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February 12, 2015


SAMHSA Prescription Drug Abuse Weekly Update
Issue 109  |  February 12, 2015
The Prevention of Prescription Drug Abuse in the Workplace (PAW) TA Center addresses prescription drug abuse—a growing public health problem with increasing burdens on workers, workplaces, and our economy. To subscribe colleagues, family members, or friends to this listserv sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), please click here or send their e-mail addresses to paw@dsgonline.com.
Table of Content Featured Article Journal Articles and Reports Professional Education National News International News Northeast/Mid-Atlantic News South News Midwest News West News Other Resources Audio Grant Announcements Take-Back Events and Drop Boxes Upcoming Conferences and Workshops


Federal Government Set to Crack Down on Drug Courts That Fail Addicts
Ryan Grim and Jason Cherkis, The Huffington Post
February 5, 2015

The federal government is cracking down on drug courts that refuse to let opioid addicts access Suboxone (buprenorphine). Drug courts that receive federal funding will no longer be allowed to ban medication-assisted treatments. A spokesman for the Office of National Drug Control Policy said future drug court grantees will be required to allow access to medications such as Suboxone and forbidden to force defendants to wean off the medication as a condition of participating in court programs. (Includes video: 13:30 minutes)

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Journal Articles and Reports

M. Blom Nilsson, D. Chassler, and L.M. Lundgren. 2015. "Factors Associated with Work and Taking Prescribed Methadone or Buprenorphine Among Swedish Opiate Addicts." Evaluation and Program Planning, doi:10.1016/j.evalprogplan.2014.12.015.

Logistic regression analysis of 2002–08 Swedish national register data on opiate addicts (n = 2,638) showed odds of being employed and taking prescription methadone or buprenorphine for at least one year were higher for men (odds ratio [OR] = 2.0), people with more education (OR = 1.07 per year of education), and people with children (OR = 7.1), as well as those who had inpatient drug treatment episodes (OR = 1.05 per episode), been charged with a crime (OR = 3.2), and used psychiatric medications (OR = 8.4).

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M. Geier and J.J. Gasper. 2015. "Naloxone Prescribing by Psychiatric Clinical Pharmacists for Patients Receiving Opioid Agonist Treatment." Mental Health Clinician—Examining the Impact of the Psychiatric Pharmacist 5(1):46–49, doi:10.9740/mhc.2015.01.046.

Over 17 months, a San Francisco Department of Public Health treatment program that provided buprenorphine or methadone to 200 patients with opioid use disorders dispensed 47 intranasal naloxone kits. Patients reported three successful overdose reversals with the kits.

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K.S. Kendler, H. Ohlsson, H.H. Maes, K. Sundquist, P. Lichtenstein, and J. Sundquist. 2015. "A Population-Based Swedish Twin and Sibling Study of Cannabis, Stimulant, and Sedative Abuse in Men." Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2015.01.016.

Analysis of national Swedish registers on male identical (1,720 pairs) and fraternal (1,219 pairs) twins and near-age male full siblings (76,457 pairs) showed susceptibility to drug abuse was highly heritable, but also influenced by shared environment. Estimated heritability for cannabis, stimulant, and sedative abuse ranged from 64 percent to 70 percent. Between 75 percent and 90 percent of that genetic risk was non-specific, with the remainder deriving from substance-specific genetic risk factors. By contrast, none of the shared environmental effects, which accounted for 18 to 20 percent of the variance in liability, were substance specific.

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M.D. Stein, D.S. Hermana, E. Moitra, J. Hecht, R. Lopez, B.J. Anderson, and R.A. Brown. 2015. "A Preliminary Randomized Controlled Trial of a Distress Tolerance Treatment for Opioid Dependent Persons Initiating Buprenorphine." Drug and Alcohol Dependence 147(1):243–50.

