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July 24, 2013

SAMHSA Prevention of Prescription Drug Abuse in the Workplace Listserv

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Featured Article 
D.C. McDonald and K.E. Carlson. 2013. "Estimating the Prevalence of Opioid Diversion by 'Doctor Shoppers' in the United States." PLoS ONE 8(7):e69241.

Abuse of prescription opioid analgesics is a serious threat to public health, resulting in rising numbers of overdose deaths and admissions to emergency departments and treatment facilities. Doctor shoppers can obtain multiple opioid prescriptions for nonmedical use from different, unknowing physicians. This study estimates the prevalence of doctor shopping in the United States in 2008 and the amounts and types of opioids involved. The sample included IMS Health's Prescription LRx data for 146.1 million opioid prescriptions dispensed in 2008 by 76 percent of U.S. retail pharmacies. Prescriptions were linked to unique patients and weighted to estimate all prescriptions and patients in the nation. Finite mixture models were used to estimate different latent patient populations with different patterns of using prescribers. On average, patients in the extreme outlying population (0.7 percent of purchasers), presumed to be doctor shoppers, obtained 32 opioid prescriptions from 10 different prescribers. They bought 1.9 percent of all opioid prescriptions, constituting 4 percent of weighed amounts dispensed. Very few of these patients can be classified with certainty as diverting drugs for nonmedical purposes; however, even patients with legitimate medical need for opioids who use large numbers of prescribers may signal dangerously uncoordinated care.

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Journal Articles

A. Huffman. 2013. "Controlling Opioid Abuse in the Emergency Department: Legitimate Public Policy or 'Legislative Medicine?'" Annals of Emergency Medicine 61(6):A13-A15.

This paper discusses prescription drug abuse in emergency departments throughout the United States and how hospitals are dealing with patients seeking prescription medications to support their habits. Better monitoring is needed throughout the country, but some healthcare officials are convinced more rigorous restrictions are necessary for those who try to circumvent the monitoring program.

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M.H. Swahn. 2013. "Commentary on Acion et al. (2013): Alcohol and Drug Use Among Children from Deployed Military Families in the United States--An Important and Growing Health Disparity." Addiction 108(8):1426-27. doi:10.1111/add.12222.

Military-connected youth have substantially higher levels of substance use than other youth for a number of reasons and, as such, should be considered an important health disparity. Unfortunately, lack of action to address this issue more deliberately raises important questions about capacity, commitment, and willingness to provide the support services that many of these children need and deserve. Increased substance use among children in military families appears to be troubling, in particular because substance use may exacerbate many other issues these children and youth are facing. Findings from Acion and colleagues on the increased risk of alcohol and drug use among children from deployed families clearly demonstrate higher levels of current alcohol use, heavy alcohol use, current marijuana use, current illegal drug use, and current prescription drug misuse among children in deployed families versus children in other families. This issue is particularly troubling given that the United States has seen a substantial increase in deployed military personnel in recent years and a corresponding increase in the number of children who have had their parents deployed.

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B.K. Larson, M.E. Eisenberg, and M.D. Resnick. 2013. "Engagement in Risk Behaviors Among Adolescents Who Misuse Prescription Drugs: Evidence for Subgroups of Misusers." Journal of Substance Use. doi:10.3109/14659891.2013.810308.

This study examined whether there is variation in selected risk behavior engagement (multiple sexual partners, binge drinking, vandalism, self-harm, and suicide ideation) among groups of high school students who report misusing prescription drugs. Data were taken from the Minnesota Student Survey. Participants (n=64,997) were categorized into four groups: non-drug users who misused neither prescription drugs nor illicit drugs other than alcohol; prescription-only users; prescription and marijuana users; and prescription and other illicit drug users. Eight percent reported prescription misuse. Among misusers, 92 percent also used illicit drugs, including 75 percent who used illicit drugs other than marijuana. Risk behavior engagement was compared across groups using general linear modeling. Consistent with studies of multiproblem youth, self-reports of externalizing risk behaviors (number of sexual partners, binge drinking, vandalism) were significantly higher for prescription misusers than non-drug users, higher still for those who also used marijuana, and highest for those who also used other illicit drugs. Internalizing risk behaviors (self-harm and suicidal ideation) were significantly higher among prescription drug misusers and rose a modest amount more for those who also used illicit drugs other than marijuana. Contrary to a statement in the article's abstract, patterns are similar by gender.

