West Virginia University Logo

June 18, 2014


SAMHSA Prescription Drug Abuse Weekly Update
Issue 76  |  June 18, 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 & Editorial News Other State and Local News Other Resources Audio Request for Proposal Grant Announcement Take-Back Events and Drop Boxes Save the Date Upcoming Conferences and Workshops


Michael R. Grazier, Patil Armenian, and Rais Vohra. 2014. "Illicit Distribution of Prescription Drugs: Report of Inadvertent Chloroquine Toxicity and a Market Survey of Businesses Serving Ethnic Minority Populations in Central California." Annals of Pharmacotherapy, doi:10.1177/1060028014535908

Following an overdose from illicitly purchased prescription drugs, the authors visited four local ethnic markets. Three were illegally selling a total of 35 different prescription medications, including 5 discontinued by the FDA: diphenidol, phenacetin, metamizole, phenylbutazone, and sibutramine.

Read more:

Summit on Heroin and Prescription Drugs: Federal, State, and Community Responses
White House Office of National Drug Control Policy

Thursday, June 19, 2014
9:00 a.m. to 12:30 p.m.
Streamed live online for the general public to view on www.WhiteHouse.gov/Live

This summit will highlight the public health and safety issues surrounding prescription pain relievers and heroin. Its goals are to discuss trends and challenges in the epidemic of opioid abuse in the United States, identify innovative practices and models, and discuss how practitioners at every level can help reduce overdose deaths and bad public health consequences. Issues explored will include expanding drug treatment access to millions through the Affordable Care Act, supporting the use of naloxone, and encouraging people and medical professionals to learn the signs and symptoms of problematic drug use and intervene before substance use becomes a chronic condition.

Read more:

Journal Articles and Reports

Carol J. Boyd and Amy Young. 2014. "Psychological and Drug Abuse Symptoms Associated With Nonmedical Use of Opioid Analgesics Among Adolescents." Substance Abuse, doi:10.1080/08897077.2014.928660

This study reports on a school-based online study of 2,627 adolescents in southeastern Michigan during 2009–10. The large majority—70.4 percent—reported no lifetime opioid use, 24.5 percent were medical users, 3.5 percent were nonmedical users who used for pain relief only, and 1.6 percent were nonmedical users for reasons other than for pain relief (to get high, for example). Both medical users and nonmedical users reported more pain and substance abuse symptoms compared with those who had never used. Nonmedical users who used opioids for sensation-seeking were more likely to have psychological symptoms. Sixty-five percent were white; 29.5 percent were African American. Average age was 14.8 years.

Read more:

Kristin A. Cutler. 2014. "Prescription Stimulants Are 'A Okay': Applying Neutralization Theory to College Students' Nonmedical Prescription Stimulant Use." Journal of American College Health, doi:10.1080/07448481.2014.929578.

This paper examines justifications students incite to defend their nonmedical use of prescription stimulants. Researchers conducted semistructured interviews of 76 college students from a large, public Northwestern University during the 2010–11 academic year. One group of students justified their nonmedical use with safety claims, stating that these drugs are Food and Drug Administration approved, doctor prescribed, and used by many (including children). They compared prescription stimulants and everyday stimulants such as coffee and energy drinks, sometimes even saying that using prescription stimulants was more effective and just as safe as using these everyday stimulants. A second group compared their nonmedical use with others’ more reckless, deviant use, pointing out their relatively responsible use of these drugs. A final group said that authority figures (primarily parents and doctors) either explicitly or implicitly sanctioned their nonmedical use.

Read more:

Belinda Garth, Meridith Temple–Smith, Malcolm Clark, Cathy Hutton, Elizabeth Deveny, Ruby Biezen, and Marie Pirotta. 2014. "'Your Lack of Organization Doesn't Constitute Our Emergency'—Repeat Prescription Management in General Practice." Australian Family Physician 43(6):404–08.

This semistructured interview study examined how practices manage urgent requests for repeat prescriptions and why patients require them urgently. Twenty practice staff (receptionists, practice managers, general practitioners, a practice nurse) from 10 general practices participated. Requests for same-day appointments from patients needing repeat prescriptions were problematic for most clinics in the study. Reasons included convenience, lost prescriptions, and running out of medication. Clinics gave patients appointments, left prescriptions for collection at reception, or ran prescription clinics.

Read more:

Heather Z. Mui, Paloma Sales, and Sheigla Murphy. 2014. "Everybody's Doing It: Initiation to Prescription Drug Misuse." Journal of Drug Issues 44(3):236–53.

