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July 7, 2016

PAW Weekly Update

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SAMHSA
SAMHSA Prescription Drug Abuse Weekly Update
WEEKLY
UPDATE
Issue 181  |  July 07, 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
National
Marijuana
International
Northeast/Mid-Atlantic News
South News
Midwest News
West News
Grant Award
Grant Announcements
Take-Back Events & Drop Boxes
Upcoming Events, Conferences & Workshops

Featured

A. Casolin. 2016. “Comparison of Urine and Oral Fluid for Workplace Drug Testing.” Journal of Analytical Toxicology, doi:10.1093/jat/bkw055.

In 2014, 25 percent random testing of Sydney and New South Wales, Australia, rail workers collected 1,500 paired urine and oral fluid workplace drug tests. Substances were detected in 3.7 percent of urine samples (56) but only 0.5 percent (8) of oral fluid samples. Positive tests triggered screening for substance use disorders. One worker had marijuana markers detected in oral fluid alone versus 49 workers who had substances detected in urine alone. Twelve workers (0.8 percent) used an illicit drug or a controlled substance without a clinical indication and prescription. Of these, nine tested positive on urine alone, one on oral fluid alone and two on both. Six of 11 workers who tested positive on urine had possible impairment at work and two had a substance use disorder; two of three who tested positive on oral fluid had possible impairment and none had a disorder. Two of three cocaine users were detected by urine alone, as were two of three users of phentermine (a diet pill/amphetamine, Suprenza) and one of two methamphetamine users, but mean time to use was comparable in the urine and oral fluid groups. The five marijuana users detected by urine only had used the drug an average of 86 hours earlier. Detection by urine only included 25 uses of prescribed or over-the-counter codeine an average of 10 hours earlier and 18 prescribed uses of morphine an average of 19 hours earlier.

Read more:
http://jat.oxfordjournals.org/content/early/2016/06/24/jat.bkw055.full

Can Ohio Lawyers Use Medical Marijuana? Ohio Supreme Court Panel to Weigh In
Jackie Borchardt, Advance Ohio
June 21, 2016

Lawyers have submitted requests for formal opinions on medical marijuana to the Ohio Supreme Court’s Board of Professional Conduct. They want to know whether lawyers may represent marijuana cultivators, processors, dispensaries, patients and caregivers; whether lawyers may own or operate medical marijuana businesses; and whether lawyers may use medical marijuana. The law stipulates licensed professionals cannot be disciplined “solely for engaging in professional or occupational activities related to medical marijuana.” However, the supreme court is allowed to issue nonbinding advisory opinions in response to prospective or hypothetical questions about the Ohio Rules of Professional Conduct, which prohibit attorneys from knowingly counseling or assisting a client to break the law and from committing an illegal act that “reflects adversely on the lawyer’s honesty or trustworthiness.” Ohio’s medical marijuana law also allows employers to fire workers who are medical marijuana patients if they violate drug-free workplace policies. The rules vary from state to state. For example, lawyers in Connecticut who use medical marijuana within the state’s medical marijuana law do not violate the rule against engaging in illegal activity. In Washington, lawyers can advise marijuana business clients, own marijuana businesses, and legally purchase marijuana.

Read more:
http://www.cleveland.com/open/index.ssf/2016/06/can_ohio_attorneys_use_medical.html

Journal Articles and Reports

G. Ambrose, A. Amlani, and J.A Buxton. 2016. “Predictors of Seeking Emergency Medical Help during Overdose Events in a Provincial Naloxone Distribution Programme: A Retrospective Analysis.” BMJ Open 6:e011224, doi:10.1136/bmjopen-2016-011224.

British Columbia, Canada, distributed more than 2,000 free take-home naloxone kits between September 2012 and March 2015. The kits included a form for recipients to complete and return if they administered the drug. After using a kit, it was not necessary to complete the form to get a replacement. Of 182 forms voluntarily completed following overdose events, 10 events were reported by the person who overdosed and eight did not indicate whether emergency medical help was sought. Among the remaining reports, someone called 911 to get medical help in 89 cases (54 percent). Administration events occurred primarily in private residences (51 percent) and on the street (23 percent), with reported 911 call rates of 28 percent and 81 percent, respectively. In multivariate analysis, compared to overdoses in a private residence, odds ratios (OR) of calling 911 were 10.7 for overdoses on the street and 3.9 for overdoses in other settings. Stimulant use by the person who overdosed was significantly associated with lower odds of calling 911 (OR = 0.3).

Read more:
http://bmjopen.bmj.com/content/6/6/e011224.full

A-N. Carmichael, L. Morgan, and E. Del Fabbro. 2016. “Identifying and Assessing the Risk of Opioid Abuse in Patients with Cancer: An Integrative Review.” Substance Abuse and Rehabilitation 7: 71–79, doi:10.2147/SAR.S85409.

A search of PubMed and other scholarly databases for “identification and assessment of opioid abuse in cancer.” “advanced cancer and opioid abuse,” “hospice and opioid abuse,” or “palliative care and opioid abuse” identified 34 relevant articles, many of them case studies or narrative reviews. Screening questionnaires and urine drug screens indicated at least 20 percent of patients with cancer may be at risk of opioid use disorder. Several studies demonstrated associations between high-risk patients and clinical outcomes, such as aberrant behavior, prolonged opioid use, higher morphine-equivalent daily dose, greater health care utilization, and symptom burden.

