentaries have been posted about this article and the authors have responded. Notable was commentary about unregulated off-label use of ketamine and opioids.                

Read More                
http://www.ncbi.nlm.nih.gov/pubmed/26982922                 
http://www.tandfonline.com/doi/abs/10.1080/15265161.2016.1153170?journalCode=uajb20                                  

D.S. Aschenbrenner. 2016. “Nasal Spray Formulation of the Opioid Antagonist Naloxone Approved.” American Journal of Nursing 116(4):20, 21, doi:10.1097/01.NAJ.0000482133.81929.44.                

The FDA recently approved a nasal spray formulation of the opioid antagonist naloxone. It is intended to be easier to administer than injectable formulations.                 

Read more:                
http://journals.lww.com/ajnonline/Abstract/2016/04000/Nasal_
Spray_Formulation_of_the_Opioid_Antagonist.12.aspx
                                  

I. Danovitch. 2016. “PTSD and Opioid Use Disorder: A Narrative Review of Conceptual Models.” Journal of Addictive Diseases, doi:10.1080/10550887.2016.1168212.                

This review explores evidence underpinning three explanatory perspectives on comorbid posttraumatic stress disorder (PTSD) and opioid use disorder: the opioid susceptibility model/self-medication hypothesis, the PTSD susceptibility model, and the common factors model.                 

Read more:                
http://www.tandfonline.com/doi/abs/10.1080/10550887.2016.1168212                                  

W. Ling. 2016. “A Perspective on Opioid Pharmacotherapy: Where We Are and How We Got Here.” Journal of Neuroimmune Pharmacology, doi:10.1007/s11481-016-9663-z.                

This article discusses the social and political decisions behind the choice to develop methadone, naltrexone, and buprenorphine to treat opioid addiction. It also discusses how these drugs influence clinician interactions with patients who have opioid use disorders.                 

Read more:                
http://link.springer.com/article/10.1007/s11481-016-9663-z                                  

J. Rehm, P. Anderson, B. Fischer, A. Gual, and R. Room. 2016. “Policy Implications of Marked Reversals of Population Life Expectancy Caused by Substance Use.” BMC Medicine 14:42, doi:10.1186/s12916-016-0590-x.                

Marked reversal of life expectancy has been linked to substance use and related policies. This policy analysis gives examples from three countries including the impact of rising misuse of prescription opioids on white non-Hispanic people in the United States.                 

Read more:                
http://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-016-0590-x                 
               

National

One-Third of Opioid-Related Deaths in Baltimore Due to Fatal Drug Combination                
Emily Rappleye, Becker’s Healthcare                
March 31, 2016                

Baltimore City Health Commissioner Leana Wen, M.D., in a March 30 Wall Street Journal editorial, highlighted the dangers of taking opioids and benzodiazepines together. Dr. Wen reported that 70 percent of opioid deaths in Maryland also involved benzodiazepines. She and 40 other city and state health officials have formed a coalition that is pushing for a black box warning from the FDA highlighting the fatal consequences of using the drugs in combination. The FDA black box warnings on opioids announced last week failed to address this issue.                

Read more:                
http://www.beckershospitalreview.com/population-health/baltimore-health-commissioner-one-third-of-opioid-related-deaths-due-to-fatal-drug-combination.html                                  

President Obama Announces More Actions to Address Opioid and Heroin Abuse                
The White House                
March 29, 2016                

President Obama, speaking at the recent National Rx Drug Abuse and Heroin Summit in Atlanta, announced additional public and private sector actions to address prescription opioid misuse and heroin epidemic. The actions include expanding medication-assisted treatment and behavioral health support for people with opioid use disorders; establishing a mental health and substance use disorder parity task force; implementing mental health and substance use disorder parity in Medicaid; and making $11 million in grants available to states to purchase and distribute naloxone and train first responders on its use. More than 60 medical schools will require their students to take some form of prescriber education starting in the fall of 2016.                

