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July 30, 2014


SAMHSA Prescription Drug Abuse Weekly Update
Issue 82  |  July 30, 2014
The Prevention of Prescription Drug Abuse in the Workplace (PAW) TA Center addresses prescription drug abuse—a growing public health problem with increasing burdens on workers, workplaces, and our economy. To subscribe colleagues, family members, or friends to this listserv sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), please click here or send their e-mail addresses to paw@dsgonline.com.
Table of Content Featured Article Journal Articles and Reports Professional Education News Other State and Local News Other Resources Grants Awarded Request for Proposal Take-Back Events and Drop Boxes Save the Date Upcoming Conferences and Workshops


Partnership for Drug-Free Kids. The Partnership Attitude Tracking Study: Teens and Parents 2013. Accessed July 23, 2014.

The 2013 Partnership Attitude Tracking Study, sponsored by MetLife Foundation, found a significant increase in the reported lifetime use of synthetic human growth hormone among 3,705 teens enrolled in grades 9–12. Lifetime, 11 percent reported they had used synthetic human growth hormone without a prescription, an increase from just 5 percent in 2012. In the past year, 1 in 11 respondents reported misusing or abusing prescription opioids, and 1 in 12 reported misusing or abusing Ritalin or Adderall.

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Indiana Atty. Gen Zoeller, Colts Partner to Combat Prescription Drug Abuse
Office of Indiana Attorney General
July 22, 2014

The Indiana Attorney General's Office and the Indiana Prescription Drug Abuse Prevention Task Force are partnering with the Indianapolis Colts to raise awareness about prescription drug abuse. The Indiana Prescription Drug Task Force will have a presence during Colts home games, at Colts special events, and during Colts radio and TV programming. It will launch the new partnership by operating a booth inside the Colt's training camp. [Editor's note: given the recent bad press the NFL has seen on this issue, this partnership is likely to be replicable.]

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Journal Articles and Reports

S. Babalonis, M.R. Lofwall, P.A. Nuzzo, A.J. Siegel, and S.L. Walsh. 2014. "Conference Abstract: Abuse Potential and Analgesic Effects of Oxymorphone in Prescription Opioid Abusers." Drug and Alcohol Dependence 140:e8, doi: 10.1016/j.drugalcdep.2014.02.044.

The study compared the subjective, physiological, and analgesic effects with the relative potency of oxymorphone and oxycodone. Healthy, nondependent prescription opioid abusers were enrolled as inpatients in a double-blind, placebo-controlled, three-week study. Seven experimental sessions (6.5 h) were conducted; during each session an oral dose of oxymorphone (10, 20, 40 mg), oxycodone (10, 20, 40 mg), or placebo was administered. Outcomes were assessed before and repeatedly after dosing, including physiological indices, standard abuse likability questionnaires, and two tests of experimental pain (the cold pressor test and pain pressure algometer). Oxymorphone 40 mg and oxycodone 40 mg produce equivalent miotic effects (mean trough values = 2.4 and 2.3 mm, respectively), comparable ratings on prototypic subjective indices of abuse potential (e.g., "drug liking," "high"), and equal pain relief effects on the cold pressor test. However, at identical lower doses (10 and 20 mg), oxycodone produces effects of greater magnitude compared with oxymorphone for most measures, with 10 mg oxymorphone appearing placebo-like.

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S. Bashirian, M. Barati, and Y. Fathi. 2014. "Prevalence and Factors Associated With Tramadol Abuse Among College Students in West of Iran: An Application of the Theory of Planned Behavior." Avicenna Journal of Neuro Psych Physiology 1(1):e20314.

In 2012 the authors surveyed a random sample of 400 college students attending one of four universities in Hamadan, Iran, about their use. Lifetime, 12.5 percent stated they had abused tramadol, with 11 percent abusing in the past year. The surveyed asked questions about the four Theory of Planned Behavior constructs. Attitude and perceived behavioral control predicted intention. Intention and perceived behavioral control in turn predicted abuse.