Read more:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4898427

E.C.J. Carr, J. Watt-Watson, M. McGillion, and A. Huizinga. 2016. “The Quest of Pain Education Leaders in Canada and the United States (U.S.): A Qualitative Study.” Journal of Advanced Nursing, doi:10.1111/jan.13050.

Semi-structured telephone interviews in 2012 with 17 Canadian and U.S. leaders in pain education revealed an early pain experience prompted most to enter the field. Their work toward change was motivated by their pain quest where they embraced their personal experiences of pain, a need for social action, and a need for individual change. The authors suggest development of future pain leaders may require an approach that recognizes personal stories of pain, includes a local pain champion, and incorporates a model of mentorship.

Read more:
http://onlinelibrary.wiley.com/doi/10.1111/jan.13050/abstract

S. Carreiro, K. Wittbold, H. Fang, J. Zhang, and E.W. Boyer. 2016. “Wearable Biosensors to Detect Physiologic Change during Opioid Use.” Journal of Medical Toxicology, doi:10.1007/s13181-016-0557-5.

Thirty emergency department patients who were prescribed intravenous opioid medication for acute pain were recruited to wear a wristband biosensor. Within subjects, a significant decrease in locomotion and increase in skin temperature were consistently detected by the biosensors after opioid administration, but electrodermal activity did not change. Between subjects, heavy users demonstrated a greater decrease in short amplitude movements (fidgeting) compared to non-heavy users. Biometric response did not vary with sex or type of opioid.

Read more:
http://link.springer.com/article/10.1007%2Fs13181-016-0557-5

P.O. Coffin, E. Behar, C. Rowe, G.M. Santos, D. Coffa, M. Bald, and E. Vittinghoff. 2016. “Nonrandomized Intervention Study of Naloxone Coprescription for Primary Care Patients Receiving Long-Term Opioid Therapy for Pain.” Annals of Internal Medicine, doi:10.7326/M15-2771.

Among 1,985 adults who received long-term opioid therapy for pain between February 2013 and April 2014 at any of six safety-net primary care clinics in San Francisco, 38 percent were prescribed naloxone. In multivariate analysis, patients were more likely to be co-prescribed naloxone if they were prescribed higher doses of opioids (odds ratio [OR] = 1.7 on log [daily dose]) or had an opioid-related emergency department visit in the past 12 months (OR = 2.5). Patients who received a naloxone prescription had 47 percent fewer opioid-related emergency department visits per month in the 6 months after receipt of the prescription and 63 percent fewer visits after 1 year compared with patients who did not receive naloxone. Opioid dose changes over time were similar for those who received naloxone and those who did not.

Read more:
http://annals.org/article.aspx?articleid=2531366

M. Darwish, M. Bond, Y. Ma, W. Tracewell, P. Robertson, and L.R. Webster. 2016. “Abuse Potential with Oral Route of Administration of a Hydrocodone Extended-Release Tablet Formulated with Abuse-Deterrence Technology in Nondependent, Recreational Opioid Users.” Pain Medicine, doi:10.1093/pm/pnw122.

In a double-blind study, U.S. adult nondependent, recreational opioid users who were able to discriminate hydrocodone immediate release 45 mg from placebo received each of four oral treatments once in a random order: finely crushed placebo, hydrocodone immediate release 45-mg powder, intact hydrocodone extended release 45-mg tablet, and finely crushed hydrocodone extended release 45-mg tablet. Mean maximum effect for “at the moment” drug liking was significantly lower for intact (53.9) and finely crushed hydrocodone extended release (66.9) vs. hydrocodone immediate release (85.2). Drug liking for intact hydrocodone extended release was comparable to placebo (53.9 vs. 53.2). Secondary measures were consistent with these results, indicating that positive, negative, and sedative drug effects were diminished with intact and crushed hydrocodone extended release tablet vs. hydrocodone immediate release. The 72-hour plasma concentration-time profile for each treatment mimicked its respective “at the moment” drug-liking-over-time profile. Incidence of adverse events was lower with intact hydrocodone extended release (53 percent) vs. hydrocodone immediate release (79 percent) and finely crushed extended-release hydrocodone (73 percent). [Editor’s note: misusers who alter extended release tablets in ways that differ from fine crushing may get different results].

Read more:
http://painmedicine.oxfordjournals.org/content/early/2016/06/21/pm.pnw122.abstract

Researchers Profile Overdose Patients and Predictors of Death
Geisinger Health System
June 2, 2016

Analysis of electronic health records of more than 2,000 Geisinger Health System patients admitted to New Jersey and Pennsylvania hospitals for overdoses between April 2005 and March 2015 showed that 9.4 percent died within a year. Most people admitted for an opioid overdose were women with an average age of 52. Being married and having private health insurance had a protective effect, while history of previous addiction, mental illness and having other chronic diseases were all associated with adverse overdose outcomes, including death. The authors concluded that patients who taking higher doses of prescription opioids combined with psychotropic medicines may need closer monitoring to avoid death and other serious complications.

Read more:
http://www.prnewswire.com/news-releases/geisinger-researchers-profile-overdose-patients-and-predictors-of-death-300278769.html

M. Housman, R.D. Williams Jr., and C.L. Woolsey. 2016. “Impact of Alcohol and Alcohol Mixed with Energy Drinks on Non-Medical Prescription Stimulant Use in a Nationally Representative Sample of 12th-Grade Students.” American Journal on Addictions, doi:10.1111/ajad.12390.

