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June 23, 2016

PAW Weekly Update

SAMHSA Prescription Drug Abuse Weekly Update
Issue 179  |  June 23, 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.
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Dark Shadows: Drug Abuse and Addiction in the Veterinary Workplace
Jon Geller, DVM360 Magazine
June 16, 2016

Veterinarians experience higher than average levels of workplace stress, depression, and suicidal ideation due to long hours, economic challenges, and other issues. They also have increased access to potentially addictive and deadly drugs, including controlled and non-controlled substances. Vulnerability and access lead to a high risk of misuse and addiction. An online survey of 368 veterinarians found that 72 percent said they had worked with someone they suspected of having a drug problem, and more than 40 percent said they knew at least two people who fit that description. Only 30 percent of respondents reported any drug testing in their workplaces, with 18 percent testing pre-employment, 18 percent for cause; and 8 percent randomly. Moreover, 23 percent of testers excluded veterinarians from the testing. The survey found drug control procedures were relatively lax, employee assistance programs were few, and health insurance coverage for drug use disorder treatment was uncommon. The author started this research after two of his veterinary practice staff died from drug overdoses.

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A. Kennedy-Hendricks, A. Gielen, E. McDonald, E.E. McGinty, W. Shields, and C.L. Barry. 2016. “Medication Sharing, Storage, and Disposal Practices for Opioid Medications Among US Adults.” JAMA Internal Medicine, doi:10.1001/jamainternmed.2016.2543.

A survey in February and March 2015 used GfK’s paid KnowledgePanel to poll a national sample of 1,032 U.S. adults with recent opioid medication use. Among the 592 respondents who were no longer using prescription pain relievers at the time of survey, 60.6 percent reported having leftover pills. And, 61.3 percent of those with leftover pills said they had kept them for future use rather than disposing of them. Among all respondents, one-in-five reported they had shared their medication with another person, with a large number saying they gave them to someone who needed them for pain. Nearly 14 percent said they were likely to share their prescription pain relievers with a family member in the future and nearly eight percent said they would share with a close friend. Fewer than 10 percent said they kept their opioid pain medication in a locked location. Nearly half said they were not given information on safe storage or proper disposal of leftover medication. More than 69 percent of those who got instructions said they had received information about turning over the remaining medication to a pharmacist or a take-back program, but few actually did. Fewer than 10 percent reported throwing leftover medication out in the trash after mixing it with used coffee grounds, sawdust, or moistened kitty litter.

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Journal Articles and Reports

H.D. Chilcoat, P.M. Coplan, V. Harikrishnan, and L. Alexander. 2016. Decreased Diversion by Doctor-Shopping for a Reformulated Extended Release Oxycodone Product. Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2016.06.009.

Analysis of IMS LRx longitudinal data covering more than 150 million patients and 65 percent of retail U.S. prescriptions showed that introduction of reformulated extended release (ER) OxyContin with abuse-deterrent properties reduced the rate of doctor-shopping by 50 percent (for 2+ prescribers/3+ pharmacies) for ER Oxycontin, but not for comparator opioids. The largest decreases in rates occurred among young adults (73 percent), those paying with cash (61 percent) and those receiving the highest available dose (62 percent), with a 90 percent decrease when stratifying by all three characteristics. The magnitude of doctor-shopping reductions increased with increasing number of prescribers/pharmacies (e.g., 75 percent reduction for 2+ prescribers/4+ pharmacies). The study compared July 2009 to June 2010 and January 2011to June 2013.

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D. Clements, J.C. Lopez, S. Rachakonda, K. Sedky, and A. Pumariega. 2016. “Physical Pain, Opiate Prescription Medications, and Heroin Addiction: A Case Series.” Addictive Disorders & Their Treatment, doi:10.1097/ADT.0000000000000089.

A case series and literature review illustrated how medical and psychiatric disorders play a major role in the tragic transition some patients make from prescription analgesics to illicit heroin.

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N.J. Connors and L.S. Nelson. 2016. “The Evolution of Recommended Naloxone Dosing for Opioid Overdose by Medical Specialty.” Journal of Medical Toxicology, DOI10.1007/s13181-016-0559-3.

A convenience sample of commonly available references was queried for the recommended intravenous naloxone dose. When dosing recommendations were different for opioid-tolerant patients these were also recorded. Twenty-five references were located. Forty-eight percent recommended a starting dose ≤ 0.05 mg while 36 percent recommend a dose 10-fold higher. More than half of medical toxicology and general medical sources recommended a low-dose strategy with a starting dose lower than 0.05 mg intravenously. The inconsistency in dosing guidelines may in part reflect the difference between clinical administration and administration by laypersons at an overdose scene. Nevertheless, with rapidly rising naloxone use, empirically based consensus dosing guidelines clearly are needed.

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A.B. Jena, D. Goldman, and P. Karaca-Mandic. 2016. “Hospital Prescribing of Opioids to Medicare Beneficiaries.” JAMA Internal Medicine, doi:10.1001/jamainternmed.2016.2737.

In a 20 percent random sample of Medicare beneficiaries hospitalized in 2011 without an opioid prescription claim in the 60 days before hospitalization (623,957 hospitalizations), 92,882 (14.9 percent) had an opioid claim within 7 days of hospital discharge. Among that group, by day 90 post-discharge, 15,790 had died and 32,731 (42.5 percent of survivors) were still taking opioids. In multivariate analysis controlling for patient mix, across 2512 hospitals, the rate of new opioid use was modestly positively associated with the percentage of inpatients reporting that their pain was always well controlled in 2011 Hospital Consumer Assessment of Healthcare Providers and Systems surveys. An increase from the 25th to the 75th percentile on this performance measure was associated with an absolute increase in new opioid users of 0.9 percentage points (a 6.0 percent increase in users).

