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July 28, 2016

PAW Weekly Update

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SAMHSA
SAMHSA Prescription Drug Abuse Weekly Update
WEEKLY
UPDATE
Issue 184  |  July 28, 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.
Index
Featured
Journal Articles and Reports
Professional Development
Professional Opinion
National
Marijuana
International
Northeast/Mid-Atlantic News
South News
Midwest News
West News
Other Resources
Webinars
Grant Announcements
Take-Back Events & Drop Boxes
Upcoming Conferences and Workshops

Featured

B. Saloner, M. Bachhuber, and C.L. Barry. 2016. “Physicians as a Source of Medications for Nonmedical Use: Comparison of Opioid Analgesic, Stimulant, and Sedative Use in a National Sample.” Psychiatric Services, doi:10.1176/appi.ps.201500245.

Analysis of 2006–13 National Survey on Drug Use and Health data showed that among nonmedical users of prescription drugs, the percentage that reported that the drugs were prescribed for them was 24 percent for opioid analgesics, 12 percent for tranquilizers/sedatives, 10 percent for stimulants, and 20 percent for misusers of multiple classes of drugs. In multivariate analysis, misusers were more likely to get their drugs directly from a physician if they were male, African American, receiving mental health treatment, misusing frequently, and not also using illicit drugs.

Read more:
http://ps.psychiatryonline.org/doi/abs/10.1176/appi.ps.201500245

Journal Articles and Reports

C. Blanco, M.M. Wall, M. Okuda, S. Wang, M. Iza, and M. Olfson. 2016. “Pain as a Predictor of Opioid Use Disorder in a Nationally Representative Sample.” American Journal of Psychiatry, doi:10.1176/appi.ajp.2016.15091179.

Applying a structural equation model to data from waves 1 (2001–02) and 2 (2004–05) of the National Epidemiologic Survey on Alcohol and Related Conditions showed prescription opioid use disorder (as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) risk rose with pain level at baseline and at 3-year follow-up. Pain was measured with a five-point scale of interference in daily activities. Pain at baseline was associated with a 41 percent increase in relative risk of developing a prescription opioid use disorder.

Read more:
http://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2016.15091179

D.M. Colangelo and A.K. Sepulveda. “Evaluation of the Effectiveness of a Prescription Drug Abuse Prevention Curriculum for College Students.” California Polytechnic State University, Kinesiology Department, June 2016.

In fall 2015, at California Polytechnic State University, 88 students received classroom-based education about prescription drug misuse while 64 control students received general information about drug misuse. Relative to controls, the focused education was associated with increases in knowledge of prescription drug misuse and self-efficacy for preventing it.

Read more:
http://digitalcommons.calpoly.edu/kinesp/10

A. Lembke and J.H. Chen. 2016. “Use of Opioid Agonist Therapy for Medicare Patients in 2013.” JAMA Psychiatry, doi:10.1001/jamapsychiatry.2016.1390.

In 2013, 7,000 prescribers filed 486,000 Medicare Part D claims for Suboxone written for 81,000 patients. Suboxone prescribers represented less than 2 percent of the 382,000 prescribers who filed more than 56.5 million claims for prescription pain relievers in 2013. Specialists in addiction medicine handed out the most prescriptions for Suboxone, nearly 99 claims per prescriber. Pain management physicians were the most prolific opioid prescribers but rarely prescribed Suboxone, writing fewer than five Suboxone prescriptions per doctor. On average, family doctors wrote 7 Suboxone prescriptions and 161 pain reliever prescriptions.

Read more:
http://archpsyc.jamanetwork.com/article.aspx?articleid=2535238
https://consumer.healthday.com/bone-and-joint-information-4/opioids-990/opioid-abusers-missing-out-on-addiction-fighting-medication-713050.html

S.P. Novak, C. Glasheen, and C.L. Roland. 2016. “Prescription Pain Reliever Misuse and Levels of Pain Impairment: 3-Year Course in a Nationally Representative Outpatient Sample of US Adults.” Substance Abuse and Rehabilitation 7: 87–98, doi:10.2147/SAR.S102251.

Analysis of data from waves 1 (2001–02) and 2 (2004–05) of the National Epidemiologic Survey on Alcohol and Related Conditions showed 10 percent of respondents reported high pain interference with activities in the past month at each wave. Five percent reported high impairment from pain in both surveys, suggesting their pain was chronic. Of those with high pain interference at baseline, one-third stayed at high pain, one-third moved to mild/moderate pain, and one-third had complete remittance. Only 3.5 percent of those with no reported pain at baseline moved to high pain interference at follow-up. Baseline levels of pain were more strongly associated with prescription pain reliever misuse concurrently than at follow-up, with the likelihood of misuse increasing with pain level. A continuing history of 5 or more emergency department visits per year or a recent hospital admission predicted transition to problem use.

Read more:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4935147

P.J. Peters, P. Pontones, K.W. Hoover, M.R. Patel, R.R. Galang, J. Shields, S.J. Blosser, M.W. Spiller, B. Combs, W.M. Switzer, C. Conrad, J. Gentry, Y. Khudyakov, D. Waterhouse, S.M. Owen, E. Chapman, J.C. Roseberry, V. McCants, P.J. Weidle, D. Broz, T. Samandari, J. Mermin, J. Walthall, J.T. Brooks, and J.M. Duwve. 2016. “HIV Infection Linked to Injection Use of Oxymorphone in Indiana, 2014–2015.” New England Journal of Medicine 375:229–39, doi:10.1056/NEJMoa1515195.