Analysis of 2012 Monitoring the Future data on U.S. high school seniors showed students who mixed alcohol with energy drinks more often used Ritalin and Adderall without a prescription than students who only drank alcohol. Male students were slightly more likely to use prescription stimulants nonmedically than female students (odds ratio = 1.15).

Read more:
http://onlinelibrary.wiley.com/doi/10.1111/ajad.12390/abstract

A. Jaiswal, J.F. Scherrer, J. Salas, C. van den Berk-Clark, S. Fernando, and C.M. Herndon. 2016. “Differences in the Association between Depression and Opioid Misuse in Chronic Low Back Pain versus Chronic Pain at Other Locations.” Healthcare 4(2), 34, doi:10.3390/healthcare4020034.

Among chart data on 166 patients who received chronic pain management services at an academic family medicine clinic in Illinois during 2013–14, patient self-assessment data were available for 122. In multivariate regression on that subset, odds of self-reporting a high misuse risk misuse rose with opioid pain interference (a measure of therapeutic effectiveness, odds ration [OR] = 2.1) and was much higher for depressed patients suffering from pain other than low back pain (OR = 10.6). Misuse risk did not vary by pain severity.

Read more:
http://www.mdpi.com/2227-9032/4/2/34

B.J. Piper, C.E. Desrosiers, J.W. Lipovsky, M.A. Rodney, R.P. Baker, K.L. McCall, S.D. Nichols, and S.L. Martin. 2016. “Use and Misuse of Opioids in Maine: Results from Pharmacists, the Prescription Monitoring, and the Diversion Alert Programs.” Journal of Studies on Alcohol and Drugs 77(4), 556–65, doi:10.15288/jsad.2016.77.556.

In 2014 online surveys completed by 275 Maine pharmacists (a 22 percent response rate to invitations sent to all licensed pharmacists), 86 percent agreed that opioid misuse was a concern, 77 percent agreed that diversion was, and 54 percent agreed that access was. Only 56 percent used the state’s prescription drug monitoring program (PDMP). County-level analysis of PDMP data on 1.22 million opioid prescriptions in 2014 showed opioids were dispensed to 22 percent of residents (including 38 percent of women in their 80s). This was enough to supply everyone in Maine for 16 days. Buprenorphine accounted for almost half of opioid prescriptions to young adults, with no variation by sex. Arrests reported to the Maine Diversion Alert Program rose by 13 percent from 2014 to 2015. The proportion of arrests involving prescription opioids decreased while arrests involving stimulants and heroin increased.

Read more:
http://www.jsad.com/doi/abs/10.15288/jsad.2016.77.556

M.E. Sutter, R. Gerona, M.T. Davis, B.M. Roche, D.K. Colby, J.A. Chenoweth, A.J. Adams, K.P. Owen, J.B. Ford, H. Black, T.E. Albertson, and K.J. Heard. 2016. “Fatal Fentanyl: One Pill Can Kill.” Academic Emergency Medicine, doi:10.1111/acem.13034.

Over an 8-day period in March 2016, 18 patients were treated for exaggerated opioid toxicity at a northern California Veteran’s Affairs hospital. The patients provided a similar history: ingesting their “normal dose” of hydrocodone/acetaminophen tablets purchased on the street. Pill analysis revealed the pills were counterfeits containing 600-6900 μg of fentanyl each They were virtually indistinguishable from authentic hydrocodone/acetaminophen tablets and were similar in weight. One of the 18 patients died in hospital. Five patients underwent cardiopulmonary resuscitation; one required extracorporeal life support; three required intubation; and two received bag-valve mask ventilation. Seventeen of 18 patients required boluses of naloxone, and 4 required prolonged naloxone infusions (26–39 hours). One had recurrence of toxicity 8 hours after naloxone discontinuation. To date, the county has reported 56 cases of fentanyl opioid toxicity, with 15 fatalities. The outbreak stressed the capabilities and resources of the emergency department and intensive care units.

Read more:
http://onlinelibrary.wiley.com/doi/10.1111/acem.13034/abstract

A.N. Turner, C. Maierhofer, N.T. Funderburg, B. Snyder, K. Small, J. Clark, J.A. Bazan, N.C. Kwiek, and J.J. Kwiek. 2016. “High Levels of Self-Reported Prescription Opioid Use By HIV-Positive Individuals.” AIDS Care: Psychological and Socio-Medical Aspects of AIDS/HIV, doi:10.1080/09540121.2016.1198746.

During 12 weeks in 2014–15, researchers in Columbus, Ohio, characterized medical and nonmedical prescription medication use among HIV-positive patients attending an academic medical center (n = 149) and a community clinic (n = 105). Respondents were largely male (91 percent), aged 40 or older (61 percent), and were men who have sex with men (85 percent). Antiretroviral therapy use was nearly universal (95 percent). Eleven percent used prescription opioids nonmedically and 43 percent used them medically. Among community-clinic respondents 41 percent used anti-anxiety medications medically compared to 23 percent of hospital clinic respondents. Prescription sedative use was 43 percent among community-clinic participants and 12 percent at the hospital clinic, with 72 percent of use medical. Stimulant use was rare in both sites. No demographic characteristic was significantly associated with medical or nonmedical use of any prescription medication.

Read more:
http://www.tandfonline.com/doi/abs/10.1080/09540121.2016.1198746

S.J. Waisbren. 2016. “The Opioid Epidemic and the Minnesota Board of Medical Practice.” Minnesota Medicine 99(3):39–41.