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M.C. Otterstatter, A. Amlani, H. Guan, L. Richardson, and J.A. Buxton. 2016. “Illicit Drug Overdose Deaths Resulting from Income Assistance Payments: Analysis of the ‘Check Effect’ Using Daily Mortality Data.” International Journal of Drug Policy, doi:10.1016/j.drugpo.2016.05.010.

Daily time series regression on 2009–13 British Columbia, Canada, coroners service data found illicit drug overdose mortality was 40 percent higher during weeks with income assistance payments compared to weeks without payments. Mortality increased the day after check disbursement, were significantly higher for two days, and marginally higher after 3 days. The data included 1343 overdose deaths, with 394 during 60 check weeks (6.5/week), and 949 occurred during 202 non-check weeks (4.5/week).

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O.A. Oluwoye, A.L. Merianos, and L.A. Nabors. 2016. “Nonmedical Use of Prescription Drugs and Peer Norms Among Adolescents by Race/Ethnicity.” Journal of Substance Use, doi:10.1080/14659891.2016.1177615.

In the 2013 National Survey on Drug Use and Health, 6 percent of youth ages 12–17 (N = 17,736) reported any nonmedical use of prescription drugs in the past year. Multivariate logistic regression analysis, not surprisingly, students who reported most/all students in their grade use substances were more likely to use any nonmedical prescription drug than students who reported none/few in their grade use substances. This finding largely held across races.

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R.L. Peralta, B.C. Stewart, J.L. Steele, and F.A. Wagner. 2016. “Nonmedical Use of Prescription Drugs in Emerging Adulthood: Differentiating Sex from Gender.” Addiction Research & Theory, doi:10.3109/16066359.2016.1140745.

In online survey data collected during the 2013–14 academic year from a convenience sample of 796 college students taking introduction to sociology at a midsize Ohio university (a 78 percent response rate), 30 percent had used prescription drugs nonmedically with males (37 percent) self-reporting lifetime use more often than females (25 percent). After assessing gender-orientation, masculine males and masculine females reported the highest frequency of nonmedical use (38 percent and 35 percent respectively), significantly above feminine men and feminine women (26 percent and 25 percent respectively).

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W.A. Ray, C.P. Chung, K.T. Murray, K. Hall, and C.M. Stein. 2016. “Prescription of Long-Acting Opioids and Mortality in Patients with Chronic Noncancer Pain.” JAMA, doi:10.1001/jama.2016.7789.

Analysis of 1999–2012 Tennessee Medicaid data identified 22,912 new episodes of prescribed therapy for long-acting opioids or control medications (analgesic anticonvulsants or low-dose cyclic antidepressants) among propensity-score-matched patients with chronic noncancer pain and no evidence of palliative or end-of-life care. The long-acting opioid group was followed for a mean 176 days and had 185 deaths and the control treatment group was followed for a mean 128 days and had 87 deaths. The hazard ratio (HR) for total mortality among opioid users was 1.64 with a risk difference of 68.5 excess deaths per 10,000 person-years. Increased risk was due to out-of-hospital deaths (HR = 1.90; risk difference = 67.1 excess deaths per 10,000 person-years). For out-of-hospital deaths other than unintentional overdose, the HR was 1.72 with a risk difference of 47.4 excess deaths per 10,000 person-years. The HR for cardiovascular deaths was 1.65 with a risk difference of 28.9 excess deaths per 10,000 person-years. The HR during the first 30 days of therapy was 4.16 with a risk difference of 200 excess deaths per 10,000 person-years.

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M.D. Stein, M. Kanabar, B.J. Anderson, A. Lembke, and G.L. Bailey. 2016. “Reasons for Benzodiazepine Use Among Persons Seeking Opioid Detoxification.” Journal of Substance Abuse Treatment, doi:10.1016/j.jsat.2016.06.008.

In a September 2014 to May 2015 survey of 438 consecutive persons initiating inpatient opioid detoxification in Fall River, Mass., 40 percent used a benzodiazepine for an average of 13 days in the month prior to admission, and 25 percent of these met Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria for benzodiazepine dependence. Users averaged 32 years of age, 64 percent were male, and 85 percent used heroin. Alprazolam (Xanax) was the most commonly used benzodiazepine (52 percent), and buying it on the street the most common source (48 percent). The most commonly reported reason for use was to manage anxiety (43 percent), followed by to get or enhance a high (28 percent), to help with sleep (11 percent), and to decrease opioid withdrawal (10 percent). The 23 percent who were prescribed the drug were more likely to report anxiety as their primary reason for use.

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J. Timonen, H. Kauppinen, and R. Ahonen. 2016. “Impact of Electronic Prescription on the Job Descriptions of Community Pharmacy Staff in Finland—A Survey of Pharmacy Owners.” Journal of Pharmaceutical Health Services Research, doi:10.1111/jphs.12145.

A 2014 postal survey of a random sample of 191 Finnish pharmacy owners drew 155 responses, an 81 percent response rate. In many pharmacies, nationwide shift to electronic prescriptions often affected job descriptions of technical staff (74 percent) and pharmaceutical staff (47 percent), and the pharmacy owner’s own use of time (44 percent). Prescription processing decreased among technical staff (93 percent) and increased among pharmaceutical staff (42 percent). Prescription processing and dispensing became quicker, but implementation did not affect the size of the staff in most pharmacies (72 percent). ePrescription resulted in changes to furnishings or equipment in 61 percent of the pharmacies, typically computer upgrades or additions.

