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December 17, 2014


SAMHSA Prescription Drug Abuse Weekly Update
Issue 102  |  December 17, 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 Other Resources Grant Awarded Bid Opportunity Take-Back Events and Drop Boxes Upcoming Conferences and Workshops


Many Americans on Long-Term Painkillers Take Potentially Fatal Drug Combinations
December 9, 2014

A Nation in Pain, a report published by Express Scripts, analyzes prescription opioid use in the United States between 2009 and 2013. The amount of pain medication taken by Americans increased significantly over the past 5 years, while the number of people using pain medications long-term remained flat. Nearly half of patients who took opiate pain relievers for more than 30 days in the first year of use continued to use the drugs for 3 years or more. Almost 50 percent of these patients were taking only short-acting opioids, putting them at higher risk for addiction. Nearly 60 percent of patients on opioid pain treatments for long-term conditions were prescribed potentially dangerous mixtures of medications during the same time period. Two thirds of patients on these medication mixtures were prescribed the drugs by two or more physicians, and nearly 40 percent filled their prescriptions at more than one pharmacy. In addition to taking opiates, nearly one in three patients was taking benzodiazepines, and 28 percent were taking muscle relaxants. Eight percent were combining all three. Additionally, 27 percent were taking multiple opiate pain treatments at the same time. The use of pain medications was most prevalent in small, southeastern cities.

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Nursing Homes Rarely Penalized for Oversedating Patients
Ina Jaffe and Robert Benincasa, National Public Radio
December 9, 2014

Antipsychotic drugs can be deadly for older people with Alzheimer's disease or other forms of dementia. But almost 300,000 nursing home residents still get them. In 2012, the federal government started a campaign encouraging nursing homes to reduce their use of antipsychotic drugs. National Public Radio's analysis of government data found harsh penalties are almost never used when nursing home residents get unnecessary drugs. Texas nursing homes have the highest rate of antipsychotic drug use in the nation. The Centers for Medicare and Medicaid Services' new goal for nursing homes is a 15 percent reduction of antipsychotic drug use by the end of 2016. If this goal is accomplished, it will mean that after a 5-year effort, almost a quarter of a million nursing home residents will still be getting largely unnecessary and potentially lethal antipsychotic drugs. (Duration: 6:27 minutes)

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Journal Articles and Reports

M. Asbridge, J. Cartwright, and D. Langille. 2015. "Driving Under the Influence of Opioids Among High School Students in Atlantic Canada: Prevalence, Correlates, and the Role of Medical Versus Recreational Consumption." Accident Analysis and Prevention 75:184–191, doi:10.1016/j.aap.2014.12.001.

In a 2012 survey of 3,655 students in grades 10 and 12 in three Atlantic Canadian provinces, 4.3 percent said they drove under the influence of opioids in the past year. The rate was 14 percent among students who had used a prescription opioid at least once in the past year, with a higher rate among medical and recreational users (25 percent) compared with those using opioids for medical purposes only (10 percent). Logistic regression showed predictors of driving under the influence of opioids: higher socioeconomic status, higher sensation seeking, lower parental attachment, and being a recreational prescription opioid user. Driving under the influence of opioids was strongly associated with driving under the influence of other substances or riding with someone who was under the influence.

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V.J. Ganem, A.G. Mora, S.M. Varney, and V.S. Bebarta. 2014. "Emergency Department Opioid Prescribing Practices for Chronic Pain: A 3-Year Analysis." Presentation Abstract. Journal of Medical Toxicology, doi:10.1007/s13181-014-0449-5.

