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January 1, 2014

 

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SAMHSA
SAMHSA Prescription Drug Abuse Weekly Update
WEEKLY
UPDATE
Issue 52  |  January 1, 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.
SURVEILLANCE IDEA OF THE WEEK
Carroll County, Md., is launching an Overdose Fatality Review Board to review each fatal overdose. The board will be patterned on the child death and family violence death review teams used in many states and localities.
Table of Content Featured Article Journal Articles and Reports News Other State and Local News Grant Announcement Take-Back Events and Drop Boxes Upcoming Conferences and Workshops

Featured Article

Stacy E.F. Melanson, Adam S. Ptolemy, and Ajay D. Wasan. 2013. “Optimizing Urine Drug Testing for Monitoring Medication Compliance in Pain Management.” Pain Medicine 14(12):1813–20, doi: 10.1111/pme.12207.

The pain management center at Harvard’s Brigham and Women’s Hospital previously reported that medication compliance monitoring by urine tests showed 14.7 percent of its patients were potentially diverting drugs, 28.7 percent were positive for nonprescribed or illicit drugs, and oral opioids had a misuse rate of 40 percent. This study looked retrospectively at 18 months of urine test data. Researchers gathered data on test volumes, positivity rates, and the frequency of false-positive results. They also reviewed the clinical utility of their testing algorithms, assay cutoffs, and adulterant panel. In addition, the cost of each component was calculated. The positivity rate for ethanol and 3,4-methylenedioxymethamphetamine were <1 percent, so they eliminated this testing from their panel. The researchers also lowered the screening cutoff for cocaine to meet the clinical needs of the pain management center. In addition, they changed their testing algorithm for 6-acetylmorphine, benzodiazepines, and methadone. For example, because of the high rate of false-negative results using their immunoassay-based benzodiazepine screen, they removed the screening portion of the algorithm and now perform benzodiazepine confirmation up front in all specimens by liquid chromatography-tandem mass spectrometry. Conducting an interdisciplinary quality improvement project allowed the authors to optimize the testing panel for monitoring medication compliance in pain management. This reduced outside laboratory costs by 15 percent and internal costs of reagents, calibrators, and quality control by $5,000 a year (roughly $2 per test battery). There were no significant savings in labor, hardware, or service.

Read more:
http://onlinelibrary.wiley.com/doi/10.1111/pme.12207/abstract

Journal Articles and Reports


Kelly L. Huffman, Giries W. Sweis, Allison Gase, Judith Scheman, and Edward C. Covington. 2013. “Opioid Use 12 Months Following Interdisciplinary Pain Rehabilitation With Weaning.” Pain Medicine 14(12):1908–17, doi: 10.1111/pme.12201.

Researchers used a longitudinal retrospective treatment outcome study in a large academic medical center with 120 patients, 32.5 percent of whom were dealing with therapeutic opioid addiction (TOA). Only those with addiction were counseled to avoid opioids for nonacute pain. The large majority of participants (77.5 percent) were predominately married, and two thirds (66.7 percent) were female. The mean age was 49.5 (±13.7), and 29.2 percent had a lifetime history of nonopioid substance use disorder. TOA was diagnosed using consensus definitions developed by the American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine to supplement the Diagnostic and Statistical Manual of Mental Disorders (fourth edition), text revision (DSM–IV–TR) criteria. Nonopioid substance use disorders also were diagnosed using DSM–IV–TR. Data including pain severity, depression, and anxiety were collected at admission, discharge, and 12 months. Opioid use during treatment was based on medical records, and use at 12 months was based on self-report. Only 22.5 percent of the patients reported resuming use at 12 months. Neither patients with TOA nor those with nonopioid substance use disorders were more likely to resume use than those without substance use disorders. Only posttreatment depression increased the probability of resumption. Chronic noncancer pain and co-occurring TOA can be successfully treated within a chronic pain rehabilitation program. Patients report low rates of resumption regardless of addiction status. This is in marked contrast to reported outcomes of nonmedically induced opioid addictions. Prolonged abstinence may depend on the successful treatment of depression.

