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February 19, 2014

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SAMHSA Prescription Drug Abuse Weekly Update
Issue 59  |  February 19, 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 Journal Articles and Reports News International News Other State and Local News Other Resources Audio Grant Announcements Grants Received Take-Back Events and Drop Boxes Save the Dates Upcoming Conferences and Workshops This week's listing is chockfull of notable studies. Two are featured here, and seven others are double-asterisked below.


Apply for a Free AMCC Rx Drop-Off Box
American Medicine Chest Challenge

The American Medicine Chest Challenge is offering a limited number of AMCC Permanent Rx Collection Boxes, without cost, to partners in communities across the country. If law enforcement organizations are interested in receiving an AMCC Permanent Collection Box, please contact AMCC. The organization is ready to assist in establishing or promoting a permanent Rx disposal location.

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Patients Suffering From Chronic Pain Should Question Certain Tests and Treatments
January 21, 2014

The American Society of Anesthesiologists (ASA) released its second list of five targeted, evidence-based recommendations that support conversations between patients and physician anesthesiologists about necessary care. The five recommendations are 1) don't prescribe opioid analgesics as first-line therapy to treat chronic noncancer pain; 2) don't prescribe opioid analgesics as long-term therapy to treat chronic noncancer pain until the risks are considered and discussed with the patient; 3) avoid imaging studies (MRI, CT, or X rays) for acute low-back pain without specific indications; 4) don't use intravenous sedation for diagnostic and therapeutic nerve blocks, or joint injections as a default practice for nonpediatric patients; and 5) avoid irreversible interventions for noncancer pain that carry significant costs and/or risks. The ASA Committee on Pain Medicine was charged with developing the "Choosing Wisely" list on pain medicine. Committee members submitted recommendations for the campaign and from this list voted on which should be included in the Choosing Wisely list. The literature was then searched to provide supporting evidence. Once approved by the committee, the Choosing Wisely list was reviewed by ASA's senior leadership groups. The American Pain Society has endorsed ASA's Choosing Wisely list on pain medicine.

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Journal Articles and Reports

Timothy E. Albertson. 2014. "Recreational Drugs of Abuse." Clinical Reviews in Allergy and Immunology 46(1):1–2, doi: 10.1007/s12016–013–8382–y.

The use of recreational drugs of abuse continues to expand without limitations to national boundaries, social status, race, or education. Beyond the prevalence of illicit drug use and of its dependence, their contribution to the global burden of disease and death is large and troubling. All medical providers should be aware of the evolving drugs of abuse and their medical and social consequences. In addition to heroin and stimulants, new designer stimulants called "bath salts" and cannabinoids called "spice"—along with the abuse of prescription drugs and volatile substances—are now widely recognized problems in many societies. This piece attempts to summarize six major classes of drugs of abuse and their clinical effects, with special emphasis on their immunological and respiratory effects.

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**Brian T. Bateman, Sonia Hernandez–Diaz, James P. Rathmell, John D. Seeger, Michael Doherty, Michael A. Fischer, and Krista F. Huybrechts. 2014. "Patterns of Opioid Utilization in Pregnancy in a Large Cohort of Commercial Insurance Beneficiaries in the United States." Anesthesiology, doi: 10.1097/ALN.0000000000000172

This study aimed to define the prevalence and patterns of opioid use in a large cohort of pregnant women who were commercial insurance beneficiaries. Data for the study were derived from a de-identified research database of women from across the United States who had both medical and prescription benefits. By using diagnostic codes, the authors defined a cohort of 534,500 women with completed pregnancies who were enrolled in a commercial insurance plan from six months before pregnancy through delivery. Overall, 76,742 women (14.4 percent) were dispensed an opioid at some point during pregnancy. There were 30,566 women (5.7 percent) dispensed an opioid during the first trimester, 30,434 women (5.7 percent) during the second trimester, and 34,906 women (6.5 percent) during the third trimester. Of these, 11,747 women (2.2 percent) were dispensed opioids three or more times during pregnancy. The most commonly dispensed opioids during pregnancy were hydrocodone (6.8 percent), codeine (6.1 percent), and oxycodone (2.0 percent). The prevalence of exposure at any time during pregnancy decreased slightly during the study period, from 14.9 percent for pregnancies that delivered in 2005 to 12.9 percent in 2011. The prevalence of exposure varied significantly by region and was lowest in the Northeast and highest in the South.

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Benedikt Fischer, Annette Keates, Gerhard Bühringer, Jens Reimer, and Jürgen Rehm. 2014. "Considering Prescription Opioid–Related Harms in the Population: Response to Commentaries." Addiction 109(2):186–88, doi:10.1111/add.12423.

