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December 10, 2014


SAMHSA Prescription Drug Abuse Weekly Update
Issue 101  |  December 10, 2014
The Prevention of Prescription Drug Abuse in the Workplace (PAW) TA Center addresses prescription drug abuse—a growing public health problem with increasing burdens on workers, workplaces, and our economy. To subscribe colleagues, family members, or friends to this listserv sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), please click here or send their e-mail addresses to paw@dsgonline.com.
Table of Content Other Journal Articles and Reports Professional Education National News International News Northeast/Mid-Atlantic News Midwest News South News West News Take-Back Events and Drop Boxes Upcoming Conferences and Workshops


This week, your Editor also highly recommends the lead National News stories.

M. Warner, H. Hedegaard, and L–H. Chen. 2014. "Office of Analysis and Epidemiology Trends in Drug-Poisoning Deaths Involving Opioid Analgesics and Heroin: United States, 1999–2012." National Center for Health Statistics Health E-Stat.

National Vital Statistics multiple cause-of-death data indicate 41,502 people died from drug poisoning in the United States in 2012. This included 16,007 deaths involving prescription opioid analgesics and 5,925 deaths involving heroin. The age-adjusted drug-poisoning death rate rose from 6.1 per 100,000 population in 1999 to 13.1 in 2012. The age-adjusted rate of deaths involving opioid analgesics rose from 1.4 to 5.1 per 100,000. Opioid-analgesic death rates increased by an average of 18 percent per year through 2006, then slowed. Conversely, the rise in the age-adjusted rate of deaths involving heroin from 0.7 per 100,000 in 1999 to 1.9 in 2012 involved an accelerating death rate after 2006. From 2011 to 2012, total opioid deaths rose from 6.8 to 7.0 per 100,000, with analgesic deaths declining from 5.4 to 5.1 per 100,000, while heroin deaths rose from 1.4 to 1.9 per 100,000. In 2012, 14 states had significantly higher age-adjusted drug-poisoning death rates than the overall U.S. rate. States with the highest rates per 100,000 population were West Virginia (32.0), Kentucky (25.0), New Mexico (24.7), Utah (23.1), and Nevada (21.0).

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A.J.H. Kind, L.L. Jensen, and K.A. Kennelty. 2014. "Far Too Easy: Opioid Diversion During the Transition from Hospital to Nursing Home." Journal of the American Geriatrics Society, 62(11):2229–231. doi:10.1111/jgs.13084.

A pilot project designed to improve discharge communications uncovered a flaw in the system that made it easy for people who transport the elderly to steal their opioid prescriptions. Most prescription drug monitoring programs do not track nursing home patients or the names of people who pick up their medications. The researchers suggest that hospitals create tamper-proof packaging for discharge orders and prescriptions and routinely track opioid prescriptions. Better communication between hospitals and nursing homes can prevent stolen opioid prescriptions.

Read more:

Journal Articles and Reports

S.S. Martins, J.H. Kim, L–Y. Chen, D. Levin, K.M. Keyes, M. Cerdá, and C.L. Storr. 2014. "Nonmedical Prescription Drug Use Among US Young Adults by Educational Attainment." Social Psychiatry and Psychiatric Epidemiology, doi:10.1007/s00127-014-0980-3.

Analysis of 2008–10 National Survey on Drug Use and Health (NSDUH) data on young adults ages 18–22 showed those who did not attend college had a higher rate of past-year nonmedical use of prescription opioids than those who did (adjusted odds ratio [OR] 1.23), and a lower rate of prescription stimulant use. NSDUH defines nonmedical use as taking a prescription drug that is not prescribed for you, or using your prescribed drug recreationally. Among users, regardless of drug type, non-college-attending youth were more likely to have a past-year disorder secondary to use (ORs 1.55 for high school graduates and 1.75 for dropouts). Educational attainment interacted with gender and race. Notably, nonmedical opioid use was low among Hispanics, relative to whites.

