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December 3, 2014


SAMHSA Prescription Drug Abuse Weekly Update
Issue 100  |  December 3, 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 Northeast/Mid-Atlantic News Midwest News South News West News Webinars Video Take-Back Events and Drop Boxes Upcoming Conferences and Workshops


Statewide Prescription Drug Misuse and Abuse Prevention and Education Campaigns: Selected Examples
Substance Abuse and Mental Health Services Administration
Accessed November 24, 2014

This Web page briefly summarizes and provides contact information for and links to eight prevention and education campaigns developed by states and localities to address prescription drug misuse and abuse. Most are social marketing campaigns that promote specific prevention or health-promotion messages. As the page states, inclusion in this list does not reflect message endorsement.

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Medicare Program Integrity: CMS Pursues Many Practices to Address Prescription Drug Fraud, Waste, and Abuse
U.S. Government Accountability Office
November 24, 2014

The Government Accountability Office (GAO) identified 23 practices for addressing prescription drug fraud, waste, and abuse that fall within three categories based on GAO's Fraud Prevention Framework: 1) prevention, 2) detection and monitoring, and 3) investigation and prosecution. Federal efforts to address these problems in the Medicare Part D prescription drug program encompass 14 of the 23 practices. Medicare plans to implement three additional practices focused on using prescription monitoring programs and pursuing enforcement options. Strategies not adopted include limiting the supply of abused drugs, limiting selected patients to certain prescribers or dispensers, and providing clinical guidelines.

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Journal Articles and Reports

E. Arribas–Ibar, A. Sánchez–Niubò, X. Majó, A. Domingo–Salvany, and M.T. Brugal. 2014. "Coverage of Overdose Prevention Programs for Opiate Users and Injectors: A Cross-Sectional Study." Harm Reduction Journal 11:33, doi:10.1186/1477-7517-11-33.

A survey in Catalonia, Spain, recruited 306 opiate users from outpatient treatment centers, therapeutic communities, and harm-reduction facilities. Of the 43.5 percent of this non-representative sample who had participated in an overdose prevention program, 60 percent were trained at a harm-reduction facility, 24 percent at an outpatient treatment center, 19 percent in prison, and 16 percent in a therapeutic community. A Poisson regression (PR) with robust variance that controlled for age, sex, and type of recruitment center showed participation rates for overdose prevention programs were significantly higher for individuals with foreign nationality (PR=1.3), those who lived in municipalities with more than 100,000 inhabitants (PR=2.0) or the Barcelona conurbation (PR=2.5), those who had been imprisoned before (PR=1.6), and those who first consumed opiates before age 12 (PR=1.2).

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S.M. Bird, M.K.B. Parmar, and J. Strang. 2014. "Take-Home Naloxone to Prevent Fatalities from Opiate-Overdose: Protocol for Scotland's Public Health Policy Evaluation, and a New Measure to Assess Impact." Drugs: Education, Prevention, and Policy, doi:10.3109/09687637.2014.981509.

Among a group of small-scale take-home naloxone schemes in Scotland, pre/post monitoring found the fatality rate of opiate overdoses witnessed by take-home naloxone trainees was 6 percent (9/153, 95 percent confidence interval [CI]: 2–11 percent). Based on this information, the country set a national policy that take-home naloxone schemes should aim to issue 20 times as many naloxone kits as there are opiate-related deaths per year. In evaluating the policy, the primary outcome will be the percentage reduction in opiate-related deaths within 4 weeks of prison release relative to the 1,970 deaths in a 2006–10 baseline period. The goal is a 20 to 30 percent reduction. (Editor's note: We were unable to access the full article to answer our questions about this abstract.)

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C.J. Boyd, E. Austic, Q Epstein–Ngo, P.T. Veliz, and S.E. McCabe. 2014. "A Prospective Study of Adolescents' Nonmedical Use of Anxiolytic and Sleep Medication." Psychology of Addictive Behaviors, doi:10.1037/adb0000026.

