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December 18, 2013


SAMHSA Prescription Drug Abuse Weekly Update
The Prevention of Prescription Drug Abuse in the Workplace (PAW) TA Center addresses prescription drug abuse—a growing public health problem with increasing burdens on workers, workplaces, and our economy. To subscribe colleagues, family members, or friends to this listserv sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), please click here or send their e-mail addresses to paw@dsgonline.com.
Table of Content Featured Article Journal Articles and Reports News Other State and Local News Other Resources Webinar Archive Call to Action Videos Grant Announcements Take-Back Events and Drop Boxes Upcoming Conferences and Workshops

Featured Article

Attorneys General Ask FDA to Rethink Zohydro ER Approval
December 12, 2013

Attorneys general from 29 states and territories sent a letter to the Food and Drug Administration (FDA) asking the agency to consider reversing its approval of Zohydro ER (Zogenix Inc). They believe Zohydro approval will exacerbate the prescription drug abuse epidemic because the hydrocodone-only opioid narcotic is 5 to 10 times more potent than traditional hydrocodone products. It also lacks abuse deterrents. The decision went against the recommendation of the agency's advisory panel—a surprise to some since the FDA plans to reschedule all other combination hydrocodone formulations from Schedule III to Schedule II.

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Journal Articles and Reports

A. Borwein, G. Kephart, E. Whelan, and M. Asbridge. 2013. "Prescribing Practices amid the OxyContin Crisis: Examining the Effect of Print Media Coverage on Opioid Prescribing Among Physicians." The Journal of Pain 14(12):1686–693.e1.

Researchers analyzed whether media coverage of oxycodone extended release (ER) in North American newspapers led to prescribing changes in Nova Scotia. An interrupted time-series design examined the effect of media attention on physicians' monthly opioid prescribing. For each physician, outcome measures were monthly proportions of all opioids prescribed and the proportion of strong opioids prescribed that were for oxycodone ER. The exposure of interest was defined as the number of articles published each month in 27 North American newspapers. Variations in media effects by provider characteristics (specialty, prescribing volume, and region) were assessed. Within-provider changes in prescribing of oxycodone ER in Nova Scotia were observed and followed changes in media coverage. Prescribing rose steadily prior to receiving media attention and slowed following peak media attention in the United States. After peak coverage in Canadian newspapers, prescribing declined again. These patterns were observed across prescriber specialties and by prescriber volume, though the magnitude of change in prescribing varied.

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J. Cain. 2013. "Mandatory CME on Opioid Prescribing Fails to Address True Causes of Prescription Drug Abuse." Pain Medicine 14(12):1821–822. doi:10.1111/pme.12285_2.

The American Academy of Family Physicians (AAFP) supports the White House initiatives on prescription drug abuse, except for mandatory continuing medical education (CME) for physicians who prescribe controlled substances. With this legislation, physicians would be required to complete CME to receive or renew their Drug Enforcement Administration registration. AAFP feels prescription diversion does not result from physician ignorance, but that users and addicts get their drugs from family and friends. Family physicians are trained in residency and practicing physicians continue with educational opportunities appropriate for pain treatment and prescribing. AAFP provides medical education on pain treatment through a variety of sources.

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J. Csete and H. Catania. 2013. "Methadone Treatment Providers' Views of Drug Court Policy and Practice: A Case Study of New York State." Harm Reduction Journal 10:35. doi:10.1186/1477-7517-10-35.

Researchers conducted qualitative structured interviews of 15 methadone maintenance treatment (MMT) providers and four nongovernmental organization advocates in counties with diverse court policies on MMT. Courts in some counties require MMT patients to "taper off" methadone over an arbitrary period or require methadone be a "bridge to abstinence." Treatment providers repeatedly noted that MMT is stigmatized and poorly understood by certain drug court personnel. Some providers feared court practices were fueling nonmedical use of prescription opiates. They felt practices in certain jurisdictions were a barrier to MMT access and could constitute discrimination against people in need of treatment. The providers suggested changing such practices and ensuring that treatment decision making by drug courts is delegated to or involves close consultation with qualified health professionals.

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N. Kirschner, J. Ginsburg, and L. Snyder Sulmasy. 2013. "Prescription Drug Abuse: A Policy Position Paper from the American College of Physicians." Annals of Internal Medicine. doi:10.7326/M13-2209.

In July 2013, a position paper and recommendations on prescription drug abuse developed by the American College of Physicians (ACP) Health and Public Policy Committee was approved by ACP's Governing Board. The paper guides prescribers and policymakers in measures to effectively address prescription drug abuse. Ten recommendations were developed based on a literature review and input from various college constituencies and nonmember field experts. One recommendation was to create a national prescription drug monitoring program so prescribers and pharmacists can check their states and neighboring states before writing and filling prescriptions for substances with high abuse potential.