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M. Cerdá, P. Bordelois, K.M. Keyes, A.L. Roberts, S.S. Martins, S.L. Reisner, S.B. Austin, H.L. Corliss, and K.C. Koenen. 2014. "Family Ties: Maternal-Offspring Attachment and Young Adult Nonmedical Prescription Opioid Use." Drug and Alcohol Dependence, doi: 10.1016/j.drugalcdep.2014.06.026.

Researchers analyzed data from the Growing Up Today Study, a longitudinal cohort of U.S. adolescents followed into adulthood. Analyses with the full sample and with a sibling subsample both showed that mutual medium/high maternal-offspring attachment at age 21 was associated with lower odds of nonmedical prescription opioid use at age 26. The association was partly mediated by mean age 23 offspring smoking, heavy episodic drinking, and illicit drug use, but not by a history of depressive symptoms.

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E.Y. Hilario, M.L. Griffin, R.K. McHugh, K.A. McDermott, H.S. Connery, G.M. Fitzmaurice, and R.D. Weiss. 2014. "Denial of Urinalysis-Confirmed Opioid Use in Prescription Opioid Dependence." Journal of Substance Abuse Treatment, doi: 10.1016/j.jsat.2014.07.003.

Researcher examined the prevalence and patterns of denying urinalysis-confirmed opioid use in prescription opioid dependent patients. Opioid use self-reports were compared with weekly urinalysis results in a 12-week multisite treatment study for prescription opioid dependence. Among those who used opioids during the study (n=246/360), 44.3 percent denied urinalysis-confirmed opioid use, although usually only once (78 percent). Overall, 22.9 percent of opioid-positive urine tests (149/650) were denied on self-report. Initially using opioids to relieve pain was associated with denying opioid use. These findings support the use of both self-reports and urine testing in treating prescription opioid dependence.

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B.C. Kelly, H.J. Rendin, M. Vuolo, B.E. Wells, and J.T. Parsons. 2014. "Influences of Motivational Contexts on Prescription Drug Misuse and Related Drug Problems." Journal of Substance Abuse Treatment, doi: 10.1016/j.jsat.2014.07.005.

In a survey of 400 young adults recruited by time–space sampling, both negative and positive motivations to use drugs were associated with increases in prescription drug misuse frequency. Negative motivations were associated directly with drug problems and drug dependence, as well as indirectly through prescription opioid misuse.

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J. Sanchez. 2014. "Self-Medication Practices among a Sample of Latino Migrant Workers in South Florida." Frontiers in Public Health, doi: 10.3389/fpubh.2014.00108.

A survey of a stratified network-based sample of 278 Latino migrant workers in the Homestead, Fla., area and follow-up focus groups with 24 of them found that these workers face many health problems but lack access to healthcare services. They already engaged in self-medication practices in their countries of origin. On arrival in the United States, practices such as self-prescribing and lay injection continued and often increased.

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Sara B. Varner, G. Villalobos, M. Weaver, and Dace Svikis. 2014. "Conference Abstract: Chronic Disease as a Predictor of Prescription Medication Misuse: Findings From a Self-Report Study." Drug and Alcohol Dependence 140:e233, doi: 10.1016/j.drugalcdep.2014.02.644.

Among 2,695 patients receiving outpatient services at a large urban hospital who completed a computerized survey, 203 reported they recently had taken their prescription more frequently or at a higher dosage than prescribed, taken someone else's prescription, or obtained the same prescription from multiple physicians. Respondents were primarily African American (71.5 percent) and female (75.6 percent). The conditions most likely to be associated with prescription misuse were pancreatitis (17.3 percent), hepatitis (16.3 percent), and liver disease (14.5 percent). Compared with patients reporting no chronic conditions, patients having one or two chronic conditions were 2.4 times as likely to report misuse in the past month, while patients with three or four conditions were 2.7 times as likely to report misuse, and patients with fivefold conditions were 3.6 times as likely to report misuse.

