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August 4, 2016

PAW Weekly Update

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SAMHSA
SAMHSA Prescription Drug Abuse Weekly Update
WEEKLY
UPDATE
Issue 185  |  August 4, 2016
The Prevention of Prescription Drug Abuse in the Workplace (PAW) TA Center addresses prescription drug abuse—a growing public health problem with increasing burdens on workers, workplaces, and our economy. To subscribe colleagues, family members, or friends to this listserv sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), please click here or send their e-mail addresses to paw@dsgonline.com.

WEBINAR

Employee-Targeted Webinar: A Workplace Wellness Approach for Prescription Abuse Prevention
SAMHSA
Sept. 7, 2016, 2 p.m. – 3:15 p.m. (ET)

This interactive webinar, facilitated by Joel Bennett, Ph.D., of Organizational Wellness & Learning Solutions, is geared toward workplace staff and best experienced in a group setting. Participants will learn about the role health consciousness plays in preventing prescription drug misuse; the risk factors associated with the increase in prescription drug misuse and healthy alternatives that can diminish those risks; action steps to implement healthy options; and how to reduce prescription drug misuse and abuse in their work setting. Those who plan on organizing a group to watch the webinar should contact Michael Neeper at MNeeper@OrganizationalWellness.com for materials to help with the session, including handouts and anonymous forms to assess changes in attitudes and behaviors resulting from the webinar. The webinar will also be archived on the SAMHSA YouTube site for later viewing.

Register:
https://join.onstreammedia.com/register/22396317/paw.
Index
Featured
Journal Articles and Reports
Professional Opinion
Professional Development
National
Marijuana
International
Northeast/Mid-Atlantic News
South News
Midwest News
West News
Webinars
Grant Announcements
National Take-Back Initiative
Take-Back Events & Drop Boxes
Upcoming Conferences and Workshops

Featured

B. Walitt, P. Klose, M.A. Fitzcharles, T. Phillips, and W. Häuser. 2016. “Cannabinoids for Fibromyalgia.” Cochrane Database of Systematic Reviews, doi:10.1002/14651858.CD011694.pub2.

A Cochrane systematic review of synthetic cannabiniod use to control fibromyalgia pain identified just two studies with a total of 72 participants. The reviewers rated the quality of all outcomes as very low due to indirectness, imprecision, and potential reporting bias. No study reported the proportion of participants who experienced at least 30 percent or 50 percent pain relief or who were very much improved. No study provided high to moderate quality evidence of efficacy, tolerability, or safety. Very low quality evidence indicated greater reduction of pain and limitations of health-related quality of life compared to placebo in one study.

Read more:
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD011694.pub2/full

Experts Want Doctors, Pharmacies to Include Reason for Prescription on Label
Dr. Mallika Marshall, CBS Boston
July 27, 2016

Experts at Brigham and Women’s Hospital in Boston and the Massachusetts College of Pharmacy and Health Sciences think doctors and pharmacies should include the reason a medication is ordered on the prescription to educate patients, reduce medication errors, and make it easier for other doctors to understand what a patient is taking and why. They plan to study whether this change can lead to safer and more efficient ways to prescribe drugs. (Includes video: 0:45 minutes)

Read more:
http://boston.cbslocal.com/2016/07/27/experts-want-doctors-pharmacies-to-include-reason-for-prescription-on-label

Journal Articles and Reports

M. Amin-Esmaeili, A. Rahimi-Movaghar, V. Sharifi, A. Hajebi, R. Radgoodarzi, R. Mojtabai, M. Hefazi, and A. Motevalian. 2016. “Epidemiology of Illicit Drug Use Disorders in Iran: Prevalence, Correlates, Comorbidity and Service Utilization Results from the Iranian Mental Health Survey.” Addiction, doi:10.1111/add.13453.

This 2011 Iranian household mental health survey was conducted face-to-face by trained psychologists who assessed 7,841 people ages 15–64. The prevalence of 12-month use disorders for any illicit drug, according to Diagnostic and Statistical Manual of Mental Disorders (DSM, fourth and fifth editions) criteria, were 2.09 percent and 2.44 percent, respectively. Opioid use disorders, and opium in particular, were the most common use disorder. The odds of drug use disorders were greater in men than in women, in previously married participants than in currently or never married participants, and in participants with lower socio-economic status than in those with higher socio-economic status. Approximately half of those with drug use disorders, including 40 percent with DSM–IV opioid dependence had a 12-month unmet need for treatment. Self-help groups were the most common type of treatment service used, followed by obtaining medication from pharmacies directly and outpatient treatment services.

Read more:
http://onlinelibrary.wiley.com/doi/10.1111/add.13453/abstract

A.M. Arria, K.M. Caldeira, K.B. Vincent, K.E. O’Grady, M. Dolores Cimini, I.M. Geisner, N. Fossos-Wong, J.R. Kilmer, and M.E. Larimer. 2016. “Do College Students Improve Their Grades By Using Prescription Stimulants Nonmedically?” Addictive Behaviors, doi:10.1016/J.Addbeh.2016.07.016.

A study that failed to control for illicit drug and alcohol misuse found a modest negative relationship between prescription stimulant misuse and college grades. In mid-2003, a University of Maryland study polled 3,401 high school students pre-enrollment (89 percent response rate). The researchers then enrolled a sample of 1,440 respondents to participate in annual paid surveys, oversampling youth who had used an illicit drug or nonmedically used a prescription drug at least once during high school. Annual assessments consisting of a 2-hour interview and self-administered questionnaires were completed by 87 percent (1,253 first-year, 1,142 second-year, and 1,101 third-year students). Among 898 students without an attention deficit/hyperactivity disorder diagnosis, multivariate analysis showed grade point average (GPA) increased significantly by .053 from sophomore to junior year among the 618 (69 percent) who never used prescription stimulants. GPA rose .016 (not a significant change) among the 52 (6 percent) who used only in their second year, and decreased by .025 among the 78 (9 percent) who used only in their third year and among the 150 (17 percent) who used in both years. Use was generally infrequent, but users in both years used more frequently than those who desisted (11.7 versus 3.4 days in Year 2) and initiated (13.6 versus 4.0 days in Year 3), controlling for sex and second-year GPA.

