West Virginia University Logo

February 12, 2014

If you are having difficulty viewing the Weekly Update, please click here.
ARCHIVE MAIN PAGE SUBSCRIBE TO THE WEEKLY UPDATE
 
SAMHSA
SAMHSA Prescription Drug Abuse Weekly Update
WEEKLY
UPDATE
Issue 58  |  February 12, 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 Featured Article Also Featured Journal Articles and Reports News Other State and Local News Audio Video Grant Announcements Take-Back Events and Drop Boxes Upcoming Conferences and Workshops

Featured

Aaron J. Blashill and Steven A. Safren. 2014. "Sexual Orientation and Anabolic–Androgenic Steroids in U.S. Adolescent Boys." Pediatrics, doi: 10.1542/peds.2013–2768.

Researchers compared the lifetime prevalence of anabolic–androgenic steroid (AAS) misuse among sexual minority versus heterosexual U.S. adolescent boys and, secondarily, sought to explore possible intermediate variables that may explain prevalence differences. Participants were 17,250 adolescent boys taken from a pooled data set of the 14 jurisdictions from the 2005 and 2007 Youth Risk Behavior Surveys that assessed sexual orientation. Data were analyzed for overall prevalence of AAS misuse and possible intermediary risk factors. Sexual minority adolescent boys were at an increased odds of 5.8 (95 percent confidence interval 4.1–8.2) to report a lifetime prevalence of AAS (21 percent versus 4 percent) compared with their heterosexual counterparts, P < .001. Exploratory analyses suggested that increased depressive symptoms/suicidality, victimization, and substance use contributed to this disparity.

Read more:
http://pediatrics.aappublications.org/content/early/2014/01/28/peds.
2013-2768.abstract?sid=f860d663-2a9a-4673-959d-c95836c850c2

Also Featured

Some Positive Trends in Americans' Behavioral Health
Medscape
February 3, 2014

SAMHSA reported that behavioral health of Americans is improving in some areas. The National Behavioral Health Barometer provides data on several key indicators of behavioral health problems. The report indicates that the rate of prescription pain reliever abuse decreased during the period from 2007 to 2011. Rates decreased from 9.2 percent to 8.7 percent among children ages 12 to 17 and from 12.0 percent to 9.8 percent among adults ages 18 to 25. There was a slight increase in illicit drug use among children. In 2012, 9.5 percent of 12- to 17-year-olds (about 2.4 million people) reported illicit drug use in the month before being surveyed, up slightly from 9.3 percent in 2008. The number of people getting buprenorphine treatment for heroin addiction jumped 400 percent from 2006 to 2010. Similarly, the number of people getting outpatient behavioral health treatment through Medicare increased by more than 30 percent from 2006 to 2010.

Read more:
http://www.medscape.com/viewarticle/820104?src=rss

Also see, below, the Substance Abuse and Mental Health Services Administration’s Behavioral Health Barometer: United States, 2013.

Journal Articles and Reports

Joanne E. Brady and Guohua Li. 2014. "Trends in Alcohol and Other Drugs Detected in Fatally Injured Drivers in the United States, 1999–2010." American Journal of Epidemiology, doi: 10.1093/aje/kwt327.

Researchers used data from the Fatality Analysis Reporting System for 1999–2010 to assess trends in alcohol and other drugs detected in drivers who were killed within one hour of a motor vehicle crash in six U.S. states (California, Hawaii, Illinois, New Hampshire, Rhode Island, and West Virginia) that routinely performed toxicological testing on drivers involved in such crashes. Of the 23,591 drivers studied, 39.7 percent tested positive for alcohol and 24.8 percent for other drugs. The prevalence of narcotics tripled during the study period, increasing from 1.8 percent in 1999 (95 percent CI: 1.3, 2.6) to 5.4 percent (95 percent CI: 4.4, 6.8) in 2010 (Z =−7.07, P< 0.0001). The increase occurred in both sexes. Women consistently were twice as likely as men to test positive for narcotics. Prevalence of positive results for other drugs also rose from 1999 to 2010, while prevalence of positive results for alcohol remained stable. The study was unable to differentiate illicit and prescription drugs.

Read more:
http://aje.oxfordjournals.org/content/early/2014/01/27/aje.kwt327

Dean Elbe, Sabrina Gill, Darcy Santor, Mark Norris, and Sandra Whitehouse. 2014. "DrugCocktails.ca: A Web Site for Youth and Health Care Professionals Focusing on Interactions Between Prescription Drugs and Substances of Abuse" Journal of Adolescent Health 54(2):S89.

The authors created Web-based applications that provide healthcare information to youth and separately to healthcare professionals on interactions between prescription medications and substances of abuse. They then evaluated utility, ease of use, and user satisfaction using data from a pilot study targeting both groups at a tertiary care children's hospital in Canada. Web site content review and development occurred over a three-year period. A total of 45 youths and 45 healthcare professionals completed analyzable surveys. High rates of ease of use (youths 84.5 percent, professionals 86.7 percent) and satisfaction (youths 84.4 percent, professionals 91.2 percent) were reported by survey respondents. Most stated they would use the Web site again (youths 82.2 percent, professionals 100.0 percent) or recommend the site to a friend or colleague (youths 82.2 percent, professionals 97.8 percent). Professionals (55.6 percent) were more likely than youths (26.7 percent) to suggest modifications to the Web site.

Read more:
http://www.jahonline.org/article/S1054-139X(13)00725-8/fulltext

H. Hendrikson. 2013. "Preventable Deaths on the Rise: Growing Numbers of Overdoses, Suicides, and Brain Injuries Have Lawmakers Searching for Solutions." State Legislatures, 39(10):30–31.

More Americans now die from prescription drug overdoses than from heroin and cocaine combined. Legislators around the nation are investigating these growing public health concerns and implementing programs to control them. In 2010, enough pain relievers were prescribed to medicate every American adult for a month. The same year, about 12 million Americans (age 12 or older) reported using prescription pain relievers without a medical reason. Almost all drugs involved in overdoses originally come from legitimate prescriptions. In 2013, lawmakers in 22 states passed at least 30 laws aimed at preventing prescription drug abuse and overdose; many improved prescription drug monitoring programs. Others established regulations for pain management clinics. Promising policy options that have not yet been proven effective to prevent overdose deaths, but are accepted by the scientific community as a good step toward prevention, include maintaining and strengthening prescription drug monitoring programs by ensuring that providers have real-time access to data, and providing unsolicited reports to prescribers, pharmacists, licensing boards and law enforcement agencies; ensuring that providers follow evidence-based guidelines for safe and effective use of prescription pain relievers; setting regulations to prevent pain management clinics from prescribing inappropriately; and monitoring prescription claims information in state benefits programs such as Medicaid or workers' compensation for signs of inappropriate prescribing and use of controlled prescription drugs.