This article discusses the role the Minnesota Board of Medical Practice (BMP) played in the opioid crisis. It presents a review of guidelines issued by the BMP over the last 30 years, showing that it followed national trends in emphasizing increased prescribing of narcotics for pain until 2015, when a much more cautious and nuanced approach to opioid prescribing was advised.

Read more:
http://www.ncbi.nlm.nih.gov/pubmed/27323522

I. Yanovitzky. 2016. “The American Medicine Chest Challenge: Evaluation of a Drug Take-Back and Disposal Campaign.” Journal of Studies on Alcohol and Drugs 77(4), 549–55, doi:10.15288/jsad.2016.77.549.

A telephone survey 2 weeks after a November 2010 drug take-back day in New Jersey (the American Medicine Chest Challenge) gathered data from 165 adults (an 18 percent response, which the authors weighted to match state demographics). The campaign, which relied heavily on community channels, directly reached more than 60 percent of its target audience. In multivariate analysis, campaign exposure was a strong predictor of the primary actions promoted through the campaign: having one or more conversations with others about medicine disposal (odds ratio [OR] = 2.4); actually disposing of expired, unwanted, or unused medicine in a collection site (OR = 2.1); and talking to children about the dangers of prescription drug abuse (OR = 1.6).

Read more:
http://www.jsad.com/doi/abs/10.15288/jsad.2016.77.549

Professional Development & Opinion

D.S. Aschenbrenner. 2016. “New Warnings for Opioid Analgesics.” American Journal of Nursing 116(7):25, doi:10.1097/01.NAJ.0000484936.25229.f7.

Read more:
http://journals.lww.com/ajnonline/Abstract/2016/07000/New_
Warnings_for_Opioid_Analgesics.21.aspx

National

Heroin Overdose Deaths Have Tripled in 5 Years
Jack Date and Geneva Sands, ABC News
June 29, 2016

The U.S. Drug Enforcement Administration (DEA), in the National Heroin Threat Assessment Summary, reported that deaths from heroin overdoses tripled from 2010 to 2014, rising to 10,574 from 3,036. The increase may be due to greater heroin availability, prescription drug abusers switching to much cheaper heroin, an increase in new and inexperienced users, and use of highly toxic heroin adulterants such as fentanyl. The heroin threat is particularly high in the Northeast and Midwest, where white powder heroin is used. Mexican traffickers gained a larger share of the most lucrative heroin markets in the United States such as Baltimore, Boston, Chicago, New York City, and District of Columbia. Mexican trafficking organizations also moved operations into suburban and rural areas, where they believe they can more easily conceal their activities. DEA officials expect to see deaths from fentanyl increase and perhaps outpace deaths from heroin.

Read more:
http://abcnews.go.com/US/heroin-overdose-deaths-tripled-years-dea/story?id=40205697

CVS Pays $3.5 Million to Settle Claims It Filled Fake Opioid Prescriptions
Vivian Wong, The Boston Globe
June 30, 2016

CVS has reached a $3.5 million settlement with the federal government after investigators found that pharmacists in 50 Massachusetts and New Hampshire pharmacies filled more than 500 forged prescriptions for pain relievers valued at more than $1 million. Recipients either self-paid or charged Medicare or Medicaid. As part of the settlement, CVS pledged to improve training of employees to recognize signs of forged prescriptions.

Read more:
https://www.bostonglobe.com/metro/2016/06/30/cvs-pays-million-settle-federal-probe-that-found-pharmacists-filled-forged-prescriptions/btKqNm4tYmglO3s8qm8V3I/story.html

Preventing Opioid Abuse Among Healthcare Professionals
Bette McNee, Graham Company
June 27, 2016

Businesses should be concerned about the increase in opioid misuse among healthcare workers. The employer could be exposed to legal action if patients are harmed due to the impairment of a doctor or nurse. Appellate courts in four states have held employers responsible for the overdose death of an injured employee. To prevent drug and opioid misuse among healthcare professionals, the author recommends that employers implement a drug-free workplace program that includes mandatory drug testing; have an employee assistance program available; and implement an employee education program to increase awareness about the dangers of prescription opioids. A good education program should also mention how taking prescription opioids for an injury can ultimately lead to even longer recovery times.

Read more:
http://www.grahamco.com/KnowledgeCenter/blog/preventing-opioid-abuse-among-health-care-professionals

Doctors Wrestle with Mixed Messages When Deciding Whether to Prescribe Opioids
Shefali Luthra, Kaiser Health News
June 28, 2016

Some doctors are conflicted when it comes to prescribing pain relievers. The Centers for Disease Control and Prevention issued new guidelines advising doctors to prescription opioids in smaller doses and only when needed. However, the Affordable Care Act of 2010 links hospital payments to patient satisfaction surveys. Patients can evaluate how doctors manage their pain, and if clinicians did all they could to treat it. Doctors believe their patient satisfaction ratings can get caught between patient demands and sound medical judgment. Now, physicians are asking federal authorities to change these satisfaction surveys. Legislation has already been introduced to eliminate the pain questions from the official hospital survey. Centers for Medicare & Medicaid Services officials noted that there is no evidence that prescribing pain relievers improves a hospital’s scores. Others argue the pain questions are just a small part of a large survey. Still, doctors are feeling pressured.

