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July 23, 2014


SAMHSA Prescription Drug Abuse Weekly Update
Issue 81  |  July 23, 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 Journal Articles and Reports Professional Education News Other State and Local News Other Resources Video Grants Awarded Request for Proposal Take-Back Events and Drop Boxes Save the Date Upcoming Conferences and Workshops


Quest Diagnostics. 2014. "Prescription Drug Misuse in America: Diagnostic Insights into Managing the Drug Epidemic." Quest Diagnostic Health Trends: Prescription Drug Monitoring Report 2014.

The Prescription Drug Misuse in America report summarizes 1,409,037 de-identified urine lab test results collected in 2011–13 by Quest Diagnostics clinical laboratories from male and female patients of all ages in 46 states and the District of Columbia. This report does not include workplace drug testing. All testing was performed in connection with the company's prescription drug monitoring services, which aid clinicians in monitoring patients for appropriate use of up to 26 commonly abused prescription medications. Florida, Georgia, Kentucky, New York, and Tennessee showed the highest rates of reduced prescription misuse over the past 3 years. The average decline for these states was 10.7 percent, compared with 4.4 percent for all other states combined. The study also found that 55 percent of Americans who physicians monitored after prescribing abusable drugs potentially put their health at risk by misusing medications in 2013—down from 63 percent in 2011. The high rate of prescription medication misuse by monitored patients was observed across all age groups and in both genders, as well as across different types of health plans. Tested patients ages 10–17 experienced the greatest compliance gains, with inconsistency rates decreasing from 70 percent in 2011 to 57 percent in 2013. Tested patients age 64 and older had the lowest rate of inappropriate drug use at 44 percent.

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Are Medicare's Patient Satisfaction Surveys Contributing to Opioid Abuse?
Jeffrey Bendix, Medical Economics
June 26, 2014

The Affordable Care Act provides incentive payments to acute care hospitals based on the quality of care they provide to Medicare patients, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems Survey. In a letter to the Centers for Medicare & Medicaid Services (CMS), Senators Dianne Feinstein (D-Calif.) and Chuck Grassley (R-Iowa) report anecdotal evidence suggesting the associated patient satisfaction surveys may have the unintended effect of encouraging practitioners to unnecessarily and improperly prescribe opioid pain relievers. If doctors refuse to write scripts sought by nonmedical users, they get bad ratings that can affect their Medicare payments. The senators asked CMS to investigate.

Read more:

Journal Articles and Reports

B.G. Messina, M.M. Silvestri, A.R. Diulio, J.G. Murphy, K.B. Garza, and C.J. Correia. 2014. "Alcohol Use, Impulsivity, and the Non-Medical Use of Prescription Stimulants Among College Students." Addictive Behaviors, doi:10.1016/j.addbeh.2014.07.012.

At Auburn University, 1,016 students received extra credit for responding to a substance abuse survey. (The paper does not indicate how many students chose not to respond.) In the past year, 25.4 percent of the students reported using prescription drugs nonmedically; 10.8 percent reported combining stimulants and alcohol. Logistic regression models indicated increased alcohol use, alcohol-related negative consequences, and impulsivity were significantly associated with nonmedical use of prescription drugs and nonmedical use of prescription drugs/alcohol co-ingestion. Respondent sex was not a significant predictor.

Read more:

Pain & Policy Studies Group. 2014. Achieving Balance in State Pain Policy: A Progress Report Card (CY 2013). Madison, Wisc.: University of Wisconsin Carbone Cancer Center.