Over a 3-year period in emergency departments at two tertiary care military hospitals, 28,103 visits generated an opioid prescription. Of 1,322 visits associated with chronic pain, 443 (33 percent) resulted in an opioid prescription. Without adjusting for covariates, physician assistants were more likely to prescribe an opioid than physicians (55 percent vs. 23 percent). Civilian providers were more likely to prescribe an opioid than active duty providers (58 percent vs. 42 percent). Providers were 79 percent physicians, 19 percent physician assistants, 81 percent male, and 69 percent active duty military. Medications were 43 percent oxycodone, 30 percent hydrocodone, 9.5 percent tramadol, 2.5 percent codeine, and 15 percent other. The number of pills was 20 (range 1–240); morphine equivalents per pill was 7.5 (2.5–120); and total morphine equivalents per prescription was 150 (15–6,000).

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E.L. Garland and H.B. Froeliger. 2014. "Neurophysiological Evidence for Remediation of Reward Processing Deficits in Chronic Pain and Opioid Misuse Following Treatment with Mindfulness-Oriented Recovery Enhancement: Exploratory ERP Findings from a Pilot RCT." Journal of Behavioral Medicine. Epub ahead of print.

A pilot study randomized chronic pain patients at risk for opioid misuse to 8 weeks of Mindfulness-Oriented Recovery Enhancement (n=11) or a support group control condition (n=18). The study outcome measure was change after 8 weeks of treatment in late positive potential (LPP), an event-related brain potential response in the 400–1,000 ms time window to images representing naturally rewarding stimuli (e.g., beautiful landscapes, intimate couples) and to neutral images. Treatment was associated with significant increases in LPP response to natural reward stimuli relative to neutral stimuli. The difference correlated with enhanced positive affective cue-responses and reductions in opioid craving from pre- to post-treatment. Thus, cognitive training regimens centered on strengthening attention to natural rewards may reduce reward-processing deficits underpinning addictive behavior.

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A.L. Giordano, E.A. Prosek, E.A. Reader, C.M. Bevly, K.D. Turner, Y.N. LeBlanc, R.A. Vera, C.E. Molina, and S.A. Garber. 2014. "Collegiate Misuse of Prescription Stimulants: Examining Differences in Self-Worth." Substance Use and Misuse, doi:10.3109/10826084.2014.980956.

A 2013–14 online survey of a convenience sample of 3,038 Texas undergraduates at a public university found significant differences in self-worth between four groups: stimulant medication nonusers, appropriate users, nonprescribed misusers, and prescribed misusers. External aspects of self-worth, such as appearance and approval, were associated with misuse. Internal aspects, such as God's love and virtue, were associated with nonuse and appropriate prescribed use.

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C.S. Hwang, L.W. Turner, S.P. Kruszewski, A. Kolodny, and G.C. Alexander. 2014. "Prescription Drug Abuse: A National Survey of Primary Care Physicians." Research Letter. JAMA Internal Medicine, doi:10.1001/jamainternmed.2014.6520.

In February 2014, researchers sent surveys to a nationally representative sample of 1,000 U.S. internists, family physicians, and general practitioners. Fifty-eight percent responded. Among respondents, 85 percent believed opioids are overused in clinical practice. Many reported they are "very" or "moderately" concerned about serious opioid overuse risks, such as addiction (55 percent being "very concerned"), death (48 percent), and motor vehicle crashes (44 percent). Many also said adverse events such as tolerance (62 percent) and physical dependence (56 percent) occur "often," even when medications are used as directed for chronic pain. Nearly all physicians surveyed (88 percent) expressed confidence in their ability to appropriately prescribe opioids. Nine in 10 primary care physicians who responded said prescription drug abuse is a moderate or big problem in their communities, and nearly half said they were less likely to prescribe opioids to treat pain than they were a year ago.

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J.E. Nargiso, E.L. Ballard, and M.R. Skeer. 2015. "A Systematic Review of Risk and Protective Factors Associated with Nonmedical Use of Prescription Drugs Among Youth in the United States: A Social Ecological Perspective." Journal of Studies of Alcohol and Drugs 76(1):5–20.