From October 2014 to October 2015, 181 people who resided in Scott County, Ind., or shared syringes or sex with a resident contracted HIV. The large majority (88 percent) injected extended-release prescription oxymorphone, and 92 percent were co-infected with hepatitis C. Contact tracing investigations identified 536 contacts of case patients; 468 (87 percent) were located, assessed for risk, tested for HIV, and, if infected, linked to care. The more infected patients who named the same contact as a syringe-sharing partner, the higher the risk that contact would be HIV infected (adjusted risk ratio = 1.9 for each time named). In response to this outbreak, a public health emergency was declared on March 26, 2015, and a syringe-service program was established in Indiana.

Read more:
http://www.nejm.org/doi/full/10.1056/NEJMoa1515195?query=featured_home

R.N. Rosenthal, M.R. Lofwall, S. Kim, M. Chen, K.L. Beebe, and F.J. Vocci. 2016. “Effect of Buprenorphine Implants on Illicit Opioid Use Among Abstinent Adults With Opioid Dependence Treated with Sublingual Buprenorphine: A Randomized Clinical Trial.” JAMA 316(3):282–90, doi:10.1001/jama.2016.9382.

A randomized double-blind trial at 21 U.S. sites from June 2014 through May 2015 was conducted among outpatients who had been prescribed daily sublingual buprenorphine for 6 months or more, were abstinent from other opioids except their prescribed 8 mg/d or less of sublingual buprenorphine for 90 days or longer, and were clinically stable. Ninety patients were randomized to receive sublingual buprenorphine plus four placebo implants and 87 to receive sublingual placebo plus four 80-mg buprenorphine hydrochloride implants (expected efficacy, 24 weeks). The trial was completed by 96.4 percent of those receiving buprenorphine implants and 87.6 percent of those receiving sublingual buprenorphine. Over 6 months, 86 percent of those receiving buprenorphine implants and 72 percent of those receiving sublingual buprenorphine maintained opioid abstinence. Implant-related adverse events occurred in 23 percent of the buprenorphine implant group and in 53 percent and 14 percent of participants in the sublingual buprenorphine group. Roughly half of both groups experienced non-implant-related adverse events.

Read more:
http://jama.jamanetwork.com/article.aspx?articleid=2533504

Related Article

W.M. Compton, and N.D. Volkow. 2016. “Improving Outcomes for Persons with Opioid Use Disorders: Buprenorphine Implants to Improve Adherence and Access to Care.” JAMA 316(3):277–9, doi:10.1001/jama.2016.8897.

This editorial says long-acting buprenorphine implant technology is an important addition to the opioid addiction treatment options. It is effective in achieving long-term opioid abstinence for patients who have already achieved and sustained prolonged clinical stability on low-to-moderate doses of oral buprenorphine. The FDA recently approved the implant for up to 1 year of treatment for those patients.

Read more:
http://jama.jamanetwork.com/article.aspx?articleid=2533484
https://www.drugabuse.gov/news-events/news-releases/2016/07/nida-editorial-supports-use-buprenorphine-implant-opioid-use-disorder


R. Sacks-Davis, M. Daniel, É. Roy, Y. Kestens, G. Zang, Y. Ramos, M. Hellard, D.J. Aswad, and J. Bruneau. 2016. “The Role of Living Context in Prescription Opioid Injection and the Associated Risk of Hepatitis C Infection.” Addiction, doi:10.1111/add.13470.

In Montréal, Canada, 854 people who inject drugs were interviewed and tested for hepatitis C virus every 3–6 months from 2004 to 2012. At baseline, inner-city participants were more likely to report prescription opioid injection in the past month (40 percent vs. 25 percent). The association between prescription opioid injection and heroin injection, syringe sharing and sharing of injecting equipment was greater in the inner city, as was the risk of HCV (adjusted hazard ratio = 3.4).

Read more:
http://onlinelibrary.wiley.com/doi/10.1111/add.13470/abstract

A. Shmagel, E. Krebs, K. Ensrud, and R. Foley. 2016. “Illicit Substance Use in U.S. Adults with Chronic Low Back Pain.” Spine, doi:10.1097/BRS.0000000000001702.

In the 2009–10 National Health and Nutrition Examination Survey, 700 of 5,103 adult respondents (unweighted) reported chronic low back pain. Those who had taken illicit drugs during their lifetime (around half of the sample) were more likely to have an active prescription for opioid analgesics than those who had not (22 percent vs. 15 percent).

Read more:
http://journals.lww.com/spinejournal/Abstract/publishahead/Illicit_
Substance_Use_in_US_Adults_With_Chronic.95932.aspx


P.B. Smulowitz, C. Cary, K.L. Boyle, V. Novack, and L. Jagminas. 2016. “Variation in Opioid Prescribing Patterns between ED Providers.” Internal and Emergency Medicine, doi:10.1007/s11739-016-1505-8.

At a Boston community hospital, from November 13, 2014, through July 31, 2015, 21 full-time emergency department providers saw 17,382 patients and wrote a 2,211 prescriptions for opioids. The rate of opioid prescribing averaged 127 per 1,000 visits, with a range among providers from 33 per to 332 per 1,000 visits. The number of pills written per prescription also varied widely.

Read more:
http://link.springer.com/article/10.1007/s11739-016-1505-8

M. Waukers, M. Elseviers, B. Vaes, J. Degryse, O. Dalleur, R.V. Stichele, T. Christiaens, and M. Azermai. 2016. “Too Many, Too Few, or Too Unsafe? Impact of Inappropriate Prescribing on Mortality, And Hospitalisation in a Cohort of Community-Dwelling Oldest Old.” British Journal of Clinical Pharmacology, doi:10.1111/bcp.13055.

