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January 29, 2014

 

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SAMHSA
SAMHSA Prescription Drug Abuse Weekly Update
WEEKLY
UPDATE
Issue 56  |  January 29, 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.
Table of Content Featured Article Journal Articles and Reports News Other State and Local News Other Resources Grant Announcements Take-Back Events and Drop Boxes Upcoming Conferences and Workshops

Featured

Centers for Disease Control and Prevention. 2013 Prevention Status Reports. January 10, 2014.

The Prevention Status Reports (PSRs) highlight the status of policies and practices designed to prevent or reduce important public health problems. Individual reports are available for all 50 states and the District of Columbia on 10 key health topics: 1) prescription drug overdose, 2) excessive alcohol use, 3) food safety, 4) healthcare-associated infections, 5) heart disease and stroke, 6) HIV, 7) motor vehicle injuries, 8) nutrition, physical activity, and obesity, 9) teen pregnancy, and 10) tobacco use. Each report describes the public health problem, identifies potential solutions to the problem drawn from research and expert recommendations, and reports the status of those solutions for each state and the District of Columbia, using a simple, three-level rating scale—green, yellow, or red. A related fact sheet highlights the status of two key practices that states can use to reduce prescription drug overdose, including implementing state pain clinic laws and prescription drug monitoring programs that follow selected best practices.

Read more:
http://www.cdc.gov/stltpublichealth/psr/prescriptiondrug/index.html#4
http://www.cdc.gov/injury/pdfs/NCIPC_Overview_FactSheet_PPO-a.pdf
Related Guide:

Centers for Disease Control and Prevention. PSR Quick Start Guide. January 21, 2014.

The CDC created the Prevention Status Report (PSR) Quick Start Guide to help state health officials and other public health leaders use the PSRs. The guide provides users with tips and tools for using the PSR to increase the use of evidence-based public health practices and improve health outcomes in their respective states.

Read more:
http://www.cdc.gov/stltpublichealth/psr/quickstart.html
B. Fischer, A. Keates, G. Bühringer, J. Reimer, and J. Rehm. 2014. "Nonmedical Use of Prescription Opioids and Prescription Opioid-Related Harms: Why So Markedly Higher in North America Compared to the Rest of the World?" Addiction 109(2):177–81, doi: 10.1111/add.12224.

Researchers reviewed and integrated scientific literature and information related to relevant areas of health systems, policy, and practice. They identified several factors contributing to the observed differences. First, North American healthcare systems consume substantially more prescription opioids (POs)—even when compared with other high-income countries—than any other global region, with dispensing levels associated strongly with levels of nonmedical prescription opioid use (NMPOU) and PO–related harms. Second, North American healthcare systems, compared with other systems, appear to have lesser regulatory access restrictions for, and rely more on, community-based dispensing mechanisms of POs, facilitating higher dissemination level and availability (e.g., through diversion) of POs implicated in NMPOU and harms. Third, they noted that the generally high levels of psychotrophic drug use, dynamics of medical–professional culture (including patient expectations for "effective treatment"), and the more pronounced "for profit" orientation of key elements of health care (including pharmaceutical advertising) may have boosted the PO–related problems observed in North America. Differences in the organization of health systems, prescription practices, dispensing and medical cultures, and patient expectations appear to contribute to the observed interregional differences in nonmedical prescription opioid use and prescription opioid–related harms, though consistent evidence and causal analyses are limited.

Read more:
http://onlinelibrary.wiley.com/doi/10.1111/add.12224/abstract
Related Article

A.C. Rintoul, and M. Dobbin. 2014. "Prescription Opioid Deaths: We Need to Treat Sick Populations, Not Just Sick Individuals." Addiction 109(2):185–86, doi: 10.1111/add.12343.

Referring to the Fisher and colleagues (2014) article, the authors argue that the United States’ relatively poor population health outcomes, lack of universal health insurance, poor voluntary use of prescription monitoring programs, short consultation times, and inappropriate and intense marketing of Oxycontin contributed to increased consumption. Professional guidelines claimed inaccurately that the risk of addiction or other serious adverse effects was low. Widespread prescribing provided more opportunities for diversion, nonmedical use, and unintentional poisoning. This resulted in stigmatization of patients considered "risky" and undertreating of some in need. The authors maintain that the public health response requires treating sick populations and shifting expectations and practices around the total opioid supply. Consumers need to be supported carefully in this process; those experiencing addiction cannot be abandoned.

Read more:
http://onlinelibrary.wiley.com/doi/10.1111/add.12343/full

Journal Articles and Reports

L. Ashrafioun, and R.A. Carels. 2014. "Prescription Opioid Use Among University Students: Assessment of Postcue Exposure Craving." Addictive Behaviors 39(3):586–92, doi: 10.1016/j.addbeh.2013.11.012.

This study assessed the impact of prescription opioid-related cue exposure on craving in university students. Students (n=277) recruited from a large university in the Midwestern United States were randomly assigned to two conditions to test the impact of cue exposure to either prescription opioid-related stimuli or control stimuli. Relative to the control condition, prescription opioid-related cue exposure significantly increased overall craving, desire and intention to use prescription opioids, relief from negative states by using prescription opioids, and perceived control over prescription opioid use. In addition, when assessing correlates of postcue exposure craving, negative mood and procurement of prescription opioids from nonmedical sources were the only measured variables that were significantly associated with overall craving and/or any of the craving measure's subscales.

