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February 4, 2016

PAW Weekly Update




SAMHSA Prescription Drug Abuse Weekly Update
 Issue 159  |  February 4, 2016          
The Prevention of Prescription Drug Abuse in the Workplace (PAW) TA Center addresses prescription drug abuse—a growing public health problem with increasing burdens on workers, workplaces, and our economy. To subscribe colleagues, family members, or friends to this listserv sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), please click here or send their e-mail addresses to paw@dsgonline.com.                      
Journal Articles and Reports                            
Northeast/Mid-Atlantic News                            
South News                            
Midwest News                            
West News                            
Other Resources                            
Grant Announcements                            
Take-Back Events & Drop Boxes                            
Upcoming Conferences and Workshops                            


C.M. Jones, P.G. Lurie, and D.C. Throckmorton. 2016. “Effect of U.S. Drug Enforcement Administration’s Rescheduling of Hydrocodone Combination Analgesic Products on Opioid Analgesic Prescribing.” JAMA Internal Medicine, doi:10.1001/jamainternmed.2015.7799.                        

Prescriptions for hydrocodone analgesics abruptly and markedly declined after the U.S. Drug Enforcement Administration in 2014 reclassified them from Schedule III to the more restrictive Schedule II, according to an analysis of 2011–15 IMS Health National Prescription Audit data. Hydrocodone combination agents declined 22 percent and hydrocodone combination tablets declined16 percent, which equates to a 1-year decrease of 26.3 million prescriptions for hydrocodone combination products and 1.1 billion hydrocodone combination tablets. Three-quarters of the decline was attributable to fewer refills, consistent with the prohibition on prescription refills for Schedule II medications. Most medical specialties reduced prescribing, with surgeons and primary care physicians accounting for the largest decreases.                        

Read more:                        

Oregon Medical Marijuana Program January 2016 Statistical Snapshot                        
Oregon Health Authority                        
Accessed January 28, 2016                        

In Oregon’s Medical Marijuana Program, 22 physicians wrote prescriptions for 60,908 patients, an average of 2,769 patients each. Another 1,700 physicians served 1–449 patients each and prescribed for 19,087 patients in aggregate. Fifty-nine percent of the patients were men and 41 percent were women. The top three conditions people registered for were severe pain (92 percent), spasms (29 percent), and nausea (14 percent). More than one condition could be selected.                        

Read more:                        

Journal Articles and Reports

W.L. Chan, D.M. Wood, and P.I. Dargan. 2016. “Misuse of Prescription and Over-the-Counter Medicines in South London Nightclubs.” Journal of Substance Use, doi:10.3109/14659891.2015.1068388.                

In a survey of 313 nightclub attendees in South London, 90 percent were male, including 79 percent who were men who have sex with men. In their lifetime, 36 percent had misused at least one medicine. Diazepam (25 percent) and Z-drugs (zolpidem, zopiclone, zaleplon; 16 percent) were the most commonly misused medicines. Sources were friends (33 percent), dealers (16 percent), primary care doctors (14 percent), Internet purchases (11 percent), and overseas (7 percent).                

Read more:                

T.K. Drazdowski. 2016. “A Systematic Review of the Motivations for the Non-Medical Use of Prescription Drugs in Young Adults.” Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2016.01.011.                

Young adults ages 18–25 use prescription stimulants non-medically for academic reasons, their therapeutic effects, or recreational purposes, according to a systematic review of 37 articles. Almost all of the studies focused on stimulant misuse by U.S. college students. Seven also assessed motivations for misusing pain relievers and five assessed motivations for misusing central nervous system depressants. Motivations included therapeutic effects and recreational purposes.                

Read more:                

A.K. Finlay, A.H.S. Harris, J. Rosenthal, J. Blue-Howells, S. Clark, J. McGuire, C. Timko, S.M. Frayne, D. Smelson, E. Oliva, and I. Binswanger. 2016. “Receipt of Pharmacotherapy for Opioid Use Disorder by Justice-Involved U.S. Veterans Health Administration Patients.” Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2016.01.013.                

Among the 46,289 people with a Veterans Health Administration opioid use disorder diagnosis in fiscal year 2012, the 1-year rate of receipt of medication-assisted treatment was 27 percent for prison-involved veterans versus a significantly larger 34 percent for jail/court-involved veterans and 33 percent for veterans not involved in the justice system.                

Read more:                

K.R. Holloway, T.H. Bennett, and R. Hills. 2016. “Non-Fatal Overdose Among Opiate Users in Wales: A National Survey.” Journal of Substance Use, doi:10.3109/14659891.2015.1063718.                