Read more:
http://onlinelibrary.wiley.com/doi/10.1111/pme.12201/abstract

Christine Kohn, Hassan Saleheen, Kevin Borrup, Steven C. Rogers, and Garry Lapidus. 2014. “Correlates of Drug Use and Driving Among Undergraduate College Students.” Traffic Injury Prevention 15(2):119–24, doi: 10.1080/15389588.2013.803221.

Researchers conducted an anonymous, confidential, 24-question survey at a large New England public university during the 2010–11 academic year among undergraduates in courses that met a graduation requirement. Data included demographics, academics, housing status, lifestyle, personal values, high school/college drug use, and driving following alcohol use, drug use, or both, and as a passenger with a driver who used alcohol, drugs, or both. Descriptive statistics were calculated. Chi-square tests compared driver alcohol use, drug use, or both with demographic, academic, and lifestyle variables. Logistic regression analyses were performed with drugged driving as the dependent variable. Odds ratios with corresponding 95 percent confidence intervals were calculated for each of the potential explanatory variables in relation to the outcome. Of 675 students, 444 completed surveys (a 65.7 percent participation rate). Participants were representative of the student body, with a mean age of 19.4 (±1.3 years), 51 percent male, 75 percent white, and 10 percent Hispanic. Seventy-eight percent lived on campus, 93 percent had a driver’s license, and 37 percent had access to a car. Students disagreed that cannabinoids impair driving (18 percent) compared with other drugs (17 percent), stimulants (13 percent), depressants (11 percent), hallucinogens (8 percent), and alcohol (7 percent). Twenty-three percent drove after alcohol use, and 22 percent drove after drug use. Forty-one percent reported having been a passenger with a driver who had been drinking, and 37 percent with a driver using drugs. Drugged driving was more likely among males than among females (30 percent versus 14 percent; P < .01), those living off campus (34 percent versus 19 percent, P < .01), those reporting that parties are important (33 percent versus 14 percent, P < .01), those reporting that community service is not important (28 percent versus 18 percent, P < .05), those reporting that religion is not important (28 percent versus 14 percent, P < .01), and those reporting personal drug use in high school (75 percent versus 14 percent, P < .01), as well as that their best friends used drugs in high school (42 percent versus 12 percent, P < .01) and during college (50 percent versus 8 percent, P < .01). Those factors most associated with drugged driving included using drugs in high school (odds ratio [OR] = 9.5, 95 percent confidence interval [CI]: 4.6–19.6) and best friends in college used drugs regularly (OR = 6.2, 95 percent CI: 3.4–11.6).

Read more:
http://www.tandfonline.com/doi/abs/10.1080/15389588.2013.803221

Stacy E.F. Melanson, Adam S. Ptolemy, and Ajay D. Wasan. 2013. “Optimizing Urine Drug Testing for Monitoring Medication Compliance in Pain Management.” Pain Medicine 14(12):1813–20, doi: 10.1111/pme.12207.

The pain management center at Harvard’s Brigham and Women’s Hospital previously reported that medication compliance monitoring by urine tests showed 14.7 percent of its patients were potentially diverting drugs, 28.7 percent were positive for nonprescribed or illicit drugs, and oral opioids had a misuse rate of 40 percent. This study looked retrospectively at 18 months of urine test data. Researchers gathered data on test volumes, positivity rates, and the frequency of false-positive results. They also reviewed the clinical utility of their testing algorithms, assay cutoffs, and adulterant panel. In addition, the cost of each component was calculated. The positivity rate for ethanol and 3,4-methylenedioxymethamphetamine were <1 percent, so they eliminated this testing from their panel. The researchers also lowered the screening cutoff for cocaine to meet the clinical needs of the pain management center. In addition, they changed their testing algorithm for 6-acetylmorphine, benzodiazepines, and methadone. For example, because of the high rate of false-negative results using their immunoassay-based benzodiazepine screen, they removed the screening portion of the algorithm and now perform benzodiazepine confirmation up front in all specimens by liquid chromatography-tandem mass spectrometry. Conducting an interdisciplinary quality improvement project allowed the authors to optimize the testing panel for monitoring medication compliance in pain management. This reduced outside laboratory costs by 15 percent and internal costs of reagents, calibrators, and quality control by $5,000 a year (roughly $2 per test battery). There were no significant savings in labor, hardware, or service.