Between September 2008 and February 2012, using snowball sampling, researchers interviewed a convenience sample of 120 young adults ages 18 to 25 in the San Francisco Bay, Calif., area who used prescription drugs nonmedically at least 12 times in the 6 months before the interview. The findings suggest nonmedical use typically follows steps similar to other substance abuse. First, exposure to nonmedical prescription drug use and the safety implied by legal medical use normalize the behavior and allay. Exposure led to an assessment of personal costs and benefits and motivations for use. Access to prescription drugs was the next step toward the decision to initiate use. Most said they found prescription drugs readily available in the family's medicine cabinet, at student health centers, or from friends. The final step was being in a physical and social setting where they felt safe to initiate use.

Read more:

Nelson E. Sessler, Jerod M. Downing, Hrishikesh Kale, Howard D. Chilcoat, Todd F. Baumgartner, and Paul M. Coplan. 2014. "Reductions in Reported Deaths Following the Introduction of Extended-Release Oxycodone (Oxycontin) With an Abuse-Deterrent Formulation." Pharmacoepidemiology and Drug Safety, doi: 10.1002/pds.3658.

This study compared the mean numbers of deaths/quarter reported to the manufacturer in the three years after reformulated extended-release oxycodone introduction versus in the year before. Comparison groups consisted of nonfatal reports involving extended-release oxycodone and fatality reports involving extended-release morphine. Annual reports of deaths decreased from 131 the year before to 23 the third year after reformulation (82 percent); overdose death reports decreased 87 percent, and overdose deaths with mention of abuse-related behavior decreased 86 percent. In contrast, nonfatal extended-release oxycodone reports did not decrease postreformulation, and reported emergency room morphine fatalities remained unchanged. The ratio of extended-release oxycodone fatalities to all oxycodone fatalities decreased from 21 percent to 8 percent in the year prereformulation to the second year postreformulation.

Read more:

SAMHSA Center for Behavioral Health Statistics and Quality. 2014. The CBHSQ Report: A Day in the Life of Young Adults: Substance Use Facts. Rockville, Md., June 10.

According to combined 2011 and 2012 National Surveys on Drug Use and Health, on the average day 1,754 young adults ages 18 to 25 used prescription pain relievers nonmedically for the first time. By comparison, daily initiation counts were 2,470 for marijuana, 850 for nonmedical use of licit or illicit stimulants, and 258 for heroin. The report also provides substance-specific profiles from the 2011 Treatment Episode Data Set and the 2011 Drug Abuse Warning Network.

Read more:

Professional Education & Editorial

Stephen Barlas. 2014. "DEA Proposal on Hydrocodone Combination Products Divides Pharmacists: The Impacts on Pharmacy Workload and Prescription Drug Abuse Are at Issue." Pharmacy and Therapeutic 39(5):311.

This editorial discusses the debate among pharmacists and pharmacy associations about changing hydrocodone combination products from a Schedule 3 to a Schedule 2 controlled substance. Michael Sinks said he is in total agreement with the proposal. His pharmacy often receives prescriptions for outlandish quantities of hydrocodone combination products. Quantities can be as high as 540 tablets for a single prescription. Doug Wells, a community pharmacist for 35 years, thinks physicians will start prescribing acetaminophen with codeine phosphate instead of hydrocodone-combination products. The American Society of Health-System Pharmacists supports the rescheduling. The National Association of Chain Drug Stores opposes it. The National Community Pharmacists Association said rescheduling will likely pose significant hardships and delay relief for many patients, especially those in rural areas and in nursing home and long-term care settings.

Read more:

Stephanie Jane Dowden. 2014. "Considerations of Nonmedical Use of Prescription Opioids in Pediatric Pain Management." International Association for the Study of Pain, Pediatric Pain Letter 16(1–2).

This commentary discusses medical and nonmedical use of prescription opioids and considerations for pediatric pain management clinicians.

Read more:


Top 5 Percent of Opioid Prescribers Write 40 Percent of U.S. Narcotic Prescriptions
Wall Street Journal
June 9, 2014

This press release discusses an Express Scripts study that revealed 40 percent of U.S. narcotic prescriptions during 2011–12 were written by only 5 percent of opioid prescribers. The study identifies prescribers who prescribe opioids at a much higher rate than peers who are in the same specialty, treat patients of similar age, and practice in the same geographic region. High prescribers wrote an average of 3.5 times as many opioid prescriptions—4.6 prescriptions per patient compared with 1.3 in their peer group. Opioid cost per patient per day of therapy was nearly 5 times as high, on average, for patients treated by high prescribers. Internal medicine and family practice are among the specialties with the highest prevalence of high prescribers. Nearly 20 percent of the high prescribers were prescribing opioids to only one patient.