Read more:
http://www.ncbi.nlm.nih.gov/pubmed/24446576

Amanda J. Hetland and David B. Carr. 2014. "Medications and Impaired Driving: A Review of the Literature." Annals of Pharmacotheraphy, doi:10.1177/1060028014520882.

Researchers searched the Medline and Embase databases for articles published from January 1973 to June 2013 on classes of medications associated with driving impairment. The search included outcome terms such as automobile driving, motor vehicle crash, driving simulator, and road tests. Only English-language articles that contained findings from observational or interventional designs with ≥ 10 participants were included in this review. Cross-sectional studies, case series, and case reports were excluded. Driving is an important task and activity for the majority of adults. Some commonly prescribed medications have been associated with driving impairment measured by road performance, driving simulation, or motor vehicle crashes. This review of 30 studies identified findings about barbiturates, benzodiazepines, hypnotics, antidepressants, opioid and nonsteroidal analgesics, anticonvulsants, antipsychotics, antiparkinsonian agents, skeletal muscle relaxants, antihistamines, anticholinergic medications, and hypoglycemic agents in therapeutic use. Additional studies of medication impact on sedation, sleep latency, and psychomotor function, as well as the role of alcohol, are also discussed. Psychotropic agents and those with central nervous system side effects were associated with measures of impaired driving performance. It is difficult to determine whether such associations are actually a result of medication use or the medical diagnosis itself.

Read more:
http://aop.sagepub.com/content/early/2014/01/28/1060028014520882

Amanda J. Hetland, David B. Carr, Michael J. Wallendorf, and Peggy P. Barco. 2014. "Potentially Driver-Impairing Medication Use in Medically Impaired Adults Referred for Driving Evaluation." Annals of Pharmacotheraphy, doi:10.1177/1060028014520881.

This study aimed to describe the frequency of medication use and to determine the association between routine use of potentially driver-impairing (PDI) medications and performance on driving and cognitive tests. A total of 225 drivers with medical impairment (mean age 68 ± 12.8 years, 62.2 percent male) were referred to an occupational therapy–based driving evaluation clinic. Medication lists were reviewed to identify PDI drugs, as defined by the study above examining medications and crash risk. Outcome variables included road testing on the modified Washington University Road Test and cognitive scores on Trail Making Test Parts A and B, Snellgrove Maze Task, Clock Drawing Task, Driving Health Inventory (DHI) Useful Field of View, DHI Motor Free Visual Perceptual Test, Epworth Sleepiness Scale (ESS), Geriatric Depression Scale, and Functional Assessment Questionnaire. PDI medication use was documented in 68.9 percent of the sample, with the average subject taking 1.4 PDI drugs. Few significant differences in outcome measures were noted in any medication class. Drivers taking routine PDI medications had a mean ESS score of 7.8 compared with 6.0 in the control group, suggesting increased sleepiness (P = .007). Total number of routine medications, regardless of PDI designation, also correlated positively with sleepiness scores (P = .023). Use of PDI medications was associated with informant ratings of daytime drowsiness, which has been linked to motor vehicle crash risk.

Read more:
http://aop.sagepub.com/content/early/2014/01/28/1060028014520881

Robert H. Howland. 2014. "Gabapentin for Substance Use Disorders: Is it Safe and Appropriate?" Journal of Psychosocial Nursing and Mental Health Services 52(2):13–16, doi: 10.3928/02793695–20131217–01.

Gabapentin is effective for the treatment of alcohol dependence and can be used for treating anxiety, insomnia, headaches, and pain in patients who have comorbid substance use disorders (SUDs) or who are at high risk of substance abuse. Some evidence of gabapentin misuse and abuse exists. Withdrawal symptoms also have been described in cases where gabapentin was abruptly discontinued. Although discontinuation symptoms can be associated with many different psychotropic, misuse risk is low and the author believes gabapentin can be considered safe and appropriate for use in patients with all types of SUDs, including patients who take opioid drugs.

Read more:
http://www.healio.com/psychiatry/journals/jpn/%7B3402853c-b555-4579-b2ec-
34b90100cafe%7D/gabapentin-can-it-be-misused


Bridget M. Kuehn. 2014. "Back From the Brink: Groups Urge Wide Use of Opioid Antidote to Avert Overdoses." Journal of American Medical Association, doi:10.1001/jama.2014.481

This article discusses Project Lazarus's efforts to put naloxone into as many hands as possible. The Centers for Disease Control and Prevention reported that, between 1996 and 2010, community-based overdose prevention programs may have saved as many as 10,000 lives. Naloxone can be administered intranasally or by injection. It costs as little as $8.00 a vial for injection use to $50.00 dollars for a nasal administration kit. The drug's effects last for 30 to 90 minutes and may trigger withdrawal in individuals who are dependent on opioid medications. R. Gil Kerlikowske, director of the White House Office of National Drug Control Policy, supports first responders and public health workers using naloxone. Last year, SAMSHA released an opioid overdose prevention toolkit, including a recommendation that physicians prescribe naloxone alongside pain medications. Project Lazarus's multipronged strategy includes nalozone, which has helped reduce overdose deaths in Wilkes County, N.C., from 46.6 per 100,000 in 2009 to 29.0 per 100,000 in 2010. The proportion of overdose deaths resulting from medications prescribed by Wilkes County physicians has also declined from 82 percent in 2008 to 10 percent in 2010. The North Carolina Medical Board in 2008 issued a statement backing the effort to distribute naloxone. In 2013, a state law allowed individuals who are not at risk themselves to get a naloxone prescription for another person at risk of overdose. Seventeen states and the District of Columbia now have legislation to allow wider distribution of naloxone. Making primary care physicians more comfortable with co-prescribing naloxone to pain patients and educating them about the risks posed by prescribed opioids is an emphasis of organizations at the national and local level. SAMHSA does not recommend third-party prescribing, because the practice may be illegal in some states. While naloxone can help in an emergency, there is wide agreement that substance abuse prevention and treatment programs are essential as well.