Nicotine cessation research has shown that quit rates are affected by the ability to tolerate physical and psychological distress, and that supportive coaching can increase distress tolerance. A pilot randomized controlled trial with 49 adults seeking outpatient treatment for opioid dependence in Providence, R.I., assessed if a distress-tolerance intervention during buprenorphine initiation decreased opioid relapse. Participants received buprenorphine–naloxone induction and 3 months of maintenance buprenorphine, plus seven, 50-minute manualized, individual sessions (distress tolerance vs. health education control) over a 28-day period, linked to clinician medication dosing visits. The first two sessions were 2 days prior to and just before buprenorphine induction. Those randomized to distress tolerance had lower rates of opioid use at all three monthly assessments. At 3 months, 72 percent of health education participants were opioid positive, compared with 62 percent of distress tolerance participants. One fourth of patients dropped out of each arm.

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N.A. West, S.G. Severtson, J.L. Green, and R.C. Dart. 2015. "Trends in Abuse and Misuse of Prescription Opioids Among Older Adults." Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2015.01.027.

Researchers compared trends in prescription opioid misuse and associated fatal outcomes between adults 60 and older and adults 20 to 59. They analyzed 184,136 opioid cases and 1,149 deaths reported by U.S. poison centers to the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS®) System between 2006–Q1 and 2013–Q4. Although prescription opioid misuse and abuse rates were lower for older than for younger adults, the mortality rate among older adults rose over time and exceeded the younger adult rate in 2012 and 2013. Mortality rates among younger adults rose, then fell during the period. Subanalysis revealed an increasing linear trend in suicidal acts among older adults, while suicidal acts increased, then decreased among younger adults.

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Professional Education

D.S. Aschenbrenner. 2015. "Extended-Release Opioid Returns to Market." American Journal of Nursing 115(2):20–21, doi:10.1097/01.NAJ.0000460683.43060.88.

Embeda (a combination of morphine and naltrexone) is an extended-release opioid analgesic used around the clock to treat severe, chronic pain. New labeling describes features that make the drug less likely to be abused. Naltrexone's particles are kept separate from those of morphine. The opioid antagonist is released only if the pellets containing naltrexone are crushed or dissolved. The drug must be swallowed whole to prevent naltrexone's release.

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M.D. Garasic and A. Lavazza. 2015. "Performance Enhancement in the Workplace: Why and When Healthy Individuals Should Disclose Their Reliance on Pharmaceutical Cognitive Enhancers." Frontier System Neuroscience, doi:10.3389/fnsys.2015.00013.

This conceptual paper underlined the tension between the bio-liberal motto "the use of pharmaceuticals cognitive enhancer is a freely eligible personal choice," and the practical context in which its "secret" or concealed implementation might lead to potential dysfunctional or dangerous interpersonal or social consequences.

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A. Kolodny, D.T. Courtwright, C.S. Hwang, P. Kreiner, J.L. Eadie, T.W. Clark, and G. Caleb Alexander. 2015. "The Prescription Opioid and Heroin Crisis: A Public Health Approach to an Epidemic of Addiction." Annual Review of Public Health, doi:10.1146/annurev-publhealth-031914-122957.

The authors describe the scope of prescription opioid and heroin abuse, the historical context, contributing factors, and lines of evidence indicating the role of addiction in exacerbating morbidity and mortality. They provide a framework for interventions addressing the opioid addiction epidemic.

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L.J. Maier and M.P. Schaub. 2015. "The Use of Prescription Drugs and Drugs of Abuse for Neuroenhancement in Europe." European Psychologist, doi:10.1027/1016-9040/a000228.

This paper reviewed recent research on pharmacological neuroenhancement in Europe, defined the substances used, and advised physicians on responding to requests for neuroenhancement drug prescriptions.

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D.P. Wermeling. 2015. "Review of Naloxone Safety for Opioid Overdose: Practical Considerations for New Technology and Expanded Public Access." Therapeutic Advances in Drug Safety 6(1):20–31, doi:10.1177/2042098614564776.

Naloxone has a long history of safe and effective use by organized healthcare systems and providers to treat opioid overdose, and by emergency medicine technicians, emergency medicine physicians, and anesthesiologists. The drug's safety in prehospital settings administered by non-healthcare professionals has not been formally established, but will likely parallel medically supervised experiences. Naloxone dose and route of administration can produce variable intensity of potential adverse reactions and opioid withdrawal symptoms. Intravenous administration and higher doses produce more adverse events and severe withdrawal symptoms in opioid-dependent individuals. More serious adverse reactions after naloxone administration rarely occur, and may be confounded by the effects of other co-intoxicants and prolonged hypoxia. One component of the new opioid harm-reduction initiative is to expand naloxone access to high-risk individuals (addicts, abusers, and patients taking high-dose or extended-release opioids for pain) and their close family or household contacts. These individuals receive a prescription to carry the medication for use during an emergency. Contacts are trained in overdose recognition, rescue breathing, and naloxone administration by intramuscular injection or nasal spray before emergency medical personnel arrive.