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S.M. Varney, V.S. Bebarta, L.M. Mannina, R.G. Ramos, V.J. Ganem, and K.R. Carey. 2016. “Emergency Medicine Providers’ Opioid Prescribing Practices Stratified by Gender, Age, and Years in Practice.” World Journal of Emergency Medicine, doi:10.5847/wjem.j.1920–8642.2016.02.004.

In an anonymous survey of 89 emergency medicine providers at a U.S. military trauma and referral center (100 percent response), 55 percent were in practice less than 5 years and 80 percent were male. Forty percent believed at least 10 percent of patients seen at this military emergency department misused opioids. Male providers were more likely than women to prescribe more opioid tablets, regardless of whether they were concerned about opioid misuse. Sixty percent thought changing their prescribing behavior would not prevent opioid misuse. Seventy percent said patient age influenced their prescribing decisions.

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W.A. Zule, C. Oramasionwu, D. Evon, S. Hino, I.A. Doherty, G.V. Bobashev, and W.M. Wechsberg. 2016. “Event-Level Analyses Of Sex-Risk and Injection-Risk Behaviors Among Nonmedical Prescription Opioid Users.” American Journal of Drug and Alcohol Abuse, doi:10.1080/00952990.2016.1174706.

In 2005–08, this study recruited 1,985 people in North Carolina who were intravenous drug users or men who had sex with men or sex partners of recruits. In multivariate analysis, when both partners were nonmedical prescription opioid users, they were 2.2 times more likely than other respondents to have unprotected sex. Nonmedical opioid use was also associated with sharing syringes during injection episodes (odds ratio = 6.6).

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Professional Development

D. Busch. 2016. “Clinical Management of the Breast-Feeding Mother–Infant Dyad in Recovery from Opioid Dependence.” Journal of Addictions Nursing 27(2):68–77, doi:10.1097/JAN.0000000000000117.

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E.E. Krans and S.W. Patrick. 2016. “Opioid Use Disorder in Pregnancy: Health Policy and Practice in the Midst of an Epidemic.” Obstetrics & Gynecology, doi:10.1097/AOG.0000000000001446.

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J.K. Lim, J.P. Bratberg, C.S. Davis, T.C. Green, and A.Y. Walley. 2016. “Prescribe to Prevent: Overdose Prevention and Naloxone Rescue Kits for Prescribers and Pharmacists.” Journal of Addiction Medicine, doi:10.1097/ADM.0000000000000223.

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D.Q. Nguyen, L.L. Osburn, M.A.D. Paolera, and B. Chavez. 2016. “Utilization of Pharmacists in Addressing Medication Abuse in the Pacific Northwest.” Journal of Pharmacy Practice, doi:10.1177/0897190016652066.

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Prescription Opioid Abuse and Heroin Use Epidemic Facts
White House
Accessed June 17, 2016

This fact sheet shows the estimated amount of funding each state could qualify for under the president’s $1.1 billion budget proposal to expand access to opioid treatment, particularly medication-assisted treatment. States would receive funding based on the severity of the epidemic in their communities and the strength of their strategy to respond to it.

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Drug Enforcement Administration Warns: Fentanyl Exposure Kills
U.S. Drug Enforcement Administration
June 10, 2016

The U.S. Drug Enforcement Administration released a video to all law enforcement nationwide about the dangers of improperly handling fentanyl and its deadly consequences. Any law enforcement personnel who come in contact with fentanyl or fentanyl compounds should take the drugs directly to a lab. Do not field test it in the car, on the street, or take it back to the office. Fentanyl can potentially harm police canines as well.

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Senate Struggles with Concept of Prescription Heroin, Injection Sites
Andrea Woo, Globe and Mail
June 15, 2015

Scott MacDonald, M.D., a physician at Providence Health Care’s Crosstown Clinic in Vancouver, Canada, testified before a U.S. Senate committee about the concept of prescription heroin and supervised-injection sites. Dr. MacDonald spoke of clinical trials conducted at the clinic on prescription heroin treatment, which involves giving pharmaceutical-grade heroin to people who are severely addicted, which they inject in a medical setting under the supervision of doctors. This keeps them from using potentially contaminated street heroin, reduces their risk of blood-borne illnesses, reduces their rate of criminal activities, and allows them to interact with physicians every day. Only 5 percent of trial participants have returned to work, but MacDonald hopes that figure will grow as the two-year-old program continues.

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Drug Salesmen Arrested for Paying Doctors to Prescribe Fentanyl
Liz Szabo, USA TODAY
June 15, 2016

Two former Insys Therapeutic employees have been arrested for allegedly paying doctors to prescribe Subsys, a fast-acting form of fentanyl. They allegedly paid two New York area physicians $259,000 in kickbacks in 2014. Court documents revealed that those doctors wrote a total of more than $6 million in Subsys prescriptions that year—more than all but a few doctors in the country. An Insys manager allegedly knew of the scheme and instructed sales staff to demand that the doctors prescribe “large quantities of fentanyl” in exchange for the money. Insys noted that it is against company policy to provide money or “items of value” to doctors to encourage them to write prescriptions. Still, Subsys sales jumped from $14.2 million in 2012 to $462 million in 2015; prescriptions grew from 4,528 to 49,063 over the same time. Insys has been investigated for its marketing practices by Arizona, Oregon, Massachusetts, Illinois, and by the U.S. attorney for central California. Last year, Oregon became the first to reach a settlement with Insys, which paid the state $1.1 million. In a case in the U.S. District Court for the Southern District of Alabama, a former Insys saleswoman pleaded guilty in February to conspiracy to commit health care fraud, including engaging in kickback schemes. In 2015, a Connecticut nurse practitioner pleaded guilty to prescribing Subsys in exchange for $83,000 in kickbacks from Insys.

