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July 17, 2013

SAMHSA Prevention of Prescription Drug Abuse in the Workplace Listserv

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Featured Article
M. Joynt, M.K. Train, B.W. Robbins, J.S. Halterman, E. Caiola, and R.J. Fortuna. 2013. "The Impact of Neighborhood Socioeconomic Status and Race on the Prescribing of Opioids in Emergency Departments Throughout the United States." Journal of General Internal Medicine.
Researchers examined the effect of neighborhood socioeconomic status (SES) on opioid prescribing for moderate to severe pain to determine if racial disparities in opioid prescribing persist after accounting for SES. They used cross-sectional data from the National Hospital Ambulatory Medical Care Survey between 2006 and 2009 to examine opioid prescribing among patients presenting with moderate to severe pain, and logistic regression to examine the association between opioid prescribing, SES, and race. Models were adjusted for age, sex, pain level, injury status, frequency of emergency visits, hospital type, and region. The primary outcome measure was whether an opioid was prescribed during a visit for moderate to severe pain. SES was determined based on income, percentage in poverty, and educational level within a patient's zip code. Opioids were prescribed more frequently at visits from patients in the highest SES quartile compared with patients in the lowest quartile, with differences by percentage in poverty (49.0 percent vs. 39.4 percent, P<0.001), household income (47.3 percent vs. 40.7 percent, P<0.001), and educational level (46.3 percent vs. 42.5 percent, P=0.01). Black patients were prescribed opioids less frequently than white patients across all measures of SES. In adjusted models, black patients (AOR 0.73; 95 percent CI 0.66-0.81) and patients from lower-income areas (AOR 0.76; 95 percent CI 0.68-0.86) were less likely to receive opioids after accounting for pain level, age, injury status, and other covariates. Patients presenting to emergency departments from lower SES regions were less likely to receive opioids for equivalent levels of pain than those from more affluent areas. Black and Hispanic patients were also less likely to receive opioids for equivalent levels of pain than whites, independent of SES.
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Journal Articles

R. Collier. 2013. "Street Versions of Opioids More Potent and Dangerous." Canadian Medical Association Journal. doi:10.1503/cmaj.109-4535.

In April, police in Montreal, Quebec, found 12,400 desmethyl fentanyl pills, an illicit derivative of fentanyl that is 40 times more powerful than heroin, according to the Montreal Gazette. A U.S. public affairs officer said the derivative is 100 times more potent than the legitimate medication. The United States is also seeing a surge in overdose deaths from heroin cut with fentanyl.
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J. Logan, Y. Liu, L. Paulozzi, K. Zhang, and C. Jones. 2013. "Opioid Prescribing in Emergency Departments: The Prevalence of Potentially Inappropriate Prescribing and Misuse." Medical Care.

This study determined the prevalence of indicators for potential emergency department (ED) opioid misuse and inappropriate prescription practices among ED providers in a large, commercially insured, adult population. Researchers analyzed the 2009 Truven Health MarketScan Research Databases to examine ED visits of enrollees aged 18-64. Indicators used to mark potential inappropriate use included opioid prescriptions overlapping by 1 week or more; overlapping opioid and benzodiazepine prescriptions; high daily doses (≥100 morphine milligram equivalents); long-acting/extended-release (LA/ER) opioids for acute pain; and overlapping LA/ER opioids. Analyses were stratified by sex. Researchers identified 400,288 enrollees who received at least one ED opioid prescription. At least one indicator applied to 10.3 percent of enrollees: 7.7 percent had high daily doses; 2.0 percent had opioid overlap; 1.0 percent had opioid-benzodiazepine overlap. Among LA/ER opioid prescriptions, 21.7 percent were for acute pain and 14.6 percent were overlapping. Females were more likely to have at least one indicator. In some instances, the prescribing of opioid analgesics in EDs might not be optimal in terms of minimizing risk of misuse.   
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S.G. Weiner, C.A. Griggs, P.M. Mitchell, B.K. Langlois, F.D. Friedman, R.L. Moore, S. Cheng Lin, K.P. Nelson, and J.A. Feldman. 2013. "Clinician Impression Versus Prescription Drug Monitoring Program Criteria in the Assessment of Drug-Seeking Behavior in the Emergency Department." Annals of Emergency Medicine.