Interviews in February and March 2013 with 661 opiate users, who were recruited from 29 needle and syringe exchange programs in Wales, found 47 percent had overdosed at least once and 15 percent had overdosed in the past year. The average respondent who overdosed in the past year did so twice. Most overdoses (95 percent) were accidental and involved injected opiates (96 percent). Life-saving actions were common and included calling for an ambulance (66 percent), administering naloxone (40 percent), and using cardiopulmonary resuscitation (27 percent).                

Read more:                

D.D. Maeng, R.C. Snyder, C.J. Medico, W.M. Mold, and J.E. Maneval. 2016. “Unused Medications and Disposal Patterns At Home: Findings from a Medicare Patient Survey and Claims Data.” Journal of the American Pharmacists Association 56(1):41–6.e6, doi:10.1016/j.japh.2015.11.006.                

Eight percent of 2,994 prescriptions filled in 2013 were not fully used by patients, according to a survey of 721 Medicare Advantage members in Central Pennsylvania who had Part D coverage. The most commonly unused medications were for pain (15 percent), hypertension (14 percent), infection control (11 percent), and psychiatric disorders (9 percent). Approximately 15 percent were controlled substances. Reasons for being unused varied by drug type. For pain medications, adverse effects and overprescribing were the most commonly cited reasons. For hypertension medications, dosage changed by doctor was the most common reason. Unused portions accounted for 25–50 percent of unused medications identified by most patients. The unused drugs were kept in a cabinet (55 percent), thrown in the trash (14 percent), disposed of via drug take-back programs (11 percent), flushed down the toilet (9 percent), given away (3 percent), or handled in other ways (8 percent).                

Read more:                


Adapt Pharma Offering Free Overdose Reversal Kits to U.S. High Schools                
January 27, 2016                

Adapt Pharma is offering free naloxone kits to any high school in the United States. Schools can receive a free carton of Narcan Nasal Spray as part of a Clinton Foundation Initiative. School nurses often act as first responders in school settings, and the National Association of Student Nurses supports the initiative.                

Read more:                

Electronic Custody and Control Form Preparations Underway                
Nicole Jupe, Quest Diagnostics                
January 19, 2016                

Quest Diagnostics has announced that it should soon be able to offer its clients the more efficient electronic version of the five-part paper Custody and Control Form used for drug test ordering, specimen collection processing, and chain-of-custody documentation for workplace drug testing. The provider of clinical testing successfully completed a mock inspection with the electronic Custody and Control Form (eCCF) and has applied for National Laboratory Certification Program approval of the electronic process.                

Read more:                

Five States Have the Most Campus Alcohol and Drug Arrests                
Lauren Camera, U.S. News & World Report                
January 26, 2016                 

There were 44,873 arrests and over 250,000 disciplinary actions on college campuses for drug- and alcohol-related offenses in 2014, according to an analysis of federal data by ProjectKnow.com. Drug arrest rates per 1,000 students were highest in Montana, West Virginia, South Dakota, Wyoming, and Delaware—all at least 2.3 times higher than the national average of 1.1. Arrest rates increased most rapidly from 2013 to 2014 in Alabama, Florida, and South Carolina.                

Read more:                

Senate Response to Opioid Abuse Could Hit FDA, Drugmakers                
Steven Dennis, Bloomberg                
January 27, 2016                

A bipartisan group of senators have said they will stall confirmation of the next FDA commissioner to pressure the Obama administration to do more to address the heroin and opioid abuse crisis. Several senators are also putting pressure on the Centers for Disease Control and Prevention to act quickly on putting stricter guidelines in place for prescribing pain relievers. Administration officials testified at a hearing that they are addressing the problem. Senators want to see more funding for treatment and legislation to address the heroin crisis. Meanwhile, there is bipartisan support in the senate for legislation to counter the crisis that has potential implications for pharmaceutical companies.                 

Read more:                

What Science Tells Us About Opioid Abuse and Addiction                
Nora D. Volkow, M.D., National Institute on Drug Abuse                
January 27, 2016                

Nora D. Volkow, M.D., director of the National Institute on Drug Abuse, recently testified before the U.S. Senate Judiciary Committee about the intertwined problems of non-medical use of prescription pain medicines, heroin use, and opioid overdose deaths in the United States. She said that overprescribing of pain relievers must be addressed to slow the heroin addiction epidemic.                