Read more:

Federal Views Diverge on Proper Use of Painkillers
Washington Post
June 11, 2014

Federal agencies differ in their descriptions of the opioid drug abuse problem. The White House has called opioid abuse an "epidemic" and a "growing national crisis." The head of the Centers for Disease Control and Prevention and a top-ranking Drug Enforcement Administration official have called on doctors to dramatically scale back their use of prescription opioids. Food and Drug Administration Commissioner Margaret Hamburg has acknowledged that opioids are overprescribed but emphasized the importance of keeping the drugs accessible to Americans with chronic pain. Federal agencies also have different messaging about the appropriate medical role of opioids, which has been the subject of debate for more than 20 years.

Read more:

Drug Overdoses Kill More Than Cars, Guns, and Falling
Sara Bellum, National Institute on Drug Abuse for Teens
June 11, 2014

This article discusses an oft-quoted chart that shows 38,329 drug overdose fatalities in 2010—more than cars, guns, and falls. It also discusses the dangers of mixing alcohol with prescription pain medications and other drugs. It mentions what individuals should do if someone overdoses.

Read more:

When Prosecution Replaces Prescription
Lynn Webster, Pain Medicine News
June 11, 2014

Lynn Webster, the immediate past president of the American Academy of Pain Medicine, discusses the prosecution of doctors who treat patients using pain relievers. When this happens, patients pay the ultimate price. Practitioners reduce their willingness to prescribe strong medications, even when they are critical to recovery and administered in safely. Webster thinks it is imperative that opioids remain an available option to those who suffer pain, and important to take the necessary steps to ensure that these medications are not abused or inappropriately prescribed. She believes opioids should be prescribed by clinicians with the training and competence to assess and monitor patients in accordance with accepted medical guidelines. Also, each and every patient with chronic pain should have access to a minimum level of insurance benefits, and for some patients with certain pain conditions this may include opioids. She said the United States needs to change its attitude about chronic pain.

Read more:

Seniors' Use of Potent Meds Through Medicare Staggering
Peter Eisler, USA Today
June 10, 2014

USA Today examined federal data that showed the number of senior citizens getting narcotic pain relievers and antianxiety medications under Medicare's prescription drug program is increasing sharply, and those older patients are being put on the drugs for longer periods of time. During 2007–12, the number of patients 65 and older getting Medicare prescriptions for powerful opioid pain medications rose more than 30 percent to upward of 8.5 million of the nation's 43 million seniors. Use of some of the most commonly abused pain relievers increased more than 50 percent, and narcotics prescribed per recipient grew 15 percent to a three-month supply.

Read more:

Addicts Will Always Find a Way to Get High
David Sack, Psych Central
June 11, 2014

Addiction medicine specialist David Sack thinks addicts will abuse drugs no matter the reformulations, laws, and vaccines. When Oxycontin was reformulated, it prompted a surge in heroin abuse and a switch to other potent pain relievers like fentanyl. Sack says changing supply does little to change demand when it comes to drugs of abuse. He feels the same way about addiction vaccine. If a vaccine is able to block the pleasurable effects of certain drugs, he suggests, users will circumvent the vaccine by taking extremely high doses, failing to comply with vaccination schedules, or switching to other drugs or compulsive behaviors. Sack believes the solutions are prevention and long-term treatment that addresses the underlying issues that fuel the need to self-medicate with drugs.

Read more:

Other State and Local News

Illinois Human Services and Public Health Agencies Join Forces to Help Control Prescription Drug Abuse in Nursing Homes: June Is Illinois Prescription Monitoring Program Month
State of Illinois
June 12, 2014

The Illinois Department of Human Services and the Illinois Department of Public Health announced the Prescription Monitoring Program Long-Term Care initiative, designed to change the drug-prescribing culture in nursing homes. The system will take downloads from long-term care pharmacy operations (a total of 80,000 beds) on a weekly basis and develop a data warehouse on behavioral health medications by patient, by facility, by region, and statewide. It will assist medical directors, nursing directors, consultant pharmacists, and facility directors by identifying regions and facilities where prescribing appears to deviate from community standards for evidence-based clinical practice.

Read more:

Center for Health Policy, Indiana University–Purdue University Indianapolis. Key Findings and Recommendations From the 2013 IPLA INSPECT Knowledge and Use Survey. June 2014

This study evaluated the effectiveness of the Indiana Scheduled Prescription Electronic Collection and Tracking (INSPECT) Program and the impact it was making to reduce prescription drug abuse. Researchers used a Web-based survey to gather information from medical providers licensed to prescribe or dispense controlled substances in Indiana (excluding veterinarians). Data collection began Oct. 15, 2013, and ended Nov. 30, 2013. Of the 38,333 eligible practitioners, a total of 5,994 finished the survey (a 15.6 percent response rate). INSPECT is widely known and used by prescribers, although 15 percent of respondents had not hear of the system. The biggest to using the system was a lack of time; almost 40 percent of the respondents said there were no barriers to using it.