Read more:
http://www.ncbi.nlm.nih.gov/pubmed/24345309

T. Beck, C. Haasen, U. Verthein, S. Walcher, C. Schuler, M. Backmund, C. Ruckes, and J. Reimer. 2014. "Maintenance Treatment for Opioid Dependence With Slow-Release Oral Morphine: A Randomized Crossover, Noninferiority Study Versus Methadone." Addiction, doi: 10.1111/add.12440.

In this prospective, multiple-dose, open-label, randomized, noninferiority, crossover study, researchers compared the efficacy of slow-release oral morphine (SROM) with methadone as maintenance medication for opioid dependence in patients previously treated with methadone. Methadone treatment was switched to SROM with flexible dosing and vice versa according to period and sequence of treatment. Researchers selected adults from 14 outpatient addiction treatment centers in Switzerland and Germany with opioid dependence in methadone maintenance programs (dose ≥50 mg/day) for ≥26 weeks. The efficacy endpoint was the proportion of heroin-positive urine samples per patient and period of treatment. Each week, two urine samples were collected; one was randomly selected and analyzed for 6-monoacetyl-morphine and 6-acetylcodeine. Noninferiority was concluded if the two-sided 95 percent confidence interval (CI) in the difference of proportions of positive urine samples was below the predefined boundary of 10 percent. One hundred fifty-seven patients fulfilled criteria to form the per-protocol population. The proportion of heroin-positive urine samples under SROM treatment (0.20) was noninferior to the proportion under methadone treatment (0.15) (least-squares mean difference 0.05; 95 percent CI = 0.02, 0.08; P > 0.01). The 95 percent CI fell within the 10 percent noninferiority margin, confirming the noninferiority of SROM to methadone. A dose-dependent effect was shown for SROM (i.e. decreasing proportions of heroin-positive urine samples with increasing SROM doses). Retention in treatment showed no significant differences between treatments (period 1/period 2: SROM: 88.7 percent/82.1 percent, methadone: 91.1 percent/88.0 percent; period 1: P = 0.50, period 2: P = 0.19). Overall, safety outcomes were similar between the two groups.

Read more:
http://onlinelibrary.wiley.com/doi/10.1111/add.12440/abstract

E.M. Goldner, A. Lusted, M. Roerecke, J. Rehm, and B. Fischer. 2014. "Prevalence of Axis–1 Psychiatric (With Focus on Depression and Anxiety) Disorder and Symptomatology Among Nonmedical Prescription Opioid Users in Substance Use Treatment: Systematic Review and Meta-Analyses." Addictive Behaviors 39(3):520–31, doi: 10.1016/j.addbeh.2013.11.022.

Researchers conducted a systematic review and meta-analysis for Axis–1 psychiatric diagnoses and symptoms with a principal focus on depression and anxiety disorders in substance use treatment samples reporting nonmedical prescription opioid use (NMPOU) at admission to treatment (both criteria within past 30 days). Eleven unique studies (all from either the United States or Canada) met inclusion criteria and were included in the meta-analysis. The pooled prevalence of any mental health problems (both diagnosis and symptoms) among substance abuse treatment patients reporting NMPOU was 43 percent (95 percent CI: 32 percent–54 percent; I(2) for interstudy heterogeneity: 99.5 percent). The pooled prevalence of depression diagnosis among substance abuse treatment patients reporting NMPOU was 27 percent (95 percent CI: 9 percent–45 percent; I(2): 99.2 percent); the pooled prevalence of anxiety diagnosis in the sample was 29 percent (95 percent CI: 14 percent–44 percent; I(2): 98.7 percent). The prevalence rates of psychiatric problems (both diagnosis and symptoms), depression diagnosis, and anxiety diagnosis are disproportionately high in substance use treatment samples reporting NMPOU relative to general population rates. Adequate and effective clinical strategies are needed to address co-occurring NMPOU and mental health in substance use treatment systems.

Read more:
http://www.ncbi.nlm.nih.gov/pubmed/24333033

M. Jann, W.K. Kennedy, and G. Lopez. 2014. "Benzodiazepines: A Major Component in Unintentional Prescription Drug Overdoses With Opioid Analgesics." Journal of Pharmacy Practice 27(1):5–16, doi: 10.1177/0897190013515001.

Opioid analgesics are the leading class of prescription drugs that have caused unintentional overdose deaths. Benzodiazepines when taken alone are relatively safe agents in overdose. However, a fivefold increase in deaths attributed to benzodiazepines occurred from 1999 to 2009. Emergency department visits related to opioid analgesics increased by 111 percent followed by benzodiazepines (89 percent). During 2003 to 2009, the 2 prescriptions drugs with the highest increase in death rates were oxycodone (264.6 percent) and alprazolam (233.8 percent). Therefore, benzodiazepines have a significant impact on prescription drug unintentional overdoses second only to the opioid analgesics. Benzodiazepines and opioid analgesics are frequently prescribed together even though the pharmacokinetic drug interactions between benzodiazepines and opioid analgesics are complex and their combined effects can produce significant respiratory depression. Prescription drug-monitoring programs can provide important information on benzodiazepine and opioid analgesic prescribing patterns and patient usage, and may address the consequences of physician and pharmacy shopping by abusers.

Read more:
http://jpp.sagepub.com/content/27/1/5.abstract

B.C. Kelly, B.E. Wells, M. Pawson, A. LeClair, and J.T. Parsons. 2013. "Combinations of Prescription Drug Misuse and Illicit Drugs Among Young Adults." Addictive Behaviors, doi: 10.1016/j.addbeh.2013.12.003.

