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February 11, 2016

PAW Weekly Update

    

                                          
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SAMHSA
           
SAMHSA Prescription Drug Abuse Weekly Update
         
         
WEEKLY
           
UPDATE
         
                             
Issue 160  |  February 11, 2016          
   
                                                               
       
                                                                                                                   
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.                      
               
                                                                                                                 
                                                                                                                                                                     
Index                            
Featured                            
Journal Articles and Reports                            
Opinion and Professional Development                            
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Featured

 P.R. Krill, R. Johnson, and L. Albert. 2016. “The Prevalence of Substance Use and Other Mental Health Concerns Among American Attorneys.” Journal of Addiction Medicine 10(1):46–52, doi:10.1097/ADM.0000000000000182.                        

Past-year substance use rates among attorneys were 15.7 percent for sedatives, 10.2 percent for marijuana, 5.6 percent for opiates, 4.8 percent for stimulants, and 0.8 percent for cocaine, according to a survey of 12,825 licensed and employed attorneys from 19 states (response rate not calculable due to duplication across membership lists). The attorneys were invited to participate in the survey by their state bar associations. Of respondents who used drugs in the past 12 months, stimulant users had the highest rate of weekly usage (74 percent), followed by sedatives (51 percent), marijuana (31 percent), and opioids (22 percent). Substantial rates of behavioral health problems were found, with 20.6 percent screening positive for hazardous, harmful, or potentially alcohol-dependent drinking (Alcohol Use Disorders Identification Test score > = 8). Among the entire sample, 27 percent completed the Drug Abuse Screening Test-10. Rates of low, intermediate, substantial, and severe concern were 76 percent, 21 percent, 3 percent, and 0.1 percent, respectively. Levels of depression, anxiety, and stress were 28 percent, 19 percent, and 23 percent, respectively.                        

Read more:                        
http://journals.lww.com/journaladdictionmedicine/Fulltext/2016/02000/
The_Prevalence_of_Substance_Use_and_Other_Mental.8.aspx
                       
               
               

 Journal Articles and Reports

K. Bartels, L.M. Mayes, C. Dingmann, K.J. Bullard, C.J. Hopfer, and I.A. Binswanger. 2016. “Opioid Use and Storage Patterns by Patients After Hospital Discharge Following Surgery.” PLoS One 11(1):e0147972, doi:10.1371/journal.pone.0147972.                

Online, 30-day, follow-up surveys of English-speaking and Spanish-speaking adults who had a C-section or thoracic surgery at the University of Colorado Hospital in Denver between November 2014 and August 2015 drew 30 responses from C-section patients (a 26 percent response rate) and 33 thoracic surgery patients (a 31 percent response rate). All patients discharged from these services were prescribed opioids, which may be why the authors selected them. The article reports results for each service as a separate mini study and does not compare the results. After C-section, 53 percent reported taking either no or less than 5 prescribed opioid pills; another 30 percent took 5 or more but at most half the prescription; and 17 percent took all or nearly all (5 or fewer pills left over) of their prescription. The survey did not ask why people used only some of their discretionary drugs or assess whether prescriptions were appropriate. After thoracic surgery, 45 percent reported taking either no or less than 5 prescribed opioid pills; another 26 percent took 5 or more but at most half the prescription; and 29 percent took all or nearly all (5 or fewer pills left over) of their prescription. In both cohorts, use of opioids while hospitalized was higher in the group reporting using most of their prescribed opioids after discharge. Leftover opioids were retained and stored in an unlocked location in 75 percent of cases.                

Read more:                
http://www.ncbi.nlm.nih.gov/pubmed/26824844                                  

S. Berterame, J. Erthal, J. Thomas, S. Fellner, B. Vosse, P. Clare, W. Hao, D.T. Johnson, A. Mohar, J. Pavadia, A.K.E. Samak, W. Sipp, V. Sumyai, S. Suryawati, J. Toufiq, R. Yans, and R.P. Mattick. 2016. “Use of and Barriers to Access to Opioid Analgesics: A Worldwide, Regional, and National Study.” Lancet, doi:10.1016/S0140-6736(16)00161-6.                

Daily doses of opioid analgesics per million inhabitants per day worldwide more than doubled between 2001–03 and 2011–13, from 1,417 (3·billion daily doses per annum) to 3,027 (7.35 billion daily doses per annum), according to estimates for 214 countries provided to the International Narcotics Control Board. Substantial increases occurred in North America (16,046 to 31,453), western and central Europe (3,079 to 9,320), and Oceania including Australia (2,275 to 9,136). Use did not increase substantially in other regions. The increase in the United States went from 22,554 to 43,879 daily doses per million inhabitants. In a survey accompanying the data, usage deterrents that respondents often selected included an absence of training and awareness in medical professionals, fear of dependence, restricted financial resources, issues in sourcing, cultural attitudes, fear of diversion, international trade controls, and onerous regulation. The more of these deterrents a survey respondent cited, the lower the use. In multivariate analysis of dosage rates by country, rates increased with gross domestic product of the country and the country score on the United Nations’ human development index; none of the deterrents was significantly associated after the adjustment.                

Read more:                
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00161-6/abstract                                  

B-W. Bilvick Tai, M. Hata, S. Wu, S. Frausto, and A.V. Law. 2016. “Prediction of Pharmacist Intention to Provide Medication Disposal Education Using the Theory of Planned Behaviour.” Journal of Evaluation in Clinical Practice, doi:10.1111/jep.12511.                