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S.G. Severtson, B. Bucher Bartelson, J.M. Davis, A. Muñoz, M.F. Schneider, H. Chilcoat, P.M. Coplan, H. Surratt, and R.C. Dart. 2013. "Reduced Abuse, Therapeutic Errors, and Diversion Following Reformulation of Extended-Release Oxycodone in 2010." The Journal of Pain 14(10):1122–130.

This study evaluated changes in abuse exposures, therapeutic error exposures, and diversion into illegal markets associated with brand extended-release oxycodone (ERO) following introduction of reformulated ERO. Original ERO and reformulated ERO street prices were also compared. Data from the Poison Center and Drug Diversion programs of the Researched Abuse, Diversion and Addiction-Related Surveillance System were used. Quarterly rates 2 years before introduction of reformulated ERO (October 2008 through September 2010) were compared with quarterly rates after introduction (October 2010 through March 2012) using negative binomial regression. Street prices were compared using a mixed effects linear regression model. Following reformulated ERO introduction, Poison Center ERO abuse exposures declined 38 percent (95 percent confidence interval [CI]: 31–45) per capita and 32 percent (95 percent CI: 24–39) per unique recipient of dispensed drug. Therapeutic error exposures declined 24 percent (95 percent CI: 15–31) per capita and 15 percent (95 percent CI: 6–24) per unique recipient of dispensed drug. Diversion reports declined 53 percent (95 percent CI: 41–63) per capita and 50 percent (95 percent CI: 39–59) per unique recipient of dispensed drug. Declines exceeded those observed for other prescription opioids in aggregate. After its introduction, the street price of reformulated ERO was significantly lower than the price of original ERO.

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E.J. Volger, A.N. McLendon, S.H. Fuller, and C.T. Herring. 2013. "Prevalence of Self-Reported Nonmedical Use of Prescription Stimulants in North Carolina Doctor of Pharmacy Students." Journal of Pharmacy Practice. doi:10.1177/0897190013508139.

Researchers distributed an electronic survey to students at one public and one private North Carolina school of pharmacy. Of the 1,043 surveys disseminated, 407 (a 39 percent response rate) were completed. Results indicated that 9 percent (95 percent CI: 6.44–11.93) of Doctor of Pharmacy students acknowledge nonmedical use of prescription stimulants (NMUPS) at least once during their education. Additionally, 3 percent (95 percent CI: 1.90–5.45) acknowledge NMUPS at least once during the current school year (past 5 months). Nonmedical prescription stimulant users were nine times more likely to participate in NMUPS prior to pharmacy school (P < .0001) and 4.5 times more likely to use other illicit substances (P = .0076).

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P. Voon and T. Kerr. 2013. "'Nonmedical' Prescription Opioid Use in North America: A Call for Priority Action." Commentary. Substance Abuse Treatment, Prevention, and Policy 8:39. doi:10.1186/1747-597X-8-39.

Nearly 4 years after the U.S. Congress heralded a "decade of pain control and research," chronic pain remains a mounting public health concern. The escalating prevalence of chronic pain in recent years has been paralleled by a rise in prescription opioid availability, misuse, and associated human and social costs. However, national monitoring surveys in the United States and Canada fail to differentiate between prescription opioid misuse for the purpose of euphoria versus pain or withdrawal management. Furthermore, there is a lack of evidence-based guidelines for pain management among high-risk individuals and a glaring lack of education for practitioners in pain and addiction medicine. Researchers propose multiple avenues for intervention and research to mitigate individual, social, and structural problems related to undertreated pain and prescription opioid misuse.

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Nation's Largest Medical Society Says Doctors Should Check Drug Database Before Prescribing Addictive Drugs, Says Consumer Watchdog Campaign
Digital Journal
December 10, 2013

The California Patient Safety Ballot measure is being circulated to mandate that physicians check an electronic database of patients' prescription histories before prescribing drugs. The American College of Physicians stressed using this approach in a recent position paper.

