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August 21, 2013

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    SAMHSA Prescription Drug Abuse Weekly Update

    ISSUE 33  |  AUGUST 2013

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.

Featured Article

R. M. Emanuel, S. L. Frellsen, K.J. Kashima, S.M. Sanguino, F.S. Sierles, and C.J. Lazarus. 2013. "Cognitive Enhancement Drug Use Among Future Physicians: Findings from a Multi-Institutional Census of Medical Students." Journal of General Internal Medicine 28(8):1028-34.

In 2011, researchers conducted a multi-institutional census using a 31–48-item online survey on use of prescription psychostimulants among medical students. They surveyed 2,732 actively enrolled medical students at four private and public medical schools in the greater Chicago area. Researchers measured prevalence and correlates of psychostimulant use. Respondents numbered 1,115 (41 percent, with a range of 26–47 percent among schools). On average, students were 25.1 years of age (SD = 2.7, range 20–49), and single (70 percent). Overall, 18 percent (198/1,115) had used prescription psychostimulants at least once in their lifetime, with first use most often in college and 11 percent (117/1,115) reporting use during medical school (range 7–16 percent among schools). Psychostimulant use was significantly correlated with use of barbiturates, ecstasy, and tranquilizers (Pearson's correlation r > 0.5, Student's t-test p < 0.01); male gender (21 percent male versus 15 percent female, chi-squared p = 0.007); and training at a medical school that determined class rank (68 percent versus 51 percent, chi-squared p = 0.018). Non-users were more likely to be first-year students (chi-squared p = 0.048) or to have grown up outside of the United States (chi-squared p = 0.013). Researchers concluded that use of psychostimulants, including use without a prescription, is common among medical students.

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Journal Article

E.E. Bondarsky, A.T. Domingo, N.M. Matuza, M.B. Taylor, H.C. Thode Jr, and A.J. Singer. 2013. "Ibuprofen vs. Acetaminophen vs. Their Combination in the Relief of Musculoskeletal Pain in the ED: A Randomized, Controlled Trial." The American Journal of Emergency Medicine. doi:10.1016/j.ajem.2013.06.007.

Researchers tested the hypothesis that reduction in pain scores with the combination of ibuprofen and acetaminophen would be at least 15 millimeters (mm) greater than with either agent alone. They conducted a double-blind, randomized controlled trial of adult emergency department (ED) patients with acute musculoskeletal pain. Patients were randomized to oral ibuprofen 800 mg, acetaminophen 1 g, or their combination. Pain scores across the groups were compared with repeated measures analysis of variance at 20, 40, and 60 minutes. A sample of 30 patients in each group had 80 percent power to detect a 15 mm difference in pain scores across the groups (α = .05). Thirty patients were randomized to each study group. Mean (SD) age was 36 (15); 54 percent were male, 73 percent were white, and 13 percent were Hispanic. Groups were well-balanced in baseline characteristics, including initial pain scores (59, 61, and 62 for ibuprofen, acetaminophen, and their combination). Pain decreased over the 1-hour study period for all groups (p < .001) with mean (SD) scores about 20 mm lower on the Visual Analogue Scale than the mean initial score. However, there was no significant difference among treatments (p = .59). The need for rescue analgesics was similar across groups. Researchers concluded that the combination of ibuprofen and acetaminophen did not reduce pain scores or the need for rescue analgesics compared with either agent alone in ED patients with pain secondary to acute musculoskeletal injuries.

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News and Reports

Household Drugs and Your Teen: A Prescription for Addiction?
August 14, 2013

This article discusses the types of prescription drugs found in households throughout the country and those teens are abusing. It also emphasizes safe medication storage and honest conversations with teenagers about prescription drug dangers.

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Is Doping at Work and in Class OK?

August 12, 2013

Bryan Moore, a senior neurology resident at New York University, shares his views on the similarities between athletes using performance-enhancing drugs and professionals using "neuroenhancement" medications in the workplace. They include a mixture of amphetamine salts and other medications used for attention deficit hyperactivity disorder. Both parties use medications with indeterminate efficacy and risk to gain an advantage. The only difference is the level of regulation, scrutiny of abusers, and who is more likely to be punished for the abuse.