More than 70 percent of community pharmacists in four small California counties said they have time to provide medication disposal education regularly to their patients, according to a 2014 survey of 142 (71 percent of those surveyed) community pharmacists. Currently, two-thirds provide medication disposal education once a month or less. Few accurately identified all recommendations about disposal of non-controlled (16 percent) and controlled (10 percent) substances.                

Read more:                
http://onlinelibrary.wiley.com/doi/10.1111/jep.12511/full                                  

A.S.B. Bohnert, J.E. Logan, D. Ganoczy, and D. Dowell. 2016. “A Detailed Exploration into the Association of Prescribed Opioid Dosage and Overdose Deaths Among Patients with Chronic Pain.” Medical Care, doi:10.1097/MLR.0000000000000505.                

Opioid overdose decedents and controls were identified from patients of the Veterans Health Administration who had a chronic pain diagnosis. Controls were matched on demographics, diagnoses, comorbidities, concurrent non-opioid medications, and having an active opioid prescription for at least the 90 days before the matched decedent died. The average prescribed opioid dosage was higher for decedents (mean = 98 morphine-equivalent mg [MEM] per day) than controls (mean = 48). Dosage was a moderately good predictor of opioid overdose death. The authors conclude that lowering the recommended dosage threshold below the 100 MEM used in many recent guidelines would affect proportionately few patients not at risk for overdose while potentially benefitting many of those at risk for overdose.                

Read more:                
http://journals.lww.com/lww-medicalcare/Abstract/publishahead/
A_Detailed_Exploration_Into_the_Association_of.98952.aspx
                                  

R.M. Califf, J. Woodcock, and S. Ostroff. 2016. “A Proactive Response to Prescription Opioid Abuse.” New England Journal of Medicine, doi:10.1056/NEJMsr1601307.                

The FDA has announced a shift to a more proactive approach to opioid misuse, addiction, and overdose. It plans to (1) re-examine the risk-benefit paradigm for opioids and ensure that the agency considers their wider public-health effects, (2) develop changes to immediate-release opioid labeling, including additional warnings and safety information similar to ones required on extended-release/long-acting (ER/LA) opioids, (3) update risk evaluation and mitigation strategy requirements for opioids after considering advisory committee recommendations, (4) expand access to, and encourage development of, abuse-deterrent opioid formulations, (5) improve access to naloxone and medication-assisted treatment options for patients with opioid-use disorders, and (6) support better pain-management options, including alternative treatments. The agency also plans to tighten requirements for drug companies to generate post-market data on the long-term impact of using ER/LA opioids, an action, they say will generate the “most comprehensive data ever collected in the field of pain medicine and treatments for opioid use disorder. The data will further the understanding of the known serious risks of opioid misuse, abuse, overdose and death.” The FDA already asked the National Academy of Medicine to assist in developing a framework for opioid review, approval, and monitoring that balances an individual’s need for pain control with considerations of the broader public-health consequences of opioid misuse and abuse.                

Read more:                
http://www.nejm.org/doi/full/10.1056/NEJMsr1601307?af=R&rss=currentIssue                                  

S. Feeney, K. O’Brien, N. O’Keeffe, C.A. Nic Con Iomaire, M.E Kelly, J. McCormack,  G. McGuire, and D.S. Evans. 2016. “Practise What You Preach: Health Behaviours and Stress Among Non-Consultant Hospital Doctors.” Clinical Medicine 16(1):12–18, doi:10.7861/clinmedicine.16-1-12.                

Medical manpower departments in 58 public hospitals in the Republic of Ireland distributed a 25-item questionnaire to 4,074 non-consultant hospital doctors; 707 responded. Sixty percent of respondents did not take time off work when unwell, with 91 percent concerned about letting teammates down and 86 percent citing difficulty covering call. They did not visit general practitioners because they too busy (85 percent), self-prescribed (67 percent) and self-managed (53 percent). Furthermore, 23 percent would not visit a general practitioner about anxiety or depression until they began to feel hopeless, helpless or suicidal and 12 percent would not seek help at all.                

Read more:                
http://www.clinmed.rcpjournal.org/content/16/1/12.abstract                                  

E.L. Gibbs, A.E. Kass, D.M. Eichen, E.E. Fitzsimmons-Craft, M. Trockel, D.E. Wilfley, and C. Barr Taylor. 2016. “ADHD-Specific Stimulant Misuse, Mood, Anxiety, and Stress in College-Age Women at High Risk for or with Eating Disorders.” Journal of American College Health, doi:10.1080/07448481.2016.1138477.                

Among 448 women, ages 18–25 in San Francisco and St Louis, who were at high risk for or had a clinical or subclinical eating disorder, an increased likelihood of stimulant misuse was associated with greater eating disorder pathology, objective binge eating, purging, eating disorder-related clinical impairment, depressive symptoms, perceived stress, and trait anxiety. Subjective binge eating, excessive exercise, and dietary restraint were not associated with stimulant misuse.                

Read more:                
http://www.tandfonline.com/doi/abs/10.1080/07448481.2016.1138477                                  

L.S. Ham, J.D. Wiersma-Mosley, M.T. Feldner, A.J. Melkonian, L.A. Milner, and S.F. Lewis. 2016. “Posttraumatic Stress Symptoms and Nonmedical Prescription Drug Use Among College Students with Trauma Exposure.” Journal of Dual Diagnosis, doi:10.1080/15504263.2016.1146556.                

