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January 15, 2015


SAMHSA Prescription Drug Abuse Weekly Update
Issue 105  |  January 15, 2015
The Prevention of Prescription Drug Abuse in the Workplace (PAW) TA Center addresses prescription drug abuse—a growing public health problem with increasing burdens on workers, workplaces, and our economy. To subscribe colleagues, family members, or friends to this listserv sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), please click here or send their e-mail addresses to paw@dsgonline.com.
Table of Content Featured Journal Articles and Reports Professional Education National News International News Northeast/Mid-Atlantic News South News Midwest News West News Other Resources Grant Opportunity Grants Received Take-Back Events and Drop Boxes Abstracts from the 2014 Annual Meeting of the College on Problems of Drug Dependence Upcoming Conferences and Workshops


Oregon Docs to Feds: Hands Off Our Prescription Drug Info
Elizabeth Hayes, Portland Business Journal
January 8, 2015

Last month, the Oregon Medical Association (OMA) filed a friend-of-the-court brief in the state's ongoing lawsuit questioning the Drug Enforcement Administration's access to and use of the prescription monitoring program database. The American Medical Association and eight other state medical associations signed on to support the OMA in the brief. The suit is pending before the U.S. Ninth Circuit Court of Appeals.

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Journal Articles and Reports

R.N. Jamison, K.A. Sheehan, E. Scanlan, M. Matthews, and E.L. Ross. 2014. "Beliefs and Attitudes About Opioid Prescribing and Chronic Pain Management: Survey of Primary Care Providers." Journal of Opioid Management 10(6):375–82, doi:10.5055/jom.2014.0234.

A survey with responses from 56 primary care providers (PCPs) at eight centers found they had "adequate opioid knowledge." Most expressed concern about medication misuse (89 percent), said managing patients with chronic pain was stressful (84 percent), and were worried about addiction (82 percent). Less than half felt they were sufficiently trained in opioid prescribing (46 percent). Compared with older providers, younger PCPs were less knowledgeable about opioids and more reluctant to prescribe them, experienced more stress in managing patients with pain, had less overall confidence in managing those patients, and worried more about opioid dependence (p < 0.05).

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E. Kavukcu, M. Akdeniz, H.H. Avci, M. Altuğ, and M. Öner. 2014. "Chronic Noncancer Pain Management in Primary Care: Family Medicine Physicians' Risk Assessment of Opioid Misuse." Postgraduate Medicine, doi:10.1080/00325481.2015.993572.

Researchers educated a subset of 36 family physicians working at Family Health Centers affiliated with the Antalya Provincial Directorate of Health (Turkey) on assessing opioid misuse risk. Before the education, 61 percent reported concern and hesitation in prescribing opioids because of known risks, such as overdose, addiction, dependence, or diversion, and agreed family physicians should apply risk assessment before using opioids for chronic noncancer pain. Seventeen percent said risk assessment was unnecessary, and 22 percent were undecided. With education, the stated willingness to apply risk assessment before starting opioids rose from 47 percent to 78 percent, but the actual increase in self-reported use 6 months later was modest.

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P. Veliz, Q. Epstein–Ngo, E. Austic, C. Boyd, and S.E. McCabe. 2014. "Opioid Use Among Interscholastic Sports Participants: An Exploratory Study from a Sample of College Students." Research Quarterly for Exercise and Sport, doi:10.1080/02701367.2014.983219.

A Web-based survey of 4,187 full-time undergraduate students at a large midwest public university found those who participated in at least one interscholastic sport during high school had greater odds of lifetime medical prescription opioid use on multiple occasions and greater odds of being approached to divert prescribed opioid medications on multiple occasions. (Editor's note: These differences probably result from a higher serious injury rate.)

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P. Voon, C. Callon, P. Nguyen, S. Dobrer, J.S. Montaner, E. Wood, and T. Kerr. 2014. "Denial of Prescription Analgesia Among People Who Inject Drugs in a Canadian Setting." Drug and Alcohol Reviews, doi:10.1111/dar.12226.