Read more:                


R.L. Pacula, M. Jacobson, and E.J. Maksabedian. 2016. “In The Weeds: A Baseline View of Cannabis Use Among Legalizing States and Their Neighbours.” Addiction, doi:10.1111/add.13282                

Rates of life-time medical cannabis use were similar in Colorado (8.8 percent) and Washington (8.2 percent)—two states that legalized marijuana use—but lower in two neighboring states that have not, Oregon (6.5 percent) and New Mexico (1 percent), according to a survey of an ongoing probability-based Internet panel. The survey had a 74 percent response rate from Washington (787), Oregon (506), Colorado (503), and New Mexico (213). More than 60 percent of respondents were over age 40, 25 percent were ages 30–39, and 15 percent were less than age 30. Recreational use was considerably higher than medical use: 41 percent across all states and highest in Oregon and Washington. Of people who ever used medical cannabis, 86 percent also had used it recreationally. Medical users were more likely to vaporize, drink, or eat cannabis; consumed more grams per month; and spent more per month on marijuana than recreational users. Only 3 percent of medical users and 17 percent of recreational users commonly used cannabis with alcohol. More than one-fifth of medical users got their cannabis from a dealer and another 15 percent bought it from a friend. Eighty percent of both medical and recreational users consumed their cannabis in a residence.                

Read more:                

E.M. Shepard and P.R. Blackley. 2016. “Medical Marijuana and Crime: Further Evidence from the Western States.” Journal of Drug Issues, doi: 10.1177/0022042615623983.                

A fixed effects panel regression using arrest data on FBI index crimes for 1997–2009 from 11 western states found the property crime arrest rate rose with the arrest rate for drug sales or possession but had no association with the presence of medical marijuana laws. Medical marijuana laws were associated with 0.25 less violent arrests per 1,000 population, with arrest rates for violence also rising with drug arrests.                

Read more:                

Business Leaders in Arizona Watching Rec-Use Marijuana Issue Grow                
Cooper Rummell, KTAR                
January 20, 2016                

The Arizona Chamber of Commerce and Industry strongly opposes legalization of recreational marijuana, but the chamber wants businesses to be prepared in case voters in November approve a ballot measure to legalize the drug. Employers would have to consider how to keep marijuana away from work if the ballot measure passes. The Chamber urges businesses to think about their workplace policies to ensure that they can maintain a drug-free workplace.                

Read more:                

Rochester Medical Marijuana Dispensary Opens Thursday                
January 28, 2016                

Columbia Care has opened a medical cannabis dispensary in Rochester, N.Y., offering two forms of liquid tinctures, which are placed in droplets under the tongue. (Includes video: 2:31 minutes)                

Read more:                


Hundreds of Motorists in U.K. Test Positive for Drugs                  
BBC News                  
January 27, 2016                  

In December 2015, 1,888 motorists in England, Wales, and Northern Ireland were stopped and screened for drug use; 931 tested positive. Police can test for 17 illegal and prescription drugs at the roadside.                  

Read more:                  

Northeast/Mid-Atlantic News

Maryland Governor Introduces Bill to Combat Heroin and Opioid Epidemic                
Maryland Office of the Governor                
January 26, 2016                

Maryland Governor Larry Hogan has introduced legislation to improve Maryland’s prescription drug monitoring program while phasing in mandatory registration and use. The bill would also facilitate prosecution of drug trafficking as part of a criminal enterprise.                 

Read more:                

Massachusetts Insurers Hire Social Workers to Tackle the Opioid Epidemic                
Deborah Becker, KNPR                
January 25, 2016                

CeltiCare Health Plan in Massachusetts is hiring social workers to deal with the opioid epidemic. They provide long-term support to its health insurance policyholders in recovery. Nearly a quarter of CeltiCare’s hospital admissions are related to substance use. It spent more than 10 percent of its budget last year on Suboxone, more than it spent on any other drug. CeltiCare is also training some members and their families on how to use Narcan and putting tighter limits on the initial prescription of opioid pain relievers it permits for each patient. (Includes audio: 4:14 minutes)                

Read more:                

New Hampshire Dental Board Commits to Helping Reduce Opiate Addiction                
The Citizen                
January 26, 2016                

The New Hampshire Board of Dental Examiners has pledged to implement opioid prescribing rules that will allow licensees to provide the best possible care to patients while preventing the diversion of drugs for illegitimate purposes. The board also voted to adopt specific emergency rules. These include recognizing that the prescription drug monitoring program is a critical tool and urges prescribers to use it, using an informed consent for chronic pain patients, and adherence to the principles in the Dental Society’s Opioids in the Dental Practice Guidelines for New Hampshire Dentists.                 

