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June 2, 2016

PAW Weekly Update




SAMHSA Prescription Drug Abuse Weekly Update
          Issue 176  |  June 02, 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.                      
Journal Articles and Reports                            
Professional Development                            
Northeast/Mid-Atlantic News                            
South News                            
Midwest News                            
West News                            
Grant Announcements                            
Take-Back Events & Drop Boxes                            
Upcoming Events, Conferences & Workshops                                                         


N.M. Colaneri, S.A. Keim, and A. Adesman. 2016. “Physician Perceptions of ADHD Stimulant Diversion and Misuse.” Journal of Attention Disorders doi:10.1177/1087054716649664.                        

A survey of a national sample of pediatric subspecialists drew 826 responses (an 18 percent response rate). In the past year, 59 percent of respondents suspected at least one patient with attention-deficit/hyperactivity disorder (ADHD) diverted stimulants. Seventy-four percent believed at least one patient feigned symptoms to obtain an initial ADHD diagnosis; 66 percent believed at least one patient) wanted stimulants to improve academic performance. Child and adolescent psychiatrists were most likely to suspect diversion and feigning symptoms. Thirty-nine percent of physicians believed diversion was at least “common.”                        

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Journal Articles and Reports

M. Backonja, L.R. Webster, B. Setnik, A. Bass, K.W. Sommerville, K. Matschke, B.K. Malhotra, and G. Wolfram. 2016. “Intravenous Abuse Potential Study of Oxycodone Alone or in Combination with Naltrexone in Nondependent Recreational Opioid Users.” American Journal of Drug and Alcohol Abuse, doi:10.3109/00952990.2016.1167215.                

In a double-blind study, in a random order, over three sessions, 29 participants injected oxycodone hydrochloride 20 mg, oxycodone hydrochloride 20 mg plus naltrexone hydrochloride 2.4 mg (simulating an abuse-resistant formulation crushed in the manner the manufacturer intended), or placebo (0.9 percent sodium chloride). Self-reported peak effect for drug liking and high were significantly higher for intravenous oxycodone than placebo, with scores for the combined product in between. More participants experienced adverse events after intravenous oxycodone (90 percent) versus combination product (12.5 percent) or placebo (6.5 percent).                

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L.K. Bauer, J.K. Brody, C. León, and T.P. Baggett. 2016. “Characteristics of Homeless Adults Who Died of Drug Overdose: A Retrospective Record Review.” Journal of Health Care for the Poor and Underserved 27(2):846–59, doi:10.1353/hpu.2016.0075.                

Among 219 adult patients of Boston Health Care for the Homeless Program who died of drug overdose in 2003–08, 81 percent involved opioids and 40 percent involved multiple drugs. Problem substance use (85 percent), psychiatric illness (61 percent), and chronic pain (45 percent) were common, and 32 percent had documentation of all three. Half were well-connected to the program, and 35 percent had a clinic visit within 90 days of death.                 

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A.K. Gatewood, M.J. Van Wert, A.P. Andrada, and P.J. Surkan. 2016. “Academic Physicians’ and Medical Students’ Perceived Barriers Toward Bystander Administered Naloxone as an Overdose Prevention Strategy.” Addictive Behaviors, doi:10.1016/j.addbeh.2016.05.013.                

In in-depth interviews and focus groups with 30 physicians and medical students at two academic hospitals in Baltimore in early 2014, respondents perceived barriers to naloxone prescription related to drug, provider, and patient characteristics. Concerns about naloxone itself included inability to prevent addictive behaviors, duration of action, medical risks, expiration date, and route of administration. Concerns about medical providers included lack of knowledge or experience, medical community common practices and norms, insufficient provision of third-party education, physician and clinic scheduling practices, worry about insulting patients, and fear of being viewed as enabling drug misuse. Concerns about patients included increased risk-taking behaviors, opiate withdrawal symptoms, potential repeat overdose related to withdrawal-discomfort, decreased contact with medical providers, and stigma.                

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S. Kannan, L. Robles, N. Moody, M. Delgado, V. Garcia, K. Moore, L. Echeverria, P. Ruiz, and C. Martinez. 2016. “Genesis of Antibiotic Resistance XI: Critical Appraisal of Disposal Method of National Prescription Drug Take-Back Day.” FASEB Journal 30(1):S 853.2.                

Federal data collected from National Prescription Drug Take-Back Days show that by September 2014, 4.1 million lbs. of prescription medications were removed from circulation and incinerated. Analysis of the disposal process revealed that no data were collected regarding pollutants generated from the incineration; the incineration temperature and feed rate invite formation of dioxins, fly ash, and other pollutants; and not sorting the drugs according to chemical toxicity prior to incineration increases potential harm to the environment and inhabitants.                

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A. Kennedy-Hendricks, S.H. Busch, E.E. McGinty, M.A. Bachhuber, J. Niederdeppe, S.E. Gollust, D.W. Webster, D.A. Fiellin, and C.L. Barry. 2016. “Primary Care Physicians’ Perspectives on the Prescription Opioid Epidemic.” Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2016.05.010.                