Read more:
http://khn.org/news/doctors-wrestle-with-mixed-messages-when-deciding-whether-to-prescribe-painkillers

Guam Drug Test Data Unreported for Decades
Jasmine Stole, Pacific Daily News
June 27, 2016

For more than 20 years, the government of Guam has not been filing statistical reports about drug tests as outlined in the 1995 Drug-Free Workplace Program procedure. Since December 1995, more than 75 statistical reports should have been compiled and submitted to the Department of Administration’s drug program specialist. Phillip Blas, spokesman for the department, explained that the drug-free workplace coordinators for each agency are responsible for compiling the data and sending the reports to the department. The department has never received them and does not have enough staff to follow up. In recent years, some employees in various departments have tested positive for drugs. Recently, two public health department employees were arrested in connection with drug cases, and a police officer in 2015 tested positive for amphetamine.

Read more:
http://www.guampdn.com/story/news/2016/06/26/govguam-drug-test-data-unreported-decades/86025940

Marijuana

R.M. Johnson, A. Brooks-Russell, M. Ma, B.J. Fairman, R.L. Tolliver, and A.H. Levinson. 2016. “Usual Modes of Marijuana Consumption Among High School Students in Colorado.” Journal of Studies on Alcohol and Drugs 77(4), 580–8, doi:10.15288/jsad.2016.77.580.

A 2013 survey of 25,197 Colorado high school students found that 15 percent of those who use marijuana usually use a mode of consumption other than smoking, with 6 percent vaporizing, 5 percent ingesting edibles, and 4 percent using another method besides smoking. Respondents who were either male, white, Asian, or in grade 12 were most likely to report vaporizing. High perceived harmfulness was associated with vaporizing or ingesting edibles.

Read more:
http://www.jsad.com/doi/abs/10.15288/jsad.2016.77.580

S.I. Woodruff, and A.M. Shillington. 2016. “Sociodemographic and Drug Use Severity Differences Between Medical Marijuana Users and Non-Medical Users Visiting the Emergency Department.” American Journal on Addictions, doi:10.1111/ajad.12401.

Among 292 consecutive patients who visited a Colorado emergency department for any reason and reported using marijuana but no illicit drugs, 37 percent (n = 107) reported using marijuana on the advice of a medical doctor. In multivariate analysis, compared to nonmedical marijuana users, medical users reported a higher frequency of days of use, more money spent on marijuana, lower readiness to change use of marijuana, lower frequency of drug problems and were more likely to be low-risk rather than moderate-severe risk users. Medical marijuana use was associated with a greater number of days of psychological problems.

Read more:
http://onlinelibrary.wiley.com/doi/10.1111/ajad.12401/abstract

Democratic Senators Push for Downgrade of Marijuana Classification
Kate O’Keeffe, Wall Street Journal
June 24, 2016

Some lawmakers are pushing the U.S. Drug Enforcement Administration (DEA) to remove marijuana’s Schedule I classification. That classification is a main barrier to research on potential health benefits and in conflict with the 25 states that permit medical marijuana sales. The DEA is in the final stages of its deliberation on the issue, and a decision will be made soon.

Read more:
http://blogs.wsj.com/washwire/2016/06/24/democratic-senators-push-dea-to-downgrade-marijuana-classification

Supreme Court Won’t Hear Appeal of Montana Medical Marijuana Case
KTVH
June 27, 2016

The U.S. Supreme Court has denied a request to review the Montana supreme court’s decision to uphold restrictions on medical marijuana. Medical-marijuana proponents believe they have enough signatures to qualify for a ballot initiative that, if approved by voters, would abolish restrictions that limit medical-marijuana providers to only three patients. The Montana Cannabis Industry Association also has asked a district judge to block the restrictions until the November election.

Read more:
http://www.ktvh.com/2016/06/u-s-supreme-court-wont-hear-appeal-of-montana-medical-marijuana-case

Marijuana Provision Stripped From Veterans Affairs Funding Bill
Patricia Kime, Military Times
June 28, 2016

The U.S. House of Representatives has approved Department of Veteran Affairs (VA) funding without a provision that would have made it legal for VA doctors to discuss medical marijuana with their patients in some states. The provision was removed just before the vote but may be restored as the bill is likely to be reconsidered. Eleven legislators wrote a letter to congressional leaders, urging them to reinstate the provision. The Senate had already included a similar medical marijuana measure in its approved version of the VA funding bill. Veterans who live in states where medical marijuana is legal are not barred from using it, but their VA physicians cannot recommend it or fill out the paperwork needed for a patient to receive a medical marijuana card. VA doctors can weigh whether a veteran is using marijuana into prescribing decisions. The proposed legislation would not require the VA to cover the cost of medical marijuana for patients.

Read more:
http://www.militarytimes.com/story/veterans/2016/06/28/marijuana-provision-stripped-veterans-affairs-funding-bill/86471448

Canada to Unveil Recreational Marijuana Rules in November
Medical Press
June 30, 2016

Canada has formed a special task force to propose ways to regulate sales of recreational marijuana ahead of legalization in 2017. It will examine production and testing of the drug, distribution and marketing, and the experience of other jurisdictions that have lifted bans on recreational use. Canada is expected to become the first member of the Group of Seven industrialized nations to fully legalize cannabis use, after allowing medical use in 2001. Uruguay became the first country to fully legalize marijuana in 2013.

Read more:
http://medicalxpress.com/news/2016-06-canada-unveil-recreational-marijuana-november.html

International

Naloxone Not Being Used as Much as Expected; Experts Suggest Cost an Issue
Penny Timms, World Today
June 20, 2016

Australia in February 2016 became the second nation in the world to allow naloxone sales without a prescription. Some experts believe the price of naloxone has deterred users and it should be free. Pharmacists want training in administration of the drug. A nasal spray alternative will remove stigma surrounding use of a syringe.