Researchers compared emergency provider impressions of drug-seeking behavior with objective criteria from a state prescription drug monitoring program, assessed change in opioid pain reliever prescribing after prescription drug monitoring program review, and examined clinical factors associated with suspected drug-seeking behavior. They used a prospective observational study of emergency providers to assess a convenience sample of patients aged 18-64 who presented to one of two academic medical centers with a chief complaint of back pain, dental pain, or headache. Drug-seeking behavior was objectively defined as present when a patient had greater than or equal to four opioid prescriptions from greater than or equal to four providers in the 12 months before emergency department evaluation. Emergency providers completed data forms recording their impression of the likelihood of drug-seeking behavior, patient characteristics, and plan for prescribing pre- and post-prescription drug monitoring program review. Descriptive statistics were generated. They calculated agreement between emergency provider impression of drug-seeking behavior and prescription drug monitoring program definition, and sensitivity, specificity, and positive predictive value of emergency provider impression, using prescription drug monitoring program criteria as the criterion standard. A multivariate logistic regression analysis was conducted to determine clinical factors associated with drug-seeking behavior.   
Thirty-eight emergency providers with prescription drug monitoring program access participated; 544 patient visits entered into the study from June 2011 to January 2013. There was fair agreement between emergency provider impression of drug-seeking behavior and prescription drug monitoring program (κ=0.30). Emergency providers had sensitivity 63.2 percent (95 percent confidence interval [CI] 54.8 percent to 71.7 percent), specificity 72.7 percent (95 percent CI 68.4 percent to 77.0 percent), and positive predictive value 41.2 percent (95 percent CI 34.4 percent to 48.2 percent) for identifying drug-seeking behavior. After exposure to prescription drug monitoring program data, emergency providers changed plans to prescribe opioids at discharge in 9.5 percent of cases (95 percent CI 7.3 percent to 12.2 percent), with 6.5 percent of patients (n=35) receiving opioids not previously planned and 3.0 percent (n=16) no longer receiving opioids. Predictors for drug-seeking behavior by prescription drug monitoring program criteria were patient-requested opioid medications by name (odds ratio [OR] 1.91; 95 percent CI 1.13 to 3.23), multiple visits for the same complaint (OR 2.5; 95 percent CI 1.49 to 4.18), suspicious history (OR 1.88; 95 percent CI 1.1 to 3.19), symptoms out of proportion to examination (OR 1.83; 95 percent CI 1.1 to 3.03), and hospital site (OR 3.1; 95 percent CI 1.76 to 5.44). Emergency providers had fair agreement with objective criteria from the prescription drug monitoring program in suspecting drug-seeking behavior. Program review changed management plans in a small number of cases. Multiple clinical factors were predictive of drug-seeking behavior.  
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News and Reports

Substance Abuse Poses Workplace Challenge
Seacoast Media Group
July 8, 2013

This article discusses how impaired workers--especially those taking prescription medications--affect the workplace. It recommends employers use drug and alcohol tests for prospective and current employees as well as a written company policy. Employers should also rely on a qualified attorney to handle issues such as employee leave, discipline, and termination, to ensure ADA compliance. Employers should consider offering an employee assistance plan as a cost-efficient and effective way to address problem behaviors.  
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Technical Assistance Guide No. 04-13: Funding Options for Prescription Drug Monitoring Programs
Prescription Drug Monitoring Program Training and Technical Assistance Center, Brandeis University
Accessed July 10, 2013

The Prescription Drug Monitoring Program Training and Technical Assistance Center at Brandeis University has developed this guide on funding options and their rationales for prescription drug monitoring programs (PDMPs). Their goal is to inform PDMP administrators, policy makers, legislative representatives, and other interested stakeholders about funding mechanisms in use throughout the country. The guide also suggests other funding possibilities PDMPs may wish to consider to ensure sustainability and program enhancement.  
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Curbing the Growing Epidemic of Prescription Painkiller Overdoses in Women
CDC Injury Center: Director's View Blog, Centers for Disease Control and Prevention
July 11, 2013