A national Web-based survey in 2014 received responses from 1,010 primary care physicians (a 29-percent response rate from a [aid physician panel). Respondents largely attributed the causes of prescription opioid use disorder to individual-oriented factors and certain physician-oriented factors. They said that individuals with prescription opioid use disorder and physicians were primarily responsible for addressing the problem. Negative attitudes toward people with prescription opioid use disorder were prevalent, but a majority believed that treatment could be effective. The majority supported for all candidate prevention and response policies, with the strongest support for prescription monitoring of patients potentially at risk for opioid use disorder and for improving physician education and training.                

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T.M. Kilwein, E.L. Goodman, A. Looby, K.P.  De Young. 2016. “Nonmedical Prescription Stimulant Use for Suppressing Appetite and Controlling Body Weight is Uniquely Associated with More Severe Eating Disorder Symptomatology.” International Journal of Eating Disorders, doi:10.1002/eat.22534.                

Online survey of 668 North Dakota college students (79 percent, response rate and year administered unstated, but students received course credit for completing the survey) found that 20.5 percent had used prescription stimulants nonmedically. Of users, 90 percent used for cognitive enhancement, 46 percent used recreationally, 22 percent used for weight loss or appetite control, and 22 percent for other reasons. Those using for weight loss, predictably,  were more likely than other users or than nonusers to report binge eating, body dissatisfaction, negative attitudes toward obesity, restricting, purging, and cognitive restraint. In multivariate regression, current nonmedical use for weight control was associated with eating disorder symptomatology after adjusting for gender, lifetime nonmedical use, and past-month binge eating and purging.                

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D.S. Kroll, H.R. Nieva, A.J. Barsky, and J.A. Linder. 2016. “Benzodiazepines are Prescribed More Frequently to Patients Already at Risk for Benzodiazepine-Related Adverse Events in Primary Care.” Journal of General Internal Medicine, doi:10.1007/s11606-016-3740-0.                

Clinicians prescribed benzodiazepines to 15 percent of the 65,912 patients who visited hospital- and community-based practices in Harvard’s primary care network between July 2011 and June 2012. One in 20 benzodiazepine recipients got a high dose. Multivariate analysis showed benzodiazepine recipients were more likely than other patients to have diagnoses of depression (odds ratio [OR] = 2.7), drug use disorder (OR = 2.2), tobacco use (OR = 1.7), osteoporosis (OR = 1.6), chronic obstructive pulmonary disease (OR = 1.6), alcohol use disorder (OR = 1.5), sleep apnea (OR, 1.5), and asthma (OR, 1.5). Compared to low-dose benzodiazepine recipients, high-dose recipients were even more likely to be diagnosed with drug use disorder (OR = 7.5), alcohol use disorder (OR = 3.2), tobacco use (OR = 2.7), and chronic obstructive pulmonary disease (OR = 1.5). Benzodiazepine recipients had more primary care visits per 100 patients (408 vs. 323), specialist outpatient visits (815 vs. 578), emergency department visits (47 vs. 29), and hospitalizations (26 vs. 15).                

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A. Noormohammadi, A. Forinash, A. Yancey, E. Crannage, K. Campbell, and J. Shyken. 2016. “Buprenorphine versus Methadone for Opioid Dependence in Pregnancy.” Annals of Pharmacotherapy, doi:10.1177/1060028016648367.                

A literature search located 5 articles published from 1966 to March 2016 that compared methadone- and buprenorphine-assisted treatment during pregnancy. Buprenorphine significantly improved or had similar outcomes to methadone for percentage of infants requiring treatment for neonatal abstinence syndrome (NAS; 20 percent to 47 percent vs 45.5 percent to 57 percent), total amount of morphine used to treat NAS (0.5 to 3.4 vs 1.9 to 10.4 mg), duration of NAS (4.1 to 5.6 vs 5.3 to 9.9 days), peak NAS (score 3.9 to 11.0 vs 4.9 to 12.8), infant hospital stay (6.8 to10.6 vs 8.1 to 17.5 days), and gestational age at delivery (38.8 to 39.7 vs 37.9 to 38.8 weeks). No difference was found with other neonatal or maternal outcomes.                

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T. Rieckmann, J. Muench, M.A. McBurnie, M.C. Leo, P. Crawford, D. Ford, J. Stubbs, C. O’Cleirigh, K.H. Mayer, K. Fiscell, N. Wright, M. Doe-Simkin, M. Cuddeback, E. Salisbury-Afshar, and C. Nelson. 2016. “Medication Assisted Treatment for Substance Use Disorders within a National Community Health Center Research Network.” Substance Abuse, doi:10.1080/08897077.2016.1189477.                

Electronic health record data from 572,872 patients served in 2006–13 by a national network of 17 community health centers catering to underserved populations identified 6,080 (1.1 percent) with a documented opioid use disorder diagnosis. Medication-assisted treatment (MAT) was prescribed for 29 percent of disorder patients. Those prescribed MAT were more likely than other misusers to receive HIV screening (odds ratio = 1.3).                

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C. Sankey, B. Setnik, Z. Harsanyi, K. Michalko, Z. Yang, and P. Geoffroy. 2016. “Opioid Use Following the Introduction of an Extended-Release Oxycodone Formulation with Tamper-Resistant Properties: Prospective Historical Chart Review in Methadone-Maintained Patients.” Journal of Opioid Management 12(2):149-59, doi:10.5055/Jom.2016.0327.                