Read more:
http://www.abc.net.au/news/2016-06-20/heroin-antidote-naloxone-over-the-counter-cost-a-deterrent/7526306

Ontario (Canada) Makes Naloxone Available without Prescription
CBC News
June 29, 2016

Ontario, Canada, is making naloxone available without a prescription. The National Association of Pharmacy Regulatory Authorities reclassified naloxone so it can now be used in emergency overdose situations outside hospitals. Pharmacists will provide training on how to safely administer naloxone and it will be provided free of charge to people at risk of an overdose.

Read more:
http://www.cbc.ca/news/canada/toronto/ontario-makes-anti-opioid-drug-naloxone-available-without-prescription-1.3659176

Ontario (Canada) Police Warn the Public About Prescription Drug Use
Global Thunder Bay
June 25, 2016

The Ontario (Canada) Provincial Police is warning the public about the dangers of prescription drug use. In an Alcohol and Drug Use Monitoring Survey, approximately 410,000 Canadians reported misusing prescription drugs like opioid pain relievers. This article discusses the most common types of prescription drugs abused and their potential risks. It reminds the community that it is illegal to possess prescription drugs without a valid prescription or to get multiple prescriptions filled by different pharmacies. The article also provides five tips to avoid becoming an accidental drug dealer.

Read more:
http://www.tbnewswatch.com/News/390856/OPP_warning_
the_public_about_prescription_drug_use

Northeast/Mid-Atlantic News

Poll: Opiate Abuse Crisis Touches Three-Fifths of Maine Residents
Eric Russell, Portland Press Herald
June 28, 2016

In a June 2016 poll of 609 adults, 60 percent knew someone who has either used heroin or abused prescribed opiate pain relievers within the past 5 years. When asked to identify the primary cause of Maine’s heroin crisis, 25 percent said over-prescribing of prescription pain relievers; 21 percent, drug dealers; 18 percent, the disease of addiction; and 13 percent, moral failings. People with a higher level of education or income were more likely to view addiction as a disease, while the less educated put more blame on drug dealers. When asked to label the most important problem in Maine among eight individual options, 12 percent of respondents chose drug abuse, third behind jobs and the economy (33 percent), and the governor (18 percent). Women were more likely than men to say drugs were the biggest problem—14 percent to 9 percent, respectively. People ages 18–34 and 35–49 were much more likely to say that drugs are the most important problem than those over 50.

Read more:
http://www.pressherald.com/2016/06/28/opiate-abuse-crisis-touches-six-out-of-10-mainers

Maryland Reports 383 Overdose Deaths in First Quarter of 2016
WCBC Radio
June 29, 2016

The Maryland Department of Health and Mental Hygiene reported that 383 deaths were related to overdose from January to March 2016. The state had 1,259 overdose deaths in 2015. The department has expanded access to naloxone and to screening, brief intervention and referral to treatment.

Read more:
http://www.pressherald.com/2016/06/28/opiate-abuse-crisis-touches-six-out-of-10-mainers

Pennsylvania Pharmacies Must Now Report Controlled Drug Sales
Susannah Snider, Pittsburgh Business Times
June 27, 2016

Effective June 24, Pennsylvania medical dispensers, including pharmacies and dispensing practitioners, must report sales of Schedule II–V drugs to the state’s prescription drug monitoring program within 72 hours of dispensing.

Read more:
http://www.pharmacist.com/pennsylvania-pharmacies-must-now-report-controlled-drug-sales-state-database

Treatment of Addiction in the New York Workplace
Erin Torcello, Bond, Schoeneck & King
June 30, 2016

The author discusses some basic questions New York employers may have concerning drug addiction in the workplace. Questions include: “Can I discharge or refuse to hire someone because of drug use; can I ask an applicant about his or her drug use; if a recovering addict is covered by the Americans with Disabilities Act and New York Human Rights Law, does that mean an employer must provide a reasonable accommodation; can I test applicants and employees for drugs; and can I impose performance standards.” The author advises employers to remain vigilant to navigate a proper legal course of action for the health and safety of the employee in question and the rest of their workforce.

Read more:
http://www.bizjournals.com/buffalo/blog/buffalo-law-journal/2016/06/treatment-of-addiction-issues-in-the-workplace.html

Massachusetts Doctors’ Group Says Thousands Have Completed Opioid Course
Katie Lannan, Taunton Daily Gazette
June 24, 2016

The Massachusetts Medical Society has reported that 5,265 prescribers have completed continuing medical education courses in opioids and pain management in the past 13 months. Eighty-six percent are physicians and 66 percent practice in Massachusetts. The society offers 18 online courses in opioids and pain management, covering topics including safe prescribing for chronic pain, substance misuse disorder screening and evaluation, alternative therapies, and managing risk when prescribing narcotics.

