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December 4, 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 Grant Received Featured Article Journal Articles and Reports News Other State and Local News Other Resources Webinar Video Audio Grant Announcement Grant Received Take-Back Events and Drop Boxes Upcoming Conferences and Workshops

Featured Article

D.C. McDonald and S. Kuck Jalbert. 2013. "Geographic Variation and Disparity in Stimulant Treatment of Adults and Children in the United States in 2008." Psychiatric Services. doi:10.1176/appi.ps.004442012.

Researchers obtained records of 24.1 million stimulant prescriptions dispensed to insured and uninsured patients from approximately 76 percent of U.S. retail pharmacies. Data were weighted to estimate treatment prevalence on March 15, 2008, for all states and counties. Regression models were used to estimate associations among the counties' treatment rates and characteristics of the counties and resident populations. An estimated 2.5 percent of children ≤17 years of age (3.5 percent of males and 1.5 percent of females) and 0.6 percent of people >17 years of age were being treated with stimulants in March 2008. (Editor's Note: In the 2008 National Survey on Drug Use and Health, 1.4 percent of children aged 12–17 and 1.0 percent of those aged 18 and over stated they used stimulants nonmedically during 2008.) Treatment prevalence among states varied widely, and variation among counties was even greater. Two thirds of the variation among counties in treatment prevalence was associated with supply of physicians, socioeconomic composition of the population, and, among children, funding for special education. Rates of children and adults in treatment were highly correlated. Wide variations in treatment prevalence signal disparities between established clinical practice guidelines and actual practice, especially for primary care, where most patients prescribed stimulants are managed.

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Emerging Trend (Editor's Note)
Hazardous waste collection (funded by federal/state departments of environmental protection or agriculture) and prescription drug take backs are increasingly being combined. Accepted hazardous household and agricultural waste includes pesticides; lawn, garden, photo, and swimming pool chemicals; paints, thinners, and strippers; cleaning solutions; antifreeze, motor oil, and batteries; fluorescent lamps and bulbs; used gas; and small, one-pound propane tanks.

Journal Articles and Reports

P. Chariot, A. Lepresle, T. Lefèvre, C. Boraud, A. Barthès, and M. Tedlaouti. 2013. "Alcohol and Substance Screening and Brief Intervention for Detainees Kept in Police Custody. A Feasibility Study." Drug and Alcohol Dependence. doi:10.1016/j.drugalcdep.2013.10.006.

This prospective study included 1,000 detainees in French police custody who were examined by a physician to assess fitness for detention. Researchers used a standardized questionnaire that recorded individual characteristics and addictive disorders and reported assaults or observed injuries. They studied 944 men and 56 women and found an addictive disorder in 708 (71 percent), including misuse of tobacco (62 percent), alcohol (36 percent), cannabis (35 percent), opiates (5 percent), cocaine (4 percent), and psychoactive prescription drugs (1 percent). A brief intervention was performed in 544 of these cases (77 percent). Of the 708, 139 (20 percent) expressed a willingness to change; 14 (2 percent) requested information on treatment options. The main reasons why brief interventions were not performed included aggressive behaviors, drowsiness, or fanciful statements from the detainee. Screening and brief interventions for addictive behaviors in police custody are feasible in most cases.

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T.J. Cicero, M.S. Ellis, H.L. Surratt, and S.P. Kurtz. 2013. "Factors Influencing the Selection of Hydrocodone and Oxycodone as Primary Opioids in Substance Abusers Seeking Treatment in the United States." Journal of Pain 154(12):2639–648.

