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April 9, 2015

PAW Weekly Update

SAMHSA Prescription Drug Abuse Weekly Update
Issue 117  | April 9, 2015
The Prevention of Prescription Drug Abuse in the Workplace (PAW) TA Center addresses prescription drug abuse—a growing public health problem with increasing burdens on workers, workplaces, and our economy. To subscribe colleagues, family members, or friends to this listserv sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), please click here or send their e-mail addresses to paw@dsgonline.com.
Table of Content Featured Article Journal Articles and Reports Professional Education National News International News Medical Marijuana Northeast/Mid-Atlantic News South News Midwest News West News Upcoming Webinars Grant Awarded Grant Announcements Take-Back Events and Drop Boxes Upcoming Conferences and Workshops


Needle Exchanges Gain Currency
A. Campo–Flores and J. Whalen, The Wall Street Journal
March 29, 2015

Because of the rise in intravenous use of heroin and prescription pain relievers, more state and local officials are considering needle exchanges. A 2015 Kentucky law allows local health departments to set up needle exchanges after obtaining approval from city and county governments. Indiana's governor issued an executive order authorizing temporary dispensing of clean needles in Scott County after a surge in HIV cases. Recently, Nevada authorized needle exchanges, and Cincinnati and Portsmouth, Ohio, set up exchanges. Florida lawmakers are weighing a potential pilot needle-exchange program in Miami–Dade County.

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Marijuana Is Changing the Workplace. Here's How Employers Should Deal with It.
Will Yakowicz, Slate
March 27, 2015

Medical marijuana is now legal in 23 states and Washington, D.C., and millions of card-carrying cannabis users work at companies across the United States. Arizona, Delaware, and Minnesota require employers to accommodate the health conditions of employees who may be treated in part with medical marijuana—meaning employees cannot be disciplined for a positive marijuana test related to nonwork use. Increasingly, employers are facing lawsuits for failing to accommodate employees. Todd Wulffson at California's Carothers DiSante and Freudenberger defends employers in such cases. Wulffson says employers in affected states should update their policies and human resources programs and train managers. Employers should also be familiar with their state's laws and consider a drug policy allowing employees to use cannabis on their own time. Wulffson suggests adopting a simple, straightforward workplace policy, for example: "We don't allow use of, possession of, or being under the influence of any illegal drug in the workplace. 'Illegal drug' is defined as 'the abuse of over-the-counter medication, prescription medication, medical marijuana, and alcohol.'" He recommends that employers train all managers to refer employees who might have medical conditions or medical marijuana issues to HR.

Wulffson says the biggest problems arise when employers fail to get the word out, and line managers say and do things that "get the employer sued." He sees four common scenarios in lawsuits: 1) Innocent inquiry—An employee or job applicant asks if his or her employer would accommodate medical marijuana use. "That's a loaded question," Wulffson says, "because you have to accommodate the underlying disability of the medical condition. But you don't have to accommodate being stoned at work." 2) An ill employee stoned at work—To intervene without liability, the essential protection is having a zero-tolerance policy in place for use of any drug, including medical marijuana, while at work. 3) The future smoker—The employee tells a supervisor he is suffering from a medical condition and needs to deal with his symptoms. The employee plans to go outside, walk away from the building, smoke, and return. In this case, the appropriate response is "We will reasonably accommodate your condition, but we cannot allow you to be under the influence while on the clock—it's too risky for the company. You can go home for the rest of the day and come back tomorrow." 4) Social media smokers—An employee sees an online picture of an applicant smoking a joint. The employee emails this information to the hiring manager. When an unsuccessful candidate learns the employer saw the photos, Wulffson says, she claims you didn't hire her because of a perceived disability and/or because you don't want to accommodate her.

"Google 'medical marijuana rights,'" says Wulffson, "and you'll find 50 lawyers with well-written letters about how you didn't accommodate the employee and you're getting sued for hundreds of millions of dollars ... " California and other states will not prosecute someone with a medical card who is carrying less than a certain amount of marijuana, but that is not blanket permission. "You can't go on federal property, you can't work for a federal employer," Wulffson says. "Don't work for a federal contractor, because you could be fired and maybe jailed."