In a survey with responses from 273 undergraduates at a West Virginia college with an unstated response rate at an unstated date, 119 reported experiencing at least one traumatic event. Of those, 60 percent had used nonmedical prescription drugs at least once during their lifetime. Users were more likely than nonusers to report hazardous alcohol use and depressive symptoms. Regression analyses showed that posttraumatic stress disorder frequency was positively associated with nonmedical use, controlling for gender, depressive symptoms, and hazardous alcohol use.                

Read more:                
http://www.tandfonline.com/doi/abs/10.1080/15504263.2016.1146556                                  

A. Harocopos, B. Allen, and D. Paone. 2016. “Circumstances and Contexts of Heroin Initiation Following Non-Medical Opioid Analgesic Use in New York City.” The International Journal of Drug Policy, 28:106–112, doi:10.1016/j.drugpo.2015.12.021.                

In-depth interviews in August 2013 to January 2015 with 31 people in New York City with histories of opioid analgesic misuse who initiated heroin use within the past 5 years probed transition points. For many participants, their early opioid misuse involved oral administration of a dual-entity analgesic (e.g., Percocet or Vicodin) that burned if crushed and inhaled. As frequency and dosing of analgesics increased, users became concerned that acetaminophen could potentially damage internal organs if used in high doses over an extended period. While not all participants first misused dual-entity pills, for those who did, the shift from dual- to single-entity analgesics was often a defining moment along their trajectory toward physical dependence. Although this switch may initially have resulted in participants reducing the number of pills they consumed, tolerance quickly built resulting in increased use and a shift from oral to inhaled administration, and soon thereafter, development of physical dependence. After developing physical dependence, opioid withdrawal quickly overcame heroin stigma. Participants described heroin-related stigma breaking down across social networks as new drug use permeated them. Study participants ranged in age from 18 to 44 years; 25 identified as male and 30 as non-Hispanic white and heterosexual. All had stable housing at the time of interview and had graduated from high school.                 

Read more:                
http://europepmc.org/abstract/med/26818082                                  

B. Kea, R. Fu, R.A. Lowe, and B.C. Sun. 2016. “Interpreting the National Hospital Ambulatory Medical Care Survey: United States Emergency Department Opioid Prescribing, 2006–2010.” Academic Emergency Medicine, doi:10.1111/acem.12862.                

According to 2006–10 emergency department discharges from the National Hospital Ambulatory Medical Care Survey, opioids were prescribed for 18.7 percent of all emergency department discharges, representing 18.8 million prescriptions per year, with no significant temporal trend. Discharge diagnoses with the highest proportion of opioid prescriptions were kidney stones (62 percent), neck pain (52 percent), and dental/jaw pain (50 percent). In multivariate regression, a pain-related discharge diagnosis, non-Hispanic white race, older age, male sex, uninsured status, and Western region were positively associated with opioid prescribing.                

Read more:                
http://onlinelibrary.wiley.com/doi/10.1111/acem.12862/abstract                                  

S.J. Poon, M.B. Greenwood-Ericksen, R.E. Gish, P.M. Neri, S.S. Takhar, S.G. Weiner, J.D. Schuur, and A.B. Landman. 2016. “Usability of the Massachusetts Prescription Drug Monitoring Program in the Emergency Department: A Mixed Methods Study.” Academic Emergency Medicine, doi: 10.1111/acem.12905.                

The authors compared the time and number of mouse or touchpad clicks that 17 emergency medicine providers needed to review one patient’s record in the Massachusetts prescription drug monitoring program (PDMP) to three other tasks they often used the hospital’s computers to perform in the emergency department (ordering a CT scan, writing a prescription, and searching a medication history service integrated within the electronic medical record). On average, the PDMP task took 4.2 minutes and 50.3 mouse clicks, far exceeding the other tasks (CT 1.4 minutes, 24.8 clicks; prescription 1.3 minutes, 19.5 clicks; SureScripts 1.45 minutes, 9.5 clicks). The providers said the system was cumbersome and offered a non-intuitive patient medication history display. They found the system valuable despite its inefficient interface.                

Read more:                
http://onlinelibrary.wiley.com/doi/10.1111/acem.12905/abstract                                  

C.C. Reyes-Gibby, K.O. Anderson, and K.H. Todd. 2016. “Risk for Opioid Misuse Among Emergency Department Cancer Patients.” Academic Emergency Medicine, doi:10.1111/acem.12861.                

Thirty-four percent of cancer patients who presented to the emergency department of a comprehensive cancer center between February 15, 2012, and March 28, 2014, were at high risk of opioid misuse, according to the responses of 209 cancer patients (72 percent response rate) to the Screener and Opioid Assessment for Patients with Pain–Revised. High risk was based on the recommended cutoff score of 18. Prescription Drug Monitoring program data showed annual opioid prescriptions were higher in the high-risk group (18 vs. 13). In multivariate regression, depression (odds ratio [OR] = 3.1), poor coping (OR = 1.1), and illicit substance use (OR = 28.3) were associated with high risk of misuse.                

Read more:                
http://onlinelibrary.wiley.com/doi/10.1111/acem.12861/abstract                                  

E.A. Samuels, K. Dwyer, M.J. Mello, J. Baird, A. Kellogg, and E. Bernstein. 2016. “Emergency Department-Based Opioid Harm Reduction: Moving Physicians from Willing to Doing.” Academic Emergency Medicine, doi:10.1111/acem.12910.                