Read more:
http://jama.jamanetwork.com/article.aspx?articleID=1829642&utm_source=Silverchair
percent20Information percent20Systems&utm_medium=email&utm_campaign=JAMA
percent3AOnlineFirst02 percent2F07 percent2F2014


Catherine L. O'Grady, Hilary L. Surratt, Steven P. Kurtz, and Maria A. Levi–Minzi. 2014. "Nonmedical Prescription Drug Users in Private Versus Public Substance Abuse Treatment: A Cross Sectional Comparison of Demographic and HIV Risk Behavior Profiles." Substance Abuse Treatment, Prevention, and Policy 9:9, doi:10.1186/1747–597X–9–9.

This paper compares the HIV risk profiles of nonmedical prescription drug users in public (n=246) and private (n=249) treatment facilities. Participants included in the analysis reported five or more recent episodes of nonmedical prescription drug use, a prior HIV negative test result, and current enrollment in substance abuse treatment. A standardized questionnaire was administered by trained interviewers with questions about demographics, HIV risk, and substance use. Private treatment clients were more likely to be non-Hispanic white, younger, and opioid and heroin users. Injection drug use was higher among private treatment clients, whereas public clients reported higher likelihood of trading or selling sex. Public treatment clients reported higher rates of HIV testing and availability at their treatment facilities compared with private clients. Demographics, substance use patterns, profiles of HIV risk, and access to HIV testing differed between the two treatment samples. Population tailored HIV interventions and increased access to HIV testing in both public and private substance treatment centers appear to be warranted.

Read more:
http://www.substanceabusepolicy.com/content/9/1/9

Carolyn E. Sartor, Henry R. Kranzler, and Joel Gelernter. 2014. "Rate of Progression From First Use to Dependence on Cocaine or Opioids: A Cross-Substance Examination of Associated Demographic, Psychiatric, and Childhood Risk Factors." Addictive Behavior 39(2):473–39, doi: 10.1016/j.addbeh.2013.10.021.

This study uses interview data from cocaine dependent (n=6,333) and opioid dependent (n=3,513) participants in a multisite study of substance dependence. Mean age was approximately 40 years, and 40 percent of participants were women; 51.9 percent of cocaine dependent participants and 29.5 percent of opioid dependent participants self-identified as black/African American. Years from first use to dependence were calculated for each substance and a range of demographic, psychiatric, and childhood risk factors were entered into ordinal logistic regression models to predict the (categorical) transition time to cocaine dependence (CD) and opioid dependence (OD). In both the cocaine and opioid models, conduct disorder and childhood physical abuse predicted rapid development of dependence and alcohol, while nicotine dependence diagnoses were associated with slower progression to CD or OD. Blacks/African Americans were at greater risk than European Americans to progress rapidly to OD. Only a subset of factors known to be associated with CD and OD predicted the rate at which dependence developed. Nearly all were common to cocaine and opioids, suggesting that sources of influence on the timing of transitions to dependence are shared across the two substances.

Read more:
http://www.ncbi.nlm.nih.gov/pubmed/24238782

Substance Abuse and Mental Health Services Administration (SAMHSA). 2013. Behavioral Health Barometer: United States, 2013. HHS Publication No. SMA–13–4796. Rockville, Md.: SAMHSA.

This is the first edition of the Behavioral Health Barometer: United States, 2013, one of a series of state and national reports that provide a snapshot of the state of behavioral health in the nation. This national report presents a set of substance use and mental health indicators as measured through data collection efforts sponsored by SAMHSA (the National Survey on Drug Use and Health and the National Survey of Substance Abuse Treatment Services), the Centers for Disease Control and Prevention (the Youth Risk Behavior Survey), and the National Institute on Drug Abuse (the Monitoring the Future survey). Also included are data on the use of mental health and substance use treatment services by Medicare enrollees, as reported by the Centers for Medicare & Medicaid Services. This array of indicators provides a unique overview of the nation's behavioral health at a point in time as well as a mechanism for tracking change and trends over time.

Read more:
http://www.samhsa.gov/data/StatesInBrief/2K14/National_BHBarometer.pdf

News

Fatal Overdoses in Multiple States Show Dangers of Fentanyl-Laced Heroin
ABC News
February 5, 2014

This article and video (45 seconds) discuss heroin laced with fentanyl that is suspected in at least 50 recent fatal overdoses in three states: Maryland, Michigan, and Pennsylvania. In Pennsylvania, at least 17 fatal overdoses in January were suspected; in Maryland, at least 37 deaths dating from last September were linked to the drug; and in Flint, Mich., four overdoses are suspected of containing fentanyl-laced heroin. Fentanyl is 50 to 100 times as potent as heroin. The fentanyl used in heroin is illicitly manufactured rather than being taken from hospitals or pharmacies.

Read more:
http://abcnews.go.com/Health/dangers-fentanyl-laced-heroin/story?id=22374848

Breaking the Bond of Heroin and Painkillers
Bloomberg
February 6, 2014

Sally Satel, a psychiatrist and a resident scholar at the American Enterprise Institute, shares her views about how people get addicted to heroin and prescription pain relievers. Many individuals who have become addicted to prescription pain relievers discover that heroin is cheaper and easier to get. The police and Drug Enforcement Administration closed pill mills across the country, making prescription pain relievers harder to get. Also, the new Oxycontin turns into mush when crushed instead of powder that can be snorted or injected. People who lose their insurance may also switch to heroin. Satel explains how doctors contribute to people getting addicted to prescription pain relievers and how medicine cabinets are easy targets for theft by friends and relatives. She believes targeting addiction to pills can ameliorate the heroin problem and vice versa. For example, in an overdose either Oxycontin or heroin is treated with Narcan. She writes that better treatment and more access to opiate replacement medications would help people who are addicted to either heroin or pain relievers. The primary strategy for reducing pain reliever abuse is to keep the pills off the street. Keith Humphreys, a psychiatry professor and addiction expert at Stanford University, suggests that successful strategies across the country should become universal such as prescription monitoring programs and education programs that teach doctors not to overprescribe. Satel thinks using the death of a celebrity as a basis to discuss national drug problems is usually pointless, but she suggests it might call attention to the ways many individuals can be helped.