Read more:                
https://www.whitehouse.gov/the-press-office/2016/03/29/fact-sheet-obama-administration-announces-additional-actions-address                                  

Republicans Rally Support for Strategies to Combat Heroin, Prescription Drug Abuse                
Ripon Advance News Service                
March 31, 2016                

Republican legislative leaders have voiced support for addressing the opioid epidemic after President Obama announced his administration would take additional measures at the recent National Prescription Drug Abuse and Heroin Summit. Congress is debating several related pieces of legislation, including the Comprehensive Addiction and Recovery Act, which have bipartisan support.                 

Read more:                
https://riponadvance.com/featured/republicans-rally-bipartisan-support-around-strategies-combat-heroin-prescription-drug-abuse                                  

Agriculture Secretary Unveils Next Steps to Address Substance Use in Rural Communities                
United States Department of Agriculture                
March 28, 2016                

U.S. Department of Agriculture (USDA) Secretary Tom Vilsack, who leads an interagency task force focused on substance use in rural communities, will travel to five states to host town halls to raise awareness and discuss solutions with local communities. Additionally, USDA is making available $1.4 million through its rural health and safety education competitive grants program. For the first time, USDA is encouraging applicants to develop projects that specifically work to educate the public about opioid abuse and overdose. Applications are due June 1, 2016.                

Read more:
http://www.usda.gov/wps/portal/usda/usdahome?contentid=2016/03/0077.xml&contentidonly=true                 

U.S. Opioid Market May Surpass $17 Billion by 2021                
PRNewswire                
March 31, 2016                

Business intelligence provider GBI Research in a new report projects that the U.S. market for opioids will grow from $11 billion in 2014 to $17.7 billion by 2021, a compound annual growth rate of 7 percent. The projected increase is attributed to a rising prevalence of chronic pain among the U.S. population, owing to an aging population and an increasing incidence of diabetes, obesity, cardiovascular disorders, arthritis and cancer. GBI Research said the U.S. consumes 80 percent of the world’s legal and illegal opioids.                

Read more:                
http://www.prnewswire.co.uk/news-releases/us-opioid-market-to-surpass-17-billion-by-2021-despite-substance-abuse-concerns-says-gbi-research-574122751.html                                  

Five Things to Know About American Pain Society’s Postsurgical Pain Management Guideline                
Laura Dyrda, Becker’s Healthcare                
April 01, 2016                

The American Pain Society has released a guideline for postsurgical pain management. An interdisciplinary expert panel with input from the American Society of Anesthesiologists developed the guideline, which the American Society of Regional Anesthesia and Pain Management also approved. The guideline includes considering non-opioid pain management options and monitoring patients on opioids for their reaction to the medication.                

Read more:                
http://www.beckersasc.com/asc-quality-infection-control/5-things-to-know-about-american-pain-society-s-postsurgical-pain-management-guideline.html                                 

Anesthesiologists Group Forms Committee to Address Opioid Abuse                
American Society of Anesthesiologists                
March 31, 2016                

The American Society of Anesthesiologists has announced the creation of an ad hoc committee to address opioid abuse. The committee will focus on common sense methods of prevention including co-prescribing naloxone for high-risk patients.                  

Read more:                
http://www.newswise.com/articles/american-society-of-anesthesiologists-announces-a-committee-to-address-opioid-abuse-and-encourages-co-prescribing-of-naloxone                

Strategies Outlined to Combat Drug Abuse at National Rx Drug Abuse & Heroin Summit                
National Rx Drug Abuse & Heroin Summit News Release                
March 30, 2016                

Among other strategies to promote awareness about the risks of prescription drug misuse, Major League Baseball announced it will promote the U.S. Drug Enforcement Agency’s 11th Prescription Drug Take-Back Day on April 30.                 

Read more:                
http://nationalrxdrugabusesummit.org/wp-content/uploads/2016/03/3-30-16-National-leaders-outline-strategies.pdf                                  

Corra Group Creates New Electronic Chain of Custody Forms for Drug Testing                
Corra Group                
March 31, 2016                

The Corra Group, which partners with Quest Diagnostics to provide trucking companies with employee drug testing, is introducing an electronic version of the U.S. Department of Transportation’s chain of custody form. The new format will allow more efficient drug testing of truck drivers.                 

