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January 30, 2013

SAMHSA Prevention of Prescription Drug Abuse in the Workplace Listserv

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January 30, 2013 (PDF version)
Featured Article
Tara Gomes, Donald A. Redelmeier, David N. Juurlink, Irfan A. Dhalla, Ximena Camacho, and Muhammad M. Mamdani. 2013. "Opioid Dose and Risk of Road Trauma in Canada: A Population-Based Study." JAMA Internal Medicine:1-6. doi:10.1001/2013.jamainternmed.733.
Researchers conducted a population-based, nested, case-control study of 5,300 patients ages 18 to 64 who had an emergency department visit related to road trauma between April 1, 2003, and March 31, 2011, and compared them with demographically matched patients visiting for other reasons. They merged data on opioid prescriptions in place precrash. Drivers prescribed opioids have significantly higher road risks that rise with dosage. Compared with very low opioid doses (fewer than 20 morphine equivalents daily [MED]), drivers prescribed low doses had a 21 percent increased likelihood of road trauma; those prescribed moderate doses, 29 percent increased likelihood; those prescribed high doses, 42 percent increased likelihood; and those prescribed very high doses (more than 200 MED), 23 percent increased likelihood. PAW staff suspect workers operating other hazardous machinery and equipment have similarly elevated risks. 

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Related Editorial 
Mitchell H. Katz. 2013. "Opioid Prescriptions for Chronic Nonmalignant Pain: Driving on a Dangerous Road." JAMA Internal Medicine:1. doi:10.1001/jamainternmed.2013.1838.
This accompanying editorial states that over the last 2 years, The Journal of the American Medical Association has published several articles describing harms of long-term opioid use for chronic nonmalignant pain, especially when prescribed at high doses. It urges doctors to resist prescribing continuing opioids for chronic pain. 

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Journal Articles
H. Baldwin and P. Duffy. 2013. "Drug Treatment Practitioners' Perceptions of Methadone Diversion and Their Responses to It." Drugs: Education, Prevention & Policy 20(1):22-32. doi:10.3109/09687637.2012.717123.
Researchers examined drug treatment practitioners' perceptions of England's illicit methadone market. Having interviewed 120 practitioners involved in the delivery of methadone maintenance treatment, the practitioners felt methadone was diverted for monetary gain and shared with others. In addition, they felt illicit methadone was used to replace prescriptions or self-medicate if people were not in treatment. They thought supervised consumption was the only effective way to prevent diversion.

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Scott W. Keith, Vittorio Maio, Kellie Dudash, Megan Templin, and Stefano Del Canale. 2012. "A Physician-Focused Intervention to Reduce Potentially Inappropriate Medication Prescribing in Older People." Drugs & Aging. doi:10.1007/s40266-012-0043-y.
Researchers assessed the effect of a physician-focused, multifactorial, quality-improvement intervention on potentially inappropriate medication (PIM) among older patients in primary care. The 3-year study engaged 303 general practitioners in the Local Health Authority (LHA) of Parma, Italy, to improve quality of prescribing to the entire older outpatient population served by these physicians. Quarterly PIM exposure incidence rates among the older Parma LHA patients declined 31.4 percent, compared with 21.6 percent in the comparator LHA. These rates were compared with a control group of patients in a neighboring LHA. The reduction in rates was significantly greater in the Parma LHA, where the intervention resulted in 608 older patients avoiding PIM exposure during the fourth quarter of 2009. PIM exposure rate reductions for nonsteroidal anti-inflammatory drugs and digoxin were each significantly greater in the Parma LHA than in the comparator LHA. 

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Related Article 
Intervention Cut Use of Possibly Unsafe Drugs
MedPage Today
January 24, 2013
Educating physicians about potentially inappropriate medications lowered prescribing of such drugs to seniors by nearly one third over a 3-year period, according to a new study. Exposure to potentially inappropriate medications dropped from 7.8 percent at baseline to 5.3 percent among those 65 and older after general practitioners in Italy received information on prescribing for older patients. Reduction in such prescribing was greater in the intervention group than in the control group, in which the use of potentially inappropriate medication declined from 7.7 percent to 6.1 percent.

