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July 16, 2014


SAMHSA Prescription Drug Abuse Weekly Update
Issue 80  |  July 16, 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 Webinar Journal Articles and Reports Professional Education News Other State and Local News Other Resources Video Request for Proposal Take-Back Events and Drop Boxes Save the Date Upcoming Conferences and Workshops


K.T. Hegmann, M.S. Weiss, K. Bowden, F. Branco, K. DuBrueler, C. Els, S. Mandel, D.W. McKinney, R. Miguel, K.L. Mueller, R.J. Nadig, M.I. Schaffer, L. Studt, J.B. Talmage, R.L. Travis, T. Winters, M.S. Thiese, and J.S. Harris. 2014. "ACOEM Practice Guidelines: Opioids and Safety-Sensitive Work." Journal of Occupational and Environmental Medicine 56(7):e46–e53, doi:10.1097/JOM.0000000000000237.

The American College of Occupational and Environmental Medicine updated its guidelines for opioid use on the job. This report highlights the safety-sensitive work recommendation. During guideline development, literature review identified 12 moderate-quality studies addressing motor vehicle crash risk and none regarding other work injury risks of opioid-using patients. Acute or chronic opioid use is not recommended for patients who perform safety-sensitive jobs, including operating motor vehicles or other modes of transportation, forklift driving, overhead crane operation, heavy equipment operation, and tasks involving high levels of cognitive function and judgment.

Read more:

Government Issues Guidance on Driving While Taking Prescription Drugs
Christina Kenny, Pulse
July 10, 2014

The United Kingdom Department for Transport established limits on levels of eight prescription drugs while driving: clonazepam, 50 µg/L; diazepam, 550 µg/L; flunitrazepam, 300 µg/L; lorazepam, 100 µg/L; methadone, 500 µg/L; morphine, 80 µg/L; oxazepam, 300 µg/L; and temazepam, 1,000 µg/L. A medical defense will allow patients to avoid prosecution if they can demonstrate they took the drugs according to their doctors' instructions. Proposed limits for amphetamine use are being reconsidered to ensure patients taking medication for attention deficit hyperactivity disorder are not affected.

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Prescription Drug Abuse Prevention
National Institute for Occupational Safety and Health (NIOSH), Center for Workers' Compensation Studies
July 23, 2014
12 to 2 p.m. (EDT)

This Webinar will discuss NIOSH's prescription drug abuse prevention activities, emerging issues, and opportunities for future collaborations. Scheduled speakers include Drs. Rita Noonan, Noah Aleshire, David Sugerman, and Kun Zhang of the National Center for Injury Prevention and Control; Dr. Kathryn Mueller, American College of Occupational and Environmental Medicine; Dr. Gary Franklin, Washington Labor and Industries; and Dr. John Hanna, Ohio Bureau of Workers' Compensation.

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Journal Articles and Reports

Abstracts from the 2013 Annual Meeting of the College on Problems of Drug Dependence, Drug and Alcohol Dependence 140:e1–e252.

This supplement, which is not readily accessible except to subscribers, includes abstracts of numerous papers on issues related to prescription drug misuse. The conference version of abstracts is available at http://www.cpdd.vcu.edu/Pages/Meetings/CPDD13AbstractBook.pdf.

Abstracts from the 2014 Annual Meeting of the College on Problems of Drug Dependence, Drug and Alcohol Dependence.

This book includes abstracts of numerous papers on issues related to prescription drug misuse. http://www.cpdd.vcu.edu/Pages/Meetings/CPDD14AbstractBook.pdf

G. Dupuy, L. Cavalcanti, E. Bourgogne, C. Brichant–Petitjean, L. Gomberoff, V. Bloch, F. Bellivier, J–P. Lépine, O. Laprévote, and F. Vorspan. 2014. "Are Empty Methadone Bottles Empty? An Analytic Study." Harm Reduction Journal 11:20, doi:10.1186/1477-7517-11-20.

This study examined whether the residual quantity of methadone syrup in nearly empty bottles is associated with risk of intoxication, particularly for those who have a low opiate tolerance, such as children. The dose left in a sample of 175 bottles recapped after use by patients in an addiction treatment program was 1.9 +/- 1.8 mg in 30 mg bottles, and 3.3 +/- 2.4 mg in the sample of 60 mg bottles. Accidental overdose with nearly empty methadone syrup bottles is a potential danger, especially for children.

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A.A. Eslami, F. Jalilian, M. Ataee, M.M. Alavijeh, M. Mahboubi, A. Afsar, and A. Aghaei. 2014. "Intention and Willingness in Understanding Ritalin Misuse Among Iranian Medical College Students: A Cross-Sectional Study." Global Journal of Health Science, doi:10.5539/gjhs.v6n6p43.

