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August 20, 2015

PAW Weekly Update

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SAMHSA
SAMHSA Prescription Drug Abuse Weekly Update
WEEKLY
UPDATE
Issue 136  |  August 20, 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 and Policy Debate National Marijuana International Northeast/Mid-Atlantic News South News Midwest News West News Other Resources Webinars Grant Award Grant Announcement National Take-Back Initiative Take-Back Events and Drop Boxes Upcoming Conferences and Workshops

Featured

C. Mair, B. Freisthler, W.R. Ponicki, and A. Gaidus. 2015. "The Impacts of Marijuana Dispensary Density and Neighborhood Ecology on Marijuana Abuse and Dependence." Drug and Alcohol Dependence 154:111–16, doi:10.1016/j.drugalcdep.2015.06.019.

Analysis of 2001–12 California hospital discharge census data found an additional medical marijuana dispensary per square mile within a zip code was cross-sectionally associated with a 6.8 percent increase in the number of hospitalizations with a marijuana misuse/use disorder diagnosis code. Median household income, age distribution, and racial/ethnic distribution in the zip code were associated with marijuana hospitalization rates in cross-sectional and panel analyses.

Read more:
http://www.drugandalcoholdependence.com/
article/S0376-8716(15)00318-X/abstract

Journal Articles and Reports

J. Arteta, B. Cobos, Y, Hu, K. Jordan, and K. Howard. 2015. "Evaluation of How Depression and Anxiety Mediate the Relationship Between Pain Catastrophizing and Prescription Opioid Misuse in a Chronic Pain Population." Pain Medicine, doi:10.1111/pme.12886.

In multivariate analysis of survey data from 215 patients with chronic occupational musculoskeletal disorders who were treated at a Texas functional restoration center, anxiety and depression predicted higher risk for prescription opioid misuse. Furthermore, anxiety and depression acted as mediators while controlling for the effects of gender and age. The association of pain catastrophizing with risk for misuse observed in univariate analysis disappeared in analyses that accounted for depression.

Read more:
http://onlinelibrary.wiley.com/doi/10.1111/pme.12886/abstract

M.A. Bachhuber, B.C. Maughan, N. Mitra, J. Feingold, and J.L. Starrels. 2015. "Prescription Monitoring Programs and Emergency Department Visits Involving Benzodiazepine Misuse: Early Evidence from 11 United States Metropolitan Areas." The International Journal of Drug Policy, doi:10.1016/j.drugpo.2015.08.005.

Analysis of 2000–01 Drug Abuse Warning Network data from 11 metropolitan areas found rising rates of emergency department visits involving benzodiazepine misuse in all jurisdictions. Prescription drug monitoring program (PDMP) implementation was not associated with a change in visit rate. (Editor's note: With just 11 jurisdictions, this analysis could not account for PDMP characteristics.)

Read more:
http://www.ijdp.org/article/S0955-3959(15)00240-6/abstract?rss=yes

B. Chan, A. Lopez, and U. Sarkar. 2015. "The Canary in the Coal Mine Tweets: Social Media Reveals Public Perceptions of Non-Medical Use of Opioids." PLOS One, doi:10.1371/journal.pone.0135072.

Researchers retrieved a sample of 540 publicly available Twitter messages in early 2014, using common opioid medication names and slang search terms. Some messages were not drug related—notably 48 messages that used "Vikes" to refer to the Minnesota Vikings rather than to vicodin. Of 375 messages related to opioid behaviors, 316 originated from individual user accounts, and 125 described a personal experience with opioids. Seventy percent of those 125 messages referenced using opioids to obtain a "high," use for sleep, or other non-intended use. General attitudes regarding opioid use included positive sentiment (52), comments on other people's use (57), and messages containing public health information or links (48).

Read more:
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0135072

K. Karjalainen, J. Haukka, T. Lintonen, M. Joukamaa, and P. Lillsunde. 2015. "The Use of Psychoactive Prescription Drugs Among DUI Suspects." Drug and Alcohol Dependence.

This Finnish study looked at linked data to compare prescribed psychoactive medication use by 29,470 people on a registry of driving under the influence (DUI) suspects versus an age- and gender-matched 30,043-person comparison group randomly selected from the general population. DUI suspects were significantly more likely to use psychoactive prescription drugs, and benzodiazepine use was more common among female DUI suspects. DUI recidivists were more likely to use psychoactive prescription drugs than those arrested only once.

Read more:
http://www.sciencedirect.com/science/article/pii/S0376871615015884

W.J. Kowalczyk, K.A. Phillips, M.L. Jobes, A.P. Kennedy, U.E. Ghitza, D.A. Agage, J.P. Schmittner, D.H. Epstein, and K.L. Preston. 2014. "Clonidine Maintenance Prolongs Opioid Abstinence and Decouples Stress from Craving in Daily Life: A Randomized Controlled Trial with Ecological Momentary Assessment." The American Journal of Psychiatry, doi:10.1176/appi.ajp.2014.14081014.