Prevalence and correlates of recent combinations of prescription drugs and other substances among urban young adults recruited at nightlife venues using time-space sampling are analyzed using logistic regression. Overall, 16.4 percent of the sample reported combining illicit drug use with prescription drug misuse. Of those who reported any prescription drug misuse, 65.9 percent used prescription drugs in combination with at least one of the illicit drugs assessed. The most common combination was marijuana, followed by alcohol, cocaine, ecstasy, and psychedelics. Being male and identifying as gay, lesbian, or bisexual predicted the combination of prescription drugs with ecstasy, cocaine, and psychedelics. Rates of combining alcohol and illicit drug use with prescription drug misuse were high among men and those identified as a sexual minority. These rates are alarming in light of the host of negative health outcomes associated with combining prescription and illicit drugs.

Read more:
http://www.sciencedirect.com/science/article/pii/S0306460313004279

R. Koylu, Z. Defne Dundar, O. Koylu, E. Akinci, N.B. Akilli, M.O. Gonen, and B. Cander. 2014. "The Experiences in a Toxicology Unit: A Review of 623 Cases." Journal of Clinical Medical Research 6(1): 59–65, doi: 10.4021/jocmr1687w.

Researchers evaluated the etiological and demographic characteristics of adult poisoning patients in a toxicology unit in Konya, Turkey. Patients (≥ 15 years old) followed up after the diagnosis of poisoning in the toxicology unit in 2011 were included in this retrospective study. The patients’ medical records were investigated. Age, gender, medical history, the first medical center the patient had been admitted to, the routes and causes of poisoning, the toxins involved, the number of the pills taken, treatments, complications, the length of stay in the hospital and the outcome were recorded. A total of 623 patients were included in the study. The mean age of patients was 28.1 ± 15.1. Four hundred forty-five (71.4 percent) patients were female, 541 (86.9 percent) were poisoned via the oral route and 75 (12.0 percent) were poisoned by inhalation. The causes of poisoning were drugs in 408 (65.5 percent) patients, pesticides/insecticides in 58 (9.3 percent) patients, and carbon monoxide in 49 (7.9 percent) patients. The commonly used drugs were as follows: analgesics (57.2 percent), antidepressants (25.4 percent) and gastrointestinal system drugs (15.8 percent). The poisonings were suicidal in 489 (78.5 percent) patients, accidental in 120 (19.3 percent) patients, and overdose in 14 (2.2 percent) patients. The number of women was higher in the suicide group. At the end of the treatment, 604 (97.0 percent) of the patients were discharged and 3 (0.4 percent) of them died. The duration of follow-up was 39.2 ± 37.5 h.

Read more:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3881991/

E. Michna, W.Y. Cheng, C. Korves, H. Birnbaum, R. Andrews, Z. Zhou, A.V. Joshi, D. Schaaf, J. Mardekian, and M. Sheng. 2014. "Systematic Literature Review and Meta-Analysis of the Efficacy and Safety of Prescription Opioids, Including Abuse-Deterrent Formulations, in Noncancer Pain Management." Pain Medicine 15(1):79–92. doi: 10.1111/pme.12233.

To examine current understanding of the efficacy and safety of prescription opioids, the authors searched the PubMed and Cochrane Library databases for opioid-related publications between Sept. 1, 2001, and Aug. 31, 2011, and pivotal clinical trials from all years; abstracts from key pain conferences (2010–11) were also reviewed. One hundred ninety-one publications were initially identified, 68 of which met eligibility criteria and were systematically reviewed; a subset of 16 involved a placebo group (13 non-abuse-deterrent formulations (ADFs) versus placebo, 3 ADFs vs placebo) and reported both efficacy and safety outcomes, and were included for a meta-analysis. Summary estimates of standardized difference in mean change of pain intensity (DMCPI), standardized difference in sum of pain intensity difference (DSPID), and odds ratios (ORs) of each adverse event (AE) were computed through random-effects estimates for ADFs (and non–ADFs) vs placebo. Indirect treatment comparisons were conducted to compare ADFs and non–ADFs. Summary estimates for standardized DMCPI and for standardized DSPID indicated that ADFs and non–ADFs showed significantly greater efficacy than placebo in reducing pain intensity. Indirect analyses assessing the efficacy outcomes between ADFs and non–ADFs indicated that they were not significantly different (standardized DMCPI [0.39 {95 percent confidence interval (CI) 0.00–0.76}]; standardized DSPID [–0.22 {95 percent CI –0.74 to 0.30}]). ADFs and non–ADFs both were associated with higher odds of AEs than placebo. Odds ratios from indirect analyses comparing AEs for ADFs versus non–ADFs were not significant (nausea, 0.87 [0.24–3.12]; vomiting, 1.54 [0.40–5.97]; dizziness/vertigo, 0.61 [0.21–1.76]; headache, 1.42 [0.57–3.53]; somnolence/drowsiness, 0.47 [0.09–2.58]; constipation, 0.64 [0.28–1.49]; pruritus 0.41 [0.05–3.51]).

Read more:
http://www.ncbi.nlm.nih.gov/pubmed/24112715

C.A. Porucznik, E.M. Johnson, R.T. Rolfs, and B.C. Sauer. 2014. "Specialty of Prescribers Associated With Prescription Opioid Fatalities in Utah, 2002–10." Pain Medicine 15(1):73–78, doi: 10.1111/pme.12247.