This article discusses what individuals and healthcare providers can do to help curb prescription drug abuse.  
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Tips for Safe Prescription Drug Use
July 5, 2013

A government agency provides suggestions for safe prescription drug use.   
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Kids Illegally on Prescription Pills: The Epidemic Part II
The Huffington Post
July 8, 2013

This Q&A continues from Part I (see listserv archive for July 10, 2013, issue). Natalie Costa, producer of the documentary Behind the Orange Curtain, discusses the dangers of prescription drug abuse among youth and how it affects families.  
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It's Time to Talk About Drugs--The Legal Kind
The Vancouver Sun
July 8, 2013

An executive officer for the Canadian Centre on Substance Abuse discusses three ways people can help reduce harms and risks associated with prescription drug misuse. One, patients should ask questions about their prescription drugs and inquire about other therapies and treatment options. Two, they should become better informed about their medications. Three, they should never share medications.  
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Are Grandma's Medicine Cabinet and Teens A Deadly Duo?
The Patriot-News
July 9, 2013

Doctor Linda Rhodes, health and aging expert and Pennsylvania's former Secretary of Aging, answers the question: "I'm a little worried about my teenage granddaughter, as she's been coming over more frequently and I think she's getting into our pain medicine. Any thoughts?"  
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Internet Pharmacies: Federal Agencies and States Face Challenges Combating Rogue Sites, Particularly Those Abroad
United States Government Accountability Office
July 2013

This report reviews how Web sites that illegally distribute prescription drugs violate federal and state laws, and describes the challenges of investigating them. It highlights federal agencies that have conducted investigations leading to convictions, fines, and asset seizures from Internet pharmacies as well as from companies that provide services to them. Finally, it describes efforts to raise community awareness about ordering medication from the Internet.  
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Bill from Senate Hopeful Targets Medicare Drug Abuse
The Hill
July 8, 2013

A U.S. Representative's forthcoming legislation aims to cut drug abuse in Medicare Part D by requiring insurers to verify prescriptions for controlled substances. The bill would require plan sponsors in Medicare Part D to verify that an authorized physician issued the prescription for a controlled substance. Insurance companies would be instructed to restrict access to controlled substances for certain patients if credible evidence points to drug abuse.  
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Other State and Local News

Substance Abuse in South Mississippi: Prescription Meds
July 8, 2013

This article and video (1:36 minutes) discuss the dangers of prescription drug abuse from the perspectives of a Mississippi judge and pharmacist.  
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New R.I. Law Aims to Reduce Prescription Drug Abuse
Providence Journal
July 12, 2013

A new Rhode Island law adds sedatives to the list of drugs included in the prescription monitoring database, which will help reduce accidental overdose and abuse. The chief administrative officer of the state Board of Medical Licensure and Discipline says the expansion allows doctors to better monitor dangerous combinations of drugs.  
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Agency Announces 'Lock Your Meds' Campaign
Circleville Herald
July 9, 2013

The Paint Valley Alcohol Drug Addiction and Mental Health Board of Ohio is launching a campaign to help educate residents in Fayette, Highland, Pickaway, Pike, and Ross Counties about the dangers of prescription medication misuse. The campaign includes jar openers, permanent billboards, and portable billboards displaying the message, "Be Aware. Don't Share. Lock Your Meds." Flyers will also be distributed explaining the campaign and how residents can apply to receive a medicine safe.  
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Prescription Drug Abuse Meeting July 22
The Vanguard
July 11, 2013

This article discusses the upcoming community meeting on prescription drug abuse sponsored by Yarmouth MLA Zach Churchill, the Native Alcohol and Drug Abuse Counselling Association, and the Yarmouth Community Health Board. The meeting will be held on July 22, 2013, at the Nova Scotia Community College Burridge Campus in Canada.  
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Mother Implicated in Drug Overdose Deaths of 4; Charged with Murder
Fox31 Denver
July 9, 2013