In a double-blind clinical trial, 118 opioid-dependent outpatients who maintained abstinence during weeks 5–6 after starting buprenorphine continued taking the drug and were randomly assigned to receive clonidine (n = 61) or placebo (n = 57) for 14 weeks. Urine was tested thrice weekly. Relapse was defined as two consecutive opioid-positive or missed urine tests. Duration of opioid abstinence averaged 34.8 days with clonidine versus 25.5 days without it, but time to relapse did not differ between groups. Clonidine was particularly effective in patients prone to stress-induced drug craving.

Read more:
http://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.2014.14081014?journalCode=ajp
http://www.medscape.com/viewarticle/849307

R.L. Nahin. 2015. "Estimates of Pain Prevalence and Severity in Adults: United States, 2012." The Journal of Pain 16(8):769–80, doi:10.1016/j.jpain.2015.05.002.

In national estimates from the Functioning and Disability Supplement to the 2012 National Health Interview Survey, 126 million adults reported some pain in the previous 3 months, with 25 million suffering from daily (chronic) pain and 23 million reporting a lot of pain. Individuals with the highest pain levels were likely to have worse health status, use more health care, and suffer from more disability than those with less severe pain.

Read more:
http://www.sciencedirect.com/science/article/pii/S1526590015006793
http://www.nih.gov/news/health/aug2015/nccih-11.htm

C.W. Norwood and E.R. Wright. 2015. "Promoting Consistent Use of Prescription Drug Monitoring Programs (PDMP) in Outpatient Pharmacies: Removing Administrative Barriers and Increasing Awareness of Rx Drug Abuse." Research in Social and Administrative Pharmacy, doi:10.1016/j.sapharm.2015.07.008.

A 2012 survey of 1,000 outpatient pharmacists found respondents were significantly more likely to use the prescription drug monitoring program (PDMP) if they perceived no barriers associated with using the system. The largest hindrance was insufficient time, which typically led to occasional use. Pharmacists were 10 times more likely to use the PDMP and 18 times more likely to use it consistently if they were extremely concerned about prescription drug misuse in their community versus not at all concerned.

Read more:
http://www.sciencedirect.com/science/article/pii/S1551741115001540

K. Palmsten, S. Hernández–Díaz, C.D. Chambers, H. Mogun, S. Lai, T.P. Gilmer, and K.F. Huybrechts. 2015. "The Most Commonly Dispensed Prescription Medications Among Pregnant Women Enrolled in the U.S. Medicaid Program." Obstetrics & Gynecology, doi:10.1097/AOG.0000000000000982.

Analysis of 2000–07 Medicaid Analytic eXtract data on 1,106,757 pregnant women found that, excluding fertility treatments, 42 percent had at least one dispensing for a medication the Food and Drug Administration classifies as posing maternal or fetal risks during pregnancy. Codeine (dispensed to 11.9 percent of the women) and hydrocodone (dispensed to 10.2 percent) were the most common medications in this category.

Read more:
http://journals.lww.com/greenjournal/Abstract/publishahead/The_Most_
Commonly_Dispensed_Prescription.98983.aspx


T.D. Stewart and M.B. Reed. 2015. "Lifetime Nonmedical Use of Prescription Medications and Socioeconomic Status Among Young Adults in the United States." The American Journal of Drug and Alcohol Abuse 0(0):1–7, doi:10.3109/00952990.2015.1060242.

Analysis of 1994–95 school-year and 2007–08 follow-up waves of National Longitudinal Study of Adolescent Health data found higher 2007–08 levels of personal socioeconomic status—such as having health insurance or not experiencing a financial hardship in the past year—were associated with a lower likelihood of reporting lifetime nonmedical use of prescription medications. In contrast, higher levels of parent socioeconomic status (e.g., parental education) in 1994–95 were associated with an increased likelihood of reporting lifetime nonmedical use of prescription tranquilizers and stimulants.

Read more:
http://informahealthcare.com/doi/abs/10.3109/00952990.2015.1060242

White House Office of National Drug Control Policy. 2015. Drug-Free Communities Support Program: 2014 National Evaluation Report.

This annual update on Drug-Free Communities national evaluation findings reports a significant decrease in self-reported past 30-day use for prescription drugs, alcohol, tobacco, and marijuana among middle and high school youth; an increase in the percentage of students who say regular use of prescription drugs, tobacco, or alcohol has moderate or great risk; an increase in the perception of peer disapproval among middle school students in each of the four substance areas and among high school students in each substance area (except marijuana); and an increase in perception of parent disapproval for each of the substance areas, with the exception of marijuana among high school youth.

Read more:
https://www.whitehouse.gov/sites/default/files/DFC2014Interim%20ReportJuly2015Final.pdf
https://www.whitehouse.gov/blog/2015/08/05/combatting-youth-prescription-drug-use-through-coalitions

Professional Education and Policy Debate

T.C. Green, E.F. Dauria, J. Bratberg, C.S. Davis, and A.Y. Walley. 2015. "Orienting Patients to Greater Opioid Safety: Models of Community Pharmacy-Based Naloxone." Harm Reduction Journal 12:25, doi:10.1186/s12954-015-0058-x.

This case study provides state-specific examples of two policy models of pharmacy-based naloxone: Collaborative Pharmacy Practice Agreements and Pharmacy Standing Orders.

