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July 21, 2016

PAW Weekly Update

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SAMHSA
SAMHSA Prescription Drug Abuse Weekly Update
WEEKLY
UPDATE
Issue 183  |  July 21, 2016
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.
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Featured
Journal Articles and Reports
Professional Opinion
National
Marijuana
International
Northeast/Mid-Atlantic News
South News
Midwest News
West News
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Featured

Congress Sends President Obama Compromise Bill to Curb Drug Abuse
Matthew Daly (AP), Washington Post
July 13, 2016

Congress has approved a compromise Comprehensive Addiction Recovery Act that authorizes grants and other programs to help reduce the abuse of heroin and prescription pain relievers. The bill authorizes $181 million in new spending, but a conference committee deleted nearly $500 million in funding for its opioid programs. Democratic lawmakers complained the final bill lacks the appropriations to pay for its programs, but said it was better to back the measure and push for more money in future spending bills. The White House announced the president will sign the bill, but urged adding more than $900 million in additional funding.

Read more:
https://www.washingtonpost.com/politics/congress/congress-sends-obama-compromise-bill-to-curb-drug-abuse/2016/07/13/d657e7d4-494d-11e6-8dac-0c6e4accc5b1_story.html

New Law Contains Tougher Guidance on Veterans Affairs Narcotics Prescriptions
Patricia Kime, Military Times
July 14, 2016

The Comprehensive Addiction Recovery Act, which President Obama will sign, includes tougher prescription guidance for Veterans Affairs (VA) medical facilities. Under the bill, VA must ensure that its prescribers are educated in the latest practices and that all medical facilities stock naloxone and establish pain management teams to oversee opioid prescriptions for veterans with non-cancer-related pain. The bill requires the VA to ensure healthcare providers can access and provide information to state prescription drug monitoring program databases. It gives patient advocates more independence by providing an avenue for reporting patient concerns outside the hospital’s chain of command. It promotes alternatives to incarceration for those with substance abuse issues, including authorizing grants to expand veterans’ treatment courts, and it broadens the number of health care providers who can oversee patients prescribed medications for opioid addiction by allowing some nurse practitioners and physician assistants to facilitate treatment.

Read more:
http://www.militarytimes.com/story/veterans/2016/07/14/anti-addiction-bill-includes-va-measures/87083870

Journal Articles and Reports

A. Clark, S. Breitenstein, D.S. Martsolf, and E.L. Winstanley. 2016. “Assessing Fidelity of a Community-Based Opioid Overdose Prevention Program: Modification of the Fidelity Checklist.” Journal of Nursing Scholarship 48(4):371–7, doi:10.1111/jnu.12221.

The Fidelity Checklist is a reliable and valid tool designed to measure fidelity in a group-based parenting program. It assesses group leaders’ maintenance of the intervention protocol (adherence) and their group facilitation and process skills (competence). The authors worked with key stakeholders to modify the competence subscale to fit a community-based opioid overdose prevention group-education intervention. In doing so, they created an intervention that differed substantially from the intervention they used as a starting point. This article does not report on the outcomes of the intervention. The checklist did support delivery with fidelity.

Read more:
http://www.ncbi.nlm.nih.gov/pubmed/27376347

G.T. Cochran, R.J. Engel, V.J. Hruschak, and R.E. Tarter. 2016. “Prescription Opioid Misuse Among Rural Community Pharmacy Patients: Pilot Study for Screening and Implications for Future Practice and Research.” Journal of Pharmacy Practice, doi:10.1177/0897190016656673.

Across four Pennsylvania community pharmacies, 333 patients who filled opioid prescriptions completed a health screening. Respondents in rural pharmacies had poorer overall health, higher pain levels, lower education, and a higher rate of unemployment compared to patients in urban pharmacies. Rural respondents who used illicit drugs, had posttraumatic stress disorder, or with at most a high school education had increased risks of opioid misuse.

Read more:
http://jpp.sagepub.com/content/early/2016/07/05/0897190016656673.abstract

E. Groot, F.G. Kouyoumdjian, L. Kiefer, P. Madadi, J. Gross, B. Prevost, R. Jhirad, D. Huyer, V. Snowdon, and N. Persaud. 2016. “Drug Toxicity Deaths after Release from Incarceration in Ontario, 2006-2013: Review of Coroner’s Cases.” PLoS One, doi:10.1371/journal.pone.0157512.

Matching coroners’ files on 6,978 adult drug overdose deaths in Ontario, Canada, between 2006 and 2013 with provincial correctional records showed 702 deaths (10 percent) occurred within 1 year after prison release. Twenty percent (n = 137) of the 702 deaths occurred within 1 week of release and 77 percent involved opioids. The authors estimated intervention by another person might have been possible in 59 percent of the deaths involving opioids.

Read more:
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0157512

N.A. Jumah. 2016. “Rural, Pregnant, and Opioid Dependent: A Systematic Review.” Substance Abuse 20(10):35–41 (Suppl. 1), doi:10.4137/SART.S34547.

A systematic literature review using online bibliographic sources identified 22 articles on management of substance use in pregnant women living in rural areas. Substance misuse during pregnancy is higher among rural than urban women. In rural areas, management of substance use disorders is limited by access to and acceptability of treatment modalities. Several innovative, integrated addiction and prenatal care programs have been developed which may serve as models.