This longitudinal study surveyed 2,745 adolescents attending five Detroit-area secondary schools in three consecutive academic years between 2009 and 2012. Almost 9 percent of the sample had received a prescription for anxiolytic or sleep medication during their lifetime, and 3.4 percent had received at least one prescription for these drugs during the 3-year study period. Multivariate logistic regression found adolescents prescribed these medicines during the study were much more likely than other teens to engage in nonmedical use to "get high" or "experiment" (odds ratio [OR]=10.15) and more likely to engage in nonmedical use to self-treat anxiety or sleep (OR=3.2). Adolescents prescribed anxiolytics during their lifetime but not during the 3-year study were 12 times more likely to use another's anxiolytic medication, compared with adolescents never prescribed the drugs (OR=12.2).

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R.N. Jamison, M.O. Martel, R.R. Edwards, J. Qian, K.A. Sheehan, and E.L. Ross. 2014. "Validation of a Brief Opioid Compliance Checklist for Patients with Chronic Pain." The Journal of Pain 15(11):1092–1101, doi:10.1016/j.jpain.2014.07.007.

Researchers developed and pilot tested a 12-item Opioid Compliance Checklist (OCC) for chronic pain patients prescribed long-term opioid therapy. The checklist was periodically administered to 157 at-risk patients over a 6-month period. Patients exhibiting aberrant drug-related behavior were identified by positive urine toxicology screen, positive score on a Prescription Drug Use Questionnaire interview or Current Opioid Misuse Measure, or ratings by staff on the Addiction Behavior Checklist. (Editor's note: One wonders if all the other monitoring increased honest reporting on the pilot checklist.) Five checklist items appeared to best predict subsequent aberrant behaviors based on multivariate logistic regression analyses (cross-validated area under the receiver operating characteristic curve =.67). The internal consistency of the five-item OCC was a worrisomely low .33. (Your editor is skeptical the checklist discriminated well enough to warrant further testing.) The authors did not report whether other screeners used were better at detection than their checklist.

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A.C. Meyer, M.E. Patrick, and S.C. Sigmon. 2014. "Lifetime History of Heroin Use Is Associated with Greater Drug Severity Among Prescription Opioid Abusers." Addictive Behaviors, doi:10.1016/j.addbeh.2014.11.006.

This paper examines demographic and drug-use characteristics as a function of lifetime heroin use among 89 prescription opioid–dependent adults screened for a buprenorphine treatment trial. Those who had used heroin at least five times reported longer durations of illicit opioid use, greater alcohol-related problems, more past-month cocaine use, greater lifetime intravenous drug use, and greater lifetime use of cigarettes, amphetamines, and hallucinogens. They also had lower scores on the Positive Symptom Distress and Depression subscales of the Brief Symptom Inventory.

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T. Wilens, C. Zulauf, D. Ryland, N. Carrellas, and I. Catalina–Wellington. 2014. "Prescription Medication Misuse Among Opioid Dependent Patients Seeking Inpatient Detoxification." The American Journal on Addictions, doi:10.1111/j.1521-0391.2014.12159.x.

Researchers surveyed 196 consecutive admissions to a Massachusetts detoxification center, including 162 patients who were opioid dependent. Only 28 percent of patients in detox from prescription opioids reported using higher doses than prescribed. Thirty-six percent of patients reported misusing other prescription drugs: 10 percent misused clonidine, 22 percent misused gabapentin, 7 percent misused pregabalin, 25 percent misused clonazepam, and 11 percent misused amphetamine salts.

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Professional Education

A.J. Perrin. 2014. "Intentional Misuse of Veterinary Medications in Human Suicide." Journal of Veterinary Pharmacology and Therapeutics, doi:10.1111/jvp.12184.

This review educates practicing veterinarians about the most common veterinary medications people use to intentionally overdose. It suggests ways to mitigate the drugs' risks, and describes factors that predispose a person to suicide.

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K. Reed, E. Day, J. Keen, and J. Strang. 2014. "Pharmacological Treatments for Drug Misuse and Dependence." Expert Opinion on Pharmacotherapy 0(0):1–9.