Two thirds of a convenience sample of 462 people who inject drugs said they had been denied prescription analgesia. Having ever experienced this denial was more likely for people who had been enrolled in methadone maintenance treatment (odds ratio [OR] 1.76) or who injected cocaine daily (OR 2.38). The most common reason for denial was an accusation of drug seeking (44 percent). Among those denied, 40 percent bought the requested medication off the street, and 39 percent bought heroin.

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Professional Education

S. Conroy and D. Hill. 2014. "Failure to Identify or Effectively Manage Prescription Opioid Dependence Acted as a Gateway to Heroin Use—Buprenorphine/Naloxone Treatment and Recovery in a Surgical Patient." BMJ Case Reports, doi:10.1136/bcr-2014-207458.

Researchers reported the case of a young mother who became opioid dependent after being prescribed dihydrocodeine for postoperative pain. When her prescription was stopped without support, she briefly used heroin to overcome withdrawal. After re-exposure to dihydrocodeine following surgery 9 years later and treatment with methadone for dependency, she was transitioned to buprenorphine/naloxone. The patient is still in treatment but has returned to work on buprenorphine 16 mg/naloxone 4 mg, in conjunction with social and psychological support.

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L.R. Webster, G.M. Reisfield, and N. Dasgupta. 2014. "Eight Principles for Safer Opioid Prescribing and Cautions with Benzodiazepines." Postgraduate Medicine, doi:10.1080/00325481.2015.993276.

Provision of long-term opioid analgesic therapy for chronic pain requires a careful risk–benefit analysis followed by clinical safety measures to identify and reduce misuse, abuse, and addiction and associated morbidity and mortality. Benzodiazepines prescribed for comorbid insomnia, anxiety, and mood disorders heighten the risk of respiratory depression and other adverse outcomes when combined with opioid therapy. An earlier literature review offers eight principles for safer opioid prescribing.

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National News

University of Georgia Researchers to Study Whether Laws on Painkillers Impact Patients
Albany Herald
January 4, 2015

The University of Georgia School of Public and International Affairs received a Robert Wood Johnson Foundation grant to evaluate whether prescription monitoring programs are keeping opioids from patients who need them. The study will analyze Medicare Current Beneficiary Survey data.

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Top 10 Issues for Physicians to Watch in 2015
American Medical Association
January 2, 2015

The American Medical Association's (AMA's) list of top 10 issues physicians should monitor in 2015 includes prescription abuse and overdose. The AMA will continue to lead policy development around these issues in states and nationally, engage physicians in practical activities to prevent prescription abuse, and allow pain management for patients who need it.

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Heroin Use Is a Public Health Emergency That Calls for Legislative Solutions
Editorial Board, The Washington Post
January 2, 2014

To address rising heroin overdoses, The Post's editorial board thinks more states need to quickly enact bills to expand naloxone use and enact Good Samaritan laws. The board urges states to declare heroin addiction a public health emergency and establish more readily available long-term treatment programs. They also encourage states to consider measures that crack down on doctors and pharmacists who illegally or inappropriately prescribe and dispense opiates.

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International News

Immigration Officials Face Booze, Drug Tests
The Canberra Times
January 7, 2015

Australia's Immigration Department implemented 18 new workplace policies that will allow managers to use breathalyzers and drug tests on 8,000 public servants with blood alcohol level thresholds above .02 or those "impaired" by illegal or prescription drugs while on duty. A positive test will result in a code-of-conduct investigation that could lead to termination.

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Busy Students Turning to Prescription Drugs
Eliza Edwards and Andrew Purcell, The Sydney Morning Herald
January 3, 2015

The National Drug and Alcohol Research Centre commissioned a survey seeking information about prescription stimulant misuse from students at four Australian universities. An earlier study found 8 percent of undergraduates had misused these drugs.