Read more:
http://www.ncbi.nlm.nih.gov/pubmed/27375357

J.A. Kattan, E. Tuazon, D. Paone, D. Dowell, L. Vo, J.L. Starrels, C.M. Jones, and H.V. Kunins. 2016. “Public Health Detailing—A Successful Strategy to Promote Judicious Opioid Analgesic Prescribing.” American Journal of Public Health 106(8):1430–38, doi:10.2105/AJPH.2016.303274.

In Staten Island, N.Y., a 2013 public health detailing campaign used one-to-one educational visits to 866 healthcare providers to recommend (1) a 3-day supply of opioids is usually sufficient for acute pain, (2) avoid prescribing opioids for chronic noncancer pain, and (3) avoid high-dose opioid prescriptions. After the campaign, the overall prescribing rate decreased similarly in Staten Island and other New York City boroughs, but high-dose prescribing decreased more in Staten Island (12.4 percent versus 7.3 percent). Median day supply remained stable at 30 in Staten Island but increased from 20 to 23 in other boroughs.

Read more:
http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2016.303274

R.D. Maree, Z.A. Marcum, E. Saghafi, D.K. Weiner, and J.F. Karp. 2016. “A Systematic Review of Opioid and Benzodiazepine Misuse in Older Adults.” American Journal of Geriatric Psychiatry, doi:10.1016/j.jagp.2016.06.003.

A systematic literature review using online bibliographic sources identified 15 articles on misuse of prescription benzodiazepines and opioids in older adults. Thirteen assessed prescription drug misuse prevalence and included studies related to opioid shopping behavior, assessment of morbidity and mortality associated with opioid and/or benzodiazepine use, frequency and characteristics of opioid prescribing, frequency of substance use disorders and nonprescription use of pain relievers, and the health conditions and experiences of long-term benzodiazepine users. One study identified risk factors for misuse and one study described the effects of provider education and an electronic support tool as an intervention.

Read more:
http://www.sciencedirect.com/science/article/pii/S1064748116301439

M.N. Mazhar, F. Lau, C.V. Winssen, N. Bajaj, T. Hassan, T. Munshi, and D. Groll. 2016. “A Retrospective Hospital Database Analysis on Substance Use-Related Emergency Department Visits in an Ontario University-Affiliated Hospital Setting.” Canadian Journal of Addiction 7(2):22–7.

In 2014, three urban Ontario, Canada, hospital emergency departments had 2,191 substance-use-related visits by 1,355 unique patients. The most commonly abused substances were alcohol, multiple drugs, and cannabis. Adolescents were more likely to present with cannabis diagnoses and adults with opioid diagnoses.

Read more:
http://bit.ly/29ACQxX

A. Peacock, R. Bruno, B. Larance, N. Lintzeris, S. Nielsen, R. Ali, T. Dobbins, and L. Degenhardt. 2016. “Same-Day Use of Opioids and Other Central Nervous System Depressants Amongst People Who Tamper with Pharmaceutical Opioids: A Retrospective 7-Day Diary Study.” Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2016.07.003.

In Australia, 437 people who tamper with prescription drugs completed a retrospective 7-day diary detailing opioid, benzodiazepine, and alcohol intake. About half (47 percent) exclusively consumed opioids without benzodiazepines/alcohol; 26 percent had some days of opioid use with and some without benzodiazepines/alcohol; and 26 percent always mixed opioids and benzodiazepines/alcohol. Same-day use of opioids with benzodiazepines/alcohol typically occurred on 1–3 days in the past week. Six in 10 (61 percent) participants reported high dose opioid use on at least 1 day; one in five (20 percent) reported very high dose opioid use (>200 milligram-equivalents) and high dose benzodiazepine/alcohol use (>40 mg diazepam equivalent units or >4 drinks) on at least 1 day. Polydrug users were more likely to use prescribed opioid substitution therapy, often alongside diverted pharmaceutical opioids. Sociodemographic and clinical profiles did not vary with usage pattern.

Read more:
http://www.drugandalcoholdependence.com/article/S0376-8716(16)30199-5/abstract

E.C. Sun, B. Darnall, L.C. Baker, and S. Mackey. 2016. “Incidence of and Risk Factors for Chronic Opioid Use Among Opioid-Naive Patients in the Postoperative Period.” JAMA Internal Medicine, doi:10.1001/jamainternmed.2016.3298.

The authors analyzed 2001–13 Medstat private insurance claims data on 11 high-volume surgical procedures, plus a comparison group without surgery. The study included 641,941 opioid-naive surgical patients and 18,011.137 opioid-naive nonsurgical patients. Chronic opioid use was defined as having filled 10 or more prescriptions or more than 120 days’ supply of an opioid in the first year after surgery, excluding the first 90 postoperative days, or for nonsurgical patients, after a randomly assigned date. Among the surgical patients, the incidence of chronic opioid in the first preoperative year ranged from 0.12 percent for Cesarean delivery to 1.4 percent for total knee arthroplasty. The baseline incidence of chronic opioid use among the nonsurgical patients was 0.14 percent. In multivariate regression, cataract surgery, laparoscopic appendectomy, functional endoscopic sinus surgery, and transurethral prostate resection did not increase risk of chronic opioid use. All other surgical procedures were associated with increased risk, with odds ratios ranging from 1.3 for cesarean delivery to 5.1 for total knee arthroplasty. Male sex, age older than 50 years, and preoperative history of substance use disorder, depression, benzodiazepine use, or antidepressant use were associated with increased risk.