Read more:                
http://www.prweb.com/releases/2016/03/prweb13296139.htm                                  

How a Pain Reliever Designed to Deter Abuse Helped Spark an HIV Outbreak                
NPR, All Things Considered                
April 1, 2016                

When the opioid pain reliever Opana was reformulated by Endo Pharmaceuticals in 2012 in an unsuccessful attempt to make it abuse-resistant, an unintended consequence was a spike in HIV. Prior to 2012, the drug was abused by being crushed and snorted or dissolved. After reformulation, it is abused by injection. In Scott County, Ind., injected Opana is one of the drugs implicated in an outbreak of 190 HIV cases since early 2015, the largest HIV outbreak in Indiana’s history. The report investigates the public health and financial motives that prompted Endo to reformulate the drug. (Includes audio 5:18 minutes)                

Read more:                
http://www.npr.org/sections/health-shots/2016/04/01/472538272/how-a-painkiller-designed-to-deter-abuse-helped-spark-an-hiv-outbreak                                  

Do Prescription Drug Monitoring Programs Work?                
Rachael Zimlich, Managed Healthcare Executive                
March 29, 2016                

The Centers for Medicare and Medicaid Services is considering requiring prescription drug monitoring program (PDMP) consultation when dispensing opiates. Some vested interests, however, have questioned the privacy of medical data captured by PDMPs and the effectiveness of PDMPs at preventing deaths by opioids.                 

Read more:                
http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/do-prescription-drug-monitoring-programs-work                                  

Why More Veterans are Abusing Opioids and the Push for Alternate Treatments                
Lucy Schouten, Christian Science Monitor                
March 29, 2016                

Half of older veterans suffer from chronic pain, Sarah Childress reported for PBS Frontline. In the case of opioids, however, the treatment is often proving at least as dangerous as the injury. Overbooked Veterans Affairs (VA) doctors for years have prescribed opioids as a quick fix. The number of veterans misusing prescription opioids tripled between 2005 and 2008 and is significantly higher than the general population, according to a National Institute on Drug Abuse study. The VA is exploring alternate pain management methodologies, including yoga, physical therapy and acupuncture. In Tulsa, Okla., where the VA hospital and clinic have issued an average of 1.6 opioid prescriptions per patient, a treatment court specifically for veterans boasts a 90 percent success rate in prescription opioid cases.                 

Read more:                
http://www.csmonitor.com/USA/USA-Update/2016/0329/Why-more-veterans-are-abusing-opioids-and-the-push-for-alternate-treatments-video                 
                 

Marijuana

 D.I. Abrams. 2016. “Integrating Cannabis into Clinical Cancer Care.” Current Oncology, doi:10.3747/co.23.3099.                  

The author reviews marijuana’s effectiveness for pain and nausea control and appetite stimulation. The author thinks that marijuana is effective in ameliorating symptoms of cancer and chemotherapy and that oncologists may find this medicine useful in treating cancer patients.                   

Read more:                  
http://www.current-oncology.com/index.php/oncology/article/view/3099/2084                                      

M. Cerdá, T.E. Moffitt, M.H. Meier, H. Harrington, R. Houts, S. Ramrakha, S. Hogan, and R. Poulton. 2016. “Persistent Cannabis Dependence and Alcohol Dependence Represent Risks for Midlife Economic and Social Problems: A Longitudinal Cohort Study.” Clinical Psychological Science, doi:10.1177/2167702616630958.                  