A literature search identified studies published from 2006 to 2012 that examined risk and protective factors associated with nonmedical use of prescription drugs among adolescents. At the community level, ease of access increased risk. In the interpersonal domain, parental and peer prescription drug use and approval of nonmedical use were associated with nonmedical use. At the school level, academic failure/low educational attainment was associated with high school student (but possibly not with college student) nonmedical use. At the individual level, other substance use, adolescent aggressive/delinquent behavior, and lower perceived risk or harm of use were significant risk factors for nonmedical use. (Editor's note: The abstract, but not the article, incorrectly reports the association with perceived risk.)

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T.W. Park, J.H. Samet, D.M. Cheng, M.R. Winter, T.W. Kim, A. Fitzgerald, and R. Saitz. 2014. "The Prescription of Addiction Medications After Implementation of Chronic Care Management for Substance Dependence in Primary Care." Journal of Substance Abuse Treatment, doi:10.1016/j.jsat.2014.11.008.

Of 282 participants in the intervention group of an addiction treatment trial, 15 percent of opioid-dependent patients were prescribed opioid agonist therapy, with comorbid alcohol addiction reducing the likelihood of prescribing an agonist. Among those with drug dependence, 9 percent were prescribed drug dependence medications. Seventeen percent of those with alcohol dependence were prescribed alcohol dependence medications. Psychiatric medications were prescribed to 64 percent of patients.

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K. Ponnet, E. Wouters, M. Walrave, W. Heirman, and G. van Hal. 2014. "Predicting Students' Intention to Use Stimulants for Academic Performance Enhancement." Substance Use and Misuse, doi:10.3109/10826084.2014.952446.

Among 3,589 Flemish university and college students surveyed online in early 2013 using theory-of-planned-behavior constructs, subjective norm was the strongest predictor of students' intention to use stimulant medication, followed by attitude and perceived behavioral control. To a lesser extent, procrastinating tendencies, psychological distress, and substance abuse contributed to students' intention.

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Professional Education

A. Robinson and D.P. Wermeling. 2014. "Intranasal Naloxone Administration for Treatment of Opioid Overdose." American Journal of Health-System Pharmacy 71(24):2129–135, doi:10.2146/ajhp130798.

This article reviews the pharmacology, pharmacokinetic properties, and clinical efficacy of naloxone injection administered intranasally to reverse opioid overdose. The nasal mucosa has a rich blood supply that allows for efficient drug absorption and the avoidance of first-pass hepatic metabolism that would be seen with oral administration. Obtaining vascular access can be difficult in known drug users, prolonging the time required to administer the antidote. Patients awakening from an overdose may be agitated, confused, and even combative, thus increasing the risk of needle-stick injury to first responders. The intranasal route avoids the need for establishing vascular access and can be associated with speedier patient recovery. In two randomized controlled trials, intranasal naloxone alone was shown to be sufficient in reversing opioid-induced respiratory depression in 74 percent and 72 percent of the respective study populations of patients experiencing opioid overdose. In addition, the safety profile of intranasal naloxone appears to be no different than that of naloxone injection in treating opioid overdose in the prehospital setting.

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National News

Senate Dem Touts Millions for Painkiller Abuse in Funding Bill
Tim Devaney, The Hill
December 11, 2014

Senate Health Committee Chairman Tom Harkin helped secure $33 million in funding for government programs that aim to prevent pain reliever abuse and treat people who are addicted. The pain reliever package includes $20 million for Centers for Disease Control and Prevention efforts to fight prescription drug abuse at the state level, and $12 million for the Substance Abuse and Mental Health Services Administration to expand access to drug treatment programs. The Health Resources and Services Administration will receive more than $1 million to cover naloxone kits for emergency medical services personnel.

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Are 'Smart Pills' the Best Way to Stay Sharp?
Kieron Monks, CNN
December 11, 2014

People in high-performance industries increasingly turn to nootropics—cognitive enhancement drugs. Advocates argue the drugs can improve memory and focus. Expert studies have shown few negative side effects and have identified areas suited to the use of such substances. But employers and regulators feel pressure to take a firm position on this controversial issue.