Read more:
http://www.harmreductionjournal.com/content/12/1/25

M.E. Kremer and K.S. Arora. 2015. "Clinical, Ethical, and Legal Considerations in Pregnant Women with Opioid Abuse." Obstetrics & Gynecology, doi:10.1097/AOG.0000000000000991.

This article briefly reviews the medical care of opioid misuse in pregnancy and discusses the stigmatization of addiction and resultant medicolegal sequelae. It advocates for better access to opioid maintenance therapy and social services as a means of improving healthy pregnancy outcomes, and decries recent trends in the criminalization of addiction nationwide.

Read more:
http://journals.lww.com/greenjournal/Abstract/publishahead/Clinical,
_Ethical,_and_Legal_Considerations_in.98991.aspx


A. Noska, A. Mohan, S. Wakeman, J. Rich, and A. Boutwell. 2015. "Managing Opioid Use Disorder During and After Acute Hospitalization: A Case-Based Review Clarifying Methadone Regulation for Acute Care Settings." Journal of Addictive Behaviors Therapy & Rehabilitation 4(2), doi:10.4172/2324-9005.1000138.

This primer on methadone use for opioid withdrawal and opioid maintenance therapy in hospitalized, general medical, and surgical patients uses a teaching case in conjunction with national data.

Read more:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4527170

N.D. White. 2015. "Opioid Abuse and Overdose: Prevention Strategies." American Journal of Lifestyle Medicine, doi:10.1177/1559827615598527.

This article summarizes strategies for preventing prescription opioid misuse, treating existing opioid use disorders, and preventing overdose. The approaches include improved prescriber education, prescription drug monitoring programs, medication take-back programs, controlled substance lock-in programs, and community-based naloxone distribution.

Read more:
http://ajl.sagepub.com/content/early/2015/08/05/1559827615598527.abstract

S. Young and O. Sedgwick. 2015. "Attention Deficit Hyperactivity Disorder and Substance Misuse: An Evaluation of Causal Hypotheses and Treatment Considerations." Expert Review of Neurotherapeutics, doi:10.1586/14737175.2015.1059756.

This article reviews mechanisms that may influence drug use among those with attention deficit hyperactivity disorder, including self-medication, behavioral disinhibition, and comorbidity. Sensitization does not appear to play a role. Efficacious treatment of stimulant use disorders is difficult because few evidence-based interventions exist, and none are medication assisted.

Read more:
http://informahealthcare.com/doi/abs/10.1586/14737175.2015.1059756

National

FDA Approves OxyContin for Children 11 and Older
Matthew Perrone, NBC New York
August 14, 2015

The Food and Drug Administration (FDA) approved extended-release OxyContin for children ages 11 to 16 who are suffering from severe, long-term pain. Under the new approval, doctors are directed to only prescribe OxyContin to children who can already tolerate a minimum dose of 20 milligrams of oxycodone. Physicians should not combine the drug with any other medications that may compound its sedating effects. As a condition of approval, the FDA required Purdue Pharma to conduct a follow-up study examining rates of injury, overdose, accidents, and medication errors in 11- to 17-year-old patients. The study is due in April 2019.

Read more:
http://www.nbcnewyork.com/news/health/FDA-Approves-OxyContin-for-Children-11-and-Older-321822222.html

GAO Pushes CMS for Prescription Drug Fraud Controls
Dani Kass, Law360
August 10, 2015

The Government Accountability Office (GAO) says the Centers for Medicare and Medicaid Services (CMS) need to crack down on doctor shopping and automatic prescription refills to prevent prescription fraud. GAO's review of Medicare prescriptions from 2011 in four states found 16,000 beneficiaries had gone through several doctors for prescriptions that cost Medicare $33 million. About 700 Medicare beneficiaries received more than a year's worth of their drugs, costing Medicare $1.6 million. GAO recommends that CMS require states to report information about specific drug-use review controls to determine if additional guidance is needed.

Read more:
http://www.law360.com/governmentcontracts/articles/689407/gao-pushes-cms-for-prescription-drug-fraud-controls
http://www.gao.gov/products/GAO-15-390

Stopping the Spread of Disease and Overdose Deaths from Opioid Use
Peter Lipson, Forbes
August 10, 2015

Heroin use is soaring in the United States and with it a surge in overdose deaths. Many users begin with prescription pain pills but move on to heroin when cost becomes an issue. Paralleling this trend is the increase in HIV and hepatitis C infections spreading through injection drug use. But heroin and other opiate misuse are hardly new, and Lipson says preventing death and disease from their use is not rocket science. Given naloxone has no misuse potential and is very safe, he believes it should be made available without a prescription.

Read more:
http://www.forbes.com/sites/peterlipson/2015/08/10/stopping-the-spread-of-disease-and-overdose-deaths-from-opioid-use

Orexo: U.S. FDA Approves ZUBSOLV® for Induction of Buprenorphine Maintenance Therapy in Patients Suffering from Opioid Dependence
Business Wire
August 11, 2015

The Food and Drug Administration approved ZUBSOLV® (buprenorphine/naloxone CIII sublingual tablet) for patients with opioid dependence. The approval expands on the current approval of ZUBSOLV for long-term treatment of opioid dependence by allowing its use to transition from opioids to buprenorphine/naloxone.

