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June 25, 2014

 

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SAMHSA
SAMHSA Prescription Drug Abuse Weekly Update
WEEKLY
UPDATE
Issue 77  |  June 25, 2014
The Prevention of Prescription Drug Abuse in the Workplace (PAW) TA Center addresses prescription drug abuse—a growing public health problem with increasing burdens on workers, workplaces, and our economy. To subscribe colleagues, family members, or friends to this listserv sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), please click here or send their e-mail addresses to paw@dsgonline.com.
Table of Content Featured Article Journal Articles and Reports Professional Education & Editorial News Other State and Local News Other Resources Webinar Archive Request for Proposal Take-Back Events and Drop Boxes Save the Date Upcoming Conferences and Workshops

Featured

J.B. Rice, N.Y. Kirson, A. Shei, A.K.G. Cummings, K. Bodnar, H.G. Birnbaum, and R. Ben–Joseph. 2014. "Estimating the Costs of Opioid Abuse and Dependence from an Employer Perspective: A Retrospective Analysis Using Administrative Claims Data." Applied Health Economics and Health Policy, doi:10.1007/s40258-014-0102-0.

This study estimated the economic burden of prescription opioid abuse/dependence on employers. Administrative claims from beneficiaries covered by large, self-insured companies were used to identify patients—including employees and dependents—diagnosed with opioid abuse or dependence between 2006 and 2012. Healthcare and work-loss costs for abusers were assessed over a 12-month period and compared with those for propensity–score matched patients not diagnosed with abuse (comparison patients). Researchers analyzed 7,658 matched pairs of abusers and comparison patients. Relative to comparison patients, abusers had significantly higher annual healthcare resource utilization, leading to $10,627 in per-patient incremental annual healthcare costs. Additionally, abusers had $1,244 in excess annual work-loss costs. Together, this suggests there is an employer burden for diagnosed abuse of $1.71 per member per month.

Read more:
http://link.springer.com/article/10.1007/s40258-014-0102-0

S. Radakrishnan. "The Role of Information in the Market for Opioid Pain Relievers: An Analysis of Prescription Monitoring Programs." Presented at the American Society of Health Economists Fifth Centennial Conference, University of Southern California, Los Angeles, Calif., June 24, 2014.

Controlling for pre-implementation trends as well as seven other types of state laws likely to affect prescription drug abuse and diversion, a time-series analysis found prescription monitoring program presence was associated with a 13.1 percent reduction in opioid abuse treatment admissions, and may also have reduced nonmedical use of OxyContin and accidental opioid overdose deaths.

Read more:
https://ashecon.confex.com/ashecon/2014/webprogram/Paper2189.html

Journal Articles and Reports

M. Ali. "Non-Medical Use of Prescription Drugs and Mental Health Among Adolescents." Presented at the American Society of Health Economists Fifth Centennial Conference, University of Southern California, Los Angeles, Calif., June 25, 2014.

Major depressive episodes are more common among youth who report nonmedical use of prescription drugs than among similar youth who do not, according to a propensity score–matched analysis of 2009–11 National Survey on Drug Use and Health data.

Read more:
https://ashecon.confex.com/ashecon/2014/webprogram/Paper1650.html

L–Y. Chen, R.M. Crum, S.S. Martins, C.N. Kaufmann, E.C. Strain, and R. Mojtabai. 2014. "Patterns of Concurrent Substance Use Among Nonmedical ADHD Stimulant Users: Results from the National Survey on Drug Use and Health." Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2014.05.022.

Researchers examined patterns of concurrent substance use among a sample of 6,103 adults with nonmedical attention deficit hyperactivity disorder (ADHD) stimulant use. Multivariate analysis of National Survey on Drug Use and Health data for 2006–11 suggested a four-class conceptual model of nonmedical ADHD stimulant users, including 1) participants with low probabilities for any other problematic substance use (53.3 percent), 2) problematic users of other prescription drugs (13.3 percent), 3) problematic users of alcohol and marijuana (28.8 percent), and 4) problematic users of multiple drugs and alcohol (4.6 percent).