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Members of Congress Introduce Bill to Address Opioid Epidemic
Community Anti-Drug Coalitions of America
December 11, 2014

Members of the U.S. Congress introduced the Comprehensive Addiction and Recovery Act of 2014. The Act would provide incentives and resources encouraging states and local communities to advance a continuum of proven strategies combatting addiction. It would expand prevention and education efforts to prevent prescription opioid and heroin abuse and promote treatment and recovery. The bill would also strengthen prescription drug monitoring programs to help states supervise and track prescription drug diversion.

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International News

Use of Opium-Based Painkillers Climbing in B.C. Despite Safeguards
Erin Ellis, The Vancouver Sun
December 8, 2014

Prescriptions for powerful pain relievers continue to rise in British Columbia, despite strict rules to discourage their use. Nevertheless, high-dose opiate prescriptions rose slower in BC than most other provinces—only 8.4 percent between 2006 and 2011. Ontario has the highest per capita rate of opioid prescriptions in Canada. Newfoundland saw an 85 percent increase in high-dose opioid prescriptions during the study period.

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Use of Study Drugs at U of G Higher than National Average
May Warren, Guelph Mercury
December 8, 2014

In a 2013 survey at the University of Guelph in Ontario, almost 5 percent of 800 students reported using "study drugs" to get a boost. Consistent with this finding, 4.6 percent of students reported using a stimulant without a prescription—above the Canadian average of 3.7 percent for that year. The associate vice president of student affairs said using study drugs is not considered academic misconduct. Students are instead referred to counseling. The school evicts anyone caught selling drugs in their residence.

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Northeast/Mid-Atlantic News

Overdose Emergency
The Baltimore Sun
December 10, 2014

This editorial urges Governor-elect Larry Hogan to build on the progress already made toward reducing heroin overdose deaths in Maryland. Hogan, it opines, must stay on track toward achieving a 20 percent reduction in heroin overdose deaths by the end of 2015. This will require maintaining Maryland's investment in treatment and recovery programs and expanding these services. Overdose fatality review teams need to cover the entire state. Maryland also needs to strengthen the prescription monitoring program by requiring every physician to register and take a course on appropriate opiate prescribing. The editorial asks Hogan to select a health secretary who is prepared to make reducing overdose deaths a top priority.

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More than 20,000 New Jersey Physicians Signed Up for Prescription Monitoring Program Access in 2014, Attorney General Reports
State of New Jersey, Office of Attorney General
December 11, 2014

Eighty-five percent of New Jersey's physicians now have access to the prescription monitoring program (PMP). Fifty-six percent of all healthcare practitioners and pharmacists now have direct access to the PMP database.

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DHMH Partners with Pharmacies to Stock Overdose-Reversing Naloxone
State of Maryland
December 9, 2014

The Department of Health and Mental Hygiene announced a partnership with Walgreens, CVS Health, Safeway, and other pharmacies to stock naloxone in stores across Maryland and train their pharmacists in naloxone administration. The department has encouraged providers to write naloxone prescriptions for patients who may be at risk of overdosing, and made it easier for Medicaid patients to obtain naloxone by removing pre-authorization requirements. Finally, the department has authorized local entities to train and certify qualified individuals to recognize an opioid overdose and respond by administering naloxone. Safeway pharmacies will begin carrying the drug on January 2, 2015.

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Anne Arundel Overdoses Could Double in 2014
Brandi Bottalico, Capital Gazette News
December 6, 2014

Anne Arundel County drug and alcohol deaths have the second-fastest growth rate in Maryland. Drug and alcohol overdose deaths are on pace to almost double this year. Most deaths have involved multiple drugs, including opiates. In the first half of 2014, there were 74 substance overdose deaths, compared with 78 during 2013. County police handled 50 overdose deaths—double the number during the same time in 2013.