Read more:
http://www.tauntongazette.com/news/20160624/doctors-group-says-thousands-have-completed-opioid-course

South News

New Safety Measure to Curb Pharmacy Robberies in Tennessee
Maggie Smolka, WCYB
June 24, 2016

In the past year, northeast Tennessee has seen more than six pharmacy robberies. Walgreens recently installed time-delay safes in stores throughout the region. The time delay keeps the criminal in the store, giving the police more time to get to the scene. Pharmacy robberies dropped in other states where the device has been implemented. (Includes video: 2:24 minutes)

Read more:
http://www.wcyb.com/news/new-safety-measure-to-curb-pharmacy-robberies/40213290

Fentanyl, Heroin Overdoses Contributing to Backlog at Virginia Crime Lab
Colleen Quigley, WWBT
June 28, 2016

The increase in fentanyl and heroin overdose deaths has put a burden on Virginia toxicology labs. The Virginia Department of Forensic Science handles a large caseload for homicides, suicides, driving under the influence, and overdoses from across the state. There is usually a backlog of 400 cases per lab, with an average turnaround time of 60 days. The many requests for fentanyl and heroin overdose testing add to the strain. The Virginia Department of Health reported preliminarily that 468 Virginians died from fentanyl, heroin, or a combination of both in 2015, up from 351 in 2014. (Includes video: 2:10 minutes)

Read more:
http://www.nbc12.com/story/32328283/fentanyl-heroin-overdoses-contributing-to-backlog-at-state-crime-lab

Virginia and Tennessee Governors: Too Many Opioids Prescribed
Robert Sorrell, Herald Courier
June 30, 2016

During a town hall meeting to discuss the opioid epidemic in rural Appalachia, the governors of Virginia and Tennessee agreed that too many drugs are being prescribed. Virginia’s governor also believes that if more jobs are created, the drug abuse problem will decrease. The town hall was part of a series of meetings scheduled by the Obama Administration and hosted by the USDA to address the opioid epidemic a priority.

Read more:
http://www.heraldcourier.com/news/local/virginia-and-tennessee-governors-agree-too-many-drugs-prescribed-during/article_d43bc390-3eed-11e6-9926-b774e2184199.html

Alabama Medical Association Launches Smart and Safe Prescription Drug Program
WBRC
June 27, 2016

The Medical Association of Alabama has launched the Smart and Safe program to warn doctors and patients about the dangers of prescription drug addiction. Alabama has the highest per capita rate of opioid prescriptions in the United States.

Read more:
http://www.wbrc.com/story/32319789/medical-association-of-al-launches-smart-and-safe-prescription-drug-program

Alabama Doctor Indicted on Opium Trafficking
Carol Robinson, Alabama Media Group
June 28, 2016

James Fullerton Hooper, M.D., a 69-year-old psychiatrist, faces five counts of unlawful distribution of a controlled substance and five counts of trafficking opium, a controlled substance. Dr. Hooper is former chief psychiatrist at Taylor Hardin Secure Medical Facility in Alabama. The West Alabama Narcotics Task Force received numerous complaints from citizens about Hooper prescribing massive amounts of pain medication to patients without any medical verification.

Read more:
http://www.al.com/news/birmingham/index.ssf/2016/06/alabama_doctor_indicted_on_opi.html

Midwest News

St. Louis Jury Sends $17.6 Million Message in Opioid Abuse Verdict
Tony Messenger, St. Louis Post-Dispatch
June 28, 2016

Brian and Michelle Koon have been awarded $17.6 million in a medical malpractice lawsuit against Henry D. Walden, M.D., and St. Louis University. The Koons received $2.6 million in compensatory damages, and the court awarded $15 million in punitive damages against Dr. Walden and his employer. Brian Koon, a city parks employee, had been prescribed more than 37,000 pain pills between 2008 and 2012 for back pain. He became addicted and ended up in a drug rehabilitation center.

Read more:
http://www.stltoday.com/news/local/columns/tony-messenger/messenger-st-louis-jury-sends-million-message-in-opioid-abuse/article_b7628f83-0e94-5bc7-a2a8-38a12ab6d7d6.html

Heroin, Fentanyl Kill More in Cook and Will Counties (Ill.) than Crashes
By Mike Nolan and Susan DeMar Lafferty, Chicago Tribune
June 30, 2016

In the first 5 months of this year, there have been 125 deaths due to heroin and 87 due to fentanyl in Cook County, Ill., compared to 424 and 102, respectively, for all of 2015. Neighboring Will County recorded 53 overdose deaths linked to heroin and fentanyl in 2015 and 32 through May 2016. Toxicology reports are pending on additional fatalities.

Read more:
http://www.chicagotribune.com/suburbs/daily-southtown/news/ct-sta-southland-heroin-problem-st-0701-20160629-story.html

New Heroin Overdose Drug Will Save Lives, Missouri Health Officials Say
Mark Bliss, Southeast Missourian
June 26, 2016

Effective August 28, 2016, Missouri residents will be able to carry naloxone. A new law protects those who use naloxone on someone who appears to be suffering from an overdose. Pharmacists will also be able to sell naloxone without a prescription.

Read more:
http://www.semissourian.com/story/2316786.html

Missouri Attorney General Urges Action on Prescription Drug Monitoring Program
Scott Moyers, Missouri Times
June 28, 2016

Missouri’s attorney general has called on state lawmakers to implement a prescription drug monitoring program (PDMP) in the state. Law enforcement, pharmacists, and doctors all support the implementation; but key legislators have blocked bills repeatedly due to privacy concerns. Missouri is the only state without a PDMP.

Read more:
http://themissouritimes.com/31070/koster-calls-for-legislature-to-get-pdmp-done

Minnesota Prosecutors Decline to Charge Gophers Wrestler, for Now
Tom Lyden, KMSP
June 24, 2016

The Hennepin County, Minn., attorney’s office has found “insufficient evidence at this time” to charge a member of the University of Minnesota wrestling team with dealing prescription drugs. Last month, a news investigation revealed allegations of four wrestlers dealing Xanax and 10 other athletes using the drug. The wrestling coach was allegedly aware of the suspicions and asked members of the team to write personal essays admitting their guilt. The coach allegedly refused to provide the names of the athletes to the university police unless the players were granted immunity. The University of Minnesota police investigation remains open. Xanax is not a prohibited performance-enhancing drug under National Collegiate Athletic Association rules.

