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February 27, 2013

SAMHSA Prevention of Prescription Drug Abuse in the Workplace Listserv

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February 27, 2013 (PDF version)
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Featured Articles

D.D. Jeffery, L.A. Babeu, L.E. Nelson, M. Kloc, and K. Klette. 2013. "Prescription Drug Misuse Among U.S. Active Duty Military Personnel: A Secondary Analysis of the 2008 DoD Survey of Health Related Behaviors." Military Medicine 178(2):180-95, 16.
The 2008 Department of Defense Survey of Health-Related Behaviors (HRBs) Among Active Duty Military Personnel indicated that active duty service members misuse pain relievers, tranquilizers, sedatives, and stimulants at levels ranging from 2 percent to 17 percent. Researchers used secondary, multivariate analyses of HRB survey data to examine predictors of self-reported prescription drug misuse for four distinct drug categories. Receipt of a pain reliever prescription in the past month, year, or previous year were strong predictors of misuse for all drug categories; receipt of a prescription for anxiety or depression medication in the past year was the strongest predictor of sedative misuse. Absence of a drug testing program was significantly related to the likelihood of drug misuse for all drug categories.

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C.M. Jones, K.A. Mack, and L.J. Paulozzi. 2013. "Pharmaceutical Overdose Deaths, United States, 2010." Journal of the American Medical Association 309(7):657-59. doi:10.1001/jama.2013.272.
Vital statistics data recently released by the National Center for Health Statistics show drug overdose deaths increased for the 11th consecutive year in 2010. Pharmaceuticals, especially opioid analgesics, have driven the rise. Other pharmaceuticals are involved in opioid overdose deaths, but their role is less well characterized.

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Related Articles
Prescription Drugs Leading Cause of Fatal Overdoses 
MedPage Today 
February 19, 2013

National Vital Statistics System multiple cause-of-death data showed 38,329 drug overdose deaths in the United States in 2010--about 58 percent involved pharmaceuticals. The most common drugs were opioids (75.2 percent), benzodiazepines (29.4 percent), antidepressants (17.6 percent), and antiepileptic and antiparkinson drugs (7.8 percent). Among overdose deaths involving opioid analgesics, benzodiazepines were also found in 30.1 percent of cases. Antidepressants were involved in 13.4 percent of prescription opioid-related deaths, followed by antiepileptic and antiparkinson drugs at 6.8 percent, and antipsychotics and neuroleptics at 4.7 percent. 

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Overdose Deaths Continue to Climb 
The New York Times 
February 19, 2013

Drug overdose deaths rose 3.6 percent from 2009. Prescription drugs were a factor in more than half of all overdoses, with 22,134 deaths (up 6 percent from 2009). Of those, opioids were involved in the overwhelming majority, with 16,651 deaths in 2010 (up 7 percent from 2009). Deaths from prescription drug overdoses quadrupled from 1999 to 2010. 

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Journal Articles

Leena Anthony and Chanda Kulkarni. 2012. "Patterns of Poisoning and Drug Overdosage and Their Outcome Among In-Patients Admitted to the Emergency Medicine Department of a Tertiary Care Hospital." Indian Journal of Critical Care Medicine 16(3):130-35.
Researchers reviewed the pattern of poisoning and drug overdose (DO) in an urban tertiary care hospital in India as well as the determinants and final outcome of patients with poisoning and DO. Using hospital records, they retrospectively collected data on demography, hospitalization, complications, type of poison/drug, and outcome of patients with poisoning and DO. Of the total 296 records, 213 were included (122 poisoning, 91 DO). Organophosphates (OP) (32.5 percent), pyrethroids (17.2 percent), and organocarbamates (12.2 percent) were the commonly used poisons. Sedatives and antiepileptics (21 percent each) were the most common drugs in DOs. Poisoning among men was greater than poisoning among women. Outcome parameters of hospital stay and ventilator requirement were significant and the overall case fatality rate was 2.4 percent. OP compounds were the most common among poisons, while sedatives were frequently consumed drugs. Young adults from urban areas were the most common victims with suicidal intention.

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A.P. Colucci, R. Gagliano-Candela, L. Aventaggiato, A. De Donno, S. Leonardi, G. Strisciullo, and F. Introna. 2013. "Suicide by Self-Administration of a Drug Mixture (Propofol, Midazolam, and Zolpidem) in an Anesthesiologist: The First Case Report in Italy."
Journal of Forensic Science. doi: 10.1111/1556-4029.12053.

This is the first case report published in Italy of a death involving propofol and other drugs. An anesthesiologist was found dead with an empty drip still inserted in his hand and another near his body. The cause of death was respiratory depression due to self-administration of a rapidly infused lethal drug mixture.