Researchers computed the incidence and attributable risk (AR) of prescription opioid fatalities by medical specialty in Utah using data from the Utah Controlled Substance Database (CSD) linked to prescription opioid fatalities in the Utah Medical Examiner data. AR was calculated for each medical specialty and year. Opioid prescriptions are common with 23,302,892 recorded in the CSD for 2002–10, 0.64 percent of which were associated with a fatality. Researchers attached specialty to 90.2 percent of opioid prescriptions. Family medicine and internal medicine physicians wrote the largest proportion of prescriptions (24.1 percent and 10.8 percent) and were associated with the greatest number of prescription opioid fatalities. The number of active prescriptions at time of death decreased each year. The AR of fatality by provider specialty varied each year with some specialties, such as pain medicine and anesthesiology, consistently associated with more fatalities per 1,000 opioid prescriptions than internal medicine physicians the same year.

Read more:
http://www.ncbi.nlm.nih.gov/pubmed/24118974

S.E. Reddel, R. Bruno, L. Burns, A. Kirwan, K. Lokuge, and P. Dietze. 2014. "Prevalence and Associations of Quetiapine Fumarate Misuse Among an Australian National City Sample of People Who Regularly Inject Drugs." Addiction 109(2):295–302, doi: 10.1111/add.12395.

This study estimated the prevalence of self-reported misuse of the antipsychotic quetiapine fumarate among a sample of urban people who inject drugs (PWID) in Australia, and analyzed the correlation of reported misuse with health and social domains. Data were obtained from a national cross-sectional convenience sample survey of 868 urban PWID. Researchers measured self-reported life-time and recent (past six-month) use, and mode of use, of prescribed and nonprescribed quetiapine. Misuse was defined as non-oral use of the prescribed drug or nonprescribed use. Self-reported potential correlates of quetiapine misuse included sociodemographic, drug use, and health and social characteristics. Thirty-one percent of the sample [95 percent confidence interval (CI) = 28–34 percent] reported ever misusing quetiapine, 15 percent (95 percent CI = 13–17 percent) in the preceding 6 months. Multivariate logistic analysis showed that participants reporting any recent quetiapine misuse were more likely to be from jurisdictions with higher population prescription rates. They were also more likely to report violent crime in the preceding month [odds ratio (OR) = 1.96, 95 percent CI = 1.17–3.29] and nonheroin drug overdose in the preceding 12 months (OR = 3.52, 95 percent CI = 1.39–8.91). Recent quetiapine misuse was also significantly associated with nonprescribed benzodiazepine use (OR = 4.26, 95 percent CI = 2.06–8.82), nonprescribed pharmaceutical opioid use (OR = 2.76, 95 percent CI 1.47–5.19) and amphetamine use (OR = 2.08, 95 percent CI = 1.02–4.22) in the previous 6 months. Quetiapine misuse appears to be common in PWID in urban Australia. Recent misuse is associated with localities reporting a higher rate of prescriptions and among individuals with a history of nonheroin drug overdose, violent crime and use of nonprescribed benzodiazepines and pharmaceutical opioids as well as amphetamines.

Read more:
http://onlinelibrary.wiley.com/doi/10.1111/add.12395/abstract

E. Romano, P. Torres–Saavedra, R.B. Voas, and J.H. Lacey. 2014. "Drugs and Alcohol: Their Relative Crash Risk." Journal of Studies on Alcohol and Drugs 75(1):56–64.

Researchers compared blood alcohol concentrations (BACs) for 2006, 2007, and 2008 crash cases drawn from the U.S. Fatality Analysis Reporting System (FARS) with control drug and blood alcohol data from participants in the 2007 U.S. National Roadside Survey. Both included drugs tests for cannabinoids, depressants, narcotic analgesics, stimulants, and other illicit drugs. Only FARS drivers from states with drug information on 80 percent or more of the drivers who also participated in the 2007 National Roadside Survey were selected. For both sober and drinking drivers, being positive for a drug was found to increase the risk of being fatally injured. When the drug-positive variable was separated into marijuana and other drugs, only the latter was found to contribute significantly to crash risk (odds ratio 1.80, 95 percent CI 1.36–2.39). In all cases, the contribution of drugs other than alcohol to crash risk was significantly lower than that produced by alcohol. Although overall, drugs contribute to crash risk regardless of the presence of alcohol, such a contribution is much lower than that by alcohol. The lower contribution of drugs other than alcohol to crash risk relative to that of alcohol suggests caution in focusing too much on drugged driving, potentially diverting scarce resources from curbing drunk driving.

Read more:
http://www.ncbi.nlm.nih.gov/pubmed/24411797

Substance Abuse and Mental Health Services Administration. "One in 11 Past-Year Illicit Drug Users Had Serious Thoughts of Suicide." The NSDUH Report, January 16, 2014.

Suicide is a leading cause of death among illicit drug users. The 2012 National Survey on Drug Use and Health (NSDUH) reported that 3.9 percent of adults (9.0 million adults) aged 18 or older had serious thoughts of suicide in the past year. This percentage was higher among adults who used illicit drugs or prescription drugs nonmedically in the past year (9.4 percent). The percentage of adults who had serious thoughts of suicide varied by type of illicit drug used. For example, in the past year, 9.6 percent of marijuana users and 20.9 percent of sedative users (nonmedical use) had suicidal thoughts.