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AMA: Effective Pain Management with Prevention of Prescription Drug Abuse

August 14, 2013

The American Medical Association (AMA) has been working with state agencies and specialty medical societies and national organizations to identify and support solutions that curb prescription drug abuse. AMA offers a pain management continuing medical education (CME) program that provides physicians with up-to-date information on assessment and management of pain. The CME series is a comprehensive educational resource with 12 modules addressing numerous clinically important aspects of pain management. AMA continues to develop a series of 12 free Webinars for prescribers on various topics related to the intersection of addiction, pain management, and opioid use. It will continue to work with policymakers to balance physicians' ethical obligation to treat patients who are suffering from pain against the need to identify drug seekers and prevent abuse, unintentional overdose, and death from prescription drugs.

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State Senators Urge Maker of Oxycontin to Turn Over Names of Physicians

Los Angeles Times
August 12, 2013
California State Senators Lieu and DeSaulnier asked Purdue Pharma to submit the names of state physicians it suspects recklessly prescribed pills to drug dealers and addicts. Since 2002, Purdue has compiled a database of 1,800 doctors who showed signs of dangerous prescribing. The company has only reported 154 cases to law enforcement or medical regulators. Purdue trained its sales representatives to report suspicious activities, behaviors, and/or red flags in doctors' offices. If a doctor's practice is deemed too risky by Purdue, it prohibits sales representatives from marketing to the physicians. The doctors are removed from the company's sales territories and get entered into the database.

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What You Need to Know About Prescription Drug Abuse

NBC Latino
August 12, 2013

This article discusses several risk factors for prescription drug use, the three most commonly abused medications, and tips to prevent abuse. It highlights the importance of not mixing addictive drugs with alcohol or illicit substances and explains the prescription drug monitoring program.

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New Muscle-Building Drugs at Risk of Being Abused, Experts Say

The Partnership at Drugfree.org
August 14, 2013

Researchers are studying myostatin inhibitors as potential treatments for muscle wasting in other diseases. The drugs block a substance called myostatin, which the body normally produces to stop muscles from becoming too large. At least one myostatin inhibitor is likely to receive approval by the Food and Drug Administration in the next few years. Leo Sweeney, who studies muscle diseases at the University of Pennsylvania, says if myostatin inhibitors become known as doping agents, doctors may hesitate to prescribe them for legitimate medical uses. The World Anti-Doping Agency banned substances that inhibit myostatin in 2008.

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PAINWeek to Feature NADDI Drug Diversion Track
August 12, 2013

PAINWeek and the National Association of Drug Diversion Investigators (NADDI) will discuss new developments in the effort to prevent prescription drug diversion and abuse. On September 5, they will conduct four courses designed to brief and prepare pain practitioners on the complex and fast-moving environment surrounding prescription medication abuse. They are "Protecting your Medical Practice: A Law Enforcement Perspective," "Pill Mills and Pain Management: Legislation and Enforcement," "Drug Diversion vs. Pain Management--Finding a Balance," and "Bullying in Medicine: Are You the Victim or the Perpetrator?"

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Employment Drug Screening Gaining Importance in 2013 Due to Rising Drug Abuse
August 9, 2013

Pre-employment drug testing increased 5.7 percent in 2012 compared with 2011 (Quest Diagnostics, March 7, 2013). The monetary liability put companies at risk for hiring people who use drugs. The U.S. Department of Labor estimates employers lose $75 billion to $100 billion because of accidents, loss of productivity, health care, and workers' compensation costs (The Press Enterprise, June 20, 2012). For employers that decide to implement a drug-free workplace policy, the federal Drug-Free Workplace Program is a good resource.

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One in 10 Americans Have Taken Drugs Prescribed for Others: Poll
August 15, 2013

One in 10 Americans admit taking a prescription drug they have not been prescribed, and a quarter of those people have used them just to get high, according to an ongoing Reuters/Ipsos poll. The survey also discovered that about six in 10 Americans who used another's prescriptions did so for pain relief; one fifth took them to sleep or manage stress and anxiety. Two thirds of those who used other people's prescribed medicine were given the drugs by a family member, friend, or acquaintance. Only 14 percent were taken without permission or purchased. The ongoing Reuters/Ipsos online poll includes responses of 6,438 adult Americans between July 24 and August 12. The confidence interval for these results is plus or minus about 1.4 percentage points.

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Schumer Urges DEA to Fund Drug Buyback Events
The Sacramento Bee
August 15, 2013

New York Senator Charles Schumer urged the Drug Enforcement Administration to amend and approve regulations under the 2010 Secure and Responsible Drug Disposal Act that would allow pharmacies to host community drug take-back programs.