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L.A. Liberto and K.S. Fornill. 2013. "Managing Pain in Opioid-Dependent Patients in General Hospital Settings."
MEDSURG Nursing 22(1):33-7, 5.

Inadequate staff training, absence of addiction screening and intervention protocols, and stigma related to opioid use can negatively affect outcomes for opioid patients in general hospital settings.

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News and Reports

Georgia House Approves Regulations for Pain Management Clinics
The Marietta Daily Journal
February 21, 2013

The Georgia House of Representatives approved a proposal for the state to license and regulate pain management clinics. House Bill 178 is a response to unregulated businesses credited with feeding prescription drug abuse. A pain clinic is defined in the bill as a medical enterprise where at least half of the patient population is being treated for chronic pain.

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Born Addicted: Increasing Number of Babies Hooked on Drugs
The Daily News Journal
February 18, 2013

This article reports on babies born with Neonatal Abstinence Syndrome (NAS) in Tennessee. A newborn experiences NAS symptoms when his or her mother is dependent on certain illicit or prescription drugs. Tennessee Department of Health (TDH) is confident that both legal use and illegal abuse of prescription painkillers are contributing to the rise in NAS cases. A TDH study showed about 60 percent of mothers on TennCare whose babies were born in 2011 with NAS were taking legitimately obtained opioid medications. From 1999 to 2001, less than one NAS case per 1,000 births was reported annually statewide. By 2006, two of every 1,000 babies born suffered from NAS. In 2010, about 6.5 of every 1,000 babies born suffered from NAS.

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With Drug Overdose Deaths on Rise, Experts Push to Recognize Signs of Addiction
CBS News
February 20, 2013

Health experts discuss the growing problem of overdose deaths and how people can recognize signs of addiction, which include behavioral changes that seem out of the ordinary. Family members might notice a person's mood swings, altered sleep habits, bizarre behavior (including lying and stealing), changes in friends or social groups, and unexpected weight loss, while colleagues might notice tardiness at work, missed deadlines, a tendency toward isolation, and unexcused absences or absences attributed to illness. Growing financial problems and frequent medical visits may also indicate a problem.

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Within Connecticut, New Haven Area Had Highest Use of Antidepressants, Study Finds
Middletown Press
February 21, 2013

According to a new study, New Haven, Connecticut, had the state's highest rate of antidepressant use (14.7 percent, compared with the mean of 10.4 percent nationally). Stimulant use was highest in Stamford (3.9 percent, compared with 2.6 percent nationally). Antipsychotic use was highest in Hartford (3.8 percent, compared with the 0.8 percent national mean). Alexandria, Virginia, had the highest rate of antidepressant use in the country, with 40 percent of residents receiving antidepressant prescriptions.

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California Mom Fights 'Dr. Feel-Good' Pill Mills
February 15, 2013

A California mom is on a mission to drive the doctor who prescribed her son deadly painkillers out of business. Her son, a 21-year-old college student, died after consuming a cocktail of OxyContin, Xanax, and alcohol. His mother founded the National Coalition Against Prescription Drug Abuse after his death to raise awareness. Bay Area law enforcement experts have agreed it's time to go after so-called "Dr. Feel-Goods" for knowingly overprescribing painkillers and sedatives.

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Stopping Prescription Drug Abuse Starts With Primary Care
MedPage Today
February 18, 2013

Julie Craig, M.D., thinks patients battling addiction should be able to walk into any primary care clinic and receive standard-of-care treatment. Dr. Craig reports that some offices feel they lack resources to address high-needs populations, while others do not wish to attract such patients. She believes addictions treatment is not a difficult area of medicine to learn because only a handful of drugs can be used. According to Dr. Craig, primary care must become the locus of outpatient treatment, with inpatient and/or specialty treatment reserved for the most ill or incorrigible cases. In addition, she suggests primary care training centers should teach evidence-based use of supported sobriety medications.

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Prescription Drug Abuse Persists in Ohio
Coshocton Tribune
February 17, 2013

Nurses have seen an increase in prescription drug abuse in Ohio and among babies born addicted to prescription drugs. Neonatal Abstinence Syndrome can cause seizures, breathing problems, dehydration, feeding difficulties, tremors, and irritability. The article includes a 5:50-minute video of a woman struggling with addiction and shows her physical changes through police mug shots.