Read more:
http://www.businesswire.com/news/home/20150810006463/en/Orexo-U.S.-FDA-Approves-ZUBSOLV%C2%AE-Induction-Buprenorphine#.Vco-P_lVhBc

Kroger Introduces Appriss' NARxCHECK(TM) into Pharmacies
MarketWatch
August 12, 2015

Kroger introduced NARxCHECK™ at over 200 pharmacies in Ohio, West Virginia, and Arizona. The NARxCHECK™ analytics engine provides real-time clinical decision support to physicians and pharmacists when making prescribing and dispensing decisions for controlled substances. It assesses a patient's controlled substance history from prescription drug monitoring program data, computes a score, and highlights potential issues with overuse or misuse.

Read more:
http://www.marketwatch.com/story/kroger-introduces-appriss-narxchecktm-into-pharmacies-2015-08-12

Here Are the Drugs You Can't Use in Professional Gaming
Tanya Basu, Time
August 12, 2015

The Electronic Sports League (ESL) listed drugs banned at gaming competitions, effective immediately. Cocaine, steroids, and Adderall are all prohibited. Those with legitimate medical reasons for taking Adderall will need proof from a physician. Drug testing will begin at ESL One Cologne via skin tests.

Read more:
http://time.com/3995194/esl-drug-ban-list

States with Legal Cannabis Have 24.8 Percent Less Opioid Mortalities than Non-Cannabis-Friendly States
Addison Herron–Wheeler, Culture Magazine
August 10, 2015

A recent study in JAMA Internal Medicine found states with medical cannabis laws had a 24.8 percent lower mean annual opioid overdose mortality rate compared with states without medical cannabis laws. Since rate differences arose after cannabis became legal, they cannot be a case of coincidence or similar circumstances. Five years after states implemented legal cannabis, deaths were down 33 percent.

Read more:
http://ireadculture.com/article-6096-states-with-legal-cannabis-have-248-percent-less-opioid-mortalities-than-non-cannabis-friendly-states.html
http://archinte.jamanetwork.com/article.aspx?articleid=1898878&resultClick=3

MARIJUANA

D.C.R. Kerr, S.S. Tiberio, and D.M. Capaldi. 2015. "Contextual Risks Linking Parents' Adolescent Marijuana Use to Offspring Onset." Drug and Alcohol Dependence 154:222–28, doi:10.1016/j.drugalcdep.2015.06.041.

Longitudinal tracking through 2014 of boys recruited to the Oregon Youth Study in the late 1980s provided data on 93 fathers of children ages 11 and older in 2014, their 146 offspring ages 11 and over, and 85 of the children's mothers. Parents' adolescent marijuana use was associated with less monitoring of their children, offspring alcohol use, exposure to adult marijuana use, perceptions of less parent disapproval of marijuana, and deviance and marijuana use by children's peers. Only male gender, peer deviance, and peer marijuana use were positively associated with children's marijuana use onset, controlling for their alcohol use. Thus, parents' adolescent marijuana use may have had a significant indirect effect on child onset through children's deviant peer affiliations and a composite contextual risk score.

Read more:
http://www.drugandalcoholdependence.com/article/S0376-8716(15)00355-5/abstract

B.A. Reboussin, K.M. Green, A.J. Milam, D.M. Furr–Holden, R.M. Johnson, and N.S. Ialongo. 2015. "The Role of Neighborhood in Urban Black Adolescent Marijuana Use." Drug and Alcohol Dependence 154:69–75, doi:10.1016/j.drugalcdep.2015.06.029.

Analyzing data from a cohort of 556 black Baltimore first graders recruited in 1993 (with collection occurring from sixth through ninth grade) revealed marijuana involvement increased steadily between grades. The risk of transition from offers to use was slightly higher from sixth to seventh grades. Neighborhood disorder (odds ratio [OR] 1.04), drug activity (OR 1.12), and disadvantage (OR 1.44) were higher in neighborhoods where youth were more likely to transition from no involvement or marijuana offers to use and problems. Most youth in this study were exposed to the Good Behavior Game, which may have affected their transition pattern.

Read more:
http://www.drugandalcoholdependence.com/article/S0376-8716(15)00328-2/abstract

As It Grows, Marijuana Business Becomes More Tech Savvy
Michael Casey, CBS News
August 13, 2015

The marijuana business is becoming more tech savvy, with apps that provide information on everything from growing and testing to selling and delivering products. Quil is an app that allows users to order marijuana from home. EAZE's medical marijuana delivery service uses an app. Meadow offers deliveries from different dispensaries and provides doctor consultation for those who need a card. Distributors can use apps like Leafly and Weedmaps, which are similar to Yelp or Zagat for legal medical marijuana dispensaries. Steep Hill launched a mobile testing lab called QuantaCann II that can find the potency and moisture of cannabis in minutes. The company also created GenKit, which allows growers to determine the sex of a plant. Most growers prefer female plants because of their higher yields.

Read more:
http://www.cbsnews.com/news/as-it-grows-marijuana-business-becoming-more-tech-savvy

Marijuana Lit: Fact Based Information to Assist You in Providing SUD Services
Addiction Technology Transfer Center Network
Accessed August 12, 2015

The Addiction Technology Transfer Center Network Coordinating Office funded by the Center for Substance Abuse Treatment offers user-friendly, straightforward, and accurate marijuana information, along with resources to help substance use disorder providers in their work.

