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August 13, 2014


SAMHSA Prescription Drug Abuse Weekly Update
Issue 84  |  August 13, 2014
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 News Other State and Local News Webinar Archive Grants Awarded Request for Proposal National Take-Back Event Take-Back Events and Drop Boxes Save the Date Upcoming Conferences and Workshops


D.F. Weisberg, W.C. Becker, D.A. Fiellin, and C. Stannard. 2014. "Prescription Opioid Misuse in the United States and the United Kingdom: Cautionary Lessons." International Journal of Drug Policy, doi:10.1016/j.drugpo.2014.07.009.

In the United States, opioid analgesics have increasingly been prescribed to treat chronic pain—a trend accompanied by an epidemic of misuse and overdose. Prescribed opioid consumption has also risen in the United Kingdom, albeit more gradually, without an increase in reported misuse or drug-related deaths. One reason is methadone use for pain remains limited in England, unlike in the United States. Benzodiazepine prescriptions have also been trending upward in the United States and downward in the United Kingdom, and benzodiazepines tend to be dangerous when combined with opioids. Because the National Health Service pays for 99.9 percent of controlled substances dispensed in the United Kingdom (and advertising medications is illegal), the problematic pharmaceutical marketing practices and pill mill activity seen in the United States have not arisen. They have emerged, however, in Canada's National Health Insurance scheme. One difference may be a proactive UK stance. The UK Health Act of 2006 limited opioid prescriptions to a 30-day supply that could not be filled more than 28 days after being written. It also created Accountable Officers—local individuals with authority to oversee all aspects of controlled drug prescribing. Among other duties, these officials monitor and audit opioid prescriptions in their jurisdictions. But their work is hampered by a 2-month lag of information entered into an electronic prescription monitoring database. Finally, the relatively ready availability and low price of heroin, as well as easy access to opioid agonist treatment in the United Kingdom, may limit growth of the illicit market for prescription opioids.

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Journal Articles and Reports

J.J. Coleman, J. Hodson, S.K. Thomas, H.L. Brooks, and R.E. Ferner. 2014. "Temporal and Other Factors that Influence the Time Doctors Take to Prescribe Using an Electronic Prescribing System." Journal of the American Medical Informatics Association, doi:10.1136/amiajnl-2014-002822.

Researchers analyzed the time taken to generate a prescription order in the first year after a large university teaching hospital implemented an electronic prescribing system. The geometric mean time was 11.75 seconds (95 percent confidence interval 11.72 to 11.78). Time to prescribe was most affected by the display of high-level alerts (24.59 seconds) or previously unseen alerts (18.87 seconds). Prescribers took significantly less time on weekends (11.29 seconds) than on weekdays (11.88 seconds), in the first (11.25 seconds) (p<0.001) and final (11.56 seconds) hour of their shifts, and after the first month of using the system.

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F. David, P. Mateu–Gelabert, H. Guarino, A. Bennett, T. Wendel, L. Jessell, and A. Teper. 2014. "High Risk and Little Knowledge: Overdose Experiences and Knowledge Among Young Adult Nonmedical Prescription Opioid Users." International Journal of Drug Policy, doi:10.1016/j.drugpo.2014.07.013.

This paper reports further on 46 semi-structured interviews with young adults in New York City (ages 18–32) who reported using prescription opioids nonmedically within the past 30 days (see Issue 83 of the Weekly Update). Interviews were conducted in an unstated time period. Despite significant experience with overdose, including overdose deaths, participants were relatively uninformed about overdose awareness and avoidance and response strategies—especially use of naloxone and syringe exchange programs. Overdoses typically resulted from using multiple pharmaceuticals (often in combination with alcohol) or transitioning to heroin injection. Participants tended to see themselves as distinct from traditional heroin users. They were often outside the networks reached by traditional opioid safety/overdose prevention services.

Read more:

L. De Bolle, E. Mehuys, T. Christiaens, I.V. Tongelen, J–P. Remon, and K. Boussery. 2014. "Characterisation of Patient Encounters in Community Pharmacies (with Special Focus on Self-Medication)." International Journal of Pharmacy Practice, doi:10.1111/ijpp.12138.