Among a random sample of 264 Iranian medical college students, attitude, subjective norms, and prototype accounted for 29 percent of the variation in intention to misuse Ritalin and 25 percent of the variation in willingness to misuse it.

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T. Gomes, M.M. Mamdani, I.A. Dhalla, S. Cornish, J.M. Paterson, and D.N. Juurlink. 2014. "The Burden of Premature Opioid-Related Mortality." Addiction, doi:10.1111/add.12598.

Researchers analyzed the 5,935 opioid-related deaths in Ontario, Canada, between 1991 and 2010. The rate of opioid-related mortality increased by 242 percent (from 12.2 to 41.6 per 1,000,000 residents). The proportion of deaths attributable to opioids increased significantly over time within each age group. By 2010, nearly one in every eight deaths (12.1 percent) among people 25–34 was opioid related.

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E.C. McNaughton, P.M. Coplan, R.A. Black, S.E. Weber, H.D. Chilcoat, and S.F. Butler. 2014. "Monitoring of Internet Forums to Evaluate Reactions to the Introduction of Reformulated OxyContin to Deter Abuse." Journal of Medical Internet Research 16(5):e119, doi:10.2196/jmir.3397.

This study analyzed almost 46,000 posts on seven Internet forums during 2008–13 to evaluate reformulated OxyContin. Of 32 reportedly successful recipes observed for circumventing the abuse-deterrent characteristics of the reformulated drug, the most successful were chewing or crushing/shaving, then heating and further processing. The frequency of posts reporting abuse of reformulated OxyContin via these recipes was low and decreased over time. Among the 5,677 posts mentioning reformulated OxyContin, 825 discussed recipes and 498 reported abuse by such recipes (including 41 reports of injecting and 128 of snorting). Posts endorsing OxyContin dropped markedly following reformulation.

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C. Reis, M. Sinyor, and A. Schaffer. 2014. "Medications Without a Patient: Potential Lethal Implications of Pharmaceuticals Left Behind." Crisis: The Journal of Crisis Intervention and Suicide Prevention, doi:10.1027/0227-5910/a000251.

Of 567 suicide deaths by self-poisoning in Toronto between 1998 and 2010, 8 (1.4 percent) involved medications returned to the next of kin after a family member or friend had died.

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World Drug Report 2014
United Nations Office on Drugs and Crime
Accessed July 8, 2014

The World Drug Report provides an annual overview of major developments in drug markets. In 2012, the United States, Oceania, and some European and Asian countries saw users switching between heroin and pharmaceutical opioids—a trend largely dictated by low prices and accessibility. While dependent opioid users in the United States were switching from pharmaceutical opioids to heroin, users in some European countries were replacing heroin with synthetic opioids. In the United States, medical emergencies related to nonmedical use of pharmaceuticals increased 132 percent from 2004 to 2011, with the number of medical emergencies involving opiates/opioids rising 183 percent.

Read more:

2014 National Drug Control Strategy
White House Office of National Drug Control Policy
Accessed July 9, 2014

This document builds on drug policy reform achieved during the past 4 years. The strategy updates the President's 2011 Prescription Drug Abuse Prevention Plan, adding a call for increased access to naloxone.

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Professional Education

Y. Fang. 2014. "China Should Curb Non-Prescription Use of Antibiotics in the Community." BMJ 348:g4233, doi:10.1136/bmj.g4233.

This article discusses prevalence of nonprescription use of antibiotics in China. The author mentions three reasons for self-medicating: 1) antibiotics are left over from a previous treatment, 2) Chinese families store antibiotics at home to treat future illnesses, and 3) individuals acquire the drugs from pharmacies without a prescription. The author believes measures to tighten control and monitoring of nonprescription use of antibiotics in communities nationwide are needed to combat growing antibiotic resistance. He believes the Chinese government should strengthen regulation of over-the-counter antibiotic sales in retail pharmacies, provide heavier penalties for offenders, and offer funding for public and professional education on appropriate antibiotic use. He also suggests the government should implement strategies to promote more judicious dispensing and use of antibiotics in the community and deepen public hospital reforms.

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P.J. Pitts. 2014. "Who Lost Opioids?" Journal of Commercial Biotechnology 20(3).

The author of this article says the Food and Drug Administration lacks a strong voice on abuse deterrence and safe opioid use. He asserts that politicians and pundits own the conversation, and points to press coverage of Zohydro as an example.

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Addiction Medicine Suboxone Now Being Abused
Laura Unger, The Courier-Journal
July 5, 2014

This article and video (2:02 minutes) discuss abuse of Suboxone (buprenorphine), a medicine designed to help people who are addicted to pain relievers and heroin. Suboxone prevents opioid withdrawal by producing similar effects. But some people sell it to feed their drug addiction. Kentucky's medical board is drafting regulations on Suboxone prescribing and aggressively investigating complaints against doctors. Dr. James Patrick Murphy said the drug can be a "lifesaving" treatment when coupled with therapy.