In Belgium, among 500 community-dwelling adults, age 80 and older recruited in November 2008 through September 2009, 58 percent were taking five or more medications; underuse (67 percent), and misuse (56 percent) were high. Underuse and misuse coexisted in 40 percent, and were absent in 17 percent of the population. Survival analysis until death or first hospitalization was performed at 18 months after intake. A higher number of prescribed medications was correlated with more misused medications and underused medications. Each underused medication raised risk of mortality (hazard ratio = 1.4), and hospitalization (hazard ratio = 1.3). No significant risk was associated with misuse.

Read more:
http://onlinelibrary.wiley.com/doi/10.1111/bcp.13055/abstract

Professional Development

P.D. Tyler, M.R. Larochelle, and J.N. Mafi. 2016. “Access to Prescription Opioids—Primum Non Nocere.” JAMA Internal Medicine, doi:10.1001/jamainternmed.2016.3926

Read more:
http://archinte.jamanetwork.com/article.aspx?articleid=2534156

P. Voon, R. Joe, C. Fairgrieve, and K. Ahamad. 2016. “Treatment of Opioid Use Disorder in an Innovative Community-Based Setting after Multiple Treatment Attempts in a Woman with Untreated HIV.” BMJ Case Report, doi:10.1136/bcr-2016-215557.

Read more:
http://www.ncbi.nlm.nih.gov/pubmed/27402654

Professional Opinion

B. Fischer. 2016. “Policy Measures for Prescription Opioids and Harms: Enough to Protect Public Health? A Comment on Yanovitzky (2016) and Piper et al. (2016).” Journal of Studies on Alcohol and Drugs 77(4), 566–7.

States are using prescription drug monitoring programs and drug take back programs to address the prescription drug problem. The author argues that these programs will not solve the opioid public health crisis. They do not focus on the high levels of prescription opioids being dispensed. The author believes the Centers for Disease Control and Prevention’s Guidelines on Opioid Prescribing are heading in the right direction. The guidelines recommend non-opioid-based pain therapy or low-dose and/or short-term opioid therapy whenever possible—all measures aimed at reducing excessive prescription opioid exposure or availability and, hence, the risks for direct or indirect prescription opioid-related harm in the population. The author sees an urgent need for more effective policy measures to curtail medically driven prescription-opioid availability and reduce prescription opioid-related harms.

Read more:
http://www.jsad.com/doi/abs/10.15288/jsad.2016.77.566

Marcia L. Meldrum. “The Ongoing Opioid Prescription Epidemic: Historical Context.” American Journal of Public Health 106(8):1365–6, doi:10.2105/AJPH.2016.303297.

This author describes how liberal prescribing of opioids for chronic pain led to the opioid prescription crisis. Now, those who championed the idea acknowledge the unanticipated misuse. The author believes prescription under the new strict guidelines from the Centers for Disease Control and Prevention will provide evidence for or against long-term opioid therapy for chronic pain when prescribed with more caution.

Read more:
http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2016.303297

National

Doping Agency Recommends Banning Russia from Olympics After Investigation
Will Hobson, Washington Post
July 18, 2016

The World Anti-Doping Agency (WADA) has called for a ban of all Russian athletes from the 2016 Summer Olympic Games. An investigative report showed “beyond a reasonable doubt” that the Russian government ran a widespread doping system for years in multiple Summer and Winter Olympic sports. WADA found that Russia’s Ministry of Sport covered up positive doping results by hundreds of elite athletes in at least 30 sports. Cheating athletes were aided by Russian intelligence agents from the Federal Security Service who cracked open supposedly tamper-proof sample bottles at the 2014 Winter Olympics to replace tainted urine of Russian athletes with clean urine. Russian President Vladimir Putin plans to suspend government officials named in the report while the country conducts its own investigation. Putin also demanded WADA provide evidence supporting its findings. WADA does not have the authority to ban a nation from an Olympic Games. The International Olympic Committee’s executive board will decide on the sanctions. (Includes video: 1:12 minutes)

Read more:
https://www.washingtonpost.com/news/sports/wp/2016/07/18/russian-officials-ran-doping-programs-in-multiple-olympic-sports-wada-investigation-finds

SAMHSA. “Medication Assisted Treatment for Opioid Use Disorders. Final rule.” Federal Register 81(131):44711-39, July 8, 2016.

This final rule will expand access to medication-assisted treatment (MAT) by allowing eligible practitioners to request approval to treat up to 275 patients with buprenorphine under section 303(g)(2) of the Controlled Substances Act. It also includes requirements to ensure that patients receive the full array of services that comprise evidence-based MAT and minimize the risk that the medications provided for treatment are misused or diverted.

Read more:
http://www.ncbi.nlm.nih.gov/pubmed/27400463

California Seeks to Protect Privacy of Young Addicts on Parent’s Insurance
Elevate Rehab
July 18, 2016

When an insured receives treatment for a drug use disorder, the health insurance company sends a notice to the policyholder, not the patient. California is concerned that this practice breaches the privacy of young adults who are on their parents’ health insurance and may deter them from getting drug treatment. It is considering laws that will both clarify and strengthen the confidentiality protections in the Federal Health Insurance Portability and Accountability Act and ensure they are fully implemented.