Although most emergency department physicians were willing to perform opiate harm reduction interventions, few actually did, according to responses to an anonymous Web-based survey by 200 (72 percent response rate) emergency department physicians at three tertiary referral centers in Massachusetts and Rhode Island in 2013. Willingness correlated with attitude, confidence, and self-efficacy, but many physicians lacked confidence (mean = 3.1 out of 5). Knowledge, time, training, and institutional support were all prohibitive barriers. Physicians said research evidence, professional organization recommendations, and opinions of emergency department medicine leaders would strongly influence a change in their clinical practice to incorporate opiate harm reduction interventions.                 

Read more:                
http://onlinelibrary.wiley.com/doi/10.1111/acem.12910/abstract                                  

M.D. Sullivan, A.M. Bauer, D. Fulton-Kehoe, R.K. Garg, J.A. Turner, T. Wickizer, and G.M. Franklin. 2016. “Trends in Opioid Dosing Among Washington State Medicaid Patients Before and After Opioid Dosing Guideline Implementation.” Journal of Pain, doi:10.1016/j.jpain.2015.12.018.                

Analysis of opioid dosing for 273,200 adults with a paid Washington Medicaid fee-for-service claim for an opioid prescription between April 1, 2006, and December 31, 2010, showed use peaked in 2009. That year had the most opioid users (105,232), prescriptions (556,712), and person-years of prescription opioid use (29,442). Median opioid dose was unchanged from 2006 to 2010 at 37.5mg morphine-equivalent dose, but doses at the 75th, 90th, 95th, and 99th percentiles declined significantly. The state published opioid treatment and dosage guidelines in 2007.                

Read more:                
http://www.sciencedirect.com/science/article/pii/S1526590016004995                                  

R.E. Wright, N. Reed, N. Carnes, and H.E. Kooreman. 2016. “Concern About the Expanding Prescription Drug Epidemic: A Survey of Licensed Prescribers and Dispensers.” Pain Physician 19(1):E197–208.                

Most healthcare providers in Indiana said they were moderately or extremely concerned about prescription drug abuse in their communities, according to a 2013 online survey of 5,994 (15.6 percent response rate) licensed providers in the state. Dentists were less concerned than other providers. Providers with higher levels of concern often also reported recently changing their prescribing or dispensing behavior.                

Read more:                
http://www.painphysicianjournal.com/linkout?issn=1533-3159&vol=19&page=E197                
               

Opinion and Professional Development

D. Pon, K. Awuah, D. Curi, E. Okyere, and C.S. Stern. 2015. “Combating an Epidemic of Prescription Opioid Abuse.” Journal of the California Dental Association 43(11):673–8.                

Dentists are the third most frequent prescribers of opioids, according to the authors of this article. They suggest ways for dentists to help reduce the risk of prescription opioid misuse in their communities.                

Read more:                
http://europepmc.org/abstract/med/26798885                                  

J. Strang, R. McDonald, B. Tas, and E. Day. 2016. “Clinical Provision of Improvised Nasal Naloxone Without Experimental Testing and Without Regulatory Approval: Imaginative Shortcut or Dangerous Bypass of Essential Safety Procedures?” Addiction, doi:10.1111/add.13209.                

Multiple studies report overdose reversals following administration of improvised intranasal naloxone. Overdose reversal after nasal naloxone is frequent but not universal. Until late 2015, the only commercially available naloxone concentrations were 0.4 mg/ml and 1 mg/ml. Nasal medications are typically 0.05–0.25 ml of fluid per nostril. The only published study of pharmacokinetics and bioavailability finds that nasal naloxone has poor bioavailability. The authors believe the addictions treatment field has rushed prematurely into the use of improvised nasal naloxone kits. Evidence of adequate bioavailability and acceptable pharmacokinetic curves are vital preliminary steps, especially when effective approved formulations exist.                

Read more:                
http://onlinelibrary.wiley.com/doi/10.1111/add.13209/abstract                 
               

National

 President Proposes $1.1 Billion to Address Opioid, Heroin Use Epidemic                
The White House                
February 2, 2016                

President Obama has proposed in his fiscal year 2017 budget to take a two-part approach to address the prescription opioid misuse and heroin use epidemic. First, it includes $1 billion in new funding over two years to expand access to treatment for prescription drug misuse and heroin use. Second, it includes $500 million to continue and build on current efforts across the departments of Justice and Health and Human Services to expand state-level prescription drug overdose prevention strategies, increase the availability of medication-assisted treatment programs, improve access to naloxone, and support targeted enforcement activities.                 

Read more:                
https://www.whitehouse.gov/the-press-office/2016/02/02/president-obama-proposes-11-billion-new-funding-address-prescription                                  

Under Pressure, FDA Adds Measures on Opioid Abuse                
Sabrina Tavernise, New York Times                
February 4, 2016                

Under pressure from members of Congress, the FDA has announced several measures aimed at dealing with misuse. This includes convening an expert panel before approving some new opioids, strengthening requirements to study a drug after it has come to market, and increasing access to training on pain management for doctors and other prescribers.                 

Read more:                
http://www.nytimes.com/2016/02/05/health/under-pressure-fda-adds-measures-on-opioid-abuse.html?_r=0                                  

U.S. Appeals Court Ruling May Clear Barrier to Generic Oxycontin                
Brendan Pierson, Reuters                
February 1, 2016                

A federal appeals court has ruled that four patents related to Purdue Pharma’s OxyContin are invalid. Purdue had sued Teva, Amneal Pharmaceuticals, Epic Pharma and a U.S. arm of Mylan NV after they sought approval from the FDA to make generic OxyContin. Three of the patents related to an improved formulation of oxycodone, the active ingredient in OxyContin. The other patent describes technology designed to make the drug difficult to crush and causing it to form a gel when dissolved in water.                

