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July 26, 2013

SAMHSA Prevention of Prescription Drug Abuse in the Workplace Listserv

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June 26, 2013 (PDF version)
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Ameritox National Prescription Drug Report: A Review of Medication Monitoring Results of People in Chronic Pain
A new report by Ameritox revealed that more than one third (35.9 percent) of samples collected from patients prescribed opioid medications for chronic pain management last year did not contain their prescribed drug--an increase from the 31 percent found in similar research released in October 2010. The samples used in the 2012 report came from approximately 527,000 individual patients from all 50 states. Nearly one third (32.3 percent) of the tests also detected substances not prescribed by the attending physician--an increase from the 29 percent found in 2010. In both surveys, 11 percent of all samples contained an illicit drug, primarily marijuana. A significant number of tests also found cocaine.
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Journal Articles
C. Advokat and M. Scheithauer. 2013. "Attention-Deficit Hyperactivity Disorder (ADHD) Stimulant Medications as Cognitive Enhancers." Frontiers in Neuropharmacology. doi:10.3389/fnins.2013.00082.
Numerous studies have found little or no benefit of stimulants on neuropsychological tests of ADHD-diagnosed and normal individuals. This paper examines the apparent paradox: Why don't drugs that improve "attention" produce better academic outcomes in ADHD-diagnosed students? Stimulant drugs significantly reduce impairment of episodic memory in ADHD-diagnosed undergraduate students. Nevertheless, academic deficits between ADHD students and their non-ADHD counterparts are unaffected when students use stimulant medications. The authors reviewed the current literature on the behavioral effects of stimulants, seeking an explanation for these conflicting phenomena. Across a variety of behavioral tasks, stimulants have been shown to reduce emotional reactions to frustration, improve the ability to detect errors, and increase effortful behavior. These effects would presumably enhance academic performance. However, the drugs also promote "risky behavior" and increase susceptibility to environmental distraction. Such negative effects, including use of drugs to promote wakefulness for last-minute study, might explain the lack of academic benefit in the "real world" despite their cognitive potential. Like many drugs, stimulants influence behavior in multiple ways, depending on the environmental contingencies.
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N.E. Hagemeier, J.A. Gray, and R.P. Pack. 2013. "Prescription Drug Abuse: A Comparison of Prescriber and Pharmacist Perspectives." Substance Use & Misuse 48(9):783-90. doi:10.3109/10826084.2013.787101.
This study compared perceptions of prescribers and pharmacists (N=89) regarding multiple aspects of prescription drug abuse. In 2012, researchers collected data from rural Appalachia using prescriber- and pharmacist-specific survey instruments. Questions assessed perceived prevalence of prescription drug abuse, self-perceived communication competence, and additional communication and prescription drug abuse domains. Pharmacists perceived a larger percentage of patients (41 percent) as abusing opioid pain relievers than their prescriber colleagues perceived (17 percent). Both prescribers and pharmacists indicated that improvements in prescriber-pharmacist communication would serve to deter prescription drug abuse. Self-efficacy beliefs for detecting and discussing prescription drug abuse with patients were low for both cohorts.
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P.L. Ross-Durow, S.E. McCabe, and C.J. Boyd. 2013. "Adolescents' Access to Their Own Prescription Medications in the Home." Journal of Adolescent Health. doi:10.1016/j.jadohealth.2013.02.012.
Researchers conducted semistructured interviews with a cohort of 501 adolescents from two southeastern Michigan school districts. Participants were asked what medications had been prescribed to them during the previous 6 months. If they had received prescription medications, they were asked in-depth questions about them, including how medications were stored and supervised at home. The sample comprised adolescents in the 8th and 9th grades. Participants were primarily white (72.9 percent) or African American (21.6 percent). Slightly less than half of the adolescents (45.9 percent) reported having been prescribed medications in the previous 6 months. Of this group, 14.3 percent had been prescribed pain medications, 9.6 percent stimulants, 1.7 percent antianxiety medications, and 0.9 percent sedatives. Of 57 adolescents prescribed medications in the pain, stimulant, antianxiety, or sedative categories, 73.7 percent reported they had unsupervised access to the medications at home. The authors suggest clinicians need to educate parents and patients about the importance of proper storage and disposal of medications, particularly those with abuse potential.
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D.P. Wermeling. 2013. "A Response to the Opioid Overdose Epidemic: Naloxone Nasal Spray." Drug Delivery and Translational Research 3(1):63-74.