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Engage with State-Level Partners to Reduce Prescription Drug Abuse at Mid-Year Training Institute
Community Anti-Drug Coalitions of America (CADCA)
July 3, 2014

CADCA will host a prescription drug abuse course during its 2014 Mid-Year Training Institute. Engaging with State-Level Partners to Reduce Prescription Drug Abuse will provide insights that can help coalitions identify or expand their role as effective prescription drug abuse prevention partners at the state level. Participants will also get updates on the National Governors Association's Rx Drug Abuse Policy Academy recommendations.

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The Heroin Antidote? How Naloxone Can Help and Hurt Addicts
Jamison Monroe, Jr., The Huffington Post
July 9, 2014

This article discusses controversy surrounding naloxone. The author believes the drug is one way to battle the heroin epidemic.

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Other State and Local News

Pennsylvania Releases Guidelines for Physicians on Use of Prescription Opioids
Digital Journal
July 10, 2014

Pennsylvania released guidelines to address the use of prescription opioids for chronic noncancer pain. The guidelines recommend that chronic pain is best treated using an interdisciplinary, multi-model approach, which may include physical therapy, cognitive–behavioral therapy, electronic stimulation therapy, and conscientious use of medications as needed.

Read more:

ICAN's CCYSA Offering Free Prescription Drug Lockboxes to Chandler Residents
Sergeant J. Favazzo, Chandler Police Department
July 8, 2014

ICAN's Chandler Coalition on Youth Substance Abuse is having a lockbox campaign this summer. Chandler, Arizona, residents can get a free prescription drug lockbox, which fits right into medicine cabinets.

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Howard Co. Health Dept. Launches Plan to Combat Rising Drug Overdoses
Luke Lavoie, The Baltimore Sun
July 7, 2014

The Howard County Health Department unveiled its Opioid Overdose Response Program, aimed at reducing heroin and prescription pain reliever overdoses. Under the plan, high-risk residents will receive training and access to naloxone. Other initiatives include increasing community outreach and education, developing support systems to prevent relapses, and collaborating and supporting like-minded organizations. The number of Howard County deaths related to heroin and pain reliever overdoses more than doubled between 2010 and 2012—from 8 in 2010 to 18 in 2011 and 17 in 2012. Officials expect the 2013 numbers to be even higher.

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Alameda County, California Drug Disposal Ordinance Should Take a Hike
Mark Chenoweth, Forbes
July 10, 2014

The U.S. Court of Appeals for the Ninth Circuit will hear oral arguments in a challenge to Alameda County's Safe Drug Disposal Ordinance (PhRMA vs. Alameda Co., California). Alameda County wants drug manufacturers whose products enter the county to establish programs for the collection and safe disposal of unused drugs. The lawsuit contests the ordinance's constitutionality. If the court strikes down this program as unconstitutional, argues the author, it will clear the way for thinking about real solutions to the disposal challenge. He believes a public education campaign would do more to address the problem than the ordinance will.

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Rate of Painkiller Overdoses in Oregon Up Since 2000
Saerom Yoo, Statesman Journal
July 8, 2014

The Oregon Health Authority reported that in 2012, 164 Oregonians died from unintentional and undetermined prescription opioid overdose—four times the rate from 2000. At the end of 2013, only 36 percent of providers who wrote at least one controlled substance prescription were registered users of the prescription monitoring program.

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Kenosha County Tied Atop Overdose Deaths List in Wisconsin
Kenosha News
July 6, 2014

In Kenosha County, Wisconsin, overdose deaths have steadily increased over several years. Kenosha and Milwaukee counties have the highest deaths per capita, about 7 per 10,000 residents. The Kenosha County Medical Examiner's office reported 47 drug overdose deaths in 2013—the same number of deaths as reported the previous year. Heroin was involved in 15 deaths and may have been involved in another 9 where victims tested positive for morphine.

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Staten Island Lawmakers Make Another Push to Link I-STOP Prescription Database with Other States to Prevent Doctor Shopping
Ryan Lavis, Staten Island Advance
July 8, 2014

District Attorney Daniel Donovan, Assemblyman Michael Cusick, and state Senator Andrew Lanza called upon the New York State Department of Health to link the Internet System for Tracking Over-Prescribing (I-STOP) database with neighboring states to reduce doctor and pharmacy shopping across state lines.