Read more:
http://attcnetwork.org/marijuana/index.aspx

Video: Marijuana and Medical Use
Addiction Technology Transfer Center Network
August 5, 2015

Dr. Thomas E. Freese explains what is meant by "medical" marijuana, who uses it and why, and the difference between medical marijuana and Food and Drug Administration–approved medications. (Duration: 9:35 minutes)

Watch:
https://vimeo.com/135097463

Medical Marijuana Expansion Encouraged
CTPost.com
August 11, 2015

The Connecticut Board of Physicians delayed a vote on whether to expand marijuana patient eligibility to include reflex sympathetic dystrophy—a rare disorder of the sympathetic nervous system that affects heart rate, blood pressure, and blood vessel constriction. Currently, 11 afflictions are approved for patients to procure prescribed doses of marijuana, and 6 more are awaiting final approval.

Read more:
http://www.ctpost.com/news/article/Medical-marijuana-expansion-encouraged-6438395.php

Marijuana Initiative Launches in Wyoming
Gregory Nickerson, Jackson Hole News and Guide
August 12, 2015

The Wyoming National Organization for the Reform of Marijuana Laws (NORML) began collecting signatures for a ballot measure to legalize medical cannabis.

Read more:
http://www.jhnewsandguide.com/jackson_hole_daily/state_and_regional/wyofile/marijuana-initiative-launches-in-wyoming/article_0e5b96b6-bced-5e61-aaab-61b52229ac5d.html

Cocaine Is Losing Its Popularity on Online Drug Markets. But Pot Is More Potent.
Andrea Peterson, The Washington Post
August 12, 2015

Researchers at Carnegie Mellon University reported that despite law enforcement crackdown, online drug black markets have grown to more than $100 million in worldwide sales a year. They scraped data from 35 online marketplaces that were active on the "Dark Web" during 2013–14 and analyzed how much feedback sellers received from customers about their purchases. Marijuana and ecstasy were the most popular drugs, accounting for more than half of overall sales. The popularity of cocaine has fallen in recent years, while prescription drug sales climbed.

Read more:
https://www.washingtonpost.com/news/the-switch/wp/2015/08/12/governments-are-trying-to-rid-the-internet-of-illegal-drug-markets-theyre-losing

Marijuana Legalization in Colorado Leads to First 'Weedery'
Stuart Miller, The New York Times
August 11, 2015

Green Man Cannabis Ranch and Amphitheater will open in Denver in 2016. The ranch, which largely cultivates marijuana indoors, will have a performance space, a restaurant, a rooftop bar, a gift shop, and a marijuana dispensary.

Read more:
http://www.nytimes.com/2015/08/16/travel/weedery-marijuana-legalization-colorado-christian-hageseth.html

How This Chemist Unwittingly Helped Spawn the Synthetic Drug Industry
Terrence McCoy, The Washington Post
August 9, 2015

With National Institutes of Health funding, chemist John W. Huffman set out to study how the brain's cannabinoid receptors work. In the early 1990s, Huffman produced hundreds of synthetic cannabinoids to study variations in how they bind to receptors, publishing many of their formulas in a series of papers and a book called The Cannabinoid Receptors. His compounds were easy to make, so chemists producing illicit drugs experimented with them. In 2008, a German lab sprayed a synthetic cannabinoid that Huffman developed on plant leaves and sold it under the name "Spice." This so-called synthetic marijuana was legal, psychoactive, and easy to make. Soon after, similar synthetic cannabinoids called "Bath Salts" began shipping from China. In 2011, the Drug Enforcement Administration banned a list of synthetic cannabinoids. But a new generation of synthetics—quite different from Huffman's—has replaced them.

Read more:
http://www.washingtonpost.com/local/social-issues/how-a-chemist-unwittingly-helped-spawn-the-synthetic-drug-epidemic/2015/08/09/94454824-3633-11e5-9739-170df8af8eb9_story.html

Audio: Nationwide Surge in Crime and Overdoses Related to Synthetic Marijuana
The Diane Rehm Show
August 13, 2015

Doctors and police warn of a nationwide surge in crime and overdoses related to synthetic cannabinoids sold online and in convenience stores. The drugs often make users violently psychotic. Diane Rehm talks about the problem with Marilyn Huestis, senior investigator and chief of the Chemistry and Drug Metabolism Section at the National Institute on Drug Abuse; Chuck Rosenberg, acting administrator at the Drug Enforcement Administration; Dr. Gabe Kelen, emergency physician in chief at Johns Hopkins University Hospital; and Erin Artigiani, deputy director for Policy and Governmental Affairs at the Center for Substance Abuse Research, University of Maryland. (Duration: 49:02 minutes)

Listen:
https://thedianerehmshow.org/shows/2015-08-13/growing-use-of-synthetic-cannabinoids

International

Fentanyl Creating Problems in Niagara
Ray Spiteri, Niagara Falls Review
August 12, 2015

Health and law enforcement officials said fentanyl is creating problems in Niagara. Sixteen people overdosed in 1 weekend in Vancouver, Canada—six in 1 hour—after taking what officials believe to be heroin cut with fentanyl. In July, more than 20 fentanyl patches were seized by Niagara Regional Police after they observed a drug transaction in a parking lot. Related crimes around the region include people breaking into homes and robbing drug stores.