Researchers examined the association between cannabis use and dependence, prospectively assessed between ages 18 and 38, and economic and social problems at age 38. They studied the 1,037 participants in the Dunedin, New Zealand Longitudinal Study followed from birth to age 38. Study members with regular cannabis use and persistent dependence experienced downward socioeconomic mobility, more financial difficulties, workplace problems, and relationship conflict in early midlife. Cannabis dependence was not linked to traffic-related convictions. Associations were not explained by socioeconomic adversity, childhood psychopathology, achievement orientation, or family structure; cannabis-related criminal convictions; early onset of cannabis dependence; or comorbid substance dependence. Cannabis dependence was associated with more financial difficulties than was alcohol dependence; no difference was found in risks for other economic or social problems. Cannabis dependence is not associated with fewer harmful economic and social problems than alcohol dependence.                  

Read more:                  
http://cpx.sagepub.com/content/early/2016/03/16/2167702616630958.abstract                                      

Minnesota Lawmakers Propose Changes to Medical Marijuana Law                  
Jennifer Brooks, Star Tribune                  
April 1, 2016                   

A committee in Minnesota’s senate has passed legislation to amend the state’s medical marijuana law by adding inflammatory bowel disease as a covered condition, removing a requirement that pharmacists personally dispense cannabis to patients by hand and allowing pharmacists to consult via teleconference, and changing the timetable to open the state’s next five dispensaries. The state has enrolled more than 1,190 medical cannabis patients. That figure is expected to significantly increase after August, when the program expands to serve patients suffering from intractable pain.                  

Read more:                  
http://www.startribune.com/minnesota-lawmakers-propose-changes-to-medical-marijuana-law/374340261                                      

Four Arrested in Colorado for Sabotaging GMO Cannabis Crops                  
Earth First! Newswire                  
April 1, 2016                  

Four individuals were arrested in Basalt, Colo., and charged with “economic sabotage” for attempting to destroy genetically engineered marijuana plants being grown as medical marijuana by agribusiness Syngenta. The genetically modified plants can withstand harsher conditions, such as freezing temperatures, better than other varieties. The sabotage related to genetic engineering, not the distribution of medical marijuana itself.                    

Read more:                  
http://earthfirstjournal.org/newswire/2016/04/01/four-arrested-in-colorado-for-sabotaging-gmo-cannabis-crops                                      

Medical Marijuana Not Legal in Iowa Workplaces                  
Emma VanArsdale, Daily Gate City                  
March 28, 2016                  

As Iowa’s legislature considers expanding the availability of medical marijuana, employers are being reminded that laws that legalize marijuana do not make its use in the workplace legal. Employers are responsible for providing employees with a handbook that has policies regarding alcohol and drugs in the workplace. Businesses should require employees to view and sign the policies more than once a year. And, companies with high turnover should review the drug and alcohol policy more often than companies with low turnover rates.                  

Read more:                  
http://www.dailygate.com/news/article_073a6894-f4fe-11e5-bb0c-97283b94ae74.html                                      

Ohio Could Have Medical Marijuana by November                  
David Downs, East Bay Express                  
April 1, 2016                  

Ohioans for Medical Marijuana is trying to gather 305,591 signatures by early July to put a medical marijuana initiative on the ballot. Polls by marijuana advocacy groups say most Ohio residents should medical marijuana.                  

Read more:                  
http://www.eastbayexpress.com/LegalizationNation/archives/2016/04/01/ohio-could-have-medical-marijuana-by-november                 
               

 International

Prescription Drug Abuse and Canada’s Lagging Regulatory Framework                
Craig Landau and Doug Sommerville                
April 2016                

Senior executives of the two largest pharmaceutical companies in Canada have complained that the Trudeau government’s 2016 budget does not include a national anti-drug strategy similar to the U.S. government's strategy. They want the government to restrict availability of opioids that lack abuse-deterrent formulations like the ones they manufacture.                

Read more:                
http://policymagazine.ca/pdf/18/PolicyMagazineMarchApril-2016-Landau.pdf                                  

Stressed Teachers Turning to Prescription Drugs and Alcohol to Cope with Job                
Press Association                
March 25, 2016                

An online survey by the National Association of Schoolmasters Union of Women Teachers in the United Kingdom drew 5,098 responses. Seven percent of teachers had increased their reliance on prescription drugs, while 22 percent reported drinking more to manage work-related stresses. Nearly half said they had seen a general practitioner in the past year as a result of physical or mental health problems resulting from working in classrooms, and 2 percent reported suicidal acts.                

