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June 12, 2013

SAMHSA Prevention of Prescription Drug Abuse in the Workplace Listserv


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June 12, 2013 (PDF version)
 
 
 
Featured Article

C. Eccleston, P. Wiffen, S. Derry, and A. Moore. 2013. "Growing Pain: Striving for Quality, Relevance and Applicability in Cochrane Reviews." Cochrane Database of Systematic Reviews. dx.doi.org/10.1002/14651858.ED000059.
 
This editorial provides an overview of the Cochrane Pain, Palliative and Supportive Care (PaPaS) Review Group's work and lessons learned. PaPaS has completed 178 reviews and 10 are underway. An important recent finding is that the "conventional 'last observation carried forward' (LOCF) method of imputing data when patients withdraw from treatment leads to serious overestimation of treatment effects when adverse event withdrawals are high. This is likely to be a particular concern with opioids for chronic non-cancer pain." Cochrane reviews of opioid effectiveness "completed before the bias was recognized may be misleading and need revision." Outcomes also had "become overly statistical, concentrating on mean differences between an active agent and placebo in the reduction of pain intensity. That sounds reasonable, but being told that an intervention produces, on average, a 10 mm difference from placebo on a 100 mm pain intensity scale is underwhelming. Furthermore, responses to interventions are not distributed normally around the mean: some patients achieve very good pain relief, while the remainder get very little pain relief: 'average' pain relief is experienced by only a few." The Review Group arbitrarily chose a cutoff of 50 percent. Recent "research justified the choice of at least 50 percent pain reduction as a successful outcome. It is the minimum outcome that patients want, and it is associated with the restoration of function, work, and quality of life lost with chronic pain." Editors singled out a recent review of "psychological interventions for children with chronic pain. ... The evidence of effect on reducing pain experience is strong, but these are treatments rarely offered."
 
Read more:
http://www.thecochranelibrary.com/details/editorial/4795981/Growing-pain-striving-for-quality-relevance-and-applicability-in-Cochrane-Review.html
 
 
Journal Articles
 
J.B. Bossaer, J.A. Gray, S.E. Miller, G. Enck, V.C. Gaddipati, and R.E. Enck. 2013. "The Use and Misuse of Prescription Stimulants as 'Cognitive Enhancers' by Students at One Academic Health Sciences Center." Journal of the Association of American Medical Colleges. doi:10.1097/ACM.0b013e318294fc7b.
 
This study assessed prevalence of prescription stimulant misuse among students at an academic health sciences center. Researchers emailed electronic surveys to 621 medical, pharmacy, and respiratory therapy students at East Tennessee State University for 4 consecutive weeks in fall 2011. Participation was voluntary and anonymous. Surveys questioned reasons for and frequency and side effects of nonprescription misuse of prescription stimulants. An opportunity to win one of ten $50 gift cards was used as an incentive. Three hundred seventy-two students (59.9 percent) completed the survey (there was a 47.6 percent completion rate for medical students, 70.5 percent completion rate for pharmacy students, and 57.6 percent completion rate for respiratory therapy students). Overall, 11.3 percent of respondents admitted to misusing prescription stimulants for reasons that included enhancing alertness/energy (65.9 percent), improving academic performance (56.7 percent), experimenting (18.2 percent), and getting high (4.5 percent).
 
Read more:
http://journals.lww.com/academicmedicine/Abstract/publishahead/The_Use_and_Misuse_of_Prescription_Stimulants_as.99385.aspx
 
 
L.C. Burghardt, J.W. Ayers, J.S. Brownstein, A.C. Bronstein, M.B. Ewald, and F.T. Bourgeois. 2013. "Adult Prescription Drug Use and Pediatric Medication Exposures and Poisonings." Journal of the American Academy of Pediatrics. doi:10.1542/peds.2012-2978.
 