Read more:
http://www.sciencedirect.com/science/article/pii/S0376871614009041

T. D'Aunno, H.A. Pollack, J.A. Frimpong, and D. Wuchiett. 2014. "Evidence-Based Treatment for Opioid Disorders: A 23-Year National Study of Methadone Dose Levels." Journal of Substance Abuse Treatment, doi:10.1016/j.jsat.2014.06.001.

This paper examined methadone dosage levels at U.S. methadone maintenance treatment programs over 23 years. Program directors and clinical supervisors of nationally representative methadone treatment programs were surveyed in 1988 (n=172), 1990 (n=140), 1995 (n=116), 2000 (n=150), 2005 (n=146), and 2011 (n=140). The proportion of patients who received doses below 60 mg/day—the minimum recommended—declined from 79.5 percent in 1988 to 22.8 percent in 2005. Programs that serve a higher proportion of African American or Hispanic patients were more likely to report low-dose care. Programs with Joint Commission accreditation were more likely to provide higher doses, as were programs that serve a higher proportion of unemployed and older patients.

Read more:
http://www.sciencedirect.com/science/article/pii/S0740547214000907

C.S. Davis, Matthew Pierce, and Nabarun Dasgupta. 2014. "Evolution and Convergence of State Laws Governing Controlled Substance Prescription Monitoring Programs, 1998–2011." American Journal of Public Health, doi:10.2105/AJPH.2014.301923.

Researchers collected and characterized all laws and regulations governing operation of prescription monitoring programs (PMPs) from 1998 through 2011. The laws were abstracted along 11 domains, including reporting provisions, data sharing, and data access. PMP characteristics varied greatly among states and across time. Over time, data scope and reporting frequency increased, as did the range of individuals permitted to access data and authorization to proactively identify outlier prescribers and patients. As of 2011, 10 states required PMPs to report suspicious activity to law enforcement, while only 3 required reporting to the patient's physician. None required linkage to drug treatment or all prescribers to review PMP data before prescribing. Few explicitly addressed data retention.

Read more:
http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2014.301923

W.H. Fisher, R. Clark, J. Baxter, B. Barton, E. O'Connell, and G. Aweh. 2014. "Co-Occurring Risk Factors for Arrest Among Persons with Opioid Abuse and Dependence: Implications for Developing Interventions to Limit Criminal Justice Involvement." Journal of Substance Abuse Treatment, doi:10.1016/j.jsat.2014.05.002.

This study examined risk factors among 40,238 individuals diagnosed with opioid abuse or dependence who were enrolled in the Massachusetts Medicaid program in 2010. Medicaid data were merged with statewide arrest data to assess effects of co-existing mental illness, substance abuse, and previous arrests on arrests in 2010. Persons with serious mental illnesses (psychotic and bipolar disorders) and those with two or more pre-2010 arrests had significantly increased odds of arrest.

Read more:
http://www.sciencedirect.com/science/article/pii/S074054721400083X

J.A. Gershman, J.A. Gershman, A.D. Fass, and I. Popovici. 2014. "Evaluation of Florida Physicians' Knowledge and Attitudes Toward Accessing the State Prescription Drug Monitoring Program as a Prescribing Tool." Pain Medicine, doi:10.1111/pme.12476.

Of 5,000 doctors and osteopathic physicians licensed in Florida who were randomly mailed a voluntary and anonymous 15-question self-administered survey, only 7.8 percent responded. Thus, study findings are not representative or generalizable. Of the respondents, 71.5 percent considered the prescription monitoring program (PMP) a useful tool, and 72.5 percent of those with PMP access thought it would reduce doctor shopping.

Read more:
http://onlinelibrary.wiley.com/doi/10.1111/pme.12476/abstract

L. Kann, S. Kinchen, S.L. Shanklin, K.H. Flint, J. Hawkins, W.A. Harris, R. Lowry, E. O'Malley Olsen, T. McManus, D. Chyen, L. Whittle, E. Taylor, Z. Demissie, N. Brener, J. Thornton, J. Moore, and S. Zaza. 2014. "Youth Risk Behavior Surveillance—United States, 2013." Morbidity and Mortality Weekly Report, 63(SS-4):172.

