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July 10, 2013

SAMHSA Prevention of Prescription Drug Abuse in the Workplace Listserv

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Featured Article
Vital Signs: Overdoses of Prescription Opioid Pain Relievers and Other Drugs Among Women--United States, 1999-2010
Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention
July 2, 2013

This report describes drug-related deaths and emergency department (ED) visits among women. The Centers for Disease Control and Prevention analyzed rates of fatal drug overdoses and drug misuse- or abuse-related ED visits among women, using data from the National Vital Statistics System (1999-2010) and the Drug Abuse Warning Network (2004-2010). In 2010, a total of 15,323 deaths among women were attributed to drug overdose--a rate of 9.8 per 100,000 population. Deaths from opioid pain relievers (OPRs) increased fivefold between 1999 and 2010 for women; OPR deaths among men increased 3.6 times. In 2010, there were 943,365 ED visits from women for drug misuse or abuse. The highest ED visit rates were for cocaine or heroin (147.2 per 100,000 population), benzodiazepines (134.6), and OPR (129.6). ED visits related to misuse or abuse of OPR among women more than doubled between 2004 and 2010. Although more men die from drug overdoses than women, the percentage increase in deaths since 1999 is greater among women. Since 2007, more women have died each year from drug overdoses than from motor vehicle-related injuries. The prominent involvement of psychotherapeutic drugs, such as benzodiazepines, among overdoses provides insight for prevention opportunities.  
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Related Fact Sheet
Prescription Painkiller Overdoses: A Growing Epidemic, Especially Among Women
CDC Vital Signs, Centers for Disease Control and Prevention
July 2013

This fact sheet discusses prescription drug overdose deaths among U.S. women. Deaths increased more than 400 percent since 1999, compared with 265 percent among men. Nearly 48,000 women died of prescription painkiller overdoses between 1999 and 2010. About 18 women die every day of a prescription painkiller overdose in the United States--accounting for more than 6,600 deaths in 2010. For every woman who dies of a prescription painkiller overdose, 30 go to the emergency department for painkiller misuse or abuse.
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Related Podcast
Vital Signs--Prescription Painkiller Overdoses
Centers for Disease Control and Prevention
July 2, 2013

This podcast (1:15 minutes) and transcript are based on the July 2013 Centers for Disease Control and Prevention "Vital Signs" report. Prescription painkiller overdoses are an under-recognized and growing problem among women. This program includes steps women and healthcare providers can take to reduce their risk of overdose.
Related Articles
Drug Addiction Resources
NBC News
July 2, 2013

This article and video (3:32) discuss the Centers for Disease Control and Prevention report on prescription drug overdoses among women. A list of drug addiction resources is also provided.
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Sharp Rise in Women's Deaths from Overdose of Painkillers
The New York Times
July 2, 2013
This article highlights the prescription pain pill issue for women in Portsmouth, Ohio, and some of the potential factors contributing to abuse.

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Related Press Release
Leading National Pain and Addiction Treatment Specialist Comments on CDC Report
The Wall Street Journal
July 5, 2013

This press release discusses a pain recovery specialist's response to the Centers for Disease Control and Prevention report on prescription drug overdose increases among women. Drugs are dispensed at record rates in spite of available data and evidence. 
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Journal Articles
S. Bowman, J. Eiserman, L. Beletsky, S. Stanclif, and R.D. Bruce. 2013. "Reducing the Health Consequences of Opioid Addiction in Primary Care." The American Journal of Medicine 126(7):565-71. doi:10.1016/j.amjmed.2012.11.031.

Researchers reviewed the literature on screening and brief interventions for addictive disorders in primary care settings, focusing on opioid addiction. Screening and brief interventions can improve health outcomes for chronic illnesses including diabetes, hypertension, and asthma. Similarly, through the use of screening and brief interventions, patients with addiction can achieve improved health outcomes. A spectrum of low-threshold care options can reduce negative health consequences among people addicted to opioids. Screening in primary care coupled with short interventions, including motivational interviewing, syringe distribution, naloxone prescription for overdose prevention, and buprenorphine treatment, are effective ways to manage addiction and the associated risks and improve health outcomes for individuals with opioid addiction.
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N. Duquet. 2013. "Drugs and Driving." Journal de Pharmacie de Belgique (2):4-11.

Few people know that drugs can have adverse effects on their ability to drive a vehicle. Many drugs cause drowsiness and can increase the risk of accidents through attention loss or slowing reflexes. Drugs can also affect judgment, impair vision, or cause dizziness. It is the pharmacist's responsibility to draw a patient's attention to negative effects of drugs on driving.  
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T. Winhusen, J. Walker, G. Brigham, D. Lewis, E. Somoza, J. Theobald, and V. Somoza. 2013. "Evaluation of a Model of Stimulant Use, Oxidative Damage and Executive Dysfunction." The American Journal of Drug and Alcohol Abuse. doi:10.3109/00952990.2013.798663.