Read more:
http://elevaterehab.org/blog/2016/07/18/california-seeks-to-protect-privacy-of-young-addicts-on-parents-insurance

Marijuana

D. Cao, S. Srisuma, A.C. Bronstein, and C.O. Hoyt. 2016. “Characterization of Edible Marijuana Product Exposures Reported to United States Poison Centers.” Clinical Toxicology, doi:10.1080/15563650.2016.1209761.

A search of 2013–15 National Poison Data System data identified 430 single substance calls coded to human exposure to marijuana eatables – including brownies, candies, cookies, and beverages. States with decriminalized medical/recreational marijuana accounted for 91 percent of the calls (381). Colorado had 166 and Washington 96. The number of calls increased year by year. The most common age groups were: ≤5 years (109) and 13–19 (78). The most frequent clinical effects were drowsiness/lethargy (118), tachycardia (84), agitated/irritable (37), and confusion (37). Children ≤5 years had more drowsiness/lethargy, ataxia, and conjunctivitis. No deaths were reported. The most common therapies administered were intravenous fluids (85, 20 percent), dilute/irrigate/wash (48, 11 percent), and benzodiazepines (47, 11 percent). Three patients (ages 4, 10, and 57 years) received intubation. Exposures were managed at home (97, 23 percent), treated and released (217, 50 percent), or admitted to a critical care unit (12, 3 percent).

Read more:
http://www.tandfonline.com/doi/abs/10.1080/15563650.2016.1209761

M.E. Martz, E.M. Trucco, L.M. Cope, J.E. Hardee, J.M. Jester, R.A. Zucker, and M.M. Heitzeg. 2016. “Association of Marijuana Use with Blunted Nucleus Accumbens Response to Reward Anticipation.” JAMA Psychiatry, doi:10.1001/jamapsychiatry.2016.1161.

An ongoing Michigan longitudinal study of youth at high risk for substance use disorder matched to a control group has collected self-report data on marijuana and other drug use annually since age 11. At ages 20, 22, and 24, 108 participants underwent functional magnetic resonance imaging scans. This study tested how marijuana use history affected neural response in the nucleus accumbens (NAcc) region of the brain to reward anticipation during a monetary incentive delay task. Controlling for sex, age, other substance use, cigarette use, and family history of substance use disorder, greater marijuana use was associated with delayed/blunted activation in the NAcc during reward anticipation.

Read more:
http://archpsyc.jamanetwork.com/article.aspx?articleid=2532234

L.A. Schmidt, L.M. Jacobs, and J. Spetz. 2016. “Young People’s More Permissive Views About Marijuana: Local Impact of State Laws or National Trend?” American Journal of Public Health 106(8):1498–1503, doi:10.2105/AJPH.2016.303153.

In simple cross-tabs of restricted versions of 2004–13 U.S. National Survey on Drug Use and Health data that included state of residence, people ages 12–25 had more permissive views regarding marijuana’s riskiness, accessibility, and social acceptability if they lived in a state where medical marijuana was “legal.” Multivariate regression, however, showed these associations were spurious correlations, an example of the ecological fallacy. Living in a marijuana state did not affect views after adjusting for race, religiosity, marital status, parenthood, and state employment patterns and political preferences, as well as the consistent and significant national time trend toward more permissive attitudes. The national trend was less pronounced among children ages 12–14 than those ages 15–17 or 18–25.

Read more:
http://ajph.aphapublications.org/doi/full/10.2105/AJPH.2016.303153

J.B. Wang, D.E. Ramo, N.E. Lisha, and J.K. Cataldo. 2016. “Medical Marijuana Legalization and Cigarette and Marijuana Co-use in Adolescents and Adults.” Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2016.06.016.

In the 2013 National Survey on Drug Use and Health, 5.1 percent of people ages 12–64 reported using both cigarettes and marijuana in the past 30 days. Multivariate analysis showed odds of co-use were higher in states where medical marijuana was legal compared to illegal (5.8 percent vs. 4.8 percent).The odds of nicotine dependence were higher for those smokers who also smoked marijuana.

Read more:
http://www.drugandalcoholdependence.com/article/S0376-8716(16)30163-6/abstract

Colorado Town’s Water Tests Positive for Active Ingredient in Marijuana
Brian McBride, ABC News
July 22, 2016

Officials urged residents in Hugo, Colo., not to consume their water after several wells tested positive for tetrahydrocannabinol, the active ingredient in marijuana. Although no illnesses have been linked to the water; the Department of Public Health and Environment recommends that residents find other sources of water for drinking and cooking. The water is considered safe for bathing, showering, brushing teeth, washing hands, watering yards, washing dishes, cleaning, and laundry. Hugo prohibits marijuana cultivation, product manufacturing, testing facilities, and retail marijuana stores in the town of around 700 residents.

Read more:
http://abcnews.go.com/US/colorado-towns-water-tests-positive-thc-active-ingredient/story?id=40793816

Firefighter’s Medical Marijuana Suit Sent Back to Ocean City (N.J.)
Andrew Parent, The Gazette of Ocean City
July 14, 2016

A superior court judge has denied a civil suit by Donald Wilshire, an Ocean City, N.J., firefighter who was removed from active duty last fall for his use of medical marijuana. In the judge’s opinion, Wilshire first must participate in a disciplinary hearing before the city. In October 2015, Wilshire disclosed to Ocean City Fire Chief Chris Breunig that he was using marijuana for Meige syndrome, a neurological disorder that he was diagnosed with in 2006. He was originally prescribed Klonopin. Wiltshire was immediately removed from active duty and was ordered to undergo physical and medical testing by a “city physician,” and a drug test. On November 12, the drug test confirmed that Wiltshire had cannabis in his system. Wiltshire was taken off active duty immediately. Wiltshire claimed he was suspended without pay with intent to terminate. Breunig claimed that he placed Wiltshire on paid sick leave. The fire department has policies and procedures in place that prohibit using medications that could possibly impair a firefighter while on duty. Breunig and the city contend that Wiltshire violated city policy when he used marijuana and the Klonopin without telling officials.