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L. McGlone and H. Mactier. 2014. "Infants of Opioid-Dependent Mothers: Neurodevelopment at Six Months." Early Human Development 91(1):19–21, doi:10.1016/j.earlhumdev.2014.10.006

At 6 months of age, 81 infants of methadone-prescribed opioid-dependent mothers had lower neurodevelopment scores in all domains compared with controls. Polydrug-exposed infants and those treated for neonatal abstinence syndrome had the lowest scores.

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S.M. Schrager, A. Kecojevic, K. Silva, J. Jackson Bloom, E. Iverson, and S.E. Lankenau. 2014. "Correlates and Consequences of Opioid Misuse Among High-Risk Young Adults." Journal of Addiction 2014(Article ID 156954):8, doi:10.1155/2014/156954.

This study analyzes data from 575 interviews with prescription drug misusers ages 16–25 who were interviewed in Los Angeles and New York between October 2009 and March 2011. In this quota sample, roughly one third of respondents were injection drug users; another third were homeless. Latent class analysis differentiated users by use intensity and route of administration. Intensive users—participants with consistently high opioid misuse and multiple usage modes over the past 12 months, including injection—had significantly higher probabilities of engaging in recent heroin, cocaine, methamphetamine, and tranquilizer misuse; daily opioid misuse; and experiencing withdrawal from opioids than all other classes. Sociodemographic factors, homelessness, prescription history, and history of parental drug use were significantly associated with riskier opioid misuse trajectories.

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Professional Education

D.H. Eagerton, N.H. Goodbar, M.C. Dansby, S.N. Abel, and W.C. Bell. 2014. "Morphine Overdose in a 6½-Week-Old Infant: A Case Report." Austin Journal of Pharmacology and Therapeutics 2(10):4.

Researchers reported a case of lethal morphine overdose in a breastfed infant secondary to medication transfer into breast milk. The mother of a 6½-week-old breastfed infant contacted emergency services after her child became unresponsive. Her infant was pronounced dead on arrival by medical personnel, and an autopsy revealed a lethal level of morphine. She reported taking numerous medications, including morphine sulfate. At the time, she was prescribed levetiracetam, baclofen, amlodipine, desvenlafaxine, clonazepam, and hydrocodone/ibuprofen. Though she was originally prescribed morphine in 1998 after a car accident left her with chronic pain, she did not admit to taking the drug during her interview with the coroner. Further investigation revealed her morphine prescriber was unaware she had been pregnant and subsequently breastfeeding an infant. Her obstetrician and pediatrician were also unaware she was taking morphine. The mother was charged with homicide by child abuse—the first case of homicide secondary to medication transfer into breast milk—as well as involuntary manslaughter and unlawful conduct toward a child. She was tried and convicted on all three charges and subsequently sentenced to 20 years in prison.

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B. Hard. 2014. "Management of Opioid Painkiller Dependence in Primary Care: Ongoing Recovery with Buprenorphine/Naloxone." Case Report. BMJ, doi:10.1136/bcr-2014-207308.

Researchers reported a case of a young woman exhibiting dependence on codeine, originally prescribed for myalgic encephalopathy, after use escalated over a 10-year period. In 2012, a consultation with a new general practitioner who had extensive experience with substance abuse patients revealed the underlying dependence. After 6 months of building trust, the physician got the woman to admit medication abuse and referred her to the community drug and alcohol team. On presentation to the team, the patient had no pain issues and the dihydrocodeine use—600 tablets per week—solely reflected her dependence. She successfully underwent rapid induction with buprenorphine/naloxone as opioid substitution treatment over 2 days. The woman is currently stable, engaged with recovery support services and psychosocial counseling, and has returned to work. She is maintaining a therapeutic dose of buprenorphine 10 mg/naloxone 2.5 mg.

Read more:

K. Steven. 2014. "Dependence on Prescription Medication." InnovAiT, doi:10.1177/1755738014557970.

Prescribing guidance from the General Medical Council states, "You must be prepared to explain and justify your decisions and actions when prescribing, administering, and managing medicines." This is particularly pertinent for drugs associated with dependency risk.

Read more:

O.D. Taylor. 2014. "The Cultural Influence of Adolescent Prescription Drug Abuse." Journal of Human Behavior in the Social Environment, doi:10.1080/10911359.2014.969124.