Researchers surveyed community pharmacies in Belgium, obtaining data on 1,650 pharmacist encounters. In 62 percent of all encounters, patients asked for nonprescribed medication. One third of self-medication requests related to children or the elderly (Editor's note: This is probably similar to the proportion of the population in those age groups).

Read more:

E. Griffin, P. Corcoran, L. Cassidy, A. O'Carroll, I.J. Perry, and B. Bonner. 2014. "Characteristics of Hospital-Treated Intentional Drug Overdose in Ireland and Northern Ireland." BMJ Open 4:e005557, doi:10.1136/bmjopen-2014-005557.

This study compared intentional drug overdoses presenting to emergency departments in Ireland and the Western Trust Area of Northern Ireland between 2007 and 2012. Researchers found overdoses coded as intentional self-harm were twice as common in Northern Ireland as in Ireland (278 compared with 156/100,000 residents). (Editor's note: This differential could result from variations in intent coding or in risk behavior.)

Read more:

L. Jensen, A. Pagsberg, and K. Dalhoff. 2014. "Methylphenidate Misuse in Adult Patients and the Impact of Therapeutic Use." Human and Experimental Toxicology, doi:10.1177/0960327114543935

Researchers analyzed adult methylphenidate exposures reported to the Danish Poison Information Centre from January 2006 to July 2012. Of 394 exposures, 65.5 percent were prescribed methylphenidate. Exposure was motivated by suicidal attempt in 54 percent and by recreational use in 40 percent. Exposure was dominated by one trade name; exposure incidence predictably correlated with sales and the number of patients prescribed methylphenidate.

Read more:

J. Klimas, M. O'Reilly, M. Egan, H. Tobin, and G. Bury. 2014. "Urban Overdose Hotspots: A 12-Month Prospective Study in Dublin Ambulance Services." The American Journal of Emergency Medicine, doi:10.1016/j.ajem.2014.07.017.

A prospective chart review of pre-hospital advanced life support patients was performed on confirmed opioid overdose calls in Dublin, Ireland. Of 469 overdoses, 13 were fatal, with a high rate of repeated overdoses (26 percent). The majority occurred during the day (275) and on the streets (212). (Street overdoses were more common in the city center than in the suburbs.) Overdoses were more likely in affluent areas and in a 1,000-mile radius of addiction services. Residential overdoses were more probable than street overdoses in deprived areas.

Read more:

R. Meyer, A.M. Patel, S.K. Rattana, T.P. Quock, and S.H. Mody. 2014. "Prescription Opioid Abuse: A Literature Review of the Clinical and Economic Burden in the United States." Population Health Management, doi:10.1089/pop.2013.0098.

Researchers reviewed English-language clinical and economic evaluations of prescription opioid abuse from 2002 to 2012. Rates of opioid overdose–related deaths ranged from 5,528 in 2002 to 14,800 in 2008, resulting in 830,652 years of potential life lost before age 65. Opioid abusers were more likely than non-abusers to use a range of medical services. Compared with a matched control group of non-abusers, mean annual excess healthcare costs for opioid abusers ranged from $14,054 to $20,546 for those with private insurance, and $5,874 to $15,183 for those on Medicaid.

Read more:

I.L. Petrakis, M. Sofuoglu, and R. Rosenheck. 2014. "MDVA Patients with High Numbers of Opioid Prescriptions: A National Study of Sociodemographic and Diagnostic Characteristics, Health Service, and Psychotropic Medication Use." Addictive Disorders and Their Treatment, doi:10.1097/ADT.0000000000000058.