Read more:
http://www.sciencedirect.com/science/article/pii/S0306460316302659

B. Crook and R.M. Dailey. 2016. “Memorable Messages About the Misuse of Prescription Stimulants.” Health Communication, doi:10.1080/10410236.2016.1196411.

Of 315 University of Texas at Austin undergraduate advertising and communication majors surveyed, 129 remembered a message they had heard about the misuse of prescription stimulants. Memorable messages highlighted academic, health, or ethical implications. Theme, source, and highlighting of the memorable messages did not influence stated intention to misuse prescription stimulants.

Read more:
http://www.tandfonline.com/doi/abs/10.1080/10410236.2016.1196411

K. Doyle and F.G. Strathmann. 2016. “Cost and Efficacy Assessment of an Alternative Medication Compliance Urine Drug Testing Strategy.” Pain Medicine, doi:10.1093/pm/pnw165.

A U.S. reference laboratory evaluated 213 urine specimens with accompanying information on medication prescribed (302 prescriptions) by two testing algorithms: 1) conventional immunoassay screen with subsequent testing of positive results by quantitative mass spectrometry and 2) a combined immunoassay/qualitative mass-spectrometry screen that substantially reduced the need for subsequent testing. The qualitative screen was superior in confirming compliance per prescription (226/302 vs. 205/302), and identifying nonprescription abuse (97 vs. 71). Pharmaceutical impurities and inconsistent drug metabolite patterns were detected in only 3.8 percent of specimens, suggesting that quantitative results have limited benefit. The percentage difference between the conventional testing algorithm and the alternative screen was projected to be 55 percent. Alternative screen test orders have leaped in volume since 2014.

Read more:
http://painmedicine.oxfordjournals.org/content/early/2016/07/14/pm.pnw165.abstract

B. Halbert, R. Davis, and C. Wee. 2016. “Disproportionate Longer-Term Opioid Use Among U.S. Adults with Mood Disorders.” Pain, doi:10.1097/j.pain.0000000000000650.

In pooled 2005–11 Medical Expenditure Panel Survey data, an algorithm developed by the authors suggested 33,450 adult respondents had likely acute or potentially chronic pain conditions but were not using opioids at baseline. After adjusting for socio-demographics and clinical disability, mood disorders were not significantly associated for opioid initiation for likely acute pain (odds ratio [OR] = 1.05) or potentially chronic pain (OR = 0.91). Mood disorders were associated with increased odds of the transitioning to longer-term opioid use (OR = 1.77 for likely acute pain and 1.95 for potentially chronic pain). An unadjusted association between mood disorders and opioid initiation was spurious correlation fully explained by other factors.

Read more:
http://journals.lww.com/pain/Abstract/publishahead/Disproportionate
_longer_term_opioid_use_among_US.99473.aspx


K.S. Haase, N. Kunøe, A. Opheim, Z. Gaulen, A.-L.M. Njå, Z.-E.H. Latif, K.K. Solli, and L. Tanum. 2016. “Interest in Extended Release Naltrexone Among Opioid Users.” European Addiction Research 22:301–5, doi:10.1159/000447964.

In Norway, 731 opiate users recruited at a broad range of treatment facilities including in prisons responded to a 2013–14 survey. Across several similar questions, 50–59 percent were “very interested” or “quite interested” in receiving an injection every 4 weeks that would block the effects of heroin for 4 weeks, while 23–32 percent were “not interested” at all.

Read more:
http://www.karger.com/Article/Abstract/447964

A. Hughes, R.N. Lipari, and M.R. Williams. “Marijuana Use and Perceived Risk of Harm from Marijuana Use Varies within and Across States.” The CBHSQ Report, July 26, 2016.

Data from 2012–14 National Survey on Drug Use and Health (NSDUH) show past-month marijuana use varied from 9.7 percent in the West to 8.4 percent in the Northeast, 7.3 percent in the Midwest, and 6.4 percent in the South. At the substate level, past-month marijuana use ranged from 3.9 percent in the southernmost part of Texas to 15.5 percent in San Francisco. In 2012–13, NSDUH did not separately identify legal from illicit marijuana use. Across the nation, 28.5 percent of people ages 12 and over perceived a great risk of harm from monthly marijuana use, with a regional variation from 32.6 percent in the South to 26.6 percent in the Northeast, 26.1 percent in the Midwest, and 25.6 percent in the West. At the substate level, perceptions of great risk of harm ranged from 14.1 percent in Ward 3 in the District of Columbia to 49.3 percent in Florida’s combined circuits 11 and 16, which include Miami-Dade and Monroe counties.

Read more:
http://www.samhsa.gov/data/sites/default/files/report_2404/ShortReport-2404.html
http://www.samhsa.gov/newsroom/press-announcements/201607260900

M.A. Ilgen, A.S.B. Bohnert, S. Chermack, C. Conran, M. Jannausch, J. Trafton, and F.C. Blow. 2016. “A Randomized Trial of a Pain Management Intervention for Adults Receiving Substance Use Disorder Treatment.” Addiction 111(8):1385–93, doi:10.1111/add.13349.

A small randomized controlled trial tracked 65 Veterans Health Administration patients in treatment for opioid use disorders who were assigned to improving pain during addiction treatment (ImPAT) and 64 assigned to an untested comparison condition. ImPAT combines principles of cognitive-behavioral therapy and acceptance-based approaches to pain management with content related to avoiding the use of substances as a coping mechanism for pain. The comparison group received a psychoeducational attention control treatment for alcoholism modified to cover other substances. Follow-up assessments occurred at 3, 6, and 12 months. At follow-up, those receiving ImPAT had significantly lower pain intensity, less pain-related interference with functioning, and consumed less alcohol consumption, but not less illicit drugs.

Read more:
http://onlinelibrary.wiley.com/doi/10.1111/add.13349/abstract

D.F. Niedrig, G. Bucklar, M. Fetzer, S. Mächler, C. Gött, and S. Russmann. 2016. “Paracetamol Overdosing in a Tertiary Care Hospital: Implementation and Outcome Analysis of a Preventive Alert Programme.” Journal of Clinical Pharmacy and Therapeutics, doi:10.1111/jcpt.12427.