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Doctors Discourage Use of ‘Smart Drugs’
Da Hee Han, Empr.com
June 15, 2016
American Medical Association Delegates Vote to Add Naloxone to Opioid Rx
Nikki Kean, Practical Pain Management
June 15, 2016

The American Medical Association (AMA) adopted a policy at its annual meeting that discourages the nonmedical use of prescription drugs for cognitive enhancement in healthy individuals. Nootropics or “smart drugs” include various prescription drugs, supplements, and other substances that claim to enhance cognitive functions in healthy individuals especially with executive function, memory, learning or intelligence. At this same meeting, the AMA adopted policies that encourage physicians to: co-prescribe naloxone to patients at risk of an overdose; promote timely and appropriate access to non-opioid and non-pharmacologic treatments for pain; and support efforts to delink payments to health care facilities with patient satisfaction scores relating to the evaluation and management of pain. The policies also encourage private and public payers to include all forms of naloxone on their preferred drug lists and formularies with nominal or no cost sharing. They supports liability protections for physicians and other authorized health care professionals to prescribe, dispense, and administer naloxone. Other decisions by the AMA included: adopting a policy that opposes efforts that would arbitrarily restrict a patient’s ability to receive effective, patient-specific, evidence-based pain care; a recommendation to break the link between patient satisfaction surveys of pain treatment and payments to facilities; and a call for the pharmaceutical industry to fund a program to dispose of unwanted medications as hazardous waste.

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Detox Center Advises Employers on Handling Substance Abuse in the Workplace
PR Web
June 13, 2016

Novus Medical Detox Center in New Port Richey, Fla., urges employers to familiarize themselves with best practices to help deter, address and resolve substance misuse in the workplace. It recommends that all employers implement a drug-free workplace program, with documentation and education on how staff should handle suspected cases of alcohol or substance misuse in the workplace. Novus also advises companies to begin reviewing the Drug-Free Workplace Advisor resources hosted by the U.S. Department of Labor, which includes details on the five key components of a drug-free workplace: written policy, supervisor training, employee education, employee assistance, and drug testing. Novus says employers should act immediately if workers show signs of substance misuse. Approach the individual in private, and focus on performance or behavioral issues such as tardiness, absenteeism, missed deadlines or arguments/conflicts with others rather than making accusations or voicing suspicions. Employers should always maintain confidentiality, respect, and show sensitivity in dealing with employees.

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Fedex Saw Trafficking in Drugs, Prosecutor Claims
Sudhin Thanawala, Associated Press
June 14, 2016

A bench trial began for FedEx on charges of distribution of controlled substances, conspiracy to launder money, and other counts. The company knew the illegal prescription drugs came from Internet pharmacies but delivered them anyway, even after being told that one package of drugs went to a woman who used them to commit suicide. FedEx has denied the charges and claimed it only shipped what it believed were legal drugs from pharmacies licensed by states and registered with the Drug Enforcement Administration. No FedEx officials are facing prison time, but the charges carry a potential fine of $1.6 billion. The trial could last into August before a ruling is issued.

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Illegal Online Drug Outlets Pose Health and Financial Risks to Older Adults
National Association of Boards of Pharmacy
June 15, 2016

Illegal online drug outlets pose health and financial risks to seniors and their caregivers who purchase medications online. To address this issue, the Alliance for Safe Online Pharmacies, Center for Safe Internet Pharmacies, and National Consumers League launched a campaign to educate seniors about buying prescription drugs safely online. The National Association of Boards of Pharmacy (NABP) recommends that patients use Internet pharmacies that have a .pharmacy domain name, have been granted Verified Internet Pharmacy Practice Sites or Veterinary-Verified Internet Pharmacy Practice Sites accreditation, or have approved e-Advertiser status through the NABP e-Advertiser Approval Program. These sites were evaluated by NABP and found to comply with pharmacy laws and meet high standards for pharmacy practice and patient safety.

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Physical Medicine Management Alliance Joins Fight Against Opioid Abuse
National Association of Specialty Health Organizations
June 15, 2016

The Physical Medicine Management Alliance, a subsidiary of the National Association of Specialty Health Organizations (NASHO), met with several congressional leaders to discuss effective strategies for reducing opioid misuse and addiction. They discussed the benefits and advantages of conservative care for musculoskeletal disorders and pain management. NASHO believes an emphasis on non-pharmacologic, conservative care pathways including chiropractic, physical therapy and acupuncture can significantly reduce the risk of opioid misuse and dependency.

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InterConnect Will Remain Free to Participating States Past 2018
National Association of Boards of Pharmacy
June 16, 2016

The National Association of Boards of Pharmacy will continue to provide state prescription drug monitoring programs (PDMP) with access to its prescription monitoring program InterConnect at no cost past 2018. Currently, 42 states have executed memorandums of understanding to be part of InterConnect, 33 state PDMPs are active, and 40 are expected to be active by the end of 2016. InterConnect allows state PDMPs to access data from across state lines.