Medical and public health agencies are adopting opioid harm reduction strategies to reduce morbidity and mortality associated with overdose. One strategy developed by emergency medical services and public health agencies is to deliver the opioid antidote naloxone injection intranasally. Paramedics have used this route to quickly administer naloxone in a needle-free system, thus avoiding needle-stick injuries and reducing their risk of contracting a bloodborne pathogen disease such as hepatitis or human immunodeficiency virus. Public health officials advocate broader lay person access since civilians are likely to be witnesses or first responders to an opioid overdose in a time-acute setting. The barrier to greater use of naloxone is that a suitable and optimized needle-free drug delivery system is unavailable. The scientific basis for the design and study of an intranasal naloxone product is described. Lessons from nasal delivery of opioid analgesics are applied to the consideration of naloxone nasal spray.
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News and Reports
Gazette Opinion: Too Many Pills; Montana Must Stop Painkiller Abuse
Billings Gazette
June 16, 2013
In one month, Montana added 240,000 pain reliever prescriptions to the prescription drug registry. All Montana pharmacies, including mail order pharmacies shipping to the state, are required to report controlled substance prescriptions. Though participation is voluntary for the 700 prescribers, less than 17 percent are using it, according to the Montana Board of Pharmacy. The editorial staff suggests that Montana should do more to encourage prescribers to use the registry; provide more training to healthcare providers on the appropriate use of pain relievers; and educate all Montanans about the problems of prescription drug abuse. The Board of Pharmacy is working on improving the registry by increasing awareness, allowing the ability for providers to delegate authority to staff to search the registry, and sharing registry information across state lines. The 2013 Montana Legislature called for a study of prescription drug abuse. The editorial staff would like to see lawmakers give this assignment high priority.
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State Considers Tighter Controls on Popular Prescription Painkillers Like Vicodin
The Oregonian
June 14, 2013
The Oregon Narcotics Enforcement Association submitted a proposal to the Oregon Board of Pharmacy that would make it more difficult to obtain prescription pain relievers without presenting an original prescription in person. The association wants hydrocodone compounds moved from the Schedule III list of drugs to Schedule II. No refills would be allowed without another written prescription. Tramadol would shift from a non-scheduled "legend" drug to either Schedule II or Schedule IV.
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Florida Department of Health to Enhance Privacy Safeguards and Accountability for Prescription Drug Monitoring Program Users
Florida Department of Health
June 19, 2013
The Florida Department of Health will hold a workshop on July 8, 2013, to develop rules related to access and security of patient information once released from the prescription drug monitoring database. The workshop aims to identify any existing gaps and to establish accountability standards for users of prescription drug monitoring program information. This will give the public an opportunity to provide input on ways to protect prescription information.
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Fighting Prescription Drug Abuse, One Log In At a Time
Rhode Island Public Radio
June 18, 2013
This article and audio (9:14 minutes) discuss Rhode Island's prescription drug monitoring program. Launched in October 2012, only 15 percent of physicians and other prescribers are registered to use it. A researcher with the Prescription Drug Monitoring Program Center for Excellence at Brandeis University says doctors must use the program in order for it to work. Other prescription drug monitoring best practices include good, timely data and automatic reports. Rhode Island officials said their next step is to get more doctors to use the system.
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Lawmakers Call for Clampdown on Prescription Drug Abuse
The Hill
June 14, 2013
This blog post discusses lawmakers' concerns about prescription drug abuse and the importance of prescription drugs for those who need them for chronic pain. Some lawmakers want the government to pursue more clinics that illegally distribute medication. They also want the administration to reclassify hydrocodone drugs from Schedule III to Schedule II. One legislator would like to see funding for the 46 state-run prescription drug monitoring programs.
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The Uneven Justice in Two Similar Drug Cases
The Wall Street Journal
June 14, 2013
This commentary discusses two similar drug cases with different outcomes. Walgreens received an $80 million fine for recordkeeping and dispensing violations for oxycodone, whereas a pharmacist in Greeneville, Tenn., was sentenced to 63 months in prison for illegally distributing oxycodone. He admitted to giving 20,000 oxycodone pills to five men.