Read more:

Proposed Bill Would Set Up Prescription Drug Monitoring System in Pennsylvania
Ross Guidotti, CBS
June 12, 2014

Westmoreland County leaders are urging the Pennsylvania House of Representatives to pass Senate Bill 1180, which proposes tighter control of prescription drug distribution and allows physicians to check whether a patient is "doctor shopping." The bill is close to passage. Privacy concerns are one of the stumbling blocks, but state Senator Kim Ward said tools will be in place to protect patient privacy.

Read more:

Easy, Home Disposal of Prescription Drugs Urged to Stem Abuse
June 11, 2014

New York state launched MyOldMeds, a new social media–based campaign to teach residents how to dispose of outdated or unnecessary prescription medications. It urges disposal of prescription drugs by placing them in a plastic bag, using water to dissolve the pills, adding cat litter or coffee grounds to mask the substance, and then throwing the bag away. The MyOldMeds promotion will include public service ads in print and by video. Some local governments also have scheduled days for residents to drop off unneeded prescription drugs.

Read more:

State Senate Passes Bills Aimed at Heroin, Prescription Drug Scourge
Tom Wrobleski, Staten Island Advance
June 10, 2014

The New York Senate passed almost two dozen bills targeting the heroin and opiate epidemic, including a measure to allow schools to administer naloxone. The legislative package seeks to limit prescriptions of opioids for acute pain, creates a statewide heroin awareness program, and increases penalties for selling the heroin, especially on playgrounds. It also changes treatment protocols to better serve patients and helps families get better control over addicted loved ones by allowing parents to force minor children into treatment.

Read more:

Cuomo Adds 100 Officers to Units Fighting Heroin
David Goodman, New York Times
June 11, 2014

This article discusses New York Gov. Andrew Cuomo's decision to add a hundred police investigators to drug units around the state with a mandate to tackle a growing heroin problem. That will nearly double the number of investigators assigned to narcotics teams that work with local police agencies on drug enforcement. Gov. Cuomo also announced plans to make heroin and opioid pill abuse awareness part of orientation for incoming students at every State University of New York campus, to train university police to use naloxone, and to provide state funding to put naloxone in emergency vehicles throughout the state.

Read more:

Bill Targets Prescription Drug Abuse
Tara Jeffries, WRAL
June 11, 2014

The North Carolina Senate Health Care Committee approved a bill that aims to reduce prescription drug abuse. The measure would revive and strengthen a program that tracks the prescriptions of Medicaid patients who use controlled substances. The program, which has not operated since last July because of technical issues with the state's Medicaid billing system, prevents "doctor shopping" by requiring some Medicaid patients to receive controlled substance prescriptions from only one doctor at one pharmacy. The bill calls for state health officials to develop new guidelines for opioid prescribers and requires doctors to take continuing education classes on prescription opioid abuse. The legislation would streamline the prescription drug monitoring database, expanding access to the federal Drug Enforcement Administration and monitoring systems in neighboring states. The bill heads to the Senate Appropriations Committee.

Read more:

Massachusetts Governor Unveils Plan to Tackle Opioid Drug Abuse
Scott Malone, Reuters
June 10, 2014

Massachusetts Gov. Deval Patrick unveiled a $20 million package of proposals to address opioid drug addiction and called for a summit of six New England governors to address a broader regional response. A commission appointed by the governor called for expanding treatment for drug addicts in state prisons and creating new live-in centers to treat addicts as young as 13. The commission also called on state regulators to review how doctors prescribe and pharmacies dispense opioid pain relievers.

Read more:

Idaho Prescription Drug Abuse Leading to Heroin Use
Idaho Press–Tribune
June 12, 2014

Idaho State Police Lieutenant Steve Davis said that, as supply of prescription opioids tightens, addicts are to turning to heroin to feed their addiction. Davis thinks the solution is public awareness. Residents need to know the dangers, and medical professionals need to learn how to manage their patients' pain management regimens.

Read more:

National and State Leaders Address Solutions to New Jersey Prescription Epidemic at Symposium
June 11, 2014

Partnership for a Drug-Free New Jersey held a Do No Harm Symposium recently to discuss solutions to address prescription drug abuse. The symposium's supporters included the White House Office of National Drug Control Policy's High-Intensity Drug Trafficking Area Program and the Medical Society of New Jersey.