Read more:
http://www.samhsa.gov/data/spotlight/spot129-suicide-thoughts-drug-use-2014.pdf

R.J. Tait, and S. Lenton. 2014. "Commentary on Williams et al. 2014.: Family Matters—New Resources for Managing Opioid Overdose With Take-Home Naloxone." Addiction 109(2):260–61, doi: 10.1111/add.12396.

The authors commented on a previous article about take-home naloxone. Many take-home naloxone programs have tended to train peer noninjecting drug users rather than family members. The psychometric properties of the Opioid Overdose Knowledge Scale (OOKS) and Opioid Overdose Attitudes Scale (OOAS) were assessed among family members and relevant healthcare professionals. The authors recommend that the OOKS and OOAS be validated with peer opioid users. Researchers are concerned about the risk of needle stick injuries and transmission of blood-borne viruses. The advantages of using two 0.4 mg/ml 1 ml prefilled minijets® or 2.0 mg/2ml intranasal forms of naloxone include the elimination of the risks of a needle stick and simplification of training. Items in the OOKS will need to be altered to accommodate the intranasal route. Training family members or peers in overdose management includes recognizing symptoms of overdose and enacting emergency procedures. The development of the OOAS and the OOKS should now be applied to future evaluations of overdose prevention programs incorporating naloxone.

Read more:
http://onlinelibrary.wiley.com/doi/10.1111/add.12396/full

M.J. Tarrahi, A. Rahimi–Movaghar, H. Zeraati, M. Amin–Esmaeili, A. Motevalian, A. Hajebi, V. Sharifi, R. Radgoodarzi, M. Hefazi, and A. Fotouhi. 2014. "Agreement Between DSM–IV and ICD–10 Criteria for Opioid Use Disorders in Two Iranian Samples." Addictive Behavior 39(3):553–57, doi: 10.1016/j.addbeh.2013.10.032.

This study examined the agreement between the two coding systems in diagnosing dependence, abuse, and harmful use among opioid users in the general population and a clinical sample. Two series of data were used in this study. The first were data on 236 home-residing opioid abusers ages 15–64, who had previously participated in the Iran Mental Health Survey (IranMHS) in 2011, and the second were data on 104 general psychiatry patients from inpatient or outpatient wards of two psychiatry hospitals in Tehran. Opioid use disorders were evaluated with CIDI–version 2.1. The disorders were assessed in all participants who used opioid substances for at least 5 times during the past 12 months. In the sample from the general population, the agreement between the two systems on the diagnosis of dependence was excellent (0.81). The agreement between the two systems on the diagnosis of abuse and harmful use was 0.41. In the clinical sample, the agreement between the two systems on the diagnosis of dependence or any opioid use disorder was 0.96 and 0.93, respectively. The agreement between abuse and harmful use was 0.9 and –0.02 with and without regarding hierarchy, respectively. The interrater reliability of both DSM–IV and ICD–10 systems for all diagnoses was more than 0.95. The results of the diagnosis of dependence in the two systems had a weak concordance with treatment. The diagnostic criteria of DSM–IV and ICD–10 regarding dependence are very similar and the diagnosis produced by each system is concordant with the other system. However, the two systems have noticeable discrepancies in the diagnosis of abuse and harmful use. The discrepancies result from their conceptual differences and necessitate further revision in the definition of these disorders in the two systems.

Read more:
http://www.ncbi.nlm.nih.gov/pubmed/24286705

News

Commentary: Combating Substance Use Disorders in the Armed Forces
The Partnership at Drugfree.org
January 22, 2014

David C. Lewis, professor emeritus of community health and medicine, and Donald G. Millar, distinguished professor emeritus of alcohol and addiction studies at Brown University, discussed the Institute of Medicine (IOM) Committee report, Substance Use Disorders in the U.S. Armed Forces, which was delivered to the U.S. Congress and the U.S. Department of Defense (DoD) in September 2012. Congress and the DoD are concerned about opioid prescription drugs, binge drinking, and the high number of suicide deaths in the military. The IOM conducted a comprehensive analysis of the substance use disorder (SUD) problems by reviewing DoD policies and practices and by hearing from the military commanders and the troops throughout the United States. DoD issued a separate report with a point-by-point discussion of its plans in response to the IOM recommendations. DoD also issued new regulations to remove TRICARE insurance coverage of pharmacotherapy for opioid maintenance treatment. The military leadership has acknowledged that SUD problems can be prevented and can be treated when detected early, and can be addressed with interventions that allow some degree of confidentiality and are delivered in a consistent, evidence-based manner.

Read more:
http://www.drugfree.org/join-together/addiction/commentary-combating-substance-use-
disorders-in-the-armed-forces?utm_source=Join percent20Together percent20Daily
&utm_campaign=9a58ef2810-JT_Daily_News_Combating_Substance_Use_
&utm_medium=email&utm_term= 0_97f4d27738-9a58ef2810-221990529


Prescription Drug Misuse and Abuse During Pregnancy
Psychology Today
January 21, 2014

Ira J. Chasnoff, president of NTI Upstream and a professor of clinical pediatrics at the University of Illinois College of Medicine, discussed mothers who have used prescription medications during pregnancy. He argues that this is not a "new" epidemic. Physicians have been contending with it for many years. Dr. Chasnoff suggested that a pregnant woman who needs prescription medication should work with her physician to find the appropriate dose, to monitor the pregnancy closely, and to be prepared to address the needs of the child at birth and long term. Physicians need to incorporate questions in prenatal care that ask about the use of medications, whether prescribed or not. Along with this, it is important to share the message that misuse of medications during pregnancy has long-term implications for the exposed child.