A Swiss tertiary care hospital screened its electronic prescribing data for 2011–14 to identify patients at risk of overdosing on paracetamol because their prescriptions permitted repeated daily paracetamol exposure of ≥5 g. From 2011–13, prescribed overdosing occurred in 11 patients who received 5–8 g/day for 3–5 days. In 2014, real-time screening of prescriptions led to alerts to prescribes in 23 cases with subsequent changes to prescriptions in 21 cases. Prescribed overdoses, however, constitute only 0.4 percent of the 900 or more paracetamol overdoses treated at the hospital annually.

Read more:
http://onlinelibrary.wiley.com/doi/10.1111/jcpt.12427/abstract

Report: One-in-Two American Adults Misuse Their Prescription Drugs
PR Newswire
July 26, 2016

Quest Diagnostics released a report for which it analyzed the 3,143,739 de-identified patient monitoring test results its labs performed during 2011–15. Among patients prescribed opioids and assigned to testing in 2015, 54 percent had test evidence of drug misuse or deciding against taken the opioids prescribed, essentially unchanged from the 53 percent misuse rate in 2014 and well below the 63 percent rate in 2011. In 2015, 45 percent of tested patients had used other drugs in addition to their prescribed drugs, up from 35 percent in both 2014 and 2013. About 1.6 percent of patients tested for heroin showed evidence of heroin use. Heroin was most likely to be detected in patients 25-34 years of age (3.6 percent) and age 18–24 (3.2 percent). Men were tested for heroin less frequently than women, but their positivity rate was 1.97 percent vs. 1.26 percent for women. Among those testing positive for heroin, 28.6 percent combined it with benzodiazepines. In 92 percent of these patients, the benzodiazepines were not prescribed by a physician.

Read more:
http://www.questdiagnostics.com/home/physicians/health-trends/prescription-drug-misuse
http://www.prnewswire.com/news-releases/one-in-two-american-adults-misuse-their-prescription-drugs-finds-analysis-of-more-than-three-million-lab-tests-from-quest-diagnostics-300304099.html

B.D. Stein, J. Mendelsohn, A.J. Gordon, A.W. Dick, R.M. Burns, M. Sorbero, R.A. Shih, and R. Liccardo Pacula. 2016. “Opioid Analgesic and Benzodiazepine Prescribing Among Medicaid-Enrollees with Opioid Use Disorders: The Influence of Provider Communities.” Journal of Addictive Diseases, doi:10.1080/10550887.2016.1211784.

Analysis of Medicaid claims data from 12 states on the 29,611 people ages 18–64 who overdosed or were treated for opioid use disorders in 2008 and received Medicaid-reimbursed services in 2009 showed that in 2009, 45 percent filled a prescription for an opioid analgesic and 37 percent for a benzodiazepine (including 21 percent prescribed both). Multivariate analysis showed females, older individuals, individuals with pain syndromes, and individuals residing in counties with higher rates of poverty were more likely to fill prescriptions post-diagnosis. Prescribing rates in the highest quartile of prescribing communities were more than 2.5 times rates in the lowest quartile.

Read more:
http://www.tandfonline.com/doi/abs/10.1080/10550887.2016.1211784

S. Thielke, S.M. Shortreed, K. Saunders, J.A. Turner, L. LeResche, and M. von Korff. 2016. “A Prospective Study of Predictors of Long-Term Opioid Use Among Patients with Chronic Non-cancer Pain.” Clinical Journal of Pain, doi:10.1097/AJP.0000000000000409.

This article uses data Group Health of Puget Sound (Washington) collected on 762 patients ages 45 and older who entered a study on opioid therapy for chronic non-cancer pain. At one year, 46 percent of participants continued to use opioids. In multivariate analysis, baseline problem opioid use risk score and expectations about continuing opioid use, but not pain prognostic risk score or depression, were significant predictors of one-year opioid use. Compared with patients who thought continued opioid use unlikely, those who thought it was extremely or very likely had four times the odds of opioid use at one year.

Read more:
http://journals.lww.com/clinicalpain/Abstract/publishahead/
A_Prospective_Study_of_Predictors_of_Long_term.99139.aspx


P. Veliz, C.J. Boyd, and S.E. McCabe. 2016. “Nonmedical Prescription Opioid and Heroin Use Among Adolescents Who Engage in Sports and Exercise.” Pediatrics, doi: 10.1542/peds.2016-0677.

Analysis of 18 cross-sections of 8th and 10th graders from the Monitoring the Future study showed 7.6 percent lifetime misuse of prescription opioids and 1.6 percent reported lifetime heroin use. Both classes of misuse declined from 1997–2014 among adolescents who engaged in sports and exercise. In multivariate regression, adolescents who engaged in sports and exercise had lower odds than other adolescents of reporting lifetime nonmedical use of either prescription opioids (odds ratio [OR] = .73 for daily exercise and OR = 0.86 for weekly exercise) or heroin (OR = 0.71 for daily exercise and OR = 0.78 for weekly exercise). Among lifetime heroin users, adolescents who engage in sports and exercise had lower odds of first initiating prescription opioid misuse.

Read more:
http://pediatrics.aappublications.org/content/early/2016/07/21/peds.2016-0677

J.P. Wolf, W.R. Ponicki, N.J. Kepple, and A. Gaidus. 2016. “Are Community Level Prescription Opioid Overdoses Associated With Child Harm? A Spatial Analysis of California Zip Codes, 2001–2011.” Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2016.07.014.

Multivariate analysis at the zip code level of 2001–11 California hospital discharge data showed the percentage of hospital discharges involving prescription opioid overdose was positively associated with the number of hospital discharges for child maltreatment (relative rate [RR] = 1.09) and child injury (RR = 1.06), controlling for other substance use and environmental factors in the ZIP code.

Read more:
http://www.drugandalcoholdependence.com/article/S0376-8716(16)30211-3/fulltext

L-T. Wu, J. McNeely, G.A. Subramaniam, G. Sharma, P. VanVeldhuisen, and R.P. Schwartz. 2016. “Design of the NIDA Clinical Trials Network Validation Study of Tobacco, Alcohol, Prescription Medications, and Substance Use/Misuse (Taps) Tool.” Contemporary Clinical Trials, doi:10.1016/j.cct.2016.07.013.