The authors respond to three invited commentaries about their recent paper cover by Weekly Update in issue no. 56 (Jan. 29, 2014). They take no issue with the following points:
Paul Griffiths, Michael Evans–Brown, and Roumen Sedefov. 2014. "The (Mis)Use of Psychoactive Medicines: Getting the Right Balance in Complex Systems." Addiction 109:182–83. http://onlinelibrary.wiley.com/doi/10.1111/add.12306/abstract

Analyses of prescription opioid misuse environments and problems should treat the European Union as a heterogeneous entity with substantive interjurisdictional differences.

Jeffrey H. Samet and Judith I. Tsui. 2014. "Variations in Prescription Opioids and Related Harms: A Key to Understanding and Effective Policy." Addiction 109:183–85. http://onlinelibrary.wiley.com/doi/10.1111/add.12308/abstract

The lack of high-quality evidence about whether opioids are effective and safe for chronic pain creates a scenario ripe for practice heterogeneity.

Angela C. Rintoul and Malcolm Dobbin M. 2014. "Prescription Opioid Deaths: We Need to Treat Sick Populations, Not Just Sick Individuals." Addiction 109:185–86. http://onlinelibrary.wiley.com/doi/10.1111/add.12343/abstract

Little is known from a population health or social determinants perspective about prescription opioid use and related harms. Studies are needed that explore how sociodemographics, education, and socioeconomic status influence prescription abuse.

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Hayley A. Hamilton, Angela Boak, Gabriela Ilie, and Robert E. Mann. 2013. "Energy Drink Consumption and Associations With Demographic Characteristics, Drug Use, and Injury Among Adolescents." Canadian Journal of Public Health 104(7).

Researchers examined energy drink consumption and its association with demographic characteristics, drug use, and injury among adolescents. Data on 4,342 adolescents were derived from the 2011 Ontario Student Drug Use and Health Survey, a provincewide school-based survey of students in grades 7 through 12. Overall, 49.6 percent of adolescents had consumed energy drinks in the previous year. A total of 13.8 percent of seventh grade students had consumed energy drinks in the previous week, compared with 19.1 percent of adolescents overall. Energy drink consumption in the previous year was highly associated with having used tobacco and cannabis in the previous year, the nonmedicinal use of prescription drugs in the previous year, and binge drinking in the previous month. Consumption was also highly associated with sensation-seeking and self-reports of medical treatment for an injury (reported by 16 percent and 42 percent of adolescents, respectively). The odds of consuming energy drinks did not vary significantly for males and females, and sex was not a significant moderator of the associations examined.

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Mohammad Khatim Hasan and R. Mooney. 2014. "Opiate Drug Abuse: Discovering Problematic Patients in the Office and What to Do About It." West Virginia Medical Journal 110(1):34–39.

The researchers identified the risk factors and the maladaptive behaviors associated with opiate abuse and the protective factors against abuse. Age, family dynamics, and social and legal factors all play roles in abuse. For-profit clinics and some programs have made significant impacts on the use/misuse of prescription pain pills. Many refer to these clinics as legalized drug pushers. Research suggests condemnation of drug abuse by the family and society and stricter laws and higher penalties tend to deter abuse. This article discusses treatment options. Using injectable or implanted naltrexone has shown promising results; however, the costs have made treatment out of reach for most. The authors make recommendations to address the issues.

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**Lisa J. Merlo, Simone M. Cummings, and Linda B. Cottler. 2014. "Prescription Drug Diversion Among Substance-Impaired Pharmacists." American Journal on Addictions 23(2):123–28, doi: 10.1111/j.1521–0391.2013.12078.x.

This qualitative research study aimed to identify common mechanisms of prescription drug diversion by pharmacists, to facilitate the development of effective prevention programs and policies for this high-risk group. A total of 32 pharmacists (71 percent male) who were being monitored by their state professional health program because of substance-related impairment participated in anonymous guided group discussions. Participants documented six primary methods of drug diversion by pharmacists: 1) taking expired drugs that can no longer be sold by the pharmacy and are awaiting disposal, 2) assuming responsibility for managing the pharmacy inventory and/or changing inventory records to prevent detection of missing drugs, 3) forging prescriptions for themselves, family members, friends, or customers to gain access to the drugs, 4) using "sleight of hand" techniques to acquire drugs while filling prescriptions or shelving products, 5) blatantly stealing drugs from the pharmacy, even in front of coworkers or video cameras, and 6) collecting patients' unused medications and keeping them.