This study measured the association between changing adult prescription drug patterns and pediatric medication exposures and poisonings and identified high-risk classes of medications and age groups. Researchers measured monthly pediatric exposures and poisonings (using the National Poison Data System) and prescriptions written for adults (using 2000-09 National Ambulatory Medical Care Surveys). Associations between adult prescriptions for oral hypoglycemics, antihyperlipidemics, β-blockers, and opioids and exposures and poisonings among children 0 to 5, 6 to 12, and 13 to 19 were analyzed using multiple time-series analysis. Emergency department visits, serious injuries, and hospitalizations stemming from these associations were described. Adult prescriptions were significantly associated with exposures and poisonings in children of all ages, with the strongest association observed for opioids. Across medications, the greatest risk was among children 0 to 5 years old, followed by 13- to 19-year-olds. Rates of emergency department visits were highest for events related to hypoglycemics (60.1 percent) and β-blockers (59.7 percent); whereas serious injuries and hospitalizations occurred most frequently with opioids (26.0 percent and 35.2 percent, respectively) and hypoglycemics (19.5 percent and 49.4 percent, respectively). Increasing adult drug prescriptions are strongly associated with rising pediatric exposures and poisonings, particularly for opioids.
 
Read more:
http://pediatrics.aappublications.org/content/early/2013/05/29/peds.2012-2978.abstract
 
 
Related Video
Prescription Drug Safety at Home
MedlinePlus
June 3, 2013
 
This video (1:04 minutes) and transcript discuss a new Journal of Pediatrics study (L.C. Burghardt et al.), which found more adult prescription drug use leads to increased poisonings in kids.
 
Watch:
http://www.nlm.nih.gov/medlineplus/videos/news/Kids_Swiping_060313-1.html
 
 
K.M. Johnson, M. Fibbi, D. Langer, K. Silva, and S.E. Lankenau. 2013. "Prescription Drug Misuse and Risk Behaviors Among Young Injection Drug Users." Journal of Psychoactive Drugs 45(2):112-21. doi:10.1080/02791072.2013.785811.
 
In 2008-09, researchers recruited 40 Los Angeles and New York injection drug users aged 16 to 25 who reported injection of a prescription drug. They analyzed descriptive quantitative and qualitative data to illustrate risky injection and sexual behaviors. More than half of participants engaged in risky injection behavior; three fourths engaged in risky sexual behavior; nearly half reported both risky behaviors; and five did not report either risk behavior while misusing a prescription drug. Prescription opioids, tranquilizers, and stimulants were misused in the context of risky sexual behaviors while only opioids were misused in the context of injection risk behaviors. Access to clean syringes, attitudes and beliefs regarding hepatitis C, and risk reduction through partner selection were identified as key themes that contextualized risk behaviors.
 
Read more:
http://www.tandfonline.com/doi/abs/10.1080/02791072.2013.785811
 
 
K. Lynas. 2013. "Pharmacists Can Play a Key Role in Implementing New National Strategy to Combat Prescription Drug Abuse." Canadian Pharmacists Journal/Revue des Pharmaciens du Canada 146(3):128-29. doi:10.1177/1715163513488322.
 
The Canadian Centre on Substance Abuse unveiled a 10-year national strategy to curb prescription drug abuse. Pharmacists will be key participants in implementing the plan's recommendations, which call for a standardized pan-Canadian surveillance system that tracks the nature and extent of prescription drug harms and suggest all provinces and territories establish prescription monitoring programs within the next 2 years. The strategy also recommends promotion of appropriate prescribing and dispensing practices among healthcare practitioners and expanded access to a range of effective treatment options for pain and addiction. The role of pharmacists can widen to include reinforcing risks with patients and communicating with physicians who prescribe opioids. Responsibilities go beyond one-on-one communication with patients about the signs and symptoms of misuse and safe medication storage--they also include educating people at events, health fairs, and through the media.
 
