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February 6, 2013

SAMHSA Prevention of Prescription Drug Abuse in the Workplace Listserv

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February 6, 2013 (PDF version)

Featured Article 

Internet Drug Outlet Identification Program: Progress Report for State and Federal Regulators 
National Association of Boards of Pharmacy 
January 2013
This report provides an overview of the National Association of Boards of Pharmacy's (NABP's) research and education efforts over the past 5 years. NABP educates the public about the danger of websites illegally selling prescription drugs, which may have contributed to the prescription drug abuse epidemic in the United States. Of the 9,938 known Internet drug outlets, 4,839 offer foreign or non-Food and Drug Administration-approved drugs; 8,701 do not require a valid prescription; 2,302 have a physical address located outside of the United States (most rogue sites post no address whatsoever); and 1,121 dispense controlled substances.

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Related Press Release 
Education and Collaboration Key to Continued Progress in Fighting Rogue Online Prescription Drug Sellers, Reports NABP 
The Wall Street Journal 
January 25, 2013
The related press release discusses NABP's report, which outlines how continued collaboration among global stakeholders is vital for eliminating the public health threats posed by rogue Internet drug outlets. The report details the Association's 5-year progress providing data on illegal online drug sellers to public agencies and private entities. More than 10,000 websites were analyzed and nearly 97 percent did not comply with U.S. pharmacy laws and practice standards.
The report describes collaborative and global efforts to protect patients from dangerous products distributed by illegal online sellers. Efforts include working with search engines such as Google, Bing, and Yahoo to block online advertisements and participating, with other stakeholders, in a December 2010 White House forum to address the problem of counterfeit medications and their frequent distribution through the Internet. NABP will continue to review and monitor websites selling prescription drugs.

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Journal Articles

Lynn E. Fiellin, Jeanette M. Tetrault, William C. Becker, David A. Fiellin, and Rani A. Hoff. 2013. "Previous Use of Alcohol, Cigarettes, and Marijuana and Subsequent Abuse of Prescription Opioids in Young Adults." Journal of Adolescent Health 52(2):158-63.

Demographic/clinical data from community-dwelling individuals was used in the 2006-08 National Survey on Drug Use and Health to explore links between alcohol, cigarette, and/or marijuana use during adolescence and subsequent abuse of prescription opioids during young adulthood. Previous alcohol, cigarette, and marijuana use were associated with current abuse of prescription opioids among 18- to 25-year-old men, but only marijuana use was associated with subsequent abuse of prescription opioids among young women.

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Vikas H. Patel, Michael A. Schindlbeck, and Sean M. Bryant. 2013. "Delayed Elevation in Carbamazepine Concentrations After Overdose: A Retrospective Poison Center Study." American Journal of Therapeutics. doi:10.1097/MJT.0b013e3182258e51.

The study's objective was to report frequency of toxic carbamazepine (Tegretol, a mood stabilizer used off-label to treat attention deficit-hyperactivity disorder) concentrations that continue to rise, and estimate how often an initially therapeutic or subtherapeutic concentration misrepresents the potential toxicity of an acute carbamazepine overdose. An 8-year retrospective search of all carbamazepine exposures reported to the Illinois Poison Center (January 1, 2001 through December 31, 2008) was reviewed. Certain patients had progressive decreases in level of consciousness, which corresponded with increasing carbamazepine concentrations. Additionally, several patients with initial levels of therapeutic or subtherapeutic concentrations later became comatose and required ventilator management. Initial serum carbamazepine concentrations can be misleading. Serial measurements documenting a declining carbamazepine concentration or prolonged observation are recommended when managing these overdoses.

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News and Reports

Thieves Target Open Houses for Prescription Drugs 
February 1, 2013
In San Diego, California, thieves are posing as potential home buyers to target prescription drugs while attending open houses--a method in which drugs appear to be entering the black market, according to the Drug Enforcement Administration. Thieves are looking for drugs including opioid painkillers, attention deficit-hyperactivity disorder drugs, anti-anxiety medication, and muscle relaxers such as Xanax and Valium.

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Spike in Stimulant Abuse Packs ERs With Students 
Denver Post 
January 30, 2013
This article discusses results from a study conducted by the Substance Abuse and Mental Health Services Administration, which showed 63 percent of emergency room visits involving certain stimulants included use of another substance (anti-anxiety and sleep medications, painkillers, and alcohol were among the highest used). The article also describes interviews of college students with and without attention deficit-hyperactivity disorder diagnoses about their use of Adderall and Ritalin on campus.

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Coalitions in Action: Bucks County Coalition Uses Comprehensive Approach to Address Medicine Abuse
Community Anti-Drugs Coalition of America
January 31, 2013
Bucks County Promise for Youth and Communities--a consortium of coalitions in Bucks County, Pennsylvania--is striving to combat medicine abuse. When teens saw abuse rates increase, they implemented countywide prevention strategies, distributing information and collecting eight tons of unused, unwanted, and expired medications at 23 permanent drop boxes throughout the county. As a result, the coalition has reduced prescription drug and over-the-counter medicine abuse.