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Northeast/Mid-Atlantic News

NY State Ready to Deploy New Weapon in the Battle Against Prescription Drug Abuse
Business Wire
January 8, 2015

DrFirst assessed the marketplace readiness of available technology solutions to support electronic prescribing requirements mandated by New York's Internet System for Tracking Over-Prescribing (I-STOP) law. Beginning March 27, 2015, I-STOP will require all patient medications to be electronically prescribed. An infographic titled "NY I-STOP: Fighting Prescription Drug Abuse with Technology" illustrates that the majority of electronic health records and standalone e-prescribing systems will be able to support both legend drug e-prescribing (eRx) and controlled substance e-prescribing (EPCS) before the deadline. The infographic also shows that while 97 percent of New York pharmacies are currently eRx ready, only 58 percent are EPCS ready.

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Massachusetts Attorney General-Elect Targets Drug Abuse Problem
Steve LeBlanc, NECN
January 5, 2015

Maura Healey, Massachusetts attorney general-elect, plans to expand the state's prescription monitoring program and investigate the cost of naloxone. Healey said she wants to strengthen Massachusetts's pharmacy lock-in program for individuals suspected of doctor shopping or abusing prescriptions. She also wants safe disposal boxes for prescription drugs in communities across the state, and intends to create a task force addressing the drug abuse problem.

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The Fight for the Overdose Drug
Carrie Arnold, The Atlantic
December 29, 2015

This article discusses challenges faced by Alexander Walley, a Boston primary care physician, and Dan Bigg, founder of the Chicago Recovery Alliance, to get naloxone into the hands of police, families, and addicts. Walley has worked for more than a decade to advocate, train, and distribute naloxone. Now his program is being used as a model throughout the United States and around the world. Walley suggests naloxone kits become a standard part of the health system, with private health insurance covering the drug's cost. He would also like to see drug users guided into primary care.

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Drug, Alcohol Treatment Website Launches in N.H.
The Boston Globe
January 6, 2015

New Hampshire launched a website directory for locating drug and alcohol treatment. The Bureau of Drug and Alcohol Services said the number of people reporting nonmedical use of prescription pain medication has declined, but many have transitioned to heroin.

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Connecticut Opioid Overdose Deaths Top 300 in 2014
The Middletown Press
January 4, 2015

In Connecticut, 273 of the 307 opioid overdose deaths in 2014 involved heroin. In 2013, 257 people died from a heroin overdose; 174 died from the same cause in 2012.

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R.I. Deaths from Accidental Drug Overdoses at 232 for 2014, Same as in 2013
Providence Journal
January 9, 2015

Rhode Island had 232 drug overdose deaths in 2014—the same number as in the previous year. Half involved pharmaceutical drugs. Officials said Narcan® may have kept the toll from climbing.

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See What's Behind Drop in Heroin Deaths at Jersey Shore
Ken Serrano, Asbury Park Press
January 7, 2015

Naloxone may have saved the lives of more than 200 people who overdosed on heroin at the Jersey Shore last year. The overdose antidote has been used 129 times in Ocean County since its introduction in the spring (eight people were not revived). In Monmouth County, the drug was administered 97 times (11 people were not revived). Overdose deaths have fallen by nearly a third in Ocean County, from 121 in 2013 to 86. In Monmouth County, the number of heroin overdose deaths in 2013 was 75. In October 2014, it was 59.

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South News

First Responders to Carry Overdose Antidote
Bill Moss, Hendersonville Lightning
January 5, 2014

First responders in Henderson County, N.C., will soon use Narcan®. Last month, state regulators approved the drug's use among law enforcement officers, with required training and continuing education.

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DEA Hoping to Get Ahead of Heroin Trend
Elicia Dover, KATV
January 7, 2015

Arkansas' Drug Enforcement Administration (DEA) issued a warning that heroin could become a problem in the state. In the early 2000s, there were only a handful of heroin cases. By contrast in 2014, there were 58 cases. The DEA believes the prescription drug crackdown has addicts seeking other drugs. (Includes video: 2:10 minutes)

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Midwest News

New Law Requires Ohio Schools to Teach About Dangers of Prescription Drugs
January 5, 2014

A new law requires Ohio schools to teach children about the dangers of prescription pain relievers. The Governor's Cabinet Opiate Action Team must recommend lessons to the state's education department by July 1. Start Talking, an Ohio program to curb adolescent drug abuse, provided a roadmap for the law.