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Midwest News

Under Cover of the Law: Local Authorities Frustrated by Legal Shield Protecting 'Pill Mills'
Nick Shepherd, Times News
December 8, 2014

Local authorities' pain management clinics contributing to the prescription drug abuse epidemic in Tennessee are allowed to operate with immunity because of the Intractable Pain Act passed in 2001. The law states no doctor may be subject to disciplinary action by the board for prescribing or administering appropriate amounts, combinations, or durations of dangerous drugs or controlled substances while treating intractable pain. If an individual complains of intractable pain and insists on medication, the doctor has to provide the medication or refer the patient to another doctor. Sullivan County's district attorney general believes repealing the Intractable Pain Act is the best course of action.

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Chicago Is Holding Big Pharma Accountable for Their Role in Fueling the Rx Opioid Abuse Epidemic
Bechara Choucair, The Huffington Post
December 11, 2014

Bechara Choucair, M.D., commissioner of the Chicago Department of Public Health, discusses what the prescription drug epidemic has done to the city, and the lawsuit Chicago filed against five opioid drug manufacturers. The suit aims to hold pharmaceutical companies accountable for methodically executing a plan to deceive doctors and patients into overprescribing opioids. It also seeks injunctive relief so drug companies will be required to provide doctors and patients with complete and accurate information about opioids.

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First Responders Train on Drug to Reverse OD
Howard Monroe, WISHTV
December 9, 2014

Starting in January 2015, all Indianapolis first responders will be qualified to administer naloxone. Emergency medical technicians in Wayne Township and 150 firefighters will be trained to administer the drug. (Includes video: 2:08 minutes)

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Medical Examiner, Sheriff Target Drug Abuse in 2015
Judy Wiff, New Richmond News
December 11, 2014

The St. Croix County, Wisc., medical examiner and sheriff said prescription drugs and heroin are the most pressing issues for 2015. The medical examiner plans to work with the county's Community Justice Collaborating Council, school districts, and communities to develop a countywide drug prevention program.

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Rate of Prescribing Psychotropic Drugs to Kentucky Kids Studied at U of L
The Lane Report
December 12, 2014

University of Louisville researchers are investigating how often psychotropic medication is prescribed to children. Of 600,000 children receiving Medicaid in Kentucky, one in seven has been prescribed at least one psychiatric drug. Almost half the children in Kentucky's foster care system have been prescribed at least one psychotropic. Both statistics are almost twice the national average. In a year-long study, researchers will first assess Kentucky Medicaid claims data to determine if prescribing patterns emerge across geographic regions and particular to race, ethnicity, gender, and socioeconomic class. The study will also examine what types of providers are prescribing psychotropic medications to children. In phase two, researchers will talk with providers who have higher-than-average prescribing rates. Finally, they will develop informed and thoughtful approaches to correcting overuse of psychotropic medications.

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South News

Attorney General Bondi's Office and the DEA Arrest 20 in Illicit Prescription Drug Trafficking Ring
Florida Attorney General's Office
December 8, 2014

The Florida Attorney General's Office of Statewide Prosecution and the Drug Enforcement Administration arrested 20 people after a 1½-year investigation of an illicit prescription drug trafficking ring. The ring funneled prescription drugs throughout Central Florida. Its leaders were arrested in August 2014 for paying relatives and others to obtain oxycodone, hydrocodone, and hydromorphone. An employee at Charles Schwab purchased media projectors using his company account and sold them to fund the drug trafficking organization.

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Human Services Committee Receives Report on Prescription Drug and Heroin Abuse
Fairfax County, Virginia
December 10, 2014

In response to a request in late September from the Fairfax County Board of Supervisors, county staff developed a report on trends in heroin and nonmedical prescription opiate use, steps being taken to prevent use and overdoses, and a strategic plan to respond to the growing problem.

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Iredell First Responders Get New Tool to Save Lives
Donna Swicegood, Statesville Record and Landmark
December 11, 2014

The Iredell County Health Department in North Carolina received a $2,500 grant through the North Carolina Division of Public Health to buy 250 naloxone kits. Project Lazarus purchased the naloxone. The kits were presented to Iredell Emergency Medical Services.