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Target 9 Investigates Prescription Drug Abuse Epidemic (Part 2 of 3)
February 20, 2013

This investigative report and video (2:51 minutes) discuss prescription drug abuse in Ohio and how it can lead to heroin addiction. Police officials noticed some pills hit the streets when doctors prescribe them to dealers for a cash kickback. When a prescription opioid addict runs low on money, heroin is often the drug of choice. The article reports that in 2012, only five counties in the nation were deemed high-intensity drug trafficking areas. Four of the counties are in Ohio--Hancock, Brooke, Ohio, and Marshall. The area has seen increased law enforcement funding to combat the problem.

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Target 9 Investigates Prescription Drug Abuse Epidemic (Part 3 of 3)
February 20, 2013

This investigative report and video (2:32 minutes) discuss one parent's mission to raise awareness about prescription drug abuse, having lost his son to a drug overdose. He hopes sharing his story with students and parents will help prevent the tragedy from happening again.

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Bill Targets Reporting of Health Providers With Addiction Problems
The Bangor Daily News
February 18, 2013

Legislation could update Maine's requirement for reporting and disciplining medical professionals suspected of having substance abuse problems. The bill would require state medical licensing boards to investigate any report of physician alcohol or drug use that could indicate a substance abuse disorder. In addition, the legislation would give licensing boards authority to take action if a medical professional's alcohol or drug use could endanger a patient--allowing the boards to discipline doctors when it is "foreseeably likely" patients could be harmed. The author references a 2008 Harvard Review of Psychiatry article that found prescription drug abuse was five times higher among physicians than among the rest of the population.
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Drug Driving Is an Increasing Menace on the Roads
Big Rigs National Road Transport Newspaper
February 20, 2013

A new study by the Royal Automobile Club of Queensland revealed that four in 10 Queensland (Australia) drivers admit to ignoring medical and pharmaceutical warnings and driving after taking prescription drugs. The article reports that only 8 percent of motorists admitted to driving after using illicit drugs--meaning five times more drivers are affected by legal prescription drugs than illegal ones.

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DPH Proposes New Regulations for Prescription Monitoring Program
Massachusetts Medical Society
February 15, 2013

The Department of Public Health (DPH) presented draft regulations to the Public Health Council to implement state Prescription Drug Monitoring Program (PMP) changes. They detail requirements for reviewing 12 months of prescribing history in the PMP database by all fully licensed physicians and other professionals--for new patients and those who have not been seen in the past year. According to the article, the Massachusetts Medical Society wanted proposed regulations to reflect demands of clinical practice.

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CN Elected Officials to Undergo Drug Tests
Cherokee Phoenix
February 19, 2013

Tribal Councilors passed an act that requires all elected Cherokee Nation officials to undergo random drug testing for prohibited drugs. They include prescription drugs that could be abused, as well as opiates, phencyclidine, methamphetamines, and all other illegal drugs. One Councilor voted for the bill because he felt elected government officials should not receive preferential treatment in drug testing.

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VA Settles in Navy Vet's Drug Overdose Death
Marine Corps Time
February 20, 2013

The Department of Veterans Affairs (VA) agreed to pay a former Navy corpsman $100,000, settling a lawsuit alleging the Department failed to properly monitor and prescribe medications to her sister, a 37-year-old veteran who overdosed on a prescription drug in November 2010. Within a 2-month period, Darla Grese's sister received at least 900 pills of a drug she used to attempt suicide three times in the past 8 months. Darla filed the lawsuit to call attention to medication mismanagement and negligence at the VA.
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'Culturally Toxic': Swimmers Hit With Claims of Drugs and Bullying
The Sydney Morning Herald
February 20, 2013

The Australian Olympic swimming team has been accused of abusing prescription drugs, particularly Stilnox, a sedative and hallucinogen for insomnia. An independent review found the team had Stilnox "bonding nights" during the 2012 Olympics. The article and 3:10-minute video discuss lack of leadership and governance as well as efforts to take corrective action.

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Canada's Opioid Use Noteworthy
The StarPhoenix
February 21, 2013

A recent chart shows that for the first time ever, Canada has surpassed the United States in per capita opioid consumption. The article reports that consumption skyrocketed in 1984 and peaked in 2010. It puts the findings in perspective with U.S. statistics from the Centers for Disease Control.

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FOX 5 Investigates: Teen Prescription Drug Abuse
February 21, 2013

A reporter interviews a 20-year-old who started abusing prescription drugs as a teenager. Taking oxycodone, benzodiazepine, Xanax, Vicodin, methadone, and Opana around the clock to get high, she first stole the drugs from her grandmother. The article and video (5:18 minutes) interview health experts and cite national statistics about this growing epidemic.

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New Restrictions on Painkiller Prescriptions Take Effect Saturday
The Post-Standard
February 18, 2013

New Yorkers with prescriptions for Vicodin and other painkillers containing hydrocodone will not be able to refill the medicine unless they see their doctors for a new prescription. The change is required by the state's new I STOP law designed to address prescription painkiller abuse and addiction.