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Hoarding Drugs Is Bad Medicine, Even If Your Intentions Are Good
The Washington Post
January 28, 2013
Hoarding medicine can be hazardous. This article provides five tips for avoiding trouble.

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Legal Drugs, Lethal Highs 
North Shore Outlook 
January 30, 2013
Details of a panel discussion about the prescription drug abuse epidemic in Vancouver, British Columbia (Canada) are highlighted in this article. Topics included the community's challenges with pill parties and fentanyl abuse. Ontario health officials estimated fentanyl misuse caused more than 250 deaths in the province between 2009 and 2011.

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Substance Use Disorder in the U.S. Armed Forces 
Institute of Medicine 
September 17, 2012
A new study says substance abuse among U.S. troops has become a "public health crisis" and the Pentagon's methods for dealing with it are outdated. The report notes that although rates of illicit drug abuse are relatively low, the rate of medication misuse--particularly opioid painkiller misuse--has risen sharply. Eleven percent of active-duty personnel reported misusing prescription drugs in 2008--up from 2 percent in 2002. Prescription drug abuse is rising faster among military members than among civilians.

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ADHD Medication Abuse Rises Sharply 
January 29, 2013
The number of emergency department visits involving attention deficit-hyperactivity disorder medications among people ages 18 to 25 rose from 2,131 in 2005 to 8,148 in 2010, according to a study conducted by the Substance Abuse and Mental Health Services Administration. Similarly, the number of such visits increased from 1,754 to 6,094 among people ages 26 to 34 and from 2,519 to 7,957 among people over age 35 during the same period.

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NHL Drug Testing Committee Looking Into Ambien 
Sports Illustrated
February 1, 2013
The article discusses the National Hockey League's (NHL's) efforts to form a drug testing committee to study stimulant and amphetamine use and make recommendations, including whether or not to establish a testing program. The League wants to add certain stimulants to its prohibited substances list--an idea rejected by the National Hockey League Players' Association (NHLPA). Therefore, a player taking Adderall without a prescription would not be violating any rule. NHL and NHLPA have established a joint committee to study players' Ambien use. Now, each team must designate a staff member to record and monitor the prescription drug use of all players.

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OTC 'Study Aide' Supplements That Mimic Adderall Are Unregulated and Potentially Dangerous: Report
New York Daily News
January 30, 2013
ADDTabz and ADDERx are dietary supplements similar to Adderall. Dietary supplements, however, do not need FDA approval. The company behind the supplements admits to reformulating the prescription drug's ingredients for mass consumption. A Johns Hopkins University doctor says some of the chemicals are only found in prescribed medicines. Their side effects concern health experts.

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Rx for Understanding
NEA Health Information Network 
Accessed February 1, 2013
This guide contains five sequenced lessons for grades 5 to 6 and five sequenced lessons for grades 7 to 8. Each set of lessons acts as a mini unit and the grade-level-based mini units focus on the same five themes: relating the issue of prescription drug safety to overall health; understanding proper use; understanding misuse; understanding abuse; and conducting an application-based culminating project. The lessons in this guide represent a cross-curricular approach to teaching with an emphasis on national education standards, including the National Health Education Standards and Common Core State Standards for English Language Arts and Mathematics.

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Related Article 
Rx for Understanding: Free Online Tool to Teach Students 
The Partnership at Drugfree.org 
January 29, 2013
This commentary highlights Rx for Understanding, an educational tool created by the National Education Association that includes 10 cross-curricular lessons to help middle school students avoid the dangers of misusing and abusing prescription drugs. By focusing on three basic concepts (proper use, misuse, and abuse), the lessons will help build knowledge and skills needed by young people. Rx for Understanding was developed and pilot tested with input from educators throughout the country. Users report the lessons are "easy to use" and "accessible." Because they are aligned with various content areas, lessons can be included in various parts of middle school curricula.

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Rx for Danger: Legal Maneuver Could Help Doctors in Pill-Mill Cases
Orlando Sentinel
January 25, 2013
Doctors suspected of running pill mills in Florida are charged under the state's broad prescription drug-trafficking law--a first-degree felony that comes with a potential 25-year prison term. However, some defense attorneys are arguing that physicians should be charged under a rarely used Florida law written for practitioners accused of improper prescribing practices--a third-degree felony with up to 5 years in prison.

