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January 9, 2013

SAMHSA Prevention of Prescription Drug Abuse in the Workplace Listserv

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January 9, 2013 (PDF version)

Feature Article of the Week 
M.J. Walker and L.R. Webster. 2012. "Risk Factors for Drug Diversion in a Pain Clinic Patient Population." Journal of Opioid Management 8(6):351-62. doi:10.5055/jom.2012.0135.

Researchers developed an anonymous patient survey that was given to individuals at six clinics for chronic pain management. Questions determined whether patients had experienced drug loss, theft, or diversion and, if so, the number of episodes. Respondents had experienced a 45 percent incidence of some form of drug diversion on at least one occasion. The most common type of drug diversion was theft--reported by 30 percent of respondents. Other types were losing, sharing, and selling medications. The findings suggest family history of drug abuse and history of criminal behavior are associated with increased likelihood of drug diversion.

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Journal Articles

J.E. Brady and G. Li. 2013. "Prevalence of Alcohol and Other Drugs in Fatally Injured Drivers." Addiction 108(1):104-14.

Researchers used the Fatality Analysis Reporting System for 2005-09 in 14 states that tested at least 80 percent of drivers killed in crashes. They examined prevalence of alcohol and/or other drugs (AOD) detected in the drivers and found that 57.3 percent tested positive for AOD, with 19.9 percent testing positive for two or more substances. Alcohol was the most commonly detected substance (present in 40.2 percent of fatally injured drivers), followed by cannabinols (10.5 percent), and stimulants--most often cocaine (9.0 percent), narcotics (5.7 percent), and depressants (4.0 percent).

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Wilson M. Compton, Nora D. Volkow, Douglas C. Throckmorton, and Peter Lurie. 2013. "Expanded Access to Opioid Overdose Intervention: Research, Practice, and Policy Needs." Annals of Internal Medicine 158(1):65-6.

This editorial provides an overview of the Office of National Drug Control Policy's efforts to address opioid overdoses. The authors suggest that the U.S. Food and Drug Administration and the National Institute on Drug Abuse conduct pharmacokinetic studies of intranasal and injectable naloxone--treatments for opioid overdose.

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L. Crome and T. Rao. 2012. "Substance Misuse in the Elderly." Pulse 72(34):34.

These physician tips indicate that alcohol and prescription drugs are the two most commonly misused substances among older people in Great Britain. The authors recommend closely monitoring pharmacological treatment for substance misuse in the elderly.

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Aaron S. Kesselheim, Alexander S. Misono, William H. Shrank, Jeremy A. Greene, Michael Doherty, Jerry Avorn, and Niteesh K. Choudhry. 2012. "Variations in Pill Appearance of Antiepileptic Drugs and the Risk of Nonadherence." Archives of Internal Medicine:1-7. doi:10.1001/2013.jamainternmed.997.

Researchers discovered that changes in the pill color of generic drugs can significantly increase the odds of nonpersistence (failure to fill a prescription within 5 days of the elapsed days supplied). They used a case-control study of commercially insured patients in the United States who initiated an antiepileptic drug and found patients whose pills had changed color were 27 percent more likely to avoid the next refill than those whose pills hadn't changed color.

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Amy M. Kobus, David H. Smith, Benjamin J. Morasco, Eric S. Johnson, Xiuhai Yang, Amanda F. Petrik, and Richard A. Deyo. 2012. "Correlates of Higher-Dose Opioid Medication Use for Low Back Pain in Primary Care." Journal of Pain 13(11):1131-38.

Researchers documented prevalence of high-dose opioid use, as well as associated demographic, clinical, and health service use correlates among patients with low back pain. They found that higher-dose opioid therapy is prescribed to 8.6 percent of back pain patients who receive long-term opioid treatment. These patients had higher mental health and medical comorbidities and co-prescriptions of sedative-hypnotics.

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Stephen W. Patrick, Robert E. Schumacher, Brian D. Benneyworth, Elizabeth E. Krans, Jennifer M. McAllister, and Matthew M. Davis. 2012. "Neonatal Abstinence Syndrome and Associated Health Care Expenditures: United States, 2000-2009." Journal of the American Medical Association 307(18):1934-40. doi:10.1001/jama.2012.3951.

Between 2000 and 2009, researchers observed a substantial increase in the incidence of Neonatal Abstinence Syndrome (NAS)--a drug withdrawal syndrome in newborns caused by the mother's opiate use during pregnancy. The incidence of NAS among newborns increased from 1.20 to 3.39 per 1,000 hospital births per year. Antepartum maternal opiate use increased from 1.19 to 5.63 per 1,000 hospital births per year. In 2009, newborns with NAS were more likely than all other hospital births to have low birth weight. Private, generally employer-paid health insurance funded 15 percent of treatment for addicted babies, while Medicaid funded 78 percent.