Read more:
http://www.shorenewstoday.com/ocean_city/firefighter-s-medical-marijuana-suit-sent-back-to-ocean-city/article_b2198d20-49e6-11e6-ac28-03541a330869.html

First License for Concentrated Cannabis Manufacturing in California Granted by Richmond
Landrace Ventures
July 21, 2016

The city council of Richmond, Calif., will grant the first license for legal manufacture of concentrated cannabis in the state to Indigo Therapeutics. The company will operate a state-of-the-art carbon dioxide extraction and refining laboratory. Professional extraction and refinement establishes product purity, safety, and dosage control and promises to be the most valuable link in the supply chain for legal cannabis.

Read more:
http://www.prnewswire.com/news-releases/first-license-for-concentrated-cannabis-manufacturing-in-california-granted-by-city-of-richmond-300302309.html

Why New Hampshire’s Medical Marijuana Law Shuts Out People with Chronic Pain
Brian Wallstin, New Hampshire Public Radio
July 19, 2016

New Hampshire launched its medical marijuana program in April. Three of the four state-licensed dispensaries and the state’s first cannabis treatment center are now operating. More than 1,100 people with serious illnesses are approved to use the drug. The state’s “therapeutic cannabis” registry is restricted to people with qualifying medical conditions such as cancer, epilepsy, and Parkinson’s disease. Patients with “severe pain” are eligible, but only if their pain is associated with a qualifying condition. The state requires a doctor to list an eligible condition and a symptom in order to certify a patient for the program. (Includes audio: 4:29 minutes)

Read more:
http://nhpr.org/post/why-new-hampshires-medical-marijuana-law-shuts-out-people-chronic-pain

Medlab Raising $5.4 Million to Test Medical Cannabis on Humans
Chris Pash, Business Insider Australia
July 18, 2016

Biotech Medlab is raising $5.36 million to fast-track its human trials of medical cannabis as a pain reliever, conducted at a leading Australian oncology research hospital. The company has approval from the New South Wales government to conduct the trials. Its pain management therapy combines two cannabis compounds, cannabidiol and tetrahydrocannabinol.

Read more:
http://www.businessinsider.com.au/medlab-is-raising-5-4-million-to-test-medical-cannabis-on-humans-2016-7

Cannabis for Medical Use to be Legalized in Greece
Mary Harris, Greece Greek Reporter
July 21, 2016

The Greek Health Ministry has announced the formation of a working group to discuss medical use of cannabis. The group will assess the contemporary use of the cannabis and the legislative framework. By Oct. 30, 2016, it will recommend (to the minister of health) feasible regulations that would make medicinal use possible.

Read more:
http://greece.greekreporter.com/2016/07/21/cannabis-for-medical-use-to-be-legalized-in-greece

International

British Columbia (Canada) Physicians Group Defends Opioid Prescription Standards
Anna Dimoff, CBC News
July 21, 2016

The British Columbia (Canada) College of Physicians and Surgeons has adopted 15 standards and 11 guidelines designed to acknowledge the healthcare profession’s responsibility “to mitigate its contribution to the problem of prescription drug misuse, particularly the over-prescribing of opioids, sedatives and stimulants.” Critics worry the standards will force those with chronic pain to seek drugs on the streets. Ailve McNestry, M.B.B.S., the deputy registrar in charge of drug programs with the college, disputes the criticism, arguing that medical regulatory authorities have, in the past, been too flexible in their approach to prescribing. Furthermore, the standards are not new. The principles have been reframed as a professional standard document in order to give them more weight. The document is then used as a reference when assessing the validity of a complaint made to the college and as a guideline on how to proceed. Owen Williamson, president of the Pain Medicine Physicians of British Columbia Society, is concerned with the lack of funding for and access to non-pharmacological pain treatment options. (Includes audio: 7:44 minutes)

Read more:
http://www.cbc.ca/news/canada/british-columbia/opioid-prescription-standards-1.3690191

Surrey (Canada) Health Officials Warn Public After 36 Drug Overdoses in a Weekend
John Colebourn, Vancouver Sun
July 18, 2016

Surrey, Canada, had 36 drug overdoses in one weekend. Health officials and Royal Canadian Mounted Police warned people about crack cocaine being laced with fentanyl and acetyl fentanyl. They posted warning notices, handed out pamphlets, and spoke with drug addicts and the homeless about the situation.

Read more:
http://vancouversun.com/news/crime/36-drug-overdoses-in-one-weekend-prompt-warning-from-surrey-health-officials

Four Soldiers from New Zealand Discharged After Taking Prescription Medication
Kirsty Lawrence, Fairfax New Zealand Limited
July 22, 2106

New Zealand Defence has discharged four soldiers from the army after they were convicted of taking prescription medication while on deployment in Fiji. A fifth person involved was found not guilty at a summary trial.

Read more:
http://www.stuff.co.nz/national/82340246/Four-soldiers-discharged-after-taking-prescription-medication-while-deployed-to-Fiji

Northeast/Mid-Atlantic News

Massachusetts Health Official Watched Narcan Save Family Member
Lowell Sun
July 21, 2016

Massachusetts Health and Human Services Secretary Marylou Sudders watched naloxone revive a family member recently. The person has been dealing with addiction for 40 years. In 2015, Massachusetts had 12,982 naloxone administrations, up from 7,002 in 2013.