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Ameritox Leadership Supports Lawmakers, Pain Practitioners, and Patients Confronting Crisis in Pain Medication Abuse 
PR Newswire 
January 31, 2013
This news release discusses a Capitol Hill briefing that educated legislators about safe treatment for those suffering from chronic pain. The briefing was sponsored by the Coalition for Excellence in Medication Monitoring--of which Ameritox is a founding member. Dr. Leider, Ameritox's Chief Medical Examiner, emphasized the value of using tools like pain medication monitoring, which provides physicians with information to make sound treatment decisions that can help keep patients safe. Ameritox also supports the use of urine drug monitoring for physicians treating chronic pain patients.

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Elk River Treatment Program Reports on Adolescent Prescription Drug Abuse 
PR Web 
January 29, 2013
The Elk River Treatment Program's recent research suggests adolescent males are likelier to be diagnosed with attention deficit-hyperactivity disorder or attention deficit disorder and treated with stimulant medication. When stimulant medication is abused by males, they report a high similar to that achieved with cocaine and methamphetamines.

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Drowned in a Stream of Prescriptions 
The New York Times 
February 2, 2013
This in-depth story about a young man who struggled with Adderall abuse and his parents' mission to get him help includes segments about the doctors who skipped established diagnostic procedures, renewed prescriptions reflexively, and spent too little time with the patient to accurately monitor his side effects. His parents begged doctors to stop prescribing the medication to their son, but he kept convincing them he needed it for his attention deficit-hyperactivity disorder.

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Panel Prods FDA to Restrict Hydrocodone, Ingredient in Prescription Painkillers 
January 28, 2013
A Food and Drug Administration (FDA) advisory panel recommended that hydrocodone, a Schedule III drug, be included in the more restrictive Schedule II category. In this case, the FDA would limit how much hydrocodone a patient could obtain between doctor visits. The FDA has not said when it would act on the recommendation.

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Related Articles
FDA Panel Calls for Greater Restrictions on Hydrocodone 
Medscape Today News 
January 28, 2013
Many people felt the FDA's vote of 19 to 10 to recommend tighter restrictions on hydrocodone sends a strong message to physicians and the public about the abuse potential of hydrocodone combination products. In addition, several people mentioned the fact that death rates from hydrocodone combination drug overdoses have tripled during the last 20 years.

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FDA Attempt to Curb Prescription Drug Deaths Concerns Transgender Individuals
January 27, 2013
This author argues that the FDA's potential reclassification of hydrocodone as a Schedule II narcotic could negatively affect transgender patients who legitimately obtain the drug for treatment in gender reassignment.

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FDA Action on Vicodin May Mean More Pain, Not Less Addiction or Overdose 
January 31, 2013
This article discusses the FDA's new ruling to impose stricter controls on prescriptions for drugs like Vicodin. The rules would ban prescribing of more than a month's supply of hydrocodone-containing drugs and prevent refills without a new doctor visit. According to the article, the majority of people who become addicted to opioids don't get hooked after receiving legitimate prescriptions for pain treatment. Less than 1 percent of people in treatment for chronic pain (without a prior history of drug problems) became addicted to the medication. Some medical professionals don't think this will reduce addiction or overdoses, but instead will make it harder for those suffering with chronic pain to obtain the drug.

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FDA Likely to Add Limits on Painkillers 
The New York Times 
January 25, 2013
An advisory panel of experts for the FDA voted 19 to 10 to toughen restrictions on painkillers that contain hydrocodone (like Vicodin). The recommendation would limit access to the drugs by making them harder to prescribe. Some opponents expressed skepticism that the change would do much to combat abuse. They also said it could create unfair obstacles for patients in chronic pain.

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Recreational Prescription Drug Use Continues to Plague College Campuses 
Highbrow Magazine 
January 16, 2013
A college student who abused Ambien and Adderall provides his perspective. Twenty-two percent of college students have illicitly used drugs, and roughly 6 percent of adults ages 18 to 25 take prescription drugs for nonmedical uses, according to a report conducted by the Substance Abuse and Mental Health Services Administration.

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Delaware School Survey: Alcohol, Tobacco, and Other Drug Abuse Among Delaware Students 2010 
University of Delaware, Center for Drug and Alcohol Studies
Accessed January 30, 2013
Trends in prescription drug abuse include reported use of painkillers by 11th graders at its highest (12 percent) in 2003. The rate dropped to 10 percent in 2010. Psychoactives, downers, and uppers followed painkillers in the list of most abused "other illegal drugs." One percent of 8th graders and 5 percent of 11th graders reported use of Ritalin and similar drugs to get high in the past year.
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Also available, http://www.udel.edu/cdas/Files/2011StateReport.pdf

Related Article 
Red Clay Fights Drug Use 
The News Journal
January 25, 2013
The Red Clay Consolidated School District (Delaware) announced a new initiative led by five school nurses to help raise awareness of prescription drug abuse and work toward prevention. They provide a free research-based prescription drug abuse education and prevention program, "Smart Moves/Smart Choices," from the National Association of School Nurses in each middle and high school in the district. For elementary school children, they are using the "Up and Away Program" created by the Centers for Disease Control and Prevention that encourages adults to keep their children safe from prescription drugs in the home. University of Delaware's Center for Drug and Alcohol Studies showed that in 2010, painkillers were the most commonly abused drugs among 8th and 11th graders, after tobacco, alcohol, and marijuana. Ten percent of juniors said they used painkillers that year.