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W. Kondro. 2013. "Federal Health Minister Urges Provincial Crackdown on Physicians Who Overprescribe Opioids." Canadian Medical Association Journal 185(1):E43-E48. doi:10.1503/cmaj.109-4373.
Leona Aglukkaq, Canada's Federal Health Minister, has rejected a proposal to ban the generic drug oxycodone but has urged opioid abuse control among the country's provinces and territories by scrutinizing doctors who overprescribe painkillers to their patients. The article offers information on OxyContin and discusses its physiological impact on patients' health.

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I.O. Lund, S. Skurtveit, A. Engeland, K. Furu, E. Ravndal, and M. Handal. 2013. "Prescription Drug Use Among Pregnant Women in Opioid Maintenance Treatment." Addiction 108(2):367-76.
This Norwegian study describes use of prescribed drugs among women in opioid maintenance treatment (OMT) before and during pregnancy. It was based on information from two nationwide databases: the Medical Birth Registry of Norway and the Norwegian Prescription Database. Malformations were significantly more common among children born to mothers in OMT who received comedication with opioids, benzodiazepines, or z-hypnotics. In addition, a higher proportion of women in OMT in Norway use prescription drugs before and during pregnancy than pregnant women in the general population.

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M.W. McLawhorn, M.R. Goulding, R.K. Gill, and T.M. Michele. 2013. "Analysis of Benzonatate Overdoses Among Adults and Children From 1969-2010 by the United States Food and Drug Administration." Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy 33(1):38-43. 
Researchers summarized data on emergency department visits, benzonatate exposure, and reports of benzonatate overdoses from the Food and Drug Administration (FDA) Adverse Event Reporting System database (1969-2010), National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance Project (2004-09), and IMS commercial data vendor (2004-09). They found dispensed benzonatate prescriptions increased by approximately 52 percent from 2004 to 2009. Accumulating cases of fatal overdoses, especially in children, prompted the FDA to notify healthcare professionals about the risks of benzonatate overdose.

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Khary K. Rigg, Steven P. Kurtz, and Hilary L. Surratt. 2012. "Patterns of Prescription Medication Diversion Among Drug Dealers." Drugs (Abingdon Engl)19(2): 144-55. doi: 10.3109/09687637.2011.631197
Researchers analyzed 50 in-depth interviews with prescription drug dealers in South Florida. Dealers relied on a wide array of diversion methods, including visiting multiple pain clinics, working with pharmacy employees to steal medications from pharmacies, and purchasing medications from indigent patients. Dealers most commonly sold prescription opioid analgesics and, to a lesser extent, benzodiazepines such as alprazolam.

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News and Reports
Help on Avoiding Opioid Prescribing Pitfalls
American Medical News 
January 21, 2013
The American Medical Association offers free Webinars to aid doctors in effectively providing pain medicine to patients and preventing abuse of the drugs.

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CDC Labels Prescription Drug Theft, Overdoses an 'Epidemic'
January 21, 2013
The Centers for Disease Control and Prevention labeled the increase in prescription drug theft from pharmacies an epidemic. In 2010 there were 698 reported armed robberies and 1.48 million units of prescription medication stolen from pharmacies, according to the Drug Enforcement Agency. Thefts have steadily increased since 2006, when 385 armed robberies were reported and 712,684 prescription drug units stolen.

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Washington Death Rates Drop for Prescription Medication Overdoses
KNDO Local News
January 23, 2013
The Washington State Department of Health reported that the number of people who died from prescription medication overdoses was down 23 percent from 2008 to 2011, from 512 to 407. Despite the drop, the death rate in 2011 was six times as high as it was in 1998.

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Related Press Release
Death Rate Drops 23 Percent for Prescription Pain Med Overdoses
Washington State Department of Health
January 23, 2013
Fewer people in Washington died from prescription pain medication overdoses between 2008 and 2011. There was an eightfold increase in deaths spanning the decade before.

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Colorado No. 2 in Nation for Prescription Painkiller Abuse
KREX NewsChannel 5
January 22, 2013
This article summarizes interviews with Coloradans about the state's rank as second in the country for prescription drug abuse. 

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Opioid Abuse and Workers Comp: How to Tackle a Growing Problem
Business Insurance, White Paper
This white paper provides background on opioid misuse, offers concrete steps that workers' compensation managers can take before and after opioids are prescribed, and suggests ways to measure effectiveness of the steps taken.

