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January 22, 2015

SAMHSA Prescription Drug Abuse Weekly Update
Issue 106  |  January 22, 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 Upcoming Webinar Grant Announcements Grant Received Take-Back Events and Drop Boxes Upcoming Conferences and Workshops


K. Benson, K. Flory, K.L. Humphreys, and S.S. Lee. 2015. "Misuse of Stimulant Medication Among College Students: A Comprehensive Review and Meta-Analysis." Clinical Child and Family Psychology Review, doi:10.1007/s10567-014-0177-z.

Random-effects meta-analysis estimated the rate of stimulant medication misuse among college students to be 17 percent (95 percent [confidence interval 0.13, 0.23]). Variables that differentiated misusers from nonusers included attention deficit hyperactivity disorder symptoms, problem drinking, and marijuana use. Qualitative literature review also associated Greek organization membership, poor academic performance, and other substance use with misuse. Students were misusing primarily for academic reasons. The most common source of stimulant medication was peers with prescriptions. A standard stimulant misuse definition is needed, as well as validated tools for measuring misuse. The relationship between stimulant medication misuse and extracurricular participation, academic outcomes, depression, and eating disorders requires further investigation, as does whether policies on college campuses contribute to high rates of misuse among students. The authors also suggest further research on why students divert or misuse—a topic the Weekly Update editors note is well explored in articles published after this study's mid-2013 inclusion cutoff date.

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Journal Articles and Reports

Centers for Disease Control and Prevention. 2015. "QuickStats: Rates of Deaths from Drug Poisoning and Drug Poisoning Involving Opioid Analgesics—United States, 1999–2013." Morbidity and Mortality Weekly Report 64(01):32.

In 2013, 43,982 U.S. deaths were attributed to drug poisoning, including 16,235 deaths (37 percent) that involved opioid analgesics. Opiate poisoning deaths increased 6 percent from 2012 to 2013. Prescription opioid deaths rose 1 percent, but heroin mortality rose 39 percent—the third consecutive large increase. From 1999 to 2013, the drug poisoning death rate more than doubled, from 6.1 to 13.8 per 100,000 population, and the rate for drug poisoning deaths involving opioid analgesics nearly quadrupled, from 1.4 to 5.1 per 100,000. Drug poisoning deaths include all intents (i.e., unintentional, suicide, homicide, and undetermined).

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R.C. Dart, H.L. Surratt, T.J. Cicero, M.W. Parrino, G. Severtson, B. Bucher–Bartelson, and J. L. Green. 2015. "Trends in Opioid Analgesic Abuse and Mortality in the United States." New England Journal of Medicine 372:241–48, doi:10.1056/NEJMsa1406143.

According to the Researched Abuse, Diversion, and Addiction-Related Surveillance System, prescriptions for opioid analgesics increased substantially from 2002 through 2010 in the United States, but decreased slightly from 2011 through 2013. Opioid diversion and abuse rates rose rapidly from 2002 to 2010, then flattened or decreased. The rate of opioid-related deaths rose and fell in a similar pattern. Reported nonmedical use did not change significantly among college students.

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D.B. Reuben, A.A.H. Alvanzo, T. Ashikaga, G.A. Bogat, C.M. Callahan, V. Ruffing, and D.C. Steffens. 2015. "National Institutes of Health Pathways to Prevention Workshop: The Role of Opioids in the Treatment of Chronic Pain." Annals of Internal Medicine, doi:10.7326/M14-2775.

This National Institutes of Health white paper written by a seven-member expert panel finds little to no evidence for the effectiveness of opioid drugs in treating long-term chronic pain, despite the explosive recent growth in use. Many studies used to justify the prescribing of these drugs were poorly conducted or of insufficient duration. The panel concluded that individualized, patient-centered care is needed to treat and monitor the estimated 100 million Americans living with chronic pain. They recommended 1) more research and development around evidence-based, multidisciplinary approaches needed to balance patient perspectives, desired outcomes, and safety; 2) engaging electronic health record vendors and health systems to provide pain management decision support tools for clinicians; and 3) conferences aimed at harmonizing pain assessment and treatment guidelines and facilitating consistent clinical care for chronic pain treatment.

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Professional Education

R.A. Deyo, M. Von Korff, and D. Duhrkoop. 2015. "Opioids for Low Back Pain." BMJ 350:g6380, doi:10.1136/bmj.g6380.