Read more:
http://www.niagarafallsreview.ca/2015/08/12/fentanyl-creating-problems-in-niagara

Opioid Overdoses on the Rise
Ronald Zajac, The Recorder and Times
August 10, 2015

Pain pill addiction is a serious problem in Ontario, with three deaths in the tri-county area since February. Officials at the local health unit hope International Overdose Awareness Day will open up a potential solution to opioid overdoses. They began distributing naloxone kits to eligible individuals through the Revive Overdose Response program in 2014, with the goal of handing out 15 kits in 1 year.

Read more:
http://www.recorder.ca/2015/08/10/opioid-overdoses-on-the-rise

Northeast/Mid-Atlantic News

Delaware Prescription Drug Action Committee and Delaware Pharmacists Society Support New Home Drug Disposal Pilot Providing Free Deterra Drug Deactivation Products
PRNewswire
August 12, 2015

Verde Technologies, the Delaware Prescription Drug Action Committee, and the Delaware Pharmacists Society launched a pilot program in which pharmacists give free Deterra Drug Deactivation System packages to residents to dispose of unused prescription medications at home. The biodegradable bags can be put into the trash. Twelve hundred packages plus educational information will be distributed by six participating pharmacies. An evaluation is planned.

Read more:
http://www.prnewswire.com/news-releases/delaware-prescription-drug-action-committee-and-delaware-pharmacists-society-support-new-home-drug-disposal-pilot-providing-free-deterra-drug-deactivation-products-300127365.html

New Connecticut Law Expands Access to Antidote for Heroin Overdoses
Ray Hardman, WNPR
August 13, 2015

In June 2015, Connecticut's governor signed a bill allowing trained and certified pharmacists to prescribe and distribute naloxone to anyone. The state expanded its Good Samaritan law in 2014, giving first responders, treatment counselors, and family members access to the drug. Since Connecticut State Police started carrying naloxone in October 2014, they have reversed 33 overdoses. (Includes audios: 4:31 minutes; 3:31 minutes)

Read more:
http://wnpr.org/post/new-connecticut-law-expands-access-antidote-heroin-overdoses#stream/0

E-Scrips Seen as a Way to Combat Opioid Abuse
Priyanka Dayal McCluskey, The Boston Globe
August 12, 2015

The Cambridge Health Alliance will stop issuing paper prescriptions for addictive pain relievers and start sending electronic prescriptions directly to Massachusetts pharmacies. Software from Imprivata Incorporated will allow alliance doctors to order opioids by entering a password, then typing a temporary code sent to their cellphones. The hospital is also testing a hands-free feature that will relay the code through Bluetooth technology, so doctors won't have to type a second passcode.

Read more:
https://www.bostonglobe.com/business/2015/08/11/scripts-could-combat-opioid-overdose-deluge/1PMGStb8tgdVc8eHDAde7N/story.html

Law Enforcement Access to Drug Monitoring Data Raises Privacy Concern
Ana Radelat, The CT Mirror
August 13, 2015

Some people worry Connecticut's prescription drug monitoring program has given law enforcement officers access to patients' private information about prescription drugs. Currently, the state limits database access to officers involved in ongoing criminal investigations. These officers receive special training on privacy. Connecticut is one of several states that let the Drug Enforcement Administration access information without a warrant.

Read more:
http://ctmirror.org/2015/08/13/law-enforcement-access-to-drug-monitoring-program-raises-privacy-concerns

Heroin Claims 9 Lives in a Week
Rose Quinn, Delaware County Daily Times
August 14, 2015

In 1 week, there were nine suspected heroin-related deaths in Delaware County, Pa. Since January, 42 deaths were thought to be heroin related. Eighty-one county residents have been revived with naloxone since November 26, 2014.

Read more:
http://www.delcotimes.com/general-news/20150813/heroin-claims-9-lives-in-a-week

Disparate States, a Common Horror
Brian MacQuarrie, The Boston Globe
August 10, 2015

The search for solutions to the opioid crisis is something Massachusetts shares with many states, as overdose deaths continue to rise.

Read more:
https://www.bostonglobe.com/metro/2015/08/09/kentucky-opioid-epidemic-has-warnings-lessons-for-massachusetts/ZD90hbbr44Gt4pFfzNErwJ/story.html

Guest Opinion: Doctors' Response to Opioid Addiction
Dennis M. Dimitri, North Attleborough Wicked Local
August 9, 2015

In October 2013, the Trust for America's Health rated Massachusetts as one of the top states for developing strategies to curb prescription drug misuse. Despite that ranking, the commonwealth recorded more than 1,000 deaths from opioid overdoses in 2014—a jump of 33 percent from 2012.

Read more:
http://northattleborough.wickedlocal.com/article/20150809/OPINION/150807289

South News

Prescription Drug Fraud Is on the Rise, Police Say
Bianca Cain Johnson, The Augusta Chronicle
August 7, 2015

Local narcotics investigators in Columbia County, Ga., say they are seeing a surge in prescription fraud cases. Several years ago, doctors and pharmacies moved toward e-prescriptions, eliminating the opportunity for thieves to steal prescription pads and write fake scripts. Now, an out-of-town ring is accessing doctors' Drug Enforcement Administration numbers. Past prescription fraud was usually minimal—one to two instances—but recent cases have been much larger, with suspects pharmacy shopping to obtain multiple prescriptions. Police are seeing criminal interest in pain, anxiety, and diet pills.