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How Can Stimulant Abuse by College Students Be Deterred?
Medscape Today
February 15, 2013

The author, a pharmacologist from the South College School of Pharmacy, talks about measures that may reduce methylphenidate misuse and abuse among college students. Methylphenidate is a prescription medicine used to treat attention deficit-hyperactivity disorder and narcolepsy. He believes education in the classroom at all levels, educating prescribers about guidelines, and monitoring patients' medication use may help minimize the problem.

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Prescription Drug Drop Box Proving to Be a Major Success
February 18, 2013

A drop box for prescription medication is proving to be a useful tool for combating drug use within the community, according to Gainesville police. Nearly 20 pounds of unwanted, unused, or expired medication was deposited in just over a month's time. The drop box prevents unauthorized access to medications while protecting the environment through proper disposal.

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Prescription Drugs Leading to More DUIs
February 15, 2013

In Tennessee, criminal judges are hearing more cases for driving under the influence that involve prescription drugs. Sometimes the drugs are legally prescribed; other times they are not.

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Prescription Drug Abuse an 'Epidemic' in Montana
February 20, 2013

Prescription drug abuse is 15 times deadlier in Montana than methamphetamine, heroin, and cocaine combined, according to the Montana Department of Justice. It causes 300 deaths annually--accounting for 100 more deaths than Montana's roadways.

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Do Prescription Drugs and Other Medications Impair Drivers?
Southern California Public Radio
February 20, 2013

This article and audio (21:29 minutes) discuss a new law proposed by a state senator that makes it illegal to drive under the influence of certain Class I-IV drugs without a prescription. Medications such as Tylenol with Codeine and Xanax fall into this category. Officers in Orange County, California, have a training program that helps them recognize symptoms. According to the article, a California Office of Traffic Safety report showed twice as many people involved in late-night weekend traffic checkpoints tested positive for drugs, as opposed to alcohol.

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For an Exec, Breaking Pain Pill Addiction Is Impossible
CBS Evening News
February 16, 2013

This article and video (2:40 minutes) interview a real estate executive who admits to taking 12 pain pills with 10 Xanax a day. His addiction began 2 1/2 years ago, when he was injured in a car accident. Doctors prescribed oxycodone for the pain and anti-anxiety drug Xanax. His addiction has caused suicidal thoughts and he fears asking his employer for help.

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Prescription Drug Abuse Prevention Starts at Home
Daily Republic
February 21, 2013

One in five teens--4.5 million young people--reports abusing prescription drugs, according to the National Council on Patient Information and Education. This article provides helpful tips for preventing prescription drug abuse.

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Drug Makers, in Shift, Join Fight Against Doping
The New York Times
February 18, 2013

Drugmakers Roche and GlaxoSmithKline (GSK) hope to halt the abuse of the prescription drug EPO, a blood enhancer used by anemia patients. Some, including cyclist Lance Armstrong, have used it for doping. The article reports a growing number of pharmaceutical companies are joining anti-doping officials to develop tests that detect illegal use of their drugs among athletes. Roche and GSK have agreed to share information about these products with the World Anti-Doping Agency, which polices drug use in international sports.

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Maine Communities Try to Help Prescription Drug Addicts
WMTW Portland
February 20, 2013

A new Maine program focuses on education and treatment for inmates. The Kennebec County Sheriff hopes to end the cycle of addiction and incarceration with its Criminogenic Addiction and Recovery Academy, a 6-week treatment program.

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Panel Clears Prescription Drug Regulation Bill
77 Square
February 19, 2013

An Oklahoma House committee extended state oversight to companies that act as middlemen between pharmacies and people filling prescriptions through their employer's health insurance. The article reports that pharmacy benefit managers (PBMs) are private companies that contract between employers and pharmacies, often arranging for workers to receive their prescription drugs through the mail. The legislation would require PBMs to get a license from the Oklahoma State Board of Pharmacy and share more information with customers about their inner workings, bringing companies under state oversight for the first time.

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Upcoming Conference and Workshop
Prescription Drug Misuse Roundtable Discussions
March 8, 2013
8 a.m. to 3 p.m.

University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences
This meeting will focus on developing recommendations to reduce prescription drug misuse in Colorado. Key issues include Prescription Drug Monitoring Programs, provider and prescriber education, public awareness, safe disposal of prescription drugs, and data and analysis. Colorado Governor John Hickenlooper and Alabama Governor Robert Bentley co-chair the year-long policy academy designed to help states reduce prescription drug abuse.