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West News

Health Leaders Will Push Prescription Drug Legislation in Next Session
Jaclyn Cosgrove, The Oklahoman
December 10, 2014

Oklahoma health leaders will push a bill next legislative session requiring doctors to check the state's prescription monitoring program (PMP) when prescribing any of the five medications that have caused the most overdose deaths or prescribing narcotic pain relievers to new patients. The bill would also allow doctors' staff to check the PMP.

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Cracking Down on 'Pill Mills' Needed in Oklahoma's Fight Against Painkillers
The Oklahoman Editorial Board
December 7, 2014

An Oklahoma drug enforcement official said prohibiting non-physicians from owning pain management clinics is one way to reduce the flow of pills. Previous efforts to change this practice have failed. A bill that would have required pain management clinics to register with the Oklahoma Bureau of Narcotics and Dangerous Drugs did not make it out of committee. Some lawmakers saw the bill as government overregulation, and the state medical association had concerns about its wording.

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Police: Heroin Use Among Youth on the Rise in Gilbert
Jonathan Reid, The Republic
December 10, 2014

Heroin-related arrests in Gilbert, Ariz., have increased by more than 300 percent since 2007. Police say use rose mainly among people between ages 13 and 25. Many arrestees told police they first tried heroin after becoming addicted to prescription pain relievers. (Includes video: 2:05 minutes)

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Other Resources

Clean Out Your Medicine Cabinet the Safe Way: Keeping Expired Drugs Can Be Dangerous
Consumer Reports
December 9, 2014

This article lists ways to store and dispose of prescription medications.

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21 Things to Consider Before Taking Adderall
Kevin Loria, Business Insider
December 8, 2014

Before taking Adderall or other stimulants, one should know the facts. This article provides useful information on attention deficit hyperactivity disorder drugs.

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7 Reasons You Shouldn't Take Other People's Medicine
Melissa Breyer, Mother Nature Network
December 11, 2014

According to this article, there are seven reasons why people should not use another's prescribed medications.

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Grant Awarded

Training Grant Awarded to Camden Drug-Treatment Program
Courier Post
December 5, 2014

The New Jersey Department of Human Services awarded a $50,000 grant to Urban Treatment Associates of Camden to provide education and training on responding to a heroin or prescription opioid overdose. The treatment center works with more than 400 patients in the community, which includes an outreach mobile unit.

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Pfizer Awards $299,997 Grant to Community Health Center, Inc.'s Weitzman Institute
Community Health Center
December 10, 2014

Community Health Center's Weitzman Institute was awarded $299,997 from Pfizer's Independent Grant for Learning and Change. Funding will be used for an online professional learning community, PainNET, to improve pain management and reduce prescription opioid misuse in primary care. Community Health Center will work with 35 participating practices from five states to develop, test, and evaluate PainNET. The collaborators include the Integrative Pain Center of Arizona, along with practices from Maine, Delaware, Arizona, Connecticut, and New Jersey.

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Bid Opportunity

Prescription Drug Monitoring Program
Texas State Board of Pharmacy
Bid date: January 5, 2015, at 4 p.m.

The Texas Board of Pharmacy is seeking information and cost estimates from qualified solutions providers that would assist in the prescription monitoring program's proposed transition. The board is also seeking recommendations from experienced solutions providers that would improve functionality, stability, and usability, as well as options that could provide significant cost savings.

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Take-Back Events and Drop Boxes

Madison Police Department Offers Safe Disposal of Prescription Drugs
Emily Everson, Madison Patch (New Jersey)
December 9, 2014

Police Collecting Prescription Drugs as Part of Take-Back Initiative
Mike Holden, Toledo News Now (Ohio)
December 8, 2014

Get Rid of Old Prescription Drugs
WLNS (Michigan)
December 12, 2014

Hanover Borough Police Install Medication Take-Back Box
Sean Philip Cotter, The York Dispatch (Pennsylvania)
December 9, 2014

Upcoming Conferences and Workshops

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.