Read more:
http://www.psychologytoday.com/blog/aristotles-child/201401/prescription-drug-misuse-and-abuse-during-pregnancy?quicktabs_5=1

Other State and Local News

Survey Shows Most Livingston County, Mich., Teens Do Not Use Drugs
Brighton Patch
January 21, 2014

The Michigan Profile for Healthy Youth, an online student survey, revealed that most Livingston County high school and middle school students do not use alcohol, tobacco, and other drugs. It showed that 1,534 eleventh graders, 1,633 ninth graders, and 1,327 seventh graders completed the survey in 2012. Some findings included 94 percent of high school students have not abused prescription drugs in the past 30 days, and 84 percent of high school students have not used marijuana in the past 30 days. Livingston County used MOST, a social norm campaign, that lets students and their parents know that MOST Teens don't use alcohol, tobacco, marijuana, and prescription drugs.

Read more:
http://brighton.patch.com/groups/around-town/p/survey-shows-most-local-teens-do-not-use-drugs

A Deadly Habit: Prescription Drugs Leading Cause of Overdose Deaths in Larimer County, Colo.
Coloradoan.com
January 18, 2014

Accidental prescription drug overdoses killed at least 29 Larimer County residents last year. The lion's share of deaths came from prescription opiates, which killed 27 in 2012. Prescription opiate deaths in Larimer County increased starting in 2007, when there were 22 deaths, a 340 percent increase from the previous year. Experts say the availability of prescription medicines plays a role. Emergency room doctors at Medical Center of the Rockies and Poudre Valley Hospital put ER patients who repeatedly visit and complain about pain on a list. This list has about 700 individuals who are refused medications. The purpose of the list is to prevent addicts from getting even more pills. Jenny Hedrick, a coordinator of the chemical dependency intensive outpatient program at Mountain Crest Treatment Center, said a large number of the prescription drug addicts she sees got hooked from legally prescribed medications. She said patients need to take more responsibility in understanding the potential for abuse. In 2012, heroin overdoses killed 11 people in Larimer County, but prescription drug abuse and deaths exceeded these.

Read more:
http://www.coloradoan.com/article/20140118/NEWS01/301180104

Jack Conway: Treating Drug Abuse Essential
Courier–Journal
January 22, 2014

Kentucky Atty. Gen. Jack Conway discussed his efforts to stop prescription drug abuse throughout the state. He created Kentucky's first statewide prescription drug task force and helped craft legislation that has shut down half the pain clinics in the Blue Grass State. He has traveled across the commonwealth warning young people about the dangers of prescription drug abuse. He negotiated a $32 million settlement that is intended to expand treatment.

Read more:
http://www.courier-journal.com/article/20140122/OPINION04/301220040/Jack-Conway-Treating-drug-abuse-essential

Martha's Vineyard Police and Physicians Confront Opiate Abuse
Martha's Vineyard Times
January 22, 2014

The abuse of prescription pain relievers is a growing problem in Martha's Vineyard, Mass. Recently, members of the Martha's Vineyard Drug Task Force stopped a tow truck driver who said he sold Percocet pills to support his heroin habit. In a second case, police arrested an opiate dealer who had just filled a legitimate prescription for 180 Oxycontin pills. The police department has seen a rise in crime because of pill addiction. In 2011, Edgartown had 60 homes broken into, all connected to individuals trying to feed their addiction to pills. In 2012, Edgartown had about 20 break-ins; and last year, it had around 30 break-ins tied to addicted individuals. The increase in opiate addiction has also led to a spike in heroin addiction on the island. Pieter Phil, chief of the medical staff at Martha's Vineyard Hospital, said physicians require a signed pain contract with their patients before prescribing any pain relievers. Emergency room physicians are aware of the abuse issues, so they tend to prescribe lower quantities to get through the immediate crisis. Dr. Phil added that the addiction epidemic has spurred major changes in pain management protocol at Martha's Vineyard hospital, and elsewhere. The paradigm is shifting from pain medication to managing the pain with other means. Martha's Vineyard Hospital, in conjunction with Massachusetts General Hospital, has established a pain clinic and intervention service.

Read more:
http://www.mvtimes.com/2014/01/22/marthaaes-vineyard-police-physicians-confront-opiate-abuse-18728/

Holland, Ohio, Couple Clears Hurdle to Create Prescription Drug Abuse Awareness Day
Northwestohio.com
January 23, 2014

This article and video (2 minutes 42 seconds) discuss Kyle and April Schalow's mission to get statewide recognition of Prescription Drug Abuse Awareness and Education Day in Ohio. House Bill 399 passed unanimously in the Ohio House Health and Aging Committee. April overcame her own addiction to prescription pain relievers with her husband's help.