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Other State and Local News

Prescription Drug Drop-Off Box Installed
The Advertiser-Tribune
August 10, 2013

Ohio's Tiffin Police Department installed a permanent prescription drug drop-off box in its lobby. Residents can drop off any medication, except for liquids and syringes, 24 hours a day, 7 days a week. Pet medication is also accepted.

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Georgia Now Tracking Drugs to Address Abuse
The Augusta Chronicle
August 10, 2013

Georgia's prescription drug monitoring program has been available to pharmacists for a little less than a month and less than 2 weeks for physicians, according to the director of the Georgia Drugs and Narcotics Agency. Thus far, 2,000 providers have registered to see whether patients are getting prescriptions from more than one doctor and using several pharmacies. Now, those who traveled to Georgia to doctor shop will think twice about it. Georgia is the second-to-last state to implement such a program.

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'A Community Problem': Task Force Combats Prescription Drug Abuse
The Billings Gazette
August 12, 2013

In 2012, RiverStone Health, Billings Clinic, St. Vincent Healthcare, and the Rimrock Foundation developed a task force of physicians and healthcare personnel to reduce prescription drug abuse in Montana. They lobbied the 2013 Legislature to establish an interim committee that will study the crisis and identify best practices for addressing abuse. Task force founder Dr. Sharon Mulvehill developed a Chronic Pain toolkit that offers guidelines for treating pain and strategies for preventing abuse. In 2008, prescription drug abuse contributed to more deaths of Montanans than motor vehicle crashes, homicides, methamphetamine, heroin, and cocaine combined.

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More Drivers Impaired by Drugs, Research Shows
CBC News
August 15, 2013

This article and audio (5:26 minutes) discuss driving under the influence of drugs in northeastern Ontario. The Ontario Provincial Police Inspector is concerned that drug use among drivers could worsen as prescription drug abuse continues to escalate. He has trained and designated officers to recognize and charge drivers impaired by drugs. A researcher from the Canadian Centre on Substance Abuse said the problem is not unique to the north. After leading investigations on drug and alcohol use in British Columbia (BC) and testing more than 7,500 drivers in five cities, he discovered more drivers had drugs in their system than alcohol. The BC's findings likely reflect what drivers are doing in Ontario as well. People should heed the warnings labels on their drug containers about not driving.

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Permanent Prescription Drug Disposal Box Unveiled
Chicago Tribune
August 14, 2013

The Maine Community Youth Assistance Foundation, police, and Save a Star Foundation collaborated to install permanent prescription drug drop boxes at Des Plaines, Niles, and Park Ridge Police Stations in Illinois. Residents can access the boxes 24 hours a day, 7 days a week.

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Drugs: Perception Versus Reality
The Daily American
August 11, 2013

In Somerset County, Pennsylvania, prescription medications are the most commonly abused drugs next to alcohol, according to the Somerset County Drug and Alcohol Commission. Prescription drug use increased by about 13 percent between 2010 and 2012. The Daily American conducted an online survey in which 57 percent of residents said they were most concerned about heroin--prescription drugs received only 13 percent of the vote. Heroin and prescription drugs are interchangeable, said a prevention specialist with the Twin Lakes Center for Drug and Alcohol Rehabilitation. The organization collected 220 pounds of prescription drugs during April's Prescription Drug Take Back Day. Somerset Borough's Police Chief said pharmaceutical drugs are a concern behind heroin.

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GNWPCD Urging Residents to Properly Dispose of Old Meds
Great Neck Patch
August 15, 2013

New York's Great Neck Water Pollution Control District (GNWPCD) Commissioner is urging everyone to use proper disposal methods and take advantage of the Town of North Hempstead's S.T.O.P. prescription drug take-back program. The next drop off is in September. Residents can also use TakeAway Envelopes for unused medication disposal. They are available online and at local pharmacies.

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Hospital Improving Care for Drug-Impacted Babies
Green Bay Press Gazette
August 12, 2013

Wisconsin's St. Vincent Hospital is participating in an international program to improve care for babies born with drug withdrawal symptoms. The Vermont Oxford Network, a nonprofit organization, seeks the best ways to treat newborns with neonatal abstinence syndrome. The initiative involves live online sessions for medical staff with the goal to standardize care. St. Vincent is among about 3,500 healthcare providers taking part in the project. Participants plan to meet in the coming months to discuss findings and strengthen care policies. The program has stressed the importance of involving parents in the health care of their baby and informing them if their child is born with drug withdrawal symptoms.