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National News

Budget Seeks to Address Prescription Drug Abuse
Elise Viebeck, The Hill
February 2, 2015

The White House's 2016 budget proposal focuses on prescription drug abuse and measures designed to decrease opioid overdose. It would ramp up funding for programs at the Centers for Disease Control and Prevention, Substance Abuse and Mental Health Services Administration, and other agencies. The administration also proposes increased funding for states to expand prescription drug monitoring programs and support naloxone use by first responders.

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A Year of Significant Progress in Public Health
Margaret A. Hamburg, M.D., United States Food and Drug Administration
February 4, 2015

Food and Drug Administration (FDA) Commissioner Margaret A. Hamburg highlighted some of the agency's 2014 accomplishments. The FDA approved abuse-deterrent labeling for three opioid products designed to hinder prescription drug abuse. It also approved a new dosage form of naloxone, with an auto-injector.

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Rogue Internet Drug Seller Activity Highlights Need for .Pharmacy Domain Public Health Initiative
PR Newswire
January 30, 2015

The National Association of Boards of Pharmacy® January 2015 report highlights the need for a Pharmacy Top-Level Domain program to help consumers distinguish legitimate online pharmacies from rogue online drug sellers. More than 62 percent of "Not Recommended" sites don't post a physical address. Such sites are the most likely to dispense counterfeit drugs. Of 10,521 Not Recommended sites, 91 percent are affiliated with rogue networks of Internet drug outlets. Twelve percent claim they dispense controlled substances.

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International News

Government of Canada Reveals New Research on Tobacco, Alcohol, and Drug Use
February 3, 2015

The 2013 Canadian Tobacco, Alcohol, and Drugs Survey interviewed more than 14,500 Canadians ages 15 and older. Twenty-two percent reported using a psychoactive pharmaceutical in the past year. Among these users, only 2 percent said they abused the drug. Reported abuse rates were higher for youth and young adults than for adults 25 and older.

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Northeast/Mid-Atlantic News

Christie Signs Bill to Address Growing Heroin, Prescription Drug Epidemic
John Reitmeyer, The Record
February 5, 2015

New Jersey Gov. Chris Christie signed into law three bills that will help the state reduce heroin and prescription drug abuse. The bills provide immunity to emergency responders and needle-exchange program employees who administer overdose antidotes; require the state's Division of Mental Health and Addiction Services to prepare an annual report detailing the performance of treatment providers; and mandate mental health and substance abuse treatment programs for inmates in state-run or contracted facilities.

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Fentanyl: NH's 'Huge Problem'
Angeljean Chiaramida, The Daily News
February 2, 2015

Of 280 New Hampshire deaths attributed to drug abuse in 2014, fentanyl surpassed heroin as the drug component most often seen in overdoses. In 102 cases, fentanyl contributed to the death—solely or in combination with heroin and other drugs. In 82 cases, heroin was listed as a drug that contributed to the death.

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Jail Contraband Spotlights Maine's Opiate Epidemic
David Chams, WMTW
February 3, 2015

Maine addicts are smuggling drugs into correctional facilities. In 2014, the Department of Corrections seized hundreds of pieces of contraband, including 500 Suboxone strips, generic pills, and cell phones. At Two Bridges Regional Jail, investigators found contraband 22 times—from drugs sent in greeting cards to narcotics discovered in donated library books. Some letters mailed to inmates had a strip of Suboxone affixed to the stamp. In other cases, people swallowed a balloon full of pills in the parking lot to smuggle them inside. At Cumberland County Jail, 22 people were charged with trafficking contraband or drugs, most often Suboxone, followed by heroin and cocaine. (Includes video: 3:32 minutes)

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South News

Teen Drug Cases Down in Mobile County, Parent Drug Use Up
Tiffany McCall, WKRG
January 31, 2015

Juvenile Judge Edmond Naman said in the past 6 years, there has been a 38 percent decrease in Mobile County, Ala.'s, teen drug cases. Still, about 90 percent of children brought to court test positive for drugs. Many parents also test positive, often for prescription medications. (Includes video: 2:53 minutes)

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Free Clinics Now Stock Drug Overdose Antidote
Bill Moss, Hendersonville Lightning
January 30, 2015

The Free Clinics Community Pharmacy will begin dispensing naloxone. It is the only pharmacy in Henderson and Polk counties, N.C., with nasal spray kits for community members.