Read more:
http://www.northwestohio.com/news/story.aspx?id=997707

Overdose Deaths From Prescription Drug Abuse Skyrocketing in Southwestern Pennsylvania
Pittsburgh Post–Gazette
January 23, 2014

The Pennsylvania Department of Health's Bureau of Health Statistics and Research said the number of overdose deaths from prescription and illegal drugs has increased dramatically across the region. Fayette County has one of the highest death rates from drug overdoses in the country, more than that of West Virginia, the state with the highest rate of overdose deaths in the nation. In 2011, drug overdose deaths in Allegheny County totaled 243—a rate of 20.5 per 100,000 residents—an increase from 2010 and 2009, when 228 and 222 people died from overdoses, respectively. In 1990, 18 persons died of drug overdoses in the six regional counties of Beaver, Butler, Fayette, Greene, Washington, and Westmoreland. Three of the 18 died in Fayette County that year. By 2009, the number in Fayette County had reached 23. It rose to 28 in 2010, then shot to 43 in 2011—representing 33.5 deaths per 100,000 residents, surpassing West Virginia's nation-leading state rate of 28.9 overdose deaths per 100,000 residents. All counties in southwestern Pennsylvania outpaced the state in the number of deaths per 100,000 people. Several bills pending in the state legislature would address the monitoring of prescription opiates. Pennsylvania has a prescription drug monitoring program but does not monitor Schedule 2, 3, 4, or 5 drugs. Bureau of Treatment, Prevention, and Intervention Director Kenneth Martz said the problem must be addressed from many different angles, including drop-off boxes to collect unneeded prescription medicines, expanded treatment options to address addiction, and a monitoring program to track possible abusers.

Read more:
http://www.post-gazette.com/local/south/2014/01/23/Overdose-deaths-from-prescription-drug-abuse-skyrocketing-in-southwestern-Pennsylvania/stories/201401230018

Rhode Island Health Officials: 22 Overdose Deaths in 13 Days
Providence Journal
January 17, 2014

Rhode Island health officials reported that 22 people died of drug overdoses during the first 13 days of 2014, double to triple the number normally seen during this time period. The fatalities involved fentanyl, cocaine, opiates, benzodiazepines, methamphetamine, oxycodone, and carisoprodol. Those who died ranged in age from 20 to 62, dispersed across 13 cities and towns. Twenty victims were white, 2 African American; 16 were men, 8 women. The health director said most of the deaths occurred over the weekend, suggesting the victims were binging.

Read more:
http://news.providencejournal.com/breaking-news/2014/01/ri-health-officials-22-overdose-deaths-in-13-days.html

Medical Group to Propose Legislation Aimed at Preventing Abuse of Prescription Drugs
Providence Journal
January 23, 2014

The Rhode Island Medical Society plans to propose legislation intended to reduce abuse of prescription drugs. The legislation would require doctors, nurses, dentists, and others to register with the state's prescription-drug database when they renew their controlled substances registration. The bill would also permit other doctor's office workers to check the database and have the prescription monitoring program send alerts when a patient is obtaining controlled substances from multiple clinicians or pharmacies. The bill would not require doctor's offices to consult the database.

Read more:
http://www.providencejournal.com/breaking-news/content/20140123-medical-group-to-propose-legislation-aimed-at-preventing-abuse-of-prescription-drugs.ece

Twin Cities Heroin, Painkiller Deaths Surged in First Half of 2013
Star Tribune
January 23, 2014

The Minnesota Drug Abuse Trend report showed the pace of overdose deaths from heroin and prescription pain medicine abuse rose in the Twin Cities during the first half of 2013. A total of 122 people died of opiate, cocaine, and methamphetamine overdoses in Hennepin and Ramsey Counties in the first half of 2013, compared with 171 deaths in all of 2012, with the growth entirely in Hennepin County. About half of the overdose deaths in Hennepin County were people in their 20s. Distribution of admissions to Minneapolis and St. Paul treatment centers by substance abuse problem in the first half of 2013 included 13.6 percent for heroin, 10.1 percent for other opiates, 9.4 percent for meth, 4.1 percent for cocaine, 16.0 percent for marijuana, and 2.7 percent for other or unknown substances. A new strategy to fight the epidemic is to charge drug dealers with third-degree murder. State Sen. Chris Eaton, whose daughter died of a heroin overdose in 2007, has proposed a bill that would allow law enforcement to carry naloxone. Sen. Eaton's bill would also make it easier for users to call for help, protecting them from prosecution for things found at the scene of an emergency brought on by an overdose.

Read more:
http://www.startribune.com/local/minneapolis/241681501.html

Health Survey Shows High Rates of Drug Deaths in Fitchburg and Clinton, Mass.
Telegrams.com
January 22, 2014

Montachusett Public Health Network released a community health assessment using data from various sources from 2005 through 2011. It looked at health issues in 11 Massachusetts cities: Fitchburg, Gardner, and Leominster and the towns of Athol, Clinton, Phillipston, Princeton, Royalston, Sterling, Templeton and Westminster. The study found that the region's opiate-related mortality rate is greater than the state average of 9 deaths per 100,000 people. The region's rate is 10 per 100,000 people, but Fitchburg's rate of 14.8 per 100,000 and Clinton's of 12.1 per 100,000 are significantly higher. The Health Network's next major initiative is to make available sharp collection boxes for used needles and medication collection boxes.

Read more:
http://www.telegram.com/article/20140122/NEWS/301229628/1116

Coalition Looks to Implement Drug Monitoring in Walpole, Mass., Pharmacies
Wicked Local Walpole
January 20, 2014

The Walpole Drug and Alcohol Coalition is encouraging local pharmacies to use the Massachusetts Prescription Monitoring Program (PMP) database as a better way to keep track of pharmaceuticals. Two of the town's four pharmacies already use the program, but the coalition wants all of them to use it. Currently, the PMP is being phased in across the state. It will eventually be mandatory for all pharmacies. The program is currently mandatory for medical professionals when getting a new (or renewing an old) license to prescribe. Any pharmacy can start using the program at any time. Walpole's health director said fear of safety issues might be stopping pharmacies from using the database. If a pharmacist refuses a prescription to someone who is looking to abuse it, he or she may fear a violent situation or that robbery may result.