Researchers identified factors that influence selection of hydrocodone and oxycodone as primary drugs of abuse among opioid-dependent subjects (n = 3,520) entering one of 160 drug treatment programs throughout the country. They used anonymous, self-administered surveys and direct qualitative interviews to examine the influence of demographic characteristics, drug use patterns, and decision-related factors on primary opioid selection. Results showed oxycodone and hydrocodone were the drugs of choice among 75 percent of patients. Oxycodone was the choice of significantly more users (44.7 percent) than hydrocodone (29.4 percent). The quality of the high was viewed to be much better by 54 percent of the sample compared with just 20 percent among hydrocodone users, who cited acetaminophen as a deterrent to dose escalation to get high (hence its low euphoric rating). Hydrocodone users were generally risk-averse women, elderly people, noninjectors, and those who prefer safer modes of acquisition than dealers (i.e., doctors, friends, or family members). In contrast, oxycodone was a much more attractive euphorigenic agent to risk-tolerant young male users who prefer to inject or snort drugs to get high and are willing to use more aggressive forms of diversion.

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N.J. Perera, K.S. Steinbeck and N. Shackel. 2013. "The Adverse Health Consequences of the Use of Multiple Performance-Enhancing Substances—A Deadly Cocktail." The Journal of Clinical Endocrinology and Metabolism. doi:10.1210/jc.2013-2310.

Researchers reported the case of a recreational weightlifter/physical trainer to help summarize adverse health consequences and outcomes of polypharmacy among athletes and growing subsets of the population engaged in physical/fitness training. In addition to the risk inherent to "stacking" of performance-enhancing substances (PESs), they showed users are predisposed to harmful consequences, including risk of exposure to toxic contaminants. A previously healthy man with chronic use of multiple PESs, stimulants, and masking agents presented to a tertiary care hospital with jaundice and mild hepatitis that rapidly progressed into liver and multisystem organ failure. This article describes the specific toxicity (arsenic) and PESs that contributed to the poor outcome. Surreptitious or self-administered cocktails of potential PESs such as anabolic substances, emerging classes of GH-releasing peptides or androgen precursors, stimulants, and masking agents could lead to adverse consequences, including early mortality, multisystem pathology, and unmasked/accelerated malignancy. It could even expose/predispose users to extreme danger from contaminants.

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Oxycontin Maker Submits New Painkiller Pill to FDA
Bloomberg Businessweek
November 26, 2013

Purdue Pharma said the Food and Drug Administration accepted its application for Targiniq ER, an extended release tablet that combines oxycodone with Naloxone. Naloxone is intended to make the medicine less likely to be abused. Purdue's application is based on a 12-week study of 600 patients with a history of opioid pain reliever use. The company said the trial included data on the drug's likeliness to be abused.

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Clinton Foundation to Join College Newspapers to Raise Awareness for Prescription Drug Misuse on College Campuses
Clinton Foundation
November 22, 2013

This press release announced the launch of a campaign encouraging college newspapers to join the Clinton Foundation in raising prescription drug misuse awareness on college campuses. The Foundation is asking hundreds of college and university newspapers to publish a story—a feature piece, editorial, or op-ed—about this epidemic on December 4, 2013. The Clinton Health Matters Initiative aims to halve the number of young people (18 to 26 years old) misusing prescription drugs for the first time.

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1 In 6 Unemployed Are Substance Abusers
November 26, 2013

National Survey on Drug Use and Health data show 17 percent of unemployed workers had a substance abuse disorder last year, compared with 9 percent of full-time workers, according to a self-reported survey. Alcohol, illegal drugs, and prescription drug addictions were included. Long bouts of unemployment may lead people to abuse substances, according to research from St. Louis Federal Economists Alejandro Badel and Brian Greaney. They said the data are not completely conclusive, but the results could be consistent with the concept that previously drug-free workers may have turned to substances after losing their jobs.

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Consumer Watchdog Calls on Kaiser CEO to Disclose Substance Abuse and Patient Safety Problems at Health System Following High Profile Denials by Kaiser Doc
Digital Journal
November 25, 2013

Consumer Watchdog wrote a letter to Kaiser Permanente's chief executive officer, taking issue with an employee who maintained that medical negligence and substance abuse among physicians are not significant patient safety issues that need to be addressed. The organization wants Kaiser to publicly disclose the data for the last decade, showing the number of Kaiser physicians who were disciplined for drug and alcohol problems, how many arbitration cases involved substance abuse by physicians, peer review reports written by Kaiser doctors about other doctors' negligent practices or substance abuse issues, and more.