Read more:                
http://www.reuters.com/article/us-oxycontin-ruling-idUSKCN0VA3GC                                  

White and Black Americans Agree Heroin Abuse a Serious Problem                
Ariel Edwards-Levy, Huffington Post                
February 3, 2016                

Eighty-eight percent of people said heroin use is a somewhat serious or very serious national problem, nearly as troubling as gun violence, according to a recent Huffington Post/YouGov online poll of 1,000 people. More than a third of respondents said they know someone who has been addicted to heroin or another opiate. About half said heroin use is at least as much of an issue in their community as it is elsewhere. Black respondents were more likely than white respondents to describe heroin use as a serious issue, but members of both races were equally likely to know someone with an addiction or to consider their community especially hard-hit. Eight percent of respondents said they think heroin abuse is more common among black people than white people, 27 percent said it is more common among white people, 46 percent said it is equally common for both groups, and 19 percent were not sure. Twenty-five percent of white respondents said heroin abuse is more common among white people, while 7 percent said it is more common among black people. Among black respondents, 48 percent said it is more common among white people, and only 6 percent said it is more common among black people.                

Read more:                
http://www.huffingtonpost.com/entry/heroin-abuse-survey-race_us_56b23ecee4b04f9b57d81285                 
                 

Marijuana

R. Auer, E. Vittinghoff, K. Yaffe, A. Künzi, S.G. Kertesz, D.A. Levine, E. Albanese, R.A. Whitmer, D.R. Jacobs Jr, S. Sidney, M.M. Glymour, and M.J. Pletcher. 2016. “Association Between Lifetime Marijuana Use and Cognitive Function in Middle Age: The Coronary Artery Risk Development in Young Adults (CARDIA) Study.” JAMA Internal Medicine, doi:10.1001/jamainternmed.2015.7841.                  

Of 3,385 participants in a longitudinal study with cognitive function measurements at year 25 in 2011, 84 percent reported past marijuana use but only 12 percent continued to use marijuana into middle age. The study involved a cohort of 5,115 men and women ages 18–30 at baseline in 1985 and follow-ups over 25 years. Current use of marijuana was associated with worse verbal memory and processing speed. After excluding current users and adjusting for potential confounders, for each 5 years of past exposure, verbal memory was 0.13 standardized units lower, corresponding to a mean of half of participants remembering one word fewer from a list of 15 words for every 5 years of use. After adjustment, univariate associations with lower executive function and processing speed were no longer significant.                  

Read more:                  
http://archinte.jamanetwork.com/article.aspx?articleid=2484906                                      

J.C. Maxwell and B. Mendelson. 2016. “What Do We Know Now About the Impact of the Laws Related to Marijuana?” Journal of Addiction Medicine 10(1):3–12, doi:10.1097/ADM.0000000000000188.                  

Existing surveys in Denver and Seattle before and after legalization of recreational marijuana show youth marijuana use has not increased, youth ratings of the riskiness of marijuana use have decreased, and use by adults has increased. Potency continues to increase, as has the proportion of drivers testing positive for marijuana use. Data from Denver show increases in hospital admissions, emergency department visits, and calls to poison centers, with decreasing arrests and admissions to substance abuse treatment programs. Data from Seattle show similar decreases in treatment admissions and police involvement, and increased prevalence of frequent use.                  

Read more:                  
http://journals.lww.com/journaladdictionmedicine/Citation/2016/02000/
What_Do_We_Know_Now_About_the_Impact_of_the_Laws.2.aspx
                                      

Marijuana Use and Its Impact on Workplace Safety and Productivity                  
Terri L. Dougherty, Occupational Health & Safety                  
February 1, 2016                  

Companies prohibit marijuana in the workplace due to safety concerns. Marijuana use has been linked to an increase in job accidents and injuries. Marijuana also impacts transportation safety. It impairs attentiveness, motor coordination, and reaction time. Drug testing services report more positive tests for marijuana, both in pre-employment drug screens and drug tests conducted for other reasons. The penalty for a positive test is often a refusal to hire or, for those who are already employees, discipline up to and including termination. Although attitudes are changing across the country with the legalization of medical and recreational marijuana, an employer’s substance abuse policy can prohibit an employee from using or being under the influence of the marijuana, including medical marijuana, at work. The policy should not be generic; and it should comply with state laws. Employers in safety-sensitive industries, or those with federal contracts or grants, need to follow applicable federal laws that prohibit illegal drug use, with no exceptions for marijuana.                   

Read more:                  
https://ohsonline.com/articles/2016/02/01/marijuana-use-and-its-impact-on-workplace-safety-and-productivity.aspx?admgarea=news                                      

Legal Marijuana Sales Nationwide Could Hit $6.7 Billion in 2016                  
Tom Huddleston, Jr., Fortune                  
February 1, 2016                  

Legal cannabis sales in the United States increased 17 percent to $5.4 billion in 2015 and could rise 25 percent to $6.7 billion in 2016, according to ArcView Market Research, a leading marijuana industry investment and research firm. ArcView further predicts a $21.8 billion legal cannabis market by 2020, with recreational sales accounting for 53 percent of the legal cannabis market—a 1,150 percent increase in sales over the next four years.                  