In the United States, opioid prescribing for low back pain has increased, and opioids are now the most commonly prescribed drug class. More than half of regular opioid users report back pain. Opioid prescribing rates in the United States and Canada are two to three times higher than in most European countries. The analgesic efficacy of opioids for acute back pain is inferred from evidence for other acute pain conditions. Opioids do not seem to expedite return to work among injured employees or improve functional outcomes of acute back pain in primary care. For chronic back pain, systematic reviews find scant evidence of efficacy. Randomized controlled trials (RCTs) have high dropout rates, brief duration (4 months or less), and highly selected patients. Opioids seem to have short-term analgesic efficacy for chronic back pain, but benefits for function are less clear. The magnitude of pain relief across chronic noncancer pain conditions is about 30 percent. Given the brevity of RCTs, the long-term effectiveness and safety of opioids are unknown. Loss of long-term efficacy could result from drug tolerance and emergence of hyperalgesia. Complications of opioid use include addiction and overdose-related mortality, which have risen in parallel with prescription rates. Common short-term side effects are constipation, nausea, sedation, and increased risk of falls and fractures. Longer-term side effects may include depression and sexual dysfunction. Screening for high-risk patients, treatment agreements, and urine testing has not reduced overall rates of opioid prescribing, misuse, or overdose. Newer strategies for reducing risks include more selective prescribing and lower doses, prescription monitoring programs, avoidance of co-prescription with sedative hypnotics, and reformulations that make drugs more difficult to snort, smoke, or inject.

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H. Hendrikson and M. Hansen. 2014. "Methadone and Prescription Drug Overdose." NCSL Legisbrief 22(45):1–2.

Methadone accounted for 2 percent of pain reliever prescriptions and more than 30 percent of prescription pain reliever deaths in 2009. The rise in methadone overdose deaths is related to the drug's use for pain management—not for treating drug abuse. Preferred drug lists in most Medicaid programs identify methadone as a preferred drug for managing chronic pain, but most experts do not consider it a first choice.

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M. Soyka. 2015. "New Developments in the Management of Opioid Dependence: Focus on Sublingual Buprenorphine–Naloxone." Substance Abuse and Rehabilitation 2015(6):1–14, doi:10.2147/SAR.S45585.

Buprenorphine (Suboxone) is an effective and safe medication for treating opioid dependence. It is available as a monodrug or in a fixed 4:1 ratio combination with naloxone. Reduced risk of diversion and abuse for the combination drug is likely, but not firmly established. Recent studies, including a Cochrane meta-analysis, suggest retention with buprenorphine is lower than with methadone, but that buprenorphine may be associated with less drug use. Higher doses of buprenorphine are associated with better treatment retention rates. The drug has a ceiling effect at the opioid receptor with regard to respiratory depression, and may cause less fatal intoxication than methadone. Possible antidepressant effects of buprenorphine and its use in comorbid psychiatric patients have not been studied in much detail. Conventional formulations are given sublingually to avoid the hepatic first-pass effect. A novel film tablet is available only in the United States and Australia, but other novel, sustained-release formulations (implant, depot) are being developed and tested.

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National News

The Drug Suboxone Could Combat the Heroin Epidemic. So Why Is It So Hard to Get?
The Washington Post
January 13, 2015

The Washington Post interviewed Edwin Chapman, a Washington, D.C., internist and cardiologist who uses Suboxone at his medical practice. Dr. Chapman wishes Suboxone was more widely available. Most doctors are not licensed to prescribe the drug, and wouldn't want to work with heroin addicts. Private doctors can only prescribe Suboxone to a small number of patients after getting training from the Drug Enforcement Administration, and some patients cannot afford the drug. Methadone can cost $3,000 to $3,500 per patient per year, whereas generic Suboxone costs two to three times as much. Additionally, there are insurance companies that strictly limit the drug. Medicaid covers it, but pays only a tiny fraction of the office visit. Many doctors who dispense Suboxone take cash only and simply cannot accept more patients. A bill in the Senate would increase the number of patients doctors can treat.

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Nine Ways People Are Getting Ahold of Painkillers
Kevin Torres, KUSA
January 14, 2015

Dr. Patrick Fehling, an addiction psychiatrist at the University of Colorado Hospital's Center for Dependency, Addiction, and Rehabilitation, lists nine common ways people get pain relievers (both legally and illegally). The methods include getting drugs from a doctor or dentist—by complaining about back pain or a sore tooth—or by raiding medicine cabinets at open houses.