This report card and companion analysis of state policies have drawn much local press coverage. The report card summarizes and grades state laws and regulations that govern the way doctors prescribe pain medications, looking at the balance between patient access to needed medication and control of medication abuse. An "A" grade means no restrictive or ambiguous language exists in the pain policy. (Editor's note: States are downgraded for some policies directed at reducing prescription drug abuse—e.g., requiring use of forgery-resistant state prescription pads for Schedule II narcotics but not other drugs; not allowing nurse practitioners or midwives to prescribe Schedule II narcotics; or voiding Schedule II narcotic prescriptions if they are not filled in less than 14 days.) The report concludes that state pain policies are becoming more balanced. Since 2012, 24 states changed policies or adopted new policies with language that fulfilled at least one evaluation criterion. Alabama and Idaho earned an A in 2013, joining Georgia, Iowa, Kansas, Maine, Massachusetts, Michigan, Montana, Oregon, Rhode Island, Vermont, Virginia, Washington, and Wisconsin as the states with the most balanced pain policies. Idaho showed the largest grade improvement between 2008 and 2013, increasing a full grade level. Only two states have a grade below C, compared with 11 in 2008. No state's grade has decreased since 2006. The policy improvement that occurred between 2012 and 2013 was largely the result of 1) adopting policies to encourage appropriate pain management, palliative care, or end-of-life care and 2) state legislatures or regulatory agencies repealing restrictive or ambiguous policy language.

The report card is sponsored by the American Cancer Society and its Cancer Action Network, as well as the LiveStrong Foundation.

Read more:

M.D. Stein, B.J. Anderson, P. Thurmond, and G.L. Bailey. 2014. "Comparing the Life Concerns of Prescription Opioid and Heroin Users." Journal of Substance Abuse Treatment, doi:10.1016/j.jsat.2014.07.001.

People entering opioid detoxification rated their level of concern about 43 health and welfare items. Using exploratory factor analysis, the authors collapsed the items into 10 areas. Participants (n=529) were 69.9 percent male, 87.5 percent non-Hispanic Caucasian, and 24.2 percent prescription opioid users. They were most concerned about drug problems, followed by money problems, relationship problems, mental health, and cigarette smoking. Prescription opioid users expressed significantly less concern about drug problems and transmissible diseases and more concern about alcohol use (p<.001) than heroin users. Concern about the other seven areas did not differ significantly between the two user groups.

Read more:

Professional Education

S. Rauenzahn and E. Del Fabbro. 2014. "Opioid Management of Pain: The Impact of the Prescription Opioid Abuse Epidemic." Current Opinion in Supportive and Palliative Care, doi:10.1097/SPC.0000000000000065.

This review examined the financial, regulatory, and clinical practice impact of the prescription opioid abuse epidemic, factors contributing to its growth, and strategies that may counter this public health crisis. Despite the call for urgent practice change and new initiatives such as electronic prescription monitoring and additional education programs for providers and patients, evidence for improved outcomes is limited. Critics worry some patients may suffer from underprescribing as an unintended consequence of more stringent state and federal regulations. Consensus exists that some form of universal precautions should be adopted for all patients, including those being treated for cancer-related pain, to better identify and manage those at risk of opioid abuse.

Read more:

J.A. Trafton and E.M. Oliva. 2014. "Legislative Strategies Other than Legalizing Illicit Opioids May Help to Reduce Overdose Fatalities." Addiction 109(8):1243–44, doi:10.1111/add.12585.

Authors present their views on heroin legalization's impact on overdose rates. They discuss the size of the population exposed to opioids, risk of overdose when exposed, and risk of dying in the case of overdose. They also talk about implementation of overdose education and naloxone distribution programs. The authors believe targeted legislative approaches such as Good Samaritan 911 laws, along with public health and healthcare system efforts to improve overdose recognition and response, show more promise for reducing overdose mortality than heroin legalization.

Read more:


FedEx Faces Federal Indictment over Role in Distributing Controlled Substances, Prescription Drugs
CBS San Francisco
July 17, 2014

FedEx Corporation was indicted by a federal grand jury in San Francisco, Calif., and charged with conspiracies to traffic controlled substances and misbranded prescription drugs for two illegal Internet pharmacies. In each case, FedEx is alleged to have knowingly and intentionally conspired to distribute controlled substances and prescription drugs to customers who had no legitimate medical need for them based on invalid prescriptions issued by doctors acting outside the usual course of professional practice.