Read more:
http://archinte.jamanetwork.com/article.aspx?articleid=2532789

A. Tadros, S.M. Layman, S.M. Davis, R. Bozeman, and D.M. Davidov. 2016. “Emergency Department Visits by Pediatric Patients for Poisoning by Prescription Opioids.” American Journal of Drug and Alcohol Abuse: Encompassing All Addictive Disorders, doi:10.1080/00952990.2016.1194851.

Weighted 2006–12 Nationwide Emergency Department Sample data included 21,928 pediatric visits for prescription opioid poisonings. More than half were unintentional, with intentional poisonings concentrated among those ages 15–17. Mean charge per discharge was $1,840 for those treated and released and $14,235 for those admitted. [Editor’s note: charges tend to be three to four times the amount paid. These charges also exclude almost all physician fees.]

Read more:
http://www.tandfonline.com/doi/abs/10.1080/00952990.2016.1194851

S. Ward and G. Wasson. 2016. “Bridging the Gap: Improving Safe Prescribing From University to Workplace.” International Journal of Clinical Pharmacy, doi:10.1007/s11096-016-0346-x.

In Ireland, a clinical pharmacy team developed a 3 hour workshop for final year medical students that focused on practical prescribing scenarios identified as high risk by local medicines safety teams. The workshops included simulated case studies requiring the student to discuss medicine use with patients, prescribe admission drug charts, and use local guidelines to safely prescribe high risk medicines. Students appreciated the practical elements of the workshop. Initially there was an over-reliance on written medication history without verbally engaging the patient. Following pharmacist feedback, students improved their patient communication.

Read more:
http://link.springer.com/article/10.1007/s11096-016-0346-x

Professional Opinion

D. Herrick. “E-Prescribing: A Commonsense Solution to Opioid Abuse that is Being Ignored.” National Center for Policy Analysis, Policy Report No. 385, July 8, 2016.

The author argues that mandatory e-prescribing would allow doctors, pharmacies, and law enforcement to better detect inappropriate opioid use, drug-seeking behavior, and drug diversion.

Read more:
http://www.ncpa.org/pub/e-prescribing-a-commonsense-solution-to-opioid-abuse-that-is-being-ignored

J. Petras and R. Eastman-Abaya. ‘“Genocide by Prescription’: Drug Induced Death in America: The ‘Natural History’ of the Declining White Working Class in America,” July 12, 2016.

This confrontational paper identifies the (1) nature of long-term, large-scale drug-induced deaths, (2) the dynamics of “demographic transition by overdose,” and (3) the political economy of opioid addiction. It concludes by discussing whether each “death by prescription” is to be viewed as an individual tragedy, mourned in private, or as a corporate crime fueled by greed or even a pattern of “Social-Darwinism-writ-large” by an elite-run decision making apparatus.

Read more:
http://www.globalresearch.ca/genocide-by-prescription-drug-induced-death-in-america/5535449

M. Soledad Cepeda, P.M. Coplan, N.W. Kopper, J.Y. Maziere, G.P. Wedin, and L.E. Wallace. 2016. “ER/LA Opioid Analgesics REMS: Overview of Ongoing Assessments of Its Progress and Its Impact on Health Outcomes.” Pain Medicine, doi:10.1093/pm/pnw129.

The FDA determined that a risk evaluation and mitigation strategy (REMS) for extended-release and long-acting opioids was necessary to ensure that the benefits of these analgesics continue to outweigh the risks. Key components of the REMS are providing patient educational materials and training prescribers through accredited continuing education. Although the increasing rates of opioid misuse, addiction, overdose, and death observed prior to implementation of the REMS leveled off or started to decline, these benefits cannot be attributed solely to the extended release formulations or to REMS since many other initiatives to prevent abuse occurred contemporaneously. After these improvements, the large majority of patients surveyed still expressed satisfaction with their access to opioids.

Read more:
http://painmedicine.oxfordjournals.org/content/early/2016/07/02/pm.pnw129

National

Black-Market Oxycontin Spurred Town’s Descent into Crime, Addiction, Heartbreak
Harriet Ryan, Scott Glover and Lisa Girion, Los Angeles Times
July 10, 2016

Part 2: More Than 1 Million Oxycontin Pills Ended Up in Hands of Criminals and Addicts
Harriet Ryan, Lisa Girion, and Scott Glover, Los Angeles Times

This article discusses how illicit OxyContin devastated Everett, Wash., and surrounding communities. It was a factor in more than half of the crimes in Snohomish County, and misuse sparked an epidemic of pain reliever and heroin addiction. Authorities knew the drug was coming from traffickers in the Los Angeles area, but they were unable to determine how pills were getting on the black market. People who sent OxyContin from Southern California to a dealer in Everett were buying pills from Lake Medical that was a front for a drug ring. Records indicated that Inland Empire Crips gang members drove bags of OxyContin north on Interstate 5 to Washington State and sent couriers aboard planes to Seattle with pills strapped to their bodies. Purdue Pharma was tracking the prescriptions written by Lake Medical’s doctors and the large quantities of pills ordered by corrupt pharmacies filling those prescriptions. It, however, did not track Lake Medical pills to their final destinations. Years later, authorities brought down the ring with information Purdue shared with law enforcement. By then, 1.1 million pills had spilled onto the black market. Now, heroin addiction is a public health crisis in Snohomish County; more than 40 residents fatally overdose each year. For more than a decade, Purdue collected extensive evidence suggesting illegal trafficking of OxyContin and did not share it with law enforcement or cut off the flow of pills. Purdue had monitored pharmacies for criminal activity, acknowledged that even when the company had evidence pharmacies were colluding with drug dealers, it did not stop supplying distributors selling to those stores. Purdue knew about many suspicious doctors and pharmacies from prescribing records, pharmacy orders, field reports from sales representatives and, its own surveillance operations. Purdue claims it compiled with the law at all times.