A disproportionate number of adolescents are abusing prescription medications at alarming rates. Many parents are naïve or oblivious about their adolescent's prescription drug use. Drugs stored at home in medicine cabinets are often adolescents' primary source of recreational use. At-risk youth may fall prey to the prolific environmental influences that saturate communities across the United States. Healthy beliefs and clear standards, promoted by parents and teachers in conjunction with familial and community bonding, can reduce prescription drug abuse among youth. Adolescents bonded to prosocial peers who reject substance-abusing peer pressure are less likely to abuse prescription medications themselves.

Read more:

National News

Naloxone, a Drug to Stop Heroin Deaths, Is More Costly, the Police Say
J. David Goodman, The New York Times
November 30, 2014

Police and public health officials across the country have seen a 50 percent increase (or more) in the price of naloxone. In Georgia, police officials say the cost of a naloxone kit has risen from $22 to $40. New Jersey has seen similar increases. The New York City Health Department said a more than 50 percent price increase for nasal naloxone has officials concerned over the future of its distribution programs. In an e-mail, Jason B. Shandell, president of Amphastar, said "manufacturing costs have increased on an annual basis." (Editor's note: If anything, economies to scale should be reducing the price.) Hospira, another manufacturer, said its form of naloxone is "on average, about the cost of a large pizza."

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Using Doctors with Troubled Pasts to Market a Painkiller
Katie Thomas, The New York Times
November 27, 2014

Insys Therapeutics enlisted pain specialists who were facing legal or disciplinary action to promote the company's powerful and addictive painkiller: Subsys. They paid significant speaking fees and covered travel and meals, with costs in 2013 often exceeding $50,000. An analysis of the new federal Open Payments database showed 5 of the 20 physicians who received the most money from Insys recently faced legal or disciplinary action, including 3 accused of inappropriately prescribing pain relievers. Many of the 20 highly paid doctors were also top prescribers of Subsys, and in at least two cases, the company hired doctors' adult children to serve as sales representatives. According to Insys, federal investigators began looking into its sales and marketing practices last December. In September, the company said it had received another federal subpoena.

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Federal Exchanges Top 10 Most Pressing Challenges for HHS in 2015
Healthcare Finance News
December 2, 2014

The U.S. Office of the Inspector General recently compiled a detailed report highlighting 10 of the most pressing challenges faced by the organization. It lists "Ensuring Appropriate Use of Prescription Drugs in Medicare and Medicaid" as the second challenge. The report found a host of questionable utilizations and billing patterns that suggest many people are illegally receiving, and perhaps selling, prescription drugs.

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Lawsuit for Investors in FedEx Corporation (FDX) Shares Against Directors Announced by Shareholders Foundation
December 1, 2014

A lawsuit filed by a current investor claims FedEx was aware it shipped illegal prescription drugs. The investor also claims FedEx's founder, chief executive officer, and chairman of the board, among others, refuse to take responsibility for their failure to correct known problems. On August 15, 2014, FedEx Corporation was indicted in a criminal case for alleged conspiracy to launder money over deliveries for illegal online pharmacies. According to the allegation, FedEx delivered controlled substances and prescription drugs from online pharmacies to individuals who subsequently died or accidentally caused the death of others.

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Lightlake Therapeutics Commences Trial for Treatment of Opioid Overdose with the U.S. National Institute on Drug Abuse
PR Newswire
December 4, 2014

Lightlake Therapeutics, a biopharmaceutical company that specializes in addiction treatments, has begun a trial to evaluate its intranasal naloxone application for opioid overdose, which it claims could widely expand naloxone's availability and use in preventing opioid overdose deaths. The trial is being conducted in partnership with the National Institute on Drug Abuse.