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Professional Education

L. Manchikanti, S. Atluri, K.D. Candido, M.V. Boswell, T.T. Simopoulos, J.S. Grider, F. J.E. Falco, and J.A. Hirsch. 2014. "Zohydro Approval by Food and Drug Administration: Controversial or Frightening?" Pain Physician 17:E437–50.

This health policy review analyzed three important principles of drug approval and utilization based on safety, efficacy, and medical necessity. Based on the limited literature that the authors reviewed, including materials submitted to the Food and Drug Administration by the manufacturers, the authors think that safety, efficacy, and medical necessity were not demonstrated for Zohydro. The study submitted to the FDA showed a 50 percent pain improvement in 48 percent of the patients in the treatment group and 21 percent of the patients in the placebo group at 85-day follow-up. Although this result is statistically significant, its clinical relevance is unknown.

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S.J. Poon and M.B. Greenwood–Ericksen. 2014. "The Opioid Prescription Epidemic and the Role of Emergency Medicine." Annals of Emergency Medicine, doi: http://dx.doi.org/10.1016/j.annemergmed.2014.06.016.

This article argues that a combination of policy and education reforms will result in decreased rates of opioid abuse, misuse, and death.

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R.K. Twillman, R. Kirch, and A. Gilson. 2014. "Efforts to Control Prescription Drug Abuse: Why Clinicians Should Be Concerned and Take Action as Essential Advocates for Rational Policy." CA: A Cancer Journal for Clinicians, doi: 10.3322/caac.21243.

The authors believe that three federal policy initiatives addressing prescription drug abuse impair legitimate access to prescription opioid analgesics for individuals with pain. The policies they oppose are 1) the Food and Drug Administration's (FDA's) recent addition of a Limitations of Use package insert section that reiterates the risks of addiction, abuse, and misuse of prescription opioid analgesics and urges the prescriber to use long-acting/extended-release versions only "in patients for whom alternative treatment options (e.g., nonopioid analgesics or immediate-release opioids) are ineffective, not tolerated, or would be otherwise inadequate to provide sufficient management of pain," 2) FDA rescheduling of hydrocodone-containing combination products to tighten control over them, and 3) Drug Enforcement Administration (DEA) pressure on wholesale and retail pharmacies to control inappropriate prescribing, as well as enforcement actions DEA took against Florida pill mills. The authors suggest trusting healthcare professionals to implement policies and practices that do not unduly restrict access to prescription opioid analgesics for those in severe pain.

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Food and Drug Administration Approves New Extended-Release Oxycodone With Abuse-Deterrent Properties
Food and Drug Administration
July 23, 2014

The Food and Drug Administration approved Targiniq ER (oxycodone hydrochloride and naloxone hydrochloride extended-release tablets), an extended-release/long-acting opioid analgesic to treat pain. Targiniq ER should be prescribed only to people for whom alternative treatment options are ineffective or not tolerated, or for whom alternative treatments would be otherwise inadequate to provide sufficient pain management. When crushed and snorted, or crushed and dissolved and injected, the naloxone in Targiniq ER blocks the euphoric effects of oxycodone, making it less likely to be misused than oxycodone alone. Targiniq ER can still be misused when taken by mouth. Taking too much Targiniq ER can cause an overdose that can result in death. The Food and Drug Administration (FDA) is requiring postmarketing studies of Targiniq ER, to assess the serious risks of misuse, abuse, increased sensitivity to pain (hyperalgesia), addiction, overdose, and death associated with use beyond 12 weeks. The FDA is also requiring postmarketing studies to further assess the effects of the abuse-deterrent features on the risk for abuse of Targiniq ER.

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Plan to Include Controlled Drugs on Electronic Script Scheme
Pharmaceutical Journal
July 21, 2014

Comments are sought on a British Department of Health proposal to extend the National Health Service's electronic prescription service to Schedule 2 and Schedule 3 controlled drugs and asks whether this requirement should also apply to private prescriptions.