This study examined 250 charts from methadone-maintenance-therapy patients at three methadone clinics in Ontario, Canada, who had data during the time periods when only OxyContin was available (baseline period), during the transition to OxyContin with tamper-resistant properties (OxyNEO), and when only OxyNEO was available. The prospective element included an exploratory questionnaire regarding retrospective opioid use. A marked reduction in oxycodone-positive urine drug screens occurred at each transition point. Morphine-related-positive urine drug screens remained relatively stable during the same periods. The article did not report the trend in hydrocodone screens.                

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Y. Zhou, W. Luo, X.B. Cao, B. Zhang, and Z.Y. Wu. 2016. “Overdose of Heroin and Influencing Factors in Intravenous Drug Users in Parts of Yunnan.” Article in Chinese.  Zhonghua Liu Xing Bing Xue Za Zhi, doi:10.3760/cma.j.issn.0254-6450.2016.05.012.                

During July and August 2015, 340 intravenous drug users were surveyed at four methadone maintenance treatment clinics and two compulsory drug rehabilitation centers in Honghe and Dehong prefectures, Yunnan province of China. The users were 85 male with a mean age of 38. Half were HIV positive and 23 percent misused club drugs (e.g., ephedrine, methamphetamine, benzodiazepines or ketamine in the past year. Overdose rate was 42 percent lifetime (median of 3 overdoses per person who overdosed) and 16 percent in the past year. Dosage increase (26 percent) and multidrug use (28 percent) were the main causes for overdose of heroin. Multivariate regression showed that methadone maintenance treatment during the past year was associated with decreased risk of overdose of heroin (odds ratio [OR] = .53), while needle sharing in the past 6 months (OR = 2.74) and mandatory drug rehabilitation of less than one year (OR = 2.88) were independently associated with increased risk of overdose.                

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D. Zhua, D. Xu, G. Dai, F. Wang, X. Xu, and D. Zhou. 2016. “Beneficial Effects of Tai Chi for Amphetamine-Type Stimulant Dependence: A Pilot Study.” American Journal of Drug and Alcohol Abuse, doi:10.3109/00952990.2016.1153646.                

Sixty men with stimulant dependence from a Shanghai Mandatory Detoxification and Rehabilitation Center participated in a 12-week trial, with half randomized to Tai Chi as a supplement to standard care (recreation activity, a gesture language exercise, and self-education. Test scores in the Tai Chi group significantly improved after 12 weeks in terms of physiology, balance, symptoms, society, and quality of life.                 

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Professional Development & Opinion

D.K. Duong, P.S. O’Sullivan, D.D. Satre, P. Soskin, and J. Satterfield. 2016. “Social Workers as Workplace-Based Instructors of Alcohol and Drug Screening, Brief Intervention, and Referral to Treatment (SBIRT) for Emergency Medicine Residents.” Teaching and Learning in Medicine: An International Journal, doi:10.1080/10401334.2016.1164049.                

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J.A. Jacob. 2016. “As Opioid Prescribing Guidelines Tighten, Mindfulness Meditation Holds Promise for Pain Relief.” JAMA, doi:10.1001/jama.2016.4875.                

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A.G. Lipman. 2016. “Evolving Government Policy on Opioid Availability and Use Is a Double-edged Sword.” Journal of Pain & Palliative Care Pharmacotherapy, doi:10.3109/15360288.2016.1173764.                

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B. Saloner, and J. Sharfstein. 2016. “A Stronger Treatment System for Opioid Use Disorders.” JAMA 315(20):2165–6, doi:10.1001/jama.2016.3674.                

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L.R. Webster. 2016. “Chronic Pain and the Opioid Conundrum.” Anesthesiology Clinics 34(2):341–55, doi:10.1016/j.anclin.2016.01.002.                

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Opioid Prescriptions Decline for First Time in 20 Years; Fatal Overdoses Still Climbing                
Samantha Olson, Medical Daily                
May 22, 2016                 

IMS Health reported that for the first time in two decades, prescriptions for opioid pain relievers declined in the United States. In 2015, nearly 17 million fewer prescriptions were filled for opioid pain-relievers than in 2014.                

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Where People Drink the Most Booze and Do the Most Drugs                
Keith Humphreys, Washington Post                
May 23, 2016                

SAMHSA’s annual survey of Americans ages 12 and older shows whether they use opioid pain relievers for nonmedical reasons or consume any marijuana, alcohol, or cocaine. States are ranked into quintiles based on what proportion of their population uses each substance. Colorado is the only top consumer of all four substances. Washington, Alaska, and Oregon are heavy consumers of marijuana and Oregon is also a leader in nonmedical use of prescription opioids. None of the New England states is among the nation’s highest for nonmedical consumption of prescription pain relievers. Vermont, Massachusetts, and New Hampshire are leading consumers of alcohol, marijuana and cocaine, with Maine and Connecticut also being leaders in two of those three. New York is a top consumer of cocaine only. Washington, D.C., ranks among the nation’s leaders for cocaine, alcohol, and marijuana use. The top states for nonmedical pain reliever use in the Southeast and “Bible Belt” are Oklahoma, Arkansas, Louisiana, Alabama, Virginia, Maryland and Ohio. The Midwest and Plains states are not leading consumers of any of the three illicit drugs. In the west, California, Arizona, and New Mexico have a substantial consumption of cocaine. Arizona is also a leader in nonmedical use of opioid pain relievers.                