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MLB's Joint Drug Prevention Reports Slight Increase in Positive Tests for Banned Substances
Christian Red, New York Daily News
December 1, 2014

Major League Baseball released an annual report on its drug prevention and treatment program. The league detailed 10 positive tests for stimulants during the 2013–14 offseason through the end of the 2014 postseason, two positive tests for steroids, and one non-analytical positive for violating the steroid policy. The year before, the league reported eight positive tests for stimulants, no positive tests for steroids or performance-enhancing substances, and 13 non-analytical positives for steroids. Adderall® was responsible for 8 of the 10 positive tests for stimulants according to this year's report. (Editor's note: Some suspect this system fails to detect most abuse.)

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Ravens' Haloti Ngata Is the Latest Star Athlete Suspended for Using Adderall
Childs Walker, The Baltimore Sun
December 4, 2014

Baltimore Raven player Haloti Ngata was suspended for four games after testing positive for Adderall®. The National Football League tests every player at least once a season, and randomly tests 10 players a week from each team. Players can apply for therapeutic use exemptions for Adderall®, but they must ask a physician to file an application with the administrator of the league's drug policy. Attention deficit hyperactivity disorder is one of the valid reasons for which a player can request an exemption.

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Employers Struggle to Catch Addicted Nurses—Sort Of
Patricia Borns, News Leader
December 5, 2014

The News Leader investigated thousands of Virginia Board of Nursing records showing disparities in how healthcare facilities identify and handle employees who steal patients' medications or work while high on alcohol or drugs. Virginia law requires healthcare facilities to report theft or "significant loss" of narcotics to a regulatory board, and protects the facilities from liability. Another law requires them to report an impaired nurse or face a fine as high as $25,000. Nevertheless, nurses who steal drugs or are discovered to be high at work are often not reported. Although the Virginia Health Practitioners' Monitoring Program allows nurses to get treatment and return to work under supervision without a black mark on their records, less than 10 percent of healthcare employers refer their nurses to the monitoring program before law enforcement or the nursing board gets involved. Some facilities terminate nurses instead for behavior or job issues. Virginia Board of Nursing data indicate only a fraction of nurses who struggle with substance abuse are caught by their employers and reported to the state. In 2000, a Joint Commission on Health Care decided it would be too costly to require Virginia facilities to adopt drug-free workplace programs.

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International News

Prescription Drug Abuse Grows in Newfoundland
Sue Bailey, The Canadian Press
December 2, 2014

Police said prescription pain relievers are a problem in Newfoundland and Labrador, Canada. Royal Newfoundland and Labrador lacks a full computer network that could trace those who fill multiple prescriptions from various doctors at different pharmacies. Health Minister Steve Kent said addressing the rising rate of opioid addiction is a top government priority. Most other provinces have some form of pharmacy network where doctors, pharmacists, government officials, and multiple information technology vendors cooperate. Stephen Reid, executive director of the Pharmacists' Association of Newfoundland and Labrador, said a new committee will lead a similar effort in the province.

Read more:

Methadone Most Common Cause of Drug Overdose Deaths in Region: Coroner
Matt Vis, The News Watch
December 1, 2014

The supervising coroner in Northwestern Ontario, Canada, said the number of people dying from methadone overdose is increasing, with the majority of those taking the drug illegally. Methadone use was a factor in 15 to 20 overdose deaths. The coroner said recent cases show it is not uncommon for people to sell or trade their supply.

Read more:

Northeast/Mid-Atlantic News

Opiates Outpace Alcohol as Cause for Treatment
Dave Gram, The News and Observer
November 29, 2014

Vermont Health Department figures show for the first time, more residents sought treatment for opiate addiction than for alcoholism in fiscal year 2013. The number of Vermonters seeking alcohol treatment decreased from 4,987 in 2004 to 3,776 in fiscal year 2013, while those seeking opiate addiction treatment increased from 1,199 to 4,043.

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Taunton Police Responding to Two to Three Heroin ODs Per Week
Marc Larocque, Taunton Daily Gazette
December 3, 2014

The Taunton Police Department reported that since late August, the city has averaged two or three heroin-related overdoses each week. The 183 known overdoses this year included 11 deaths. Many fatal overdoses involved heroin tainted with fentanyl.