The indictment states that beginning in 2004, the Drug Enforcement Administration (DEA), Food and Drug Administration, and members of Congress and their staff warned FedEx that illegal Internet pharmacies were using its shipping services to distribute controlled substances and prescription drugs in violation of the Controlled Substances Act; Food, Drug, and Cosmetic Act; and numerous state laws. In 2004, FedEx established an Online Pharmacy Credit Policy requiring that all online pharmacy shippers be approved by the credit department before opening a new account. The stated reason for this policy was that many Internet pharmacies operated outside federal and state regulations over the sale of controlled drugs, and many sites had been shut down by the government without warning, leaving a large balance owed to FedEx. FedEx also established a sales policy in which all online pharmacies were assigned to a "catchall" classification to protect sales professionals' commission-based compensation from the volatility caused by online pharmacies moving shipping locations—often to avoid detection by the DEA.

As early as 2004, FedEx also knew it was delivering drugs to dealers and addicts. FedEx couriers in Kentucky, Tennessee, and Virginia expressed safety concerns that were circulated to senior management, including that FedEx trucks were stopped by online pharmacy customers demanding packages of pills; that the delivery address was a parking lot, school, or vacant home where several carloads of people were waiting for the driver to arrive with their drugs; that customers were jumping on FedEx trucks and demanding online pharmacy packages; and that FedEx drivers were threatened if they insisted on delivering packages to a specified address instead of giving the packages to customers who demanded them. In response to these concerns, FedEx adopted a procedure whereby Internet pharmacy packages from problematic shippers were held for pickup at specific stations, rather than delivered to the recipient's address.

A senior vice president said FedEx is innocent and will plead not guilty on July 29.

Read more:

Exclusive: Feds Quietly Investigating Prescription Drug Abuse in NFL Locker Rooms, Sources Say
Michael O'Keeffe, New York Daily News
July 12, 2014

The Drug Enforcement Administration (DEA) launched an investigation of prescription drug abuse in the National Football League (NFL). The probe began after attorneys representing 1,300 NFL retirees filed a lawsuit accusing the league of illegally handing out pain relievers, sleeping pills, and other drugs without informing players of the risks of health problems and addiction. The DEA's New York division is contacting former players to learn how NFL doctors and trainers get access to narcotics such as Percodan and Vicodin.

Read more:

Prescription Drug Drop-Off Boxes Spread Across U.S.
Paulina Firozi, USA Today
July 11, 2014

This article discusses growing use of prescription drug drop-off boxes at police stations across the country. In the past year, Pennsylvania installed 250 boxes and this month, four precincts in Staten Island, New York, also received drop-off boxes. Four years ago, the National Association of Drug Diversion Investigators started providing grants to police departments to pay for the boxes. It has funded 100 boxes annually.

Read more:

A Growing Number of Veterans Struggle to Quit Powerful Painkillers
Quil Lawrence, National Public Radio
July 10, 2014

This article and audio (7:33 minutes) discuss military troops and veterans who struggle with prescription drug addiction. A National Public Radio reporter talks with Bryan McDonel who was honorably discharged after testing positive for morphine. While serving his second tour in Iraq, he injured his back and underwent surgery. McDonel was prescribed six Vicodin per day. When he got home, his doctor kept him on opiates. During his third tour in Iraq, McDonel went to a medic who informed him he was experiencing Vicodin withdrawal. The medic put him on Percocet.

Read more:

Veterans Kick the Prescription Pill Habit, Against Doctors' Orders
Quil Lawrence, National Public Radio
July 11, 2014

This article and video (8:27 minutes) discuss service members who stop using drugs prescribed for their injuries. Leo Kalberg was taking more than 20 pills a day. He realized he was addicted to Percocet because he felt like a "zombie" and became nervous if he only had a few pills left.

Read more:

Other State and Local News

Law Contributes to Prescription Drug Abuse, Some Say
Rick Amburgey, Herald-Citizen
July 12, 2014

The Tennessee Intractable Pain Treatment Act gave patients who suffer from chronic pain a Patient's Bill of Rights, which "guarantees access to long-term opioids as a first-line treatment of chronic pain." The Act's critics say it led to prescription opioid misuse and abuse. Representative Ryan Williams sponsored a bill in the house that would have deleted the Act (which also regulates pain clinics) in its entirety, but the bill died in the state senate.

Read more:

First Woman Charged on Controversial Law that Criminalizes Drug Use During Pregnancy
Gillian Mohney, ABC News
July 13, 2014

This article and video (43 seconds) discuss the arrest of a Tennessee woman—the first to be charged under a new state law that makes it a crime to take drugs while pregnant. Mallory Loyola was arrested after she and her newborn infant tested positive for methamphetamines.