Read more:                  
http://fortune.com/2016/02/01/marijuana-sales-legal                                                         

Medical Marijuana Bills Move Forward in Utah Legislature                  
Ben Winslow, Fox 13                  
February 5, 2016                  

A committee in Utah's senate has approved two medical marijuana bills to the full senate for debate. One bill would allow an extract with trace amounts of tetrahydrocannabinol, or THC. The other piece of legislation is a “whole plant” bill. Both would place the prescription and distribution of cannabis under heavy regulation by the state. (Includes video: 3:21 minutes)                  

Read more:                  
http://fox13now.com/2016/02/04/medical-marijuana-bills-move-forward-in-the-utah-state-legislature                                      

Maryland Hospital CEO Backs Medical Marijuana                  
Tina Reed, Washington Business Journal                  
February 2, 2016                  

Barry Ronan, CEO of the Western Maryland Health System, said he supports medical marijuana. The hospital will assist Peak Harvest Health on cannabis research by partnering on clinical trials. Ronan’s decision came about after his son-in-law developed an aggressive form of cancer in his knee that made him a candidate for medical marijuana. Ronan does not support legalization of marijuana for recreational use.                   

Read more:                  
http://www.bizjournals.com/washington/news/2016/02/02/exclusive-maryland-hospital-ceo-is-backing-medical.html                                      

Facebook Shuts Down Medical Marijuana Pages in New Jersey                  
Ben Finley, Associated Press                  
February 3, 2016                  

Facebook has shut down the business pages of New Jersey medical marijuana dispensaries Compassionate Sciences, Garden State, and Breakwater Treatment and Wellness for allegedly violating the social network’s community standards. Compassionate Sciences said it communicated with customers primarily through Facebook.                  

Read more:                  
http://abcnews.go.com/US/wireStory/facebook-shuts-medical-marijuana-pages-jersey-36697719                 
               

International

On-the-Job Drug Testing may be Introduced for Northern Territory (Australia) Police                
Kieran Banks, NT News                
February 2, 2016                

Police in Australia’s Northern Territory soon may be subject to random on-the-job drug and alcohol testing. Most other police forces in Australia already have testing. Officers who fail drug tests would face the same penalties as the public. If Australia’s parliament passes the necessary legislation, drug and alcohol testing for Northern Territory police could begin in 2016.                

Read more:                
http://www.ntnews.com.au/news/northern-territory/onthejob-drug-testing-may-be-introduced-for-nt-police-in-2016/news-story/a9c56b264c6e2e3c85335a411de12b9b                 
               

Northeast/Mid-Atlantic News

All Pennsylvania Schools to Get Free Limited Doses of Heroin Antidote                
Susan Baldridge, Lancaster Online                
February 1, 2016                

Pennsylvania will make a limited supply of Narcan available for free to all public schools in the state. Schools will have access to educational materials and training developed by the National Association of School Nurses as part of the program.                

Read more:                
http://lancasteronline.com/free-narcan-for-all-pennsylvania-schools-says-governor/article_a8d58b5c-c911-11e5-b0ea-3fea81c665e2.html                                  

Police Finding More Drugged Drivers on Pennsylvania Roads                
John Finnerty, Daily Item                
January 30, 2016                

In Pennsylvania, almost 4-in-10 arrests for driving under the influence in 2014 involved drugs. Drivers under the influence also caused 114 fatal crashes. That total included drivers using legal prescriptions or illegal drugs. Prosecutors agree that the heroin and prescription drug crisis is fueling the surge in cases involving driving under the influence.                

Read more:                
http://www.dailyitem.com/news/police-finding-more-drugged-drivers-on-pennsylvania-roads/article_c6daf280-c7a0-11e5-bf17-53ea3b566599.html                 
               

South News

Bill to Curb Overprescribing of Opioids Advances in Virginia Legislature                
Tammie Smith, Richmond Times-Dispatch                
February 3, 2016                

A Virginia House subcommittee has advanced a bill that would require prescribers to check the prescription drug monitoring program before writing a prescription for pain relievers for longer than 2 weeks. It excludes prescriptions written for patients in hospice or palliative care, non-refillable prescriptions written for a patient having invasive treatment, opioids prescribed during a hospital stay or at discharge, and if the database is not working. The state’s senate is also considering a version of the bill.                

Read more:                
http://www.richmond.com/life/health/article_b06ec8a2-eb03-5534-be78-f6909bfea046.html                                  

New Orleans Issues Public Health Advisory After Spike in Heroin Overdoses                
Gina Swanson, WDSU                
January 29, 2016                

New Orleans health officials have issued a public health advisory due to the increase in overdose cases this year. The New Orleans Emergency Services unit sees up to 10 overdose patients a day, with seven overdose deaths already in 2016. Narcan is available without a prescription to help reduce mortality.                

Read more:                
http://www.wdsu.com/news/new-orleans-issues-public-health-advisory-after-spike-in-heroin-overdoses/37718408                                  

Virginia Attorney General Addressed Opioid Abuse Before Senate Special Committee on Aging                
Augusta Free Press                
February 1, 2016                

Virginia’s attorney general recently testified before the U.S. Senate’s Special Committee on Aging, informing members that more Virginians ages 55–64 are dying of heroin and prescription drug overdose than those ages 15–24.                