Read more:
http://cph.sagepub.com/content/146/3/128.full#sec-2
 
 
S.L. Tragesser, R.E. Jones, R.J. Robinson, A. Stutler, and A. Stewart. 2013. "Personality Disorder Features and Risk for Prescription Opioid Use Disorders." Journal of Personality Disorders. doi:10.1521/pedi_2013_27_094
 
This study examined the relationships between borderline personality disorder (BPD) and prescription opioid use, risk for misuse, consequences, and dependence, and explored which aspects of BPD account for these associations. As predicted, BPD features were associated with greater quantity and frequency of opioid use, risk for pain medication misuse, consequences, and dependence features. Additional analyses indicated that most of these effects were accounted for by the self-harm/impulsivity component of BPD.
 
Read more:
http://guilfordjournals.com/doi/abs/10.1521/pedi_2013_27_094
 

 
News and Reports
 
Briefing on PDMP Effectiveness
Prescription Drug Monitoring Program Center of Excellence, Brandeis University
April 2013
 
This report offers an overview of the utility and benefits of prescription drug monitoring programs (PDMPs) by incorporating findings from recent research studies, PDMP evaluations and surveys, and PDMP Center of Excellence reports and analyses.
 
Read more:
http://www.pdmpexcellence.org/sites/all/pdfs/briefing_PDMP_effectiveness_april_2013.pdf
 
 
OxyContin Formulation Is Good for Workers Comp, But Bad for Society
Business Insurance
June 2, 2013
 
The latest OxyContin formulation provides relief for workers' compensation payers who have been paying for illegal diversion of prescription pain relievers. It also aids pharmaceutical payer efforts to eliminate diversion of addictive narcotic opioids. Payers have discouraged diversion by using urine tests to ensure claimants are consuming prescribed opioids rather than diverting them. Unfortunately, addicts are replacing the OxyContin formulation with heroin and other drugs.
 
Read more:
http://www.businessinsurance.com/article/20130602/NEWS08/306029983?tags=%7C79%7C304%7C92
 
 
Real Life 'Limitless' Drug Trending Among Office Workers to Stay Ahead
Business Standard
June 1, 2013
 
Some Australians who work in high-pressure industries illegally use prescription Modafinil to improve wakefulness. Workers buy it online without a prescription to stay ahead of the competition. The drug is marketed in the United States as Provigil.
 
Read more:
http://www.business-standard.com/article/news-ani/real-life-limitless-drug-trending-among-office-workers-to-stay-ahead-113060100139_1.html
 
 
Ways to Dispose of Prescriptions Safely in Cambridge
Cambridge Chronicle and Tab
June 7, 2013
 
The Cambridge Police Department, Prevention Coalition, and Public Health Department placed a permanent prescription drug drop box at the Cambridge Police Department. The site is secure, well-lit, and accessible to residents 24 hours a day, 7 days a week. In addition, residents can get free postage-paid mailers to send unwanted or unused prescription medicines to a company that will dispose of them properly.
 
Read more:
http://www.wickedlocal.com/cambridge/news/x625967757/Ways-to-dispose-of-prescriptions-safely-in-Cambridge#axzz2VZ2y2smK
 
 
Police Question Large Accumulations of Prescription Drugs
CBC News
June 5, 2013
 
This article and audio (7:37 minutes) investigate why Ontario Provincial Police see people returning large quantities of narcotics at prescription drug drop-off sites. Last month, they saw one woman turn in 130 fentanyl patches; another girl dropped off 1,800 Tylenol 3s. One factor is a doctor shortage that prompts physicians to prescribe enough medication to last several months.
 
Read more:
http://www.cbc.ca/news/canada/sudbury/story/2013/06/05/sby-prescription-drug-drop-off-program-opp-report-narcotics-sudbury-drug-abuse.html
 
 
Dotter M. Dotter: You Can Help Fight Back Against Drug Dealers
Wausau Daily Herald
June 2, 2013
 
The Marathon County Alcohol and Other Drugs Partnership of Wisconsin has launched a new campaign, "Pushback Against Drug Abuse," to educate the public about the dangers of heroin, prescription medication, and other illicit drug abuse. The campaign aims to empower the community to stand up, take action, and fight back.
 