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B. St. Marie. 2013. "Coexisting Addiction and Pain in People Receiving Methadone for Addiction." Western Journal of Nursing Research. doi:10.1177/0193945913495315.

This qualitative study examined narratives of 34 people who experienced chronic pain over 6 months or more and received methadone through a major methadone clinic to treat opiate addiction. The paper features the pathway of how participants developed chronic pain and addiction, as well as their beliefs about how prescription opioids would impact their addiction in the future. Findings cover three topics: 1) whether participants experienced addiction or pain first and how their exposure to addictive substances influenced their experiences, 2) the significance of recreational drug use and patterns of abuse behaviors leading to chronic pain, and 3) participants' experiences and beliefs about the potential for abuse of prescription opioids used for pain treatment.

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News and Reports 
America's Full-Blown Painkiller Epidemic Detailed in Two Minutes 
Business Insider
July 17, 2013

As of May 2012, Americans consumed 80 percent of the world's pain relievers. Abuse of these drugs now kills more U.S. citizens than heroin and cocaine combined. This article includes a video infographic on teen prescription drug use, a breakdown of prescription pain relievers sold by state, and state overdose rates.

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Inside Doctors' Prescribing Habits
Los Angeles Times
July 16, 2013

Why does so much secrecy shroud the prescribing habits of doctors? Senior reporters at ProPublica met resistance before obtaining a list of drugs prescribed by health professionals to enrollees in Medicare's prescription drug program. They found hundreds of physicians throughout the country were prescribing large numbers of dangerous, inappropriate, or unnecessary drugs. Their findings are available in an online database that allows anyone to look up a doctor's prescribing patterns and see how they compare with those of other doctors.

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Friends of NIDA Briefing Offers Insight on Prescription Drug Abuse
Community Anti-Drug Coalitions of America
July 11, 2013

Dr. Nora Volkow spoke at a recent Friends of the National Institute on Drug Abuse (NIDA) briefing on Capitol Hill, calling prescription drug abuse the "most challenging" substance use disorder facing the United States. "We need to recognize that prescription medications, when used appropriately, can be lifesaving in and of themselves," she said, adding that at the same time we can't ignore thousands of people are abusing prescription medicines and dying due to overdoses. According to NIDA, 201.9 million prescriptions were filled for opioid medicines in 2011, including 6 million for people ages 10-19. Dr. Volkow said the solution is a multifaceted, multipronged approach that should include developing prescription painkillers that are less addictive, educating healthcare providers about proper prescribing practices, and creating easy ways to administer Naloxone. Amy Haskins, Project Director of the Jackson County Anti-Drug Coalition in West Virginia, also spoke about her program's efforts to curb prescription drug abuse.

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Addiction Should Be Treated as Public Health Issue: Kerlikowske
The Partnership at Drugfree.org
July 19, 2013

Addiction is a brain disease and should not be treated as a moral failure, said National Drug Control Policy Director R. Gil Kerlikowske at a conference on prescription drug abuse. He reported a decrease in the number of people abusing prescription drugs, from 7 million in 2010 to 6.1 million.

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Anything for an 'A': The Adderall Epidemic
July 16, 2013

According to a recent study in the Addiction Journal, one in four college students admits to taking attention deficit hyperactivity disorder pills to study. Dr. Ralph Manchester of the University of Rochester and Sara Ormsby, an addiction therapist at Unity Health, say it is going to take a lot of education on the part of universities and parents to curb Adderall abuse. At local universities, punishment for students caught buying or selling prescription pills can range from mandatory drug counseling programs to outright expulsion.