Six sites evaluating 12-step facilitation for stimulant abusers obtained peripheral blood samples from methamphetamine-dependent (n=45) and cocaine-dependent (n=120) participants. Blood samples were submitted to a comet assay to assess oxidative DNA damage. Executive dysfunction was assessed with the Frontal Systems Behavior Scale, which is a reliable and valid self-report assessment of executive dysfunction, disinhibition, and apathy. Stimulant-use measures included self-reported stimulant use and stimulant urine drug screens. Although more recent cocaine use (<30 days abstinence) was associated with greater oxidative DNA damage (W=2.4, p<0.05, d=0.36), the results did not support the hypothesized relationship between oxidative DNA damage, executive dysfunction, and stimulant use outcomes for cocaine-dependent patients. Support for the model was found for methamphetamine-dependent patients, with oxidative DNA damage significantly greater in methamphetamine-dependent patients with executive dysfunction (W=2.2, p<0.05, d=0.64) and with executive dysfunction being a significant mediator of oxidative DNA damage and stimulant use during active treatment (ab=0.089, p<0.05). As predicted, neither disinhibition nor apathy was a significant mediator of oxidative damage and future stimulant use.
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F. Yaqub. 2013. "Pakistan's Drug Problem." The Lancet 381(9884):2153-54. doi:10.1016/S0140-6736(13)61426-9.

This article reports on the high rates of drug misuse in Pakistan. According to the Drug Use in Pakistan 2013 Technical Summary Report, roughly 6.45 million Pakistanis aged 15-64 years used plant-based or synthetic drugs or prescription drugs for nonmedical purposes in the past 12 months. Factors that contributed to the country's drug problem include unemployment, paucity of social safety nets, and bleak prospects for young people.  
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News and Reports
Seniors Selling Prescription Drugs for Food
CBC News
July 3, 2013

Police in Cumberland County, Nova Scotia, reported that seniors are selling their prescription medications to drug dealers for food. Drug dealers are approaching them and offering groceries or money in exchange for medicine. Seniors could be charged with drug trafficking, regardless of the reason for selling medication.
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'Talk Sooner' App Answers Substance Abuse Questions for Parents, Children
The Grand Rapids Press
July 2, 2013

Kent County-based Network 180 and the Lakeshore Coordinating Council launched an iPhone application, Talk Sooner, which answers questions about prescription medication abuse and the dangers of tobacco, alcohol, and other substances. The application is free and available on iTunes. Android users can access a mobile version of the TalkSooner.org Web site. Funding for the app was provided by a Drug-Free Communities Support grant from the Office of National Drug Control Policy and SAMHSA.  
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FDA Approves Orexo Drug to Treat Opioid Addiction
July 4, 2013

The Food and Drug Administration has approved Orexo AB's drug to treat opioid addiction. The Zubsolv tablet combines buprenorphine and naloxone and dissolves under the tongue. Orexo expects to launch the drug in the United States this fall.  
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NCPDP White Paper Tackles Overutilization of Opioids, Addresses Gap to Reduce Fraud and Abuse for Medicare Part D Plans
Digital Journal
June 28, 2013

This press release discusses the availability of a white paper, "NCPDP Recommendations for a Standardized Process to Share Medicare Part D Opioid Overutilization Data Between Sponsors," written by the National Council for Prescription Drug Programs (NCPDP). The paper provides Medicare Part D plans a standardized method to share beneficiary information related to point-of-sale edits and opioid overutilization information from the previous plan of record with the new plan of record. The recommended method is anticipated to be less time consuming, reduce administrative and audit burdens, and potentially result in a real-time transaction standard. When a Part D beneficiary changes insurers, Centers for Medicare & Medicaid Services requires that the plan he or she dropped offer to submit information to the beneficiary's new insurer. The NCPDP's white paper details a three-step process health plan that can be used to initiate, conduct, and standardize the required transaction over secure e-mail. The new plan has 2 weeks to communicate its acceptance or rejection. If the new plan accepts the offer, the old plan should provide the information and supporting documentation within 2 weeks of the acceptance date. In the absence of a response within the 2-week time period, the previous plan is instructed to treat it as a rejection of its offer.  
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Eminem Opens Up About Drug Use: 'My Bottom Was Going to Be Death'
New York Daily News
June 29, 2013

In this article and video (2:27 minutes), rapper Eminem discusses his struggles with prescription drug addiction. He admits to using 20 Vicodin a day and entering rehab for sleeping pill addiction. He recalls a time when he was rushed to the hospital because of an overdose and felt sure he was going to die. After leaving the hospital, he suffered a relapse.  
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Drug Tests Before Exams Could Curb Students' Ritalin Use, Academics Say
The Telegraph
June 30, 2013