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Drugged Drivers, Beware: Use of Field Sobriety Tests Now Allowed for Drivers Using Drugs
January 2, 2015

Michigan law enforcement officers can now use field sobriety tests to determine if someone is driving under the influence of drugs. They may also use a drug or urine screen. The state plans to train more troopers to recognize drugged drivers.

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West News

New Form of Drug in Grand Forks
Aries Serrano, KVRR
January 7, 2015

Police in Grand Forks, N.D., are seeing powdered fentanyl on the streets, and officials suspect the prescription drug is behind the recent death of an 18-year-old. They warn the drug has many unpredictable symptoms and the smallest dose can kill. Police are searching for the source. (Includes video: 1:34 minutes)

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Drug Overdoses Are Growing Problem in Rural Oklahoma
Andrew Knittle, The Oklahoman
January 4, 2014

Rural Oklahoma counties are seeing an increase in prescription drug abuse. For the past 2 years, Craig County has had the state's highest fatal and nonfatal overdose rates.

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Heroin Cheaper than Painkillers in Denver
Kevin Torres, KUSA
January 7, 2015

Heroin and prescription drug abuse are two leading causes of overdose deaths in Colorado. A single dose of heroin purchased on the street costs between $10 and $25, whereas some individual pain pills cost as much as $50. Recently, a bad batch of heroin sent more than 30 people to the emergency room. Denver Health said it sees as many overdose cases for heroin as it does for pain relievers. (Includes video: 2:11 minutes)

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Pharmacy Take-Back Program Proposed
Deborah Baker, Albuquerque Journal
January 8, 2015

Senator Michael Padilla filed legislation that would require the New Mexico Board of Pharmacy to establish a take-back program with 390 retail pharmacies to collect unwanted drugs. Dale Tinker, executive director of the New Mexico Pharmacists Association, said there are concerns about how the program would be paid for, and collection systems would have to be secure.

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Portland Police to Carry Lifesaving Drug Narcan
Sara Roth, KGW
January 8, 2015

Thirteen Central Precinct officers started carrying naloxone to help prevent opioid overdose deaths in Portland, Oregon. The officers volunteered for a 1-year pilot program. (Includes video: 2:21 minutes)

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Other Resources

Finding Interventions to Prevent or Reduce Opioid Abuse and Overdose: Selected Resources
Substance Abuse and Mental Health Services Administration, Center for the Application of Prevention Technologies
December 2014

This document includes various tools developed by federal organizations and state prevention systems to support state-level planners in preventing or reducing abuse of heroin and other opioids and its consequences.

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How Should U.S. Regulate Powerful Painkillers?
January 6, 2014

Gwen Ifill interviews Bob Twillman of the American Academy of Pain Management and Dr. Andrew Kolodny of Physicians for Responsible Opioid Prescribing on tighter prescription drug laws and whether they are creating new problems for people taking opioid pain relievers. (Duration: 7:52 minutes, includes transcript)


Grant Opportunity

Strategic Prevention Framework Partnerships for Success State and Tribal Initiative (SPF-PFS)
Substance Abuse and Mental Health Services Administration
Deadline: March 16, 2015

The Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Prevention is accepting applications for fiscal year 2015 Strategic Prevention Framework Partnerships for Success (SPF-PFS) cooperative agreements. The SPF-PFS program is designed to address two of the nation's top substance abuse prevention priorities: 1) underage drinking among people aged 12 to 20 and 2) prescription drug misuse and abuse among people aged 12 to 25.