Read more:
http://www.bloomberg.com/news/2014-02-06/heroin-and-painkillers-come-together.html

Heroin Resurgence in United States Sparked by Cheap Cost, Access
Bloomberg
February 4, 2014

This article discusses why the United States has seen an increase in heroin and its street value. The Drug Enforcement Administration said one reason for the increase may be the rise in production from countries that produce the drug. Heroin is cheaper and more easily obtained than prescription pain relievers whose use has been limited by federal and state laws tightening doctor and patient access. A bag of heroin sells for about $10.00 on Long Island, while the equivalent amount of Vicodin costs $30.00. The National Survey on Drug Use and Health reported that heroin use increased 79 percent from 2007 to 2012, with 669,000 people in the United States reporting they used the drug. Emergency room doctors have seen an increase in heroin use in Maryland, New York, Pennsylvania, and Vermont. Heroin is hitting middle- to upper-class neighborhoods. The recent increase in heroin deaths resulted in part from a version that combines heroin and fentanyl.

Read more:
http://www.businessweek.com/news/2014-02-03/heroin-resurgence-seen-sparked-by-cheap-
cost-easy-availability#p1


Ready Access, Low Cost, Pill-Like High: Heroin's Rise and Fatal Draw
CNN
February 4, 2014

This article and video (2 minutes, 38 seconds) discuss the increase in heroin in the United States. A reporter interviews a 33-year-old Boston, Mass., native about his heroin addiction. He started at a young age: drinking, smoking pot, then taking pain pills, and eventually heroin. The low cost, accessibility, and the prescription pill-like high makes heroin appealing to some. Bill Patrianakos was hooked on Oxycontin, but when he could not afford it he moved to heroin. He said it gave him the same high for a fraction of the cost. The police in Delray Beach, Fla., said they seized more heroin in the first two weeks in January than they did in the past 10 years combined. Authorities reported that, between 2008 and 2012, the amount of heroin seized each year at the southwest border more than tripled.

Read more:
http://www.cnn.com/2014/02/02/us/heroin-use-rising/

2,500 Community Leaders Renew Commitment to Preventing Youth Substance Abuse at CADCA's National Leadership Forum
Community Anti-Drug Coalitions of America
February 6, 2014

This article discusses the Community Anti-Drug Coalitions of America's (CADCA's) 24th National Leadership Forum held recently in Washington, D.C. More than 2,500 community leaders representing almost every state and U.S. territory learned new strategies to address local drug-related issues and renewed their commitment to preventing teen drug use. The conference started with the SAMHSA Prevention Day. This one-day event provided an array of course offerings that focused on strengthening behavioral health and public health for the next decade, with particular emphasis on prescription drug misuse and abuse prevention and on underage drinking prevention.

Read more:
http://www.cadca.org/resources/detail/2500-community-leaders-renew-commitment-
preventing-youth-substance-abuse-cadca percentE2 percent80 percent99s-na


Keeping Children Safe around Pills and Medications
Eagle–Tribune
February 7, 2014

This article discusses ways to keep children safe around prescription drugs. It focuses on storage and disposal.

Read more:
http://www.eagletribune.com/local/x1262669494/Keeping-children-safe-around-pills-and-medications

Organizations Commit to Fighting Prescription Abuse
Health Data Management
February 5, 2014

Thirteen organizations agreed to collaborate on addressing ways to combat prescription drug abuse and help practitioners comply with legal responsibilities for prescribing, dispensing, and distributing controlled substances. The organizations pledged to create two educational documents for industrywide use. The first will identify circumstances or red flags that should initiate actions to ensure legitimacy of a controlled substance prescription. The second will offer guidance on how to engage in and improve dialog and collaboration among stakeholders to address red flags, with the hope of eliminating confusion caused by current proprietary policies. The organizations include the American Academy of Family Physicians, the American Medical Association, the American Osteopathic Association, Cardinal Health, CVS Caremark, the Federation of State Medical Boards, the National Association of Boards of Pharmacy, the National Association of Chain Drug Stores, the National Community Pharmacists Association, the Pharmaceutical Care Management Association, the Pharmaceutical Research and Manufacturers of America, Rite Aid, and Walgreen Company.

Read more:
http://www.healthdatamanagement.com/news/organizations-commit-to-fight-prescription-
abuse-47209-1.html

http://www.nabp.net/system/rich/rich_files/rich_files/000/000/209/original/consensus-
document.pdf


Two Dozen Charged in $500 Million New York Pain Pill Scheme
MSN
February 5, 2014

Federal officials charged 24 people with conspiracy to distribute and possession with intent to distribute narcotics. A doctor, Robert Terdiman, was indicted separately in New York state court for conspiracy and criminal narcotic sales for writing eight oxycodone prescriptions to undercover officers during the investigation. The massive scheme flooded New York City's black market with as much as $500 million in pain relievers. The operation was based at a clinic operating under the name Astramed in the Bronx. The clinic sold phony prescriptions to drug dealers, who bought 5.5 million oxycodone pills at pharmacies around the city and as far away as Florida. Astramed's owner collected nearly $12 million in exchange for fake doctors' visits made by phony patients sent in by drug dealers between January 2011 and January 2014. He conducted no physical examination and prescribed oxycodone, no matter what response the officers gave to his cursory questions. Doctors at Astramed wrote more than 31,500 prescriptions for oxycodone to high-level drug traffickers, who paid the clinic's employees up to $300.00 for each phony patient's appointment. Some pharmacies in New York refused to fill prescriptions written by Terdiman, but out-of-state pharmacies filled 20 percent of them.

Read more:
http://news.msn.com/crime-justice/two-dozen-charged-in-dollar500-million-new-york-pain-pill-scheme

Hoffman Found With 50 Bags of Heroin, Addiction Meds: Sources
NBC News
February 3, 2014

This article and video (1 minutes, 39 seconds) discuss the apparent overdose death of actor Philip Seymour Hoffman. Police found 49 full bags of heroin, 23 empty bags of heroin, four bags of what appeared to be cocaine, and 6 bottles of prescription drugs, including blood pressure medication clonidine hydrochloride, the addiction treatment drug buprenorphine, the attention-deficit disorder treatment drug vyvanse, the antianxiety drug hydroxyzine, and the muscle relaxer methocarbamol. Last year, Hoffman told TMZ, celebrity gossip and entertainment news, that he had begun using prescription medicines and his use escalated to heroin.