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Senator Calls for Investigation of Purdue Pharma Following Story on Oxycontin                
Harriet Ryan, Los Angeles Times                
May 27, 2016                

In response to a Los Angeles Times report, Sen. Edward Markey (D-Mass.) urged the Justice Department, FDA, and Federal Trade Commission to launch a probe of Purdue Pharma. The report revealed that Purdue knew and failed to disclose that Oxycontin wears off early in many patients, exposing them to increased risk of addiction. Markey wrote in a letter that “if warranted” the Justice Department should try to recoup “taxpayer dollars that federal healthcare programs may have needlessly and unnecessarily spent on OxyContin prescriptions.” The FDA is reviewing Markey’s letter and will respond directly to him.                

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Does Workplace Drug Testing Work?                
Bob McCormick, Quest Diagnostics                
April 15, 2016                

Quest Diagnostics argues that drug testing works. It drives down drug positivity. This leading testing firm argues employers should continue to strive to keep their workforces drug-free. To support this conclusion, it highlighted how people under the influence of drugs perform their jobs duties, the trend in worker drug use, and the effectiveness of workplace testing in discouraging use                

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A Deadly Crisis: Mapping the Spread of America’s Drug Overdose Epidemic                
Nadja Popovich, The Guardian                
May 25, 2016                

The Guardian mapped 16-years of county-level data on drug overdose deaths that the Centers for Disease Control and Prevention released this year. The overdose epidemic spread from a few concentrated pockets in Appalachia and northern New Mexico to nearly every corner of America from 1999–2014.                 

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New Anthem Program Aims to Fight Opioid, Prescription Drug Abuse                
New Hampshire Union Leader                
May 25, 2016                

Anthem Blue Cross and Blue Shield launched the Pharmacy Home Program on April 1 to help address opioid addiction and prescription drug misuse. The program focuses on a small, high-risk segment of members who are using multiple prescribers or different pharmacies to obtain medications. Program members who do not change their behavior within two months of written notification will be asked to choose a single home pharmacy to fill all prescriptions.                 

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State Medicaid Agencies Limiting Opioid Prescriptions                
Virgil Dickson, Modern Healthcare                
May 26, 2016                

State Medicaid agencies are limiting how many opioids providers can prescribe. Medicaid beneficiaries are prescribed pain relievers at twice the rate of other patients and are at three to six times the risk of opioid overdose. North Carolina, for example, found that while the Medicaid population represented approximately 20 percent of the overall state population, it accounted for one-third of drug overdose deaths. Since 2014, Colorado has limited short-acting opioid prescriptions to a maximum of four tablets a day or 120 tablets per 30 days. In February, it also limited use of long-acting opioids. Colorado saved $629,000 as a result of the 2014 policy change. Starting October 1, Medicaid providers in Nebraska will be limited to prescribing five pills a day or 150 tablets per 30-day period for short-acting opioids. These changes require educating doctors and patients.                

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Could This Implant Be the New Weapon Against Opioid, Heroin Addiction?                
The Charlotte Observer                
May 24, 2016                

The FDA is considering an approval application for a Probuphine implant by Braeburn Pharmaceuticals. The product would provide 6 months of continuous medication for opioid dependence. The implant’s safety and effectiveness have not been proven.                

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V.A. Hill, M.I. Schaffer, and G.N. Stowe. 2016. “Carboxy-THC in Washed Hair: Still the Reliable Indicator of Marijuana Ingestion.” Journal of Analytical Toxicology 40(5):345–9, doi:10.1093/jat/bkw031.                  

During hair analysis, the removal of any potential11-nor-9-carboxy-delta-9-tetrahydrocannabinol (C-THC) external contamination that could result from marijuana smoke or close personal contact via a wash procedure is critical. Researchers performed a series of experiments to demonstrate that C-THC is the reliable indicator of marijuana ingestion when paired with the correct washing procedure to remove potential external contamination.                  

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L.A. Lin, M.A. Ilgen, M. Jannausch, And K.M. Bohnert. 2016. “Comparing Adults Who Use Cannabis Medically with Those Who Use Recreationally: Results from a National Sample.” Addictive Behaviors, doi:10.1016/j.addbeh.2016.05.015.                  

Using 2013 National Survey on Drug Use and Health data, adults who used cannabis in the past year and lived in a state that had legalized medical cannabis were divided into recreational-only and medical users. Seventeen percent of users used cannabis medically. The two groups of users did not differ in race, education, past year depression and prevalence of cannabis use disorders. Multivariate analysis showed medical cannabis users were more likely than recreational users to report poor health and had lower levels of alcohol use disorders and non-cannabis drug use. A third of medical cannabis users used daily compared to 11 percent of recreational users.                  

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Medical Marijuana and an Employer’s Rights in D.C., Maryland, and Virginia                  
Daniel Deacon, Conn Maciel Carey PLLC                  
May 25, 2016                  

Washington, D.C., Maryland, and Virginia have legalized medical marijuana. Courts in jurisdictions where medical marijuana is legal consistently have ruled that an employer may maintain a drug-free workplace and terminate an employee for failing a drug test. The author recommends that employers evaluate their current drug policies with respect to drug-use and drug testing, and continue to monitor changes in state laws surrounding the use of medical marijuana. Policies with an imprecise definition of “illegal drug” may lead employees to believe using medical marijuana is not prohibited because it is “legal” under state law. The definition of “illegal drugs” for zero-tolerance employers should be clearly stated, and employers should emphasize that the policy prohibits the use of any drug that is illegal under federal law, including marijuana. National employers should pay attention to each individual state’s laws where employees are located and confirm that their handbook complies with each state’s laws.                   