Read more:
http://www.latimes.com/projects/la-me-oxycontin-everett
http://www.latimes.com/projects/la-me-oxycontin-part2

Related Article

Connecticut Senator May Seek Hearing on OxyContin Maker
Josh Kovner, Hartford Courant
July 12, 2016

Sen. Richard Blumenthal (D-Conn.) may seek a congressional hearing on Purdue Pharma’s role in monitoring its pain reliever OxyContin. Blumenthal had some revelations after an article was recently published in the Los Angeles Times about the pharmaceutical company. It appears to indicate a lack of proper monitoring and tracking of OxyContin. Purdue Pharma waited to pass on to law enforcement the information the company had gathered about a drug ring. The company has not been accused of any wrongdoing, and reiterated that it did cooperate with authorities in California. (Includes video: 1:06 minutes)

Read more:
http://www.courant.com/news/connecticut/hc-oxycontin-abuse-0712-20160712-story.html


Alabama Joins Other States in Fight Against Opioid Addiction
Bethany Sharpton, WVTM
July 13, 2016

The Compact to Fight Opioid Addiction, developed by and released through the National Governors Association, has been signed by 46 governors. The governors agreed to address the opioid epidemic with steps to reduce inappropriate prescribing, change the nation’s understanding of opioids and addiction, and ensure a pathway to recovery for individuals suffering from addiction. The governors last made a pact through NGA to coordinate action on an urgent national issue more than a decade ago. At the 2017 winter meeting, the association will report on specific steps governors have taken to meet their commitments and build on existing efforts.

Read more:
http://www.wvtm13.com/news/alabama-joins-other-states-in-fight-against-opiod-addiction/40696090

Employer Groups Sue to Block Federal Drug Testing Provisions
Robin E. Shea, Constangy, Brooks, Smith & Prophete, LLP
July 12, 2016

Some employers and employer groups, including the National Association of Manufacturers and Associated Builders and Contractors, have filed suit in federal court seeking to block parts of the new Occupational Safety and Health Administration rule related to injury retaliation, which blocks mandatory post-accident drug testing. The lawsuit contends that parts of the rule dealing with discrimination and retaliation exceed the Agency’s authority, interfere with state workers’ compensation laws, and are arbitrary and capricious. The plaintiffs also argue that OSHA did not comply with procedures it is required to follow before issuing a new rule, and did not conduct a required regulatory analysis. The lawsuit does not challenge the OSHA rule’s requirement for electronic submission of information about workplace injuries and illnesses, but only the rule’s discrimination and retaliation provisions.

Read more:
http://www.jdsupra.com/legalnews/employer-groups-sue-to-block-osha-s-68383

New Reporting Rule to Take Effect —Are Your Drug Testing Policies Placing You at Risk?
Rebecca Bernhard, Marilyn Clark, Jack Sullivan, Dorsey & Whitney LLP
July 14, 2016

The Occupational Safety and Health Administration’s (OSHA) new reporting rule, which takes effect Aug. 10, 2016, involves employers’ post-injury and post-accident drug testing policies. The authors remind employers to set aside time to confer with counsel, review their policies, and revise them as needed to avoid costly enforcement action. This article includes an overview of the relevant provisions and discusses their practical implications.

Read more:
http://www.jdsupra.com/legalnews/new-osha-rule-effective-next-month-are-24409

Collision at the Corner of Intoxicants and Drug Testing in the Workplace
Kaitlin L. Robidoux
July 12, 2016

The author advises employers who are confronted with a drug testing issue in the workplace, to consult competent counsel for guidance, rather than make assumptions. The author uses an example of an employer in West Virginia.

Read more:
http://www.natlawreview.com/article/collision-corner-intoxicants-and-drug-testing-workplace

Singer Chaka Khan and Sister Enter Rehab over Prescription Drugs
Associate Press, Killeen Daily News
July 10, 2016

Singer Chaka Khan and her sister have entered a drug rehabilitation program to manage their addictions to prescription drugs. Khan is addicted to fentanyl, the same drug her friend Prince died from in April. His overdose helped hasten her decision to get help.

Read more:
http://kdhnews.com/news/ap/chaka-khan-and-sister-enter-rehab-over-prescription-drugs/article_0720705f-eb48-5263-8f91-c20ce9598944.html

Marijuana

R. Queirolo, M.F. Boidi, and J.M. Cruz. 2016. “Cannabis Clubs in Uruguay: The Challenges of Regulation.” International Journal of Drug Policy, doi:10.1016/j.drugpo.2016.05.015.

In 2015, researchers interviewed government officials and representatives of Uruguayan Cannabis Clubs that legally can grow up to 99 marijuana plants. The article describes how clubs are formed, their resources, rules for marijuana production and distribution; and relationships with government institutions and the community. The clubs face four main challenges: compliance with the extant regulation, financial sustainability, tolerance from the community, and collective action dilemmas.

Read more:
http://www.ijdp.org/article/S0955-3959(16)30169-4/abstract

Legalization of Medical Marijuana in Ohio and Workers’ Compensation Programs
Julie E. Andrews, and Joan M. Verchot, Dinsmore & Shohl LLP / Insight
July 14, 2016

Ohio’s medical marijuana law takes effect Sept. 8, 2016. It provides for licensing of treating physicians and registration of patients who will receive the medical marijuana. Registered patients are not authorized to operate a vehicle, watercraft, or aircraft while under the influence of medical marijuana. Registered patients are not authorized to work in opposition of their employer’s policies. Future limitations will be outlined in new rules and undoubtedly through litigation. Workers’ compensation policies and practices will not be immediately impacted.