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Purdue Pharma L.P. to Present Data Describing Changes in Oxycodone Abuse in Rural Kentucky Following the Introduction of Reformulated OxyContin® (Oxycodone HCI Controlled-Release) at the College on Problems of Drug Dependence 2013 Annual Meeting
PR Newswire
June 17, 2013
This press release discusses Purdue Pharma's presentation poster at the College on Problems of Drug Dependence annual meeting. The poster describes changes in abuse of OxyContin and immediate-release oxycodone in rural Kentucky following the August 2010 introduction of reformulated OxyContin. These data comprise 6-month follow-up interviews with a cohort of individuals who self-identified as original OxyContin abusers. Among 164 participants who completed the 6-month follow-up interviews, 76 percent selected original OxyContin as their preferred drug prior to reformulation. In contrast, 66 percent selected immediate-release oxycodone as their preferred drug after reformulation; only one participant selected reformulated OxyContin as his or her preferred drug. In follow-up interviews, 23 percent of participants reported attempting to manipulate reformulated OxyContin for purposes of abuse. From the initial interviews following reformulation to the 6-month follow-up, overall prevalence of original OxyContin abuse declined from 60 percent to 11 percent, and overall frequency of abuse among those who abused declined from 11.3 days per month to 3.3 days per month. During the same time period, prevalence of reformulated OxyContin abuse declined from 33 percent to 18 percent, while frequency among those who abused remained stable at 5.9 days per month vs. 5.7 days per month. Prevalence of immediate-release oxycodone abuse declined from 96 percent to 85 percent during this time, but frequency of abuse remained relatively constant.
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DUI Not Just About Alcohol, It's About Medications Too
NBC Latinos
June 17, 2013
Almost 10 million Americans drove while under the influence of some type of medication and/or drug, according to a 2010 survey conducted by the Substance Abuse and Mental Health Services Administration. Driving under the influence (DUI) laws generally include any drug that can impair a person's ability to safely operate a motor vehicle. Some states have a zero-tolerance policy in which an individual will be found guilty of a DUI  if a police officer finds evidence of any medication in the person's body. This article lists eight common medication types that could impair driving.
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Kentucky to Study Whether New Pain-Pill Laws Are Curbing Abuse
The Courier-Journal
June 15, 2013
This article and video (1:41 minutes) discuss Kentucky's plan to launch a 1-year study on its new prescription drug abuse laws. The University of Kentucky College of Pharmacy's Institute for Pharmaceutical Outcomes and Policy will conduct the research and develop recommendations for improvements. This study will measure changes in prescribing patterns, KASPER use, prescription drug-related deaths and emergency room visits, patient behavior, and the impact on drug treatment centers. Researchers will also survey doctors, dentists, and other prescribers and interview licensing boards. They will examine KASPER data, hospital discharges, deaths, and admissions to substance abuse treatment facilities. Research will include whether new drug laws have brought about unintended consequences for pain patients and others.
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Examining the Federal Government's Response to the Prescription Drug Abuse Crisis
U.S. Food and Drug Administration
June 14, 2013
Dr. Douglas C. Throckmorton, Deputy Director for Regulatory Programs at the Food and Drug Administration's Center for Drug Evaluation and Research, testified before the House Committee on Energy and Commerce Subcommittee on Health.
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Related Video
Prescription Drug Abuse
June 14, 2013
Officials testified before the House Committee on Energy and Commerce Subcommittee on Health on prescription drug abuse and prevention programs. They addressed the increases in prescription abuse rates over the past several years, availability of pain medications, and education programs. National Drug Policy Director Gil Kerlikowske told committee members that the United States had "turned a corner" in the fight against prescription drug abuse. (Duration: 1:53:34)
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Autopsy Finds Son of Wrestler Ric Flair Died From Overdose of Heroin and Prescription Drugs
The Washington Post
June 15, 2013
The Mecklenburg County, N.C., Medical Examiner reported that toxicology tests showed the 25-year-old son of professional wrestler Ric Flair died from a combination of heroin, clonazepam, and alprazolam. He was also a wrestler.
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Carteret County Sheriff's Office PSA--M.E.D.S.
Carteret County Sheriff's Office
June 3, 2013
In North Carolina, the Carteret County Sheriff and Carteret County Health Department encourage all residents to monitor their medications, educate friends and family about the dangers of prescription drug abuse, dispose of unused medications, and secure their medications in a safe location. This PSA is part of a new initiative called M.E.D.S.--Monitor, Educate, Dispose, and Secure. (0:31 seconds)
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Other Resources
Safe Opioid Prescribing
State of Rhode Island Department of Health
Accessed June 20, 2013
The Rhode Island Department of Health provides information on what healthcare professionals should do when prescribing opioid medications, and what patients should expect.
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Other Local News
HEALTH LINE: How to Properly Dispose of Prescription Drugs
Health Canal
June 20, 2013
The best way to dispose of medications is to use resources available through sanctioned government programs. Twice a year, the Drug Enforcement Administration holds take-back events nationwide so citizens can properly dispose of prescription medications. In Ohio, citizens have access to more than 50 prescription drug drop boxes at police stations, 24 hours a day, 7 days a week. Six of the drop boxes are located throughout Greater Cincinnati--one is on the University of Cincinnati's main campus. It is intended to be used by students, faculty, and staff. A list of drop box locations can be found on the Ohio attorney general's Web site.