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Midwest News

Poll Reveals Kentuckians' Views on Heroin and Prescription Drug Misuse
February 5, 2015

The October 2014 Kentucky Health Issues Poll revealed heroin use is increasing in metropolitan areas across Kentucky, while prescription pain reliever misuse may be decreasing. Eleven percent reported that family or friends had experienced problems resulting from heroin—up from 9 percent in 2013. Twenty-four percent reported that family members or friends had experienced problems as a result of abusing prescription pain relievers—down from 32 percent in 2011. Eastern Kentucky has the highest percentage of adults (34 percent) who indicated family members or friends have experienced problems as a result of pain reliever abuse.

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AIA Supports Missouri Legislation to Enact Prescription Drug Monitoring Program
American Insurance Association
February 4, 2015

The American Insurance Association (AIA) testified in support of the Prescription Drug Monitoring Program Act (HB 130/SB 63) under consideration in the Missouri State Legislature. The bill would require reporting on all Schedule II, III, and IV controlled substances.

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St. Louis County Police: 'Heroin Is Killing Our Society'
Stephanie Lecci, St. Louis Public Radio
February 2, 2015

Detective Casey Lambert, leader of the new Saint Louis County Police heroin initiative, says their campaign will raise public awareness of heroin's dangers though presentations at public events, connecting people with resources, and a media campaign targeting high-risk people. (Includes audio: 4:06 minutes)

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Waukesha County Squads to Carry Heroin Overdose Drug Narcan
Ashley Luthern, Journal Sentinel
February 3, 2015

Last month, the Waukesha County Sheriff's Department in Wisconsin equipped its marked vehicles with naloxone kits.

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West News

Oklahoma Leaders Resurrect Efforts for 'Doctor Shopping' Measure
Warren Vieth, Oklahoma Watch
February 3, 2015

Governor Mary Fallin and lawmakers are endorsing proposed legislation that would require Oklahoma doctors to check the prescription drug monitoring program (PDMP) database when first prescribing opiate pain relievers or other frequently abused drugs, and at least once every 180 days after that. The legislation would exempt drugs prescribed at nursing homes, and contains a 5-year "sunset" provision. Veterinarians would be required to check the PDMP, and the Oklahoma Bureau of Narcotics and Dangerous Drugs would be required to forward a monthly list of the top 20 prescribers of controlled dangerous substances to licensing boards. The Oklahoma State Medical Association supports the legislation. A state House committee sent the measure to the House floor for debate and a vote.

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Wide Access to Naloxone Could Save Lives
Romany Redman, The Durango Herald
February 1, 2015

Colorado State Senator Irene Aguilar introduced legislation that would allow for "standing orders" of naloxone. A physician with prescribing authority could issue a written order permitting designated overdose-prevention programs to distribute naloxone to those at risk and potential bystanders. A community-based Denver program has saved 146 lives using the drug.

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How You Can Stop Prescription Drug Abuse
David Gonzales, The Arizona Republic
February 1, 2015

David P. Gonzales, U.S. marshal for the District of Arizona, said prescription drug abuse is the country's fastest-growing drug problem. The rate of emergency room cases in the state related to drug misuse or abuse more than doubled from 2005 to 2012. Gonzales recommended locking up medicine cabinets and talking to children about prescription medications. (Includes video: 2:49 minutes)

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Other Resources

Millennium Health Partners with the Mark Wahlberg Youth Foundation and Partnership for Drug-Free Kids to Launch 'Drop Them Off'
Millennium Health
February 3, 2015

Millennium Health announced the "Drop Them Off" campaign, in partnership with the Mark Wahlberg Youth Foundation and Partnership for Drug-Free Kids' Medicine Abuse Project. The campaign aims to educate teens and parents about the dangers of prescription medicine misuse and abuse, and how to properly use, store, and dispose of these medications.