Read more:
http://www.natlawreview.com/article/legalization-medical-marijuana-ohio-and-impact-your-workers-compensation-program

Yakima (Wash.) Clarifies: Marijuana Use Not Allowed for All Public Employees
Crystal Bui, KIMA
July 13, 2016

Although recreational marijuana has been legal in Washington for nearly 4 years, the city of Yakima still prohibits public employees from using medical and nonmedical marijuana during work and after-hours. This also applies to Yakima city council members. Some employees including those with city commercial driver’s licenses are subject to random drug and alcohol tests. The city has a zero-tolerance policy on marijuana and other drugs, which means employees cannot have anything in their system. Employees found to be under the influence can be suspended or terminated. (Includes video: 1:58 minutes)

Read more:
http://kimatv.com/news/local/yakima-clarifies-marijuana-not-allowed-for-public-employees

Medical Marijuana Bill Finds an Audience in Frankfort (Ky.)
Ryland Barton, WFPL
July 11, 2016

The Kentucky Nurses Association endorsed a measure that would create a regulatory framework for a medical marijuana industry in the state. It believes providing legal access to medical cannabis is imperative. Experts argue that they do not know enough about properties of cannabis. The Kentucky Medical Association will not support legalizing medical marijuana until it is approved for use by the FDA. The measure did not get a hearing during this year’s legislative session.

Read more:
http://wfpl.org/medical-marijuana-discussed-frankfort

Georgia’s Medical Marijuana Law Just Turned One Year Old
Kristina Torres, Atlanta Journal-Constitution
July 13, 2016

Georgia legalized medical marijuana in 2015. Now, 830 people are certified to possess up to 20 ounces of a limited form of cannabis oil. The state banned the growing and manufacturing of any form of medical marijuana within state boundaries.

Read more:
http://www.myajc.com/news/news/state-regional-govt-politics/georgias-medical-marijuana-law-just-turned-one-yea/nrxPr

The Philippines Congress Members File Medical Marijuana Bill
Ellson A. Quismorio and Charina Clarisse L. Echaluce, Manila Bulletin
July 9, 2016

Members of The Philippines Congress have refiled legislation that would legalize medical marijuana in the country. The Department of Health has also formed a panel of health experts to research the health benefits of cannabis.

Read more:
http://www.mb.com.ph/medical-marijuana-bill-refiled-doh-forms-research-team

International

Working to Treat Opioid Misuse in Niagara (Canada)
Maryanne Firth, St. Catharines Standard
July 14, 2016

Though misuse of prescription pain medications continues to increase in Niagara, Canada, so do efforts to address the problem. Physicians monitor their patients to ensure medication is being properly taken; pharmacists keep an eye on prescriptions being filled; and dentists raise red flags when patients request certain prescription refills following a procedure. Education initiatives are also held in elementary and high schools; and citizens are encouraged to participate in an annual prescription drug drop-off day. Families also are encouraged to safely dispose of unused prescriptions at Niagara pharmacies.

Read more:
http://www.stcatharinesstandard.ca/2016/06/30/working-to-treat-opioid-misuse-in-niagara

Northeast/Mid-Atlantic News

Pennsylvania to Open 20 New Centers to Coordinate Opioid Addiction Treatment
Don Sapatkin, The Inquirer
July 15, 2016

Pennsylvania will open 20 “Centers of Excellence” by Oct. 1, 2016, to coordinate care for people addicted to opioids. Existing organizations will function as navigational hubs to coordinate a range of services for Medicaid patients. Legislators approved $15 million, along with $5 million in federal matching funds, to open the centers.

Read more:
http://www.philly.com/philly/health/20160715_Gov__Wolf_announces_
20_new_centers_to_coordinate_opioid_addiction_treatment.html


2016 Drug Deaths in New Hampshire Set to Surpass Last Year’s Record
Ella Nilsen, Concord Monitor
July 11, 2016

A New Hampshire medical examiner’s office analysis showed that the number of drug deaths this year is set to surpass last year’s record of 439. Thus far in 2016, the office confirmed 161 deaths, with hundreds more pending cases. Fentanyl was involved in 108 deaths; and the drug by itself killed 62 people this year. The chief forensic investigator is projecting a total of 494 deaths in 2016.

Read more:
http://www.concordmonitor.com/2016-drug-deaths-set-to-pass-2015-numbers-3383178

New Program Offers Narcan at Tribal Clinics to Address Overdoses
Jen Lynds, Bangor Daily News
July 12, 2016

Diversion Alert and the Husson School of Pharmacy have targeted Maine’s five Native American tribes to participate in its initiative, Wabanaki Pathway to Hope and Healing, which includes take-home naloxone programs in each of the five tribal clinics. The clinics are located on tribal land of the Aroostook Band of MicMacs in Presque Isle, Penobscot Nation at Indian Island, Passamaquoddy Tribe at Pleasant Point, Passamaquoddy Tribe at Indian Township, and the Houlton Band of Maliseet Indians. The take-home naloxone programs will involve prescribing the medication to patients at risk of overdosing and to family members who are concerned about loved ones overdosing.