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Safe at Home
January 12, 2013
This article discusses federal and state government efforts to prevent home-care crimes. For example, a federal pilot program conducted background checks on direct patient-care workers in seven states in 2006 and 2007. Nearly 7,500 people were excluded for past crimes among the more than 204,000 total applicants. Another 38,400 people withdrew their background check applications before checks were completed, according to an August 2008 report on the program.

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California and Oklahoma: Drug Monitoring Program Dichotomy
DePaolo's Work Comp World
January 23, 2013
This blog post written by a workers' compensation lawyer contrasts the funding and sophistication of California and Oklahoma drug monitoring programs.

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Will FDA Limit Vicodin Rx?
MedPage Today
January 23, 2013
The Drug Enforcement Administration has asked the Food and Drug Administration (FDA) to consider tightening prescribing and other rules on hydrocodone drugs. The FDA will conduct a 2-day hearing on whether hydrocodone products should be more highly regulated like other narcotics (OxyContin and morphine)--a shift from Schedule III (the current classification for Vicodin) to Schedule II. Stricter Schedule II status means fewer prescriptions can be written at one time. Historically, the FDA has not supported stricter controls on hydrocodone because it limits patients' access to pain medicine. FDA researchers argue that patients do not develop hydrocodone addictions and thus it has less potential for abuse than oxycodone. Other scientists disagree, stating inadequate evidence supports this claim.

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Related Article
Pain Pill Abuse Helped by Doctor Inattention, DEA Says
January 24, 2013
The Drug Enforcement Administration does not think physicians are taking high abuse rates of drugs like Vicodin (hydrocodone combination painkillers) seriously. They have been debating with the FDA about their request to limit prescriptions of hydrocodone combination pills and cough suppressants to 90-day supplies instead of the current allowance--five refills within 6 months. The proposal would also strip physician assistants and nurse practitioners of their authority to prescribe the products.

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Lawmakers, Advocates Work to Mitigate Prescription for Disaster
StarNews Online
January 22, 2013
Advocates are urging North Carolina to embrace a comprehensive plan to curb overdoses and strengthen law enforcement. The North Carolina Child Fatality Task Force and Governor's Crime Commission support increased funding for antidrug efforts and expanded access to the prescription monitoring program (PMP) database. The Commission recommended requiring PMP doctors and pharmacists to use the PMP; a similar proposal previously encountered stiff resistance from lawmakers and physicians. The North Carolina Harm Reduction Coalition urges legislation promoting naloxone availability to treat overdoses and a Good Samaritan law that offers immunity from arrest to people who call 911 to report an overdose, even if they committed a misdemeanor related to the incident. Others advocated for more funding to support treatment and early intervention programs.

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Veterans Fight Chronic Pain, Drug Use With Yoga
The Auburn Villager
January 24, 2013
A nursing student at Auburn University talks about how veterans with chronic pain are using yoga as an alternative to prescription drugs. The article cites varied statistics about pain, reporting how often an unidentified random sample of abusers misused prescription drugs (29.4 percent reported zero to two episodes in 6 months, 25.1 percent reported three to six episodes in 6 months, and 45.5 percent reported more frequent use). Finally, it states that because of chronic pain and drug abuse prevalence, patients are increasingly given alternative therapies.

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Hooked: Drug Overdose Deaths Surge Locally
The Morning Journal
January 20, 2013
Drug overdoses are rising in Lorain County, Ohio. The overdose death toll tripled to 60 last year--up from 22 in 2011. Victims' ages ranged from 13 to 70. LifeCare responded to 1,962 overdose calls in 2012, through Dec. 24. In Amherst, overdoses have more than quintupled--from 25 in 2008 to 137 in 2012. Lorain's overdose calls jumped 46 percent, from 827 in 2008 to 1,208 in 2012. In Elyria, overdose calls went up almost 8 percent, from 542 in 2008 to 583 in 2012.

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Abuse of Prescription Pills on Rise
The Daily Southerner
January 24, 2013
Prescription pill abuse is a rising trend in Edgecombe County, N.C. The most common pills abusers are using and buying on the streets are Percocet, OxyContin, Opana, methadone, fentanyl, Klonopin, and Xanax. The article lists 10 warning signs to assess whether family members are abusing prescription drugs.

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Use of Prescription Medications at Work
January 21, 2013
Disability laws may govern what an employer can do if prescribed medications interfere with work performance. If an employee has a covered disability, the employer may have to accommodate a worker's use of prescription medication. However, employers may not ask their employees about the prescription drugs they use.