Veterans Health Administration patients (n=5,300,000) who attended more than or at least one outpatient visit during fiscal year 2010 were classified into five groups: no opioid prescriptions, 1 to 2, 3 to 10, 10 to 19, and more than 20 opioid prescriptions filled during the year. On bivariate analysis, patients in the high opioid group (1 percent of the sample) were more likely to be diagnosed with metastatic cancer, other medical illnesses, and various forms of pain, drug abuse, alcohol abuse, mood disorders, and anxiety, and to have psychotropic prescriptions. In logistic regression, however, only drug abuse, depressive disorders, and dual diagnosis were independently associated with high prescription opioid use. Medical outpatient visits (but not mental health or emergency room visits) and antidepressant prescriptions (but not other psychotropics) were associated with high opioid use. Service during recent Middle East conflicts was associated with less risk of high opioid use.

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R. Saitz, T.A. Palfai, D.M. Cheng, D.P. Alford, J.A. Bernstein, C.A. Lloyd–Travaglini, S.M. Meli, C.E. Chaisson, and J.H. Samet. 2014. "Screening and Brief Intervention for Drug Use in Primary Care: The ASPIRE Randomized Clinical Trial." JAMA 312(5):502–13, doi:10.1001/jama.2014.7862.

This three-group randomized trial, which took place at a Boston hospital-based primary care internal medicine practice, tested the efficacy of two brief counseling interventions for unhealthy drug use (any illicit drug use or prescription drug misuse)—a brief negotiated interview (BNI) and an adaptation of motivational interviewing (MOTIV)—compared with no brief intervention. The BNI is a 10- to 15-minute structured interview conducted by health educators; the MOTIV is a 30- to 45-minute intervention based on motivational interviewing with a 20- to 30-minute booster conducted by master's-level counselors. The study included 528 adult patients identified by screening from June 2009 to January 2012. All participants received a written list of substance use disorder treatment and mutual help resources. At baseline, 63 percent reported their main drug was marijuana, 19 percent said their main drug was cocaine, and 17 percent said their main drug was an opioid. At 6 months, 98 percent completed follow-up. There were no significant or sizable effects of BNI or MOTIV on any outcome or in analyses stratified by main drug or drug use severity.

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J Sharpe Potter, J.A. Dreifuss, E.N. Marino, S.E. Provost, D.R. Dodd, L.S. Rice, G.M. Fitzmaurice, M.L. Griffin, and R.D. Weiss. 2014. "The Multi-Site Prescription Opioid Addiction Treatment Study: 18-Month Outcomes." Journal of Substance Abuse Treatment, doi:10.1016/j.jsat.2014.07.009.

This paper reports on an 18-month telephone follow-up to the Prescription Opioid Addiction Treatment Study—a multisite, randomized controlled trial examining varying durations of buprenorphine–naloxone treatment and different intensities of counseling for prescription opioid dependence. Although opioid use outcomes were poor during treatment and immediately following a buprenorphine–naloxone taper (compared with those receiving 12 weeks of buprenorphine–naloxone stabilization), outcomes equalized at the 18-month follow-up. At that time, 49.6 percent of those treated reported abstinence in the previous 30 days, with only 16.3 percent reporting opioid dependence.

Read more:

Substance Abuse and Mental Health Services Administration (SAMHSA). 2014. The DAWN Report: Emergency Department Visits for Drug-Related Suicide Attempts Among Middle-Aged Adults Aged 45 to 64. Rockville, Md.: SAMHSA, Center for Behavioral Health Statistics and Quality.

In 2011, the majority of drug-related emergency department visits involving suicide attempts among patients aged 45 to 64 typically involved prescription drugs and over-the-counter medications (96 percent). Such visits rose from 26,983 in 2005 to 56,172 in 2011. In 2005, narcotic pain relievers were involved in 3,603 visits; in 2011, they were involved in 8,939 visits. Visits involving benzodiazepines increased from 10,709 in 2005 to 23,588 in 2011.

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M. Vijayaraghavan, D. Freitas, D.R. Bangsbergc, C. Miaskowskid, and M.B. Kushel. 2014. "Non-Medical Use of Non-Opioid Psychotherapeutic Medications in a Community-Based Cohort of HIV-Infected Indigent Adults." Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2014.06.044.