Read more:                
http://www.dailymail.co.uk/wires/pa/article-3510141/Stressed-teachers-turning-prescription-drugs-alcohol-cope-job.html                 
               

Northeast/Mid-Atlantic News

Data Suggest Use of Heroin Rose in Maine as Access to Pills Waned                
Joe Lawlor, Portland Press Herald                
March 27, 2016                

Federal data show that prescription opioid treatment admissions in Maine increased steadily for more than 10 years before declining in 2013. Admissions to heroin addiction treatment nearly tripled over the last three years. In 2012, the state’s MaineCare system tightened its rules for patients receiving prescription opioid. Its opioid prescription volume fell by 45 percent from 2012 to 2014, with patients in MaineCare and other state-sponsored programs admitted to treatment for prescription opioid addiction declining from a peak of 5,132 in 2012 to 3,391 in 2014. Admissions for heroin treatment, however, increased from 1,634 in 2012 to 3,103 in 2014.                

Read more:                
http://www.pressherald.com/2016/03/27/maine-health-officials-working-to-prevent-unintended-consequences-from-opioid-prescribing-bill                                  

The Opioid Epidemic’s Impact on the Workplace in Massachusetts                
Kait Walsh, 22WWLP.com                
March 29, 2016                

Failure to pass pre-employment drug screening is becoming an issue for a local hiring agency in Massachusetts. A separate but equally significant issue is current employees losing their jobs due to failing random drug testing.  (Includes video 1:43 minutes).                

Read more:                
http://wwlp.com/2016/03/29/the-opioid-epidemics-impact-on-the-workplace                                  

New Jersey Hospital First to Stop Using Opioids for Pain Management                
Aimee Kuvadia, The Daily Good                
March 29, 2016                

The busy emergency department at St. Joseph’s Regional Medical Center in Paterson, N.J., has shifted to an opioid prescribing protocol that seeks to substitute non-opioid medications and physical therapy for opioids as a first line of pain management. The program helped 75 percent of the 300 patients seen in January and February 2016 without using opioids, primarily by using non-opioid pain relievers and physical therapy for pain management. The program excludes chronic pain patients who are opioid-dependent.                 

Read more:                
https://www.good.is/articles/hospital-drops-opioids                 
               

South News

Florida Law Exempts Certain Facilities from Prescription Drug Monitoring Program                
April 1, 2016                

Florida’s governor has signed into law a bill that exempts nursing homes, assisted living facilities, and rehabilitation hospitals from reporting many prescriptions issued onsite to the state’s prescription drug monitoring program.                

Read more:                
http://www.wctv.tv/home/headlines/Scott-Signs-Bills-on-Credit-Card-Skimmers-Police-Seizures-374309251.html                                 

Drug Testing Mandatory Next Year for West Virginia Advanced Career Tech Students                
Darlene J. Swiger, Exponent Telegram                
March 27, 2016                

At the urging of employers, all West Virginia high school students in third- and fourth-year career technical education courses will be required to undergo drug testing next school year.                 

Read more:                
http://www.theet.com/news/local/drug-testing-mandatory-next-year-for-west-virginia-advanced-career/article_2b073754-d3fe-5a72-a103-615e8db44335.html                                  

Here’s Why Doctors Believe Tennessee’s Fetal Assault Law Backfired                
Associated Press                
April 1, 2016                

Tennessee’s 2014 law that criminalized pregnant women who use drugs will expire July 2016. Doctors who treat addicts report that the law had the unintended consequence of causing pregnant women who were drug dependent to delay prenatal care and addiction treatment until later in pregnancy, if at all, further endangering the fetus. The bill’s sponsor, Rep. Terri Lynn Weaver, however, believes the bill made a positive impact. The number of drug dependent newborns has not decreased in Tennessee, where roughly 1,000 babies suffer from dependence each year.                 