Researchers described the design of the National Drug Abuse Treatment Clinical Trials Network’s tobacco, alcohol, prescription medications, and substance use/misuse screen and brief assessment tool validation study. They will demonstrate the validity of both a screen component and a two-stage screening and brief assessment tool by comparing them to reference standard screening and assessment measures of no use, problem use, and substance use disorder; and establishing the feasibility and acceptability of the self-administration and interviewer-administration of the tool. The design includes a pilot testing phase (n = 30) and a main study of 2,000 adult primary care participants randomly assigned in counter-balanced order to have the interviewer-administration or the self-administration of the screening and brief assessment tool followed by the other administration format.

Read more:
http://www.contemporaryclinicaltrials.com/article/S1551-7144(16)30133-1/abstract

Professional Opinion

G. Kinrys, A.K. Gold, and A.A. Nierenberg. 2016. “Proper Drug Disposal: Studying a Solution to Household Prescription and Over-the- Counter Drug Abuse.” Journal of Drug Abuse 2:2.

This commentary discusses the current state of drug take-back programs and their relevance to prescription and over-the-counter drug abuse. It includes suggestions on future directions in drug disposal that can help fight against prescription and over-the- counter drug abuse.

Read more:
http://drugabuse.imedpub.com/proper-drug-disposal-studying-a-solutionto-household-prescription-and-overthecounter-drug-abuse.php?aid=9749

Professional Development

D.S. Goldberg, E. Blumberg, M. McCauley, P. Abt, and M. Levine. 2016. “Improving Organ Utilization to Help Overcome the Tragedies of the Opioid Epidemic.” American Journal of Transplantation, doi:10.1111/ajt.13971.

Read more:
http://onlinelibrary.wiley.com/doi/10.1111/ajt.13971/abstract

R. Kelly, J.H. Ehrentraut, and D.L. Anghelescu. 2016. “Risk Factors for Opioid Misuse in Adolescents and Young Adults with Focus on Oncology Setting.” Journal of Opioid Management 12(3), doi:10.5055/jom.2016.0333.

Read more:
http://www.wmpllc.org/ojs-2.4.2/index.php/jom/article/view/315

V.C. Smith, and C.R. Wilson. 2016. “Families Affected by Parental Substance Use.” Pediatrics, doi:10.1542/peds.2016-1575.

Read more:
http://pediatrics.aappublications.org/content/early/2016/07/14/peds.2016-1575

J. Sweeney. 2016. “Hospital Pharmacists Can Help Reduce Opioid Prescriptions.” Psychology Today 22(7):1.

Read more:
http://pharmacytoday.org/article/S1042-0991(16)30505-9/fulltext

National

President Signs Comprehensive Addiction and Recovery Act that ‘Lacks Adequate Funding’
The White House
July 22, 2016

President Obama has signed into law the Comprehensive Addiction and Recovery Act of 2016. However, he said the legislation to address the opioid epidemic lacks adequate funding for treatment. Nevertheless, “given the scope of this crisis, some action is better than none,” said President Obama.

Read more:
https://www.whitehouse.gov/the-press-office/2016/07/22/statement-president-comprehensive-addiction-and-recovery-act-2016
https://www.congress.gov/bill/114th-congress/senate-bill/524

Feds Delay Controversial Anti-Retaliation Enforcement
Lisa Nagele-Piazza, SHRM
July 26, 2016

The Occupational Safety and Health Administration has delayed the enforcement of the anti-retaliation provisions in its injury and illness record-keeping rule from August 10 until Nov. 1, 2016. Postponement will permit time for additional outreach and distribution of educational materials and guidance for employers.

Read more:
https://www.shrm.org/resourcesandtools/legal-and-compliance/employment-law/pages/osha-delays-enforcement.aspx

University Partnering with Tennessee Mayors to Help Prevent Substance Abuse
Sydney Cameron, WJHL
July 26, 2016

East Tennessee State University’s new Center for Prescription Drug Abuse Prevention, Insight Alliance, and the First Tennessee Development District introduced a workplace prevention initiative to 50 employers from across the Tri-Cities region. The initiative uses the Team Awareness program, which strives to create a positive work culture and reduce the stigma around getting help. Team Awareness is on SAMHSA’s National Registry of Evidence-Based Programs and Practices (NREPP). The center started working with city and county mayors about two years ago after they expressed interest in helping to combat prescription drug misuse in the region.

Read more:
http://wjhl.com/2016/07/26/etsu-partnering-with-city-county-mayors-to-help-prevent-substance-abuse

Medication Disposal Kiosks Now Available at Nearly 300 Walgreens in 21 States
Business Wire
July 25, 2016

Walgreens has installed safe medication disposal kiosks at 288 pharmacies across 21 states and the District of Columbia. The kiosks provide a safe and convenient way to dispose of unwanted, unused or expired prescription medications and over-the-counter drugs at no cost. Walgreens also has made naloxone available without requiring a prescription in more than 2,600 pharmacies across 14 states.

Read more:
http://www.businesswire.com/news/home/20160725005180/en/Walgreens-Safe-Medication-Disposal-Kiosks-300-Pharmacies

In Fight Against Addiction, Dentists Turn Away from Opioids
Wes Venteicher, Trib Total Media
July 25, 2016

Some dentists are rethinking how they prescribe opioids in hopes of limiting new addictions and reducing the number of pills unused in medicine cabinets. However, it is difficult for dentists to change their prescribing habits and what patients expect. Dr. Paul Moore at the University of Pittsburgh School of Dental Medicine points out that dentists have been prescribing opioids since they proved effective at treating pain in the 1970s. Nonsteroidal anti-inflammatory drugs only were shown to be effective a decade later. Since then, the anti-inflammatory drugs “consistently have been shown to be more effective” than drugs like Vicodin that contain hydrocodone. He believes “it is difficult to change traditional thinking and initiate alternative drug therapies that may involve acquiring new knowledge in pharmacology and therapeutics.” Health care providers tend to stay with what they know and trust even when it is not in the patient’s best interest.