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Smoking Out the Tristate Area: Employer Concerns with Local Medical Marijuana Laws                  
Gina R. Merrill, Samuel Sverdlov and Meredith-Anne Berger, Seyfarth Shaw LLP                  
May 17, 2016                  

This article provides employers with practical guidance on medical marijuana laws in New York, New Jersey, and Connecticut. The authors do not expect employers in the tristate area to experience a high volume of employees presenting issues related to medical marijuana. However, employers should be aware of their obligations under these laws and are encouraged to: consult with employment counsel immediately if employees come to work under the influence of marijuana, or if employee performance declines and marijuana is suspected to be at issue; review employer policies and employee handbooks to ensure that drug-free workplace policies are in compliance with the law; and educate managers and supervisors regarding their responsibilities and obligations under the law. [Editor’s note: Weekly Update has not verified the accuracy of the legal opinions stated in this article.]                  

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Medical Marijuana Advocates Frustrated by Slow Pace in Maryland                  
Aaron Gregg and Fenit Nirappil                  
May 22, 2016                  

Maryland’s medical marijuana commission capped the number of businesses that can process marijuana into pills, oils, and other products. It also gave conflicting information about when the first growing licenses would be issued. Marijuana advocates and entrepreneurs have grown frustrated with the slow process and its secrecy. An analysis by the advocacy group Marijuana Policy Project found Maryland to be among the slowest states to get its approved cannabis program up and running. The commission was supposed to start awarding licenses to grow marijuana for medical use in January but has shifted issuance to July.                  

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New Jersey Vets Need Medical Marijuana for Posttraumatic Stress, Patients Say                  
Susan K. Livio, NJ Advance Media                  
May 25, 2016                  

The NJ Medicinal Marijuana Review Panel listened to veterans talk about the need for medical marijuana for posttraumatic stress disorder and other ailments. The panel will make recommendations to the acting New Jersey Health Commissioner who will decide whether the medical marijuana program should help a larger group of people. The health department will also seek suggestions from the public about which conditions should be added to the list. There were 6,126 active patients in the medical marijuana program in 2015. Jim Miller from the Coalition for Medical Marijuana for New Jersey pointed out that more than 600 participants in the program have already died, a sign of those severely ill.                  

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Temptation Grows in Australia to Use Drugs to Stay Awake in the Workplace                
Anna Patty, Sydney Morning Herald                
May 26, 2016                

Psychiatrists and drug experts in the United States and Australia warn that people are using Modafinil, a narcolepsy prescription drug, because it appears to result in fewer symptoms associated with cognitive enhancing drugs. Employees in law firms, financial institutions, and other workplaces use these drugs to stay awake for long hours. This is a bad idea and could lead to health problems. To change the work culture, this reporter suggests a law firm could get rid of billable hours.                 

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Australian Pharmacist Drugged Colleague 23 Times for Rebuffing Sexual Advances                
Rachel Olding, Sydney Morning Herald                
May 24 2016                

Yan Chi “Anthony” Cheung, an Australian pharmacist, admitted to drugging his colleague 23 times with prescription drugs because she refused his sexual advances. He then started putting prescription drugs in her water and coffee. Over a year, he drugged his colleague with phenergan, doxylamine, endep, Seroquel, and deptran. The drugs made his colleague drowsy, so she had to take naps on the pharmacy storeroom. Some drugs cause infertility over prolonged use. His colleague reviewed store video footage when she noticed that her water tasted odd. Cheung was terminated from the pharmacy and reported to the Pharmacy Guild. Cheung pleaded guilty to one count of poisoning to injure or cause distress or pain; he will be sentenced in June.                

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Why Your Prescription Drug Could Get You Banned from the Roads in England                
Lorna Hughes, Echo                
May 22, 2016                

Officials are urging motorists to check if their prescription drugs could get them charged with drug driving and banned from the roads. England set driving limits for prescription drugs and introduced new road-side drug screening devices 12 months ago. Since March 2015 the number of people charged with drug driving has increased 140 percent. The author recommends that individuals read their drug safety brochures before driving, ask the pharmacists, or do not drive. This article includes a list of legal medications that could result in a drug-driving charge.                

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Activists: Canada’s Prescription Drug Drop-Off Day Not Enough to Stem Abuse                
Rachel Ward, CBC News                
May 21, 2016                

Activists feel Canada’s National Prescription Drug Drop-Off Day does not do enough to address prescription drug misuse. Amy Graves, founder of Get Prescription Drugs Off the Street, hopes people do not get a false sense of security about the drugs being out of the medicine cabinet. It is an ongoing problem and some addicts get their drugs on the street or with a prescription that a doctor gave them. Graves, who lost her brother to an overdose, believes Drop-Off Day raises awareness but it has little effect on the issue. She recommends that people be allowed to drop-off prescription drugs any time.                 

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Northeast/Mid-Atlantic News

Rhode Island House Passes Bill to Expand Access to Prescription Database                
State of Rhode Island General Assembly                
May 25, 2016                

The Rhode Island House of Representatives passed legislation that would authorize any vendor, agent, contractor, or designee who operates an electronic medical health record or clinical management system to access the prescription drug monitoring program.                 