From September 2007 to June 2010, the authors conducted quarterly interviews on substance abuse with 296 homeless or marginally housed HIV-infected adults in San Francisco, California. These individuals were still participating in a longitudinal study they joined between 1996 and 2004. Seventy percent were lifetime substance abusers. At enrollment, 52 percent reported prescribed use of opioid analgesics and 54.4 percent reported nonmedical use during their lifetime. Comparable percentages were 17.9 and 28.7 for benzodiazepines, and 8.1 and 14.9 for muscle relaxants. Over the 2-year study interval, 53.4 percent reported prescription opioid misuse, 25.3 percent reported nonmedical use of benzodiazepines, 11.5 percent reported nonmedical use of muscle relaxants, and 6.1 percent reported nonmedical use of prescription stimulants. Mixed-effects multivariate logistic regression found opioid analgesic misuse in the past 90 days was associated with nonmedical use of benzodiazepines, muscle relaxants, and prescription stimulants during the same time interval. Illicit substance use and depression were not associated with nonmedical use of these medications.

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J.A. Wasserman, J.E. Fitzgerald, M.A. Sunny, M. Cole, R.R. Suminski, and J.J. Dougherty. 2014. "Nonmedical Use of Stimulants Among Medical Students." The Journal of the American Osteopathic Association 114(8):643–53, doi:10.7556/jaoa.2014.129.

In 2012, 380 first- and second-year students at a large osteopathic medical school completed a survey on nonmedical use of prescription stimulants. Fifteen percent reported using prescription stimulants nonmedically as a study aid. Positive perceptions of nonmedical use of stimulants and other substance misuse correlated with nonmedical use of stimulants.

Read more:


New Law Aimed at Opioid Crisis Expands Treatment Access
New England Public Radio
August 7, 2014

Massachusetts Governor Deval Patrick signed a bill aimed at curbing prescription drug and other substance abuse and expanding access to treatment. The law prohibits pre-authorization requirements for substance abuse treatment and requires 14 days of inpatient treatment if deemed medically necessary. The bill will be reviewed by the Health Policy Commission before it goes into effect in October of next year.

Read more:

Reversing the Prescription Drug Abuse Epidemic
Bill Corr, The Huffington Post
August 4, 2014

Bill Corr, deputy secretary of the Department of Health and Human Services (HHS), believes overprescribing opioid pain relievers contributes to prescription drug abuse, and that a small percentage of practitioners is responsible for prescribing the majority of opioids. Recently, HHS hosted governmental partners from across the country to share state success and comprehensively focus on prescriber-targeted interventions. Corr said this meeting expanded the reach of knowledge from states that have already succeeded in areas such as provider oversight and collaboration, prescription monitoring programs, and prescribing guidelines and education. He thinks a long-term partnership with states to develop and implement policies and programs can reduce prescription drug abuse.

Read more:

Police: Prescription Drug Thief Caught Thanks to GPS-Equipped Bottle
Elizabeth Reed, KOB
August 4, 2014

This article discusses a robbery in Albuquerque, New Mexico, where a CVS employee handed a robber a GPS–equipped bottle of prescription drugs after he demanded OxyContin. Albuquerque police were able to track down the suspect in the robbery and charged him with conspiracy to commit a third-degree felony and tampering with evidence. He admitted to taking the pills and had tried to discard the bottle when he found the tracking device.

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When Prosecution Replaces Prescription
L. Webster, Pain Medicine News
August 2014

Lynn Webster, immediate past president of the industry-funded American Academy of Pain Medicine, argues it is critical for opioids to remain an available option to those suffering agonizing pain. When physicians fear prosecution for treating patients with pain relievers, practitioners reduce their willingness to prescribe strong medication. In turn, patients are denied care they need. Opioids should be reserved for a subset of patients who truly need them. Also, Webster believes every patient with chronic pain should have access to a minimum level of insurance benefits.

Read more:

Dealing with Opioid Abuse Would Pay for Itself
Austin Frakt, The New York Times
August 4, 2014

Austin Frakt, a health economist, discusses ways to reduce the cost of opioid abuse. He suggests reducing prescriptions by targeting use to patients for whom these medications are most appropriate. Requiring doctors to check the prescription monitoring program database before prescribing has reduced overuse. Frakt also says better treatment, such as maintenance therapy, saves society money.