Read more:
http://triblive.com/news/healthnow/10835748-74/dentists-opioids-dental
http://jada.ada.org/article/S0002-8177(16)30415-9/abstract

International Institute for Analytics, and SAS Institute. “Data and Analytics to Combat the Opioid Epidemic.” Accessed July 28, 2016.

This white paper from the International Institute for Analytics and SAS Institute explores how data and predictive analytics can help develop better treatment protocols, both for initial plan and for remediation when patients become dependent on drugs.

Read more:
http://www.sas.com/en_us/whitepapers/iia-data-analytics-combat-opioid-epidemic-108369.html

Marijuana

R. Phifer. 2016. “A Sensible Approach to Workplace Drug Testing for Cannabis.” Journal of Chemical Health and Safety, doi:10.1016/j.jchas.2016.06.004

As states legalize cannabis, the issue of workplace safety due to possibly impaired workers presents a dilemma for employers. While drug testing can determine if a worker has consumed cannabis, it does not indicate the date and time when the worker took the drug. Since the metabolites of cannabis products can remain in the body for three to four weeks, a worker who shows no evidence of impairment and can safely and productively handle job responsibilities may test positive and be sanctioned. This paper proposes an approach to evaluating a worker’s ability to perform in a safe and productive manner.

Read more:
http://www.sciencedirect.com/science/article/pii/S1871553216300433

T.J. Trull, A.M. Wycoff, S.P. Lane, R.W. Carpenter, and W.C. Brown. 2016. “Cannabis and Alcohol Use, Affect and Impulsivity in Psychiatric Outpatients’ Daily Lives.” Addiction, doi:10.1111/add.13471.

This observational study collected electronic diaries six random times a day for 28 consecutive days from 93 adult psychiatric out-patients in Columbia, Mo. with borderline personality or depressive disorders. During the 28 days, 3 patients reported using only cannabis, 58 only alcohol, and 32 both at least once. Cannabis use was associated with elevated feelings of impulsivity on days of use and increased hostility at time of use.

Read more:
http://onlinelibrary.wiley.com/doi/10.1111/add.13471/abstract

D.F. Ullman. 2016. “The Effect of Medical Marijuana on Sickness Absence.” Health Economics, doi:10.1002/hec.3390.

A cross-sectional time series analysis of 1992–2012 Current Population Survey data estimated legalization of medical marijuana is associated a statistically insignificant 8 percent reduction in work absences due to sickness. The insignificant correlation was stronger in states with ‘lax’ medical marijuana regulations, for full-time workers, and for middle-aged males, which is the group most likely to hold medical marijuana cards. All models included controls for race, marital status, age cohort, and educational attainment. [Editor’s note: not only was the difference not significant at p=.05 but the models failed to adjust for state unemployment rate and shifting industrial mix. Furthermore, the number of people using medical marijuana in most states is far too small to cause the reported inter-state difference in sickness absence.]

Read more:
http://onlinelibrary.wiley.com/doi/10.1002/hec.3390/abstract

G.S. Wang, M.C. Le Lait, S.J. Deakyne, A.C. Bronstein, L. Bajaj, and G. Roosevelt. 2016. “Unintentional Pediatric Exposures to Marijuana in Colorado, 2009–2015.” JAMA Pediatrics, doi:10.1001/jamapediatrics.2016.0971.

In 2009-2015, 81 single-substance marijuana exposures of patients 0 to 9 years of age were evaluated at the Aurora, Colorado Children’s Hospital emergency department, urgent care centers, or inpatient unit and 163 similar exposure calls were fielded at the regional poison control center. The mean rate of marijuana-related visits to the children’s hospital increased from 1.2 per 100 000 population 2 years prior to marijuana legalization to 2.3 per 100,000 population 2 years after legalization. Known marijuana products involved in exposures included 30 infused edibles (48 percent). Annual PPC cases increased from 9 in 2009 to 47 in 2015. Colorado’s average annual increase in PCC was 34 percent, well above the 19 percent US average.

Read more:
http://archpedi.jamanetwork.com/article.aspx?articleid=2534480

Drivers Caught Intoxicated with Marijuana Grew After Legalization in Oregon
Kandra Kent, KPTV
July 21, 2016

Oregon State Police data show a 111 percent rise in driving under the influence of intoxicants (DUII) arrests where marijuana was a contributing factor in the first six months after marijuana legalization. In those six months, total DUII arrests went up 7 percent. Urine samples are often taken in drug DUII cases, and the evidence is sent to police crime labs for analysis. The Portland Forensic Lab currently has a 90 to 100 day backlog. The lab is testing new technology that will allow crime labs to detect synthetic cannabinoids in urine for the first time. Faster analysis could mean faster prosecution and faster data collection. (Includes video: 5:04 minutes)

Read more:
http://www.kptv.com/story/32494702/duiis-from-marijuana-see-huge-increase-in-first-year-of-legal-recreational-use

Tallahassee (Fla.) Medical Marijuana Dispensary Opens
Mariel Carbone, WCTV
July 26, 2016

Tallahassee recently opened the first medical cannabis dispensary in Florida. Trulieve stocks low- tetrahydrocannabinol (THC) products in gel, capsule, oil, or vapor. In August, it will add high-THC products. Qualified patient are terminally ill or suffer or show signs of cancer or a chronic illness that causes seizures or muscle spasms. The patient also must have a 90 day relationship with a qualified doctor. To be able to order the drug, doctors must complete an eight hour course, take an exam, and register with the state. (Includes video: 1:59 minutes)

Read more:
http://www.wctv.tv/content/news/Tallahassee-marijuana-dispensary-will-be-first-in-Florida-to-open-387658471.html

No Tetrahydrocannabinol in Colorado Town’s Water, New Tests Show
Jason Hanna and Carma Hassan, CNN
July 23, 2016

Laboratory testing showed there is no tetrahydrocannabinol (THC) in the water supply in Hugo, Colorado. Investigators learned that a company in town was testing its employees for drugs with a field-testing kit, but was noting some discrepancies in the results. The company then tested the tap water, anticipating that it would serve as a control for further tests by showing what an absolute negative result would look like. The field kit indicated the tap water was positive for THC. Further testing found THC-positive results in one of the town’s five water wells and at other locations in the system. The Colorado Bureau of Investigation was called to collect samples for laboratory tests. The lab tests were negative and investigators believe the field test results were false.