The Centers for Disease Control and Prevention released the 2013 Youth Risk Behavior Surveillance (YRBS) surveys, including the national survey, 42 state surveys, and 21 large urban school district surveys conducted among students in grades 9–12. Prevalence of having ever taken prescription drugs without a doctor's prescription decreased from 20.7 percent (in 2011) to 17.8 percent (in 2013). Across 34 states, prevalence of having ever taken prescription drugs without a doctor's prescription ranged from 8.7 percent to 21.5 percent (median: 16.2 percent). Across 18 large urban school districts, prevalence ranged from 7.8 percent to 18.1 percent (median: 13.2 percent). YRBS first asked about prescription misuse in 2011.

Read more:
http://www.cdc.gov/mmwr/pdf/ss/ss6304.pdf

J.G. Katzman, G.D. Comerci, M. Landen, L. Loring, S.M. Jenkusky, S. Arora, S. Kalishman, L. Marr, C. Camarata, D. Duhigg, J. Dillow, E. Koshkin, D.E. Taylor, and C.M.A. Geppert. 2014. "Rules and Values: A Coordinated Regulatory and Educational Approach to the Public Health Crises of Chronic Pain and Addiction." American Journal of Public Health, doi:10.2105/AJPH.2014.301881.

In 2012–13, chronic pain and addiction education was required for New Mexico prescribers. The authors of this paper surveyed 1,000 clinicians educated at their academic medical center. Pre and post surveys showed gains in knowledge, self-efficacy, and attitudes. Controlled substance dispensing data from the New Mexico Board of Pharmacy demonstrated safer prescribing; there was also a decline in overdose deaths. Note: The outcome findings in this study lack a control group.

Read more:
http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2014.301881

M–C. Le Lait, E.M. Martinez, S.G. Severtson, S.A. Lavery, B. Bucher–Bartelson, and R.C. Dart. 2014. "Assessment of Prescription Opioid Intentional Exposures Across the Rural–Urban Continuum in the United States Using Both Population and Drug Availability Rates." Pharmacoepidemiology and Drug Safety, doi:10.1002/pds.3653.

This paper examines commingled unintentional and deliberate self-harm poisoning/overdose from intentional misuse of prescription opioids in rural areas. Researchers analyzed 2010–12 national RADARS® System Poison Center Program data and IMS Health estimates of the number of unique recipients of dispensed drugs by zip code. The analysis used three-digit zip code areas. Per capita intentional exposure cases significantly increased as the proportion of the population residing in rural areas increased. After adjusting for the number of recipients of the dispensed drug, however, intentional exposure cases decreased with increasing rural population. Note: Terminology in this paper is very confusing.

Read more:
http://onlinelibrary.wiley.com/doi/10.1002/pds.3653/abstract;jsessionid=39211A
F76705C54B46EACFD59A5336C3.f03t03


D. Matteliano, and Y–P. Chang. 2014. "Describing Prescription Opioid Adherence Among Individuals with Chronic Pain Using Urine Drug Testing." Pain Management Nursing, doi:10.1016/j.pmn.2014.04.001.

This study reports on a retrospective chart review of 120 consecutive patients at an urban pain management clinic. Urine drug testing suggested 54 percent of patients did not adhere to their prescribed opiate regimen as defined by absence or inappropriate level of prescribed controlled medication, presence of additional nonprescribed controlled substances, presence of illicit substances, or presence of adulterant in the urine sample. Of the participants, 23 percent tested negative for a prescribed controlled medication, and 12.5 percent tested positive for other opioids. Marijuana was the main illicit substance used (24.2 percent), followed by cocaine (11.7 percent).

Read more:
http://www.sciencedirect.com/science/article/pii/S1524904214000484

M.C. Mercado–Crespo, S.A. Sumner, B. Spelke, D.E. Sugerman, and C. Stanley. 2014. "Notes from the Field: Increase in Fentanyl-Related Overdose Deaths—Rhode Island, November 2013–March 2014." Morbidity and Mortality Weekly Report 63(24):531.

From November 2013 to March 2014, twice as many all-intent drug overdose deaths were reported in Rhode Island as were reported over the same period in previous years. Most deaths were among injection-drug users, and 31.5 percent (52) of unintentional overdose deaths involved fentanyl. Most decedents lacked active fentanyl prescriptions.