A neuroscientist at the University of Cambridge said universities should start conducting drug tests before exams to address Ritalin misuse. Schools should have clear policy statements regarding the use of cognitive-enhancing drugs, and a drug test should serve as a deterrent. Some students buy the drug on the black market and online, while others fake symptoms of attention deficit hyperactivity disorder to get Ritalin prescriptions.  
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College Students Abusing ADHD Medication
June 28, 2013

This article and video (3:13 minutes) discuss changing college policies regarding attention deficit hyperactivity disorder (ADHD) medications. Changes include submitting to a drug test or signing a contract in order to receive the pills. Several colleges decided to stop prescribing stimulant medication. Now, students will have to obtain medications from home or from off-campus pharmacies. Other schools say they will still fill prescriptions, but will not continue to diagnose. Some colleges consider misuse of ADHD medications to be cheating, and students could face expulsion.  
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New Teacher Guide to Prevent Prescription Drug Abuse by High Schoolers
The Wall Street Journal
June 28, 2013

This press release discusses a new resource guide, Rx for Understanding: Preventing Prescription Drug Abuse, for high school teachers. It is designed to help students in grades 9-12 learn about health problems caused by prescription drug misuse and abuse and uses lessons in multiple subject areas or as a supplement to an existing curriculum on health and/or substance abuse. The guide also provides educators with background information, lessons, teaching resources, a reproducible reflective student journal, national education standards alignment charts, and parent information.  
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Kids Illegally on Prescription Pills: The Epidemic--Part I
The Huffington Post
July 3, 2013

The reporter conducts a Q&A with Natalie Costa, producer of the documentary Behind the Orange Curtain, about the dangers of prescription drug abuse among youth.  
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Oklahoma, Nebraska Press Google to Stop Ads for Illegal Products
July 2, 2013

Attorney generals in Nebraska and Oklahoma sent letters to Google complaining about its placement of advertisements for pharmacies willing to sell Percocet and OxyContin without a prescription. Google said it has stringent advertising guidelines.  
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Number of Prescription of ADHD Drugs Increases Nine-Fold, Prompts Investigation
Parent Herald
June 29, 2013

National Health Services statistics revealed that the number of prescriptions for attention deficit hyperactivity disorder increased almost ninefold. Ritalin prescriptions increased from 158,000 in 1999 to 661,463 in 2010. Medical experts are advising control and reduction of prescription dispensing. The British Psychological Society is investigating the matter.  
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Conquering Prescription Drug Abuse in the Workplace
Precast Magazine
July/August 2013

This article discusses the importance for businesses to have comprehensive substance abuse policies. Employers should also provide treatment access for employees who abuse prescription drugs and involve professional case managers to ensure effective approaches.   
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Other Local News

Health Officials Warn of Fatal Fentanyl Overdoses
National Pain Report
June 27, 2013

After confirming five overdoses in Lebanon County, the Pennsylvania Department of Drug and Alcohol Programs asked coroners and medical examiners to screen for acetyl fentanyl in all apparent heroin and other opioid deaths. As a result, the department determined recreational use of fentanyl or acetyl fentanyl resulted in at least 50 fatalities and five nonfatal overdoses this year. The Centers for Disease Control and Prevention has urged public health agencies, emergency departments, medical examiners, and coroners to be alert for overdoses possibly caused by fentanyl and acetyl fentanyl.
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Drop Box Aids in Drug Abuse Prevention
Sequoyah County Times
July 5, 2013

Muldrow and Sequoyah County received a prescription drug drop box from the Oklahoma Bureau of Narcotics. Residents have access to the box every day of the week.  
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Providers Urge Use of Suboxone for Patients with Co-Occurring Pain, Addiction
The Lund Report
July 1, 2013

Along with Central City Concern's medical director, the medical director of addiction and mental health services for Oregon's Multnomah County and other stakeholders are raising awareness about buprenorphine for patients dealing with pain and chemical dependency issues. The drug has been approved to treat chronic pain or chemical dependency. Pilot projects involving its use in primary care settings have shown high success rates.  
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Painkiller Overdose Deaths Grow Among Oklahoma Women
The Oklahoman
July 2, 2013

Oklahoma overdose death rates are growing faster than national rates. The prescription death rate among Oklahoma women increased from 29 in 1999 to 204 in 2010; the rate for men rose from 56 in 1999 to 296 in 2010, according to the state Department of Mental Health and Substance Abuse Services. A previous study showed Oklahoma was the top state for nonmedical use of painkillers and ninth for fatal painkiller abuse.  
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La Familia Tackles Infant Drug Addiction
Hispanic Business
July 4, 2013