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Daniel J. Snipes, Brooke A. Green, Eric G. Benotsch, and Paul B. Perrin. 2014. "The Nonmedical Use of Prescription Drugs and Lifetime Experiences of Sexual Victimization Among College Men." Journal of Interpersonal Violence, doi: 10.1177/0886260513520229.

This study examined the associations between nonmedical use of prescription drugs, recreational drug use, and experiences of sexual victimization among college men. Undergraduate men (n=253) elected to take an online survey examining drug use and lifetime sexual victimization experiences. Seventeen percent of the sample reported instances of being sexually victimized in their lifetimes across four domains (being coerced, threatened, physically forced, or taken advantage of while incapacitated). Results indicate that, across all domains of sexual victimization, nonmedical sedative use was robustly associated with sexual victimization in a multivariate model controlling for recreational drug use and demographics. No other nonmedically used drug class (anxiolytics, pain medications, and stimulants) was associated with experiences of sexual victimization in the multivariate model. Results expand past literature by illustrating specific drug classes used by survivors of sexual victimization. Implications for interventions for male sexual victimization survivors are discussed.

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M.D. Stein, G.L. Bailey, P. Thurmond, N. Paull. 2014. "Looking for the Uninsured in Massachusetts? Check Opioid-Dependent Persons Seeking Detoxification." Drug and Alcohol Dependence, doi: 10.1016/j.drugalcdep.2013.12.016.

Researchers examined the rate of uninsurance among the narrow population seeking detoxification at a large drug treatment program in Massachusetts in 2013, five years after insurance mandates. They interviewed 340 opioid-dependent persons admitted for inpatient detoxification in Fall River, Mass. Potential predictors of self-reported insurance status included age, gender, ethnicity, employment, homelessness, years of education, current legal status, and self-perceived health status. Participants ' mean age was 32 years, 71 percent were male, and 87 percent were non-Hispanic white. Twenty-three percent were uninsured. In the multivariate model, the odds of being uninsured were positively associated with years of education (OR=1.22, 95 percent CI=1.03; 1.46, p<.05), higher among males than females (OR=2.63, 95 percent CI=1.33; 5.20, p<.01), and inversely associated with age (OR=0.94, 95 percent CI=0.90; 0.98, p<.01). Opioid-dependent persons recruited from a detoxification program in Massachusetts are uninsured at rates far above the state average.

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Julie Worley. 2014. "What Prescribers Can Learn From Doctor Shoppers." Journal for Nurse Practitioners 10(2):75–82, doi:10.1016/j.nurpra.2013.11.016.

The article provides information about tactics of people who engage in doctor shopping, the role of prescribers in this phenomenon, and recommendations for prescribers about how to prevent or reduce doctor shopping.

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**Maine's Governor Prepares to Restrict Access to Lifesaving Drug That Can Prevent Heroin Overdoses
February 12, 2014

Maine Gov. Paul LePage has approved a policy change to Maine's Medicaid program that cuts off coverage for substance abuse treatment after two years and has proposed budget cuts to substance abuse services. He also has consistently opposed efforts to broaden the use of naloxone. Soon, the state legislature will hold a hearing on a bill that would allow police officers, first responders, and the family members of people with opiate addiction to have access to naloxone. The governor's chief health policy adviser has already indicated that LePage will not support the measure. LePage believes naloxone will make the drug user or abuser feel invincible.

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**Dangerous Prescriptions Fell in Ohio in 2013, Reports Show
Columbus Dispatch
February 8, 2014

The Ohio Board of Pharmacy reported that more than 200,000 fewer patients were prescribed addictive drugs last year compared with 2010, according to the Ohio Automated Rx Reporting System. Last year, 326,111 Ohioans were red-flagged for being prescribed high levels of narcotic pain relievers. That was nearly a 41 percent drop from the 549,519 patients who received high doses in 2010. Physicians recently began receiving new Practice Insight Reports, which list their top 25 patients in terms of drugs prescribed, patients ranked by the amount of opiates prescribed, and the top 10 drugs they prescribe. The goal is to help make doctors, dentists, and clinicians more aware of the massive amount of narcotic painkillers prescribed and the consequences. Key to the new reports is the Morphine Equivalent Daily (MED) Dose. If that number is 80 milligrams or higher, which is the equivalent of 11 five-milligram oxycodone pills per day, it is a red flag that the patient could be at risk for overdose or developing a dangerous addiction to painkillers. The MED Dose represents what the patient is receiving from all medical sources.