Read more:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6324a3.htm?s_cid=mm6324a3_w

B. Morasco, D. O'Hearn, D. Turk, and S. Dobscha. 2014. "Associations Between Prescription Opioid Use and Sleep Impairment Among Veterans with Chronic Pain." Pain Medicine, doi:10.1111/pme.12472.

A VA medical center compared self-reported sleep of 72 patients with chronic pain and a current prescription for opioid medications, 104 with chronic pain and no opioid prescription, and 91 who did not report current chronic pain or an opioid prescription. In univariate analyses, patients with chronic pain who were prescribed opioids were more likely to have sleep apnea diagnoses, and reported more impairment on the sleep global score and across four sleep parameter subscales (subjective sleep quality, sleep latency, sleep disturbance, and use of sleeping medications). Controlling for demographic and clinical covariates, in an analysis restricted to patients with chronic pain, opioid use and dose were associated with significantly worse sleep global scores, including worse sleep latency, sleep duration, sleep disturbance, and daytime dysfunction, and greater use of sleep medications.

Read more:
http://onlinelibrary.wiley.com/doi/10.1111/pme.12472/abstract

C. Parks Thomas, M. Kim, R.V. Nikitin, P. Kreiner, T.W. Clark, and G.M. Carrow. 2014. "Prescriber Response to Unsolicited Prescription Drug Monitoring Program Reports in Massachusetts." Pharmacoepidemiology and Drug Safety, doi:10.1002/pds.3666.

This study explored prescriber response to unsolicited reports of patients' prescription histories from the Massachusetts prescription monitoring program (PMP). PMP data showed 106 patients received a Schedule II prescription from four or more prescribers, and filled these prescriptions at four or more pharmacies within a 6-month period. The PMP mailed reports about each patient of the patient's prescribers, for a total of 2,200 patient reports. The average patient report documented 50 prescriptions, 22 prescribers, and 12 dispensing pharmacies in 6 months. Reports listed names of other prescribers associated with the patient, drugs prescribed, dates of prescriptions, pharmacy names, and dispensing dates for a full year. Prescribers were surveyed upon receipt of the unsolicited reports and 3 months later. Of 333 people who responded to the initial survey, only 28 (8.4 percent) were aware of most, all, or nearly all other prescribers. Of 146 (43.8 percent) who reported having sufficient knowledge to determine whether prescriptions were medically necessary, 102 (69.6 percent) felt they were unwarranted. Of 163 respondents to the follow-up survey, 9 percent saw the patient again after receiving the report, 6 percent discussed the report with the patient, 31.3 percent added the report to the patient's file, 22.7 percent discussed the report with other prescribers on the report, and 21.5 percent took no action. Most respondents felt the report was useful for their practice and easy to understand.

Read more:
http://onlinelibrary.wiley.com/doi/10.1002/pds.3666/abstract

E.A. Taylor and R. Liccardo Pacula. "Did Medicare Part D Contribute to the Rise in Opioid Overdose Deaths in the U.S.?" Presented at the American Society of Health Economists Fifth Centennial Conference, University of Southern California, Los Angeles, Calif., June 25, 2014.

This paper examined whether Medicare Part D, which started in January 2006, contributed to the rise in prescription drug overdose deaths. Researchers linked Medicare formulary coverage and enrollment data by state with Automation of Reports and Consolidated Orders System data on legal distribution of prescription drugs and Vital Statistics mortality data. Note: This abstract does not report study results.

Read more:
https://ashecon.confex.com/ashecon/2014/webprogram/Paper1995.html

S. Veldhuizen and R.C. Callaghan. 2014. "Cause-Specific Mortality Among Individuals Hospitalized with Opioid-Related Conditions: A Retrospective Cohort Study." Annals of Epidemiology, doi:10.1016/j.annepidem.2014.06.001.

Of 68,066 people diagnosed with opioid dependence, abuse, poisoning, or withdrawal who were discharged from California hospitals between 1990 and 2005, 13,107 subsequently died. During 390,438 person-years of follow-up, the standardized mortality rate was 37.6 per 1,000, and the standardized mortality ratio (SMR, a measure of mortality above life table predictions) was 4.36. SMRs were greater than 1 for all causes except Alzheimer's disease. They were highest for drug-induced deaths (62.2), HIV (24.6), and endocarditis (23.2). Broad causes associated with the most excess deaths were drug- or alcohol-induced death (23 percent of excess deaths), cancer (18 percent), heart disease (14 percent), and lower respiratory disease (7 percent). Note: The study fails to report whether mortality records were accessed beyond 2005.