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http://www.rilin.state.ri.us/pressrelease/_layouts/RIL.PressRelease.ListStructure/Forms/                 DisplayForm.aspx?List=c8baae31-3c10-431c-8dcd-9dbbe21ce3e9&ID=11887                                  

Washington County (Penn.) Honors First Responders Who Prevented Overdose Deaths                
Lily Oppenheimer, Pittsburgh Post-Gazette                
May 24, 2016                

Pennsylvania honored 46 first responders who revived 61 overdose victims with Narcan in Washington County. Since July 1, more than 600 first responders were trained.                

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New Hampshire Attorney General to Investigate Deceptive Drug Marketing                
Jeremy Blackman, Concord Monitor                
May 20, 2016                

New Hampshire prosecutors got approval from the Joint Legislative Fiscal Committee to hire outside lawyers to help investigate marketing practices of companies that manufacture powerful prescription pain relievers. The attorney general’s office will pay a law firm to examine whether five drug companies have deceptively minimized the addictive risks of their pain relievers in the state. The drug companies are appealing the approval.                

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Elderly New York Woman Accused of Selling Drugs                
May 26, 2016                

Laura Viehdeffer, age 85, allegedly sold prescription medication to an uncover officer. She is facing counts of criminal sales and possession of a controlled substance, punishable by up to 25 years in prison. Viehdeffer takes Hydrocodone prescribed by her doctor for arthritis. She admits to giving the drug to a friend who wanted them for her husband. He suffers from chronic back pain and has no access to medication. An informant alleged that Viehdeffer may have been selling pills on a regular basis, so the Genesee County Drug Task Force began an investigation.                

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Harvard Med Students Take Battle Against Opioid Epidemic into Their Own Hands                
Michael McLaughlin, Huffington Post                
May 23, 2016                

This semester, 19 students at Harvard’s Center for Primary Care arranged for optional trainings on administering buprenorphine. Only resident physicians or doctors who receive a U.S. Drug Enforcement Administration (DEA) waiver after completing an eight-hour course can prescribe the drug. The students took the course required by the DEA and appear to be the first to receive the training prior to obtaining their medical degree. Also this semester, about 200 Harvard students learned how to use naloxone. Some students who took the training then taught nurses and other medical professionals around Boston how to use the antidote. (Includes video: 1:38 minutes)                

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University of Pennsylvania Professor on Why Dentists Write Too Many Scripts                
Paul Jablow, Inquirer Daily News                
May 27, 2016                

Elliot Hersh, a professor at the University of Pennsylvania dental school who specializes in pharmacology, believes dentists write too many scripts because of habit. Some practitioners have been writing opioid prescriptions for years and have not kept up with the effectiveness of alternate drugs. In other cases, they are anticipating a pain level that might occur in only a small minority of patients. Patient demand is another reason. An unhappy patient delivers a bad rating that can damage a dental or medical practice. Carlos Aquino, a retired police officer who lectures to Hersh’s students, suggests that they stick with what they know: dentistry not pain anagement.                

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South News

West Virginia Sues McKesson Corporation for Incentivizing Opioid Sales                
May 25, 2016                

West Virginia is suing McKesson Corporation, the nation’s largest drug supplier, for allegedly distributing pain relievers irresponsibly and incentivizing opioid sales. The Drug Enforcement Administration, along with six states, sued McKesson in 2008 for supplying hundreds of suspicious hydrocodone orders to rogue pharmacies. McKesson settled, paying more than $13 million in fines and agreeing to closely monitor their pill supply. The company started violating the law again and the wholesaler paid $150 million in fines and had distribution centers suspend operations in four states. Now, West Virginia is suing McKesson after records revealed the wholesaler delivered nearly 100 million doses of opiates to a state with 1.8 million people in a five-year period. (Includes video: 4:09 minutes)                

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Drug Firms Shipped Thousands of Pills to Rural West Virginia                
Associated Press                
May 24, 2016                

A Boone County judge ordered the release of previously sealed court documents about prescription pain pill shipments to West Virginia. The drug distributors wanted to keep the pill shipment numbers sealed. The attorney general’s office and other agencies allege the firms helped fuel the prescription drug problem in the state. Court records show the drug distributors shipped large quantities of oxycodone and hydrocodone tablets to small towns like War, Kermit, Oceana, Van, and Crab Orchard. The records show one distributor shipped more than 300,000 hydrocodone tablets over four years to a pharmacy in War, population 808. Records show another distributor supplied 149,000 hydrocodone pills to a pharmacy in Williamson in 2009.                

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CVS and Walgreens to Sell Nalaxone Without a Prescription in Louisiana                
David J. Mitchell, The Advocate                
May 26, 2016                

CVS Pharmacy will make naloxone available without a prescription in all 132 of its Louisiana pharmacies by early June. Walgreens also will make available the drug without a prescription in its 157 pharmacies by the end of the year. Pharmacists will provide counseling on how to administer the antidote.                 

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West Virginia Prescription Drug Plan Gains Support of State Nursing Board                
Chris Dickerson, West Virginia Record                
May 24, 2016                

West Virginia’s Board of Examiners for Registered Professional Nurses supports the attorney general’s plan to eradicate prescription drug misuse. The draft best practices offer recommendations for prescribers and pharmacists who prescribe or dispense opioid prescriptions.  The best practices project underscores the importance of using the state’s prescription drug monitoring program; educating patients about safe use, storage and disposal of opioid drugs; and incorporating naloxone into opioid treatment discussions.                 