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Abuse-Deterrent Formulations of Purdue's OxyContin and Endo Pharmaceuticals' Opana ER Have Not Increased PCPs' Comfort When Prescribing These Products for Chronic Pain
July 16, 2013

Despite the replacement of Purdue Pharma's OxyContin and Endo Pharmaceuticals' Opana ER with abuse-deterrent formulations, surveyed primary care physicians do not feel more comfortable prescribing these products for the treatment of chronic pain, according to Decision Resources. However, the majority of surveyed pain specialists report they are more comfortable prescribing OxyContin and Opana ER now that the products feature abuse-deterrent properties.

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AMA Pain Management Program Aims to Strike a Balance
Medscape Today
July 11, 2013

The American Medical Association announced a new pain management continuing medical education program that attempts to strike a balance between appropriate pain management and prescription drug abuse prevention. The series comprises 12 modules addressing clinically important aspects of pain management, including pain mechanisms and assessment, management options, and management of cancer and persistent noncancer pain. Some modules focus on specific populations, disorders, and conditions.

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Government, Industry Warn Private Pilots About Prescription Drugs
Aviation Today
July 19, 2013

The Federal Aviation Administration (FAA) joined 11 aviation groups in sending a heightened warning to general aviation pilots regarding side effects from certain prescription medications that could affect their performance. Specifically, FAA wants pilots to be more aware of prescribed medicines and non-prescription drugs containing antihistamines. According to the letter, about 12 percent of fatal general aviation accidents over the past decade involved pilots who had taken medication that is currently prohibited by FAA.

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Pilots Hide Prescription Drug Use, Create Deadly Trend
News 9.com
July 15, 2013

A review of plane crashes in Oklahoma revealed that pilots are taking drugs that go unreported to the Federal Aviation Administration until it's too late. A small plane crashed on April 28, 2008, near Miami, killing the pilot. Over the next 3 years, a series of small plane crashes killed 10 more people in Oklahoma. Autopsy reports show all of the pilots had prescription drugs in their systems when they crashed--many of them narcotic pain relievers and drugs with warnings about operating heavy machinery. Crash scene investigation reports show pilot drug use may have been a contributing factor in six of 15 Oklahoma crashes between 2008 and 2010.

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Other State and Local News

AIA Testifies in Support of D.C. Prescription Drug Monitoring Program Bill
American Insurance Association
July 12, 2013

This news release discusses the testimony of Eric M. Goldberg, Mid-Atlantic region vice president for the American Insurance Association (AIA), supporting B20-127, the "Prescription Drug Monitoring Program Act of 2013." AIA writes approximately one third of the nation's workers' compensation coverage. The organization supports the bill as a means to help curb abuse. Currently, D.C. does not have a functional prescription drug monitoring program.

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Nearly 200K Pills Left in Police Drug Drop Boxes
Central Kentucky News
July 12, 2013

In 2 years, Clark County, Kentucky, has collected nearly 200,000 items in its drug disposal collection boxes located at the Winchester Police Department and Clack County Sheriff's Office. Though most are nonscheduled items, 18,000 are scheduled.

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'Doctor Shopping' Is a 'Daily Problem'
New Hampshire Union Leader
July 13, 2013

The director of the emergency and emergency medical services departments at St. Joseph Hospital in Nashua says doctor shopping is a daily problem that affects his ability to provide care to other patients. Some doctors ask a series of questions to determine whether patients are lying about their conditions. If that doesn't stop them, patients might photocopy prescriptions and visit multiple pharmacies. Others make their own prescriptions using computer programs. Doctor shopping is a Class B felony in New Hampshire and carries a sentence of 3.5 to 7 years in prison and up to a $4,000 fine. In 2012, New Hampshire passed a law to create a prescription drug monitoring program so doctors and pharmacists could see whether a patient has been prescription shopping. The state's Board of Pharmacy said the program won't be ready until June 2014.

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Warrenbrook Senior Center in Warren Hosts Medicine Disposal Program
Independent Press
July 13, 2013

The Somerset County Department of Human Services, Somerset County Sheriff's Office, EMPOWER Somerset and Safe Communities Coalition, and Office on Aging and Disability Services held a medication disposal program at the Warrenbrook Senior Center in New Jersey, collecting expired and unused prescription drugs. The sheriff's office is planning quarterly events and inviting the public to drop off its medications as well.