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Koehn D. Clinic to Help Drug-Addicted Babies
June 18, 2013
All Children's Outpatient Care has opened a Neonatal Abstinence Syndrome Clinic in Sarasota, Florida. The free clinic provides a variety of services for addicted babies from birth to 24 months. Infant visits are scheduled at 3-month intervals. The clinic's physician hopes families will return at 1-year intervals up to age 5. In March, the Journal of Clinical Obstetrics and Gynecology described the clinic as a model that could be emulated throughout the country.
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Prescriptions with Deadly Consequences
New Jersey Herald
June 15, 2013
In 2012, Sussex County, N.J., had 19 drug overdoses--12 of which included prescription drugs. Thus far in 2013, two of the four drug overdose deaths involved prescription medications. The executive director of the Center for Prevention and Counseling first recognized the problem in 2008 when an annual youth survey indicated a sharp increase in the use of prescription drugs.
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Prescription Drug Disposal Drop-Box Set Up at RCSO
The Rockdale News
June 17, 2013
In Georgia, the Rockdale County Sheriff's Office and National Association of Drug Diversion Investigators will launch a year-round 2013 Rx Drug Drop Box program. A drop box will be located in the lobby of the Rockdale County Sheriff's Office administration building. Residents can dispose of prescription medications 24 hours a day, 7 days a week.
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Silent Addiction: Babies at Risk
The Journal Gazette
June 16, 2013
Experts say the number of babies born dependent on prescription narcotics has reached epidemic levels. Over the past decade, the Riley Neonatal Intensive Care Unit in Indiana saw a 3,900 percent increase in babies addicted to prescription narcotics. In 2001, doctors saw one case a year; by 2010, this had increased to one case a week. In Indiana, inflation-adjusted annual hospital charges for dependent babies increased from less than $2 million in 2002 to about $28 million in 2010. In Fort Wayne, Ind., a perinatologist at Women's Health Advantage said his group delivers at least one in 100 babies dependent on narcotics. Mothers are typically white and professionally employed.
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White Lake Police to Offer Prescription Drug Drop-Off Year Round
White Lake-Highland Patch
June 14, 2013
The White Lake Police Department in Michigan launched a permanent prescription drug drop-off program. Residents can access the location inside the police department 24 hours a day, 7 days a week.
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Focus Groups Work to Enhance Prevention Program
Las Cruces Sun-News
June 17, 2013
In New Mexico, the Unified Prevention! (UP!) Coalition for a Drug-Free Doña Ana County is conducting focus groups as part of the Partnerships for Success II grant requirements. It requires communities to address underage drinking among youth ages 12 to 20 and prescription drug misuse and abuse among youth and adults ages 12 to 25. The goal is to provide input for UP! and the state on how to enhance current prevention programs. UP! uses CADCA's Assessment Primer: Analyzing the Community, Identifying Problems and Setting Goals to conduct the focus groups.
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Grants Received
Connecticut Selected for National Initiative to Address Prescription Drug Abuse
June 18, 2013
The Connecticut Department of Public Health announced the state has been selected by the Association of State and Territorial Health Officials to participate in a national effort to address policy options and to decrease prescription drug misuse, abuse, and diversion. This initiative provides an opportunity for states to collaborate on strategies to improve health outcomes and reduce the human and economic costs associated with prescription drug abuse.
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Patrick Administration Announces $1.3M to Fight Opioid Abuse in MA
June 14, 2013
Massachusetts received $1.3 million in grant funding to create the Massachusetts Opioid Abuse Prevention Collaborative Program. It will distribute funding to 71 communities through a federal Substance Abuse Prevention and Treatment Block Grant. They will be responsible for implementing policy, practice, systems, and environmental changes at the local level to prevent abuse of opioids and reduce the number of hospitalizations and deaths associated with opioid poisonings.
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Drug Free NB Receives Grant to Fight Pharmaceutical Abuse
South Coast Today
June 21, 2013
The Massachusetts Department of Public Health approved the second phase of a Strategic Prevention Framework grant to the City of New Bedford's Pathways DrugFreeNB Coalition. The 3-year, $300,000 grant will support implementation of a program designed to help reduce nonmedical use of prescription drugs throughout the community.