Read more:
https://bangordailynews.com/2016/07/12/news/aroostook/new-program-offers-narcan-at-tribal-clinics-to-address-overdoses/?ref=moreInstate

Delaware State Police Investigate Armed Robbery of Rite Aid Pharmacy
Associated Press, Washington Post
July 9, 2016

The Delaware State Police is investigating an armed robbery at a Rite Aid in the Claymont area, where one of the robbers demanded prescription drugs from the pharmacist. Three suspects fled with the prescription drugs.

Read more:
https://www.washingtonpost.com/national/state-police-investigate-armed-robbery-of-rite-aid-pharmacy/2016/07/09/5461dc6e-461c-11e6-a76d-3550dba926ac_story.html

South News

Urine Testing Labs Draw Scrutiny of Oklahoma Attorney General
Andrew Knittle, The Oklahoman
July 9, 2016

The Oklahoma attorney general’s office is investigating a group of urine testing laboratories doing millions of dollars in business with Oklahoma healthcare providers. Financial records provided by the Oklahoma Health Care Authority, the state’s Medicaid agency, show that a some laboratories have received nearly $100 million in reimbursements since 2011 for testing the urine of chronic pain patients, recovering addicts, and others routinely prescribed narcotics by a physician. Some of those same laboratories have been in trouble before, from either criminal investigations or multimillion dollar judgments in civil court. In 2011, urine testing laboratories received $3.7 million from the Oklahoma Health Care Authority. By the end of 2014, those same reimbursements had increased to $32 million, up more than 700 percent in three years. The state’s Medicaid agency changed the way laboratories are paid for urine testing services in May 2015. Before the “emergency changes,” some laboratories were charging Oklahomans covered by Medicaid an average of $2,600 per claim for urine testing services, while other laboratories were reimbursed an average of less than $300 per claim for workups.

Read more:
http://newsok.com/article/5508856

National Heroin, Opioid Epidemic Surging on Virginia Peninsula
Daily Press
July 9, 2016

Law enforcement agencies in Virginia Beach, Va. and surrounding communities have investigated more heroin-related overdoses this year than in all of 2015. By June, the city of Hampton alone had doubled its number of suspected heroin overdoses. Newport News’ numbers were not far behind. Because of fentanyl and its combination with other drugs, Sentara Careplex Hospital is admitting more patients who would have previously been treated and released in the emergency department.

Read more:
http://www.dailypress.com/health/dp-nws-heroin-opiate-pain-doctor-20160618-story.html

Use of Opioid Overdose Antidote Expanding in Knox County (Tenn.) Area
Kristi L. Nelson, Knoxville News Sentinel
July 11, 2016

Rural/Metro paramedics in Knox County, Tenn., administer naloxone around 30 times a week. Though ambulances have carried the drug for around 20 years, Rural/Metro personnel have seen a steady increase in the need to use it. Over the last six months, Rural/Metro’s first responders have been using it 100–120 times a month. Since Knoxville Police Department began carrying naloxone in September 2015, officers have used it 27 times on people overdosing on opioids or heroin. Thus far in 2016, Knoxville Fire Department has used it 46 times, compared to 54 times in all of 2015.

Read more:
http://www.knoxnews.com/news/local/use-of-opioid-overdose-antidote-expanding-in-knox-county-area-371bdb02-1720-0be7-e053-0100007fdf03-386210581.html

North Carolina Medical Board Calls Prescription Drug Overdoses a Health Crisis
Allison Latos, WSOCTV
July 11, 2016

The North Carolina Medical Board is analyzing doctors’ prescribing records and the steps they take to prevent misuse of pain relievers. It also is reviewing how doctors are identifying patients who misuse pain relievers. The medical board is investigating 12 high-dose prescribers and 60 physicians who had two or more patient deaths from opioid poisonings between July 2014 and June 2015. When the medical board conducts an investigation, it checks to see if doctors have safeguards in place such as performing risk assessment of patients, random urine screenings, and checking the state’s prescription drug monitoring program to make sure patients are not receiving opioids from other doctors. If the board finds issues with a doctor prescribes opioid drugs, the doctor may be required to take more educational training or may be disciplined. (Includes videos: 2:45 minutes | 0:45 minutes | 0:09 minutes)

Read more:
http://www.wsoctv.com/news/9-investigates/9-investigates-nc-medical-board-calls-prescription-drug-overdoses-a-health-crisis/396681007

Midwest News

Availability of Drug Overdose Antidote Soars in Ohio
Jordyn Grzelewski, The Vindicator
July 9, 2016

More than 20 people in Summit County, Ohio, overdosed in one week. Most survived because emergency responders used naloxone. The availability of the antidote has soared around the state. Since last July when the law allowed pharmacies to dispense naloxone without a prescription, nearly 1,000 pharmacies in 78 counties have begun participating. In addition to doctors and law enforcement, pharmacists can give the medication to family and friends who believe a loved one is at risk of experiencing an opioid-related overdose.

Read more:
http://www.vindy.com/news/2016/jul/09/access-to-opioid-antidote-expanding-savi

Overdoses Spike in Ohio Cities amid Drug Death Concerns
Kantele Franko, Morning News
July 11, 2016

This article discusses the increase in overdoses in the Ohio cities of Akron and Columbus. It lists questions and brief answers about the abuse of heroin and fentanyl. This includes what is happening in Akron, concerns by other cities in Ohio, the state’s response, and what is the overdose antidote.
Read more:
http://www.scnow.com/news/article_b4de6829-9972-5180-b5f5-52673abf0f38.html

Michigan Lawmakers Push for Bills to Curtail Opioid Abuse and Overdoses
Nick Minock, WWMT
July 14, 2016

Michigan lawmakers are working to pass a good Samaritan law that would allow someone of any age to report an overdose and face immunity from prosecution; and a law that would allow pharmacies to sell naloxone without a prescription.