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**Prescription Drugs Could Be Gateway to Heroin, Officials Say
NBC News
February 11, 2014

Federal officials said prescription drug abuse is worse in the United States than heroin use, and pain relievers could be a gateway drug for most heroin users. Opioid prescription pain relievers have the same effect on the brain and body as heroin does, causing physical addiction. Overdoses send victims into a coma, slowing heartbeat and breathing to the point of death. The White House is pressing state and local authorities to equip first responders with naloxone. Officials are also calling for more use of substance abuse treatments. Health insurance companies must now cover substance abuse treatment, under provisions of the 2010 Affordable Care Act.

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Two of America's Biggest Drug Problems Are Intertwined
Huffington Post
February 7, 2014

This article uses infographics to show the link between prescription drugs and heroin.

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Prescription Painkillers Seen as a Gateway to Heroin
New York Times
February 10, 2014

This article and video (4 minutes, 48 seconds) discuss prescription drug abuse and how it can lead to heroin use or death. Prescription pain relievers can act as an introduction to an opiate high, and the pills can set off heroin craving in recovering addicts. Throughout the country, heroin is much cheaper than prescription opiates and easier to access. Needle exchange programs and clinics now have overdose prevention courses, teaching users to notice danger signs and to administer naloxone.

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Drug Czar R. Gil Kerlikowske Calls for More Access to Heroin Antidote
Los Angeles Times
February 11, 2014

R. Gil Kerlikowske, the director of the White House Office of National Drug Control Policy, would like to see naloxone more widely available to emergency-care providers and other first responders. He also urged states and local communities to pass "Good Samaritan" laws to provide immunity from criminal prosecution to individuals who call for emergency help during an overdose. Seventeen states and the District of Columbia have laws that increase access to the drug. Some advocates are pushing to allow doctors to prescribe the substance not only to individuals with addictions but also to their relatives.

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The Heroin Epidemic and the Antidote for Overdose
February 10, 2014

This article and video (2 minutes, 9 seconds) discuss naloxone. New York Police Department officers on Staten Island carry naloxone nasal spray as part of a pilot program. Someone on Staten Island dies from an unintentional heroin overdose on average every five days. Officials across the country are pushing for first-line responders and emergency medical technicians to use the drug. As of 2010, naloxone had been distributed in 15 states and the District of Columbia. Naloxone distribution programs train potential overdose witnesses to correctly recognize an overdose and administer the drug. Since 2012, the Food and Drug Administration has discussed making naloxone for over-the-counter use in hopes of reducing overdose fatalities.

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It Is a Disease and Needs to Be Treated as Such
New York Times
February 11, 2014

This article features six debaters discussing what is addiction, what causes addiction, and is it a disorder, a matter of human frailty, or something else? Sharing their opinions are David Sack, a psychiatrist; Gene Heyman, a lecturer at Boston College; Carl L. Hart, an associate professor of psychology at Columbia University; Marc Lewis, a developmental neuroscientist at Radboud University; Lisa Miller, the director of clinical psychology and of the Spirituality Mind Body Institute at Columbia University's Teachers College; and Peg O'Connor, a professor of philosophy and gender, women and sexuality studies, at Gustavus Adolphus College.

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The Facts About Heroin
U.S. News and World Report
February 10, 2014
This article discusses how heroin affects the brain, how it kills, and what individuals need to know about the drug.

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Adderall Abuse Rising Among College Campuses
Beartooth NBC
February 11, 2014

This article and video (1 minute, 26 seconds) discuss Adderall abuse among college students. Students abuse the drug to help them focus for exams and to stay awake. The National Institute of Drug Abuse classifies Adderall as addictive and dangerous. Adderall is a combination of Dextrone Emphatmine salts that act as a stimulant. It can increase heart and blood pressure and cause a heart attack or stroke.

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Federal Budget Expands National Antidrug Strategy
Free Daily News Group
February 11, 2014

The Canadian government plans to invest $44.9 million to address prescription drug abuse among youth to expand its national antidrug strategy. It will educate Canadian consumers on the safe use, storage, and disposal of prescriptions drugs. The money will also enhance treatment and prevention of prescription drug abuse in First Nations Communities.

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Health Officials Monitoring Highly Addictive Drug Prescriptions
February 10, 2014

The Prince Edward Island (Canada) government is now monitoring a list of commonly prescribed drugs to identify instances of misuse and help curb prescription drug abuse. The monitoring and reporting of drugs under the Narcotics Safety and Awareness Act is part of the actions announced to address concerns of rising prescription drug abuse. The list of monitored drug prescriptions includes oxycodone, codeine, hydromorphone, morphine, and fentanyl.