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Indiana Launches Website to Fight Rx Drug Abuse
The Journal Gazette
August 16, 2013

Indiana Attorney General Greg Zoeller and the Indiana Prescription Drug Abuse Prevention Task Force launched www.BitterPill.IN.gov, a comprehensive Web site to raise awareness about the state's prescription drug abuse problem. Features of the site include knowing the dangers of prescription drugs, dealing with addiction, and proper prescription disposal. The goal of the task force is to reduce abuse of controlled prescription drugs and decrease the number of deaths associated with such drugs in Indiana.

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Prescription Drug Crackdown
Los Angeles Times
August 16, 2013

The Los Angeles Times editorial board gives their views about cracking down on prescription drugs, urging lawmakers to push doctors to improve data on what is being prescribed and dispensed, to whom and by whom. The California prescription drug monitoring program does not provide doctors up-to-the-minute information on drugs patients may have obtained from other sources. That would require a change in state law giving people who dispense drugs up to 7 days to report their actions. Lawmakers should also require coroners to report more information about deaths from prescription drug overdoses to the state medical board. In addition, state regulators should find a way to incorporate information drug companies gather about doctors.

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Bill to Curb Prescription Overdose Deaths Gains in Assembly
Los Angeles Times
August 13, 2013

A bill aimed at strengthening California's prescription drug monitoring system was approved 14–0 by members of the Committee on Business, Professions and Consumer Protection. The bill would create a steady stream of funding for the CURES program by raising licensing fees on doctors, pharmacists, and other prescribers. The bill is headed to the Assembly Appropriations Committee for consideration.

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Thousands of Pills Involved in Doctor Shopping Case
New Port Richey
August 13, 2013

A Florida man was prescribed 7,228 pills from 37 doctors over the last 2 1/2 years. Several doctors refused to prescribe him medications.

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Little-Known Law Can Help Families of Teen Drug Users
August 10, 2013

When Jane Brown's 17-year-old daughter started abusing prescription drugs and they were no longer available, she resorted to using heroin. After exhausting all options to get her daughter help, Ms. Brown stumbled upon Act 53, a Pennsylvania mandate that allowed her to force her daughter into a 60-day treatment program. Parents in any county can use the law to force their minor children into drug and alcohol treatment.

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8-Month-Old Died of Fatal Cocktail of Prescription Medications, Court Documents Reveal
The Sacramento Bee
August 15, 2013

A California mother was charged with murder and two felony counts of child endangerment after her 8-month-old son overdosed on a mixture of Xanax, methadone, and Opana from her breast milk, according to Sacramento County court documents. The mother had been warned to stop breastfeeding because high levels of methadone were found in her baby's bloodstream. She said she was not breastfeeding and a bottle taken from the baby's crib at the time of death registered none of the drugs reportedly found in his system.

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Utah Spends $26K to Catch 9 Welfare Drug Users
July 12, 2013

Utah spent more than $26,000 looking for welfare applicants who used drugs from August 2012 through June 2013. Of the 4,400 applicants, about 400 were identified after taking a written test as having a "reasonable likelihood" of using drugs. Only nine tested positive, according to data from the Department of Workforce Services, which administers the benefits and tests. Utah's law doesn't disqualify those who test positive for drugs from receiving benefits; instead, it requires them to enter treatment for substance abuse.

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New Weapon in Rx Abuse War for Staten Island
Staten Island Advance
August 11, 2013

New York law requires the new I-STOP program to go live on August 27. The program will provide physicians and pharmacists access to up-to-the-minute prescription patient histories. Users can also determine if patients are "doctor shopping" for prescription medications. An earlier version has been in effect for the past 8 weeks and doctors have made more than 138,000 requests for information on almost 128,000 patients. I-STOP will also be used for patients getting prescriptions as they are discharged from the hospital and for the hospital's clinic patients. Emergency room patients are exempt from the database requirement.

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Education Is Best Answer to Halt Prescription Drug Abuse
The Tennessean
August 13, 2013

Tennessee district attorneys and the Tennessee District Attorneys General Conference have created "Deceptive Danger," a public awareness campaign that uses a video, posters, and brochure to share information on the dangers of prescription medication abuse. These materials are available throughout the state.