Read more:
http://www.cnn.com/2016/07/23/health/colorado-thc-water/index.html

[Video] Marijuana and Legalization
Addiction Technology Transfer Center Network
July 27, 2016

Dr. Rosalie Pacula, Director of the Bing Center for Health Economics at the RAND Corporation, discusses the variance among marijuana laws and the complexity of the impact of decriminalization or legalization. (Duration: 9:37 minutes)

Watch:
https://vimeo.com/176512686

International

Stoney First Nations Facing Prescription Addiction Crisis
Michele Jarvie, Calgary Herald
July 24, 2016

Stoney Nakoda in Morley, Alberta, Canada, declared a state of emergency due to the high rates of prescription drug addictions and overdoses among three First Nations bands. Anecdotal addiction rates have increased to 60 percent among adult members of the reserve, but actual numbers are not known. The chief executive officer of the Chiniki band estimated that within a two-year period, 139 deaths were attributed to opiates. Fentanyl is the main problem on the reserve. The province has been working with First Nations in responding to the fentanyl crisis by providing addictions treatment and education. Health Canada also has been working with First Nations’ chiefs and administration and the Alberta government to support the communities and address mental illness and suicide, addictions and chronic disease, and improve access to quality health care. On June 17, the federal Health Minister announced actions to address opioid misuse, which includes better prescribing practices and treatment options, reducing easy access to unnecessary opioids, and improving the national evidence base.

Read more:
http://calgaryherald.com/news/local-news/stoney-first-nations-facing-prescription-addiction-crisis

Ontario’s (Canada) Public Drug Plans to Cut High Doses of Morphine, Fentanyl
Rob Ferguson, Toronto Star
July 25, 2016

Effective January 2017, Ontario’s public drug plans will stop paying for high doses of morphine and fentanyl to curb misuse and overdoses. The changes involve morphine doses above 200 milligrams and fentanyl patches over 75 micrograms. Lower strength, long-acting opioids still will be funded and patients who require higher doses for adequate pain management will continue to be prescribed those formulations. Hydromorphone capsules over 24 mg and Meperidine 50 mg tablets will no longer be covered. Ontario will be the first province to implement this plan.

Read more:
https://www.thestar.com/news/queenspark/2016/07/25/ontarios-drug-plans-cutting-off-high-doses-of-morphine-fentanyl-to-curb-abuse.html

New Initiative in Ireland to Tackle Drugs on Streets
Public Health Agency
July 27, 2016

RAPID (Remove All Prescription and Illegal Drugs) is addressing illegal and prescription drugs by providing drug disposal bins across Northern Ireland. So far, 14 bins are deployed in the Belfast, South Eastern and Northern Health and Social Care Trust areas, with 65,000 tablets, 90 percent of them prescription drugs, collected. RAPID was piloted in 2010.

Read more:
http://www.publichealth.hscni.net/news/new-initiative-tackle-drugs-our-streets

Northeast/Mid-Atlantic News

As Lower-Dose Law Nears, Maine Doctors Prepare to Wean Patients Off Opioids
Joe Lawlor, Portland Press Herald
July 27, 2016

About 16,000 Maine residents currently are prescribed high doses of opioids for chronic and acute pain. A state law that takes effect this week will start to reduce their doses. By 2017, some doses will be released by one-half to two-thirds. Maximum doses for many patients will be 100 morphine milligram equivalents per day. Doctors also will be required to use the state’s prescription drug monitoring program. The Maine Medical Association is launching a public education program to ensure that this law does not push people to illicit drugs and is touring the state to educate physicians about how to best wean patients off high doses of opioid.

Read more:
http://www.pressherald.com/2016/07/27/as-lower-dosage-law-nears-maine-doctors-prepare-to-wean-patients-off-opioids

Narcan Saves Opioid Overdose Victims on Long Island (N.Y.), But Many Keep Using
Jo Napolitano, The Newsday
July 24, 2016

Some people are rescued by naloxone just once; others are saved multiple times. Police and police ambulances on Long Island have used naloxone more than 1,500 times since 2012.

Read more:
http://www.ems1.com/narcan/articles/110188048-Narcan-saves-opioid-overdose-victims-but-many-keep-using

Northwell, Mayo Clinic Tackle Opioid Epidemic in New York
Gregory Zeller, Innovate Long Island
July 26, 2016

Northwell Health will join the Mayo Clinic and the University of Pennsylvania’s Perelman School of Medicine on a 3-year study designed to track pain reliever dependency among emergencydepartment patients, and ultimately lower the risk. This study will enroll 1,200 total patients, 400 for each research group, who arrive in emergency departments with pain from kidney stones or lower-back ailments. Patients suffering these conditions are traditionally prescribed opioids for pain relief. The mission is to track patient pain levels and recoveries on and off opioids while potentially stemming the global opioid-abuse tide.

Read more:
http://www.innovateli.com/northwell-mayo-clinic-tackle-painkiller-epidemic

South News

Morphine Calculator Launches to Reduce Opioid Abuse in West Virginia
Blaine Carragher, WSAZ
July 28, 2016

West Virginia has launched a morphine equivalency calculator. The calculator uses a formula to analyze all of the opioid drugs a patient is prescribed. It then converts the dosage amounts to morphine-milligram equivalents. It is available for prescribers and pharmacists on the state’s prescription drug monitoring program. A score for the patient’s opioid use will appear at the top of the page. (Includes video: 1:36 minutes)

Read more:
http://www.wsaz.com/content/news/Morphine-calculator-launches-to-reduce-opioid-abuse-388598962.html

Lincoln County (W.Va.) Ready to Launch Student Drug Testing Program
Chris Lawrence, MetroNews
July 25, 2016

Lincoln County, W.Va., students who drive to school or participate in extra-curricular activities will be randomly drug tested in the upcoming school year. Parents can request addition of other children to the random testing program. If a student tests positive, the first offense results in suspension of driving privileges or participation in athletics or extra-curricular activities until the parents produce documentation the child has undergone a certified drug education program. The second offense will result in a 90 day suspension of driving privileges. A second offense for athletes will result in a 14-day suspension and a third offense in a calendar year prohibition on participation.