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Sleeping Pills and Heavy Duty Painkillers to Be Added to Illicit Drugs List
Herald Sun
February 14, 2014

The National Rugby League (NRL) may become the first Australian sport to test for prescription drugs. This season, chemicals contained in sleeping pills and pain relievers will be included on the game's illicit substance list. If ratified at next month's Australian Rugby League Commission meeting, the proposal will ban prescription drugs and enable clubs to test for them in house. Suspensions would not be contemplated immediately; the NRL is more interested in measuring the depth of the problem. Integrity Unit boss Jim Doyle said talks were under way with the Rugby League Players Association about the proposal. (Video—1 minute, 40 seconds—included.)

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Other State and Local News

**Drug Thefts Rise as 'Pill Mills' Close
Augusta Chronicle
January 31, 2014

The article discusses the increase of pharmacy robberies in Georgia because of the crackdown on "pill mills." Last year, the Georgia General Assembly passed legislation to get rid of pill mills, requiring pain clinics to be licensed by the state medical board and owned by physicians. The increase in robberies led Georgia Drugs and Narcotics to issue guidelines to pharmacists on what to do during such incidents. Pharmacies are now keeping lower quantities of controlled drugs on their premises.

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**Drug Enforcement Administration Needs Warrant to Access Oregon Prescription Database, Judge Says
February 11, 2014

A federal judge ruled that federal drug investigators cannot access an Oregon-maintained database that records patients' prescription information without first getting a warrant. Senior U.S. District Judge Ancer Haggerty sided with the American Civil Liberties Union in declaring that patients have a reasonable expectation to privacy of their prescription drug information, even if it is forwarded to Oregon's Prescription Drug Monitoring Program. Federal investigators must prove probable cause to a judge before being able to access the state's database. The DEA argued that an administrative subpoena was sufficient to demand information relevant to investigations into potential drug violations.

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Denver Health Gives Drug Addicts Nasal Syringe Antidote to Prevent Deadly Overdoses
February 13, 2014

This article and video (1 minute, 47 seconds) discuss Denver (Colo.) Health Medical Center's giving naloxone prescriptions directly to patients. Dr. Eric Lavonas of Denver Health estimates that 60 lives could be saved every year with the introduction of the nasal syringes. Denver Health began giving the syringes directly to addicts after 91 persons died from heroin overdoses alone in 2012.

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Boston Mayor Supports Overdose Antidote
Boston Globe
February 11, 2014

Boston (Mass.) Mayor Martin Walsh announced a series of community workshops and called for all first responders to carry naloxone spray mist. His plan would expand the program to include police and firefighters. The executive director of the Public Health Commission said heroin overdoses increased 76 percent between 2010 and 2012 and prescription drug overdoses jumped 38 percent between 2009 and 2012. The Public Health Commission will host five community workshops in February in South Boston, East Boston, the South End, Dorchester, and Allston–Brighton. The events aim to provide residents with overdose prevention training, an overview of treatment options, information on how to access naloxone, and an opportunity to meet with the neighborhood substance abuse coalitions.

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Heroin Popularity Tied to Painkiller Abuse
Daily Reveille
February 12, 2014

East Baton Rouge, La., has seen a growth in heroin use in the last two years. There were 5 heroin-related deaths in East Baton Rouge Parish in 2012 and 35 in 2013. Shane Evans, chief of investigations at the East Baton Rouge Parish Coroner's Office, said reduced penalties for heroin distributors and increased prescription monitoring have contributed to heroin-related deaths in East Baton Rouge Parish. Vincent Wilson, director of undergraduate programs for the School of the Coast and Environment, said heroin and codeine both come from the same group of drugs, and when people abuse pain relievers their bodies begin to develop a tolerance and dependency.

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Bad Medicine: Prescription Drug Abuse on the Rise in North Dakota; Dickinson Sees Several Thefts
Dickinson Press
February 8, 2014

This article discusses the increase in prescription drug abuse cases in North Dakota. The Dickinson (N.D.) Police Department said that prescription drugs are reported stolen regularly and sometimes by an abuser. Muscle relaxants are reported stolen the most. Addicts are getting them from their friends and from doctors who will prescribe them when they are not needed. The Department of Human Services has been running a campaign that recommends securing medications in the home.

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Horowitz: Vermont Gives Nation a Wake-Up Call on Opiate Addiction
February 11, 2014

Rob Horowitz, a strategic and communications consultant, discusses the interview of Vermont's governor on ABC's This Week With George Stephanopoulos. The governor described the role of overprescribing of prescription pain relievers in this new epidemic of opiate addiction. He said people are now moving from prescription drugs to heroin. Horowitz believes that the governor is leading the way in Vermont by putting in place a comprehensive policy response, including public education, stricter law enforcement, and expanded treatment. He thinks it is time for others to act.