Read more:
http://www.wausaudailyherald.com/article/20130602/WDH06/306020237/Dotter-You-can-help-fight-back-against-drug-dealers-column-?gcheck=1&nclick_check=1
 
 
Vermont Bills to Help Prevent Overdose Deaths Signed into Law
eNews Park Forest
June 5, 2013
 
Vermont signed two bills into law to help prevent overdose deaths. H.65 provides immunity to people who witness an overdose and call 911 for help. It provides protection from all drug charges, civil asset forfeiture, and violations of parole or probation condition and restraining orders. H.522 allows family members, friends, and others to receive a prescription for naloxone to administer to opioid overdose victims and provides limited immunity from criminal and civil liability for using it. In addition, the law instructs Vermont's Department of Health to develop and implement a prevention, intervention, and response strategy to opioid overdose as well as develop and administer a statewide pilot program for distributing naloxone. 
 
Read more:
http://enewspf.com/latest-news/health-and-fitness/43769-vermont-bills-to-help-prevent-overdose-deaths-signed-into-law.html
 
 
Embattled Board Mulls Prescription Abuse Solutions
Los Angeles Times
June 5, 2013
 
The California medical board will start searching for a new executive director and consider proposals to combat reckless prescribing. Recently, the board discussed the need to immediately develop new guidelines for prescribing OxyContin, Vicodin, and other narcotic pain relievers. It also expressed support for a proposal that would form specialized enforcement teams to identify and investigate doctors engaged in suspicious prescribing. State legislators have threatened to disband the board if it did not show significant progress.
 
Read more:
http://www.latimes.com/news/local/la-me-rx-medical-board-20130605,0,5729243.story
 
 
Adderall Use Becoming Tough Pill to Swallow for Sports
The Post and Courier
June 6, 2013
 
The author, an orthopedic surgeon and Sports Medicine Director at Medical University of South Carolina, discusses Adderall use and abuse among college and professional athletes. Recently, a University of Oklahoma pitcher tested positive for Adderall and lacked a prescription for it. He is expected to enter the National Baseball League as its number one draft pick. Some college athletes use the drug to combat fatigue, and professional athletes use it to focus and concentrate. They obtain prescriptions from their doctors or friends.
 
Read more:
http://www.postandcourier.com/article/20130606/PC20/130609524/1268/adderall-use-becoming-tough-pill-to-swallow-for-sports&source=RSS
 
 
Pharmacists, Doctors Ignore Prescription Drug Database
WUSF News
June 5, 2013
 
One third of pharmacists and 10 percent of doctors use the Florida Prescription Drug Monitoring Database. Florida does not require its use, even though pill mills are still a serious problem. The subcommittee chair on prescription drug abuse asked the pharmacy board to make database checks mandatory and the National Community Pharmacist Association is developing database improvements, which will be discussed by board members at future meetings.
 
Read more:
http://wusfnews.wusf.usf.edu/post/pharmacists-doctors-ignore-prescription-drug-database
 
 
Crane Operator Had Drugs in His System After Building Collapse: Sources
NBC10
June 7, 2013
 
Sources tell NBC10 News that a crane operator had marijuana and prescription pain relievers in his system when a building under demolition collapsed in downtown Philadelphia. The man was required to take blood and urine tests. Six people were killed and 13 were injured. There is an ongoing investigation but no criminal charges have been filed.
 
Read more:
http://www.nbcphiladelphia.com/news/local/Crane-Operator-Had-Drugs-in-His-System--210608021.html
 
 
Shopping for Drugs Online Carries Risks
USA Today
June 6, 2013
 
This article and video (2:14 minutes) discuss the risks of purchasing prescription drugs online. A mother lost her 22-year-old son to an overdose when he used medication purchased online without a prescription. Officials warn that online purchasers without a prescription may risk receiving counterfeit, contaminated, or incorrect medicine. The National Association of Boards of Pharmacy and Legitscript list legitimate drug Web sites.
 