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Overprescribing and Medical Board Enforcement: How to Avoid Discipline
Becker's Hospital Review
January 22, 2013
This article provides insight into how a doctor can avoid discipline for overprescribing, including registering for access to a patient database that allows physicians to obtain reports on patients and provides statistical information about prior prescriptions. The author also recommends physicians perform complete examinations of patients and keep meticulous notes in the patients' charts. 

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Commentary: Time to 'Make An Impact' on Rx Epidemic
The Partnership at Drugfree.org
January 22, 2013
Karen Kelly, President/Chief Executive Officer of Operation Unite, discusses the effect that the inaugural National Rx Drug Abuse Summit had on its 700 participants in 2012. 

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Restricting Vicodin Is the Wrong Rx
Los Angeles Times
January 21, 2013
This editorial suggests reclassifying Vicodin and other drugs could make it harder for those with chronic pain to find relief.

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Sheriffs Want Access to State's Prescription Drug Tracking System
The Fayette Tribune
January 21, 2013
County sheriffs in West Virginia will be pressuring legislators to grant them access to the state's prescription drug tracking system. Only about 15 members of the West Virginia State Police Bureau of Criminal Investigation and an equal number of drug task forces currently have access to the system, which collects information about controlled substances, doctors who prescribe these drugs, pharmacies that dispense them, and individuals who purchase them. 

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State Must Address Prescription Drug Abuse
January 20, 2013
The South Carolina Inspector General thinks the state should increase its use of the prescription monitoring program to determine why pills are being prescribed and whether action is necessary. South Carolina is ranked 10th in the nation for opiate use per capita and 19th in overdose deaths.

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Deaths Linked to Prescription Drugs Plunge in Spokane County
January 24, 2013
The number of prescription drug deaths in Spokane County, Wash., dropped 40 percent, comparing 3-year time spans (from 2006 to 2008 and 2009 to 2011). In the earlier 3-year span, 193 deaths were linked to prescription drug overdoses. From 2009 to 2011, there were 115 deaths.

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Pharmacy Announces Prescription Drug Abuse Education Initiative
Cedarville University
January 18, 2013
In 2013, pharmacy faculty members and student pharmacists will visit schools, service organizations, and churches to share news and clarify common misconceptions about prescription drug abuse. Discussions will emphasize problems related to prescription drug abuse and dangers of misuse. To request a presentation, contact Cedarville University School of Pharmacy. 

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Renewing the Fight Against Rx Drug Abuse
The Fayette Tribune
January 17, 2013 
This article by U.S. Rep. Nick Rahall (D-W.Va) announced the relaunch of the bipartisan Congressional Caucus on Prescription Drug Abuse, whose goals are to raise awareness of abuse and develop innovative and effective treatment, prevention, law enforcement, and research policy solutions in the federal sphere. An estimated 40,000 people in West Virginia are addicted to some form of controlled substances and one in every five pregnant women in the state has a drug issue that will affect her newborn child.

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Army Urged to Do More With Alternative Medicine Techniques
Las Vegas Review Journal
January 18, 2013
This article discusses how an Army General with fibromyalgia once took 15 prescription drugs for pain, sleep, and eating, but now copes by going to a chiropractor and taking dietary supplements. The General suggests the military needs to place more emphasis on alternative medicine and less on prescribed drugs. Chiropractic and holistic treatments, including acupuncture, are now approved benefits for veterans and active-duty soldiers. In addition, the Veterans Administration offers physical therapy, acupuncture, and Tai Chi classes to help veterans better manage combat stress. 

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Higher Child Abuse Reports Correlate With Parents' Drug Use
Watertown Daily Times
January 22, 2013
This article links prescription drug abuse to child abuse and neglect in Lewis County, N.Y.

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Kim Smith: Help Curb Fatal Drug Abuse With Alternative Techniques
The Bakersfield Californian
January 24, 2013
This article is written by a neurofeedback clinician who thinks doctors and patients should take steps to reduce the need for pharmaceutical responses to pain. She has used neurofeedback to treat a variety of health issues, including chronic pain. When she used it to treat veterans with posttraumatic stress disorder, she saw rapid improvements in sleep problems, pain, anger management, and substance dependency. She also references a study in the journal Frontiers in Psychiatry, in which medical researchers used low-dose electric stimulation to certain parts of the brain to release an opiate-like substance considered one of the body's most powerful painkillers. 