Read more:
http://wvmetronews.com/2016/07/25/lincoln-county-ready-to-launch-student-drug-testing-program

Naloxone Now Available in Florida Without an Individual Prescription
Jack Suntrup, Tampa Bay Times
July 25, 2016

Naloxone is now available in Florida without a prescription. CVS will begin to stock naloxone in all 878 of its Florida pharmacies this month.

Read more:
http://www.tampabay.com/news/health/medicine/overdose-reversal-drug-naloxone-now-available-in-florida-without-an/2286681

Nalaxone Available Without a Prescription at All Texas CVS Pharmacies
CVS Health
July 25, 2016

CVS Health has made naloxone available without a prescription at all CVS Pharmacy locations in Texas. It established a standing order with physicians in Texas. CVS Health also joined with the Partnership for Drug-Free Kids to create the Medication Disposal for Safer Communities Program, which donates disposal units to local police departments. The program has donated 37 units and collected more than two and a half metric tons of unwanted medications in Texas.

Read more:
http://cvshealth.com/newsroom/press-releases/cvs-health-makes-overdose-reversal-drug-available-without-prescription-all-0

Midwest News

University of Wisconsin Campus Promotes Life-Saving Opioid Overdose Drug
Shamane Mills, Wisconsin Public Radio
July 22, 2016

University Health Services (UHS) on the University of Wisconsin-Madison campus is partnering with Walgreens to promote access to naloxone for students. Students seeking naloxone at a pharmacy will be instructed how to use the medication. UHS also plans to send staff psychologists into the community to train student organizations on the proper use of the antidote.

Read more:
http://www.wpr.org/uw-campus-promotes-life-saving-opioid-overdose-drug

West News

Nearly Half of Utahans Have Been Affected by Prescription Drug Abuse Epidemic
Bob Bernick, Utah Policy
July 26, 2016

A June 2016 survey of 614 Utah adults found 18 percent have or had a family member who was addicted to prescription drugs or overdosed and another 29 percent know personally know someone was addicted or overdosed. The percentage were almost identical for “active” Mormons.

Read more:
http://utahpolicy.com/index.php/features/today-at-utah-policy/10278-poll-nearly-half-of-utahns-have-been-affected-by-prescription-drug-abuse-epidemic

Civil Rights Lawyers Push Feds Over Warrantless Prescription Database Access in Utah
Joe Uchill, The Hill
July 28, 2016

Utah’s prescription drug monitoring program (PDMP) is refusing to turn over prescription data to the Drug Enforcement Administration. The American Civil Liberties Union agrees with this decision and it has filed a motion to join a June lawsuit demanding access to the database without a warrant. In 2015, the state passed laws to guarantee the PDMP would not turn over data from its files without a warrant.

Read more:
http://thehill.com/policy/cybersecurity/289660-aclu-pushes-dea-in-warrantless-prescription-database-access-lawsuit

South Dakota Medical Association Hopes to Curb Opioid Prescriptions
Dana Ferguson, Argus Leader
July 26, 2016

The South Dakota State Medical Association released resources that focus opioid pain relievers and educating patients on the potential dangers of pain reliever misuse. The association also issued a white paper outlining appropriate opiate pain reliever prescriptions for chronic non-cancer pain. The state Division of Criminal Investigation also hs partnered with the state Board of Pharmacy to track pain relievers through the prescription drug monitoring program.

Read more:
http://www.argusleader.com/story/news/2016/07/26/medical-association-hopes-curb-painkiller-prescriptions/87581756

A New Deadly Opioid Threat on the Scene in Snohomish County (Wash.)
Rikki King, Everett Herald
July 24, 2016

Officials are concerned about the emergence of Fentanyl in Snohomish County, Washington. The county Medical Examiner’s Office says fentanyl was a factor in 5 deaths in 2015. In 2015, most of the 40+ opiate-related deaths involved multiple substances. King County reported 132 heroin deaths in 2015 and 97 deaths from pharmaceutical opioids. That number included the first documented death in that county from acetylfentanyl.

Read more:
http://www.heraldnet.com/news/a-new-deadly-opioid-threat-on-the-scene-in-snohomish-county

Webinars

[Live-streaming] Translating Science into Practice: Strategies for Combating the Opioid Epidemic
Addiction Policy Forum and National Criminal Justice Association
Monday, Aug. 8, 2016 | 1:45 p.m. – 3:45 p.m. (ET)
Loews Philadelphia Hotel
1200 Market Street
Philadelphia, Pa.

This session will examine best practices for responding to substance use disorders in criminal justice settings. Panelists will talk about programs that are showing promising results. What would it look like to take these models to scale? What role can law enforcement play in communities struggling with addiction? How can big data help curb the opioid epidemic and inform new responses in the criminal justice system? This workshop will be in a moderated question-and-answer format.

Read more:
https://www.eventbrite.com/e/translating-science-into-practice-strategies-for-combating-the-opioid-epidemic-tickets-26349023639?utm-medium=discovery&utm-campaign=social&utm-content=attendeeshare&utm-source=cp&utm-term=listing

Stopping the Revolving Door & Saving Lives: Innovative Approaches for Addressing Opioid Overdose and Opioid Use Disorders in Hospital Emergency Departments
White House National Drug Control Policy
Aug. 5, 2016 | 2–3 p.m. (ET)
http://ems6.intellor.com/index.cgi?p=601354&t=2&do=register&s=&rID=32&edID=

Reducing Opioid Abuse by Incorporating Patient Management Strategies from Psychiatry and Behavioral Health
American Dental Association
August 24, 2016 | 3:00 pm - 4:00 pm (ET)
http://pcss-o.org/event/reducing-opioid-abuse-by-incorporating-patient-management-strategies-from-psychiatry-and-behavioral-health
Pain Management in Dentistry: A Changing and Challenging Landscape
American Dental Association
Sept. 2, 2016 | 3–4 p.m. (ET)
http://pcss-o.org/event/pain-management-in-dentistry-a-changing-and-challenging-landscape