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Marijuana and Cocaine Now Account for Smaller Proportion of Positive Employee Drug Tests
CESAR Fax, Center for Substance Abuse Research
December 9, 2013

This fact sheet shows the drugs detected in positive urine tests among U.S. workers in 2002 and 2012. Of the more than 6.7 million workplace urinalyses conducted by Quest Diagnostics in 2012, 3.5 percent tested positive for at least one illicit drug—slightly lower than the 2002 rate of 4.4 percent. Positive drug tests containing marijuana decreased from 58.4 percent in 2002 to 44.4 percent in 2012. The proportion containing cocaine also decreased, from 14.8 percent to 6.3 percent. Tests containing amphetamines nearly tripled, from 7.2 percent to 21.1 percent. The percentage of positive drug tests containing opiates and sedatives increased from 11.9 percent to 15.4 percent and 7.2 percent to 12.1 percent, respectively, over the period. (See full report in the November 27, 2013, Weekly Update.)

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PCP–Related U.S. Emergency Department Visits on the Rise; Likely Driven by Increases in New York City and Chicago
CESAR Fax, Center for Substance Abuse Research
December 2, 2013

This one-page fact sheet shows the estimated number of U.S. emergency department (ED) visits involving PCP from 2004 to 2011. The sharpest increase in visits that involved PCP as a direct cause or contributing factor occurred from 2009 (36,719) to 2011. Metropolitan-area estimates indicate that PCP–related ED visits are increasing in only two of the 11 oversampled metropolitan areas: New York City (618 percent increase from 2004 to 2011) and Chicago (182 percent increase). CESAR notes that nearly three fourths (72 percent) of PCP–related ED visits in 2011 involved another substance (i.e., alcohol, prescription drugs, illicit drugs) combined with PCP, which means the visit may not have been attributed solely to PCP.

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Record Number of British Baby Boomers Taking Illicit Drugs—and Landing in Hospital
NBC News
December 9, 2013

The United Kingdom's Health and Social Care Information Center released a report showing a record number of British retirees are receiving hospital treatment after taking recreational drugs like cocaine, cannabis, and amphetamines. Doctors diagnosed 888 people over age 65 who were poisoned by illicit drugs, with 473 age 75 and over. Ten years ago, the total was 283.

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Prescription Drug Misuse—Is It Worth It?
U.S. Army
December 13, 2013

Lieutenant Colonel John F. Detro, deputy surgeon of clinical operations/training for the XVIII Airborne Corps, discusses using prescription drugs while being subject to drug testing in the Army. Medical Command Regulation 40–51 outlines procedures for medical review officers when determining if a medical explanation exists for a positive urinalysis drug test result. The regulation states soldiers are authorized to use a prescribed controlled substance for 6 months from the prescription date printed on the label. Though the update to MEDCOM Regulation 40–51 was published in July 2010, soldiers are still unaware of the 6-month expiration on controlled medications. If they test positive for a substance on urinalysis, it can result in Uniform Code of Military Justice action. The policy includes medication that is prescribed off-post.

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Other State and Local News

Ameritox Webinars to Help Educate Physicians on New Indiana Prescription Drug Mandates
December 11, 2013

Ameritox will sponsor a series of Webinars to educate Indiana physicians about new laws intended to curb prescription drug misuse and abuse. The Medical Licensing Board's Emergency Rule will go into effect December 15 for physicians who prescribe opioids for chronic pain. It aims for safe and responsible opioid prescribing and requires specific actions from physicians. The new requirements involve heightened patient assessment and management, including calculating the morphine equivalent dosage of a patient's prescription and taking action when such dosing exceeds certain levels. In addition, patients are required to sign treatment agreements consenting to periodic drug screens and random pill counts, among other things.

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Parental Substance Abuse the Main Reason Kids End Up in Foster Care
Arizona Daily Star
December 9, 2013

Drug and alcohol abuse is a major factor contributing to the spike of Arizona children placed in foster care. Of the 10,141 kids removed from their homes statewide in fiscal year 2012, drug or alcohol use was linked to maltreatment in at least 59 percent of cases. Since October, 67 percent of Pima County families involved in a dependency case had substance abuse issues, according to data from Pima County Juvenile Court. Child Protective Services (CPS) enrolled 406 children under age 5 between July and October, averaging 102 a month—nearly twice the monthly average 7 years ago. In October alone in Pima County, 22 babies under 3 months were removed from their birth families and 20 of those cases involved allegations of parental substance abuse. The University of Arizona Medical Center's Chief of Neonatology said about two babies a week enter CPS custody after testing positive for illicit drugs—a 50 percent increase from 6 years ago. Methamphetamine, marijuana, cocaine, and alcohol remain the most common drugs used by parents involved in dependency cases in Pima County, but there has been a sharp increase in heroin and prescription drug use in the past 5 years. The number of county families in dependency cases that abuse opiates has tripled over that time. In 2008, 29 cases involved heroin and 56 involved prescription drugs. Among open cases through October 31, 138 involved heroin and 148 involved prescription drugs.