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Prescription Drugs a Major Problem Among Oklahoma Nurses
Andrew Knittle, The Oklahoman
July 6, 2014

According to the most recent annual report released by the Oklahoma Nursing Board, 13 percent of all cases opened by investigators in 2013 were drug related. Over a 10-year period, some nurses paid hefty fines—as much as $250,000 in one case—for diverting and stealing drugs.

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Dispose of Prescription Drugs? It's Not Easy in Louisville
Martha Elson, The Courier-Journal
July 8, 2014

This article discusses the lack of a prescription drug disposal drop-off site at the Louisville Metropolitan Police Department. Louisville is not planning to open a drop-off site, but the police department hosts drop-off events throughout the year. The City of Louisville is trying to get the word out on proper disposal. Public officials said security and safety concerns are obstacles to having more disposal sites.

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Kansas Selected for Program to Reduce Prescription Drug Abuse
Kansas Health Institute
July 8, 2014

Ten people from Kansas will attend a SAMHSA training on addressing prescription drug abuse by increasing access to and use of intervention and treatment resources, developing a state strategic plan for treatment, and building evidence-based strategies.

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Walgreens Partners with MAG Foundation 'Think About It' Campaign
Think About It
July 9, 2014

Georgia's Walgreens stores will support the Medical Association of Georgia Foundation's Think About It campaign to reduce prescription drug abuse. Effective immediately, they will distribute informational leaflets to patients who fill prescriptions at Walgreens pharmacies. The "Help Stop Rx Drug Abuse in Georgia" leaflets encourage people to only take their medicine as prescribed, not share their medicine, store their medicine in a safe and secure place, and properly dispose of any unused medicine.

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Other Resources

The Role of a Prescription Drug Monitoring Program in Reducing Prescription Drug Diversion, Misuse, and Abuse
Centers for Medicare & Medicaid Services
June 2014

This fact sheet includes an overview of how prescription drug monitoring programs can provide healthcare prescribers, pharmacists, patients, state regulatory boards, and law enforcement agencies with a collaborative method for reducing prescription drug diversion, misuse, and abuse.

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Opioids: Proper Prescribing and Treating Addiction
Charles E. Argoff, Medscape
July 8, 2014

Dr. Charles Argoff, a neurology professor at Albany Medical College and director of Comprehensive Pain Management at Albany Medical Center, talks about support systems available to physicians who treat chronic pain patients—namely, the Providers' Clinical Support System for Opioid Therapies and Providers' Clinical Support System for Medication Assisted Treatment. (Duration: 8:22 minutes, includes transcript)


Request for Proposal

Chronic Pain Management Research Grant
Milbank Foundation
Postmarked by November 1, 2014

Take-Back Events and Drop Boxes

Havre De Grace Police Install Permanent Drug Drop-Off Box
Bryna Zumer, The Baltimore Sun
July 9, 2014

Nisswa to Get Drug Disposal Program
Renee Richardson, Brainerd Dispatch (Minnesota)
July 8, 2014

You Can Now Safely Get Rid of Unwanted Drugs in Hamden
Brian McCready, Hamden Patch (Connecticut)
July 3, 2014

Drug Drop-Off Boxes Installed in Police Departments
Anne Jungen, LaCrosse Tribune (Wisconsin)
July 9, 2014

Fire Prevention 24-7—Thanks for Disposing 81 Gallons of Unused Meds!
Soraya McLaughlin, Positively Naperville (Illinois)
July 7, 2014

Task Force: Drop Boxes Will Reduce Local Heroin Use
Amy DuPont, WXOW (Wisconsin)
July 8, 2014

Save the Date

Sixth Annual American Medicine Chest Challenge: National Day of Awareness and Safe Disposal of Rx and OTC Medicine
American Medicine Chest Challenge
November 8, 2014

Upcoming Conferences and Workshops

CADCA's Mid-Year Training Institute 2014
July 20–24, 2014
Orlando, Florida

Pharmacy Diversion Awareness Conference
U.S. Department of Justice, Drug Enforcement Administration
August 2–3, 2014—Denver (Colo.) Marriott Tech Center

Prevention of Youth Substance Abuse in Rural Communities Conference: Bringing Hope to Communities in Despair
Coalition for Healthy Youth
August 6–8, 2014
Lancaster, South Carolina

Preventing Prescription Drug Abuse—Non-Members
New Jersey Pharmacists Association
August 7, 2014
Secaucus, New Jersey

27th Annual NPN Prevention Research Conference
National Prevention Network
September 15–18, 2014
Hartford, Connecticut

2014 Harold Rogers PDMP National Meeting
Brandeis University, Prescription Drug Monitoring Program Training and Technical Assistance Center
September 22–24, 2014
Washington, D.C.

142nd Annual Meeting and Exposition
American Public Health Association
November 15–19, 2014
New Orleans, Louisiana
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.