Read more:

Portman, Brown, and Ohio Representatives Urge the Administration to Offer Safe Prescription Drug Disposal Options
United States Senator Robb Portman
August 1, 2014

U.S. lawmakers sent a letter to the Office of Management and Budget's director, expressing concern that the implementing guidance for the Drug Disposal Act has stalled.

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One in Four Americans Admits Abusing Prescription Drugs, Says FindLaw.com Survey
Digital Journal
August 5, 2014

In a survey by FindLaw.com of 1,000 Americans, one in four admitted to misusing prescription drugs. (Editor's note: This survey uses a much smaller sample than that which responds to similar questions annually in the National Survey on Drug Use and Health.) Twenty-four percent said they have taken a medicine prescribed to someone else, or given their own prescription medicines to another person. Three percent said they have paid someone to obtain a prescription medicine, and 1 percent said they have stolen a medicine prescribed for someone else.

Read more:

Witness to Corruption: The Merchants of Speed or the Modern-Day ADHD Medicine Show
Lawrence Diller, M.D., The Huffington Post
August 7, 2014

Dr. Lawrence Diller, a behavioral and developmental pediatrician, talks about why the United States produced and used 70 percent of the world's legal stimulants in 2012. He feels the single biggest influence is drug companies. These companies fund medication-oriented attention deficit hyperactivity disorder research and market to doctors, teachers, parents—even children. Parents and doctors have known about the risk of amphetamines, including addiction and abuse, for decades. With Ritalin, doctors could tell parents their children weren't taking an amphetamine, even though the positive effects, side effects, and risks were basically the same.

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Other State and Local News

Columbus Police, Fire Chiefs Now Subject to Drug Tests
Lucas Sullivan, The Columbus Dispatch
August 6, 2014

A few months ago, Columbus, Ohio, extended random testing to all police and fire personnel, including chiefs. Testing includes prescription drugs, steroids, and illegal narcotics. In some cases, employees who test positive can opt to enter a diversion program without losing their jobs.

Read more:

Governor Markell Signs Bill Authorizing Law Enforcement to Carry, Administer Anti-Overdose Medication
State of Delaware
August 4, 2014

Governor Markell signed Delaware House Bill 388, authorizing law enforcement officers to carry naloxone after completing an approved training course. He also recently signed Senate Bill 219, which allows family, friends, and community members to buy the drug after they have been trained by the Department of Health and Social Services.

Read more:

Drug Overdose Deaths Continue to Rise in Tennessee
State of Tennessee
July 29, 2014

Drug overdose deaths continue to rise in Tennessee, with 1,166 fatalities in 2013 compared with 1,094 overdoses in 2012. In the past 2 years, more people died from drug overdoses in the state than from motor vehicle accidents, homicides, or suicides. In 2013, 54 percent of overdose deaths were men. Median age at overdose death was 46, with 75 percent between 30 and 59 years of age. Whites accounted for 90 percent of overdose deaths.

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Bernstein: As You Were Saying … Hospitals Must Meet Opioid Crisis
Edward Bernstein, Boston Herald
August 2, 2014

Edward Bernstein, a physician in the Department of Emergency Medicine at Boston Medical Center, shares his views about opioid overdose and addiction and what hospitals can do to help. He believes active involvement of Massachusetts's acute care hospitals is needed to prevent opioid overdose deaths and would like to see state hospitals participate in developing a comprehensive and systematic approach to addiction—similar to the American Heart Association's well-known chain of survival for heart disease.

Read more:

Empty Pill Bottles Signify Pain of Addiction
Pittsburgh Post-Gazette
August 5, 2014

Hundreds of empty prescription drug bottles will line the pavement of Pittsburgh's Art Institute on August 22, when Kyle Schalow brings the second annual traveling Rx Epidemic Memorial to his alma mater. The outdoor art exhibit pays tribute to people suffering or recovering from prescription drug abuse and addiction, allowing passers-by to arrange empty pill containers however they choose. Schalow, a Toledo, Ohio, resident has been exposed to the problem as a recovering alcoholic and cocaine addict and husband who watched his family unravel over the course of his wife's prescription drug addiction.