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Drug Maker Doesn't Want Public to Think 'Popping Vicodin Is Trendy or Cool'
Good Morning America
November 23, 2013

Drug maker AbbVie is suing Kitson, a boutique owner, for selling t-shirts and sweatshirts that resemble the pharmaceutical trademark Vicodin on the back. AbbVie recently filed a lawsuit in the U.S. District Court claiming the public's confusion that the company is promoting drug abuse counters its efforts to curb the problem. Kitson launched its "designer drug" apparel in late August along with other products using the drug names Xanax and Adderall. (See September 4, 2013, Weekly Update.)

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How (and How Much) the 50 States Do Drugs, in 5 Maps
The Washington Post
November 22, 2013

This article provides a breakdown of drug use by state and shows the drug choices of red states and blue states. Of the 12 states with the highest percentages of prescription drug overdoses, just one is a solidly blue state: Rhode Island.

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Other State and Local News

Gazette Opinion: Remedies for State's Painkiller Problems
Billings Gazette
November 22, 2013

Billings Gazette shared its views about how to reduce pain reliever abuse in Montana, emphasizing the importance of all health care providers participating in the prescription drug registry. The Indian Health Service and some tribal health agencies use the registry; however, the U.S. Department of Veterans Affairs does not participate. As of October, the database was searched about once for every 50 pain reliever prescriptions registered. Only about 20 percent of health care providers eligible to use the registry for patient care have enrolled. Public education and awareness are also necessary for reducing prescription drug abuse. A shift requires changes in how doctors work, how the public views and handles prescription medicines, and legislative reform. Billings Gazette recommends everyone clean out their medicine cabinets by disposing of unwanted prescription drugs.

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6 Recommendations from P.E.I. Addictions Report
CBC News
November 22, 2013

The Prince Edward Island legislature's standing committee on health delivered a report on prescription drug addictions in the province, which included six recommendations: partner with Portage, invest in safety education, refocus legislation, report progress, create a guide for addiction services, and proclaim September 7, 2014, as Recovery Day.

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Grieving Families Warned of Unused Medication Dangers
Office of the Ocean County Prosecutor
Accessed November 27, 2013

Ocean County Prosecutor Joseph D. Coronato and Ocean County Funeral Homes and Directors announced an awareness program aimed at alerting loved ones about the dangers of unused prescription medications. Members of the Prosecutor's Office are providing warning cards to Ocean County Funeral Homes for directors to hand out during memorial service counseling sessions. The cards alert grief-stricken people about the need to dispose of unused medications that may be left in a deceased person's home. They provide locations of the four prescription drug drop-off boxes in Ocean County, New Jersey.

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State Commission to Consider Legislation to Curb Abuse of Prescription Drugs
The Providence Journal
November 26, 2013

Rhode Island's House of Representatives approved a resolution to establish a study panel determining whether doctors must access patients' prescription history before prescribing controlled substances. The commission will consider establishing a "prescription monitoring program registry containing data about controlled substances dispensed to individuals, requiring healthcare practitioners and permitting pharmacists to access such a registry before prescribing or dispensing additional doses of such substances, and requiring that prescriptions be transmitted electronically from practitioners to pharmacists." The commission is slated to report findings and recommendations to the General Assembly by April 1, 2014.

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Drug Overdose Deaths Continue to Plague Region
The Times Media Company
November 23, 2013

Porter County, Indiana, officials continue to see an alarming rate of drug overdose deaths. In 2012, there were 34 overdose deaths related to all drugs; this year, the county reported 30 fatal drug overdoses. Fifteen people have died from heroin overdoses as of mid-November; last year, the county had nine heroin-related deaths. Northwest Indiana officials said the economics of street sales create a link between prescription drug abuse and heroin use.