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The Generation Rx University Conference for Prescription Drug Abuse Prevention and Recovery
August 7-8, 2013
The Ohio State University Blackwell Inn and Conference Center
2110 Tuttle Park Place
Columbus, Ohio

This second annual 2-day conference will provide information and resources for collegiate prescription drug abuse prevention and recovery. College students, faculty, student life staff members, administrators, counselors, student health professionals, and others are invited to participate, with a goal to develop take-home plans for prevention/recovery programs at their colleges or universities.

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Preventing Prescription Drug Overdoses: A National Strategy
March 13-14, 2013
The Loudermilk Center
40 Courtland Street NE
Atlanta, Georgia
Register at nsc.org/RxDrugSymposium

Are you concerned that prescription drug overdose has become one of the leading and fastest growing causes of unintentional death in the United States? More than 15,000 Americans die each year from prescription overdoses. The problem has reached epidemic proportions and now is the time to act. Join the National Safety Council as they partner with local and federal policymakers, healthcare professionals, prevention experts, and drug and alcohol treatment specialists to craft a national strategy for reducing injuries and fatalities associated with prescription drug misuse.

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Upcoming Webinar
Responding to the Nation's Prescription Drug Abuse Crisis
Webinar: Feb. 28, 2013, 2:00 to 3:30 p.m. EST

Please join SAMHSA and the Preventing Prescription Abuse in the Workplace (PAW) Technical Assistance (TA) Center for their second Prescription Abuse in the Workplace Webinar. The Webinar is aimed at SAMHSA grantees working at both the state and community levels. The presentation will provide information for prevention planners interested in developing and operating programs that respond to prescription drug abuse. It will concentrate on how the nation is responding to the prescription drug abuse crisis.

PAW TA Center Director Ted Miller, Ph.D., of the Pacific Institute for Research and Evaluation will classify current and conceptually appropriate responses. Then he will examine how selected workplaces and communities are structuring their response. He will identify evidence-based individual prevention programs with prescription drug abuse content as well as a wide range of environmental prevention approaches. Dr. Miller will discuss other approaches such as screening and brief/early intervention, treatment, and harm reduction through co-prescription of naloxone antidote to those with prescriptions for opioid painkillers. Finally, the Webinar will describe SAMHSA's PAW TA Center and the resources it offers.
SAMHSA and the PAW TA Center hope you will be able to join them Feb. 28.

For Participants
URL: https://www.mymeetings.com/nc/join
Conference number: PW4848524
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1. Conference number: PW4848524.
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Participants should access the Net portion 30 minutes before the scheduled start time to ensure they can log on. We will use Microsoft Live Meeting software. It should load onto your computer once you click on the link. However, if you have problems or need assistance, please contact the Product Help Desk at 800.857.8777, option 3.
About PAW and the Listserv
The PAW TA Center addresses prescription drug abuse--a growing public health problem with increasing burdens on workers, workplaces, and our economy. Prescription drug abuse affects workplace productivity and increases employee absenteeism, employee presenteeism, and workers' compensation claims. On a wider scale, overdose deaths linked to prescription opioids tripled from 1999 to 2006, and prescription drug abuse killed more Americans in 2009 than died that year in auto crashes.
Send your request for PAW technical assistance to PAW-TA@pire.org or contact Rekaya Gibson at 504.261.8107 or Deborah Galvin at 240.276.2721. Requests are subject to SAMHSA approval. You will be notified of the status of your request.
We aim to conduct systematic and inclusive searches of professional journals, leading newspapers and magazines, and federal websites, as well as contributions from listserv subscribers (please e-mail suggestions to rgibson@pire.org). We will send links to articles along with brief descriptions of those articles. As we develop the listserv, however, we hope to add commentary and invite feedback from subscribers. Our goal is to expand the listserv to become a widely used and recognized source of the most current and authoritative information on prescription drug abuse--especially in workplaces.
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The "SAMHSA Prevention of Prescription Drug Abuse in the Workplace Listserv" 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 viewpoints or opinions and are not assessed for validity, reliability, or quality. The "SAMHSA Prevention of Prescription Drug Abuse in the Workplace Listserv" 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 journal articles.
The Injury Control Research Center at West Virginia University (WVU-ICRC) archives past Listserv issues at http://www.hsc.wvu.edu/icrc/Pages/SAMHSA-Prevention-of-Prescription-Drug-Abuse-in-th. The partnership efforts of WVU-ICRC are supported by Grant Number 1 R49 CE002109 from the Centers for Disease Control and Prevention (CDC). The contents of the Listserv archive are solely the responsibility of the authors and do not represent the official views of CDC or SAMHSA.
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