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New Trends in Drug Violations
Iowa State Daily
February 12, 2014

Iowa State Police made 15 more arrests for drug violations from 2012 to 2013. The number of arrests made for drug equipment violations, or drug paraphernalia, increased by two arrests. These arrests are not all made on campus and do not exclusively involve students. There has been an increase in the amount of arrests made for people in possession of prescription drugs for which they were not prescribed; the most common were antidepressants and pain relievers. The number of arrests made in residence halls has decreased.

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Missouri House Endorses Prescription Drug Database
Kansas City Star
February 11, 2014

Missouri House members voted in favor of a bill that would create a prescription drug monitoring database in the only state that has not authorized one. It would need a second affirmative vote before advancing to the state Senate. Under the House legislation, pharmacies would submit information about the identity of the patient, the pharmacy, and the prescribing doctor. The Department of Health and Senior Services would be responsible for establishing and maintaining the program. Data within the database would be considered confidential, but information could be provided to doctors, pharmacists, regulators, and law officers who have a subpoena or a court order. Funding the database would need to come from gifts, grants, and donations.

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Drug Monitoring Program Flagging More Patients Using New Software
Kansas Health Institute
February 7, 2014

The number of patients flagged by Kansas Tracking and Reporting of Controlled Substances (K–TRACS) increased more than sixfold after officials began using new software last year. In the second half of 2013, warnings were triggered by 584 patients when they tried to fill prescriptions too frequently or otherwise signaled potential for abuse of the drugs. Only 91 patients were flagged in the first half of 2013, when the system was using older, more costly software. Once a transaction is flagged, program officials alert doctors and pharmacists with a letter. Patients are flagged if their prescriptions exceed a certain number or type in a three-month period. The quarterly thresholds are confidential to make it harder for potential abusers to dodge the system. Licensed Kansas pharmacies are required by state law to use the K–TRACS system.

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Heroin Task Force Hits Roadblock in Law
LaCrosse Tribune
February 14, 2014

La Crosse County, Wis.'s Heroin Task Force attributes the region's growing heroin problem to a prevalence of prescribed opiates. It wanted to place permanent drop-off boxes in secure locations for people to dispose of prescriptions. The task force co-chairman said existing regulations make the plan tougher to implement than previously believed because of new Drug Enforcement Administration rules that could come out in March.

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House Clears Way for Electronic Prescriptions of Powerful Drugs
Lund Report
February 7, 2014

The Oregon House of Representative unanimously passed House Bill 4013, which will allow doctors to prescribe Schedule 2 drugs electronically. This would make prescribing easier for practitioners and pharmacists while cutting down on prescription fraud. The bill now heads to the Oregon Senate.

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Willacy's Biggest Drug Problem Is Elderly Selling Meds to Kids, Expert Says
February 9, 2014

This article discusses the drug problems in Willacy County, Texas. The Communities Against Substance Abuse learned by talking to residents that the area's biggest problem stems from the elderly selling prescription drugs to children. Xanax has become the most abused drug in the county.

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Dog Helps Parents Sniff Out Drug Abuse in Children
February 14, 2014

This article and video (3 minutes, 9 seconds) discuss why one parent hired Chewy, a K9 trained to smell narcotics, and his handler to go through his daughter's bedroom. NBC 7 spoke to a father whose daughter is in rehab for Adderall and alcohol addictions. While she was away for the program, he had Chewy check her room. The father stripped down her room himself and didn't find anything. After Chewy went through it, he found traces of drugs and alcohol hidden under the mattress, in the closet, and in a shoe container under the bed. Chewy is trained to smell narcotics (specifically meth and marijuana) and detect oxycodone, cocaine, Adderall, and Spice.

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Explainer: Prescription Monitoring Program Enters Crucial Phase
New Jersey Spotlight
February 11, 2014

New Jersey is considering whether to increase requirements for doctors to participate in Prescription Monitoring Program (PMP). This article describes the PMP, explains why it is needed, and discusses provider participation and law enforcement's push to use it. It also mentions doctors' resistance to the program.