Read more:
http://www.lowellsun.com/news/ci_30152301/state-health-chief-watched-narcan-save-family-member

Overdoses Increasing in Rural Pennsylvania Counties
Mark Hofmann, Herald Standard
July 17, 2016

Drug Enforcement Administration (DEA) Philadelphia Field Division Intelligence Program data reveal that drug overdose deaths in Pennsylvania rural counties were on the rise in 2015, 12 of those counties are among the top 20 counties in the state for overdose deaths. Fayette, Westmoreland, Greene, and Washington counties are all ranked in the top 20. Heroin overdose deaths occurred in 59 of the 62 counties that provided data for the DEA’s analysis. Heroin was identified in 55 percent of overdoses in 2015; with fentanyl the second-most identified drug. In 2015, 49 percent of drug overdose deaths were white males (who make up 40 percent of the state’s population).

Read more:
http://www.heraldstandard.com/new_today/rural-counties-show-number-of-overdoses-increasing-says-state-report/article_b2e33da6-a71d-5759-8353-e2b307080fbf.html

Maine’s Attorney General Launches Ad Campaign on Drug Abuse
Mal Leary, Maine Public Broadcasting
July 18, 2016

Maine’s attorney general has launched a television advertisement campaign aimed at reducing prescription drug misuse. The advertisements stress the addictive nature of pain relievers and warn against use without a doctor’s prescription. The campaign adapted advertisements were produced by the Wisconsin attorney general’s office.

Read more:
http://news.mpbn.net/post/attorney-general-launches-ad-campaign-drug-abuse

Maine Seeks More Foster Families, Citing Drug Abuse in Parents
A.J. Higgins, Maine Public Broadcasting
July 14, 2016

Maine is looking for 66 new foster families for children who parents are addicted to opioids. Currently, Maine has 1,943 children in foster care. (Includes audio: 2:35 minutes)

Read more:
http://news.mpbn.net/post/state-seeks-more-foster-families-citing-drug-abuse-parents#stream/0

Heroin and Pill Overdoses Claim Immigrant Victims in New York
Liz Robbins, New York Times
July 21, 2016

The misuse of opioids has spread to New York City’s immigrant communities. Anecdotal evidence suggests that it is emerging or getting worse. In the last two years, the director of an Islamic Funeral Home buried six young men. Some believe it was from heroin, but the families of the men would not discuss the causes of death. Drug overdose is considered suicide, a sin in Islam, and therefore a source of shame for many in the Arab-American community. Bay Ridge, Brooklyn had 19 overdoses from opioids during the last two years within the Arab-American community. Among Russian-speaking immigrants, some young addicts are taking pills from their grandparents. The Dynamic Youth Community, an adolescent treatment program, has 161 young adults currently in treatment and about 25 percent are from families who emigrated from the former Soviet Union. Experts explain that immigrant parents are often unfamiliar with the signs of drug abuse and may not know how to navigate the world of treatment and recovery. Immigrant families can also have a strong culture of shame around addiction that discourages asking for help. Some organizations educate mothers about the signs and dangers of drug abuse.

Read more:
http://www.nytimes.com/2016/07/22/nyregion/heroin-and-pill-overdoses-claim-immigrant-victims-catching-families-off-guard.html?_r=0

Ex-Nurse in Massachusetts Wrote More Than 100 Fake Prescriptions for Drugs
Norman Miller, WCVB
July 20, 2016

Roberta Regan, a former nurse practitioner at the MetroWest Medical Center in Massachusetts, wrote more than 100 prescriptions for various pills to friends and family members. She pled not guilty in Suffolk Superior Court to six counts of illegally prescribing oxycodone. On June 30, a statewide grand jury indicted Regan on 10 counts of the unlawful prescription of oxycodone and one count of lorazepam. She also faces one count each of illegally prescribing clonazepam in Suffolk, Norfolk and Plymouth counties. Regan was terminated from her job for misusing hospital prescription pads. The state prescription drug monitoring program showed that Regan wrote 119 prescriptions in one year for 10,007 tablets. Only 12 of the prescriptions were for legitimate patients.

Read more:
http://www.wcvb.com/news/exnurse-wrote-more-than-100-fake-prescriptions-for-drugs-officials-say/40805566

Fatal Opioid Overdoses Double Last Year’s Rate in Lowell (Mass.)
Grant Welker, Lowell Sun
July 21, 2016

In 2016, the number of opioid-related deaths in Lowell, Mass., has nearly doubled from 2015, with an average of three deaths every two weeks. The 40 deaths through the end of June compare with last year’s total of 47. Drug-related emergency calls are also on the rise. The 243 calls in the first six months of the year are a 16-percent increase from last year and a 43-percent rise from 2012. Heroin laced with fentanyl has been cited as a reason for a spike in fatalities.