Dependence can be characterized as a cycle of three stages: binge/intoxication, withdrawal/negative affect, and preoccupation/anticipation (craving). Pharmacotherapeutic interventions can address these stages. The authors review clinical options for patients dependent on stimulants, cannabis, and prescribed medications, including opiates and benzodiazepines. They conclude that the current range of licensed pharmacological treatments is narrow. Possible pharmacotherapies of the future include anti-craving medications, ultra-long-acting formulations, and drug "vaccines" that stimulate production of antibodies to, for example, cocaine.

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National News

Hope for Saving Lives While Facing an Overdose Epidemic
Debra Houry, The Huffington Post
November 21, 2014

Debra Houry, director of the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention, summarized the agency's efforts to reduce prescription opioid–related overdoses and deaths. Houry said prevention strategies are working and are likely to have positive effects on related issues, such as heroin overdose deaths over the long term.

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Can Artificial Intelligence Solve the $55 Billion Problem of Opioid Abuse?
PR Newswire
November 24, 2014

AiCure is conducting a 1-year clinical trial of an artificial intelligence approach to monitoring and intervening with patients who receive medication-assisted therapy for opioid addiction. AiCure's smartphone app is designed to automatically detect whether a person is taking his or her medication as prescribed. Patients who take incorrect doses or fail to use the software are flagged for immediate follow-up. A National Institute on Drug Abuse grant will assess whether 130 patients at the Cincinnati Addiction Research Center who use the technology are more adherent, with longer treatment durations and lower relapse risks.

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Hospital Visits Due to Substance Abuse Up 63 Percent in Vancouver Area
Randy Shore, Vancouver Sun
November 24, 2014

From 2010 to 2013, the Greater Vancouver area saw a 63 percent increase in hospital visits attributed to alcohol and drug abuse. The number of days spent in the hospital due to opioid abuse increased 48 percent between 2006 and 2011. Hospital stays due to alcohol abuse are growing three times faster than stays for all other drugs combined, according to a national report released by the Canadian Centre on Substance Abuse. Treating opioid abuse recently surpassed cocaine as the second greatest use of hospital resources (after alcohol).

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Northeast/Mid-Atlantic News

N.H. to Fight Glut of Heroin Overdoses by Availing Reversal Drug
Nick Reid, Concord Monitor
November 24, 2014

The New Hampshire Department of Safety's commissioner submitted a report to the governor detailing a strategy to improve naloxone accessibility. The report, developed by a coalition of safety and medical leaders, recommended allowing police and fire department personnel to become licensed to carry intranasal naloxone. It also advocated creating a new licensing level for emergency medical services, streamlining the licensing process, and establishing specific naloxone training standards by including a 3-hour class on the drug and 4 hours on CPR and rescue breathing. The report recommended permitting friends and family members of people with opioid abuse histories to access naloxone kits through standing-order prescriptions at pharmacies, with a warning to administer the drug only during an emergency and after calling 911. Finally, it suggested expanding naloxone access through healthcare facilities and treatment programs and protecting those who administer the drug from civil liability.

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Patrick Administration Announces Grants to 23 Communities to Help First Responders Reverse Opioid Overdoses
State of Massachusetts
November 21, 2014

The Massachusetts Department of Public Health announced grant awards for 23 communities to fund opioid overdose response training and the provision of naloxone kits. Police and fire departments will share $600,000 in funding under the pilot program. In addition to grants from the state, Kaléo, a Virginia-based pharmaceutical company, has offered 4,000 of its EVZIO naloxone auto injectors at no cost. EVZIO was approved by the Food and Drug Administration in April.

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Delaware County Distributing Anti-Overdose Drug Kits Widely to Police
Jim Melwert, CBS Philly
November 24, 2014

Delaware County, Pa., officials announced that all 400 of their patrol vehicles will be among the first in the state to carry naloxone.

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State Requests $4.45 Million for Addiction Services
Jen Rini, The News Journal
November 26, 2014

Delaware's health department requested more than $4 million for next year's budget to support programs that expand bed space, increase access to treatment centers, and prevent teenage prescription drug use.