Read more:

Journal Articles and Reports

A. Abbasi–Ghahramanloo, A. Fotouhi, H. Zeraati, and A. Rahimi–Movaghar. 2015. "Prescription Drugs, Alcohol, and Illicit Substance Use and Their Correlations Among Medical Sciences Students in Iran." International Journal of High Risk Behaviors and Addiction 4(1):e21945, doi:10.5812/ijhrba.21945.

A survey distributed in randomly selected medical science classes in Tehran, Iran, in 2012 and 2013 polled 1992 students. Prevalence of prescription drug misuse was 4.9 percent. Multiple logistic regression showed prescription drug misuse was associated with past-year alcohol use (odds ratio [OR] = 5.3), lifetime illicit substance use (OR = 3.2), and illicit substance use by friends (OR = 2.6).

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P. Crits–Christoph, C. Lundy, M. Stringer, R. Gallop, and D.R. Gastfriend. 2015. "Extended-Release Naltrexone for Alcohol and Opioid Problems in Missouri Parolees and Probationers." Journal of Substance Abuse Treatment, doi:10.1016/j.jsat.2015.03.003.

Propensity-scored Treatment Episode Data Set information indicated that patients with opioid problems receiving injected extended-release naltrexone had longer durations of care than those receiving daily oral naltrexone or psychosocial treatment only. These patients were more likely to become abstinent than those treated with daily oral naltrexone, buprenorphine/naloxone, or psychosocial treatment only. Findings were similar when clients treated for alcohol problems were included.

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C.H.Y. Dahlem, M.J. Horstman, and B.C. Williams. 2015. "Development and Implementation of Intranasal Naloxone Opioid Overdose Response Protocol at a Homeless Health Clinic." Journal of the American Association of Nurse Practitioners, doi:10.1002/2327-6924.12249.

A homeless shelter developed and implemented an Opioid Overdose Response Protocol using intranasal naloxone.

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M.L. Griffin, H.E. Bennett, G.M. Fitzmaurice, K.P. Hill, S.E. Provost, and R.D. Weiss. 2015. "Health-Related Quality of Life Among Prescription Opioid-Dependent Patients: Results from a Multi-Site Study." The American Journal on Addictions, doi:10.1111/ajad.12188

Compared with the U.S. population, at treatment entry (without matching by age and sex), 653 prescription opioid–dependent patients had worse scores on physical (−1.7 points) and mental (−12.3 points) components of quality of life. Women had lower mental quality-of-life scores than men (−4.3 points), while older patients had lower physical quality-of-life scores (−5.2 points), but not mental quality-of-life scores. The assessment used the Medical Outcomes Study Short Form (36) quality-of-life instrument.

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I. Rossow and J.G. Bramness. 2015. "The Total Sale of Prescription Drugs with an Abuse Potential Predicts the Number of Excessive Users: A National Prescription Database Study." BMC Public Health 15:288, doi:10.1186/s12889-015-1615-7.

This study analyzed the number of defined daily doses for 10 drugs with abuse potential (pain relievers, anxiolytics, and hypnotics) in Norway during 2005 (4,053,624 doses prescribed to 815,836 patients). Drug use distribution was skewed. Those using more than 365 daily doses annually accounted for almost half of anxiolytic and hypnotic sales.

Read more:

Abuse-Deterrent Opioids—Evaluation and Labeling; Guidance for Industry; Availability
U.S. Food and Drug Administration
April 1, 2015

The Food and Drug Administration issued guidelines for pharmaceutical companies looking to develop abuse-deterrent opioids. This guidance recommends how to perform and evaluate abuse potential studies, and how to describe those studies and their implications in product labeling.

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K.E. Vowles, M.L. McEntee, P.S. Julnes, T. Frohe, J.P. Ney, and D.N. van der Goes. 2015. "Rates of Opioid Misuse, Abuse, and Addiction in Chronic Pain: A Systematic Review and Data Synthesis." Pain 156(4):569–76, doi:10.1097/01.j.pain.0000460357.01998.f1.