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Partnership HealthPlan of California Signs Program Participation Agreement With SafeUseNow
July 23, 2014

California's Medicaid plans will adopt SafeUseNow to quickly identify patients at risk of misusing and abusing controlled substances such as prescription opioids. SafeUseNow, a prescription drug abuse risk identification and intervention program developed by Principled Strategies, delivers actionable information to help healthcare stakeholders educate prescribers to more effectively and safely treat their patients. It also supports proactive monitoring of prescribing patterns to detect changes in prescribing trends and behavior.

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National Institutes of Health System to Monitor Emerging Drug Trends
National Institutes of Health
July 17, 2014

The University of Maryland's Center for Substance Abuse Research will receive five years of funding from the National Institute on Drug Abuse to develop a National Drug Early Warning System (NDEWS). NDEWS will identify emerging drugs and their metabolites, including a focus on synthetics. It will establish a system of harmonized community indicators for tracking drug trends and emerging drugs nationally, using traditional data collection strategies, and social media and Web scans. Finally, it will serve as a coordinating center to generate critically needed information about emerging drug concerns and their public health consequences so that rapid, informed, and effective public health responses can be developed.

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Markey Introduces Legislation to Expand Treatment for Heroin and Prescription Drug Addiction
U.S. Sen. Ed Markey
July 23, 2014

Sen. Edward Markey introduced The Recovery Enhancement for Addiction Treatment Act (TREAT Act) which would expand treatment for opioid addiction. The bill would increase the number of patients for whom a doctor can prescribe these drugs and allow certain nurse practitioners and physician assistants to prescribe medication-assisted treatments.

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Nearly 2,000 Leaders From Across the Country Learn Valuable Prevention Skills at CADCA Midyear
Community Anti-Drug Coalitions of America
July 24, 2014

CADCA's 2014 Midyear Training Institute on July 20–24 included courses on how to prevent prescription drug abuse. About 1,900 persons attended.

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Other State and Local News

Missouri Alone in Resisting Prescription Drug Database
Alan Schwarz, New York Times
July 21, 2014

This article discusses why Missouri is the only state in the United States without a prescription monitoring program database. ExpressScripts reported that residents of its eight neighboring states travel into Missouri to fill their prescriptions much more often than Missourians fill theirs elsewhere. Though Missouri has been urged to establish a database by the Missouri medical associations, members of Congress from neighboring states, the White House, and Mallinckrodt Pharmaceuticals, opponents claim that allowing the government to keep prescription records violates personal privacy.

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Drug-Addicted Newborns on the Rise
Rebekah Hoeger, Fox 10
July 23, 2014

This article and video (2 minutes 17 seconds) discuss babies born with neonatal abstinence syndrome in Alabama and what USA Children's and Women's hospital is doing to help them recover. In the children's wing, several private rooms are available for mothers to have quiet time with their newborns. The hospital trained more staff members to handle these cases; and works with new mothers to get help for their addictions. The most important thing is mother-to-baby contact.

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Why Pennsylvania Needs Prescription Drug Database: Guest Voice of Deb Beck and Rep. Joe Hackett
Deb Beck and State Representative Joe Hackett
July 20, 2014

Deb Beck, president of the Drug and Alcohol Service Providers Organization of Pennsylvania, and state Rep. Joe Hackett share their opinions about the need for the state to upgrade its prescription drug monitoring legislation. House Bill 1694, which would establish a prescription drug database for healthcare professionals, has passed the state Senate and is currently in the House Health Committee. In addition, the legislation calls for continuing education for healthcare professionals on identification and referral to addiction treatment. The authors said this database will improve patient care, reduce drug diversion, identify doctor shoppers, and, most important, save lives.