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Related Articles
Pain Pills' Littlest Victims
The Wall Street Journal
December 28, 2012
This article highlights data from the Journal of the American Medical Association to describe the increase in babies born dependent on narcotic drugs. In the United States, 3.4 of every 1,000 infants born in 2009 suffered from NAS.
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More Newborns Showing Ill Effects of Maternal Opioid Use
American Medical News
May 21, 2012
Researchers estimated that NAS affected 13,539 newborns in 2009 compared with 4,682 babies in 2000, because of a surge in opiate use among pregnant women. However, it is unclear what percentage of NAS cases result from mothers' appropriate use of prescribed opioids and how many cases are caused by illicit drug use.
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Tami L. Mark, Joan Dilonardo, Rita Vandivort, and Kay Miller. 2012. "Psychiatric and Medical Comorbidities, Associated Pain, and Health Care Utilization of Patients Prescribed Buprenorphine." Journal of Substance Abuse Treatment. doi:10.1016/j.jsat.2012.11.004.
Researchers used the 2007-09 MarketScan Research Databases to describe comorbidities and health care use among individuals treated with buprenorphine. They found that buprenorphine recipients had a high prevalence of comorbidities associated with chronic pain, including back problems (42 percent). In addition, buprenorphine recipients were frequently diagnosed with anxiety and mood disorders, and filled prescriptions for antidepressants and benzodiazepines at high rates.
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News and Reports
New Hampshire's New DUI Law Covering Prescription Drugs Goes Into Effect Jan. 1
New Hampshire Public Radio
December 31, 2012
Effective Jan. 1, 2013, driving under the influence of prescription drugs, over-the-counter medications, or any other chemical substance is a crime in New Hampshire.
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FDA Seeks Input on Using Corrective TV Ads to Remedy Mistakes in Prior Ads
Bloomberg BNA
January 3, 2013
The Food and Drug Administration plans to study the effects of corrective television ads that aim to address incorrect information in direct-to-consumer pharmaceutical advertising. The FDA is soliciting comments on an experimental study, "Examination of Corrective Direct-to-Consumer Television Advertising." According to the article, the agency said its regulations require prescription drug ads "to contain accurate information about the benefits and risks of the drug advertised. When this is not the case, corrective advertising is designed to dissipate or correct erroneous beliefs resulting from a false claim." The project will examine the influence of corrective messages in the realm of consumer-directed prescription drug advertising.
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New Tennessee Law Targets Prescription Drug Abuse
December 30, 2012
The Prescription Safety Act of 2012 requires all licensed physicians in Tennessee to register their offices. In addition, the law reduces doctors' reporting time of patients' pill data from 30 days to 7 days. One doctor in Tennessee wrote more than 5 million prescriptions for opiates like oxycodone for 3,600 patients in 2011. Tennessee is in the nation's top 10 for overdose deaths, and unintentional drug overdose is now the leading cause of death--exceeding death rates for motor vehicle crashes, homicides, and suicides.
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Addiction to Strong Narcotic Pain-Killers Killing More
The Telegraph
December 31, 2012
This article reported that the number of people in New Hampshire who entered state-funded substance abuse treatment for oxycodone increased by more than 60 percent, making the drug the second most prevalent choice behind alcohol. According to the state medical examiner's office, drug overdose deaths have tripled since 2000, reaching 174 in 2010. Of the overdose victims, 44 percent had methadone or oxycodone--or both--in their systems.
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Oregon Prescription Drug Crimes--When Prescription Use Violates the Law
EIN News
December 25, 2012
Under Oregon and federal law, individuals who misuse or overuse prescription medication can be found guilty of a drug crime. This press release states it is illegal to give prescription pills to another person without a doctor's written prescription, or to take a pill prescribed for someone else. It is also illegal to possess prescription pills that are not in their labeled prescription bottle. Some drugs are legal to use for only a limited time after the prescription date. Finally, it is illegal for a doctor to write a prescription for too many pills while recognizing the amount is too much for a single patient.
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Prescription Drug Overdoses on the Rise in the Ozarks
January 4, 2013
The Safety Council of the Ozarks reported that prescription drug overdoses have increased among people between ages 35 and 50, according to a safety report from the county health department. Green County had an average rate of nearly 500 cases of poisoning and prescription overdose--higher than the state's average rate. The group is concerned about the effect this may have on families and workplaces.
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Abuse Resistance an Issue With Opioid Generics
MedPage Today
January 3, 2013
As patents on the popular opioid painkillers OxyContin and Opana start expiring, makers of the brand products are warning that the potential non-tamper-resistant generics are unsafe. Individuals will be able to crush, chew, and dissolve the pills again as they could in the past. Original OxyContin comes off patent in April 2013, and generic versions of original Opana could be marketed beginning Jan. 1 if approved by the Food and Drug Administration.
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Prescription Painkiller Overdoses Surpass 'Street' Drugs
December 31, 2012
Nearly 15,000 people die from prescription overdoses each year--more than cocaine and heroin overdoses combined. A Today.com reporter talks to a family member who lost a loved one to prescription overdose. The host also has a conversation with an expert about the dangers of prescription drugs.
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Unused Tool Could Help State Flag Reckless Doctors
Los Angeles Times
December 30, 2012