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Amid Prescription Pill Crackdown, Heroin Takes Hold
The Times–Picayune
November 26, 2013

The Louisiana Prescription Monitoring Program has made it difficult for addicts to obtain pills from doctors. Now they've turned to heroin, which has fueled an increase in overdoses in the New Orleans metropolitan area. Jefferson Parish had the most drug deaths last year and the most deaths caused by heroin, according to state data from 2012. Prescription drug abuse is still a problem in the state. Recently, Louisiana joined the National Prescription Monitoring Interconnect Program with the hope of sharing data with other states.They will begin to share information with Mississippi by the end of the year. However, an emergency room doctor and deputy coroner in Jefferson Parish said it is possible data sharing could drive heroin use even higher.

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Westtown PD, DEA Fighting Drug Abuse
West Chester Patch
November 24, 2013

The Drug Enforcement Administration's (DEA's) Philadelphia Division has established a new Tip Line. Information on suspected prescription fraud or drug diversion can be submitted anonymously via text or by visiting the DEA's Web site.

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Powerful Pain Killer Is Deadliest Drug in Clark County
8 News NOW
November 26, 2013

This article and video (2:17 minutes) discuss oxycodone, the deadliest drug in Clark County, Nevada, according to the Clark County coroner. Oxycodone has claimed more lives than heroin, methamphetamine, cocaine, and methadone. Last year, methadone was ruled either a contributing or primary factor in 63 deaths in Clark County, while oxycodone contributed to 146 deaths. This year, 89 people have lost their lives to the drug.

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Other Resources

Prescription Drug Patient Education Safety Materials
Medical Association of Georgia Foundation, Incorporated
Accessed November 26, 2013

Order posters and brochures from the Think About It Campaign! The campaign aims to educate people about prescription drug abuse and support prevention.

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Delivering the Scientific Facts About Drug Abuse to Teens
Children's Safety Network
December 9, 2013
2 to 3 p.m. (EST)

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Adderall Use Rising Among College Students
November 22, 2013

Students are using stimulants with or without a doctor's prescription to boost their grades. (Duration: 2:41 minutes)



Pain Management a Problem When Doctors Won't Prescribe Narcotics
CBC Radio
November 27, 2013

A CBC Radio host interviewed a Sudbury counselor who said hundreds of people in the Sudbury–Manitoulin area suffer from chronic pain because they cannot find a doctor to prescribe and manage their narcotics. The host also interviewed a man struggling with this problem. (Duration: 8:56 minutes)


Grant Announcement

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

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Grant Received

Local Counties to Get Waste Disposal Grants
LaCrosse Tribune
November 25, 2013

The Wisconsin Department of Agriculture, Trade and Consumer Protection announced the recipients of the annual Clean Sweep grants, including villages, cities, counties, tribes, and regional consortiums. Adams, Crawford, Jackson, La Crosse, Monroe, and Vernon Counties will receive $60,000 for household hazardous waste collection, $35,000 for agrichemical collection, and $3,200 for prescription drug collection. More than half ($413,000) of the funding will go toward collecting household hazardous wastes. Agricultural waste collections will receive $250,000 and prescription drug collections will receive $100,000.

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Take-Back Events and Drop Boxes

City of Clermont to Offer Hazardous Waste Collection Dec. 12
Orlando Sentinel
November 22, 2013

Town of Rockland Now Has a Permanent MedReturn Drug Collection Unit
Rockland Standard
November 25, 2013

New Prescription Take-Back Boxes in Van Buren County
November 26, 2013

Upcoming Conferences and Workshops

Staten Islanders Looking for Rx Abuse Epidemic Answers Can Attend Dec. 10 Forum
December 10, 2013
Staten Island, New York

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

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.