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Board of Health Learns Hard Facts on Prescription Drug Overdose Deaths in Allen County, Ind.
Ellie Bogue, News–Sentinel
July 22, 2014

The rate of accidental overdose by prescription drugs in Allen County exceeds the national average. Researchers analyzed county overdose deaths for 2008–13. In 2010 the rate of overdose in Indiana was 14.9 percent, almost 2 percentage points higher than the national rate. Prescription pain relievers are involved in more deaths than heroin and cocaine combined. White men ages 35–54 years were most likely to overdose. Seventy-five percent of the pharmaceutical opioids used in overdoses were prescribed to someone else. In addition, 75 percent of those who overdosed were using multiple substances, anywhere from one to 11 drugs at once. While younger people most often overdosed on benzodiazepines, people over the age of 40 instead overdosed on opioid pain relievers. Researchers recommended increasing electronic notification alerts to clinicians about high-risk use and increasing access to naloxone.

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Prescription Drug Abuse Growing Despite Efforts to Curb Problem
Matt Riedl, Wichita (Kan.) Eagle
July 21, 2014

This article interviews Kansas residents about their struggles with prescription drug addiction. Officials with the Center for Change said they have seen an increase in patients in recent years. Centers for Disease Control and Prevention data indicate that Kansas's rates are similar to the nationwide average for opioid prescriptions.

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Adderall Abuse High Among Montana College Students
Lauren Bradley, KECI
July 24, 2014

This article and video (2 minutes 36 seconds) discuss Adderall abuse among college students in Montana. It covers short- and long-term side effects of using the drug.

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Students Take Their Fight Against Underage Drinking and Prescription Drug Misuse to the Airways
July 21, 2014

This press release and video (2 minutes 24 seconds) discuss television commercials produced by Baldwin County students aimed at reducing underage drinking and prescription drug misuse. Students from 10 schools competed in the Baldwin County Community Alliance contest to produce a 30-second commercial that will air on local television next year. The commercials target youth and parents in Alabama.

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Denver Mom Survives Darkness of Prescription Drug Abuse Epidemic
Michael Martinez, Ana Cabrera, and Sara Weisfeldt, CNN
July 24, 2014

This article discusses the life of Cynthia Scudo who abused prescription pain relievers. Later, she transitioned to heroin because it was cheaper. Dr. Patrick Fehling, a psychiatrist at the University of Colorado Hospital's Center for Dependency, Addiction and Rehabilitation, said that prescription opiate abuse can be a gateway drug to heroin.

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Other Resources

Centers for Medicare and Medicaid Services. 2014. Prescription Drug Diversion Resource Guide, June.

This resource guide defines prescription drug diversion. It describes the drugs most often diverted; who can divert; how to identify drug-seeking behaviors; and where to report drug diversion. [four-page PDF]

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Proactive Role Employers Can Take: Opioids in the Workplace
National Safety Council
Accessed July 21, 2014

This report informs employers about the current evidence surrounding opioid medications and their potential impact on the workplace. It sounds a call to action, urging employers to partner effectively with benefit providers, assess current workplace policies and scope of drug testing, prioritize essential education efforts, and improve access to confidential help for employees.

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Grants Awarded

Massachusetts Grants $100,000 to Step Up Drug Fight
James Niedzinski, Gloucester Times
July 19, 2014

The Healthy Gloucester Collaborative, a wing of Gloucester's Public Health Department, was awarded $100,000 from the Massachusetts Department of Public Health to prevent opiate abuse and reduce current abuse. This state grant will fund 1) installation of drug drop-off boxes, 2) fund a mass media campaign to raise awareness of the hazards of opioids and increase awareness about the "Good Samaritan Law," and 3) expand access to naloxone.

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Request for Proposal

Interventions for Youths Who Misuse/Abuse Prescription Stimulant Medications in High School and/or College-Attending Youths (U01)
National Institutes of Health
Deadline: Nov. 13, 2014, 5:00 p.m.

This funding opportunity solicits research applications that develop and test the efficacy of interventions to either prevent or reduce the misuse and diversion of prescription stimulant medications among high school and college students.