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Data Show Prescription Drug Abuse Problem
Norman Transcript
February 10, 2014

Oklahoma Watch released data showing that Oklahoma pharmacies filled nearly 10 million prescriptions for narcotic pain relievers and other controlled dangerous substances last year. This averaged 68 per patient and contained 597 million doses of pain relievers, tranquilizers, sleeping pills, steroids, and other controlled pharmaceuticals tracked by the state's Prescription Monitoring Program (PMP). Nearly 16,000 medical professionals are registered to write narcotics prescriptions in the state, and about 1,500 of them accounted for nearly three fourths of all controlled substance prescriptions filled in 2013. Many medical professionals do not routinely check the PMP's database before writing or refilling scripts. In 2012, overdoses killed 844 Oklahomans. Three out of four overdose deaths involved prescription drugs. A key to reducing the toll is to get more doctors to participate in the PMP. State officials said they will look at several options for new legislation to increase physician use of the PMP. The governor's office hopes to devise a plan that includes new restrictions on prescribing practices, tougher penalties for offenders, and more public and professional outreach campaigns.

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Heroin in Central New York: Why Have Realtors Been Recruited for the Fight Against a Deadly Drug?
February 7, 2014

Law enforcement officials warned Central New York's realtors that not everyone who takes a house tour is looking for a new place to live. Drug dealers sometimes go to open houses pretending to be interested buyers. At some point, they will sneak into the bathroom and steal whatever pills they can find in medicine cabinets and counters. They will then sell them to patients whose doctors have cut them off their prescriptions, or to those just looking to get high.

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Westmoreland County, Pa., Addicts, Overdose Victims Skew Older
Trib Total Media
February 7, 2014

The coroner's office reported that older adults in Westmoreland County, Pa., are using heroin and are dying from overdoses involving a combination of drugs. Of the 86 overdose victims in 2013, nearly 70 percent were between ages 41 and 70, an increase from 59 percent in 2012 and 55 percent in 2011 for the same age group. The Gateway Rehabilitation Center is seeing new heroin users over age 50 for the first time, according to the medical director. Allegheny County has reported higher addiction rates in users ages 50 to 60. Experts said that older addicts' drug problems are rooted in legitimate medical issues, not recreational drug use. They become addicted to prescription pain relievers after being treated for medical ailments, chronic pain, or postsurgical pain. Most of the addicts Greenbrier treats start with prescription drug abuse. Last year, about 60 percent of the patients were addicted to oxycodone and other powerful pain relievers. When their physicians stop prescribing the drugs, some turn to buying opiates on the street, then sometimes switch to heroin. Coroners' records showed Hempfield with 12 overdose deaths; New Kensington had 7; and South Huntingdon, with a population of about 6,100 residents, had 6 fatalities. The coroner said 86 percent of the deaths were caused by a combination of drugs. Only 30 percent were linked to heroin, but half the victims had Xanax, Valium, other benzodiazepines, and antidepressants in their systems.

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Babies Born Addicted Growing Problem Across Western Pennsylvania
Trib Total Media
February 9, 2014

The article discusses the increase in the number of babies born addicted to prescription drugs in Pennsylvania. The state does not mandate substance testing for newborns, track the number of babies born addicted, or require hospitals to report women who are in drug rehabilitation when they deliver. Reporting is mandatory only when babies born to mothers not in rehab have withdrawal symptoms. Last year, Uniontown, Magee–Women's Hospital, and West Penn and Forbes hospitals had at least 648 babies who were born addicted or treated for addiction. Officials agree the number has multiplied during a decade that has seen a statewide surge in heroin and prescription drug abuse. Excela Health Westmoreland Hospital reported that addicted infants typically fill two of the six beds in the special care nursery. Nearly 30 percent of the babies delivered at Uniontown Hospital in one year were addicted. Their mothers used opiate street drugs consisting of heroin, morphine, and oxycodone or prescription pain medication while pregnant. In 2013, Westmoreland County Jail had 32 inmates test positive for pregnancy; 13 were sent to Magee–Women's Hospital to start drug withdrawal treatment. Allegheny County Jail records show 22 inmates tested positive for pregnancy. Women in withdrawal are sent to Magee for methadone treatment. Officials estimate a 50:50 mix of heroin and prescription drug use.

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Metro Atlanta Sees Uptick in Heroin Addiction
February 10, 2014

Opiate addiction is increasing in the Atlanta, Ga., metropolitan area. In DeKalb County, heroin deaths increased from 5 to 10 between 2012 and 2013. In Gwinnett County, deaths rose from 2 in 2012 to 7 in 2013. Cobb County saw heroin-related deaths increase from 9 in 2011 to 16 in 2012. In Fulton County, heroin deaths increased from 24 to 31 from 2012 to 2013. Since 2011, the county medical examiner has recorded 73 deaths caused by the drug. In rural Georgia, 13 heroin-related deaths were reported in the first nine months of 2013. Georgia Medical Examiner Kris Sperry said deaths related to prescription medication are the main cause in drug-related deaths and that heroin deaths will continue to rise.