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Columbia County Schools Have More Drug Cases than Richmond County
The Augusta Chronicle
December 9, 2013

Columbia County, Georgia, schools had almost twice the number of drug cases as Richmond County schools over the past 3 years. More than 30 percent of Columbia County's 296 cases involved pills, while 11 percent of Richmond County's 164 cases did, according to 3 years of incident reports reviewed by The Augusta Chronicle. The top three prescription drugs found in Columbia County were hydrocodone, Adderall, and Xanax. Columbia County schools consist of about 70 percent white students with just one third on free or reduced lunch. Richmond County schools, which are 73 percent black and where 78 percent of students qualify for free or reduced lunch, had a stronger presence of marijuana than any other drug, with about seven offenses in elementary schools. Columbia County had no offenses in those grades.

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Two Percent of Students Report Painkiller Abuse in Past Month
The Badger Herald
December 13, 2013

The University Health Services (UHS) Director at University of Wisconsin (UW) said up to 2 percent of students have reported misusing pain relievers in the past month alone. Heroin addiction and overdoses have also increased from taking too many prescription drugs or switching from opioid pain medication to heroin. UW sees about the same number of students misusing prescription pain medication as other universities throughout the country, according to the director. In the past year, about 7 percent of students reported misusing pain relievers. If they come forward to UHS, students receive treatment to address their addiction.

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Is High Driving the New Drunk Driving?
The Cambridge Times
December 11, 2013

The 2013 Ontario Student Drug Use and Health Survey recently released an analysis of 10,272 students that showed rates of prescription drug misuse and driving after drug use were still up among Ontario students in grades 7–12. One in eight students reported taking a prescription opioid pain medication recreationally in the past year, and most said they got the drug from home. About one percent (13,500) reported using stimulant drugs without a prescription. The number of students who reported using over-the-counter cough medication to "get high" rose, with more than 94,000 (about 10 percent) admitting to use. One in six high school students reported symptoms of a drug use problem, representing 132,700 students in grades 9–12. Fourteen percent reported being a passenger in a car when the driver had used drugs.

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Coalition Forms, Aims at Stopping Prescription Drug Abuse
The Dispatch.com
December 10, 2013

Stop Prescription Drug Abuse Now announced its formation at the first Davidson County, Kentucky, Project Lazarus Forum. The coalition recently placed billboards throughout the county in an effort to stop prescription drug abuse.

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Bills Aim to Curb Heroin, Prescription Abuse
Mansfield News Journal
December 11, 2013

Ohio has packaged 11 bills to address heroin and prescription drug addiction. The bills would divert $180 million in Medicaid expansion to recovery housing and fund additional beds in existing locations. Another provision would earmark $9 million for specialty court dockets that address addiction. All funds would come from Medicaid expansion savings—an estimated $404 million over 2 years.

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Bill Offers Protection to Drug Overdose Witnesses
The Meadville-Tribune
December 11, 2013

Pennsylvania's Senate recently passed a bill that offers immunity to people who call 911 after witnessing a drug overdose. The bill will now go before the House.

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Drug Abusers May Be Injuring Pets to Get Pain Killers
Springfield News-Sun
December 11, 2013

Ohio Attorney General Mike DeWine is working with the Ohio Veterinary Medical Association and state licensing boards to educate veterinarians about possible pet abuse by people seeking medications for dogs, cats, and other animals. Police officers and community leaders have received complaints about individuals abusing drugs legitimately prescribed to pets or intentionally injuring animals to obtain the medication. Lawmakers approved House Bill 274 that adds tougher penalties for cruelty to "companion animals" that live indoors.

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Adderall Use Popular for Studying, but for a Risky Price
December 9, 2013

This article and video (3:39 minutes) discuss Adderall abuse among college and high school students. One graduate student gets the drug from his friend. He doesn't think of it as a drug deal and uses Adderall as a study aid. But Steven Maxell of the Mississippi Bureau of Narcotics explains that the exchange is a felony. Any transfer of Adderall can carry up to a 30-year prison sentence and $1 million fine for the distributor. Whoever is on the receiving end could face up to a 16-year prison sentence.

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SBI Says Theft of Prescription Drugs Up 25 Percent in Recent Years
December 10, 2013

This article and video (2:02 minutes) discuss the estimated 25 percent increase in thefts at North Carolina homes and businesses over the past few years. Lenoir County Sheriff Chris Hill said pain relievers like Percocet and OxyContin are prime targets. Law enforcement and pharmacists share tips to keep medications safe.