A systematic review of 38 studies found rates of problematic opioid use for chronic pain treatment ranging from < 1 percent to 81 percent. Most studies found misuse rates between 21 and 29 percent. Addiction rates averaged 8 to 12 percent and were lower in studies identifying prevalence assessment as a primary, rather than secondary, objective.

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Professional Education

D.C. Jurcik, A.H. Sundaram, and R.N. Jamison. 2015. "Chronic Pain, Negative Affect, and Prescription Opioid Abuse." Current Opinion in Psychology, doi:10.1016/j.copsyc.2015.03.020.

This article outlines the benefits and complications of opioid medications for chronic pain treatment. It explores the roles of negative affect and craving in exacerbating chronic noncancer pain and discusses psychiatric comorbidity, validated assessment tools for identifying those at greatest risk for opioid misuse, and treatment strategies for chronic pain patients. Strategies include frequent monitoring, motivational counseling, periodic urine screens, and opioid checklists designed to improve compliance with prescribed treatment regimens.

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S. Levy and M. Schizer. 2015. "From the American Academy of Pediatrics: Adolescent Drug Testing Policies in Schools." Journal of Pediatrics, doi:10.1542/peds.2015-0054.

Because of the lack of solid evidence for their effectiveness, the American Academy of Pediatrics opposes widespread implementation of school-based drug testing programs. Nevertheless, those who use school-based drug testing should carefully monitor the program for potential adverse effects, including decreased participation in sports, higher use of substances not included on testing panels, breach of confidentiality, and greater numbers of students facing disciplinary actions.

The academy recommends that pediatricians advocate school substance abuse prevention programs and support schools in developing intervention programs and referral systems for adolescents with substance use disorders. It also supports development and analysis of school-based programs and promotes effective substance abuse services.

Read more:


Mood-Altering Drug Use Highest in West Virginia, Lowest in Alaska
April 1, 2015

A 2014 national Gallup survey found 18.9 percent of adults use drugs or medications daily, including prescription drugs, which affect their mood and help them relax. States with the highest daily drug use are West Virginia (28 percent), Rhode Island (26 percent), Kentucky (24.5 percent), Alabama (24.2 percent), Louisiana (22.9 percent), South Carolina (22.8 percent), Mississippi, Missouri and Indiana (22 percent), and Oregon (21.9 percent). States with the lowest daily use are Alaska (13.5 percent), Wyoming (15.5 percent), California (15.8 percent), Illinois (16 percent), North Dakota (16.4 percent), New Jersey (16.5 percent), Colorado (16.7 percent), Texas (16.7 percent), Utah (16.8 percent), and Maryland (17.3 percent).

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IPA Asks Govt to Take Immediate Measures to Curb the Menace of Misuse of Prescription Drugs
Suja Nair Shirodkar, Pharmabiz.com
March 30, 2015

The Indian Pharmaceutical Association asked the government to take immediate action to curb prescription drug misuse. The association developed an action plan to address this issue, offering its full support to the government. It also urged the government to strengthen regulatory mechanisms and create awareness about prescription drug dangers.

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Detecting Drug Impaired Drivers a Challenge
Tim Schewe, Albernt Valley Times
March 30, 2015

Tim Schewe, a retired Royal Canadian Mounted Police constable, said detecting and successfully prosecuting drug-impaired drivers on British Columbia's highways is a complicated task. He believes the Cannabix marijuana breathalyzer may soon allow police to conduct roadside tests for THC. The psychoactive ingredient in marijuana will have to undergo scientific testing to ensure the concentration on the driver's breath is accurately measured and related to blood level. Laws will also need to set a maximum allowable THC level for drivers.