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International News

Rising Abuse of Prescription Drugs Heralds Epidemic, Claims Survey
Alan Travis, The Guardian
January 14, 2015

The 2014 annual DrugScope survey showed drug workers are reporting a significant increase in pregabalin and gabapentin use among British heroin addicts and prisoners. When combined with depressants, these drugs can cause drowsiness, sedation, respiratory failure, and death. Pregabalin and gabapentin were mentioned on 41 United Kingdom death certificates in 2013. General practitioners and other prescribers are being asked to take more care to ensure the drugs do not appear on the illicit market. The annual DrugScope survey is based on interviews with police, drug action teams, and frontline drug workers in 17 towns and cities across the United Kingdom.

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Coroner Calls for Urgent Drug Overdose Action
Nino Bucci, The Sydney Morning Herald
January 12, 2015

Corner Jacinta Heffey has linked a sixth Victorian drug overdose to lack of a real-time electronic prescription monitoring program (PMP). Heffey called for a PMP in the inquest findings for a man who died after being prescribed methadone by one doctor and benzodiazepines by another. It was the fifth time in less than 9 months that a coroner recommended a PMP.

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Northeast/Mid-Atlantic News

LePage Budget Cuts Methadone Funds in Effort to Transition Recovering Opiate Addicts to Suboxone
Christopher Cousins, The Bangor Daily News
January 15, 2015

Maine Governor Paul LePage has proposed elimination of state-funded methadone regimens in order to transition opiate addicts to Suboxone. Gov. LePage proposes to cut $727,000 in state funds in fiscal year 2016 and $868,000 in fiscal year 2017—meaning Maine would not receive annual federal matching funds of $1.2 million and $1.5 million, respectively. In 2013, about 4,760 Mainers were receiving methadone treatment. More than 65 percent were Medicaid patients.

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As Demand Rises, So Does Price of Overdose Reversal Drug
Elaine Thompson, Telegram
January 10, 2015

The AIDS Project Worcester (APW) has saved nearly 300 lives with naloxone in the past 3 years. Since August, the Worcester Police Department has saved 35 lives with the drug. Now, naloxone's cost has doubled, and some are concerned it will be less available. The Massachusetts Department of Public Health was paying around $42 per kit. As of November, the same kit cost approximately $75. APW is concerned some people will not be able to afford the drug. CVS and Walgreens have been selling two-dose nasal naloxone kits for $39.89 and $50.99, respectively, when prescribed.

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Improving Prescription Drug Monitoring in New York
C.J. Arlotta, Forbes
January 14, 2015

This article discusses New York's Internet System for Tracking Over-Prescribing (I-STOP) that monitors Schedule II, III, and IV controlled substances. I-STOP requires prescribers consult the database before writing prescriptions for these drugs. The registry is also available to licensed pharmacists in New York. By March 27, I-STOP will require practitioners to begin electronically transmitting all prescriptions. The program cannot be accessed by neighboring states, and according to some doctors, it takes time for prescribers to log in and review patient data.

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Mental Health Association Starts Help Line for Heroin, Painkiller Addiction
Beth Fitzgerald, NJ Biz
January 13, 2015

The Mental Health Association in New Jersey, Inc. (MHANJ) has launched NJ Connect for Recovery, a confidential help line for individuals and families coping with heroin and prescription pain reliever addiction. The help line is a partnership between MHANJ, the state's Division of Mental Health and Addition Services, the New Jersey Attorney General's Office, and Actavis plc, a pharmaceutical company.

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Verona, Cedar Grove Police Departments Receive Narcan Kits
Joshua Jongsma, Verona–Cedar Grove Times
January 10, 2015

The Essex County, N.J., Prosecutor's Office announced that Verona and Cedar Grove police officers will now be equipped with Narcan kits.

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Suffolk County to Offer Anti-Heroin Drug Vivitrol to Help Users Beat Addiction
David M. Schwartz, Newsday
January 13, 2015

In Suffolk County, N.Y., officials will encourage Vivitrol (injected extended‐release naltrexone) use at drug courts, county jails, and nonprofit drug and alcohol treatment centers. Suffolk does not have money earmarked for Vivitrol, but the county has applied for grants, and most insurance programs cover the prescription.

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South News

Attorney General Proposes New Bills to Fight Heroin
Nick Ochsner, 13News Now
January 12, 2015

Attorney General Mark Herring is proposing four bills to address heroin deaths in Virginia: 1) a Good Samaritan provision that protects people from prosecution if they witness an overdose and call for medical help; 2) a more effective "drug induced homicide" statute that will enable police to charge drug dealers with a felony homicide; 3) a statute that expands naloxone use by equipping first responders with the drug; and 4) a statute that expands prescription monitoring program use by providing more information to police officers, probation officers, and parole officers. (Includes video: 3:33 minutes)

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Overdose Drug Naloxone Dubbed 'Double Edged Sword'
Linda Harris, The State Journal
January 10, 2015

West Virginia does not allow first responders to administer naloxone. Supporters said they will try to change this by reintroducing legislation during the 2015 regular session. Some fear dealers would use the drug to resuscitate people who have overdosed so they can keep selling them more drugs. Others believe naloxone would provide a sense of security enabling addicts to continue risky behaviors. Mike Jarrett, chaplain of the Kanawha County Emergency Ambulance Authority, called the drug a "double edged sword." He doesn't think police should carry naloxone to resuscitate addicts.