Read more:
http://www.lowellsun.com/breakingnews/ci_30154880/lowell-officials-fatal-opioid-overdoses-double-last-years

South News

Addicted Arkansas: Prescription Drug Abuse
KTHV
July 20, 2016

Arkansas has the 25th highest overdose death rate in the country with 400 deaths a year. As prescription drug misuse gets worse, officials fear heroin abuse could grow. The sale of opioids in Arkansas is 25 percent higher than the national average. In April alone, the Drug Take Back Program collected more than 25,000 pounds of prescription drugs, more than Louisiana, Alabama, and Mississippi. So far this year, the crime lab recorded 63 cases of heroin. The Drug Enforcement Administration believes the first line of defense is Arkansas’ prescription drug monitoring program; and the second line of defense is police. Benton Police officers carry naloxone, and several other departments are following suit, including North Little Rock, Maumelle, Jacksonville, and Arkansas State Police. The final part of the solution involves individuals educating others about the misuse of prescription drugs. (Includes videos: 4:15 and 3:55 minutes)

Read more:
http://www.thv11.com/news/local/addicted-arkansas-prescription-drug-abuse/278215744

Midwest News

Kentucky Attorney General Announces Funding to Fight Drug Abuse in Bowling Green
Michael Gossum, WBKO
July 21, 2016

Kentucky’s attorney general presented a check for $700,000 to Necco to start a program to address drug addiction. The money is part of the settlement funds from an oxycontin lawsuit. (Includes video: 0:45 minutes)

Read more:
http://www.wbko.com/content/news/Beshear-announces-funding-to-fight-drug-abuse-in-Bowling-Green-387850292.html

Officials Push for Prescription Drug Monitoring in Missouri
Fox 2 News
July 21, 2016

Department of Agriculture Secretary Tom Vilsack was in Missouri pushing for the use of a statewide prescription drug monitoring program (PDMP). Missouri remains the only state in the country without a PDMP. Secretary Vilsack and Sen. Claire McCaskill (D–Mo.) hope Missouri takes advantage of recently passed federal legislation aimed at creating local and countywide PDMPs. (Includes video: 1:47 minutes)

Read more:
http://fox2now.com/2016/07/21/mccaskill-agriculture-secretary-vilsack-push-for-prescription-drug-monitoring

Workplace Injury Left Lorain (Ohio) Man Addicted to Opioids, Heroin
Evan MacDonald, Advance Ohio
July 18, 2016

Brandon McGinnis, age 26, died of a heroin overdose 6 months after he fell at work, causing four bulging discs in his lower back. The Ohio resident took pain relievers to ease the pain. When his prescription expired, McGinnis started stealing his mother’s Vicodin and buying pain relievers on the street. One night, he stopped at a friend’s house for pain relievers. When he arrived home, he got into the shower. His mother checked on him 45 minutes later; but he was already unconscious. (Includes video: 1:45 minutes)

Read more:
http://www.cleveland.com/metro/index.ssf/2016/07/heroins_human_toll_workplace_i.html

West News

More People in King County (Wash.) Now Seek Treatment for Heroin than Alcohol
KOMO News
July 19, 2016

The University of Washington Alcohol and Drug Abuse Institute reported that more people seek treatment for heroin than alcohol in King County, Wash. In 2015, 132 people died of heroin overdoses in King County, down from the peak of 156 in 2014. Heroin has been the most common drug identified with overdose deaths in the last two years. Heroin also is the most commonly mentioned drug among callers to the Recovery Helpline; the 2,100 mentions in 2015 almost doubled the number in 2012. Callers interested in opioid use disorder treatment with buprenorphine increased from 147 in 2013 to 363 in 2015. Heroin is the most common drug detected in police evidence, with 348 cases in 2015 following a steady increase since 2011. Use of pharmaceuticals is still high. Fifty-three percent of clients at syringe exchanges reported being “hooked” on prescription-type opiates prior to using heroin, up from 38 percent in 2011. In contrast, treatment admissions for marijuana have declined.

Read more:
http://komonews.com/news/local/more-local-people-now-seek-treatment-for-heroin-than-alcohol

Montana’s ‘Pain Refugees’ Leave State to Get Prescribed Opioids
Corin Cates-Carney, Montana Public Radio
July 22, 2016

The author interviews three Montana residents who travel to Los Angeles to get opioids for their chronic pain. The self-proclaimed “pain refugees” take this trip every 90 days because they cannot get prescriptions in their state. Montana is rural so residents often travel long distances for specialty care and some doctors are wary about prescribing medications. Los Angeles physician Forest Tennant, M.D., is lobbying for a Montana bill that guarantees more access to opioids for pain patients so patients do not have to travel out-of-state. He currently has about 75 out-of-state patients, including residents from Montana.

Read more:
http://khn.org/news/montanas-pain-refugees-leave-state-to-get-prescribed-opioids

Oregonian Turns to Heroin for Pain Relief after Opioid Prescription Cut
Kristian Foden-Vencil, KUOW
July 18, 2016

The author interviewed John, an Oregon carpenter, about his progression to heroin after his opioid prescription was cut. John had a car crash and was prescribed OxyContin and oxycodone to deal with the pain. His doctor started reducing his dosage due to the new state prescribing guidelines. He misses work without pain relievers. He stuck with the low doses for 7 weeks, then decided to buy heroin. Now, he lives in his pickup truck and is in constant pain.

Read more:
http://kuow.org/post/oregonian-turns-heroin-pain-relief-after-opioid-prescription-cut

New Albuquerque Lab Tests Patients for Possible Pill Abuse
Megan Cruz, KOAT
July 16, 2016

Southwest Labs opened recently in Albuquerque, N.M., to assist doctors who prescribe medications to their patients. The lab uses urine samples to determine if the patient is taking the prescribed medication(s) and/or other drugs. (Includes video: 2:02 minutes)

Read more:
http://www.koat.com/news/new-albuquerque-lab-tests-patients-for-possible-prescription-pill-abuse/40717652

Other Resources

Taking Action to Prevent & Address Prescription Drug Abuse: A Resource Kit for America’s College Campuses
National Council on Patient Information and Education
Accessed July 21, 2016

These downloadable handouts are designed to equip peer educators and campus leaders with timely and practical informational resources and programming ideas to educate college students about prescription drug misuse prevention and treatment, and also to help build skills so that students can take action against the problem.