Read more:                
http://www.timesfreepress.com/news/local/story/2016/apr/01/doctors-explain-why-tennessees-fetal-assault-law-backfired/358347/                                 

University of North Carolina Asheville Summit Combats Heroin Abuse Epidemic                
Kelly Doty, News 13                
March 30th 2016                

The U.S. Department of Justice recently hosted the area’s first Heroin Summit at University of North Carolina Asheville with more than 200 people attending. The goal of the summit was to bring together law enforcement, first responders, and healthcare professionals to share information on how to fight the problem. Local ABC affiliate News 13 on April 21 will host a town hall about the heroin epidemic in western North Carolina. (Includes video 0:57 minutes).                 

Read more:                
http://wlos.com/news/local/unc-asheville-summit-combats-heroin-abuse-epidemic                                  

Efforts Increasing in North Carolina to Combat Prescription Drug Misuse                
Beth De Bona, Times-News Staff Writer                
March 30, 2016                

Western North Carolina acutely experiences the opioid epidemic. Henderson County has four deaths per month due to overdose, according to the Sherriff’s Office. A multimodal effort is needed to address it. For example, Blue Ridge Community Health is using $350,000 from the Affordable Care Act to enhance their substance misuse prevention services including adding screenings and treatments. The Smokey Mountain Managed Care Organization/NC Harm Reduction Coalition are using $100,000 in Medicaid savings to distribute Naloxone kits to 23 counties. Since 2013 NC Harm Reduction Coalition has distributed 25,000 naloxone kits and 2,500 have been used.                

Read more:                
http://www.blueridgenow.com/article/20160330/NEWS/160329793                 
               

Midwest News

Pain Doctors in Fort Wayne, Ind., Swamped with Patient Referrals                
Angelica Robinson, wane.com                
March 31, 2016                

Pain clinics in Fort Wayne, Ind., are triaging 1,700 patients to new providers after a physician’s license was suspended for 90 days, while the U.S. Drug Enforcement Agency investigates allegations of over prescribing. (Includes video 1:57 minutes)                

Read more:                
http://wane.com/2016/03/31/local-pain-doctors-swamped-with-patient-referrals                
               

West News

New Law in Washington Fights ‘Doc Shopping’ by Addicts                
InvestigateWest                
April 1, 2016                

A new law in Washington will allow physician practices with more than five medical professionals to import the prescription drug monitoring program into their own system. The goal is to make the process of checking if patients are using multiple providers to access opiates faster and easier for physicians.                 

Read more:                
http://crosscut.com/2016/04/new-law-fights-doc-shopping-by-addicts                                  

Nevada to Address Prescription Drug Abuse                
Elko Daily Free Press                
March 31, 2016                

The Nevada Division of Public and Behavioral Health, aided by a $1 million grant from the Centers for Disease Control and Prevention, is implementing a strategic plan to reduce prescription drug abuse. The plan is designed to improve safe prescribing practices through physician education and implementation of a prescriber report card, which will identify high-risk prescribing activity by geographic area and provider specialty. Nevada has the fourth-highest drug overdose mortality rate in the United States. The 2013 Nevada Youth Risk Behavior Survey found that 19.4 percent of high school students had taken prescription drugs without a prescription.                

Read more:                 
http://elkodaily.com/news/state-and-regional/state-to-address-prescription-drug-abuse/article_c22a5610-2f87-5d1b-8d9e-0c716bee2743.html                                  

Fentanyl Linked to Six Deaths and Numerous Overdoses in Sacramento Area                
Soumya Karlamangla and Joseph Serna, Los Angeles Times                
March 31, 2016                

Several overdoses and six deaths in Sacramento linked to fentanyl are prompting additional surveillance by California law enforcement. Sellers of illicit fentanyl are disguising the drug as Norco (a brand name acetaminophen and hydrocodone tablet).                