Read more:
http://usnews.nbcnews.com/_news/2014/02/03/22557861-hoffman-found-with-50-bags-of-
heroin-addiction-meds-sources?lite
Related Article

Hoffman's Death Sheds Light on Opiate Addiction Epidemic
KARE 11
February 2, 2014

This article and video (2 minutes, 20 seconds) discuss how the apparent overdose death of actor Philip Seymour Hoffman sheds light on prescription drug abuse in the United States. Dr. Joseph Lee, medical director of Hazelden's youth facility in Minnesota, says the problem is that prescription pain medication that is found in neighborhood homes and medicine cabinets. Heroin is usually the end stage of a prescription drug problem.

Read more:
http://www.kare11.com/story/news/2014/02/02/phillip-seymour-hoffman-overdose-heroin-hazelden-addiction-prescription-drugs-dr-joseph-lee/5173057/
Philip Seymour Hoffman Didn't Have to Die
Time
February 3, 2014

This article discusses three ways to prevent loved ones from becoming victims of an overdose: being an active witness, knowing the signs, and knowing about naloxone.

Read more:
http://healthland.time.com/2014/02/03/philip-seymour-hoffman-didnt-have-to-die/?iid=ent-main-mostpop2

Nearly Two Thirds of States Lack Rescue Drug and Good Samaritan Overdose Laws
PR Newswire
February 3, 2014

This press release lists states with Good Samaritan Laws that provide immunity from criminal charges or mitigation of sentencing for individuals seeking to help themselves or others experiencing an overdose. It also lists states with Rescue Drug Laws that expand access to and use of naloxone. Both lists were released in a report by Trust for America's Health in October.

Read more:
http://www.prnewswire.com/news-releases/nearly-two-thirds-of-states-lack-rescue-drug-and-good-samaritan-overdose-laws-243403701.html

Loaded Gun in the Medicine Cabinet
Times–News
February 5, 2014

This article discusses probable consequences and scenarios to consider when medications are no longer needed. It explains the importance of getting rid of unwanted, unused prescription drugs to prevent theft and abuse. The Henderson County, N.C., sheriff frequently speaks of the medicine cabinet as “a loaded gun” because 80 percent to 85 percent of crime in the United States is directly related to opioid abuse or methamphetamine. Economy Drugs and Whitley Drugs attaches the sheriff's Medication Collection Program brochure to each filled prescription. It has specific instructions on how to dispose of old or unwanted medications. North Carolina Printing Company has volunteered to print double-sided bright green paper strips to distribute throughout the county and attach to prescription bags at Economy and Whitley pharmacies. It gives information about the upcoming Community Kickoff for HopeRx, a local coalition that will prescription drug abuse and its prevention in the community.

Read more:
http://www.blueridgenow.com/article/20140205/articles/402051000?tc=ar#gsc.tab=0

Former Congressman's Son Sentenced to 12 Years for Selling Oxycodone to Young People
Washington Post
January 31, 2014

George Washington Crane V, the son of a former Illinois congressman, was sentenced to 12 years in prison for selling oxycodone to high school students and graduates in Loudoun County, Va., including the overdose death of William Huff. An assistant U.S. attorney argued in court that Crane bore some responsibility for Huff's overdose and stated that he caused oxycodone addictions among a wide range of young people, including some who then turned to heroin. Prosecutors also charged John George, a friend of Huff's who gave him oxycodone pills hours before he overdosed. George pleaded guilty in April 2012 to conspiracy to distribute oxycodone and was later sentenced to four years in prison.

Read more:
http://www.washingtonpost.com/local/crime/former-congressmans-son-to-be-sentenced-
for-selling-oxycodone-to-young-people/2014/01/31/470f27c0-8930-11e3-a5bd-
844629433ba3_story.html


9 Investigates: The VA's Painkiller Problem
WSOC TV
February 4, 2014

This article and video (3 minutes, 10 seconds) discuss a news investigation into whether veterans are being overmedicated and what the Veterans Administration hospitals are doing about it. Veterans die from prescription drug overdoses at nearly twice the national average. Channel 9 talks to the parents of Specialist Christopher Pesta whose 22-year-old son's death was "complicated by mixed drug toxicity," according to the U.S. Army's autopsy report. Pesta's parents said he suffered from posttraumatic stress disorder and that he was getting treatment at the VA for alcohol abuse. They believe that alone should have kept the agency from prescribing him a list of opioids and muscle relaxers. Since Sept. 11, 2001, VA prescriptions for four addictive pain relievers have increased by 270 percent, and the overdose death rate for veterans is nearly double the general population. When reviewing numbers from the Salisbury (N.C.) VA, the reporter found that, between 2001 and 2012, prescriptions of pain relievers more than quadrupled, with 83.5 prescriptions for every 100 patients. The hospital's pain management specialist said that increase reflects the toll on troops fighting in Iraq and Afghanistan. Salisbury VA officials said the facility has made policy changes to monitor patients more closely. Higher doses of pain relievers now require secondary approval, and a pain school was created to teach veterans how to manage medications.

Read more:
http://www.wsoctv.com/news/news/special-reports/9-investigates-vas-painkiller-problem/ndBc9/

Other State and Local News

Mother Warns Heroin, Rx Use Prevalent Among OC Teens
CBS Los Angeles
February 3, 2014

An Orange County, Calif., mother is concerned that prescription pill addiction can easily turn into heroin dependency. She is warning others that prescription pills are a synthetic form of heroin. Roughly one person dies from a prescription overdose in Orange County each day, according to the coroner. Also, the coroner recorded 49 deaths from heroin in 2012.

Read more:
http://losangeles.cbslocal.com/2014/02/03/mother-warns-heroin-rx-use-prevalent-among-oc-teens/

California Widens Access to Naloxone, Drug That Can Reverse Heroin Overdose
CBS News
February 6, 2014

This article and video (1 minute, 39 seconds) discuss a new law in California that will allow anyone to get a prescription for naloxone. The law became effective Jan. 1.