Read more:

Webinar Archive

Empowered Use, Health Consciousness and Prescription Drugs with Special Focus on Parents and the Workplace
Organizational Wellness and Learning Systems
August 1, 2014

Dr. Joel Bennett, president of Organizational Wellness and Learning Systems, discussed antidotes to prescription misuse: neuroscience, motivators (pain, mood energy), at-risk populations, policy, and mind–body practices. Dr. Bennett shared a presentation developed for the Substance Abuse and Mental Health Services Administration that participants can use in their own settings. This Webinar focused on the workplace and working parents, and may be beneficial to wellness coaches.

Recording and Slides:

Slides Only:

Grants Awarded

On the 'Front Line' of Prescription Drug Abuse, Kentucky Gets $1 Million from CDC to Fight Overdoses
Jacob Ryan, WFPL
August 6, 2014

Kentucky will receive a $1.08 million award from the Centers for Disease Control and Prevention to combat the rising prescription drug overdose epidemic. Kentucky was one of five states awarded this 3-year grant.

Read more:

Request for Proposal

Prescription Drug Abuse: Reducing Prescriptions for Opioids
Health Canada
Deadline: August 29, 2014, no later than 4 p.m. EDT

Chronic Pain Management Research Grant
Milbank Foundation
Postmarked by November 1, 2014

Interventions for Youth Who Misuse/Abuse Prescription Stimulant Medications in High School and/or College-Attending Youth (U01)
National Institutes of Health
Deadline: November 13, 2014, by 5 p.m.

National Take-Back Event

National Take-Back Initiative
Drug Enforcement Administration
September 27, 2014

Take-Back Events and Drop Boxes

Cuyahoga County Rx Drug Drop Boxes Collect 7,000+ Pounds of Unwanted, Unused Prescription Drugs
Megan Shaw, WEWS TV/NewsNet 5 (Ohio)
August 2, 2014

New Drug Disposal Box Now at Vance AFB
Cass Rains, Enid News and Eagle (Oklahoma)
August 5, 2014

Public Can Drop Off Unused Prescriptions at ASU Police Department
Arizona State University
August 1, 2014

Police Department Installs Medication Deposit Box
Georgia Institute of Technology
August 4, 2014

Police Pleased with Response to Drop Box for Prescription Drugs
Melissa Erickson, Ames Tribune (Iowa)
August 4, 2014

Prescription Drug Drop Off
Ocean County Prosecutor's Office (New Jersey)
August 1, 2014

Torrington Officials, Substance Abuse Agency to Unveil Drug Drop Box
Esteban L. Hernandez, Register Citizen (Connecticut)
August 5, 2014

Safe Disposal: Drug Dropoff Set to Open in Mebane
Natalie Allison Jamicello, Times-News (North Carolina)
August 4, 2014

Save the Date

Sixth Annual American Medicine Chest Challenge: National Day of Awareness and Safe Disposal of Rx and OTC Medicine
American Medicine Chest Challenge
November 8, 2014

Upcoming Conferences and Workshops

Pills Kill: Prescription to Addiction Symposium
City of Santa Clarita, California
August 27, 2014
Santa Clarita, California

2014 Arkansas Prescription Drug Abuse Summit
University of Arkansas, Criminal Justice Institute
September 10, 2014
Little Rock, Arkansas

27th Annual NPN Prevention Research Conference
National Prevention Network
September 15–18, 2014
Hartford, Connecticut

2014 Harold Rogers PDMP National Meeting
Brandeis University, Prescription Drug Monitoring Program Training and Technical Assistance Center
September 22–24, 2014
Washington, D.C.

142nd Annual Meeting and Exposition
American Public Health Association
November 15–19, 2014
New Orleans, Louisiana
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.