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Let's Fight a Different 'War on Drugs'
January 24, 2013
Simple public policy changes can achieve significant reductions in prescription drug mortality, according to this article's author. He recommends policymakers focus on prescribers, because once drugs reach patients' hands, the distribution network becomes informal. "By shutting down the 'pill mill' doctors, the larger distribution network will dry up," he says. He also mentions New York's efforts to enact a law increasing prescription painkiller monitoring through mandatory electronic health records. 

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Update on Emergency Department Visits Involving Energy Drinks: A Continuing Public Health Concern
Substance Abuse and Mental Health Services Administration, the DAWN Report
January 10, 2013
The number of emergency department visits involving energy drinks doubled from 10,068 in 2007 to 20,783 in 2011. Of the 20,783 visits, 42 percent also involved other drugs. Pharmaceuticals were most commonly combined with energy drinks (27 percent), with 9 percent involving energy drinks and central nervous system stimulants (e.g., Adderall, Ritalin). 

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Sharp Rise in Emergency Department Visits Involving ADHD Medications
January 24, 2013
The number of emergency department (ED) visits involving attention deficit/hyperactivity disorder (ADHD) stimulant medications more than doubled, from 13,379 in 2005 to 31,244 in 2010. The number of ED visits involving nonmedical use of ADHD medications also nearly tripled during this period--from 5,212 in 2005 to 15,585 in 2010. 

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Drug Overdoses, Vehicle Crashes, Suicide Common Types of Unnatural Nevada Deaths
Reno Gazette-Journal
January 20, 2013
Nevada has the second highest per capita rate of deaths from accidental drug overdoses in the United States. Centers for Disease Control and Prevention data show 18,203 non-natural deaths in Nevada from 1999 to 2009. Of those deaths, 3,197 people died of accidental drug overdoses. Fifty-seven percent of the overdoses involved narcotics or hallucinogens. 

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Four Cities Win Grants for Outstanding Prescription Drug Abuse Prevention Initiatives
United States Conference of Mayors
January 19, 2013
This press release announces the winners of the 2013 Safeguard My Meds Prescription Drug Abuse Recognition Program. Awards are given to outstanding local initiatives that have the greatest potential to reduce misuse and abuse of prescription drugs, particularly among young people. Mayoral-based initiatives in four cities--Asheville, N.C., Baltimore, Md., Madison, Wis., and New Bedford, Mass--received grants of $5,000 to $10,000. Purdue Pharma funds this program.

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National Poll on Children's Health: Parents Numb to Misuse of Narcotics Pain Medicines by Youth?
University of Michigan C. S. Mott Children's Hospital
January 23, 2013
In a national survey, about one third of parents reported receiving at least one pain medicine prescription for their children in the last 5 years; 35 percent of parents were very concerned about narcotic pain medicine misuse by children and teens in their communities; 19 percent were concerned about misuse in their families; and nearly half opposed a requirement to return unused pain medicine to their doctor or pharmacy.

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Related Article
Are Parents Really Blind Concerning Narcotic Misuse in Kids?
January 23, 2013
A University of Michigan poll revealed that regardless of information on the rising rates of narcotic pain medication abuse and overdoses, most parents were not very concerned about their children or teens misusing the medications. The survey was sent in September 2012 to a group of 1,304 randomly selected parents who had a child age 5 to 17 from GfK's Web-enabled Knowledge Panel®. According to the poll, 35 percent of parents said they were very concerned about narcotic pain medicine misuse by children and teens in their communities. Only one parent in five was very concerned about pain medicine misuse in his or her own family.

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Ohio Energy Officials Concerned With Number of Applicants Failing Drug Tests
January 16, 2013
This article and video report that the Ohio Oil and Gas Energy Program is looking to hire 200,000 employees over the next few years. So far, 10 percent to 60 percent of job applicants have failed drug screenings, according to the firm's executive director, who is concerned she will not be able to find enough people to fill the positions. As an illustration, the story describes a mother who was on Percocet for 6 years and lost out on nine jobs because she could not pass a drug test.