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Report: Twin Cities Heroin Use Rising, Opiate Use May Be Slowing 
Minnesota Public Radio 
January 28, 2013
This article includes a brief audio (2:36) about heroin, which accounted for 12.5 percent of admissions to addiction treatment in the first half of 2012 compared with 10.7 percent in 2011. Other opiates, mostly prescription painkillers, accounted for 9 percent of treatment admissions in the first half of 2012 compared with 9.5 percent in 2011.

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Rules Could Hurt Maine Drug Takeback Programs 
Morning Sentinel 
January 27, 2013
Federal and state proposals could erode healthcare savings and pave the way for less ecologically sound disposal methods. Changes proposed by the Drug Enforcement Administration would forbid takeback programs from gathering data on which drugs are being returned and in what amounts. This data has been used to reduce costs associated with the state's Medicaid program by imposing 15-day limits on initial prescriptions of often-wasted drugs--many of which are opiates, according to the article. Researchers have counted drugs returned to collection boxes at Maine pharmacies while under close supervision by law enforcement. But the proposed federal rules say collected drugs "may not be individually handled, counted, inventoried, or otherwise discerned."

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9 Pulaski Students Expelled for Selling Drugs; 10 May Face Charges 
Greenbay Press-Gazette 
January 25, 2013
The Pulaski School District in Wisconsin recently expelled nine students, and one more left the district after school administrators discovered they were selling a variety of prescription drugs at the school. The group included seven freshmen, a sophomore, a junior, and a senior, and the drugs were mostly treatments for attention deficit disorder. Two of the ninth graders were girls; the rest were boys. Pulaski police are recommending the students be charged with selling Schedule II narcotics at a school.

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Other Resources
The Lock Your Meds® Campaign 
Informed Families/The Florida Family Partnership 
January 2013
Download free tools to spread awareness and take action against prescription drug abuse. The target audience for Lock Your Meds® is 20- to 80-year-old adults, with a primary focus on keeping prescription and over-the-counter pharmaceuticals away from drug abusers.

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U.S. Pain Network Launches Nevada Pain Management Website for Patient Education and Assistance 
PR Web 
January 28, 2013
The U.S. Pain Network has launched the Nevada Pain Network website, which provides more than 100 pages of pain management education while offering pain clinic, chiropractic, physical therapy, and acupuncture provider options for those interested.

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OHSAA Sets Prescription Drug Abuse Prevention Contest
Chillicothe Gazette 
January 29, 2013
The Ohio High School Athletic Association's Prescription for Prevention Campaign has launched a contest for students to help prevent prescription drug abuse. Students are invited to use their creativity in the form of an infographic, website, video, or poster to present five of eight facts highlighting prescription drug abuse throughout the state and among teens and young adults.

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Upcoming Webinar
The Intersection of Suicide Research and Public Health Practice: Suicide and the Military 
Wednesday, February 13, 2013 
2 p.m. to 3 p.m. (EST)
The Children's Safety Network Injury Control Research Center for Suicide Prevention is providing a Webinar designed for researchers and state or local practitioners in injury or suicide prevention. Suicide among our nation's veterans and approaches the Veterans Administration is taking to reduce suicide will be discussed. The Webinar will also provide information about the Statewide Advocacy for Veterans' Empowerment Program of the Massachusetts Department of Veterans' Services.
Follow-Up Conference Call  
Wednesday, February 20, 2013 
2 p.m. to 3 p.m. (EST)
This call will provide an opportunity to participate in an in-depth discussion of materials presented during the Webinar.

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Save the Date!
The Substance Abuse and Mental Health Services Administration Will Present Its Second Prescription Abuse Workplace Webinar: Responding to the Nation's Prescription Abuse Crisis 
Thursday, February 28, 2013 
2 p.m. to 3:30 p.m. (EST)

The Webinar will focus on how the nation is responding to the prescription drug abuse crisis--classifying current and conceptually appropriate responses. It will examine how selected workplaces and communities are structuring their responses and identify evidence-based individual prevention programs with prescription drug abuse content, as well as a wide range of environmental prevention approaches. Other approaches for discussion will include screening and brief/early intervention, treatment, and harm reduction through distribution of naloxone to those with prescriptions for opioid painkillers. Finally, the Webinar will describe the Substance Abuse and Mental Health Services Administration's Prescription Abuse Workplace (PAW) Technical Assistance Center and the resources it offers. 
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.
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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