Read more:
http://www.usatoday.com/story/money/columnist/2013/06/06/online-pharmacy-counterfeit-drugs-prescription-dangers/2389219
 
 
Paediatric Death Review Committee and Deaths Under Five Committee: Annual Report 2013
Office of the Chief Coroner for Ontario
Accessed June 5, 2013
 
A study by the University of Toronto Forensic Science program and Office of the Chief Coroner, Ontario, evaluated all 47 drug toxicity deaths of children and youth ages 0-19 from 2008 to 2010. Prevalence of lethal toxicity from prescription drugs was compared with that of illicit and over-the-counter drugs, including ethanol (alcohol). None of the drugs showed a statistically significant trend. The majority of deaths occurred as a result of a lethal dose of prescription drugs (75 percent), especially among teenagers 17 to 19 years old (81 percent). Overall, male deaths were much more common than female deaths (72 percent and 28 percent, respectively). Most deaths were classified as unintentional (77 percent).
 
Read more:
http://www.mcscs.jus.gov.on.ca/stellent/groups/public/@mcscs/@www/@com/documents/webasset/ec163306.pdf
 
 
U.S. House Approves Bill on Prescription Drug Tracking
Reuters
June 3, 2013
 
The U.S. House of Representatives passed a bill to track prescription drugs moving through the distribution chain. The bill, which aims to enhance supply chain security for patients, requires that entities along the supply chain verify authenticity of drugs and notify authorities of suspect or illegitimate products.
 
Read more:
http://www.reuters.com/article/2013/06/03/us-usa-health-drug-tracking-idUSBRE95218420130603
 
 
Oregon Drug Deaths: More People in Their 20s Dying Over Heroin Overdoses
The Oregonian
May 31, 2013
 
When Oregon's medical examiner reviewed drug-related deaths, she discovered victims of heroin overdoses were predominately in their 20s. She noted a trend--people addicted to prescription opioids were turning to heroin. In 2012, there were 147 heroin-related deaths, while prescription drug-related deaths totaled 170. There were 78 methadone-related deaths--a 20 percent drop from the previous year when 100 people died. Hydrocodone deaths dropped from 37 in 2011 to 26 in 2012. Oxycodone deaths rose from 56 in 2011 to 66.
 
Read more:
http://www.oregonlive.com/health/index.ssf/2013/05/oregon_drug_deaths_more_people.html
 
 
CCSO: Scammers Go Door-to-Door, Attempting to Steal Rx
WINK News
May 31, 2013
 
The Collier County Sheriff's Office warned residents about people who go door to door claiming to represent social services and contacting senior citizens about a phony prescription drug program. Recently, a 65-year-old reported a case in which a woman approached her and asked if she was taking any medications. When the victim said yes and showed her the medicine, the woman took the pills to her truck before returning the bottles and leaving. The victim later brought her medication to a nearby drugstore, where the pharmacist said the pills were no longer what her doctor had prescribed.
 
Read more:
http://www.winknews.com/Local-Florida/2013-05-31/CCSO-Scammers-go-door-to-door-attempting-to-steal-Rx
 
 

Other Resources
 
Teens Mix Prescription Opioids with Other Substances
National Institute on Drug Abuse
April 2013
 
Infographic (one-page PDF)
 
Read more:
http://www.drugabuse.gov/sites/default/files/teens-prescipt-opioids_0.pdf
 
 
Grant Announcements
 
Prize Competitions/Challenges in Area of Drug Abuse and Addiction
Deadline: June 16, 2013 (Challenge #1)
 
Read more:
http://grants.nih.gov/grants/guide/notice-files/NOT-DA-13-029.html
 
 
Healthy Living Grant Program
Deadline: July 16, 2013
 
Read more:
http://www.ama-assn.org/ama/pub/about-ama/ama-foundation/our-programs/public-health/healthy-living-grants.page
 