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Midwest News

Missouri Government Pushing for Prescription Drug Monitoring Program
Ashley Strohmier, KQFX
November 24, 2014

Representative Holly Rehder said if Missouri passed legislation establishing a prescription monitoring program, the state could keep up with the rest of the country. The system's opponents have privacy concerns for those who do not abuse prescriptions. (Includes video: 1:57 minutes)

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South News

13 Investigates: When Nurses Fail
Linda White, WVTM
November 25, 2014

During 2009–13, the majority of Alabama's disciplined nurses had addiction issues. In 2013, 1,400 complaints were filed in the state, with nearly 1,000 nurses disciplined. Peggy Benson, deputy director of the Board of Nursing, said they are unable to fully do their job without an "arrest authority" that keeps boards informed of ongoing criminal investigations. Without that power, the nursing board must wait until an investigation has been closed to get details. The board is also unable to use the prescription monitoring program to determine if nurses are doctor shopping, and it cannot perform background checks on licensing applications. State Representative Howard Sanderford has long tried to pass a bill expanding the nursing board's authority. (Includes video: 5:39 minutes)

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Born Addicted: The Truth Behind a Surge in Drug-Addicted Infants
Emily DeVoe, WECT
November 25, 2014

A neonatologist at North Carolina's New Hanover Regional Medical Center said the neonatal intensive care unit (NICU) treated approximately 35 opioid-addicted babies each year during 2009–10, but in the past 2 years, that number spiked to 85–90 (15 percent of babies admitted to the NICU). Hospital employees, social workers, and rehabilitation centers are working to curb the upward trend. They collaborate monthly on ways to improve medical care and educate women before pregnancy. (Includes video: 4:20 minutes)

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West News

'Mexican Oxy' Moves North
Mike Gallagher, Albuquerque Journal
November 22, 2014

The United States has a new drug threat: "Mexican Oxy." Mexican Oxy is a heroin-based pill manufactured to look like pain relievers. The drug is taken orally; crushed and snorted; or crushed, heated in water, and used intravenously. Drug Enforcement Administration agents seized Mexican Oxy in Camden, New Jersey, and Massachusetts. The pills found in New Jersey contained a combination of heroin, pharmaceutical morphine, and fentanyl.

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The Abuse of 'Study Drugs' at UNR
November 26, 2014

University of Nevada–Reno students find it easy to get Adderall® on campus. Those who sell their prescription stimulants said friends approached them about buying the drug. Some students don't know the side effects of attention deficit hyperactivity disorder medicines like Adderall®, Ritalin®, and Vyvanse®. They are also unaware that possession of Adderall® without a prescription is a felony. Prescription Use Reduction Education, also known as PURE, is a new on-campus organization working to raise awareness about the dangers of abusing prescription drugs.

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Prescription Drug Abuse
Center for the Application of Substance Abuse Technologies, University of Nevada–Reno
December 9, 2014
9 to 10:30 a.m.

Workers' Compensation: Managing Prescription Painkiller Misuse
National Safety Council
December 10, 2014
2 to 3 p.m. (CT)
To register, go to http://www.nsc.org/learn/Pages/nsc-learning.aspx, select "Visit NSC University," and type "painkiller" in the search box.


Face to Face: Dr. Marlyn Cook Talks About Prescription Drugs in Indigenous Communities
Aboriginal Peoples Television Network National News
November 25, 2014

Dr. Marlyn Cook talks with host Michael Hutchinson about prescription drug abuse in indigenous Canadian communities and her struggle to incorporate indigenous views on health into Canada's healthcare system. (Duration: 23:51 minutes)


Take-Back Events and Drop Boxes

Drug Drop Box Available at Sheriff's Department
Elk Valley Times (Tennessee)
November 24, 2014

New Drop Box for Old Prescriptions
John Gutekunst, Parker Pioneer (Arizona)
November 24, 2014

Saratoga Springs Police Department Offers Prescription Drug Drop-Off Box
The Saratogian (New York)
November 25, 2014

Smyrna Police Join Other Local Agencies to Offer Medicine Disposal Site
Smyrna–Clayton Sun-Times (Delaware)
November 24, 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.