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Feds Demand Warrantless Access to Health Records to Combat Prescription Drug Abuse
J.D. Heyes, Natural News
June 15, 2016

The U.S. Drug Enforcement Administration (DEA) has been trying to claim that under federal law it has the authority to access the state’s prescription drug monitoring program database using only an “administrative subpoena.” It argues that these unilaterally issued orders do not require a showing of probable cause before a court, like what is required to obtain a warrant. In 2012, Oregon sued the DEA to prevent it from enforcing the subpoenas to snoop around its drug registry. In 2014, a U.S. District Court found in favor of the state, ruling that prescription data is covered by the Fourth Amendment’s protection against unlawful search and seizure. DEA has appealed that ruling to the U.S. Ninth Circuit Court of Appeals.

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Mallinckrodt Donates Drug Deactivation Pouches to Fight Prescription Drug Abuse
PR Newswire
June 16, 2016

Mallinckrodt Pharmaceuticals will purchase and donate more than 1 million Deterra drug deactivation pouches to help address the misuse of prescription pain medications. The pouch-based systems deactivate prescription drugs and render chemical compounds safe for landfills. The pouches are also biodegradable. The company plans to distribute the pouches through collaboration with policy champions and community leaders.

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H.J. Chaudhry, A.S. Hengerer, and G.B. Snyder. 2016. “Medical Board Expectations for Physicians Recommending Marijuana.” JAMA, doi:10.1001/jama.2016.7741.

This article examines the dilemma of physicians caught between increasingly permissive local statutes and prohibitive federal regulations. The authors summarize 10 recommendations about marijuana for patient care from agencies authorized by statute to protect the health and welfare of the public through licensure and discipline of physicians and other health care professionals. They include patient-physician relationship, patient evaluation, informed and shared decision making, treatment agreement, qualifying conditions, ongoing monitoring, consultation and referral, medical records, physician conflicts of interest, and physician use of marijuana.

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E.J. D’Amico, J.S. Tucker, J.N. V. Miles, B.A. Ewing, R.A. Shih, and E.R. Pedersen. 2016. “Alcohol and Marijuana Use Trajectories in a Diverse Longitudinal Sample of Adolescents: Examining Use Patterns from Age 11 To 17 Years.” Addiction, doi:10.1111/add.13442.

This longitudinal study surveyed 6,509 youth from age 11.5 (2008) to 17 (2015) from 16 middle schools in southern California using 5 hard-copy surveys in middle school and 2 online surveys in high school. Not surprisingly, youth with higher marijuana use in 2011 reported greater academic unpreparedness and delinquency, and poorer academic performance and mental health in high school.

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Sales of Marijuana Concentrates, Edibles Surging in Colorado
Marijuana Business Daily
June 13, 2016

BDS Analytics reported that retail sales of concentrates in the Colorado’s medical and nonmedical markets surged 125 percent in the first quarter of this year from the same period in 2015; and edibles sales increased 53 percent. Those gains far outpace the 11 percent rise in sales of marijuana flower. In the first quarter of 2016, concentrates and edibles accounted for about a third of overall marijuana sales, up from just 24 percent a year earlier. BDS Analytics expects concentrates and edibles sales to eventually surpass revenues from flower—not only in Colorado, but also nationwide.

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Medical Pot for Posttraumatic Stress Disorder Could Save Program
Robert McCoppin, Chicago Tribune
June 14, 2016

The Illinois governor’s office says that if the legislature lengthens Illinois’s medical marijuana pilot program to July 1, 2020, the governor will sign the bill. The legislative proposal adds posttraumatic stress disorder and terminal illness to the list of qualifying conditions. Advocates hope this expansion will make the program profitable. Doctors warn that they still have legal and medical concerns about the product. The bill would remove the requirement that physicians recommend the drug for their patients, and instead only require that doctors certify a patient has a qualifying condition. This change may assure doctors that they will not be held liable if something goes wrong with a patient using marijuana. The proposed change in the law would add medical marijuana to the state’s prescription drug monitoring program, so doctors would know which patients are using it, and to assure patients do not seek referrals from multiple doctors. Illinois has about 7,000 authorized patients spending $2 million/month on marijuana from 37 dispensaries statewide.

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How Medical Marijuana Laws Affect Your Substance Abuse Policy
Terri Dougherty, The Business Journals
June 16, 2016

The author recommends that employers stay on top of changing laws and maintain a current substance abuse policy that is communicated to employees. Employers in states where medical marijuana is legal can still enforce their drug-free workplace policies. Employers are not required to allow workers to use, or be impaired by, marijuana at work. Also, allowing medical marijuana use is not a reasonable accommodation under the federal Americans with Disabilities Act. However, an employer still must consider whether there is another reasonable accommodation when an employee indicates that one may be necessary because of a disability. Employers should make employees aware of the impact marijuana use can have on the workplace, how long the drug stays in an individual’s system, and what will happen if they test positive for the drug. In addition, employers should train supervisors to recognize the signs of substance misuse. They should know when a drug test is warranted, and what to do if the result is positive. Employers should also review their substance abuse policy to make sure it reflects the current needs of the workplace. Employee job functions, safety issues, and any emerging substance misuse concerns should be taken into account.