This article and video (4:57) discuss the arrest of Almeda Sullivan, a former Cherry Creek Schools teacher's aide accused of giving prescription drugs to young adults. Four died from an overdose and two were found at her house. Sullivan received 21,580 Schedule II prescription pills by using fake names from 2007 to 2011.  
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Parents: Pharmacy Handed Out Pill Bottles with Candy During Parade
July 8, 2013

A Rowan County, North Carolina, couple is upset after a pharmacy company handed out pill bottles filled with Skittles during a parade. The owner says they threw loose candy to children and specifically handed the pill bottles to adults. The bottles are blue and the label has information about the store's hours and location. Officials say the pharmacy has done nothing illegal and only one family has complained.  
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Maine, Feds Join to Fight Pharmacy Robberies
The Maine Public Broadcasting Network
July 11, 2013

Maine recently swore in 18 state, county, and local police officers to assist federal agents with investigating drugstore robberies and prescription drug abuse.  
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NJSCI Report: Illicit Medical Practices Fueling Prescription Drug and Heroin Abuse in New Jersey
News 12 New Jersey
July 10, 2013

This article and video (2:02) discuss a report from the New Jersey State Commission of Investigation that revealed illegal medical practices are fueling the state's prescription drug and heroin problem. Investigators found Medicaid patients and drug addicts were regularly taken to a doctor where they received unnecessary prescriptions for pain relievers. The report also found that during a 19-month period, a chiropractic office in Camden prescribed oxycodone with an estimated street value of nearly $10 million. The commission is proposing stronger oversight of the medical community and tougher penalties for offenders.  
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Teen Prescription Drug Abuse Rising in OC's Affluent Areas
Physicians News Network
July 8, 2013

The 2011-12 Prescription and Over-the-Counter Abuse Orange County Comprehensive Report revealed teen prescription drug abuse is on the rise, with particularly high abuse rates in affluent areas such as Mission Viejo and Laguna Beach. Researchers blame lack of parental awareness, misperception of harm, and availability of and easy access to prescription pain relievers. In Orange County, data among 9th and 11th graders showed Capistrano Unified School District had the highest percentage of pain reliever misuse among teens in 2007-08. It also showed that in Saddleback and Laguna Beach, the abuse rate was 17 percent among 11th graders--the highest in South Orange County school districts. Capistrano had a 9 percent abuse rate among 9th graders and Saddleback had an 8 percent abuse rate in the same age group.   
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County Assessment Shows Youth Are Abusing Prescription Drugs
The Deming Headlight
July 11, 2013

Luna County's Partnership for Success II program (New Mexico) developed an Assessment Report that showed people ages 12-25 are abusing or misusing prescription drugs typically stolen from family members. The report used existing data sources including the 2011 Youth Risk and Resiliency Survey, focus groups with local residents, and interviews with law enforcement and medical professionals. Luna County plans to use the assessment report to guide future outreach and education efforts for local residents.  
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Prescription Drug Abuse on the Rise in Durham
News Observer
July 9, 2013

The Duke Center for Child and Family Policy released "Substance Use and Abuse in Durham County," which showed substance abuse, prescription drug abuse included, is one of the county's biggest public health problems. In 2012, about 19,000 residents, including 1,000 children, abused or were addicted to alcohol, illegal drugs, or prescription medications. From 2010 to 2012, residents made more than 3,000 visits a year to a hospital emergency department for substance use--an 11.6 percent increase for adults and a 64.7 percent increase for juveniles. The number of deaths due to substance use increased by one third, from 34 deaths per year in 2004-06 to 48 deaths per year in 2009-11. Deaths due to prescription drugs increased 75 percent, compared with a 17 percent increase for heroin deaths and a 10 percent drop for cocaine deaths.  
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More Babies Born Dependent on Prescription Drugs
July 10, 2013