Read more:
http://www.talkaboutrx.org/rx_program.jsp

Winning the War on Opioids
Risk & Insurance
Accessed July 21, 2016

Three graphics show how actions by New York, Florida, and Tennessee reduced overdose deaths and the percentage of patients “doctor shopping” for multiple prescriptions.

Read more:
http://www.riskandinsurance.com/winning-war-opioids

Strategies to Optimize Prescriber Use of Prescription Drug Monitoring Programs
The Pew Charitable Trusts
July 20, 2016

This infographic lists several strategies to make state prescription drug monitoring programs easier to use and increase their use by prescribers.

Read more:
http://www.pewtrusts.org/en/multimedia/data-visualizations/2016/strategies-to-optimize-prescriber-use-of-prescription-drug-monitoring-programs

By the Numbers: The Prescription Drug Abuse Epidemic
CVS Health
Accessed July 20, 2016

CVS Health provides statistics on the prescription drug misuse epidemic. The data are also available in a downloadable infographic which also describes how the company is making a difference.

Read more:
https://cvshealth.com/thought-leadership/cvs-health-perspective/prescription-drug-abuse-epidemic-national-point-of-view

Webinars

Assessing Benefits and Harms of Opioid Therapy for Chronic Pain
Centers for Disease Control and Prevention
Wednesday, Aug. 3, 2016, 2–3 p.m. (ET)

Presenters will explore a case study on how recommendations from the Centers for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain were used to ascertain the associated benefits and risks when a patient with fibromyalgia was prescribed oxycodone following a motor vehicle crash.

Read more:
https://emergency.cdc.gov/coca/calls/2016/callinfo_080316.asp

[Save the Date] Stopping the Revolving Door & Saving Lives: Innovative Approaches for Addressing Opioid Overdose and Opioid Use Disorders in Hospital Emergency Departments
White House National Drug Control Policy
Friday, Aug. 5, 2016, 2–3 p.m. (ET)
http://ems6.intellor.com/index.cgi?p=601354&t=2&do=register&s=&rID=32&edID=

National Drug Control Policy Director Michael Botticelli will host a webinar highlighting innovative approaches for addressing opioid overdose and opioid use disorders by intervening with hospital emergency department (ED) patients. Director Botticelli will outline the Administration’s response to the opioid crisis and expert panelists will provide an overview of comprehensive approaches initiated in the ED setting. They will describe peer engagement and coaching, buprenorphine induction, counseling and other psychosocial services, and naloxone training and distribution. Panelists will also discuss lessons learned and provide available outcome data. Registration is forthcoming.

Read more:
http://www.cadca.org/resources/save-date-ondcps-next-webinar

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 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

Four Million Pills: Ocean County’s (N.J.) Latest Prescription Drug Incineration
Karen Wall, Toms River Patch
July 21, 2016
http://patch.com/new-jersey/tomsriver/4-million-pills-ocean-countys-latest-prescription-drug-incineration

Alexandria (Va.) Deputies Collect More than 300 Lbs. of Pills at Drug Take-Back
De Castillo, Old Towne Alexandria Patch
July 19, 2016
http://patch.com/virginia/oldtownalexandria/alexandria-deputies-collect-more-300-pounds-medication-drug-take-back

How to Dispose of Prescription Drugs Properly in California
Big Bear Grizzly
July 20, 2016
http://www.bigbeargrizzly.net/news/dispose-of-prescription-drugs-properly/article_4cfeafd8-4e1e-11e6-8b5b-f7eaf2c927e2.html

Santa Barbara (Calif.) Police Department Prescription Drug Disposal Box
City of Santa Barbara
July 21, 2016
http://www.publicnow.com/view/79203EEBF97528882F1055F8DE45445CC214B0A1?2016-07-21-17:02:27+01:00-xxx5807

Prescription Drug Drop Box to be Installed at Bridgeview (Ill.) Village Hall
Isaac Sancken, Oak Lawn Patch
July 21, 2016
http://patch.com/illinois/oaklawn/lipinski-announces-installation-drop-box-unwanted-prescription-drugs-bridgeview-village-hall

Buffalo County (Minn.) to Install Drug Collection Unit
Winona Daily News
July 19, 2016
http://www.winonadailynews.com/lifestyles/neighbors/buffalo-county-to-install-drug-collection-unit/article_34a6a06f-9284-5ea9-bad8-cbf3e519bfed.html

Medicine Deposit Units Aim to Reduce Drugs on Street in New York Towns
Kelly Gampel, Star Gazette
July 19, 2016
http://www.stargazette.com/story/news/local/2016/07/19/medicine-deposit-units-aim-reduce-drugs-street/87288096

Upcoming Conferences and Workshops

2016 Fall Research Conference: The Role of Research in Making Government More Effective
Association for Public Policy Analysis & Management
Nov. 3–5, 2016
Washington Hilton
1919 Connecticut Ave. NW
Washington, D.C.

This conference is the association’s premier forum for disseminating research findings and engaging in discussions with policy makers and other practitioners about the implications of those findings for improving policy and governance. It will offer a panel on “Supply Side Policies for Reducing Opioid Abuse.”

Read more:
http://www.appam.org/events/fall-research-conference/2016fall-research-conference-information

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, DC

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 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.