Read more:                
http://www.latimes.com/local/lanow/la-me-ln-fentanyl-contaminated-street-drugs-20160330-story.html                 
               

 Other Resources

Prescription Drug Abuse Prevention Resource for Community Action                
National Council on Patient Information and Education                

This Web site clearinghouse provides links to information organized by awareness, prevention, treatment, and recovery categories. Within each category, the resources are organized by parent organization. Information linked to the site includes awareness materials, information on interventions, and marketing campaigns for individual and community level prevention efforts.                

Read more:                
http://www.talkaboutrx.org/prescription/awareness.jsp                                 

Media Messaging to Reduce Opioid Misuse and Abuse                
SAMHSA                
March 18, 2016                

This tool highlights media messaging efforts to reduce opioid misuse developed by states located in the northeast United States. Strategies include public service announcements that encourage safe disposal of unused prescription drugs and state-wide social media campaigns aimed at reducing the stigma associated with addiction.                

Read more:                
http://www.samhsa.gov/capt/tools-learning-resources/media-messaging-reduce-opioid-misuse-abuse                                 

Prescription Drug Abuse Statistics                
Center for Lawful Access and Abuse Deterrence                

This fact sheet from an industry-funded coalition against prescription drug misuse includes sections on statistics, academic doping, addiction treatment, counterfeit and black/gray market, medication diversion, pain treatment, and youth.                 

Read more:                
http://claad.org/rx-drug-abuse-stats                 
               

Webinars

Weed in Your Workplace: What You Need to Know                
National Safety Council                
Wednesday, April 20, 2016                
2 p.m. (ET)                
http://eventcallregistration.com/reg/index.jsp?cid=59487t11                 
               

Grant Announcements

SP-16-003: Strategic Prevention Framework - Partnerships for Success                
SAMHSA                
Due: April 12, 2016                
http://www.grants.gov/web/grants/search-grants.html                                  

NIJ-2016-9090: Research and Evaluation on Drugs and Crime                
National Institute of Justice                
Due April 20, 2016                
http://www.grants.gov/web/grants/search-grants.html                                  

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                 
               

Grants Awarded

Indiana Gets New Boost in War on Rx Drugs                
Niki Kelley, Journal Gazette                
March 30, 2016                

Indiana’s health department has been awarded a $3.28 million grant from the Centers for Disease Control and Prevention to fight prescription drug overdoses. The grant will expand the Indiana Violent Death Reporting System, upgrade the state’s prescription drug monitoring program, and fund the study of opioid prescribing practices in the state.                 

Read more:                
http://www.journalgazette.net/news/local/indiana/State-gets-new-boost-in-war-on-Rx-drugs-12292063                 
               

National Take-Back Initiative

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

Take-Back Events & Drop Boxes

Brentwood (California) Hosting Drug Take-Back Program April 30                
Nate Gartrell, Contra Costa Times                
March 25, 2016                
http://www.contracostatimes.com/breaking-news/ci_29686404/brentwood-hosting-drug-take-back-program-april-30                                  

Medicine Collection Nets 205 lbs. in Basking Ridge (New Jersey)                
Bernardsville News                
March 26, 2016                
http://www.newjerseyhills.com/bernardsville_news/news/medicine-collection-nets-pounds-in-basking-ridge/article_206a4b02-b4b5-5674-9697-857e30384f95.html                                 

New Jersey State Police Collect Unused Medicine at Seaville ACME Markets                
Shore News Today                
March 25, 2016                
http://www.shorenewstoday.com/upper_township/state-police-collect-unused-medicine-at-seaville-acme/article_8e37485e-f1f1-11e5-988e-f7e0072ade22.html                                  

Royersford (Penn.) Police to Accept Old Prescription Drugs                
Justin Heinze, Limerick-Royersford-Spring City Patch                
March 28, 2016                
http://patch.com/pennsylvania/limerick/royersford-police-accept-old-prescription-drugs                 
               

Upcoming Conferences and Workshops

Pharmacy Diversion Awareness Conference                
U.S. Drug Enforcement Administration                
April 17–18, 2016                 
Towson, Maryland                
http://www.deadiversion.usdoj.gov/mtgs/pharm_awareness                                 

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                                  

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, New York                
http://www.npnconference.org                                  

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

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