Read more:
http://onlinelibrary.wiley.com/doi/10.1111/pme.12207/abstract

Lynn R. Webster. 2014. “New Policing Role for Pharmacists Undermines Partnership With Prescribers.” Pain Medicine 14(11):1619–20. doi: 10.1111/pme.12290.

Lynn R. Webster, president of the American Academy of Pain Medicine, shares a message about Walgreens Pharmacy’s new policy regarding processing prescriptions for controlled substances. Walgreens directs its pharmacists, at the point of dispensing, to contact prescribers for such detailed medical information as diagnoses, patient treatment plans, expected length of therapy, and previously tried medications. The American Academy of Pain Medicine (AAPM) shares the same concerns as prescribers, but it believes this policy threatens the physician–pharmacist partnerships. The passage of a resolution by the American Medical Association (AMA) House of Delegates is a good example. It calls for an end to what it terms “pharmacy intrusion into medical practice.” The AMA said that it would, if necessary, support legislative and regulatory measures to block pharmacists from interfering in the timely delivery of legitimate medical care. The AAPM suggests areas to explore to streamline the processes and to prevent barriers from being erected because of the policy.

Read more:
http://www.ncbi.nlm.nih.gov/pubmed/24238350

News


For Young People Addicted to Painkillers, the Path Less Taken—Why?
The Huffington Post
December 21, 2013

Partnership at Drugfree.org CEO Stephen J. Pasierb and Treatment Research Institute CEO A. Thomas McLellan share their views about medication-assisted treatment and the necessity of substance-abuse professionals’ helping families understand what such treatment is and how it is used. The two recommend that families look for three things when seeking comprehensive addiction treatment for their teens: a) the availability of professional counseling, b) medications and regular monitoring for the affected teen, and c) family therapy to help that teen. They also mention methadone, buprenorphine, and naltrexone as being successful when used as an integral part of a broader addiction treatment plan and continuing care. Pasierb and McLellan encourage families to insist that their treatment providers offer these medications as part of a treatment plan for teen and young adult patients who are struggling with a prescription opioid addiction.

Read more:
http://www.huffingtonpost.com/stephen-j-pasierb/teen-addiction_b_4473606.html

Why America Has a Prescription Drug Epidemic: To Regulate or Educate? No Question—You Do Both
The Huffington Post
December 20, 2013

Adam Winstock, founder of Global Drug Survey, shares his solutions for reducing prescription drug abuse. Two of them are regulating the pharmaceutical industry and banning consumer advertising. Two years ago, Global Drug Survey started exploring the use of prescription medications such as sleeping tablets and pain relievers.

Read more:
http://www.huffingtonpost.com/adam-winstock/why-america-has-a-prescri_b_4482058.html