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Other Resources

Medication-Assisted Treatment: An E-Book for Parents and Caregivers of Teens and Young Adults Addicted to Opioids
Partnership at Drugfree.org
Assessed December 12, 2013

This online resource features an e-book, videos, and testimonials to help parents make informed choices when helping a teen or young adult recover from an addiction to prescription pain medications, heroin, or other opiates.

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Webinar Archive

Delivering the Scientific Facts About Drug Abuse to Teens
Children's Safety Network
Assessed December 12, 2013

This Webinar, presented on December 9, 2013, provided information about the National Institute on Drug Abuse's (NIDA's) free materials for National Drug Facts Week, including the Shatter the Myths booklet and National Drug IQ Challenge. Sheri Grabus, Acting Press Officer at NIDA, and Tom Vicini, Coalition Coordinator at Operation UNITE, led the session. Visit the archive for the Webinar video, audio, and slide presentation.

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Call to Action

Join the Movement! Participate in CADCA's Annual Survey of Coalitions!
Community Anti-Drug Coalitions of America
Deadline: February 7, 2014


Babies Born Addicted to Prescription Drugs
December 6, 2013

Amber Lyon investigates the tragic trend of babies born addicted to prescription drugs in Florida. Addicted mothers may not seek help for fear authorities will take their children. Babies need to be weaned off the drugs slowly or they will go into withdrawal in the womb. One mother gradually stopped using oxycodone before her baby was born but doesn't know the long-term effects the drug could have on her daughter. Her infant already suffers from respiratory problems. In this video (13:48 minutes), Lyon shows the daily life of a woman addicted to prescription pills.

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New Push to Stop Epidemic of Prescription Painkiller Abuse
Fox News
December 10, 2013

Marc Siegel, Professor of Medicine at New York University Langone Medical Center, discusses prescription drug abuse. Dr. Siegel references the American College of Physicians' support of the Food and Drug Administration plan to reduce prescribing and make doctor visits mandatory for refills. (Duration: 4:04 minutes)


For Some Wounded Veterans, Strong Prescription Drugs Can Be Cause of More Pain
PBS Newshour
December 7, 2013

This video (9:17 minutes) and transcript discuss narcotic pain reliever addiction among veterans who served in Iraq and Afghanistan. Aaron Glantz of the Center for Investigative Reporting explores whether veterans are being overmedicated with prescription opiates.


Free Drug Tests for Teens? Will They Help?
Yahoo News
December 6, 2013

Children whose parents suspect they are abusing illegal or prescription drugs will be tested at 11 teen treatment centers in San Diego County. (Duration: 2:03 minutes)


Grant Announcements

HHS Announces Affordable Care Act Mental Health Services Funding
U.S. Department of Health and Human Services
December 10, 2013

The U.S. Department of Health and Human Services plans to issue a $50 million funding opportunity to help 200 Community Health Centers establish or expand services for people living with mental illness and drug and alcohol problems. Community Health Centers will use the funds to hire new mental health and substance use disorder professionals, add services, and employ team-based models of care.

Read more:

Medical Toxicology Foundation Research Award: Prescription Drug Abuse Prevention
American College of Medical Toxicology
Deadline: February 14, 2014, 11:59 p.m. ET

Take-Back Events and Drop Boxes

Law Enforcement Offers Prescription Drug Drop-Off Box
Laramie Boomerang
December 8, 2013

Kingston (NY) Gets Prescription Drug Disposal Site
Mid-Hudson News Network
December 10, 2013

Drop Off Prescription Drugs Anonymously at Columbia Heights Police Department
Sun Focus
December 12, 2013

Upcoming Conferences and Workshops

Lecture: Prescription Drug Use—The Dos and the Don'ts
January 29, 2014
Huntley, Illinois

SAMHSA's 10th Prevention Day
The Power of Prevention: Strengthening Behavioral Health and Public Health for the Next Decade
February 3, 2014
National Harbor, Maryland

24th National Leadership Forum: The Power of Movement
February 3–6, 2014
National Harbor, Maryland

Collaborative Perspectives on Addiction: 'Changing Addictive Behavior: Bench to Bedside and Back Again'
February 28–March 1, 2014
Atlanta, Georgia

Pain Management Through a Wide Lens: Balancing Safety and Effectiveness
March 8, 2014
St. Louis, Missouri

11th Annual World Health Care Congress
April 7–9, 2014
National Harbor, Maryland

National Rx Drug Abuse Summit
April 22–24, 2014
Atlanta, Georgia

Prescription Drug Abuse and Diversion Crimes
June 10, 2014
Cottleville, Missouri
http://www.thepoliceacademy.org/2014.6.10. percent20Prescription.pdf
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.