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Grants Received

Portland Youth Program Gets Funding for Drug Awareness Campaign
Colin Ellis, The Forecaster
January 5, 2014

YES!, an Amateur Athletic Union program in Maine, was awarded an $8,000 Healthy Living Grant from the American Medical Association Foundation. YES! will use the grant to create a 30-minute educational television program about prescription drug safety, produced and hosted by youth. The youths will also create a 30-second public service announcement to teach peers about breaking drug habits and leading healthier lives. YES! was one of 17 national community organizations that received grants.

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Attorney General's Public Health Trust Awards Drug Disposal Box Grants to Three Law Enforcement Agencies
Gilbert Times
January 6, 2015

Three West Virginia law enforcement departments have received grants from the Attorney General's Public Health Trust to purchase drug disposal boxes. The Shepherdstown Police Department received a $695 grant to buy a unit from MedReturn. Sheriffs' departments in Boone and Roane Counties received $800 grants to buy a disposal container from the National Association of Drug Diversion Investigators. Law enforcement agencies may apply for a grant to purchase a drug box by going to the attorney general's office website.

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State Will Use Settlement Funds to Provide Heroin Overdose Kits to Three Hospitals
January 7, 2015

Kentucky's governor and attorney general announced the state will spend more than $100,000 on 2,000 naloxone kits for hospitals with the highest rates of overdose deaths. Overdose patients treated at the University of Kentucky Hospital in Lexington, University of Louisville Hospital, and Saint Elizabeth Hospital system in Northern Kentucky will receive a free kit when they are discharged.

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Take-Back Events and Drop Boxes

Nearly 1,900 Lbs. Prescription Meds Collected 1st Year
WFMZ-TV (Pennsylvania)
January 7, 2015

Floyd County Discontinues Prescription Drug Drop Off
Eric Page, KWWL (Iowa)
January 5, 2015

Drug Disposal Receptacle Unavailable at Police Station
The Newton Bee (Connecticut)
January 7, 2015

Area Residents Urged to Use Drug Take-Back Box
Naomi Hatch, Arizona Journal
January 7, 2015

Sheriff's Office Now Has Prescription Drug Drop-Off Box
Crossville Chronicle (Tennessee)
January 5, 2014

Edison Police Install Drop Box for Prescription Medications
Edison Sentinel (New Jersey)
January 8, 2015

HCSO Announces Prescription Drug Drop-Box Program
Highland County Press (Ohio)
January 8, 2015

'Drug Drop Box' Available in Batavia
Evan Anstey, WBTA (New York)
January 6, 2015

Bartholomew County Sheriff's Department to Accept Rx Medication
WCSI (Indiana)
January 8, 2015

MSU Police Offer Permanent Prescription Drug Drop Box
WLNS (Michigan)
January 7, 2015

Prescription Drug Drop Box Now Active in Hartford
WBKV (Wisconsin)
January 7, 2015

Drug Drop-Off Boxes Now Available at Gundersen Health System
Sean Teham, WXOW (Wisconsin)
January 5, 2015

Abstracts from the 2014 Annual Meeting of the College On Problems Of Drug Dependence

Drug and Alcohol Dependence, 146, Online Supplement, January 2015. (Editor's note: Because these conference papers represent preliminary findings that have not yet been peer reviewed, we are only listing them, with links to the abstracts. Unfortunately, only the specific "aims" section of each abstract is available without a subscription.)

E. Evans, K. Mishlen, A. Glass, M. Pavlicova, J.J. Mariani, F.R. Levin, and M. Sullivan. "A Comparison of Young Adults Seeking Treatment for Cannabis and Opioid Dependence."

J.G. Erensen and J.D. Haddox. 2014. "Opioid Deaths or Polydrug/Multi-Cause Deaths?"

Upcoming Conferences and Workshops

SAMHSA's 11th Prevention Day
Substance Abuse and Mental Health Services Administration
February 2, 2015
National Harbor, Maryland

25th Anniversary National Leadership Forum
Community Anti-Drug Coalitions of America
February 2–5, 2015
National Harbor, Maryland

National Rx Drug Abuse Summit
April 6–9, 2015
Atlanta, Georgia
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.