Read more:
http://www.cbsnews.com/news/california-allows-public-to-ask-doctors-for-overdose-reversing-drug-naloxone/

Dog Will Be Trained to Detect Drugs, Guns at Fairfield High
Cincinnati.com
February 2, 2014

Fairfield Senior High School, Ohio, will be getting a female German shepherd trained to detect prescription and illegal drugs and gunpowder. She will become only the third dog in the country trained to detect prescription as well as illegal drugs. The German shepherd and the security monitor will begin work at the school in late March or early April. It will become the first team in Butler County to work full time in a school and only the second in the region.

Read more:
http://news.cincinnati.com/article/20140203/NEWS/302030017/Dog-will-trained-detect-drugs-guns-Fairfield-Senior-High-School?gcheck=1

Doc: My State in Addiction Stranglehold
CNN
February 6, 2014

Mark Publicker, an addiction medicine physician at Mercy Hospital Recovery Center and editor for ASAM Magazine, shares his views about the heroin epidemic plaguing Maine. He has seen Mainers transition from prescription pain medication to heroin; for three years, more have been seeking treatment solely for heroin addiction. He believes officials must respond by providing proven-effective treatment, combining Food and Drug Administration–approved stabilization medications with holistic rehabilitation.

Read more:
http://www.cnn.com/2014/02/06/opinion/publicker-maine-heroin/?hpt=he_c2

Colorado Ski Towns See Rise in Heroin Deaths and Abuse
Denver Post
February 4, 2014

Law enforcement and health authorities said that the increase in heroin use in Colorado has shown up in rural towns and mountain resorts. The Roaring Fork Valley in the past year has had three deaths from heroin overdoses. Two young men died within 10 days of each other last year in Durango. A man recently overdosed on New Year's Eve in Crested Butte, the second known overdose in a year. Two people were arrested for dealing heroin in Steamboat Springs last month. Four others were arrested, and a man died of an overdose there in the past year and a half. In Summit County, at least 3 inmates in a jail that holds 35 were detoxing from heroin use in recent months. In January, officers seized more than five pounds of heroin from a vehicle just after it entered the state west of Grand Junction. More than three pounds of heroin was seized in the same area in September. Steve Ayers, an emergency room physician at Aspen Valley Hospital, said the three overdose deaths in that valley in the past year and the four or five nonfatal overdoses he has seen in the same period may be linked to the same potency factor. He said prescription drugs are still the most common cause of overdoses in Aspen.

Read more:
http://www.denverpost.com/news/ci_25055825/colorado-ski-towns-see-rise-heroin-deaths-and

ICT Applauds House Study of Prescription Drug Abuse
Insurance Council of Texas
February 4, 2014

This media release discusses the Insurance Council of Texas and the Texas Association on Business support for the Texas House of Representatives speaker's efforts to address prescription drug abuse. On Jan. 31, the House speaker directed the House Committee on Public Health to study the prevalence of nonmedical health impacts resulting from prescription drug abuse and recommend strategies to curb emerging substance abuse trends among Texans. The Texas Association of Business, which formed the Coalition for Responsible Prescription Drug Use before the 2013 legislative session, said drug abuse among the state's workforce poses many potential problems.

Read more:
http://www.insurancecouncil.org/docs/public/news/2014/feb042014.pdf

Monitoring Prescription Drugs
Keloland TV
February 4, 2014

This article and video (1 minute, 36 seconds) discuss South Dakota's efforts to address the increase in prescription drug abuse by using the prescription drug monitoring program. Through the program, doctors and pharmacists can check out how often a doctor prescribes a person a controlled substance. It also shows if a patient has been going from doctor to doctor getting prescription drugs. Only 25 percent of South Dakota prescribers are enrolled, along with 60 percent of the state's pharmacists. Dr. Dan Heinemann, a Sanford Clinic chief medical officer, encourages all doctors to use the database.

Read more:
http://www.keloland.com/newsdetail.cfm/monitoring-prescription-drugs/?id=159708

Heroin Overdose Deaths on the Rise in Clark County
KLAS–TV
February 4, 2014

This article and video (2 minutes, 42 seconds) discuss the increase in heroin use fueled by prescription drug abuse. An 8 News Now analysis reveals heroin overdoses in Clark County, Nev., have increased 44 percent in the past three years. Heroin overdose deaths increased from 32 in 2011 to 44 in 2012 and to 46 in 2013. Two people have already died in 2014. People addicted to prescription drugs get hooked and then turn to heroin. A recent study found Nevada has the fourth-highest drug overdose mortality rate in the United States.

Read more:
http://www.8newsnow.com/story/24635602/heroin-overdose-deaths-on-the-rise-in-clark-county

Heroin Deaths on the Rise in Los Angeles County After Dipping in Recent Years
KPCC
February 6, 2014

Law enforcement and health officials say heroin-related deaths are on the rise in Los Angeles County, Calif., after a decrease in 2012. Officials say the heroin problem is not as serious as the problem of prescription drug abuse. Various Southern California counties have experienced different rates of change, but health officials across the board are concerned because many addicts who abuse pharmaceutical drugs graduate to heroin. In Los Angeles County, there were 225 heroin deaths in 2010, just 29 in 2012, but 46 in 2013, according to the County Coroner's Office. Both Orange and Riverside Counties have seen a decrease in heroin deaths in recent years, but an increase in prescription drug-related hospital visits and deaths.

Read more:
http://www.scpr.org/news/2014/02/06/42019/heroin-deaths-on-the-rise-in-socal-after-dipping-i/

Poll: Problems With Heroin Use Increasing, Especially in Northern Kentucky
Lane Report
February 6, 2014

The Kentucky Health Issues Poll (KHIP) revealed that the problems surrounding heroin use are increasing, especially in northern Kentucky, while misuse of prescription pain relievers may be decreasing. Some of the KHIP highlights include one third (30 percent) of adults in northern Kentucky report knowing a family member or friend who has had problems as a result of using heroin; statewide only 9 percent report knowing a family member or friend who has had problems as a result of using heroin; and in the 18–29 age group 39 percent have had family members or friends experience problems because of misusing prescription pain relievers; 26 percent reported problems from methamphetamine, and 15 percent from heroin. A random sample of 1,551 Kentucky adults were interviewed by telephone in late 2013. The poll has a margin of error of ±2.5 percent.