Read more:                
http://augustafreepress.com/herring-addresses-opiod-abuse-before-senate-special-committee-on-aging                                  

Pharmacy Break-Ins Throughout Florida Panhandle and Alabama                
WJHG/WECP                
February 2, 2016                

Thieves have stolen controlled drugs from pharmacies throughout Florida’s panhandle and Alabama in recent months. Law enforcement believes two men are involved. Local police have no leads in the case. (Includes video: 2:16 minutes)                

Read more:                
http://www.wjhg.com/home/headlines/Pharmacy-break-ins-throughout-Alabama-Panhandle-367439821.html                 
               

 Midwest News

Wisconsin Attorney General: ‘Dose of Reality’ Campaign to Work with Employers In 2016                
Andrew LaCombe, FOX 11                
January 30th 2016                

The Wisconsin Attorney General’s Office last year launched a public awareness campaign called “Dose of Reality.” Initial efforts focused on the medical community. This year, the campaign will distribute drug addiction information to employers.                

Read more:                
http://fox11online.com/news/state/ag-schimel-dose-of-reality-campaign-to-work-with-employers-in-2016                                  

Northern Illinois Hospital Drug Screens Patients Prescribed Opioids                
WIFR                
February 2, 2016                

SwedishAmerican Medical Group in northern Illinois has adopted a policy to drug test patients prescribed opioid medications. It wants to make sure that patients are taking their medications and not selling them. It also will monitor patients who have illegal drugs in their systems. Patients getting long term narcotic medications will be required to sign a pain contract. If the drug screening comes back positive for an illegal substance, the physician will no longer prescribe narcotics to that patient.                

Read more:                
http://www.wifr.com/home/headlines/Local-Hospital-Drug-Screens-Patients-Taking-Pain-Killers-367427541.html                                  

All Ohio CVS Pharmacies to Make Naloxone Available Without a Prescription                
CNN                
February 1, 2016                

CVS Health has announced it would make naloxone available without a prescription at all CVS pharmacies in Ohio, beginning in late March 2016.                 

Read more:                
http://money.cnn.com/news/newsfeeds/articles/prnewswire/NE11736.htm                                  

Bill for Prescription Drug Monitoring Program Passes Missouri House Committee                
Lindsey Berning, KMIZ                
February 4, 2016                

A Missouri House committee has approved a bill that would require the state’s health department to establish a prescription drug monitoring program. Pharmacists would have to submit information into a database within 7 days of filling a prescription. The bill heads to the House floor for debate. (Includes video: 2:33 minutes)                

Read more:                
http://www.abc17news.com/news/bill-for-prescription-drug-monitoring-program-passes-committee/37828714                 
               

West News

2014 Saw Highest Number of Utah Deaths from Prescription Drugs                
Annie Knox, Salt Lake Tribune                
January 29, 2016                

The Utah Department of Health in 2014 recorded a record high 358 deaths due to prescription drug overdoses. Overdoses claimed the lives of 326 Utahans in 2007. The overdoses rate fell by 28 percent from 2007 to 2010 amid a statewide campaign warning of the effects of pain reliever addiction. Since legislative funding for the prevention effort expired in 2010, the number of deaths has climbed.                 

Read more:                
http://www.sltrib.com/news/3476249-155/lawmakers-hope-trio-of-bills-will                 
               

Other Resources

Prescription Drug Overdose Prevention: State Efforts to Address Opioid Use in Workers’ Compensation Systems                
National Institute for Occupational Safety and Health                
January 6, 2016                

This updated National Institute for Occupational Safety and Health topic page provides useful information for workers, employers, healthcare providers, and other stakeholders interested in learning more about work-related factors involved with prescription drug overdose prevention. The site provides links to all state workers’ compensation opioid prescribing policies, protocols, and guidelines.                 

Read more:                
http://www.cdc.gov/niosh/topics/prescription/default.html                                  

FBI, DEA Release Documentary Film Addressing Heroin/Prescription Drug Abuse                
FBI                
February 4, 2016                

The FBI and Drug Enforcement Administration have unveiled a documentary, “Chasing the Dragon: The Life of an Opiate Addict.” The 45-minute film profiles people who either misused opiates or had family members become addicted to opiates. It shows the cycle of addiction and looks at the consequences associated with opioid misuse. The documentary also features interviews with medical and law enforcement professionals discussing the effects of addiction.                

Read more:                
https://www.fbi.gov/news/pressrel/press-releases/fbi-dea-release-documentary-film-addressing-heroin-prescription-drug-abuse                                  

Maps of Overdose Death Rates in the U.S.                
Prescription Drug Monitoring Program Training and Technical Assistance Program, Brandeis University                
Accessed February 4, 2016                

The Prescription Drug Monitoring Program Training and Technical Assistance Program has created a series of color-coded maps and associated data tables that detail the overdose death rates for each state from 2009 through 2014. They include: all drugs (prescription, illicit, and unknown), prescription drugs, illicit drugs, all opioids (prescription, illicit, and unknown), prescription opioids, and illicit opioids.                