Read more:

Joplin Truckers Learn About Proactively Combating Changing Drug Use Trends
Jordan Aubrey, KOAM
June 6, 2014

This article and 54-second video discuss a seminar for Conway drivers in Joplin, Kan.. The seminar covered changing trends of drug abuse across the nation. It included statistics that showed how illegal drug use and prescription drug abuse can affect industrial work.

Read more:

Other Resources

The Bad Ad Program and Prescription Drug Promotion
Food and Drug Administration, Medscape
Accessed June 12, 2014

The Food and Drug Administration and Medscape are offering an online course through its Bad Ad Program to raise awareness about the risks associated with false or misleading prescription medication marketing. The goal of this activity is to educate healthcare professionals and students about the role they can play in helping the Food and Drug Administration ensure that prescription drug advertising and promotion is truthful and not misleading. Upon completion of this activity, participants will be able to identify the role that Food and Drug Administration, Office of Prescription Drug Promotion, and healthcare professionals play in regulating prescription drug promotion and advertising; describe the most common regulatory issues raised by prescription drug promotion; and recognize false or misleading prescription drug promotion.

Read more:


Epidemiology and Drivers of Opioid Pain Reliever Epidemic
National Prescription Drug Abuse Summit, April 22–24, Orlando, Florida
June 12, 2014

This podcast by the Centers for Disease Control and Prevention provides an overview of prescription drug overdose including the epidemiology and drivers of the epidemic. It also provides information on state policy implementation and exploration to curb prescription drug overdose and its consequences, including known impacts. Finally, it discusses data sources for surveillance of prescription drug overdose. [Duration: 38 minutes 28 seconds]


Request for Proposal

Colorado Consortium for Prescription Drug Abuse Prevention Public Awareness Workgroup Prescription Drug Safe Use, Storage and Disposal Statewide Social Marketing Campaign
Colorado Governor's Office
Deadline: July 1, 2014

Grant Announcement

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

Grant applications are solicited for research on management of chronic pain in physical medicine and rehabilitation. Special consideration will be given to applications focused on outcomes or comparative effectiveness research. Applicant and/or at least one co-investigator must be a member of the American Academy of Physical Medicine and Rehabilitation or the Association of Academic Physiatrists.

Read more:

Take-Back Events and Drop Boxes

Bainbridge (Wash.) Police Take-Back Event Is a Success
Bainbridge Island Review
June 10, 2014

551 Pounds Collected During Drug Take-Back
Daily Light (Texas)
June 7, 2014

Hiram Joins a Nationwide Effort to Prevent Prescription Drug Diversion
Dallas–Hiram (Ga.) Patch
June 9, 2014

Kane County, Tri-Cities Authorities Offer Prescription Drug Disposal Programs
Ashley Sloboda, Kane County (Ill.) Chronicle
June 12, 2014

West Grange Pharmacy, Trenton Police to Host Annual Yellow Jug Drug Take-Back Day
News–Herald (Michigan)
June 12, 2014

Armstrong Police Department Collects Nearly 500 Pounds of Prescription Drugs
Liz Buckthorpe, WSAV (Georgia)
June 6, 2014

Youngstown State University Installs Prescription Drop Box
WYTV (Ohio)
June 11, 2014

Save the Date

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

Upcoming Conferences and Workshops

2014 Council of State and Territorial Epidemiologists Annual Conference
June 22–26, 2014
Nashville, Tennessee

Pharmacy Diversion Awareness Conference
U.S. Department of Justice, Drug Enforcement Administration
June 28–29, 2014—Renaissance Phoenix (Ariz.) Downtown
July 12–13, 2014—Sheraton Philadelphia (Pa.) Downtown Hotel
August 2–3, 2014—Denver (Colo.) Marriott Tech Center

Clinical Challenges in Opioid Prescribing: Balancing Safety and Efficacy
Colorado Prescription Drug Abuse Prevention Program of Peer Assistance Services, Inc. SAMHSA
July 11, 2014
Denver, Colorado

CADCA's Midyear Training Institute 2014
July 20–24, 2014
Orlando, Florida

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

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

2014 Harold Rogers Prescription Drug Monitoring Program 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
Ernest N. Morial New Orleans Convention Center
900 Convention Center Blvd.
New Orleans, Louisiana

This annual meeting serves as the home for public health professionals to convene, learn, network, and engage with peers. It strengthens the public health profession, shares the latest research and information, promotes best practices, and advocates for public health issues and policies grounded in research.

Read more:
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.