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New FirstHealth Policy Outlines Emergency Department Protocols for Prescription Medications
The Pilot
July 11, 2013

Three FirstHealth Hospitals in North Carolina adopted a new policy on emergency department administration of narcotic and sedative medications. The policy establishes guidelines to be followed by Moore Regional Hospital, Richmond Memorial Hospital, and Montgomery Memorial Hospital personnel when a patient claims to be in acute pain but has no evidence of an emergency medical condition. These patients will no longer be treated with Schedule II, III, or IV drugs. Patients seeking pain relief will be designated as having a "chronic pain syndrome" if they have visited an emergency department more than twice in a 30-day period or more than six times in a year. They will be encouraged to follow up with their primary care provider.

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Bitter Pills Series: Fort Bragg Spc. Stephen Currier Puts Face on Growing Prescription Drug Problem
The Fayetteville Observer
July 14, 2013

Two and a half years after a soldier's bullet wounded Fort Bragg Specialist Stephen Currier, he died from an accidental overdose of prescription pain relievers. Three days before his death, Fort Bragg doctors wrote him a prescription for 240 Percocet pills. Prescription pain relievers have soared at North Carolina's Fort Bragg. Last year alone, more than 18,000 soldiers received a total of 46,870 opiate pain reliever prescriptions from Womack Army Medical Center.

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Bitter Pills Series: Prescription Oversight Lax as Overdoses Tick Up
The Fayetteville Observer
July 15, 2013

Ann Butler was in prison on charges of prescription fraud. Six days after her release, she overdosed on prescription pain pills and died. Investigative records from the Moore County Sheriff's Office show Butler had been doctor shopping for more than a year. Some police, drug abuse counselors, and medical providers say they see certain clinics as evidence of a wider problem: there are few repercussions for prescribers whose patients exhibit signs of addiction, sell their drugs on the street, or overdose from them. According to the Drug Enforcement Administration, more oxycodone is sold in the Fayetteville area than anywhere else in North Carolina.
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Bitter Pills Series: Addiction to Pain Medications a Growing Problem Among Fayetteville Teens
The Fayetteville Observer
July 16, 2013

Prescription drug misuse is the fastest-growing cause of teen death in North Carolina, according to a 2013 report published by the N.C. Child Fatality Task Force. Angela Koskosky is a resident who became addicted to prescription pills at a young age. She was 14 when she first took Vicodin after a dentist pulled one of her molars; at 20, she was snorting and injecting prescription pain relievers. Today, Koskosky works with recovering addicts and has not been high in 3 years.

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Duxbury Police Station Site for Prescription Pill Disposal
Wicked Local Duxbury
July 13, 2013

Massachusetts' Duxbury Police Department and the Duxbury Board of Health announced it has a prescription drug drop box at the Duxbury Police headquarters. Residents can drop off medications 24 hours a day, 7 days a week.

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911 Good Samaritan Recommendations: Analysis and Recommendations for Reducing Drug-Related Overdoses in Wisconsin
Wisconsin State Council on Alcohol and Other Drug Abuse
May 2013

This report details research findings and recommendations of the 911 Good Samaritan Ad Hoc Committee. The recommendations are grouped into four broad categories: 911 Good Samaritan Legislation Recommendations, Naloxone Recommendations, Data Recommendations, and Additional Recommendations, and are designed to assist legislators in drafting a 911 Good Samaritan Law that addresses the needs of Wisconsin residents.

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Attorneys General in Nebraska and Oklahoma Call on Google to Remove 'No Prescription Required' Ads from YouTube
National Association of Boards of Pharmacy
July 17, 2013

Two attorneys general are calling on Google to remove video ads from YouTube that promote rogue Internet sites marketing medications, including controlled substances, as "no prescription required" products. Nebraska Attorney General Jon Brunning and Oklahoma Attorney General Scott Pruitt wrote to Google, noting several state attorneys general have expressed their concern about ads promoting illegal medications and counterfeit products. Google profits from these ads, they wrote.