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Marijuana Meeting Set: Guam May Adopt Arizona Pot Regulations
Maria Hernandez, Pacific Daily News
April 2, 2015

The Department of Public Health and Social Services has less than 5 months to submit medical marijuana rules and regulations to the Guam Legislature. A nine-member advisory board is looking at implementing many of the rules and regulations used in Arizona. The department will send two Division of Environmental Health workers to the state to assess its program and provide feedback for the draft. It is also interested in using aspects of marijuana programs in Minnesota, Massachusetts, and Washington.

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Northeast/Mid-Atlantic News

War on Pill Mills: Maura Healey Targets Rogue Doctors Fueling Opioid Abuse
Matt Stout, Boston Herald
April 2, 2015

Massachusetts Attorney General Maura Healey is targeting doctors and "pill mill" clinics that are illegally prescribing addictive narcotics. Her office is searching Medicaid databases and following tips. Healey has called for Massachusetts to modify its prescription drug monitoring program to help identify doctors who are dishing out pain medicines.

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2015/04/war_on_pill_mills_maura_healey_ targets_rogue_doctors_fueling

CT Official: VA's Failure to Share Data Hurts Vets at Risk of Prescription Abuse
Ana Radelat, The Connecticut Mirror
March 30, 2015

Connecticut officials blame the U.S. Department of Veteran Affairs (VA) for not uploading data to the state's prescription drug monitoring program (PDMP), missing people at risk for abusing prescription drugs. Since the VA does not share this information, external prescribers don't get a complete picture of the medications a veteran is taking. The VA said concerns about privacy kept many of its doctors and facilities from participating in state PDMPs, but it is working to eliminate those barriers.

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217 Suspected Massachusetts Heroin Overdose Deaths This Year
Boston Herald
April 2, 2015

Excluding Massachusetts's three largest cities (Boston, Worcester, and Springfield), state police reported 217 suspected heroin overdose deaths from January to March 2015.

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More People Die from Drug and Alcohol Overdoses than Murder in Baltimore
Catherine Hawley, WMAR
April 2, 2015

Last year in Baltimore, more people died from drug and alcohol overdoses than from murder. Heroin contributed to 143 deaths. Mayor Blake's Heroin Treatment and Prevention Task Force will report on steps to prevent opioid overdose deaths and ways to connect addicts with effective treatment this summer. (Includes video: 3 minutes)

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With Dangerous Fentanyl-Laced Heroin Spiking in Rochester and Overdoses Dramatically Rising, Schumer Pushes to Reverse President's Proposed Cut to Drug Trafficking Program
Charles E. Schumer, U.S. Senator for New York
March 30, 2015

New York Senator Chuck Schumer opposes cuts to the High Intensity Drug Trafficking Area (HIDTA) program that the Rochester Police Department said is essential for combatting heroin and other drug trafficking. Schumer called for a $100 million HIDTA funding increase.

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Bethesda Pharmacist Charged in Prescription Drug Shipping Scheme
Andrew Metcalf, Bethesda Magazine
April 1, 2015

A Maryland man who operated a pharmacy in Washington, D.C., was indicted on federal charges for illegally shipping more than 9,000 Internet orders of prescription drugs worth at least $8.3 million. No doctor–patient relationship existed between customers and physicians, and there was no verifiable evidence of the identity or illnesses allegedly suffered by customers.

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South News

State Expands Access to Overdose Reversal Drug
Marisa Matyola, WBOY
March 30, 2015

West Virginia's governor signed Senate Bill 335, the Access to Opioid Antagonists Act, which authorizes first responders to administer naloxone—provided they have proper training. (Includes video: 2:02 minutes)

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Midwest News

Missouri Prescription Drug Database Earns Initial Approval
Fox 2 Now
March 31, 2015

Missouri senators have approved a prescription drug monitoring program database. The bill moved forward after senators reduced the time data could be saved in the system from 2 years to 180 days.

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Governor Signs Law to Reduce Pill Mills in Tennessee
Olivia Bailey, WCYB
March 31, 2015

Governor Haslam signed Senate Bill 157 to eliminate pill mills in Tennessee. SB 157 repeals the Intractable Pain Treatment Act (IPTA), which required doctors to prescribe opiates to patients who said they were in severe chronic intractable pain, or refer them to doctors who would. SB 157 restores physician discretion. The bill will go into effect July 1, and within 180 days, all IPTA rules must be eliminated.