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More Responders Using 'Wonder Drug' Narcan to Treat Overdose Victims
Skyler Magnoli and John Nickerson, The News-Times
November 30, 2014

Redding, Conn., police officers will carry Narcan® by the end of November. Ridgefield Police Department is also considering training officers to use the drug. Police departments in Danbury, Newton, and Greenwich have no plans to carry Narcan®.

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Assembly Panel Advances Angelini Prescription Drug Disposal Bill
December 4, 2014

An assembly panel advanced A-709, which requires pharmacies and physicians to instruct patients on how to safely dispose of unused prescribed controlled dangerous substances. The measure requires New Jersey's Division of Consumer Affairs to post a notice on its website advising patients about the availability of drug take-back programs sponsored by a local, state, or federal government agency and describing how to determine where they can drop off unused prescription drugs.

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Midwest News

Kentucky Awarded Grant for Prescription Drug Abuse Prevention Program
University of Kentucky
December 1, 2014

The Kentucky Injury Prevention and Research Center was awarded a $400,000 grant from the Bureau of Justice Assistance to develop data-driven, multidisciplinary approaches to reduce prescription drug abuse and overdoses in the state. The award is a collaborative effort between criminal justice and public health agencies to enhance Kentucky's analytical capacity to identify existing and emerging prescription drug abuse trends and individuals and communities at risk of overdose. The project will also address sources of diversion and determine best practices for sharing prescription drug overdose–related data.

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Heroin Deaths Prompt Duluth to Spread the Word on Anti-Overdose Drugs
Jon Collins, Minnesota Public Radio
December 2, 2014

Minnesota public health workers are rushing to get naloxone into the hands of drug users, following three opiate overdose deaths in 2 days. Through a standing order from a doctor at Valhalla Place, a Duluth-based organization was able to obtain 300 doses of naloxone to distribute to patients. Naloxone is also available in the Twin Cities at Valhalla Place, which provides mental health counseling and medication-assisted addiction services. Valhalla Place is working to form additional naloxone access partnerships.

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A New, Simple Device Could Lower the Number of Drug Overdoses in the State
December 3, 2014

A safe locking device on medicine bottles would keep drugs out of the wrong hands. Illinois lawmakers hope to introduce a mandate in January for such a device. (Includes video: 1:29 minutes)

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South News

Council: SC Database Can Stem Prescription Abuse
Seanna Adcox, The State
December 1, 2014

The Prescription Drug Abuse Prevention Council, created by South Carolina's governor, approved a 127-page report requiring all healthcare professionals with prescription-writing authority to participate in the state's prescription monitoring program. The council said doing so can significantly stem rampant pain reliever abuse. According to the report, 21 percent of prescribers have registered for the program, but few of them use it. The number of residents admitted to a state treatment program for opiate abuse or dependence has more than tripled in the past decade.

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Obesity and Substance Abuse Identified as Issues
Brandon Rivera, Robesonian
December 1, 2014

The Robeson County (N.C.) Department of Public Health and Southeastern Health began implementing initiatives based on a Community Health Needs Assessment completed by county residents. Objectives include increasing by 5 percent the number of adults who participate in physical activity or exercise and reducing by 5 percent the number of people under 26 who abuse prescription drugs.

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HHS Committee Releases Interim Recommendations
Edgar Walters, The Texas Tribune
December 1, 2014

The Texas Senate Committee on Health and Human Services released its recommendations for the 2015 legislative session, including suggestions for stopping prescription drug abuse. Senator Charles Schwertner, who chairs the committee, said the report provides a blueprint for tackling some of the state's most pressing healthcare issues.

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Texas Excited About Drug Policy Reform
Joy Strickland, The Huffington Post
December 2, 2014

The founder and chief executive officer of Mothers Against Teen Violence discusses some of the drug policy bills that have been pre-filed for the 84th Legislature. House Bill 225 protects 911 callers from being prosecuted for their illegal drugs. Representative Eric Johnson has agreed to file a naloxone access bill that will make the drug available to anyone at risk of overdose.