Killing Pain: Tramadol the ‘Safe’ Drug of Abuse
MedPage Today
December 22, 2013

This article discusses the abuse potential of tramadol and the push to make it a controlled substance. A Journal Sentinel–MedPage Today investigation discovered that the U.S. Food and Drug Administration (FDA) overlooked key evidence indicating tramadol had the potential to be abused and decided not to put tramadol under the Controlled Substance Act. The FDA decision was based largely on research in which the drug was injected. The FDA also weighed evidence from Europe, where tramadol had been on the market for years. However, the FDA also had research showing that when given to opioid abusers orally in high doses, rather than being injected, it produced opiate-like effects similar to oxycodone. Opioid companies paid doctors and nonprofit medical societies to use the drugs in treating chronic, noncancer pain. An analysis by the Journal Sentinel and MedPage Today revealed that tramadol was linked to 20,000 emergency room visits nationwide in 2011. In Florida alone, there were 379 overdose deaths involving tramadol in 2011, more than triple the 106 tramadol-related deaths that occurred in 2003. In Milwaukee County, Wis., in a period beginning in 2010 and continuing through October 2013, 20 persons died of drug overdoses involving tramadol, according to records from the Medical Examiner’s Office. Ten states already have listed tramadol as a controlled substance. In February 2013, Great Britain’s Advisory Council on the Misuse of Drugs recommended that tramadol become a scheduled drug. Last month, the Drug Enforcement Agency recommended that it be put under schedule 4 of the act after receiving four petitions. Now, the FDA has recommended making it a controlled substance.

Read more:
http://www.medpagetoday.com/PainManagement/PainManagement/43554

Other State and Local News


Maryland, Carroll County Develop Plans to Combat Opioid Dependence
Carroll County Times
December 22, 2013

The state of Maryland and Carroll County, Md., implemented measures they hope will reduce the abuse of prescription pain relievers and heroin. Maryland created a statewide Opioid Overdose Prevention Plan in 2010, which resulted in the development of the newly launched Prescription Drug Monitoring Program, and required local jurisdictions to draft their own prevention plans. In 2011, Carroll County health officials sent a letter to local physicians about the trend in prescription drug abuse treatment admissions and urged them to educate patients on proper medication usage, the potential for abuse, disposal guidelines, and the locations of the county’s medication disposal sites. Dentists were added to the mailing list the following year, and the county alerted them of the spread of adolescent “pharm parties” with prescription drugs smuggled from medicine cabinets. Carroll County began implementing its Opioid Overdose Prevention Plan in July. The county submitted its letter of intent to participate in Maryland’s new naloxone program. An Overdose Fatality Review Board to review each fatal overdose launches in January 2014.

Read more:
http://www.carrollcountytimes.com/news/local/maryland-carroll-county-develop-plans-to-
combat-opioid-dependence/article_77cfe796-2836-5fdf-b708-dde8bb38e126.html


What if Holiday Stress Leads to Prescription Drug Abuse?
KUHF
December 23, 2013

This article and audio (2 minutes, 30 seconds) discuss how stress and depression could cause an increase in prescription drug misuse or overdose around the holidays. Some people find the holidays overwhelming and are unable to cope with family and guests visiting. Individuals drink more alcoholic beverages during this time, which puts them at a higher risk if they are using narcotic pain relievers.

Read more:
http://app1.kuhf.org/articles/1386612445-What-If-Holiday-Stress-Leads-To-Prescription-Drug-Abuse.html

‘Typical’ Heroin User in Connecticut Is White, Male, Suburban; Often Unaware of What [He Is] Actually Using
New Haven Register
December 21, 2013

The heroin addict who needs help in Connecticut is likely to be white, suburban, and young. For economic reasons, he or she may have switched from prescription narcotics to heroin. A typical heroin user also does not know exactly what he is smoking, snorting, or injecting. This snapshot of a heroin user emerged from statistics on heroin-related deaths released by the state office of the chief medical examiner. The Department of Mental Health and Addiction Services reported that admissions for heroin abuse were 11,677 in 2010. They increased to 15,584 in 2011 and to 15,727 in 2012. During the same period, admissions for treatment of prescription drug abuse rose from 2,517 in 2010 to 3,410 in 2011 and to 3,457 in 2012.