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More Incidents of Workplace Pot Use Reported After Legalization in Colorado
Sean Whaley, Las Vegas Review-Journal
June 10, 2016

In the November general election, Question 2 will address the legalization of recreational marijuana use in Nevada. If approved, Nevadans would be able to possess 1 ounce or less of marijuana legally under state law starting January 1, 2017. Nevada employers need to know the state laws about marijuana use, their rights as employers, and the implications for such programs as workers’ compensation. When Colorado legalized recreational marijuana in 2012, workplace incidents of employees under the influence rose from 6 percent to 20 percent the following year. Jo McGuire, with a drug testing company in Colorado, also told attendees at a Carson City Chamber of Commerce event that workplaces are not doing a good job explaining that workplace drug use is not okay. Absenteeism, workplace injuries, workplace theft to support a drug habit and the sale of drugs by one employee to another are all issues employers face because of illicit drug use, McGuire said. McGuire said all employers should have a clearly written drug and alcohol policy that is communicated to employees. In Colorado, companies with clear zero tolerance policies have been winning in court when employees have legally challenged marijuana-use-related dismissals, she said.

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Eugene Monroe Will Never Stop Pushing NFL to Accept Medical Cannabis
June 16, 2016

Though Eugene Monroe was released by the Baltimore Ravens, he will continue his campaign to get medical marijuana removed from the National Football League’s banned substances list. A Raven’s coach said that Monroe’s release was a football decision and had nothing to do with his stance on medical marijuana. Monroe is the only active player to publicly support lifting the ban. He has donated funds to John Hopkins and the University of Pennsylvania to examine the impact of cannabinoid therapies on current and former players. Monroe also wrote an essay in the Players’ Tribune about the need for the NFL to reduce players’ use of opioids. (Includes video: 1:50 minutes)

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Germany Plan to Legalize Medical Marijuana
William Smith, Daily Chronic
June 16, 2016

Germany’s minister of health, Hermann Gröhe, hinted that the country will start a medical cannabis program in 2017. Medical marijuana will be available only to patients who are seriously ill, have already received a doctor’s consultation, and “have no therapeutic alternative.” Cannabis will be the last solution for the sick people. A draft bill was created and the new law is expected to pass easily from the Bundestag. Germany will not legalize cannabis for nonmedical use.

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Fleets Urged to Investigate Drug-Testing Methods before Committing to Policy
Natalie Middleton, Fleet World
June 10, 2016

Suzannah Robin, a drug safety expert at AlcoDigital in Canada, recommends that fleets have a good understanding of the pros and cons of each drug testing process before reaching any conclusions on future test policy. For example, a urine sample might be ideal for random testing policies, but it has limitations. Urine tests will not reveal if an individual has consumed drugs in the last two hours. Saliva testing will not reveal a positive result for any drugs that may have been taken more than 48 hours ago. That is why Robin recommends that companies with employees operating heavy machinery or driving vehicles adopt saliva testing as part of their best practice policy.

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Emerging Epidemic of Prescription Drug Abuse in Kenya
Kizito Lubano, Standard Digital
June 15, 2016

Kenya is seeing an increase in prescription drug misuse. Fourteen percent of Kenyan adults take at least one prescription drug, and eight percent take three or more prescribed medications. Officials need to consider and implement a prescription drug monitoring program to identify possible drug misuse and diversion. Hopefully, this can be done without infringing on patient privacy and affecting those who have legitimate need for medication.

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Dangerous Mix of Medication Leads to Faulty Alzheimer’s Diagnosis
Rosa Marchitelli, CBC News
June 15, 2016

Betty Wallwork, an 85-year-old, was taking a mix of medications for various ailments. When Wallwork told her family physician about the side-effects, he diagnosed her with Alzheimer’s disease after conducting tests. He never considered that her medications were causing the problems. Wallwork learned from an Internet search that the mix of medications was making her health worse. After stopping her medication, Wallwork had new cognitive tests done, which showed none of the concerning signs her doctor noted in her previous test. Seniors and their family members should track all prescription and nonprescription drugs and share that information with their doctor and pharmacist. They should also talk to their doctor before making any changes to their medication. (Includes video: 2:09 minutes)

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Northeast/Mid-Atlantic News

New York Governor and Lawmakers Reach Agreement to Combat Opioid Abuse
June 14, 2016

New York’s governor and lawmakers announced a final agreement on legislation to address heroin and prescription opioid misuse in the state. The legislation builds on the state’s efforts to better monitor prescription drugs and increase access to treatment. This includes requiring insurers to cover necessary inpatient services for treatment of substance use disorders for as long as an individual needs them. It also includes reducing prescription limits for opioids from 30 days to 7 days, with exceptions for chronic pain and other conditions.

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Pennsylvania Senate Adopts Bill that Addresses Opioid Prescription Practices
Gant Daily News
June 17, 2016

Pennsylvania’s senate passed a bill that requires two additional hours of pain management education for licensed medical professionals who prescribe opioids. The bill heads to the state’s house of representatives.

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First Responder with Naloxone Save Over 1,000 Pennsylvanians
Kirstin Kennedy, The Times
June 13, 2016

Pennsylvania first responders have revived people more than 1,000 times using naloxone. It is unknown if how many people were revived more than once.

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New Jersey Colleges Use Sober Dorms to Combat Opioid Epidemic
Teresa Wiltz, Stateline
June 15, 2016

Higher educational institutes are opening “sober dorms,” a substance-free housing and activities for students in recovery from alcohol and drug addiction, to address the nation’s opioid epidemic. Last year, New Jersey’s governor signed a law that requires all state colleges and universities in New Jersey to offer sober housing if at least a quarter of the students live on campus. The law gives schools four years to comply. Rutgers University in New Brunswick and Newark both offer sober housing. About 30 students live in the New Brunswick dorm, while four currently live in the Newark dorm. To live in the dorms, students must have been sober for at least 90 days. Prospective students must interview with recovery center counselors and current residents, to ensure they will be a good fit. Once accepted into the program, students are required to attend at least two 12-step meetings a week. Students may live in the dorm year-round. According to the Association of Recovery in Higher Education, 95 percent of students involved in collegiate recovery programs maintain their recovery and do not relapse. Relapse rates in the general population are from 40–60 percent.