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Yavapai Completes One Year of State Pilot to Reduce Rx Drug Abuse
The Verde Independent
August 13, 2013

Yavapai County, under the leadership of MATFORCE, concluded its 1-year participation in Arizona's pilot Prescription Drug Abuse Reduction Project on June 30. The project focused on three main goals by asking the community to 1) Stay informed: learn more about prescription drug abuse and talk to your kids about the dangers, 2) Stay safe: safeguard medications in your home and safely dispose of unwanted medication, and 3) Save lives: ask your doctor or pharmacist if he or she is "signed up to save lives" with the state's prescription monitoring program. Some of their accomplishments include collecting 2,900-plus pounds of medication and giving educational presentations to 5,859 youth and 263 adults.

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Georgia's Prescription Drug Monitoring Program Still in Jeopardy
WRBL News 3
August 13, 2013

This article and video (1:59 minutes) discuss Georgia's prescription drug monitoring program that started in May but will end September 30 if the state does not receive federal funding. The program director said the system has helped identify abusers, and blames personnel changes at the Bureau of Labor Assistance for the delay. Thus far 2,300 doctors and pharmacies have signed up to use the database. Program participants report their prescription information to the state at least once every 8 days.

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Monitoring Program Part of State's Plan to Curb Prescription Drug Abuse
New Hampshire Public Radio
August 15, 2013

Dr. Seddon Savage talks with All Things Considered host Brady Carlson about the state's approach to curbing prescription drug abuse. Dr. Savage serves on New Hampshire's Call to Action prescription drug task force. The multidisciplinary group is developing the state's prescription drug monitoring program. (Duration 3:24 minutes)

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Alarming Rise in Stimulant Overdoses for Teens and Moms
ABC News
August 10, 2013

This transcript and video (2:17) discuss the 300 percent increase in the number of people who go to emergency rooms after taking stimulant drugs. Some users suffer from elevated heart rates, high blood pressure, and seizures.

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Morning Rounds with Dr. LaPook: Dangers of ADHD Rx Abuse
CBS News
August 10, 2013

A government study of young adults found a sharp increase in emergency room visits due to stimulant drug use, most involving people taking attention deficit hyperactivity disorder medication without a prescription. Dr. Jon LaPook, chief medical correspondent for the CBS Evening News with Scott Pelley explains that even a single dose can cause dangerous side effects. (Duration 3:52 minutes)

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Exploring the Link: Drugs and Mental Health
Community Anti-Drug Coalitions of America
August 29, 2013

During this hour-long broadcast, participants will learn about the most common co-occurring disorders, available treatment options, and how the shift toward a behavioral health model can make a difference. In addition, the Cherokee Nation of Oklahoma will explain how coalitions and health professionals have linked substance use and mental health for some time.

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Insights from a National Epidemic: The Medicine Abuse Project--Free Resources for States and Communities
Children's Safety Network
September 5, 2013

Save the Date

DEA's National Take-Back Initiative
October 26, 2013

Upcoming Conferences and Workshops

PAINWeek National Conference
September 4-7, 2013
The Cosmopolitan of Las Vegas
3708 South Las Vegas Blvd
Las Vegas, Nevada

PAINWeek is the nation's largest pain conference for front-line clinicians with an interest in pain management. The conference offers pain education resources with more than 100 hours of continuing medical education. A complete agenda of satellite events and exhibits complement the program curriculum.

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Pharmacy Diversion Awareness Conference
September 21 and 22
Boston, Massachusetts

National Conference on Addiction Disorders 2013
September 21-25, 2013
Anaheim, California

Harold Rogers Prescription Drug Monitoring Program National Meeting
September 25-27, 2013
Washington, District of Columbia

2013 National Safety Council Congress and Expo
Congress: September 28-October 4, 2013
Expo: September 30-October 2, 2013
Chicago, Illinois

4th Annual Executive Forum on Creating a Culture of Health and Wellness
October 7-8, 2013
Chicago, Illinois

2013 American Association for Treatment of Opioid Dependence Conference
November 9-13, 2013
Philadelphia, Pennsylvania

11th Annual World Health Care Congress
April 7-9, 2014
National Harbor, Maryland
News and Research on Prescription Drug Abuse 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. News and Research on Prescription Drug Abuse 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 News and Research on Prescription Drug Abuse.