This article and video (3:16) discuss prescription drug abuse among pregnant women and their newborns in Tucson, Arizona. Diamond Children's Hospital has seen an increase in Neonatal Abstinence Syndrome. Every month at least one baby is born dependent on prescription drugs; whereas in the past, the hospital would see one or two cases per year. Mothers are taking Vicodin, Percocet, and OxyContin. Some are not aware of the impact these drugs can have on their unborn babies.  
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Prescription Drugs Drop-Off Aimed at Cutting Abuse
Clarion Ledger
July 10, 2013

Mississippi safety officials plan to install nine prescription drop boxes at driver's license offices throughout the state to reduce prescription drug abuse and provide a way for people to discard their expired and unwanted medications. The Department of Public Safety said 90 percent of Mississippi's drug overdose deaths in 2012 were from misused prescriptions.  
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Law Enforcement Directive to Back N.J. Overdose Prevention Act
South Jersey Times
July 6, 2013

The acting attorney general sent a directive to all New Jersey police chiefs and executives, county and municipal prosecutors, and county sheriffs to familiarize themselves with the Overdose Prevention Act. The law grants immunity from arrest and prosecution to people who call 911 to report an overdose, even if the individuals are drug users.  
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AUDIO: Get Rid of Your Old Prescription Drugs
July 11, 2013

This brief article and audio (5:50) discuss the Palm Beach County Substance Awareness Coalition's RX Drop Box Awareness Day, with 22 locations, many available 24 hours a day, 7 days a week.  
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Maryland Sees Increase in Drug Overdoses
July 10, 2013

A recent state health department report showed fatal overdoses from drugs and alcohol rose 15 percent in Maryland from 2011 to 2012, driven by a 54 percent increase in heroin-related deaths. Heroin-related overdose deaths increased from 245 in 2011 to 378 in 2012, after having declined 36 percent between 2007 and 2011. Total alcohol- and drug-related deaths rose from 663 in 2011 to 761 in 2012. Deaths related to prescription drugs dropped 12 percent from 2011 to 2012, after increasing 18 percent between 2007 and 2011.   
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Other Resources

Opioid and Pain Management CMEs
National Institute on Drug Abuse
Accessed July 12, 2013

The National Institute on Drug Abuse and Medscape Education are offering continuing medical education courses for physicians on screening pain patients for substance use disorder risk factors and identifying when patients are abusing medications. These courses use videos that model effective communication about sensitive issues, without losing sight of addressing the pain.  
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New Treatment for Pregnant Drug Addicts
The Wall Street Journal
July 5, 2013

This video (3:40) discusses prescription drug abuse among pregnant women. Some clinics are now offering women like Teresa Starks, who is battling prescription drug addiction, obstetrical care combined with counseling and addiction treatment.

Healthlink: Prescription Drug Abuse
Seattle Children's Hospital
June 25, 2013

This video (2:58) discusses the dangers of prescription drug abuse.

Prescription Drug Abuse Prevention Radio and Poster PSAs
Ulster Prevention Council
July 3, 2013

This video (1:28) announces the Ulster Prevention Council 2013 Prescription Drug Abuse Prevention Media Campaign Radio PSA and Poster Winners.  
Grants Received

Area Communities Plan Team Effort Against Opiate Abuse
The Boston Globe
July 10, 2013

Two Massachusetts cities (Brockton and Quincy) were awarded $300,000 grants from the state to lead regional coalitions in the fight against opiate abuse. Quincy will be partnering with Braintree, Randolph, Stoughton, and Weymouth, while Brockton will work with East Bridgewater, Rockland, and Whitman. The 3-year grants offer two options to renew that could allow recipients to receive up to $700,000 over 7 years.  
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Save the Date

DEA's National Take-Back Initiative
October 26, 2013
10 a.m.-2 p.m.

National Prescription Drug Take-Back Day aims to provide a safe, convenient, and responsible means for disposing of prescription drugs while educating the general public about the potential for medication abuse.  
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Upcoming Conferences and Workshops

Pharmacy Diversion Awareness Conference
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  
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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.
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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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