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South News

Public Service Announcement Initiative Aims to Reduce Opioid Abuse in West Virginia
Kyla Asbury, West Virginia Record
June 16, 2016

West Virginia launched a series of public service announcements to promote a better understanding of the opioid epidemic and to encourage West Virginians to explore non-opioid alternatives to pain therapy. The public service announcements encourage patients to seek alternative pain therapy and ask their prescriber three questions – “Am I being prescribed opioids?” “Is there an alternative treatment?” “If not, is there a lower effective dosage?” The public service announcements will appear in print, radio and social media.

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Fentanyl Now Virginia’s Deadliest Opioid
John Ramsey, Richmond Times-Dispatch
June 11, 2016

Fentanyl caused more deaths in Virginia last year than any other prescription pain reliever. The amount of legal fentanyl prescribed in Virginia rose only 10 percent from 2007 to 2014. Drug deaths nearly tripled in that time frame, from 48 to 134. In 2015, fentanyl was linked to an estimated 221 deaths in the state, more than any other opiate-based substance aside from heroin. Some people who use heroin are being sold fentanyl or heroin mixed with fentanyl. (Includes videos: 0:43 minutes | 2:00 minutes)

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Doctor Warns of Epidemic of Opioid Addiction in Arkansas
John Lyon, Arkansas News
June 13, 2016

Dr. G. Richard Smith, a University of Arkansas for Medical Sciences professor, told a state legislative panel that Arkansas is experiencing an opioid addiction epidemic. He recommends creating more treatment programs, changing state law to allow more flexibility in the use of data from the state’s prescription drug monitoring program, strategic use of “moderate” state resources to address the problem, and encouraging cooperation from organizations around the state.

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Despite Overdose Epidemic, Georgia Caps Number of Opioid Treatment Clinics
Michell Elroy, NPR
June 15, 2016

Effective June 1, Georgia legislation put a one-year moratorium on issuing license to clinics that use medicine to treat people addicted to heroin or pain relievers. The law establishes a committee to investigate why so many opioid treatment programs have opened in Georgia. Georgia has 67 opioid treatment programs, more than any other southeastern state. Florida has 65, Tennessee has 12, Alabama has 24, and Mississippi has one. The Department of Community Health only has three staff members to keep track of the 67 clinics; with a fourth in training. The agency’s rules and regulations do not specify how frequently treatment centers should be inspected, but re-licensure surveys are conducted every two years. (Includes audio: 4:25 minutes)

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The Opioid Epidemic in New Orleans
David S. Lewis, Gambit
June 13, 2016

Louisiana has allowed police to carry and administer naloxone since 2014, but none do. In New Orleans this year, 48 people died have from accidental opioid overdose compared to 53 murders . Of the 48 overdose deaths, 19 tested positive for Fentanyl. In 2015, Orleans Parish had 63 opioid deaths with 12 were attributed to Fentanyl. In 2014, only two overdose deaths were attributed to Fentanyl. The City will determine if the New Orleans Police Department should be trained to administer naloxone. New Orleans firefighters and emergency medical services workers already carry it. Legislators recently passed a law that expands access to naloxone for third-party purchasers. It opened the door to national pharmacy retailers who want to provide access to naloxone kits without a prescription.

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Midwest News

After National Call to Cut Down, South Dakota Prescribed More Opioids
Dana Ferguson, Argus Leader
June 17, 2016

South Dakota’s pain reliever prescriptions increased 22 percent to 710,000 opioid prescriptions in 2015 from 583,428 in 2014. South Dakota doctors gave out 283,268 opioid prescriptions between January 1 and May 31, 2016; so the total seems likely to drop slightly this year. The police have seen an uptick in violent crimes involving drug deals gone badly; and they are starting to see heroin on the streets. The state is addressing these issues by tracking pain relievers through the prescription drug monitoring program and implementing guidelines and education programs for physicians on how to avoid prescribing opioids for chronic pain.

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Drugged Driving in Ohio, Kentucky, and Indiana a Bigger Threat than Drunken Driving?
Terry DeMio, The Enquirer
June 13, 2016

Public Policy Polling conducted a survey on behalf of AAA that took place on June 6–7, 2016, in Ohio, Kentucky, and Indiana. The new AAA survey showed nearly 75 percent of motorists from the tristate who were surveyed said the use of illegal drugs before driving was a “very serious threat” to their safety. That compared to 71 percent who said the same about those driving after drinking alcohol. Thirty-four percent said that driving after taking prescription drugs was a very serious threat.

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West News

Alaska Becomes Eleventh State to Restrict DXM Sales to Adults
Michael Johnsen, Drug Store News
June 3, 2016

Alaska has become the 11th state to restrict the sale of products containing dextromethorphan to residents aged 18 years and older. Those under age 18 must have a prescription to buy the drug.