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Medical Board: Funding Will Help Identify 'Pill Mills'
The Texas Tribune
June 20, 2013
The Texas Medical Board received an additional $600,000 from lawmakers to hire three investigators, an attorney, and an administrative assistant to inspect 380 pain clinic sites a year. It hopes to address the findings published in a recent state auditor's report. The June 13, 2013, report stated that the board should make improvements to ensure it registers pain management clinics in accordance with statutes, rules, polices, and procedures. The audit discovered the board had not verified ownership of 41 of 60 clinics reviewed by the auditors. In addition, the agency could not validate ownership for 22 of those clinics. As of January 31, 2013, 111 pain management clinics had expired certificates and the board had no information about the clinics' operation status.
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Health Officials Want Drug Makers to Pay for Safe Disposal
KING 5 News
June 20, 2013
This article and video (2:24 minutes) discuss Washington State's King County Board of Health proposal, which could force drug manufacturers to pay for safe disposal of unwanted prescription drugs. The Local Hazardous Waste Management Program would cost the county $280,000 to install 400 disposal boxes. Drug makers would be responsible for picking up the medicines and disposing of them. The Pharmaceutical Research and Manufacturers of America opposes such a program and is already suing Alameda County, Calif., for a similar plan. King County attorneys say the new program would be legal.
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Related News Release
Colin R. Council Encourages Creation of Prescription Drug Disposal Program
Seattle City Council
June 17, 2013
This news release discusses a resolution adopted by Seattle City Council to encourage the Seattle/King County Board of Health to establish a return program for prescription medications. The resolution asks that it be financed by drug makers to cover the cost of collection, transportation, and disposal of medications.
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Grant Announcements
Healthy Living Grant Program
Deadline: July 16, 2013
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Cooperative Agreements for Electronic Health Record (EHR) and Prescription Drug Monitoring Program (PDMP) Data Integration
Deadline Extended to July 24, 2013
The purpose of this program is to reduce prescription drug misuse and abuse by providing healthcare providers with access to PDMP data to make sound clinical decisions without disturbing their regular clinical workflow. SAMHSA expects grantees to 1) improve the quality of prescription drug information available to healthcare providers by integrating PDMP data into existing technologies, e.g., EHRs, Health Information Exchanges; and 2) support real-time access to prescription drug information by integrating PDMP data into existing clinical workflows. Grant funds will assist states in addressing prescription drug misuse and abuse strategies by integrating their PDMP data into EHRs and other Health Information Technology systems.
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Upcoming Conferences and Workshops
Pharmacy Diversion Awareness Conference
July 13 and 14: Portland, Oregon
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
Four Points by Sheraton
1201 K Street N.W.
Washington, District of Columbia
This meeting, sponsored by the Training and Technical Assistance Center at Brandeis University, will help government agencies and partnering organizations better understand prescription drug monitoring programs, their capabilities, interoperability, integration, and how people can use them to most efficiently address prescription drug abuse and diversion issues.
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2013 National Safety Council Congress and Expo
Congress: September 28-October 4, 2013
Expo: September 30-October 2, 2013
Chicago, Illinois
2013 American Association for Treatment of Opioid Dependence Conference
November 9-13, 2013
Philadelphia Marriott Downtown
1201 Market Street
Philadelphia, Pennsylvania
This conference will discuss the impact of healthcare reform on the delivery of MAT services and on individuals, families, and communities; identify and provide new critically important information to the field and evaluate its implications for patients, clinicians, administrators, and policymakers; facilitate integration of medication-assisted recovery into medical care delivery models; demonstrate techniques and highlight programs for improving clinical and program administration and patient outcomes; and promote and encourage the benefits of community and health care/wellness partnerships and collaborations.
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About PAW and the Listserv
The PAW TA Center addresses prescription drug abuse--a growing public health problem with increasing burdens on workers, workplaces, and our economy. Prescription drug abuse affects workplace productivity and increases employee absenteeism, employee presenteeism, and workers' compensation claims. On a wider scale, overdose deaths linked to prescription opioids tripled from 1999 to 2006, and prescription drug abuse killed more Americans in 2009 than died that year in auto crashes.
Send your request for PAW technical assistance to PAW-TA@pire.org or contact Rekaya Gibson at 504.261.8107 or Deborah Galvin at 240.276.2721. Requests are subject to SAMHSA approval. You will be notified of the status of your request.
We aim to conduct systematic and inclusive searches of professional journals, leading newspapers and magazines, and federal websites, as well as contributions from listserv subscribers (please e-mail suggestions to rgibson@pire.org). We will send links to articles along with brief descriptions of those articles. As we develop the listserv, however, we hope to add commentary and invite feedback from subscribers. Our goal is to expand the listserv to become a widely used and recognized source of the most current and authoritative information on prescription drug abuse--especially in workplaces.
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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