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Lawmaker: Law Won't End Driving Rights if Taking Medication Properly
The Oakland Press
January 24, 2013
A new Michigan law, Senate Bill 353, passed unanimously in the Upper Chamber and nearly unanimously in the House. It gives police the authority to test drivers for prescription drugs. It was signed into law on Jan. 2, 2013, by Gov. Rick Snyder and takes effect on March 31. Under the law, a motorist who is impaired and has taken a listed drug can be charged with the felony of "operating a vehicle while under the influence of an intoxicating substance," with possible loss of license. The law lists 40 medications, including antidepressants, anti-anxiety medications, anticonvulsants, muscle relaxants, over-the-counter drugs such as Benadryl, and one nonprescription item (Endust, an aerosol cleaning product commonly inhaled for a high).

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Database Not Ready for State's New Prescription Drug Monitoring Program
Wisconsin State Journal
January 20, 2013
Under a 2009 law, Wisconsin's 1,200 pharmacies and other dispensers of frequently abused prescription drugs were required to gather data on each filled order starting Jan. 1, 2013. However, the prescription drug monitoring database is not ready to collect the information, and officials don't know when it will be available.

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January 10, 2013: Impairment in the Workplace: Drugs, Alcohol, and Marijuana
The Proactive Employer
Accessed January 23, 2013
In this episode, Peter Lowe discusses impairment in the workforce, referencing the prescription drug pandemic, medical marijuana laws, new recreational marijuana laws in Washington and Colorado, and conflicts between federal and state laws. The interview concludes with recommendations for employers on workplace alcohol and drug policies as well as how to enforce those policies.

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Upcoming Events
Preventing Prescription Drug Overdoses: A National Strategy
March 13-14, 2013
The Loudermilk Center
40 Courtland Street NE
Atlanta, GA
Join the National Safety Council (NSC) and other leading experts in crafting a national strategy to combat prescription drug overdoses. Your perspective is needed to inform and shape the Council's actions to address this critical safety issue. NSC is a nonprofit organization whose mission is to save lives by preventing injuries and deaths at work, in homes, and in communities.

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National Rx Drug Abuse Summit
April 2-4, 2013
Omni Orlando Resort 
1500 Masters Blvd.
ChampionsGate, Fla.
The 2013 National Rx Drug Abuse Summit will focus on ways to Make an Impact in the fight against prescription drug abuse. The Summit is the largest national collaboration of professionals from local, state, and federal agencies; businesses; academia; clinicians; treatment providers; counselors; educators; state and national leaders; and advocates affected by Rx drug abuse. Through this type of collaboration, Americans can find more effective solutions to the issue the Centers for Disease Control and Prevention declared a public health crisis in 2012.

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Please e-mail Rekaya Gibson at rgibson@pire.org with questions or comments about the SAMHSA Prevention of

About PAW and the Listserv
The PAW TA Center addresses prescription drug abuse--a growing public health problem with increasing burdens on workers, workplaces, and our economy. Prescription drug abuse affects workplace productivity and increases employee absenteeism, employee presenteeism, and workers' compensation claims. On a wider scale, overdose deaths linked to prescription opioids tripled from 1999 to 2006, and prescription drug abuse killed more Americans in 2009 than died that year in auto crashes.
Send your request for PAW technical assistance to PAW-TA@pire.org or contact Rekaya Gibson at 504.261.8107 or Deborah Galvin at 240.276.2721. Requests are subject to SAMHSA approval. You will be notified of the status of your request.
We aim to conduct systematic and inclusive searches of professional journals, leading newspapers and magazines, and federal websites, as well as contributions from listserv subscribers (please e-mail suggestions to rgibson@pire.org). We will send links to articles along with brief descriptions of those articles. As we develop the listserv, however, we hope to add commentary and invite feedback from subscribers. Our goal is to expand the listserv to become a widely used and recognized source of the most current and authoritative information on prescription drug abuse--especially in workplaces.
The "SAMHSA Prevention of Prescription Drug Abuse in the Workplace Listserv" is a service provided by the SAMHSA Preventing Prescription Abuse in the Workplace Technical Assistance Center (PAW) to keep the field abreast of recent news and journal articles to assist in forming policy, research, and programs to reduce prescription drug misuse or abuse. Please note, the materials listed are not reflective of SAMHSA's or PAW's viewpoints or opinions and are not assessed for validity, reliability, or quality. The "SAMHSA Prevention of Prescription Drug Abuse in the Workplace Listserv" should not be considered an endorsement of the findings. Readers are cautioned not to act on the results of single studies, but rather to seek bodies of evidence. Copyright considerations prevent PAW from providing full-text journal articles. 

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