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More Florida Workers Failing Pre-Employment Drug Tests                
Jenny Dean, WTSP                
May 24, 2016                

Employers are having problems finding workers who can pass a drug test in Tampa, Fla. Prologistix, a Tampa staffing agency, gets about 50 people who apply for work daily; however, 10 to 15 percent cannot pass a drug test. The agency provides warehouse and distribution employees to companies. If applicants do not pass a drug test, they are not eligible for rehire for two years. USA Mobile Drug Testing of West Central Florida conducts a five panel test, which checks for illegal drugs, and a 10 panel, which tests for commonly misused prescription medications. Marijuana is the most common drug people test positive for.                  

Read more:                

Midwest News

St. Louis Alderman Vote to Create Prescription Drug Database                
Dan Greenwald, KMOV                
May 20, 2016                

The St. Louis City Board of Aldermen voted to create a prescription drug monitoring program (PDMP). St. Louis County already created a similar program. Missouri is only state in the country without a PDMP.                

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Allegations Surface of Drug Abuse by University of Minnesota Wrestlers                
Liz Sawyer, Star Tribune                
May 25, 2016                

J. Robinson, the University of Minnesota wrestling coach, is being investigated as part of allegations that wresting team members are misusing prescription drugs. Four athletes are under investigation for dealing Xanax, and 10 others are suspected of using the anti-anxiety medication recreationally. Robinson is under investigation for how he dealt with players who admitted to using narcotics this spring.                 

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Mallinckrodt Donates 250,000 Drug Deactivation Systems to ACT Missouri                
PR Newswire                
May 23, 2016                

Mallinckrodt Pharmaceuticals purchased and donated 250,000 drug deactivation systems to ACT Missouri as a safe way for individuals to dispose of unused medications. The pouch-based systems deactivate prescription drugs and render chemical compounds safe for landfills.                 

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Tennessee Successfully Petitions FDA for Action to Help Prevent Opioid Abuse                
Tennessee Department of Health                
May 23, 2016                

The Tennessee Neonatal Abstinence Working Group in March successfully petitioned the FDA to expand its black box warning to include certain immediate-release pain medicines. Black box warnings provide information about the effects of prescribed medications including potential for addiction, misuse, overdose and death. They can help clinicians make better decisions when caring for patients.                 

Read more:                

West News

New Laws Aim to Help Arizona Curb Drug Overdose, Abuse, Deaths                
Associated Press                
May 24, 2016                

Arizona passed two laws to address the opioid epidemic. One will require doctors to check the state’s prescription drug monitoring program before prescribing pain medications, effective this October. The second will allow pharmacies to dispense naloxone without a prescription starting in August. The law also gives immunity from liability to doctors and pharmacists who dispense the drug and to anyone who administers it in good faith.                

Read more:                

Opioid-Related Measures Look to Reduce Drug Abuse and Overdoses in Hawaii                
Hawaii News Now                
May 24, 2016                

Hawaii passed legislation that provides immunity to health care providers and pharmacies who prescribe, dispense, and distribute naloxone. It also authorizes emergency personnel and first responders to administer the drug. If the governor signs the bill, it will take effect Jan. 1, 2017. Hawaii passed another law that updates the Uniform Controlled Substances Act to make it consistent with amendments in federal controlled substances law. This bill is also awaiting the governor’s signature. (Includes video: 2:55 minutes)                

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Denver Hearing Assesses Veterans Affairs Hospitals’ Prescription Drug Oversight                
Lance Hernandez, ABC Denver                
May 20, 2016                

Rep. Mike Coffman’s (R-Colo.) Subcommittee on Oversight and Investigations held a rare field hearing in Denver to assess a Veterans Affairs (VA) hospital’s oversight of controlled substances. Coffman had learned about drug abuse at the hospital and thinks the VA needs to do more to make sure narcotics and prescription drugs are not stolen. Also, a recent audit by the U.S. Drug Enforcement Administration showed mail room employees with drug-related convictions have access to controlled substances. That finding raises questions about whether proper background checks were conducted and whether the hospital’s random drug testing is adequate. The audit also determined that inventories of 16 of 27 controlled medications checked did not balance with receiving, dispensing, and destruction records. (Includes video: 2:26 minutes)                

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Anchorage (Alaska) Doctor Accused of Overprescribing Opioids to Patients                
Shannon Ballard, KTVA                  
May 24, 2016                

The Alaska State Medical Board accused Mahmood Ahmad, M.D., of overprescribing pain relievers. The board suspended Ahmad’s medical license earlier this month. The state received multiple reports from pharmacists that Dr. Ahmad was prescribing large amounts of high-strength controlled substances to patients who had little or no history of pain management prescriptions. A pain relief expert found that in just a five-month span last year, Ahmad wrote over 700 prescriptions. Every patient received a prescription for high dose controlled substances and frequently in combination with benzodiazepines. In 2013, Ahmad was under investigation by the Arkansas State Medical Board for prescribing an excessive amount of controlled substances, but he failed to disclose this when he applied for his license in Alaska. Arkansas reactivated his license in 2015 to allow him to continue practicing. A hearing is scheduled to decide if Ahmad will be allowed to continue to practice medicine in Alaska. (Includes video: 1:17 minutes)                

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University of New Mexico, Indian Health Service Partner to Tackle Opioid Abuse                
University of New Mexico                
May 23, 2016                

The University of New Mexico is training more than 1,200 Indian Health Service prescribers in hopes of reducing the disproportionate misuse of opioids among Native Americans. The six-hour training provides feedback from participants to gauge the program’s effectiveness. It includes an overview of the problem, screening for opioid addiction or misuse, alternative treatments for pain, safe prescribing practices, federal regulations in prescribing opioids, and a question-and-answer session. The training will use telehealth technology to share best practices in chronic pain management with health care providers.                