The law allows a woman to be "prosecuted for assault for the illegal use of a narcotic drug while pregnant" if her infant is harmed or addicted to the drug. The American Civil Liberties Union of Tennessee is actively seeking to challenge the law, which they describe as raising "serious constitutional concerns regarding equal treatment under the law."

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After First Year, Drug-Monitoring Program Needs New Funds to Stay Alive
Nick Watson, Gainesville Times
July 12, 2014

Georgia received a $400,000 grant to implement its Prescription Drug Monitoring Program that went live in May 2013. Rick Allen of the Georgia Drugs and Narcotics Agency said new funding needs to be secured to continue the program.

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Prescription Drug Database May Get Tougher Restrictions
Dara Kam, News-press.com
July 15, 2014

This article discusses health officials' efforts to tighten security on Florida's prescription monitoring program database. In the next month, the Department of Health expects to publish a draft rule laying out terms and conditions for law enforcement and investigative agencies. The evolving draft would require training before being able to access the database, prohibit officials who have database access from making queries on someone else's behalf, and force those who gain access to the records to document when they submit the data to criminal justice agencies. The draft also outlines a process for disqualifying people who improperly handle prescription drug information in the database.

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Life Lessons: Pregnant & Addicted to Drugs
Nancy Werteen, WFMZ
July 14, 2014

This article and video (2:28 minutes) discuss babies born addicted to drugs, including prescription medications. The reporter talks to a mother who was using Dilaudid. She tried rehabilitation at a methadone clinic, but became pregnant and lost her baby. She entered Vanderbilt's Drug Dependency Clinic for pregnant women and started on buprenorphine 2 years ago. This year, she had a healthy baby girl.

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Experts, Officials Discuss How to Show Consequences of Drugged Driving
Lauren Gibbons, The Columbus Dispatch
July 12, 2014

Ohio and national experts and officials recently met to discuss drugs and driving. Michael Botticelli, acting director of the Office of National Drug Control Policy, reported that drugged driving is a growing problem locally and nationally. Common drugs used while driving include marijuana and prescription medications. The Ohio Department of Public Safety released a toxicology report that showed 9,018 of 10,378 people arrested on suspicion of driving under the influence in 2013 tested positive. Most arrests resulted from serious or fatal crashes.

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Indianapolis Leads Nation in Pharmacy Robberies
Jack Rinehart, RTV6
July 16, 2014

This article and video (3 minutes) reports that Indiana led the nation in pharmacy robberies for the third consecutive year. In 2012, the state had 97 drug store robberies.

Read more:

Use Caution When Taking Prescription Medications
Heidi Traylor, Idaho Tribune
July 15, 2014

This article discusses prescription drug abuse and overdose deaths in the United States. Terry Reilly Health Services provides tips for safely taking prescription pain relievers.

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New Hampshire Ranks No. 3 in Prescriptions for Certain Types of Painkillers, CDC Finds
Casey McDermott, Concord Monitor
July 16, 2014

According to a report released a few months ago by the Centers for Disease Control and Prevention, New Hampshire ranked 39th in the country in 2012 for per capita prescriptions of opioid pain relievers, but had the third-highest prescribing rate for long-acting and extended-release opioid pain relievers. The state ranked seventh for per capita prescriptions of high-dose opioid pain relievers. This report recommends that states expand use of prescription drug monitoring programs and take steps to connect more people with substance abuse treatment programs.

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Other Resources

CADCA to Unveil New Products to Help Address Prescription Drug Abuse at Mid-Year Training Institute
Community Anti-Drug Coalitions of America
July 11, 2014

The Community Anti-Drug Coalitions of America (CADCA) launched a new Prevent Prescription Drug Abuse Toolkit at its 2014 Mid-Year Training Institute to help community leaders prevent and reduce prescription and over-the-counter medicine abuse. This comprehensive toolkit includes fact sheets, success stories highlighting communities that have reduced prescription drug abuse, how to conduct a community assessment on Rx abuse, a sample Rx abuse prevention logic model, sample Rx abuse prevention intervention maps, a National Medicine Abuse Awareness Month Grassroots Media Kit, PowerPoint presentations for use at community meetings, video case studies, and other shareable tools. CADCA also released a new OTC Literacy Utility Guide to equip teachers, youth, and parents with information on safe use and proper storage of over-the-counter medicines.