Read more:
http://www.wickedlocal.com/walpole/news/x1515011761/Coalition-looks-to-implement-drug-monitoring-in-Walpole-pharmacies

Other Resources

Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide
National Institute on Drug Abuse
January 2014

This guide describes 13 principles to consider in treating adolescent substance use disorders, frequently asked questions about adolescent drug use, evidence-based approaches to treating adolescent substance use disorders, and the role of family and medical professionals in identifying teen substance use and supporting treatment and recovery.

Read more:
http://www.drugabuse.gov/publications/principles-adolescent-substance-use-disorder-treatment
http://www.drugabuse.gov/sites/default/files/podata_1_17_14.pdf

Targeting Doctors Who Overprescribe [AUDIO]
New Jersey 101.5
January 24, 2014

This 30-minute audio discusses the abuse of prescription pain relievers and Prosecutor Joseph Coronato's efforts to address the heroin addiction epidemic. Ocean County, N.J., ended 2013 with a total of 112 drug overdose deaths and has had 4 deaths so far in January 2014. The Ocean County Prosecutor's Office is planning a series of locally produced antidrug videos this year. Mr. Coronato said that they will be holding bigger and better drug forums in 2014 and will be expanding the drug court intervention program by addressing mental health issues with a new pilot initiative.

Read more:
http://nj1015.com/targeting-doctors-who-over-prescribe-audio/

Grant Announcements

New Applicant Workshops Announced for the Drug-Free Communities Program
Community Anti-Drug Coalitions of America
Friday, February 7, 2014—Washington, D.C.
Tuesday, February 11, 2014—Denver, Colo.
Thursday, February 13, 2014—Atlanta, Ga.
http://www.cadca.org/resources/detail/new-applicant-workshops-announced-dfc-program

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

Research to Prevent Prescription Drug Overdoses
Centers for Disease Control and Prevention, Department of Health and Human Services
Letter of Intent Deadline: February 14, 2014
Proposal Deadline: 5:00 p.m. (EST), March 19, 2014

The purpose of this funding is to conduct research to assess the impact of policies and administrative practices on the inappropriate prescribing or abuse of prescription opioid analgesics. This funding will support projects that 1) evaluate the impact of current legislation that requires state oversight of pain management clinics or sets out registration, licensure, or ownership requirements for such clinics or 2) evaluate the impact of formulary management and benefit design strategies used by public or private insurers and pharmacy benefit managers (e.g., quantity limits, step therapies, preferred drug lists, prior authorization, tiered formularies, and drug utilization review programs) that are applicable to all beneficiaries, not just those identified as abusing drugs or engaged in fraudulent activity.

Read more:
http://www.grants.gov/search-grants.html?agencies percent3DHHS percent7CDepartment percent20of percent20Health percent20and percent20Human percent20Services

Research on Integration of Injury Prevention in Health Systems
Centers for Disease Control and Prevention, Department of Health and Human Services
Letter of Intent Deadline: February 14, 2014
Proposal Deadline: 5:00 p.m. (EST), March 19, 2014

The purpose of this funding is to support research that informs the link between public health and clinical medicine in injury prevention by 1) developing the evidence base for clinical preventive services in the area of prescription drug overdose and 2) investigating models for partnership between hospitals and state/local health departments in designing community health needs assessments and improvement plans that incorporate injury prevention.

Read more:
http://www.grants.gov/search-grants.html?agencies percent3DHHS percent7CDepartment percent20of percent20Health percent20and percent20Human percent20Services

TAKE-BACK EVENTS AND DROP BOXES

National Take-Back Initiative
Drug Enforcement Administration
10:00 a.m. to 2:00 p.m.
Saturday, April 26, 2014
http://www.deadiversion.usdoj.gov/drug_disposal/takeback/index.html

Downers Grove, Ill., Police Offer Prescription Drug Disposal Program
Downers Grove Patch
January 23, 2014
http://downersgrove.patch.com/groups/police-and-fire/p/downers-grove-police-offer-prescription-drug-disposal-program

Charlotte County, Fla., Sheriff's Office Collects More Than 1,700 Lbs. of Rx Drugs in 2013
News–Press
January 21, 2014
http://www.news-press.com/article/20140121/VOLUNTEERING/140121015/Charlotte-sheriff-s-office-collects-more-than-1-700-lbs-Rx-drugs-2013?gcheck=1

Reading, Mass., Police Reach Prescription Drug Take-Back Milestone
Reading Patch
January 21, 2014
http://reading.patch.com/groups/police-and-fire/p/reading-police-reach-prescription-drug-take-back-milestone

Cambria County, Pa., Unveils Drug Collection Program
Tribune–Democrat
January 21, 2014
http://www.tribune-democrat.com/local/x1767993217/Cambria-County-unveils-drug-collection-program

UPCOMING CONFERENCES AND WORKSHOPS

Twenty-Fourth National Leadership Forum: The Power of Movement
February 3–6, 2014
National Harbor, Maryland
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, Maryland
http://forum.cadca.org/?q=node/59

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

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

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

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

Prescription Drug Abuse and Diversion Crimes
June 10, 2014
Cottleville, Missouri
http://www.thepoliceacademy.org/2014.6.10. percent20Prescription.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.