La Familia (New Mexico) was awarded a $25,000 contract to start a foundation so pregnant Santa Fe women could have greater access to drug addiction treatment. Money will be spent training and licensing La Familia's physicians to prescribe buprenorphine and hiring a case manager with addiction and maternal health experience. The medical center also plans to meet with jail officials to address women who arrive pregnant and addicted to opiate medications.  
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Stopping the 'Doctor Shop' Cycle
Sioux City Journal
June 29, 2013

Iowa drug-control officials said the prescription drug monitoring program (PDMP) is underutilized and needs to be upgraded to access prescription records in neighboring states. Nebraska and South Dakota are attempting to create compatible systems. Only 26 percent of healthcare providers who could be using the system are signed up. The number of Iowa patients with five or more prescribers or pharmacies found on the PDMP dropped from 3,293 in 2009 to 1,549 in 2011, according to the Governor's Office of Drug Control Policy.  
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Report: Idaho in Top 10 for Unprescribed Drug Use
Idaho Statesman
July 5, 2013

Ameritox reviewed urine samples collected in 2012 from at least 1,000 Idaho patients of doctors who prescribed commonly abused drugs. They analyzed whether each patient was taking a prescribed drug and whether the patient was taking any unprescribed or illegal drugs. About 39 percent of the samples contained non-prescribed drugs--a percentage that would place Idaho among the top 10 states for non-prescribed drugs. The rate of Idaho patients whose samples did not contain their prescribed drug also exceeded the national average of 35.9 percent.  
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Disposing of Medicine Safely
July 2, 2013

This article and video (3:58) discuss the new toolkit and video for medicine disposal developed by Michigan's Kent County Health Department and Department of Public Works. It tells residents what to do with unwanted or expired medications.  
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Changes to Pain Treatment for Injured Workers Begin Today
Washington State Department of Labor and Industries
July 1, 2013

This news release discusses the Department of Labor and Industries' (L&I) reduction of the time doctors can prescribe opioids for injured workers without agency authorization from 12 to 6 weeks. After 6 weeks, L&I insurance coverage for opioids will depend on doctors' use of best practices, which require monitoring whether workers are recovering their ability to perform normal activities and screening them for risks of side effects or addiction. The changes are consistent with the Department of Health's pain management rules. L&I's Pharmacy Director said the high dosage levels have been coming down and they are seeing fewer deaths among injured workers due to pain medication.  
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Grants Received

Back-Seat Driver: Grant Helps Battle Drugged Drivers
The Sacramento Bee
July 5, 2013

California's Sacramento County won nearly $2 million in state grants to reduce the number of drug-impaired drivers, which officials say is a bigger danger than previously believed. Sacramento County will get $740,000 for faster drug-testing machines that detect more drugs and the District Attorney's Office will get $1.2 million to fund specialized prosecutors. The head of the state's Office of Traffic Safety said a big task will be convincing drivers that prescription and other types of drug-impaired driving is wrong.
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Grant Announcements
Healthy Living Grant Program
Deadline: July 16, 2013
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Cooperative Agreements for Electronic Health Record (EHR) and Prescription Drug Monitoring Program (PDMP) Data Integration
Deadline: July 24, 2013  
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Upcoming Conferences and Workshops

Pharmacy Diversion Awareness Conference
July 13 and 14: Portland, Oregon
August 3 and 4: Baton Rouge, Louisiana
August 16 and 17: San Diego, California
August 18 and 19: San Jose, California
September 21 and 22: Boston, Massachusetts

The Generation Rx University Conference for Prescription Drug Abuse Prevention and Recovery
August 7-8, 2013
Columbus, Ohio 

National Conference on Addiction Disorders 2013
September 21-25, 2013
Anaheim, California
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Harold Rogers Prescription Drug Monitoring Program National Meeting
September 25-27, 2013
Washington, District of Columbia  
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2013 National Safety Council Congress and Expo
Congress: September 28-October 4, 2013
Expo: September 30-October 2, 2013
Chicago, Illinois
2013 American Association for Treatment of Opioid Dependence Conference
November 9-13, 2013
Philadelphia, Pennsylvania  
Read more:
Please e-mail Rekaya Gibson at rgibson@pire.org with questions or comments about the SAMHSA Prevention of Prescription Drug Abuse in the Workplace Listserv.  
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.
The Injury Control Research Center at West Virginia University (WVU-ICRC) archives past Listserv issues at http://www.hsc.wvu.edu/icrc/Pages/SAMHSA-Prevention-of-Prescription-Drug-Abuse-in-th. The partnership efforts of WVU-ICRC are supported by Grant Number 1 R49 CE002109 from the Centers for Disease Control and Prevention (CDC). The contents of the Listserv archive are solely the responsibility of the authors and do not represent the official views of CDC or SAMHSA.
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