Grant Announcements

Safety and Outcome Measures of Pain Medications Used in Children and Pregnant Women (R03) | (R01) | (R21)
National Institutes of Health
Due: Oct. 16, 2016 | Jan. 7, 2020 | Jan. 7, 2020
Read more (R03):
http://grants.nih.gov/grants/guide/pa-files/PA-16-313.html
Read more (R01):
http://www.grants.gov/web/grants/view-opportunity.html?oppId=284425
Read more (R21):
http://www.grants.gov/web/grants/view-opportunity.html?oppId=284428

Safety and Outcome Measures of Pain Medications Used in Children and Pregnant Women (R03) | (R01) | (R21)
National Institutes of Health
Due: Oct. 16, 2016 | Jan. 7, 2020 | Jan. 7, 2020
Read more (R03):
http://grants.nih.gov/grants/guide/pa-files/PA-16-313.html
Read more (R01):
http://www.grants.gov/web/grants/view-opportunity.html?oppId=284425
Read more (R21):
http://www.grants.gov/web/grants/view-opportunity.html?oppId=284428

Bottle Tracking Program
National Association of Drug Diversion Investigators
Due: None Specified
http://www.naddi.org/aws/NADDI/pt/sp/programs_grants
http://naddibottletracking.org/law-enforcement

National Take-Back Initiative

National Take-Back Initiative
Drug and Enforcement Administration
Saturday, Oct. 22, 2016
10 a.m. – 2 p.m.

The National Prescription Drug Take-Back Day aims to provide a safe, convenient, and responsible means of disposing of prescription drugs, while also educating the general public about the potential misuse of medications.

Read more:
http://www.deadiversion.usdoj.gov/drug_disposal/takeback

Take-Back Events & Drop Boxes

Shed the Meds Summer Program in Brewster (Conn.)
Brewster Police, HamletHub
July 23, 2016
http://news.hamlethub.com/brewster/publicsafety/2482-shed-the-meds-summer-program

Hillsborough County (Fla.) Sheriff's Office Installs Prescription Drug Drop Boxes
Tampa Bay Times
July 22, 2016
http://www.tampabay.com/news/briefs/hcso-installs-drop-boxes-for-unused-unwanted-medication/2286507

Prescription Drug Drop Box Installed in Countryside (Ill.)
Morgan Searles, La Grange Patch
July 22, 2016
http://patch.com/illinois/lagrange/unwanted-prescription-drug-drop-box-installed-countryside

Pill Take-Back Day Held at Palo Verde (Nev.) High School
Katherine Jarvis, KTNV
July 23, 2016
http://www.ktnv.com/news/pill-takeback-day-held-at-palo-verde-high-school
Ramsey (N.J.) Police Add ‘Project Medicine Drop’ Collection Box
Jerry DeMarco, Mahwah-Ramsey
July 22, 2016
http://mahwah.dailyvoice.com/police-fire/ramsey-police-add-project-medicine-drop-collection-box/673608

Warwick (N.Y.) Police Install Unit to Dispose of Drugs Safely
Times Herald-Record
July 23, 2016
http://www.recordonline.com/article/20160723/NEWS/160729784

Van Wert (Ohio) Prescription Drug Turn-In Program Only Accepts Pills
Eric Weitz, WCSM
July 25, 2016
http://www.wcsmradio.com/index.php/news/19003/117/Sheriff-Van-Wert-prescription-drug-turn-in-program-only-accepts-pills

Oconee County (S.C.) Gets Drug Collection Unit
Rachel Cumberbatch, FOX
July 26, 2016
http://www.live5news.com/story/32534761/oconee-co-gets-drug-collection-unit

Naval Hospital Bremerton (Wash.) Pharmacy Implements Innovative Ideas
Douglas Stutz, Naval Hospital Bremerton
July 22, 2016
https://www.dvidshub.net/news/204979/naval-hospital-bremerton-pharmacy-implements-innovative-ideas

Upcoming Conferences and Workshops

The Harold Rogers Prescription Drug Monitoring Program National Meeting
Bureau of Justice Assistance, and Prescription Drug Monitoring Program Training and Technical Assistance Center at Brandeis University
Aug. 17–19, 2016
Washington, D.C.

Register:
http://www.pdmpassist.org/content/ttac-meeting-registration-form

National Conference on Addiction Disorders: Taking Recovery to New Heights
Vendome Healthcare Media
Aug. 18–21, 2016
Sheraton Denver Downtown Hotel
Denver, Colo.
https://vendome.swoogo.com/ncad-2016/home

Register:
https://vendome.swoogo.com/ncad-2016/begin

2016 Annual Conference
International Health Facility Diversion Association
Sept. 13–14, 2016
Cincinnati, Ohio
https://ihfda.org/2016-annual-conference

Register:
https://www.regonline.com/Register/Checkin.aspx?EventID=1803476

Twenty-Ninth Annual National Prevention Network Conference
National Prevention Network
Sept. 13–15, 2016
Buffalo, N.Y.
http://www.npnconference.org

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

2016 Conference: Saving Lives: Access to Improved Health & Recovery
American Association for the Treatment of Opioid Dependence
Oct. 29 – Nov. 2, 2016
Baltimore, Md.
http://www.aatod.org/national-conference/2016-aatod-conference-baltimore

Register:
http://www.aatod.org/national-conference/2016-aatod-conference-baltimore/register-now

2016 Fall Research Conference: The Role of Research in Making Government More Effective
Association for Public Policy Analysis & Management
Nov. 3–5, 2016
Washington, D.C.
http://www.appam.org/events/fall-research-conference/2016fall-research-conference-information

Bridging the Gaps: Reducing Prescription Drug and Opioid Abuse and Misuse Summit
National Association of Attorneys General and the Association of State and Territorial Health Officials
Nov. 14–16, 2016
Arlington, Va.
http://www.naag.org/nagtri/nagtri-courses/national/bridging-the-gaps-reducing-prescription-drug-and-opioid-abuse-and-misuse-summit.php

National Rx Drug Abuse & Heroin Summit
Operation Unite
April 17–20, 2017
Atlanta, Ga.
https://vendome.swoogo.com/2017-rx-summit/8082

Call for Presentations
Submission Deadline Date: Friday, Aug. 5, 2016
https://vendome.swoogo.com/2017-rx-summit/2017-CFP
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.