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Brookhaven Police Fight Drug Overdoses with Naloxone Auto-Injectors
Ellen Eldridge, Reporter Newspaper
January 16, 2015

Georgia's Brookhaven Police Department received 100 cartons of Evzio naloxone auto-injectors donated from Kaléo, a Virginia-based pharmaceutical company.

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Powerful End-of-Life Painkiller Is Killing St. Tammany Street Users
Rob Masson, WVUE
January 13, 2015

The St. Tammany Parish, La., coroner is warning drug users about acetyl fentanyl, a heroin-like synthetic drug. Acetyl fentanyl can kill instantly, and claimed three lives last year. (Includes video: 2:50 minutes)

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New Number for Florida's 'Born Drug Free' Helpline
January 13, 2015

The Born Drug-Free Florida helpline has merged with the Statewide Mental Health Access Line. "Born Drug-Free Florida" is an initiative raising awareness about babies exposed to prescription drugs in the womb.

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Midwest News

Ohio Launches Drug Prevention Effort for Businesses
Washington Times
January 15, 2015

Ohio is launching a drug prevention effort aimed at businesses. The "Start Talking Business Impact Zone" will help companies promote drug-free workplaces and wellness programs for workers.

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Record Number of Ohioans Dying of Drug Overdoses
January 12, 2015

Drug overdoses killed 1,914 Ohioans in 2012—an all-time record. Senator Sherrod Brown proposed The Recovery Enhancement for Addiction Treatment (TREAT) Act, which would raise maximum Suboxone patient caseloads from 25 to 100 per physician. TREAT would also allow nurse practitioners and physician assistants to treat up to 100 patients per year if they meet certain requirements.

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Lawmakers React to Over-Prescribing Allegations at Tomah VA
Dee J. Hall, Wisconsin State Journal
January 13, 2015

Wisconsin lawmakers called for an investigation after a news report alleged excessive use of pain relievers at the Veterans Administration Medical Center in Tomah. The Center for Investigative Reporting found the facility's pain reliever use increased after Dr. David Houlihan became chief of staff. Houlihan defended his personal prescription practices, as well as the hospital's. The medical center's director said he would look into the allegations. U.S. Rep. Ron Kind (D–Wis.) also sent a letter to the Department of Veterans Affairs calling for answers.

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West News

State Adopting San Diego's ER Painkiller Policy
Laura McVicker, NBC 7 San Diego
January 12, 2015

The California Department of Public Health is working with other state agencies to adopt guidelines aimed at preventing drug abuse by restricting pain reliever use. San Diego's emergency room (ER) pain reliever policy serves as a model. There, ER doctors do not prescribe pain relievers if a patient is already receiving prescriptions from another provider. They don't refill stolen or lost prescriptions or prescribe long-acting pain medications.

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Proximity to Border Helps Make Tucson an Epicenter of Arizona's Heroin Epidemic
Stephen Hamway, Cronkite News
January 11, 2015

Data from the 2009–13 Arizona Hospital Discharge Data System show Pima County's overdose rate is almost double any other Arizona county's. The five zip codes with the most overdoses were all in metropolitan Tucson. Dr. Mazda Shirazi, a medical toxicologist and director of University of Arizona's School of Pharmacy, said freeways and other transportation corridors into Mexico make it easy to distribute heroin in the city. A rise in prescription pain reliever use also contributes to the problem.

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Other Resources

National Drug Facts Week: January 26–February 1, 2015
National Institute on Drug Abuse
Accessed January 16, 2015

National Drug Facts Week (NDFW) is a health observance for teens to promote local events that use National Institute on Drug Abuse science shattering myths about drugs. This online guide provides everything communities need to plan, promote, and host an NDFW event.

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Upcoming Webinar

Prescription Drug Abuse—Messaging Techniques to Help You Educate Your Community
Community Anti-Drug Coalitions of America
January 27, 2015
3 to 4 p.m. (EST)

This Webinar will discuss how to develop media campaigns that address root causes of prescription drug abuse and craft messages that resonate with local audiences. Participants will learn to use relevant data to create a local or statewide media campaign that effectively communicates prevention messages. A Florida coalition leader will discuss a successful mass media campaign that helped reduce a key problem fueling prescription drug abuse, and a state leader from Utah will share the process for developing such campaigns and how coalitions can participate.