Read more:
http://wwmt.com/news/michigan-politics/michigan-lawmakers-continue-push-for-bills-to-curtail-opiod-abuse-and-overdoses

‘Pill Mill’ Doctor Gets 4 Years in Prison for Giving Opioids to 250 Patients A Day
Khalil AlHajal, MLive Media Group
July 12, 2016

Oscar Linares, M.D., was sentenced to 4 years and 9 months in prison for running a “pain management” facility in Michigan that illegally distributed prescription drugs to as many as 250 patients a day over three years. Linares pre-signed prescription pads for employees who gave patients access to drugs without a doctor’s involvement. When he was too busy, Linares instructed employees to sign the prescriptions for him. Linares also received three years of supervised release and forfeiture of $236,000, seven cars, jewelry, and other items.

Read more:
http://www.mlive.com/news/detroit/index.ssf/2016/07/pill_mill_doctor_gets_4_years.html

West News

Washington Cracking Down on Pain Doctor Over Opiate Prescriptions
JoNel Aleccia, Seattle Times
July 15, 2016

The Washington State Medical Commission has suspended the license of Frank Li, M.D., medical director for Seattle Pain Centers, which has eight clinics across the state. Dr. Li has been barred from practicing medicine after state regulators charged that he failed to properly monitor prescription use of opiates, possibly contributing to at least 18 deaths since 2010. Officials also have either started investigations or filed complaints regarding more than 40 doctors and other health-care providers who have worked for Seattle Pain Centers since 2013. The state agency that oversees Medicaid also revoked Li’s ability to bill for services. The medical commission has received 13 complaints against Li since 2010; 11 were closed after no violations were found. Two complaints filed in 2015 remain open: one from the health care authority and one from the state attorney general’s office. Both detail problems with Li’s practice. In 2013, the state’s labor department denied Li’s application to prescribe drugs for the workers’ compensation program based on “noncompliant” prescribing practices and substandard care of a patient who died of an overdose. Li withdrew his application before officials could report the denial.

Read more:
http://www.seattletimes.com/seattle-news/health/dea-state-crack-down-on-pain-doctor-over-opiate-prescriptions-citing-18-deaths

California School Researches Whether Social Media Can Help Prevent Opioid Abuse
Maya Smith, Science Magazine
July 13, 2016

Researchers at the University of California, Los Angeles, will study whether social media can help reduce opioid misuse in patients with chronic pain. In a 12-week pilot project, researchers will recruit 60 patients who experience chronic pain, are on long-term opioid therapy, and have reported other behaviors such as drug or alcohol misuse that put them at high risk for addiction. Each participant will be asked to log into a private Facebook group. They can share posts, comments, pictures, and private messages among themselves, and with eight peer role models who are also on long-term opioid therapy. The researchers will monitor changes in participants’ reported use of opioids and other substances, and assess whether the strategy is effective.

Read more:
http://www.sciencemag.org/news/2016/07/can-social-media-help-prevent-opioid-abuse

More Drop Boxes Needed for Prescription Drugs in New Mexico
Diana Jeremias, Las Cruces Sun-News
July 10, 2016

Doña Ana County, N.M., has one drug drop box located at Walgreens Pharmacy. The UP! Coalition is working with community partners and agencies to increase awareness of the existing drop box, asking more stores to offer dropboxes, and identifying other sites where people could access to them.

Read more:
http://www.lcsun-news.com/story/news/local/2016/07/10/more-drop-boxes-needed-prescription-drugs/86920446

Other Resources

Finding Solutions to the Prescription Opioid and Heroin Crisis: A Road Map for States
National Governors Association
July 7, 2016

This road map is a tool to help states respond to the growing opioid crisis. The road map features a public health approach focused on preventing and treating the disease of opioid use disorder, while strengthening law enforcement efforts to address illegal supply chain activity. It is designed as a policy development tool, allowing a state to use all or portions of the road map as it applies to the state’s unique situation.

Read more:
http://www.nga.org/cms/finding-solutions-to-the-prescription-opioid-and-heroin-crisis-a-road-map-for-states

Webinars

CDC Recommendations for Non-Opioid Treatments in the Management of Chronic Pain
Centers for Disease Control and Prevention
Wednesday, July 27, 2016 | 2–3 p.m. (ET)

During this Clinician Outreach and Communication Activity Call, a case study will illustrate how clinicians can identify appropriate treatment strategies for chronic pain. In addition, clinicians will learn about the effectiveness and risks of non-opioid medications and nonpharmacologic treatments for chronic pain.

Read more:
https://emergency.cdc.gov/coca/calls/2016/callinfo_072716.asp

Reducing Opioid Abuse by Incorporating Patient Management Strategies from Psychiatry and Behavioral Health
American Dental Association
Aug. 24, 2016 | 3–4 p.m. (ET)
http://pcss-o.org/event/reducing-opioid-abuse-by-incorporating-patient-management-strategies-from-psychiatry-and-behavioral-health

Pain Management in Dentistry: A Changing and Challenging Landscape
American Dental Association
Sept. 2, 2016 | 3–4 p.m. (ET)
http://pcss-o.org/event/pain-management-in-dentistry-a-changing-and-challenging-landscape

Grant Award

Health Districts Receive State Grants to Combat Opioid Overdoses
By Nicholas Rondinone, Hartford Courant
July 12, 2016

The Connecticut Department of Public Health has awarded six health districts with $30,000 in grant funding per year for 3 years to reduce opioid-related overdoses.