Read more:
http://chronicle.augusta.com/news/crime-courts/2015-08-07/prescription-drug-fraud-rise-police-say

DEA Testifies on Legitimate Prescription Drug Denials
WESH Orlando
August 10, 2015

After months of taking the blame for Florida's prescription pill access problem, the Drug Enforcement Administration (DEA) is speaking up. In a testimony, DEA's Susan Langston highlighted stories of rejected hospice patients, and one about 4-year-old Aiden Lopez, a stage three cancer survivor whose pain prescription was rejected by three different Walgreens stores. The DEA called these cases "deeply troubling." Facing mounting criticism, the agency argued they cannot tell pharmacists what to fill and what not to fill. They also said they don't set quotas on how much pharmacists can dispense or how much they can buy from wholesalers. Since 2011, the DEA moved to revoke the license of 23 of 4,902 Florida pharmacies for blatant violations. Agents who testified said they plan to develop more educational materials to help pharmacists fill legitimate prescriptions, and pledged full support to the committee's work in helping patients receive their medication.

Read more:
http://www.wesh.com/news/dea-testifies-on-legitimate-prescription-drug-denials/34643226

Midwest News

Prescription Drug Misuse a Growing, but Preventable Problem
Debra Johnson, The Times Herald
August 11, 2015

Over the past 5 years, prescription drug abuse has soared in St. Clair County, Mich. Before 2010, the county's Drug Task Force found pills only occasionally. Now they confiscate pills by the thousands—especially prescription opiates. In 2012, 28 county residents lost their lives to drug overdose; in 2014, that number soared to 65. In 2014, 61 babies were born affected by drug or alcohol—up from 40 in 2012. An officer at the St. Clair County Health Department is convinced prescription drug misuse has become the number one public health threat in the county.

Read more:
http://www.thetimesherald.com/story/opinion/columnists/2015/08/11/prescription-drug-misuse-growing-preventable-problem/31452363

Prescription Drug Abuse Continues to Plague Oklahoma
Jaclyn Cosgrove, The Oklahoman
August 13, 2015

The Oklahoma Health Care Authority plans to launch a pain management toolkit program in October that will help physicians better understand how to properly deliver pain management. Two program facilitators will travel throughout the state, going first to Medicaid provider offices that have the highest need for pain management education. An estimated 28 percent of unintentional prescription drug overdose deaths in Oklahoma are Medicaid recipients.

Read more:
http://newsok.com/article/5440097

The 25th Annual Survey of Indiana Youth Shows High Levels of E-Cigarette Use
Indiana Prevention Resource Center
August 12, 2015

The 2015 Indiana Youth Survey of grades 6 through 12 found past-month drug use rates were lower than national averages.

Read more:
http://news.indiana.edu/releases/iu/2015/08/tobacco-survey-e-cigarettes.shtml

West News

ER Doctors: Drug-Fueled Raves Too Dangerous and Should Be Banned
Rong-Gong Lin II, Los Angeles Times
August 10, 2015

This question-and-answer article explains why emergency room doctors think electronic dance festivals are a risk to public health. Two women recently died from a drug overdose at the Hard Summer music festival in Los Angeles County.

Read more:
http://www.latimes.com/local/lanow/la-me-ln-why-some-er-doctors-want-to-end-raves-in-los-angeles-county-20150810-story.html#page=1

Other Resources

App Designed for Heroin Addicts Puts Help in the Palm of Their Hands
Brandi Spaulding, U.S. News & World Report
August 12, 2015

Brandi Spaulding, a doctoral intern at the Ohio State Wexner Medical Center, developed a free Android app, Squirrel Recovery, which gives support to recovering addicts 24 hours a day. Users can enter contact information for a 10-person support group. At several points throughout the day, the app prompts individuals to rate their mood, urges, and stress levels. It shares this information with the support group so individual progress can be tracked. The app also asks users to pre-program times of the day when they are typically tempted to relapse, and sends timely reminders to refrain from drug use.

Read more:
http://health.usnews.com/health-news/patient-advice/articles/2015/08/12/app-designed-for-heroin-addicts-puts-help-in-the-palm-of-their-hands

Webinars

Opioid Use Disorders in Hispanics/Latinos
Providers' Clinical Support System for Opioid Therapies
August 27, 2015, 12–1 p.m. (EDT)

This training is designed to educate providers about opioid use disorders among Hispanic/Latino populations. The addiction treatment gap expands exponentially in the Latino population, and evidence-based pharmacotherapy is often not an option.

Register:
https://attendee.gotowebinar.com/register/8963645768608901890

Recovery Schools
SAMHSA, Minority Fellowship Program Coordinating Center
September 2, 2015, 2–3:30 p.m. (EDT)

Webinar participants will learn about the research behind recovery schools, the theory and operation of recovery high schools and colleges, and experiences from a Recovery Coach.