Read more:
http://www.lanereport.com/29351/2014/02/poll-problems-with-heroin-use-increasing-especially-in-northern-kentucky/

Task Force: Tackling Drug Abuse in Region a Group Effort
Lowell Sun
February 4, 2014

Thus far this year, Middlesex County, Mass., has 11 drug-related deaths. The Lowell health director said that, in many cases, the trouble starts with medicine cabinets at home. The Lowell Opiate Task Force recently discussed how best to deal with drug problems. The task force was formed about a year ago as a way for various agencies and experts to share their knowledge and collaboratively work on drug problems in the Greater Lowell region. The number of opioid-related deaths in Lowell has fluctuated from 17 in 2008 to 27 in 2009, to 19 in 2010, to 34 in 2011. For 2012, 21 deaths were confirmed as opioid related, but another 16 death cases still pending could turn out to be drug related. Seventy-four percent of opioid-related deaths in the city, since 2003, were males. In Middlesex County, an estimated 80 drug-related deaths occurred in 2013, including 33 that were attributed to heroin, up from 65 drug-related deaths in 2012 including 20 attributed to heroin. Lowell District Court will open a drug court in April to help increase access to treatment programs for those who need them.

Read more:
http://www.lowellsun.com/news/ci_25057337/task-force-tackling-drug-abuse-region-group-effort

Maine Governor Cites 'Troubling Epidemic' of Addicted Babies
New York Times
February 5, 2014

Maine's governor devoted part of his "state of the state" address to babies born to drug-addicted mothers. He said that 927 drug-addicted babies were born in 2013, more than 7 percent of all births in the state last year. The governor called the births a "troubling epidemic." When the governor discussed drug addiction, he emphasized expanding law enforcement and judicial response. He called on lawmakers to expand Maine's judicial branch by adding four special drug prosecutors and four judges to sit in enhanced courts in Bangor, Lewiston, Portland, and Presque Isle. He also called for adding 14 agents to the Maine Drug Enforcement Agency.

Read more:
http://www.nytimes.com/2014/02/06/us/maine-state-of-the-state-addicted-babies.html?_r=2

Heroin Deaths Spur Action to Cut Abuse of Prescription Pills
Pocono Record
February 7, 2014

Recently, a Pennsylvania state representative announced he wants the state Legislature to convene a special task force to address prescription opiates. The task force would look at all laws relating to prescribing and dispensing opiates. After one year, they would deliver a report with recommendations to the Legislature. The expansion of PENNscript, the state program tracking the prescription of Schedule 2 narcotics, is already under way. A bill has been introduced to give its information to doctors and pharmacists so they can identify people who have been "shopping" for prescriptions. Twenty-two people died from a fatal heroin overdose in less than two weeks in western Pennsylvania. In Monroe County, 40 people have died of opiate-related overdoses since 2011. Nearly 50 percent were between 16 and 40 years old, and 75 percent were male.

Read more:
http://www.poconorecord.com/apps/pbcs.dll/article?AID=/20140207/NEWS/402070355

McConnell Proposes Law Targeting Prescription Drug Trafficking
Post and Courier
February 6, 2014

South Carolina's lieutenant government proposed legislation recently making it a crime to possess prescription drugs illegally and imposing tough penalties for prescription drug trafficking. He said a new law will provide clarity for law enforcement officials. The bill would impose penalties based on the number of pills. The measure calls for a minimum of 15 years in prison and a fine of $200,000 or more for anyone convicted of illegally having 600 or more prescription pills. The law also would make having multiple prescriptions for the same drug evidence of that person's intent to sell those drugs.

Read more:
http://www.postandcourier.com/article/20140206/PC1610/140209588/1031/mcconnell-proposes-tougher-prescription-drug-laws

Governor Cuomo Announces Progress on State's Efforts to Crack Down on Prescription Drug Abuse
State of New York
February 3, 2014

In this press release, New York's governor announced the successful implementation of the Internet System for Tracking Over-Prescribing Act (I–STOP) and other portions of the Prescription Drug Reform law. Since August 2013, more than 66,000 health care professionals have run more than 7 million individual prescription checks on nearly 3 million separate patients; by comparison, the state's older prescription monitoring program was used by only some 5,000 practitioners who checked fewer than 500,000 patients over a three-and-a-half-year period. The number of individuals engaged in doctor shopping decreased by 74.9 percent, when comparing the fourth quarter of 2013 with the fourth quarter of 2012. Prescriptions for hydrocodone decreased 19.6 percent during the second half of 2013, compared with the same period of 2012. This law also created a safe disposal program regarding prescription drugs. The New York State Department of Health has established a permanent medication drop box program throughout the state, county, and local law enforcement agencies.

Read more:
https://www.governor.ny.gov/press/02032014-crack-down-on-prescription-drug-abuse

Prescription Monitoring Program Changes Ahead
Virginia Medical Society
January 31, 2014

Physicians will be automatically enrolled in the Virginia Prescription Monitoring Program (PMP) under legislation moving through the General Assembly. The automatic enrollment will take effect when the physicians renew their licenses in 2016 or if they obtain their initial Virginia license after July 1, 2015. The Medical Society of Virginia (MSV) has worked closely with the bill patrons on the proposed language. Language in House Bill 1294, which is expected to be adapted into Senate Bill 294, currently stipulates that when a prescriber initiates a new course of treatment anticipated to last more than 90 consecutive days that includes prescribing benzodiazepine or an opiate—and for which the prescriber and the patient have entered into a treatment agreement—the PMP should be consulted to determine what, if any, other covered substances are currently prescribed to the patient. In addition, any prescriber who holds a special identification number from the Drug Enforcement Administration authorizing the prescribing of controlled substances for opioid addiction therapy shall, before or as a part of execution of a treatment agreement with the patient, request information from the PMP for the purpose of determining what, if any, other covered substances the patient is currently being prescribed. The legislation also includes a provision to allow the Health and Human Resources secretary to identify and publish a list of benzodiazepines or opiates that have a low potential for abuse by human patients. Prescribers who prescribe such identified benzodiazepines or opiates shall not be required to meet the provisions outlined above. MSV also worked to secure an exemption for prescribers if the course of treatment arises from pain management relating to dialysis or cancer treatments.