Read more:                
http://www.pdmpassist.org/content/maps-overdose-death-rates-us                
               

Webinars

Marijuana Legalization: Trends & Hot Topics                
OraSure Technologies                
Thursday, February 25, 2016                
2:00 p.m. (ET)                 
https://ohsonline.com/webcasts/2015/12/marijuana-legalization-trends-hot-topics.aspx?admgarea=Webinar&tc=page0                                 

Weed in Your Workplace: What You Need to Know                
National Safety Council                
Wednesday, April 20, 2016                
2:00 p.m. (ET)                 
http://eventcallregistration.com/reg/index.jsp?cid=59487t11                 
               

Grant Announcements

Research on Prescription Opioid Use, Opioid Prescribing, and Associated Heroin Risk (RFA-CE-16-003)                
Centers for Disease Control and Prevention                
Due: February 18, 2016                
http://www.grants.gov/view-opportunity.html?oppId=280151                                  

Increasing Access to Medication-Assisted Treatment in Rural Primary Care Practices (R18)                
Agency for Healthcare Research and Quality                
Due: March 4, 2016                
http://grants.nih.gov/grants/guide/rfa-files/RFA-HS-16-001.html                                  

Drug-Free Communities Support Program (SP-16-001)                
SAMHSA                
Due: March 18, 2016                
http://www.samhsa.gov/sites/default/files/grants/pdf/sp-15-001_0.pdf                                  

National Institute on Drug Abuse Challenge: Addiction Research: There’s an App for that                
National Institute on Drug Abuse                
Submission Period begins November 3, 2015, 9:00 a.m. (ET)                
Submission Period ends April 29, 2016, 11:59 p.m. (ET)                
http://nida.ideascale.com/a/pages/addiction-research-theres-an-app-for-that                                  

Bottle Tracking Program                
National Association of Drug Diversion Investigators                
Due: None Specified                
http://www.naddi.org/aws/NADDI/pt/sp/programs_grants                 
http://naddibottletracking.org/law-enforcement                 
               

Take-Back Events & Drop Boxes

2,000 lbs. of Unwanted Prescription Drugs Collected on Long Island (N.Y.)                
CBS                
February 3, 2016                
http://newyork.cbslocal.com/2016/02/03/long-island-drug-disposal-program                                  

Central Oregon Program Takes in 1,100 lbs. of Drugs                
KVAL                
January 31, 2016                
http://kval.com/news/local/central-oregon-program-takes-in-1100-pounds-of-drugs                                  

Unwanted Prescription Drug Drop-offs Up in Ventura County (Calif.)                
KCLU                
February 3, 2016                
http://www.kclu.org/2016/02/03/unwanted-prescription-drug-dropoffs-up-in-ventura-county                                  

Le Mars (Iowa) Police Offers Citizens Project Safe Meds Program                
Le Mars Daily Sentinel                
February 1, 2016                
http://www.lemarssentinel.com/story/2272867.html                                  

Raynham (Mass.) Police Introduce New Drug Drop-Off Bin                
Charlie Peters, Taunton Daily Gazette                
February 4, 2016                
http://www.tauntongazette.com/news/20160204/raynham-police-introduce-new-drug-drop-off-bin                                  

New Jersey State Police from Woodbine Barracks Collect Unused Medicines in Ocean View                
Shore News Today                
January 31, 2016                
http://www.shorenewstoday.com/upper_township/new-jersey-state-police-from-woodbine-barracks-collect-unused-medicines/article_f3a194f2-c6ad-11e5-92ce-d39edef1775b.html                
               

 Upcoming Conferences and Workshops

Marijuana and Cannabinoids: A Neuroscience Research Summit                
National Institute on Drug Abuse, National Institute on Alcohol Abuse and Alcoholism, National Center for Complementary and Integrative Health, National Institute of Mental Health, National Institute of Neurological Disorders and Stroke                
March 22–23, 2016                
National Institutes of Health                
Natcher Conference Center, Building 45                
9000 Rockville Pike                
Bethesda, Maryland                

This summit will focus on the neurological and psychiatric effects of marijuana, other cannabinoids, and the endocannabinoid system. Both the adverse and the potential therapeutic effects of the cannabinoid system will be discussed. The goal of the summit is to ensure evidence-based information is available to inform practice and policy.                

Read more:                
http://apps1.seiservices.com/nih/mj/2016                                  

Register:                
http://apps1.seiservices.com/nih/mj/2016/Registration.aspx                                  

Ensuring Access to Pain Care: Engaging Pain Medicine and Primary Care Teams                
American Academy of Pain Medicine                
February 18–21, 2016                
Palm Springs, California                
http://www.painmed.org/annualmeeting                                  

Pharmacy Diversion Awareness Conference                
U.S. Drug Enforcement Administration                
February 27–28, 2016                 
Charleston, West Virginia                
http://www.deadiversion.usdoj.gov/mtgs/pharm_awareness                                  

Ohio Workers’ Compensation Medical & Health Symposium                
Bureau of Workers’ Compensation                
March 10–11, 2016                
Columbus, Ohio                
https://www.bwc.ohio.gov/provider/brochureware/PainSymposium/default.asp                                  

2016 National Rx Drug & Heroin Summit                
March 28–31, 2016                
Atlanta, Georgia                
http://nationalrxdrugabusesummit.org                                  

Third Annual Smart Approaches to Marijuana Education Summit                
March 31, 2016                
Atlanta, Georgia                
http://nationalrxdrugabusesummit.org/sam-summit-2                                  

Register:                
https://www.123contactform.com/form-1486587/2016-National-Rx-Drug-Abuse-Summit                                  

Medical Marijuana Seminar                
Private Motor Truck Council of Canada                
May 3, 2016                
Alberta, Canada                

Read more:                
http://www.todaystrucking.com/alberta-hosting-spring-talk-on-medical-marijuana-in-trucking                 
http://www.pmtc.ca/News.asp?a=view&id=113                                  

2016 Annual Conference                
International Health Facility Diversion Association                
September 13–14, 2016                
Duke Energy Convention Center                
Cincinnati, Ohio                 
https://ihfda.org/2016-annual-conference                                  

Register:                
https://www.regonline.com/Register/Checkin.aspx?EventID=1803476                 
         
                                 
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.