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Grant Announcements

Comparison and Validation of Screening Tools for Substance Use Among Pregnant Women
Centers for Disease Control and Prevention
Deadline: February 24, 2015

The Centers for Disease Control and Prevention is seeking proposals for a study to compare and validate substance use screening tools for pregnant women in the United States. The tools should be designed for use by healthcare providers.

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

Grants Received

Health Innovation Grants Given to Several U.P. Agencies
Upper Peninsula Second Wave
January 10, 2015

The Michigan Department of Community Health awarded more than $1.3 million to 44 recipients with funds from the state's Health Innovation Grant. The Inter-Tribal Council of Michigan will train staff, develop a tribal-specific prescription drug abuse screening and referral system, create educational materials for the community, conduct a take-back event for prescriptions, and increase the tribe's drug abuse policy to cover 12 tribes instead of 1. The Great Lake Recovery Centers will provide mental health and substance abuse treatment services in the Upper Peninsula.

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Take-Back Events and Drop Boxes

Nearly 300,000 Pills Dropped Off in Mount Airy
WXII (North Carolina)
January 13, 2015

Pharmaceutical Drug Collections in Berks Up 64 Percent in 2014
WFMZ-TV (Pennsylvania)
January 12, 2015

Three Quarters of a Ton of Pills Dropped Off in Manchester
Karen Wall, Manchester Patch (New Jersey)
January 12, 2015

Prescription Drug Drop Off Boxes See Steady Use in Findlay
WFIN (Ohio)
January 14, 2015

Alamogordo Police to Unveil Medication Drop Off Box
Alamogordo News (New Mexico)
January 9, 2015

MONROE: Township Police Install Medicine Drop Box
The Cranbury Press (New Jersey)
January 12, 2015

Westfield Police Create Prescription Medication Drop-Off Site to Reduce Misuse
Current Publishing (Indiana)
January 14, 2015

Melbourne Police Install Drop-Off Box for Unused Drugs
Rick Neale, Florida Today
January 9, 2015

Sullivan Schedules Prescription Take Back
MidHudsonNews.Com (New York)
January 12, 2015

Sheriff's Department Accepts Old Prescription Drugs
WISHTV (Indiana)
January 13, 2015

Cold Spring Looking to Get Prescription Drug Drop-Off Box (Audio)
Dan DeBaun, WJON AM 1240 (Minnesota)
January 14, 2015

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

Pharmacy Diversion Awareness Conferences
Drug Enforcement Administration, Office of Diversion Control
February 7–8, 2015: Las Vegas, Nev.
March 28–29, 2015: Birmingham, Ala.
May 30–31, 2015: Norfolk, Va.
June 27–28, 2015: Oklahoma City, Okla.

The Drug Enforcement Administration (DEA) is hosting regional Pharmacy Diversion Awareness Conferences. Each meeting is open to pharmacy personnel employed by pharmacies or hospitals/clinics registered with the DEA. The conferences are designed to assist pharmacy professionals in identifying and responding to potential diversion activity.

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2015 AATOD Conference—Address a Public Health Crisis: Opioid Dependence
American Association for Treatment of Opioid Dependence, Inc.
March 28–April 1, 2015
Hyatt Regency Atlanta
265 Peachtree Street NE
Atlanta, Georgia

This conference will provide opportunities to socialize with professionals in the Medication-Assisted Treatment (MAT) field and gain knowledge about opioid overdose prevention, MAT research, and various treatment-related concerns. One focus will be on America's opioid dependence health crisis.

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

Fourth Annual Generation Rx University Conference for Collegiate Prevention and Recovery
The Ohio State University College of Pharmacy
August 4–6, 2015
Ohio State University Blackwell Inn and Conference Center
2110 Tuttle Park Place
Columbus, Ohio

Attendees will learn about alcohol and prescription drug abuse prevention and collegiate recovery communities, and develop take-home plans for prevention/recovery programming at their college or university.

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University of Michigan Injury Center Prescription Drug Overdose Summit
University of Michigan Injury Center
November 9, 2015
8:30 a.m. to 4 p.m.
University of Michigan, Palmer Commons
100 Washtenaw Avenue
Ann Arbor, Michigan

This summit will focus on prescription drug overdoses and new and emerging ways to address the growing public health issue.

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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.