Read more:
http://www.msv.org/MainMenuCategories/MemberCenter/PressRoom/News/2014-Archives/Prescription-Monitoring-Program-changes--.aspx

Senate Plan Targets Drug Abuse Among Women
WISH–TV
February 5, 2014

The Indiana Senate voted unanimously to approve a measure aimed at curbing drug abuse among pregnant women. The measure would require hospitals to report cases of neonatal abstinence syndrome to the state's health department. The measure will now be considered by the House.

Read more:
http://wishtv.com/2014/02/05/senate-plan-targets-drug-abuse-among-women/

2,600 Florida Drug Cases Under Review, Law Enforcement Department Chemist Suspected of Theft
WUSF
February 2, 2014

The Florida Department of Law Enforcement (FDLE) announced it is investigating 2,600 cases handled by a Pensacola-based agency chemist after discovering dozens of instances in which prescription pain pills that were seized by police and tested as evidence were swapped with over-the-counter pills. The FDLE commissioner said the chemist handled cases involving 80 law enforcement agencies from 35 counties since he was hired in 2006. Most of the cases involved testing drug evidence. This potentially means drug charges will have to be dropped and prisoners released, should it be determined the chemist tampered with evidence. Authorities don't know whether the chemist is a user or a trafficker. He is not cooperating with the investigation. The department is reviewing its drug testing program to try to prevent similar incidents. One idea may be to increase employee drug testing. Employees are drug tested only when they are hired or there is cause to suspect they are abusing drugs.

Read more:
http://wusfnews.wusf.usf.edu/post/2600-fl-drug-cases-under-review-fdle-chemist-suspected-theft

Audio

Spike in Heroin Use Can Be Traced to Prescription Pads
NPR
February 4, 2014

This article and audio (2 minutes, 50 seconds) discuss heroin use and prescription drug abuse in the United States. Heroin deaths increased 45 percent over the last four to five years, said Drug Enforcement Administration spokesman Joseph Moses. Heroin is cheaper than buying prescription pain medication, and easier to access. Experts said the heroin problem can be traced to the aggressive prescribing of opioid drugs for pain about 15 years ago. Andrew Kolodny, chief medical officer for the Phoenix House Foundation and president of Physicians for Responsible Opioid Prescribing, said to get the heroin epidemic under control, doctors and dentists have to prescribe opioids more cautiously; those already addicted to heroin and prescription pain relievers, he added, need to find treatment.

Listen:
http://www.npr.org/2014/02/04/271591524/spike-in-heroin-use-can-be-traced-to-prescription-pads

Video

On Campus: The Increasing Prevalence of Drugs
Huffington Post
February 5, 2014

HuffPost Live speaks with students about the drug culture on college campuses. As prescription drugs become harder to obtain, more dangerous substances, like heroin, are on the rise.
[Duration: 24 minutes, 15 seconds]

Watch:
http://live.huffingtonpost.com/#r/segment/on-campus-the-increasing-prevalence-of-drugs/52efebbf02a7601d04000720

Grant Announcements

Research to Prevent Prescription Drug Overdoses
Centers for Disease Control and Prevention, Department of Health and Human Services
Letter of Intent Deadline: February 14, 2014
Proposal Deadline: 5:00 p.m. (EST), March 19, 2014
http://www.grants.gov/search-grants.html?agencies percent3DHHS percent7CDepartment percent20of percent20Health percent20and percent20Human percent20Services

Research on Integration of Injury Prevention in Health Systems
Centers for Disease Control and Prevention, Department of Health and Human Services
Letter of Intent Deadline: February 14, 2014
Proposal Deadline: 5:00 p.m. (EST), March 19, 2014
http://www.grants.gov/search-grants.html?agencies percent3DHHS percent7CDepartment percent20of percent20Health percent20and percent20Human percent20Services

2014 Drug-Free Communities Support Program Grants
White House Office of National Drug Control Policy and Substance Abuse and Mental Health Services Administration
Deadline: March 24, 2014
http://www.whitehouse.gov/ondcp/Drug-Free-Communities-Support-Program
http://www.whitehouse.gov/sites/default/files/ondcp/grants-content/dfc_rfa_to_csap_1-23-14.pdf

Take-Back Events and Drop Boxes

National Take-Back Initiative
Drug Enforcement Administration
10:00 a.m. to 2:00 p.m.
Saturday, April 26, 2014
http://www.deadiversion.usdoj.gov/drug_disposal/takeback/index.html

Conway, S.C., Police Department Collects Unused, Expired Prescription Drugs
WMBF
February 6, 2014
http://www.wmbfnews.com/story/24654809/conway-pd-collects-thousands-of-unused-expired-prescription-drugs

Greenville, Ohio, Drug Drop Box Removes Unused Medications
Daily Advocate
February 7, 2014
http://dailyadvocate.com/news/home_top-news/3558990/Greenville-drug-drop-box-removes-unused-medications

Prescription Drop Boxes Collected 15 Tons of Painkillers in 2013
Star–Tribune
February 6, 2014
http://www.startribune.com/local/south/244118801.html

Vallejo, Calif., Launches New Medication Disposal Program
Times–Herald
February 6, 2014
http://www.timesheraldonline.com/news/ci_25074671/vallejo-launches-new-medication-disposal-program

Irwin, Pa., Police Receive Drug Drop-Off Box
Trib Total Media
February 5, 2014
http://triblive.com/neighborhoods/yournorwin/yournorwinmore/5423176-74/drug-prescription-drugs#axzz2sYmEkl9e

Upcoming Conferences and Workshops

Collaborative Perspectives on Addiction: 'Changing Addictive Behavior: Bench to Bedside and Back Again'
February 28 to March 1, 2014
Atlanta, Georgia
http://www.apadivisions.org/addiction-perspectives.aspx

Pain Management Through a Wide Lens: Balancing Safety and Effectiveness
March 8, 2014
St. Louis, Missouri
http://aspmnstlouisregional.org/2014-conference-information-and-registration.html

Eleventh Annual World Health Care Congress
April 7–9, 2014
National Harbor, Maryland
http://www.globalmedicalmeetings.com/events/hr14000

National Rx Drug Abuse Summit
April 22–24, 2014
Atlanta, Georgia
http://nationalrxdrugabusesummit.org
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.


 

Forward email
 
This email was sent to hlinn2@hsc.wvu.edu by paw@dsgonline.com |
 

DSG, INC. | 7315 Wisconsin Avenue | Suite 800E | Bethesda | MD | 20814