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Other Resources

Accessed February 12, 2014

Cardinal Health Foundation and Edheads launched an educational video game called "Trauma." This game is designed to help educate and raise awareness of prescription drug abuse for students in middle school, high school, and college. The video game takes the player through many activities and tests that would be conducted in stabilizing a patient in the emergency room. Throughout the game the player is educated on the dangers of prescription drug abuse, the effect it can have on parents, and the consequences that come from abusing prescription medicine.

Read more:

SAMHSA Guide Offers Practitioners Resources to Help Families Support Their LGBT Children
Substance Abuse and Mental Health Services Administration
February 18, 2014

SAMHSA is releasing A Practitioners Resource Guide: Helping Families to Support Their LGBT Children. This resource guide is designed to help healthcare and social service practitioners provide greater insight to families on how they can support their children who are coming out or identifying themselves as lesbian, gay, bisexual, and transgender (LGBT). LGBT youths who report high levels of family rejection are more likely than control youths to use illegal drugs and to misuse prescription drugs.


Drug Case Might Change Definition of Family
February 13, 2014

This audio (13 minutes, 20 seconds) discusses a Missouri law presented by state Sen. Ed Emery that would allow someone to possess prescription drugs for his or her own use or for the use of a household member. He proposes changing the law so it includes a member of the immediate family, regardless of whether that person lives in the same house. Fellow senators worry that the change might affect cases of children taking parents' prescription drugs to school and selling them and how the change might affect widespread trafficking in prescription medications. Emery says he will work with others to find the right wording.


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

Grants Received

Jersey Shore University Wins AMA Grant to Educate Youth About Prescription Medication Safety
February 13, 2014

Jersey Shore University Medical Center was recently awarded an American Medical Association Foundation Healthy Living Grant to educate youth about prescription medication safety. Jersey Shore will also launch a misuse prevention campaign directed at high school students and their parents.

Read more:

Take-Back Events and Drop Boxes

National Take-Back Initiative
Drug Enforcement Administration
10:00 a.m. to 2:00 p.m.
April 26, 2014

Paradise Valley, Ariz., Creates Prescription Drug Collection Unit
February 10, 2014

Drug Take-Back Partnership Yields 8,000 Pounds of Drugs in Hawaii
Drug Topics
February 10, 2014

Prescription Drug Disposal Box a Success in Gladwin, Mich.
Gladwin County Record and Beaverton Clarion
February 11, 2014

Saving Lives by Dropping Off Prescription Drugs in Little Falls
North Jersey Media Group
February 10, 2014

Topeka, Kan., Police to Hold Prescription Take-Back Day March 1
Topeka Capital–Journal
February 7, 2014

Jefferson County, Ohio, Authorities Hope Prescription Drug Drop-Off Box Will Curb Death Totals
February 12, 2014

Save the Dates

National Prescription Drug Take-Back Day
Office of National Drug Control Policy
April 26, 2014, 10 a.m.to 2 p.m.

Prescription drug abuse is affecting America's rural communities as profoundly as it is affecting our urban and suburban areas. Many SAMHSA partners will be interested in the following:

Rural Health Collaboration Webinar: Health and Human Services Investments in Rural Behavioral Health
Health Resources and Services Administration (HRSA)
February 20, 2014 (**Tomorrow**), 2–3 p.m. (EST)
Call-in Number: 800.857.3749800.857.3749
Adobe Connect Session: https://hrsa.connectsolutions.com/rural1/

Bill Hudock from SAMHSA and Dr. Bob Mays from the National Institute of Mental Health's Office of Rural Mental Health Research will present on their programs and expertise in rural behavioral health, as well as about opportunities for foundations to get involved. If you would like to submit questions beforehand, or want to sign up to hear more about other Webinars in the series and the May 2014 meeting on Rural Health Collaboration, please email RuralHealthPhil@hrsa.gov.

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

Pain Management Through a Wide Lens: Balancing Safety and Effectiveness
March 8, 2014
St. Louis, Missouri

Eleventh Annual World Health Care Congress
April 7–9, 2014
National Harbor, Maryland

National Rx Drug Abuse Summit
April 22–24, 2014
Atlanta, Georgia

2014 Harold Rogers Prescription Drug Monitoring Program National Meeting
Brandeis University, Prescription Drug Monitoring Program Training and Technical Assistance Center
September 23–25, 2014
Marriot Metro Center
Washington, DC
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.


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