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Prescription Drug Overdoses on the Rise in Women 35–49
Natalie Tejeda, WIAT
December 3, 2014

Jefferson County, Ala., had more than 100 prescription drug overdose deaths this year—exceeding the number of homicides. Sandor Cheka of the Addiction Prevention Coalition said he has seen an increase in prescription drug abuse among women ages 35 to 49. Mountain Brook and Pelham Police Departments have drop boxes where people can safely dispose of their medications. (Includes video: 2:09 minutes)

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West News

New Prescription Guidelines in Battle Against Addiction
Trisha Hendricks, The Arizona Republic
December 3, 2014

New Arizona opioid prescribing guidelines recommend using prescription pain relievers only when other therapies have not resolved the pain and only in appropriate doses. According to the guidelines, long-acting opioids should not be used to treat acute pain. State officials hope the new guiding principles will help reduce prescription drug abuse. More than 250 million pain relievers are prescribed each year in Arizona. In 2011, the state had the fifth highest opioid prescription rate in the country. It ranked sixth for drug overdose deaths in 2010. (Includes video: 2:49 minutes)

Read more:

Prescription for Disaster: Painkiller Use in Hawaii Increases
Tannya Joaquin, KHNL
November 27, 2014

Over the past decade, overdose deaths have increased 68 percent in Hawaii. Prescription drug overdoses have now surpassed automobile accidents as the leading cause of death. Hawaii has several initiatives to address this problem. The state has a prescription monitoring program (PMP), and pharmacists have logged 1.3 million prescriptions statewide this year. Hawaii's take-back drug program has also been successful. In January, the narcotics policy group that launched the PMP will propose urine testing for any patient seeking pain pills as part of its prescription drug legislative package.

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Health Data for Missoula County Reveals Trends in Teen Drug Use, Drinking
David Erickson, Missoulian
November 29, 2014

The 2014 Missoula County (Mont.) Health Assessment was created by a working group of health professionals from Missoula hospitals, health centers, clinics, and agencies. The assessment showed self-reported prescription stimulant and sedative misuse is rising among high school students in Missoula, with 11.4 percent misusing sedatives and 6.8 misusing stimulants.

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Naloxone Kits Now Available in Snohomish County—Potentially Lifesaving Drug
Karin Hopper, The Woodinville Weekly
December 2, 2014

Naloxone kits are now available at pharmacies in Snohomish County, Wash. Individuals can ask pharmacists for a kit without having a prescription, and pharmacists will provide education on how and when to use naloxone.

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Prescription Drug Abuse Is Big Problem for Fremont County
Jenna Jackson, KCWY
December 3, 2014

A Fremont County, Wyo., undersheriff said the department receives many calls about theft and burglary of prescription drugs. The county has prescription drop boxes where people can dispose of medications. But Riverton Police Captain Eric Murphy doesn't know if the boxes made a difference. (Include video: 1:42 minutes)

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Lock Boxes Urged for Prescription Meds
Rachel Snyder, The Duncan Banner
December 3, 2014

Wichita Mountains Prevention Network is working with local pharmacies to encourage people with pain reliever prescriptions to get a lock box for their medicine. Between 1999 and 2010, Stephens County, Okla., had an overdose death rate of 12.1 per 100,000 population related to prescription pain medication—exceeding the state's average.

Read more:

Take-Back Events and Drop Boxes

Hubbard Township Police Department Receives Grant for Drug Collection Unit
The Herald (Pennsylvania)
November 29, 2014

Mendon Police to Install Drug Drop-off Box
Mike Gleason, Milford Daily News (Massachusetts)
December 1, 2014

Drug Drop-Off Site Debuts
Glenn Barr, Mountain News (California)
December 4, 2014

Upcoming Conferences and Workshops

Opiate Symposium
Mental Health and Recovery Services Board of Stark County
December 15, 2014
Canton, Ohio

SAMHSA's 11th Prevention Day
Substance Abuse and Mental Health Services Administration
February 2, 2015
National Harbor, Maryland

25th Anniversary National Leadership Forum
Community Anti-Drug Coalitions of America
February 2–5, 2015
National Harbor, Maryland

National Rx Drug Abuse Summit
April 6–9, 2015
Atlanta, Georgia
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.