Read more:                

Study: Surge in Hospitalizations for Heroin, Drug Overdoses in Pennsylvania                
Adam Smeltz, Pittsburgh Post-Gazette                
January 26, 2016                

Pennsylvania in 2014 had 1,848 inpatient hospitalizations for overdoses of heroin or prescription pain medication, triple the number in 2000. The sharpest increase emerged among heroin overdose patients in rural counties.                 

Read more:                

South News

The Painful Truth: Prescription Drug Abuse on the Rise at Work in Florida                
Business Management Daily                
January 26, 2016                

The Florida Society of Interventional Pain Physicians has launched an educational campaign to fight prescription drug misuse. The group suggests three ways employers can spot and reduce drug misuse in the workplace: (1) provide materials to educate employees on the harm of prescription drug misuse, (2) make it clear that employer policies do not permit dangerous misuse of prescription drugs in the workplace, and (3) train supervisors to identify substance-using employees. Indicators of misuse include increased absences, decreased productivity, and involvement in accidents on- and off-the-job. Employers should consult an attorney to make sure policies do not run afoul of Americans with Disabilities Act protections for workers who legitimately need prescription pain relievers.                

Read more:                

Heroin, Prescription Opioid Overdoses Kill at Least Two Virginians Every Day                
January 28, 2016                

Untreated substance use costs Virginia state and local governments more than $600 million annually in public safety and healthcare services alone. In 2014, 80 percent of nearly 1,000 fatal drug overdoses in Virginia involved opioids. Drug overdoses claimed the lives of nearly three times as many Virginians as homicides. Opioid misuse is increasing in the state because of a plentiful prescription opioid drug supply, lack of awareness of the issue among the public and healthcare providers, and limited treatment availability. Hard-hit areas include the southwest, Southside, Hampton Roads, Richmond metropolitan area, Shenandoah Valley, and the north.                

Read more:                

Midwest News

Nebraska Bill Would Set Up and Fund Prescription Drug Monitoring                
Joanne Young, Lincoln Journal Star                
January 27, 2016                

Nebraska’s senate has unanimously advanced from the first round of debate a bill that would strengthen the state’s prescription drug monitoring program by making it accessible to all prescribers and dispensers and requiring them to report. The bill would also prohibit any patient from opting out of the monitoring system and require all human prescriptions dispensed to be entered into the system beginning Jan. 1, 2017. It would allow veterinarians to begin reporting a year later and create a task force to develop recommendations of which controlled substances would be reported by a veterinarian.                

Read more:                

What Ohioans Should Know About Drugs and Drug Testing in the Workplace                
Christina L. Corl, Plunkett Cooney, P.C.                
January 26, 2016                

In this column provided by the Ohio State Bar Association, the author answers questions about drug testing in the workplace. Questions include: Under what circumstances can an employer drug test employees? Are employees who are actively using illegal drugs or illegally using prescription drugs protected by federal employment statutes? And, if marijuana is legalized, will employers be prohibited from drug testing for the use of marijuana by employees?                

Read more:                

U.S. Drug Enforcement Administration Rolls Out Anti-Drug Initiative in St. Louis                
Robert Patrick, Saint Louis Post-Dispatch                
January 28, 2016                

The U.S. Drug Enforcement Administration’s 360 Strategy initiative in St. Louis will address opiate overdose deaths. The strategy employs traditional law enforcement efforts to combat crime. Pharmacists will help tell patients how to dispose of medications properly to ensure that they are not stolen or misused. The 360 Strategy includes $2.2 million for a public information campaign in St. Louis, Pittsburgh, Milwaukee, and West Memphis, Arkansas.                

Read more:                

West News

Arizona Bill Would Allow Families of Opiate Users to Get Overdose Drug                
Bon Christie, Associate Press                
January 26, 2016                

An Arizona House committee has approved a bill that would make it easier for family members of opiate users to get Narcan. The bill also would require the state pharmacy board to develop protocols for dispensing the drug without a prescription and would give immunity from liability to doctors, pharmacists, and anyone who dispenses the drug.                 

Read more:                

Other Resources

Opioid Overdose Prevention Toolkit—Updated 2016                
January 25, 2016                

SAMHSA has released a revised version of the Opioid Overdose Toolkit, adding information on naloxone hydrochloride to reverse overdoses. This toolkit equips healthcare providers, communities, and local governments with material to develop practices and policies to help prevent opioid-related overdoses and deaths.                