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Prescription Drug Abuse: Reducing Prescriptions for Opioids
Health Canada
Deadline: August 29, 2014, no later than 4:00 p.m. EDT

Health Canada will devote $3.6 million to support grants to develop evidence-based practices, guidelines, training and tools for appropriate prescribing of prescription opioids, stimulants, sedatives, and tranquillizers.

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Greater Lowell Health Alliance Issues RFP for Grants Addressing Substance Abuse
Greater Lowell Health Alliance
Deadline: August 8, 2014, by 5 p.m.

The Greater Lowell Health Alliance secured funding from the state of Massachusetts to offer grants to address abuse of opiates and prescription drugs in the Greater Lowell area.

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

Take-Back Events and Drop Boxes

Drug Drop-Off Set for Aug. 5
Daily Telegram (Michigan)
July 24, 2014

Prescription Drug Drop-Off
City of Raleigh (N.C.)
July 23, 2014

Elmhurst Establishes Prescription Medication Drop Box
Joseph Hosey, Elmhurst (Ill.) Patch
July 22, 2014

Yates Prescription Drug Drop-Off Site Now Permanent
Penn Yan, Finger Lake Times (New York)
July 21, 2014

Drug Lockbox at Farmington, Maine, Police Station for Prescription Pills Only
Ann Bryant, Franklin Sun Journal
July 24, 2014

New Drop Box Keeps Drugs Out of Water, Off of Streets
Kirsten Faurie, Kanabec County (Minn.) Times
July 21, 2014

New Prescription Drug Drop-Off Boxes
Metro Waste Authority (Iowa)
July 23, 2014

'Shed the Meds' Prescription Disposal Collects 150 Pounds of Prescription Drugs in Ogdensburg, N.Y.
July 23, 2014

Eden Prairie, Minn., Police Offer Medication Disposal Program to Combat Heroin
Natalie Conrad, Sun Current
July 24, 2014

Drug Disposal Bin Available at Police Department
Tahoe (Nev.) Daily Tribune
July 24, 2014

Residents Asked to Dispose of Unwanted Medications
Taylor M. Lier, Tri-Town News (New Jersey)
July 23, 2014

Save the Date

Sixth Annual American Medicine Chest Challenge National Day of Awareness and Safe Disposal of Prescription Drug and Over-the-Counter Medicine
American Medicine Chest Challenge
November 8, 2014

Upcoming Conferences and Workshops

Pharmacy Diversion Awareness Conference
U.S. Department of Justice, Drug Enforcement Administration
August 2–3, 2014
Denver, Colorado

Prevention of Youth Substance Abuse in Rural Communities Conference: Bringing Hope to Communities in Despair
Coalition for Healthy Youth
August 6–8, 2014
Lancaster, South Carolina

Preventing Prescription Drug Abuse—Nonmembers
New Jersey Pharmacists Association
August 7, 2014
Secaucus, New Jersey

2014 Arkansas Prescription Drug Abuse Summit
University of Arkansas, Criminal Justice Institute
September 10, 2014
Little Rock, Arkansas

Twenty-Seventh Annual NPN Prevention Research Conference
National Prevention Network
September 15–18, 2014
Hartford, Connecticut

2014 Harold Rogers PDMP National Meeting
Brandeis University, Prescription Drug Monitoring Program Training and Technical Assistance Center
September 22–24, 2014
Washington, D.C.

142nd Annual Meeting and Exposition
American Public Health Association
November 15–19, 2014
New Orleans, Louisiana
The Weekly Update is a service provided by the SAMHSA Preventing Prescription Abuse in the Workplace Technical Assistance Center (PAW) to keep the field abreast of recent news and journal articles to assist in forming policy, research, and programs to reduce prescription drug misuse or abuse. Please note, the materials listed are not reflective of SAMHSA's or PAW's viewpoint or opinion and are not assessed for validity, reliability or quality. The Weekly Update should not be considered an endorsement of the findings. Readers are cautioned not to act on the results of single studies, but rather to seek bodies of evidence. Copyright considerations prevent PAW from providing full text of journal articles listed in the Weekly Update.