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IDHS Prescription Monitoring Program Helps Control Prescription Drug Abuse in Illinois
State of Illinois
March 31, 2015

More than 26,000 doctors and pharmacists and 1,100 dentists are using the Illinois prescription drug monitoring program. Last year, the system collected 21 million prescription records, and participating pharmacists and doctors completed about 150,000 searches each month. The system shares information with 17 states.

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Indiana Races to Fight H.I.V. Surge Tied to Drug Abuse
Abby Goodnough, The New York Times
March 30, 2015

In Scott County, Indiana, more than 80 people have tested positive for HIV since December. They range in age from 20 to 56, and almost all live in Austin. The outbreak—the worst in the state's history—stems largely from intravenous use of Opana, a prescription pain reliever. Foundations Family Medicine has opened a new clinic, with 6 of 15 exam rooms devoted to addressing this issue. Infectious disease specialists from Indiana University will visit once a week, along with mental health counselors and addiction specialists. State workers will also be on hand to sign up uninsured patients for Medicaid. Clark County health officials have been testing people in their homes by using oral swabs that deliver preliminary results in 20 minutes. They also ask those who are tested to disclose needle sharing and sexual partners.

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West News

Governor Fallin Signs Bill Aimed at Reducing Prescription Drug Abuse
Tahlequah Daily Press
March 31, 2015

Governor Fallin signed Oklahoma House Bill 1948, requiring doctors to check the prescription drug monitoring program before writing prescriptions for addictive narcotics.

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OSU Teaching Med Students About Prescription Abuse
Fox 23
April 2, 2015

The Oklahoma State University College of Osteopathic Medicine added a second-year course on addiction in 2015. Students are trained to recognize and treat addiction. The university is considering adding the course to its core curriculum.

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Boulder County Sheriff Ends Prescription-Drug Disposal Program
Mitchell Byars, Daily Camera (Colorado)
April 1, 2015

This week, the Boulder County, Colo., Sheriff's Office suspended its prescription drug disposal program because of a lack of federal resources. Without the Drug Enforcement Administration's help, the sheriff's office is forced to take the medication to a Commerce City disposal facility that charges $40 per cubic foot of prescription drugs.

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Privacy Concerns Force Prescription Drug Monitoring Program Bill from Senate Floor
Chris Gray, The Lund Report
March 31, 2015

SB 626 will return to the Oregon Senate Health Committee for amendments, and it could be back on the Senate's docket soon. Senator Alan Bates wanted the bill pulled after discovering it allowed county health officials and state epidemiologists to receive personally identifiable information. He admitted not reading the bill closely before it passed the committee.

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Port Angeles Police First Law Enforcement Agency on Peninsula to Be Armed with Drug Overdose Antidote
Rob Olikainen, Peninsula Daily News
March 29, 2015

Port Angeles, Wash., police officers are equipped with naloxone. The department is the only one on the North Olympic Peninsula with access to the drug.

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Upcoming Webinars

Be a Safe Prescriber: Illinois Prescription Monitoring Program Update
Illinois Academy of Family Physicians, DuPage County Health Department
April 23, 2015
12–1 p.m.

The learning objectives for this Webinar include understanding how the prescription drug monitoring program (PDMP) may be integrated into daily practice, discussing variation between national opioid prescribing and Illinois prescribing, describing the potential impact of the PDMP on patients seeing multiple prescribers and dispensers, and reviewing the value and importance of the Illinois PDMP.

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Grant Awarded

State Grant Program Aims to Bolster Substance Abuse Education
Samantha Shotzbarger, Cronkite New
April 1, 2015

The Arizona Criminal Justice Commission awarded more than $600,000 in grants to 13 criminal justice agencies and nonprofit organizations, with a goal to reach youths and young adults through substance abuse prevention and education.