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How to Help Stop Opioid Abusers in California from ‘Doctor Shopping’
Editorial Board, Los Angeles Times
June 14, 2016

Last year, the California Senate passed SB482 requiring doctors and pharmacists to look up a patient’s prescription history in the state’s prescription drug monitoring program, called CURES, before prescribing or dispensing a controlled substance to that patient for the first time, and again at least once every year that the patient continues to receive the drug. The bill has yet to move in the Assembly; and a trade group for California doctors is concerned that the database is not ready for the added volume of inquiries the bill would generate. The group also argues that not all doctors are in a position to consult CURES, and the system does not sufficiently protect the privacy of prescribers or patients. The Los Angeles Times believe a compromise seems within reach. The mandate to consult CURES should be held off until the system can handle the extra volume. The state could provide tailored exemptions to some emergency-room physicians and others who cannot reasonably be expected to access the database. Setting the right limits on how CURES records can be used addresses the privacy concerns. The database will not serve the purpose for which it was created unless those who prescribe and dispense dangerous drugs check it routinely.

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Walgreens Fighting Prescription Drug Abuse in Washington with New Programs
Business Wire
June 17, 2016

Walgreens Pharmacy will install drug take-back kiosks in 10 pharmacies in Washington State as part of its safe medication disposal program. It will also make naloxone available without a prescription at all its locations in the state.

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Other Resources

Academy Delivers New Opioid Toolkit, Continuing Education to Equip Members
American Academy of Family Physicians
June 13, 2016

The American Academy of Family Physicians (AAFP) is now offering family physicians a new chronic pain management toolkit and a free continuing medical education webcast focused on chronic opioid therapy. The toolkit includes an action plan, pain inventory, work questionnaire, patient-physician medication agreement, opioid risk tool and links to additional AAFP and external resources for physicians. The webcast covers how to best develop an evidence-based treatment plan that involves the appropriate selection of an initial opioid, and continuous monitoring and adjustment for tapering, discontinuation, alternative therapies or referral to a pain subspecialist.

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New Online Videos Aim to Educate Parents about Heroin, Other Drugs
Bill Bird, Chicago Tribune
June 14, 2016

ParentsMatterToo has created a new four-part series of online videos, “Prescription Painkillers: The Accidental Road to Addiction,” to help parents deal with their children’s heroin abuse. The series is a follow-up to last fall’s “Are You an Accidental Drug Dealer” campaign, in which informational brochures on that subject were distributed to more than 250 pharmacies and stores around Naperville, Illinois. The videos show parents how to monitor, secure and safely dispose of prescription drugs; discuss why teenagers, in particular, experiment with drugs; list the warning signs of drug misuse; show how prescription drug misuse can lead to heroin addiction; and present stories of several young men and women recovering from their addictions.

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Grant Award

Project Secures Grant for Drug-Prevention Coalition in Carter County
Kristen Quon, WJHL
June 10, 2016

The Tennessee Department of Mental Health and Substance Abuse Services awarded $60,000 to East Tennessee State University to reduce prescription drugs misuse, tobacco use, and underage and binge drinking in Carter County.

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Grant Announcements

Data Resource for Post-Marketing Prescription Drug Abuse Surveillance Data from Individuals Entering or Being Assessed for Substance Abuse
Due: July 1, 2016, 4:30 p.m. (ET)

This solicitation seeks a contractor to provide prescription drug abuse summary reports to the FDA Center for Drug Evaluation and Research and the Office of Surveillance and Epidemiology, which will use the reports to help inform pharmaceutical regulatory and oversight efforts, and abuse prevention programs.

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Safety and Outcome Measures of Pain Medications Used in Children and Pregnant Women (R03) | (R01) | (R21)
National Institutes of Health
Due: Oct. 16, 2016 | Jan. 7, 2020 | Jan. 7, 2020

The overall goals for this funding opportunity are: to promote preclinical, translational, clinical and epidemiological research in pain medications use in children or in pregnant women to fill knowledge gaps in safe use of the pain medications in these special populations; and develop effective instruments or approaches to assess and evaluate maternal and child outcomes of pain medication treatments.

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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

Bolton (Mass.) Kiosk Offers Convenient Drug Disposal
Ken Cleveland, Telegram
June 12, 2016

Pleasantville (N.J.) Police Receive Prescription Drug Drop Box
Donna Weaver, Press of Atlantic City
June 10, 2016

Port Jervis (N.Y.) Installs Collection Box for Expired Prescription Drugs
Yvonne Marcotte, Epoch Times
June 15, 2016

Medication Collection Box Installed at Glens Falls (N.Y.) Police Station
Don Lehman, The Post-Star
June 13, 2016

Baldwin Borough (Penn.) Latest to Add Drop-Off Box for Old Drugs
Stephanie Hacke, Trib Total Media
June 15, 2016

Jackson (Tenn.) Residents Dispose of Unwanted Paper and Prescription Drugs
Amber Huges, WBBJ
June 11, 2016

Spokane (Wash.) Walgreens Installs Drug Disposal Kiosk
Aaron Luna, KXLY
June 15, 2016

Upcoming Events, Conferences, & Workshops

National Conference on Addiction Disorders: Taking Recovery to New Heights
Vendome Healthcare Media
Aug. 18–21, 2016
Sheraton Denver Downtown Hotel
1550 Court Place
Denver, Colo.

The National Conference on Addiction Disorders brings together professionals for four days of comprehensive education and thought-provoking discussion. The conference offers seven educational tracks, a 150-booth exhibit hall, and keynote presentations.

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Harold Rogers Prescription Drug Monitoring Program National Meeting
Bureau of Justice Assistance and Prescription Drug Monitoring Program Training and Technical Assistance Center at Brandeis University
August 17–19, 2016
Washington, D.C.


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


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


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


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
November 14–16, 2016
Arlington, Va.

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

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