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Women and Chronic Pain in Salt Lake City                
U.S. Department of Veterans Affairs                
May 26, 2016                

In 2013, Jamie Clinton-Lont, a nurse practitioner and Medical Director for Women’s Services at Salt Lake City, and her co-worker, launched the Women’s Pain Management Program to help women veterans learn how to cope with chronic pain. More than 100 women are participating in the program. Several have weaned themselves off opioids, but most are still on pain medication. The program emphasizes mindfulness, healthy lifestyles, and exercise to help divert attention away from pain. Participants attend a pain education class once every six months where they learn about the medications they are taking and how to take them correctly. The women also get to choose the type of therapy they want. They have six options: Trauma Sensitive Yoga, Living Well with Chronic Conditions, Managing Stress, Aquatic Therapy, Mindfulness Meditation, and Cognitive Behavioral Therapy. Everyone gets to switch to a different therapy every few months so they can eventually experience all six.                

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Intermountain Healthcare Community Pharmacies Help Address Utah’s Opioid Epidemic                
EIN Presswire                
May 26, 2016                

Intermountain Healthcare will begin training pharmacists to prescribe naloxone. Individuals can now visit their pharmacies in Utah and purchase naloxone without a prescription. Patients will also receive additional education which includes proper use, safe storage, how to prevent theft and misuse, and disposal of unused medications. Free drop off sites are also available at all Intermountain community pharmacies.                 

Read more:                


Human Rights, Accommodation and Medical Marijuana in the Workplace                
Canadian HR Compliance & Management                
June 8, 2016                 
12–1 p.m. (ET)                

Grant Announcements

Enhanced State Surveillance of Opioid-Involved Morbidity and Mortality                
National Center for Injury Prevention and Control                
Due: June 27, 2016                 

Bottle Tracking Program                
National Association of Drug Diversion Investigators                
Due: None Specified                

Take-Back Events & Drop Boxes

Community Turns Over 215 Lbs. of Prescriptions in Niagara (Canada) Drug Drop-Off                
Mitch Harasym, Ontario Police Reports                
May 27, 2016                

Mooresville (N.C.) Drug Take-Back Collects 72 Lbs.                
Megan Sprague, Mooresville Tribune                
May 25, 2016                

Prescription Drug Drop Off a Success in Quebec (Canada)                
The News                
May 21, 2016                

Prescription Drug Drop Off in Orillia (Canada)                
Orillia Packet & Times                
May 22, 2016                

Middletown (N.Y.) Cares Coalition Provides City with Permanent Prescription Drug Box                
May 21, 2016                

How and Where to Dump Your Leftover Drugs Responsibly in California                
Emily Bazer, Kaiser Health News                
May 27, 2016                

Upcoming Events, Conferences, & Workshops

National Rx Drug Abuse & Heroin Summit                
Operation Unite                
April 17–20, 2017                
Atlanta, Ga.                

This summit is for decision makers and allied professionals working to address prescription drug misuse and heroin epidemic in their communities.                

Read more:                

Call for Presentations                
Submission Deadline Date: Friday, Aug. 5, 2016                

2016 Conference: Saving Lives: Access to Improved Health & Recovery                
American Association for the Treatment of Opioid Dependence                
Oct. 29–Nov. 2, 2016                
Baltimore Marriott Waterfront                
700 Aliceanna Street                
Baltimore, Md.                

Conference objectives include presenting the latest evidence relevant to the field and critically evaluating the implications for patients, clinicians, administrators, and policy makers; developing strategies to assist healthcare partnerships and collaborations by advancing their understanding of medication assisted treatment as a crucial element to community wellness in an era of healthcare reform; and discussing the magnitude and impact of prescription opioids on the healthcare system and opioid treatment programs.                

Read more:                


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                
Westin Arlington Gateway                
801 North Glebe Road                
Arlington, Va.                

This 3-day summit focuses on bridging the gaps between legal, consumer protection, enforcement, and medical to address the public health epidemic od drug and opioid dependence and misuse.                 

Read more:                

American Pharmacists Association Institute on Alcoholism and Drug Dependencies                
American Pharmacists Association                
June 3–6, 2016                 
Salt Lake City, Utah                

International Conference on Opioids                
Journal of Opioid Management                
June 5–7, 2016                
Boston, Mass.                

2016 Annual Conference                
International Health Facility Diversion Association                
Sept. 13–14, 2016                
Duke Energy Convention Center                
Cincinnati, Ohio                 


Twenty-Ninth Annual National Prevention Network Conference                
National Prevention Network                
Sept. 13–15, 2016                
Buffalo, N.Y.                

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.