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Grant Announcements

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

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

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

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

Harold Rogers Prescription Drug Monitoring Program FY 2015
U.S. Department of Justice
Deadline: May 28, 2015

This grant will enhance the capacity of regulatory and law enforcement agencies and public health officials to collect and analyze controlled substance prescription data and other scheduled chemical products through a centralized prescription drug monitoring program administered by an authorized state agency.

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Take-Back Events and Drop Boxes

Over 9,000 Pounds of Meds Collected
Mike Hibbard, Finger Lakes Times (New York)
March 30, 2015

Illinois Drug Disposal Program Poised to Get Going
Jordan Maddox, The Quad-City Times (Iowa)
March 31, 2015

Acting Attorney General, Installation Commander Unveil 'Project Medicine Drop' Box at Joint Base McGuire–Dix–Lakehurst, New Jersey's First at a Military Installation
The Jersey Tomato Press (New Jersey)
March 29, 2015

Anti-Drug Coalition Plans Take-Back Day
Janice Steinhagen, Hartford Courant (Connecticut)
March 30, 2015

Lock It or Drop It
Gail Fry, The Alpenhorn News (California)
April 2, 2015

Prescription Drug Drop Off Box Now in Turlock
Sabra Stafford, The Turlock Journal (California)
April 2, 2015

OACP Supporting CACP National Prescription Drug Drop Off Day
Ontario Association of Chiefs of Police (Canada)
Accessed March 30, 2015

Prescription Drug Take Back Day
Mike Minarsky, MyGriswold.com (Connecticut)
April 2, 2015

HBPD Collecting Prescription Drugs for Disposal
The Islander (Florida)
Accessed April 1, 2015

RPD to Collect Old, Unwanted Drugs
Mike Emery, Pal-Item (Indiana)
March 31, 2015

Police Hosting Medication Drop
Molly Young, MLive Media Group (Michigan)
April 1, 2015

Evans Institutes Prescription Drug Drop-Off Box After Drug Bust
Brian Campbell, The Sun (New York)
April 2, 2015

Medication Take Back Day Scheduled for April 25
Phillipstown.info (New York)
April 2, 2015

Sheriff, Fisher–Titus Partner on Drug Dropbox
Scott Seitz, Norfolk Reflector (Ohio)
March 29, 2015

Trumbull Alliance Announces Drug Drop-Off Locations
Vindy.com (Ohio)
March 30, 2015

Hubbard Township Police Have Drug-Collection Unit
Vindy.com (Ohio)
March 31, 2015

Bay Area Medication Take Back Day Set for April 25
The Citizen (Texas)
April 2, 2015

Prescription Drug Take Back Day Coming to Cedar City
Time Beery, The Spectrum (Utah)
April 2, 2015

Upcoming Conferences and Workshops

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

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

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

International Conference on Opioids
Harvard Medical School
June 7–9, 2015
Joseph B. Martin Conference Center
77 Avenue Louis Pasteur
Boston, Massachusetts

This conference will explore emerging opioid research and initiatives aimed at improving care and reducing harm. Conference topics include best practices in opioid prescribing for pain and addiction treatment; the latest in opioid management, including opioid rotation; innovative provider education systems to improve practice; phenomenology, identification, and management of opioid misuse; and federal policies to reduce opioid-associated harm.

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

University of Michigan Injury Center Prescription Drug Overdose Summit
University of Michigan Injury Center
November 9, 2015
Ann Arbor, Michigan
The Weekly Update is a service provided by the SAMHSA Preventing Prescription Abuse in the Workplace Technical Assistance Center (PAW) to keep the field abreast of recent news and journal articles to assist in forming policy, research, and programs to reduce prescription drug misuse or abuse. Please note, the materials listed are not reflective of SAMHSA's or PAW's viewpoint or opinion and are not assessed for validity, reliability or quality. The Weekly Update should not be considered an endorsement of the findings. Readers are cautioned not to act on the results of single studies, but rather to seek bodies of evidence. Copyright considerations prevent PAW from providing full text of journal articles listed in the Weekly Update.