Read more:
http://www.fox9.com/news/investigators/165340298-story

Manitowoc (Wisc.) Doctor Indicted On Drug Trafficking Charges
The Eagle
June 24, 2016

A grand jury has indicted Wisconsin physician Charles Szyman, M.D., on 19 counts of unlawfully prescribing prescription opiates. Dr. Szyman is accused of knowingly distributed a controlled substance outside of his professional practice and not for a legitimate medical purpose. His medical license has been suspended by the state.

Read more:
http://www.theeagle.com/news/nation/manitowoc-doctor-indicted-on-drug-trafficking-charges/article_c693cbcb-1eba-57db-9c80-cd66cc7e4055.html

West News

Kaiser Permanente Advances Safe Opioid Prescribing Guidelines
Business Wire
July 1, 2016

Safe Med LA, a public/private prescription drug abuse coalition in Los Angeles County, Calif., has launched an initiative to implement safe prescribing guidelines at 80 urgent care clinics operated by 10 major physician groups and health systems throughout the county, including Kaiser Permanente and the Los Angeles County Department of Health Services. Kaiser Permanente invested in provider re-education around the latest science of pain management and facilitated collaboration between primary care, pain management, addiction medicine, physical medicine, psychiatry and neurology. Since January 2010, Kaiser Permanente Southern California clinicians have reduced prescribing of the highest risk long-acting opioid medications for non-cancer, non-hospice patients by over 72 percent; and reduced high-volume prescriptions of short-acting opioids by 98 percent.

Read more:
http://finance.yahoo.com/news/kaiser-permanente-advances-safe-opioid-130000178.html

Town Hall on Misuse of Prescription Drugs Set for July 12 at University of Nevada
Juan Carolos Flores, MyNews4.com
June 30, 2016

Join Together Northern Nevada and the Community Opioid Response Alliance will host a community town hall on the misuse of prescription drugs Tuesday, July 12, 2016, from 6–8 p.m., at the University of Nevada School of Medicine. (Includes video: 0:35 minutes)

Read more:
http://mynews4.com/news/local/town-hall-on-misuse-of-prescription-drugs-set-for-july-12-at-unr

Grant Award

Telemedicine Funding to Address Opioid Epidemic in Appalachia
USDA
June 30, 2016

The USDA awarded nearly $1.4 million to five distance learning and telemedicine grant recipients to address the opioid epidemic in rural central Appalachia, which includes Kentucky, Tennessee, and Virginia.

Read more:
http://www.usda.gov/wps/portal/usda/usdahome?contentidonly=true&contentid=2016/06/0155.xml

Staten Island (N.Y.) Gets $1.75 Million for Substance Abuse Services
Rachel Shapiro, Staten Island Advance
June 30, 2016

The New York Office of Alcohol and Substance Abuse Services has awarded $1.75 million to Community Health Action of Staten Island to provide additional support services for addicts and their families over the next 5 years.

Read more:
http://www.silive.com/news/index.ssf/2016/06/staten_island_gets_175m_for_su.html

Grant Announcements

Public Safety Grant Funding for Implementing New Legislative Initiatives in Viriginia
Danielle Guichard, WRIC
June 24, 2016

Police and sheriffs’ departments can apply for up to $5,000 in grant funding through the Virginia Criminal Justice Services to equip personnel with naloxone, implement procedures and protocols, and train officers in responding to overdose situations. Funding is also available to purchase body-worn cameras for officers; to allow law enforcement to develop procedures for receiving and storing firearms that are surrendered in domestic abuse cases; and train officers in the requirements and implementation of the new protective order law.

Read more:
http://wric.com/2016/06/24/mcauliffe-announces-public-safety-grant-funding-for-implementing-new-legislative-initiatives

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

Prescription Drug Take Back July 9, 2016, in Tioga County (N.Y.)
New York State Senator Fred Akshar
Accessed June 28, 2016
https://www.nysenate.gov/calendar/events/fred-akshar/july-09-2016/shed-meds-prescription-drug-take-back

Madison County (Ill.) Drug Collection Nets 1,500 Lbs.
Bill Tucker, Edwardsville Intelligencer
June 27, 2016
http://www.theintelligencer.com/local_news/article_0610aac6-3c86-11e6-9564-d3b81d159542.html

Niagara County (N.Y.) Expanding Drug Disposal Program
Niagara Gazette
June 27, 2016
http://www.niagara-gazette.com/news/local_news/niagara-county-expanding-drug-disposal-program/article_d22d1c7c-3cd4-11e6-b222-b73eaad8e6d6.html

Miami (Ohio)Township Police Announce Prescription Drug Collection Point
Loveland Magazine
June 27, 2016
http://lovelandmagazine.com/2016/06/miami-township-police-department-announces-prescription-drug-collection-point

Upcoming Events, Conferences, & Workshops

Fifteenth Annual Mid-Year Training Institute
Community Anti-Drug Coalitions of America
July 17–21, 2016
Las Vegas, Nevada
http://www.cadca.org/events/15th-annual-mid-year-training-institute

Register:
http://www.cadca.org/events/15th-annual-mid-year-training-institute/registration

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, D.C.

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.