 
Upcoming Conferences and Workshops
 
Prescribing Solutions: Staten Island Opioid Conference 2013
June 14, 2013
Staten Island, New York
http://sisummit2013.eventbrite.com/#
 
 
Pharmacy Diversion Awareness Conference
June 22 and 23: Chicago, Illinois
July 13 and 14: Portland, Oregon
August 3 and 4: Baton Rouge, Louisiana
August 16 and 17: San Diego, California
August 18 and 19: San Jose, California
September 21 and 22: Boston, Massachusetts
http://www.deadiversion.usdoj.gov/mtgs/pharm_awareness
 
 
The Generation Rx University Conference for Prescription Drug Abuse Prevention and Recovery
August 7-8, 2013
Columbus, Ohio
http://pharmacy.osu.edu/outreach/rxabuseconference
 
 
National Conference on Addiction Disorders 2013
September 21-25, 2013
Anaheim, California
http://www.addictionpro.com/ncad-conference/national-conference-addiction-disorders-2013
 
 
2013 National Safety Council Congress and Expo
Congress: September 28-October 4, 2013
Expo: September 30-October 2, 2013
Chicago, Illinois
http://congress.nsc.org/nsc2013/public/enter.aspx
 
 
Please e-mail Rekaya Gibson at rgibson@pire.org with questions or comments about the SAMHSA Prevention of Prescription Drug Abuse in the Workplace Listserv.  
 
 
About PAW and the Listserv
The PAW TA Center addresses prescription drug abuse--a growing public health problem with increasing burdens on workers, workplaces, and our economy. Prescription drug abuse affects workplace productivity and increases employee absenteeism, employee presenteeism, and workers' compensation claims. On a wider scale, overdose deaths linked to prescription opioids tripled from 1999 to 2006, and prescription drug abuse killed more Americans in 2009 than died that year in auto crashes.
 
Send your request for PAW technical assistance to PAW-TA@pire.org or contact Rekaya Gibson at 504.261.8107 or Deborah Galvin at 240.276.2721. Requests are subject to SAMHSA approval. You will be notified of the status of your request.
 
We aim to conduct systematic and inclusive searches of professional journals, leading newspapers and magazines, and federal websites, as well as contributions from listserv subscribers (please e-mail suggestions to rgibson@pire.org). We will send links to articles along with brief descriptions of those articles. As we develop the listserv, however, we hope to add commentary and invite feedback from subscribers. Our goal is to expand the listserv to become a widely used and recognized source of the most current and authoritative information on prescription drug abuse--especially in workplaces.
 
You currently have a free listserv subscription. If you want to stop your subscription, please click here.
 
The "SAMHSA Prevention of Prescription Drug Abuse in the Workplace Listserv" is a service provided by the SAMHSA Preventing Prescription Abuse in the Workplace Technical Assistance Center (PAW) to keep the field abreast of recent news and journal articles to assist in forming policy, research, and programs to reduce prescription drug misuse or abuse. Please note, the materials listed are not reflective of SAMHSA's or PAW's viewpoints or opinions and are not assessed for validity, reliability, or quality. The "SAMHSA Prevention of Prescription Drug Abuse in the Workplace Listserv" should not be considered an endorsement of the findings. Readers are cautioned not to act on the results of single studies, but rather to seek bodies of evidence. Copyright considerations prevent PAW from providing full-text journal articles.
 
The Injury Control Research Center at West Virginia University (WVU-ICRC) archives past Listserv issues at http://www.hsc.wvu.edu/icrc/Pages/SAMHSA-Prevention-of-Prescription-Drug-Abuse-in-th. The partnership efforts of WVU-ICRC are supported by Grant Number 1 R49 CE002109 from the Centers for Disease Control and Prevention (CDC). The contents of the Listserv archive are solely the responsibility of the authors and do not represent the official views of CDC or SAMHSA.
 
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