Read more:
http://www.nhregister.com/general-news/20131221/8216typical8217-heroin-user-in-connecticut-is-white-
male-suburban-often-unaware-of-what-they8217re-actually-using


West Vancouver MP Wants People to Lock Up the Medicine Chest
North Shore News
December 22, 2013

West Vancouver, British Columbia, Medical Practitioner John Weston met with stakeholders in Ottawa, Ontario, to discuss raising public awareness about prescription drug abuse. He wishes to expand the prescription drug dropoff event by declaring dates for the next few years. He hopes that educating the public on safe and effective ways to dispose of unused prescription drugs will help curb the problem. Currently, prescription drugs can be dropped off at pharmacies year-round.

Read more:
http://www.nsnews.com/news/west-vancouver-mp-wants-people-to-lock-up-the-medicine-chest-1.768180

Crouse Hospital Expanding Its Methadone Program as Painkiller, Heroin Addiction Grows Syracuse.com
December 20, 2013

Crouse Hospital in Syracuse, N.Y., is expanding its methadone program from 500 persons to 800, in response to a surge in prescription pain reliever and heroin addiction. The demand is so great for treatment services that addicts sometimes wait a year before they can get into the program, according to Mark Raymond, clinical supervisor of the program. Crouse expects to gradually expand the methadone program over the next two years.

Read more:
http://www.syracuse.com/news/index.ssf/2013/12/crouse_hospital_expanding_its_methadone_
program_as_painkiller_heroin_addiction_g.html

Grant Announcement


Medical Toxicology Foundation Research Award: Prescription Drug Abuse Prevention
American College of Medical Toxicology
Deadline: 11:59 pm EST, February 14, 2014
http://www.acmt.net/MTF_Prescription_Research_Award.html

Take-Back Events and Drop Boxes


Prescription Medication Drop Box Installed at Pennsville Police Station
South Jersey Times
December 23, 2013
http://www.nj.com/salem/index.ssf/2013/12/prescription_medication_drop_box_
installed_at_pennsville_police_station.html


Drop Boxes Aim to Keep Meds off Clarksville Streets
The Tennessean
December 23, 2013
http://www.tennessean.com/article/DA/20131223/NEWS01/312230028?nclick_check=1

Upcoming Conferences and Workshops


What Every Health Professional Should Know About Prescription Drug Abuse
Wednesday, January 22, 2014
8:30 a.m. to 3:30 p.m.
Brea Community Center
695 Madison Way
Brea, Calif.

This conference will help participants identify adverse consequences, trends, and signs associated with prescription drug abuse; identify strategies to prevent prescription drug misuse and diversion; and list the benefits of using the California Prescription Drug Monitoring Program.

Read more:
http://www.cspinc.org/Prescription%20Drug%20Abuse%20Conference

Lecture: Prescription Drug Use: The Dos and the Don’ts
January 29, 2014
Huntley, Ill.
http://centegra.org/event/lecture-prescription-drug-use-dos-donts/

Twenty-Fourth National Leadership Forum: The Power of Movement
February 3–6, 2014
National Harbor, Md.
http://forum.cadca.org/

SAMHSA’s 10th Prevention Day: The Power of Prevention: Strengthening Behavioral Health and Public Health for the Next Decade
February 3, 2014
National Harbor, Md.
http://forum.cadca.org/?q=node/59

Collaborative Perspectives on Addiction: ‘Changing Addictive Behavior: Bench to Bedside and Back Again’
February 28 and March 1, 2014
Atlanta, Ga.
http://www.apadivisions.org/addiction-perspectives.aspx

Pain Management Through a Wide Lens: Balancing Safety and Effectiveness
March 8, 2014
St. Louis, Mo.
http://aspmnstlouisregional.org/2014-conference-information-and-registration.html

Eleventh Annual World Health Care Congress
April 7–9, 2014
National Harbor, Md.
http://www.globalmedicalmeetings.com/events/hr14000

National Rx Drug Abuse Summit
April 22–24, 2014
Atlanta, Ga.
http://nationalrxdrugabusesummit.org

Prescription Drug Abuse and Diversion Crimes
June 10, 2014
Cottleville, Mo.
http://www.thepoliceacademy.org/web/documents/2014.6.10.%20Prescription.pdf
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.