Register:
https://attendee.gotowebinar.com/register/2092087322184269825

Innovative Practices in Medication Assisted Treatment and Primary Care Coordination
Office of National Drug Control Policy
August 27, 2015, 3–4 p.m. (EST)
http://ems6.intellor.com/index.cgi?p=600716&t=1&do=register&s=&rID=9&edID=6

Grant Award

Vermont Gets $3 Million to Expand Opioid Addiction Treatment
The Washington Times
August 7, 2015

Vermont will receive $3 million in Substance Abuse and Mental Health Services Administration funding to support medication-assisted treatment programs for opioid addiction. The number of Vermont residents getting such treatment rose from 594 in 2010 to 2,500 in 2014. The grant will expand access and treatment options in Rutland, Addison, Chittenden, and Franklin Counties.

Read more:
http://www.washingtontimes.com/news/2015/aug/7/vermont-gets-3-million-to-expand-opioid-addiction-

Grant Announcement

Data Resource for Post-Marketing Prescription Drug Abuse Surveillance Data from Individuals Entering or Being Assessed for Substance Abuse Treatment
United States Department of Health and Human Services
Response Date: September 3, 2015

The Food and Drug Administration is seeking reports from a commercially available surveillance data resource on prescription drug misuse. Data will be collected from people entering substance abuse treatment or being assessed for substance use disorders.

Read more:
https://www.fbo.gov/index?s=opportunity&mode=form&id=e9de71c18f1e6bb33bc7e66469b8c576&tab=core&_cview=0

2015 Healthy Living Grant Program
American Medical Association
Deadline: September 11, 2015, 5 p.m. (Central)
http://www.ama-assn.org/ama/pub/about-ama/ama-foundation/our-programs/public-health/healthy-living-grants.page?

Partnership for Clean Competition
Pre-applications due November 1
Full applications due December 1
http://www.cleancompetition.org/Pages/programs-grants.aspx

National Take-Back Initiative

National Prescription Drug Take-Back Day
Drug Enforcement Administration
September 26, 2015, 10 a.m. to 2 p.m.
Various locations nationwide
http://www.deadiversion.usdoj.gov/drug_disposal/takeback

Take-Back Events and Drop Boxes

24/7 Prescription Drug Drop-Off Site Now Open
KSDK (Missouri)
August 6, 2015
http://www.ksdk.com/story/news/local/2015/08/07/247-prescription-drug-drop-off-open/31272811

Drop Off Unused Prescription Drugs in Farmington Hills
Joni Hubred–Golden, Farmington Voice (Michigan)
August 13, 2015
http://www.farmingtonvoice.com/drop-off-unused-prescription-drugs-farmington-hills-000500

Permanent Drug Take Back Box Going into Oceana Town Hall
John Conley, Independent Herald (West Virginia)
August 11, 2015
http://independentherald.com/news/623/permanant-drug-take-back-box-going-into-oceana-town-hall

Upcoming Conferences and Workshops

Pain. Pill. Problem.
State of Minnesota, Office of the Governor
August 25, 2015
Minneapolis, Minnesota
https://usaomntraining.org/EBForms.aspx?EBID=299&EBtype=WLR

Prescription Drug and Heroin Conference
Berrien Community Foundation
August 28, 2015
St. Joseph, Michigan
http://www.berriencommunity.org/hope

SCOPE of Pain Training
Oakland County Prescription Drug Abuse Partnership
October 3, 2015
Waterford, Michigan
https://www.oakgov.com/health/partnerships/Pages/Oakland-County-Prescription-Drug-Abuse-Partnership.aspx#1

Register:
https://www.scopeofpain.com/in-person-training/index.php?event=145

Sixth Annual Prescription Drug Abuse Symposium
State of Indiana, Attorney General's Office
October 28–29, 2015
Westin Hotel
301 West Washington
Indianapolis, Indiana

Participants will learn which multidisciplinary strategies are required to address prescription drug misuse.

Read more:
http://www.in.gov/bitterpill/symposium.html

Register:
https://www.eventbrite.com/e/6th-annual-prescription-drug-abuse-symposium-tickets-17987317551

143rd Annual Meeting and Exposition—Health in All Policies
American Public Health Association
October 31–November 4, 2015
Chicago, Illinois
https://www.apha.org/events-and-meetings/annual

Register:
https://www.apha.org/events-and-meetings/annual/registration-information

2015 Fall Research Conference: The Golden Age of Evidence-Based Policy
Association for Public Policy Analysis and Management
November 12–14, 2015
Miami, Florida
http://www.appam.org/events/fall-research-conference/2015-fall-research-conference-information

Register:
http://www.appam.org/events/fall-research-conference/2015-fall-conference-registration

28th Annual National Prevention Network Conference: Bridging Research to Practice
National Prevention Network
November 17–19, 2015
Seattle, Washington
http://www.npnconference.org

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

University of Michigan Injury Center Prescription Drug Overdose Summit
University of Michigan Injury Center
December 1, 2015
Ann Arbor, Michigan
http://www.injurycenter.umich.edu/conferences/opioid-overdose-summit

2016 National Rx Drug Summit
March 28–31, 2016
Atlanta, Georgia
http://nationalrxdrugabusesummit.org
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.