Read more:                


Drug Testing Trends                
Quest Diagnostics                
August 13, 2015                

Barry Sample, M.D., director of science and technology at Quest Diagnostics, presented findings from the Quest Diagnostics Drug Testing Index at the Drug & Alcohol Testing Industry Association annual conference in Miami. (Duration: 16:15 minutes)                



Marijuana Legalization: Trends & Hot Topics                
OraSure Technologies                
Thursday, February 25, 2016                
2:00 p.m. (ET)                

Participants will learn about trends in marijuana laws, the latest products, use, and outcomes.                

Read more:                

Talking with Youth About Marijuana: Know the Facts                
Community Anti-drug Coalitions of America                
Thursday, February 4, 2016                 
3–4:30 p.m. (ET)                

Federal and State Policy Efforts to Prevent Prescription Opioid Diversion                
American Dental Association                
Wednesday, February 10, 2016                
2:00 p.m. (CT)                

Prescription Drug Abuse in the Workplace: Prevention Strategies and Solutions                
National Safety Council                
Thursday, February 11, 2016                
2:00 p.m. (ET)                

Weed in Your Workplace: What You Need to Know                
National Safety Council                
Wednesday, April 20, 2016                
2:00 p.m. (ET)                

Grant Announcements

Research on Prescription Opioid Use, Opioid Prescribing, and Associated Heroin Risk (RFA-CE-16-003)                
Centers for Disease Control and Prevention                
Due: February 18, 2016                

Increasing Access to Medication-Assisted Treatment in Rural Primary Care Practices (R18)                
Agency for Healthcare Research and Quality                
Due: March 4, 2016                

Drug-Free Communities Support Program (SP-16-001)                
Due: March 18, 2016                

National Institute on Drug Abuse Challenge: Addiction Research: There’s an App for that                
National Institute on Drug Abuse                
Submission Period begins November 3, 2015, 9:00 a.m. (ET)                
Submission Period ends April 29, 2016, 11:59 p.m. (ET)                

Bottle Tracking Program                
National Association of Drug Diversion Investigators                
Due: Not Specified                

Take-Back Events & Drop Boxes

Kewanna (Ind.) Prescription Drug Take-Back Day—February 27, 2016                
Kewanna-Union Township Public Library                
January 25, 2016                

Ontario County (N.Y.) Collects 10,000 lbs. of Unwanted Prescription Drugs                
Victor Post                
January 23, 2016                

Ulster County (N.Y.) Medicine Drop Box Collects Over 300 lbs. of Pills in 2015                
January 25, 2016                

Arkansas Attorney General Adds Prescription Drug Take-Back Boxes to Mobile Offices                
Arkansas Office of the Attorney General                
January 27, 2016                

Clarksville (Ark.) Police Department Announces Placement of Prescription Drug Drop Box                
River Valley Leader                
January 27, 2016                

Shenandoah (Iowa) Drug Lock Box Installed                
Mike Peterson, KMA Land                
January 27, 2016                

Derry (N.H.) Police: Prescription Drug Collection Box Proving Successful                
Hunter Mcgee, New Hampshire Union Leader                
January 22, 2016                

Westchester County (N.Y.) Gets 12 New Drop Boxes for Unused Meds                
New Rochelle Talk of the Sound                
January 29, 2016                

Sheriff’s Office Opens Drug Drop Box in Sulphur (La.)                
Justin Phillips, American Press                
January 25, 2016                

Navarro County (Texas) Gets Prescription Drug Disposal Unit                
Corsicana Daily Sun                
January 23, 2016                

Upcoming Conferences and Workshops

Ensuring Access to Pain Care: Engaging Pain Medicine and Primary Care Teams                
American Academy of Pain Medicine                
February 18–21, 2016                
Palm Springs, California                

Pharmacy Diversion Awareness Conference                
U.S. Drug Enforcement Administration                
February 27–28, 2016                 
Charleston, West Virginia                

Ohio Workers’ Compensation Medical & Health Symposium                
Bureau of Workers’ Compensation                
March 10–11, 2016                
Columbus, Ohio                

2016 National Rx Drug & Heroin Summit                
March 28–31, 2016                
Atlanta, Georgia                

Third Annual Smart Approaches to Marijuana Education Summit                
March 31, 2016                
Atlanta, Georgia                


2016 Annual Conference                
International Health Facility Diversion Association                
September 13–14, 2016                
Duke Energy Convention Center                
Cincinnati, Ohio                 

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.