Read more:

The Partnership for Drug-Free Kids Launches New Prescriber Education Campaign
The Wall Street Journal
July 15, 2014

The Partnership for Drug-Free Kids announced the new "Search and Rescue" campaign, which raises awareness about prescription drug abuse among healthcare professionals and encourages them to use basic assessment tools. Rhode Island and Maryland were selected as pilot markets for the campaign. A series of e-newsletters and banner ads will drive prescribers to a state-specific Search and Rescue website. Each state will provide a full Search and Rescue Action Kit on its website with easy-to-use tools to help prescribers identify prescription drug misuse and addiction. The state Web pages will include short introductory videos featuring a key peer leader from the state, educational information, and links to other tools.

Read more:


VIDEO: The Impact of Prescription Drugs on Mission Viejo Teens
Penny Arevalo, Mission Viejo Patch
July 17, 2014

Mission Viejo Television has developed a four-part series, "An Invisible Line: Teen Drug Abuse in Our Community," about prescription drug abuse among children. In Part 1: These Are Not Statistics, viewers learn the stark dangers of prescription drugs, the ages of experimentation for youth, and the potential warning signs for parents. The show features in-depth interviews with local physicians, law enforcement, a rehabilitation center director, a pharmacist, and parents of addicts. (Duration: 59:29)


Grants Awarded

DEQ Awards $4.3 Million in Waste Reduction and Recycling Grants
Nebraska Department of Environmental Quality
July 8, 2014

Grants totaling $4,296,581 have been awarded through the Waste Reduction and Recycling Incentive Grant Fund. The fund is generated by a fee on solid waste disposed of in landfills, an annual retail business sales fee, and a fee assessed on the sale of new tires for motor vehicles. The Nebraska Pharmacists Association was awarded $120,505 to help 500 pharmacies legally collect and properly dispose of unwanted prescription medications.

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MetroHealth Gets $74K Grant to Stem Prescription Drug Abuse
July 17, 2014

MetroHealth received a $74,000 grant from the Ohio State Board of Pharmacy to reduce prescription drug abuse and implement its NARxCHECK program. MetroHealth is one of the state's first hospitals to integrate Ohio Automated Rx Reporting System information in its electronic health records, saving physicians time and reducing prescription drug abuse.

Read more:

Drug Free Coalition Awards Mini-Grants
Bob Cox, Journal Review
July 17, 2014

Ten Indiana organizations received mini-grants from the Montgomery County Drug-Free Coalition to address prescription drug misuse and illegal use of drugs among adults and youth.

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Request for Proposal

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

Take-Back Events and Drop Boxes

Frederick County Drop-Off Boxes Collect 600 Pounds of Prescription Drugs in 6 Months
Amanda Hancock, NBC Washington
July 14, 2014

Four Prescription Drug Drop Boxes Available in Frederick County
Dawn White, WHAG (Maryland)
July 16, 2014

Yellow Jug Old Drug Program Expands to Indiana
State of Indiana, Attorney General's Office
July 14, 2014

Grayslake Offers Prescription Medication Disposal
Sheryl DeVore, Chicago Tribune
July 10, 2014

County Gets New Permanent Prescription Medication Return Boxes
Adam Clayton, Columbia-Greene Media (New York)
July 11, 2014

Norwalk Police Install New Prescription Drug Drop Box
The Hour (Connecticut)
July 12, 2014

Sheriff's Office Sets Up Drop Box for Unwanted Meds
John Richmeier, Leavenworth Times (Kansas)
July 11, 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

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

2014 Arkansas Prescription Drug Abuse Summit
University of Arkansas, Criminal Justice Institute
September 10, 2014
Statehouse Convention Center
426 W. Markham Street
Little Rock, Arkansas

Through partnerships with educational, medical, and prevention and treatment entities, this summit aims to raise public awareness of the prescription drug abuse epidemic and help reduce addiction and deaths.

Read more:

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.