Read more:
http://www.courant.com/health/heroin/hc-opioid-health-districts-grant-0713-20160712-story.html

Grant Announcements

Safety and Outcome Measures of Pain Medications Used in Children and Pregnant Women (R03) | (R01) | (R21)
National Institutes of Health
Due: Oct. 16, 2016 | Jan. 7, 2020 | Jan. 7, 2020
Read more (R03):
http://grants.nih.gov/grants/guide/pa-files/PA-16-313.html
Read more (R01):
http://www.grants.gov/web/grants/view-opportunity.html?oppId=284425
Read more (R21):
http://www.grants.gov/web/grants/view-opportunity.html?oppId=284428

Safety and Outcome Measures of Pain Medications Used in Children and Pregnant Women (R03) | (R01) | (R21)
National Institutes of Health
Due: Oct. 16, 2016 | Jan. 7, 2020 | Jan. 7, 2020
Read more (R03):
http://grants.nih.gov/grants/guide/pa-files/PA-16-313.html
Read more (R01):
http://www.grants.gov/web/grants/view-opportunity.html?oppId=284425
Read more (R21):
http://www.grants.gov/web/grants/view-opportunity.html?oppId=284428

Bottle Tracking Program
National Association of Drug Diversion Investigators
Due: None Specified
http://www.naddi.org/aws/NADDI/pt/sp/programs_grants
http://naddibottletracking.org/law-enforcement/

Take-Back Events & Drop Boxes

Gage County (Neb.) Sheriff’s Office Adds Prescription Drop-Off Box
Doug Kennedy, News Channel Nebraska
July 14, 2016
http://kwbe.com/local-news/gage-county-sheriffs-office-adds-prescription-drop-off-box

New York Counterdrug Task Force Collecting Unneeded Prescriptions at Air Base
Tech. Sgt. Catharine Schmidt, New York National Guard
July 11, 2016
https://www.dvidshub.net/news/203766/ny-counterdrug-task-force-collecting-unneeded-prescriptions-air-base

New Drug Drop Off in Oneida County (N.Y.) Aims to Combat Addiction, Prevent Abuse
Rachel Murphy, WKTV
July 11, 2016
http://www.wktv.com/news/local/New_drug_drop_off_aims_to_combat_addiction
__prevent_abuse.html


Powhatan County (Va.) Sheriff Gets Help to Combat Drug Abuse, Promote Safe Meds Disposal
Virginia Sheriff’s Association
July 13, 2016
https://vasheriff.org/2016/07/13/cvspharmacy-partnership-drug-free-kids-help-powhatan-county-sheriffs-office-combat-drug-abuse-promote-safer-disposal-unused-medication

Clark County (Wash.) Sheriff’s Office Ends Drug Drop Off; Staffing Issues Cited
Andy Matarrese, The Columbian
July 14, 2016
http://www.columbian.com/news/2016/jul/14/clark-county-sheriffs-office-ends-drug-drop-off

Upcoming Events, Conferences, & Workshops

The Harold Rogers Prescription Drug Monitoring Program National Meeting
Bureau of Justice Assistance, and Prescription Drug Monitoring Program Training and Technical Assistance Center at Brandeis University
Aug. 17–19, 2016
Washington, D.C.

Register:
http://www.pdmpassist.org/content/ttac-meeting-registration-form

National Conference on Addiction Disorders: Taking Recovery to New Heights
Vendome Healthcare Media
Aug. 18–21, 2016
Sheraton Denver Downtown Hotel
Denver, Colo.
https://vendome.swoogo.com/ncad-2016/home

Register:
https://vendome.swoogo.com/ncad-2016/begin

2016 Annual Conference
International Health Facility Diversion Association
Sept. 13–14, 2016
Cincinnati, Ohio
https://ihfda.org/2016-annual-conference

Register:
https://www.regonline.com/Register/Checkin.aspx?EventID=1803476

Twenty-Ninth Annual National Prevention Network Conference
National Prevention Network
Sept. 13–15, 2016
Buffalo, N.Y.
http://www.npnconference.org

Register:
http://www.npnconference.org/registration

2016 Conference: Saving Lives: Access to Improved Health & Recovery
American Association for the Treatment of Opioid Dependence
Oct. 29 – Nov. 2, 2016
Baltimore, Md.
http://www.aatod.org/national-conference/2016-aatod-conference-baltimore

Register:
http://www.aatod.org/national-conference/2016-aatod-conference-baltimore/register-now

Bridging the Gaps: Reducing Prescription Drug and Opioid Abuse and Misuse Summit
National Association of Attorneys General and the Association of State and Territorial Health Officials
Nov. 14–16, 2016
Arlington, Va.
http://www.naag.org/nagtri/nagtri-courses/national/bridging-the-gaps-reducing-prescription-drug-and-opioid-abuse-and-misuse-summit.php

National Rx Drug Abuse & Heroin Summit
Operation Unite
April 17–20, 2017
Atlanta, Ga.
https://vendome.swoogo.com/2017-rx-summit/8082

Call for Presentations
Submission Deadline Date: Friday, Aug. 5, 2016
https://vendome.swoogo.com/2017-rx-summit/2017-CFP
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.