Authors reported the California Attorney General does not use the Controlled Substance Utilization Review and Evaluation System--a database tracking system for prescription painkillers. Of the 212,000 eligible medical professionals, fewer than 10 percent are signed up to use the system. Government officials blame lack of funding. The Times obtained a list of prescribers in the Los Angeles area for June 2008. Of the top 10 doctors on the list, 6 were eventually convicted of drug dealing or similar crimes or sanctioned by medical regulators. One was a cocaine addict. Some had been prescribing narcotics in high volumes for years before authorities caught up with them.
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Medical Board Appeals to Public to Combat Prescription Overdoses
Los Angeles Times
December 29, 2012
The Medical Board of California has asked the public to report deaths in which doctors may have overprescribed drugs. The article notes that from 2006 through 2011, medications prescribed by doctors caused or contributed to nearly half of prescription drug deaths in four Southern California counties.
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Educators: This January, Help Educate Students About the Dangers of Rx Abuse
The Partnership at Drugfree.org
January 4, 2013
On its website, MedicineAbuseProject.org, the Medicine Abuse Project has hand-picked resources tailored specifically for teachers, school nurses, administrators, and others who work within the school community. The project hopes to prevent 500,000 teens from abusing medicine within the next 5 years. The article asks readers to join the initiative this month to inform students about the dangers of medicine abuse.
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Drug-Related Deaths Skyrocket in 2012
The Daily Review
January 4, 2012
Drug-related deaths more than tripled in Bradford County, Pa., in 2012, according to Bradford County Coroner Tom Carman.
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Lawmakers Work to Curb Prescription Drug Abuse in Massachusetts
Melrose Free Press
January 3, 2013
Massachusetts lawmakers have created new legislation to increase public awareness, reduce the supply of pills, crack down on fraudulent prescriptions, make it tougher to "doctor shop," and increase access to information and substance abuse treatment. According to the law, doctors must be fully integrated into the new Prescription Monitoring Program database within 3 years. Middlesex County launched a new drug collection program in 31 local communities by installing lockboxes at police stations where people can drop off expired or unwanted medications 24 hours a day.
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Special Report: Athletes and Prescription Painkillers
January 3, 2012
A reporter investigates college football programs' use of prescription drugs such as Toredol--designed for hospital treatment of postoperative pain--and suggests the drug is used quite often in locker rooms nationwide. The National Collegiate Athletic Association does not track Toredol's use or regulate it, but professional leagues do.
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Benzodiazepines Plus Buprenorphine Linked to ED Visits
Medscape Today
December 31, 2012
A researcher found that patients receiving buprenorphine/naloxone treatment as well as an approved prescription for benzodiazepine had significantly more visits to the emergency department (ED) than those without a prescription. In addition, the increase in ED visits was more pronounced in women, who had 2.7 times as many ED visits as men with a benzodiazepine prescription or women without a benzodiazepine prescription.
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Medication Safety: Doing Your Part
Harvard Vanguard Medical Associates
January 2, 2013
This blog post, written by an internal medicine doctor, provides eight tips for using prescription medications responsibly.
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Pentagon Spending on Prescription Drugs Soars
San Francisco Chronicle
December 30, 2012
The article discusses an analysis of Pentagon prescription drug purchases. Since 2002, drug spending has increased by more than 123 percent (to $6.8 billion in 2011)--nearly double the growth rate of total pharmaceutical sales in the United States during the same period. Over the same period, the military spent at least $2.7 billion on antidepressants and more than $1.6 billion on opioid painkillers such as OxyContin and hydrocodone.
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Rising Painkiller Addiction Shows Damage From Drugmakers' Role in Shaping Medical Opinion
The Washington Post
December 30, 2012
The Food and Drug Administration (FDA)-approved label on OxyContin said the risks of addiction were "reported to be small." Additionally, a supporting journal article that the manufacturer of OxyContin distributed to doctors nationwide indicated that in a trial of arthritis patients, only a handful showed withdrawal symptoms. "But according to a Washington Post examination of key scientific papers, a court document, and FDA records, many of those claims were developed in studies supported by... the maker of OxyContin or other drug manufacturers. In addition, the conclusions they reached were sometimes unsupported by the data, and when the FDA was struggling to come up with an opioid policy, it turned to a panel populated by doctors who had financial relationships with Purdue and other drugmakers."
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Upcoming Event
National Drug Facts Week: Shatter the Myths
National Institute on Drug Abuse
Review a one-page informational sheet about National Drug Facts Week scheduled for Jan. 28 to Feb. 3, 2013.
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Related Activity
2013 National Drug IQ Challenge
National Institute on Drug Abuse
Teens and adults can test their knowledge of prescription and illicit drugs and drug abuse by taking a 10-question multiple-choice quiz, answers included.
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Related Press Release
Observance Provides Teens With Information on the Science About Drug Abuse
National Institute on Drug Abuse
August 8, 2012
This press release discusses the third annual National Drug Facts Week scheduled for Jan. 28 through Feb. 3, 2013. According to the release, National Drug Facts Week encourages community-based events where teens can talk to addiction scientists and educators familiar with the National Institute on Drug Abuse's informational materials. Events can be sponsored by a variety of organizations, including schools, community groups, sports clubs, book clubs, and local hospitals.
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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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