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Newly Born and Withdrawing from Drugs: As Number of Maine Babies Exposed to Opiates Rises, Experts Explore New Options
Bangor Daily News
July 16, 2013

In 2012, 779 babies were born "drug affected" in Maine, according to the Department of Health and Human Services. A few years ago, experts were just trying to keep up with the problem, but today, research in the Bangor area is fueling innovative thinking about how to best treat drug-affected babies, including whether they belong in hospitals for long periods of time.

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Other Resources

The Partnership at Drugfree.org and 'Listen To Your Mother' Team Up to End Teen Medicine Abuse
The Partnership at Drugfree.org
July 10, 2013

The Medicine Abuse Project has teamed up with Listen To Your Mother--a national series of live readings from women to raise awareness about teen prescription drug abuse. These women will take the stage and share personal essays in front of live audiences beginning September 10.

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FDA to CNN: Many Online Pharmacies Selling Fake Medicine
July 1, 2013

Food and Drug Administration Commissioner Dr. Margaret Hamburg joins CNN's Dr. Sanjay Gupta to talk about an online pharmacy counterfeit crackdown. (Video duration: 6:46 minutes)


Grant Announcement

Cooperative Agreements for Electronic Health Record (EHR) and Prescription Drug Monitoring Program (PDMP) Data Integration
Deadline: July 24, 2013
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Save the Date
DEA's National Take-Back Initiative
October 26, 2013
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

Harold Rogers Prescription Drug Monitoring Program National Meeting
September 25-27, 2013
Washington, District of Columbia

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
Please e-mail Rekaya Gibson at rgibson@pire.org with questions or comments about the SAMHSA Prevention of Prescription Drug Abuse in the Workplace Listserv.  
About PAW and the Listserv
The PAW TA Center addresses prescription drug abuse--a growing public health problem with increasing burdens on workers, workplaces, and our economy. Prescription drug abuse affects workplace productivity and increases employee absenteeism, employee presenteeism, and workers' compensation claims. On a wider scale, overdose deaths linked to prescription opioids tripled from 1999 to 2006, and prescription drug abuse killed more Americans in 2009 than died that year in auto crashes.
Send your request for PAW technical assistance to PAW-TA@pire.org or contact Rekaya Gibson at 504.261.8107 or Deborah Galvin at 240.276.2721. Requests are subject to SAMHSA approval. You will be notified of the status of your request.
We aim to conduct systematic and inclusive searches of professional journals, leading newspapers and magazines, and federal websites, as well as contributions from listserv subscribers (please e-mail suggestions to rgibson@pire.org). We will send links to articles along with brief descriptions of those articles. As we develop the listserv, however, we hope to add commentary and invite feedback from subscribers. Our goal is to expand the listserv to become a widely used and recognized source of the most current and authoritative information on prescription drug abuse--especially in workplaces.

The "SAMHSA Prevention of Prescription Drug Abuse in the Workplace Listserv" is a service provided by the SAMHSA Preventing Prescription Abuse in the Workplace Technical Assistance Center (PAW) to keep the field abreast of recent news and journal articles to assist in forming policy, research, and programs to reduce prescription drug misuse or abuse. Please note, the materials listed are not reflective of SAMHSA's or PAW's viewpoints or opinions and are not assessed for validity, reliability, or quality. The "SAMHSA Prevention of Prescription Drug Abuse in the Workplace Listserv" should not be considered an endorsement of the findings. Readers are cautioned not to act on the results of single studies, but rather to seek bodies of evidence. Copyright considerations prevent PAW from providing full-text journal articles.
The Injury Control Research Center at West Virginia University (WVU-ICRC) archives past Listserv issues at http://www.hsc.wvu.edu/icrc/Pages/SAMHSA-Prevention-of-Prescription-Drug-Abuse-in-th. The partnership efforts of WVU-ICRC are supported by Grant Number 1 R49 CE002109 from the Centers for Disease Control and Prevention (CDC). The contents of the Listserv archive are solely the responsibility of the authors and do not represent the official views of CDC or SAMHSA.

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