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The Dangers of Sharing Medicine
Angela Hernandez, A Healthier Michigan
February 1, 2015

This article states three reasons why sharing medicine has dangerous consequences.

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Bill Proposes Expanded Access to Drug to Treat Overdoses
John Davis, WGCU
February 4, 2015

Florida lawmakers are considering a bill that would expand naloxone availability to friends and loved ones of those taking prescription opioids. Supporters cite the more than 2,000 accidental prescription overdose deaths in 2013. Opponents point to potential legal liability issues and argue the bill could encourage prescription drug abuse. John Davis, host of Gulf Coast Live, talks to guests about this topic. (Duration: 28:56 minutes)

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Grant Announcements

Comparison and Validation of Screening Tools for Substance Use Among Pregnant Women
Centers for Disease Control and Prevention
Deadline: February 24, 2015

Prescription Monitoring Program Script Collection
Illinois Department of Human Services
Bid Date and Time: February 25, 2015, 2 p.m.

Strategic Prevention Framework Partnerships for Success: State and Tribal Initiative
Substance Abuse and Mental Health Services Administration
Deadline: March 16, 2015

Drug-Free Communities Support Program
Substance Abuse and Mental Health Services Administration
Deadline: March 18, 2015

Translational Avant-Garde Award for Development of Medication to Treat Substance Use Disorders
National Institutes of Health
Deadline: April 15, 2015

Take-Back Events and Drop Boxes

Safe Way to Dispose of Medications Spreading in N.J.
Stephanie Loder, Press of Atlantic City (New Jersey)
February 3, 2015

State Attorney General Joins County, Little Egg Harbor in Prescription Drug Disposal Project
Pat Johnson, The Sandpaper (New Jersey)
February 5, 2015

Safe Medication Boxes Available at Cranford Community Center and Bell's Pharmacy
Cranford Chronicle (New Jersey)
February 4, 2015

Lyndhurst Installs Prescription Drug Drop Box in Police Department
New Jersey Media Group
February 4, 2015

Ontario County Honored for Drug 'Take-Back'
Julie Sherwood, Victor Post (New York)
February 3, 2015

How to Dispose of Unused Medication in East Lyme
Jaimie Cura, The Lymes Patch (Connecticut)
February 5, 2015

CCSO Continues Drug Takeback Program—for Now
Alana Cook, Lovely County Citizen (Arkansas)
February 4, 2015

Drop Box Considered for Wood River
Doug Jenkins, WBGZ Radio (Illinois)
February 3, 2015

Upcoming Conferences and Workshops

Collaborative Perspectives on Addiction 2015: 'Changing Landscapes of Addiction'
The Society of Addiction Psychology
March 6–7, 2015
Hotel Monaco Baltimore
2 North Charles Street
Baltimore, Maryland

This conference will explore frontiers in assessment and treatment of addiction, as well as the evolving nature of addiction within the broader context of societal and policy changes.

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Pharmacy Diversion Awareness Conferences
Drug Enforcement Administration, Office of Diversion Control
March 28–29, 2015: Birmingham, Ala.
May 30–31, 2015: Norfolk, Va.
June 27–28, 2015: Oklahoma City, Okla.

2015 AATOD Conference—Address a Public Health Crisis: Opioid Dependence
American Association for Treatment of Opioid Dependence, Inc. (AATOD)
March 28–April 1, 2015
Atlanta, Georgia

National Rx Drug Abuse Summit
April 6–9, 2015
Atlanta, Georgia

48th Annual Communicating Nursing Research Conference—Equity and Access: Nursing Research, Practice, and Education
Western Institute of Nursing
April 22–25, 2015
Albuquerque, New Mexico

Fourth Annual Generation Rx University Conference for Collegiate Prevention and Recovery
The Ohio State University College of Pharmacy
August 4–6, 2015
Columbus, Ohio

University of Michigan Injury Center Prescription Drug Overdose Summit
University of Michigan Injury Center
November 9, 2015
Ann Arbor, Michigan
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.