Read more:
http://www.sciencedirect.com/science/article/pii/S1047279714001975

J. Vietri, A.V. Joshi, A.I. Barsdorf, and J. Mardekian. 2014. "Prescription Opioid Abuse and Tampering in the United States: Results of a Self-Report Survey." Pain Medicine, doi:10.1111/pme.12475.

Adult respondents to the proprietary 2011 National Health and Wellness Survey were invited to complete an online survey assessing use, misuse, and abuse of prescription opioid medications in the preceding 3 months. Of 55,223 invitees, 25,864 responded. During the past 3 months, 3,727 reported using prescription opioids only for pain as directed by a physician; 1,809 reported using them in ways other than as directed by a physician (but not to get high); and 251 reported taking them to get high. (These figures differ from an erroneous estimate in the abstract.) Weighted to national estimates, 1.3 percent of U.S. adults (3 million people) used prescription opioids to get high during the 3-month period. Half tampered with the drugs. Use to get high increased with being employed, younger age, male sex, minority race, psychiatric illness, alcoholism, cigarette smoking, and higher household income. Respondents using opioids to get high reported greater impairment in work and nonwork activities and more healthcare use than nonusers. Tampering with opioid medication was associated with greater productivity loss and increased use of health care (all p<0.05). Those reporting nonrecreational misuse were not asked about tampering or health consequences.

Read more:
http://onlinelibrary.wiley.com/doi/10.1111/pme.12475/abstract

I.R. Wiechers, P.D. Kirwin, and R.A. Rosenheck. 2014. "Increased Risk Among Older Veterans of Prescribing Psychotropic Medication in the Absence of Psychiatric Diagnoses." The American Journal of Geriatric Psychiatry 22(6):531–39.

This study analyzed Veterans Health Administration (VHA) pharmacy and encounter claims for 1.85 million veterans who filled a prescription for at least one psychotropic medication from VHA during Fiscal Year 2010. Of patients prescribed a psychotropic medication, 30 percent had no psychiatric diagnosis, with the highest proportions among veterans ages 65–85. Lack of a linkable diagnosis was much higher for psychotropic medications than for HIV or diabetes medications. Comorbidity adjustment did not substantially alter the findings.

Read more:
http://www.ajgponline.org/article/S1064-7481(13)00383-7/abstract

L.K. Whiteside, R.M. Cunningham, E.E. Bonar, F. Blow, P. Ehrlich, and M.A. Walton. 2014. "Nonmedical Prescription Stimulant Use Among Youth in the Emergency Department: Prevalence, Severity and Correlates." Journal of Substance Abuse Treatment, doi:10.1016/j.jsat.2014.05.003.

Between September 2010 and March 2013, surveys of a statistical sample of youth aged 14–20 seen at the University of Michigan emergency department showed that 8.3 percent of 4,389 respondents self-reported past-year nonmedical prescription stimulant use, and 44 percent of those with past 3-month nonmedical prescription stimulant use reported at least monthly use. Parents were often present as youth responded to the survey on a tablet. Controlling for demographics, participants with mild nonmedical prescription stimulant use or moderate/severe nonmedical prescription stimulant use had higher odds of all substance use risk factors compared with those who had no nonmedical prescription stimulant use. Those with moderate/severe nonmedical prescription stimulant use were more likely to report dating violence and nonmedical use of opioids or sedatives and less likely to use marijuana than those with mild nonmedical prescription stimulant use. This study affirms the finding that nonmedical prescription drug use is concentrated among multi-problem youth.

Read more:
http://www.sciencedirect.com/science/article/pii/S0740547214000841

B. Zedler, L. Xie, L. Wang, A. Joyce, C. Vick, F. Kariburyo, P. Rajan, O. Baser, and L. Murrelle. 2014. "Risk Factors for Serious Prescription Opioid-Related Toxicity or Overdose Among Veterans Health Administration Patients." Pain Medicine, doi:10.1111/pme.12480.

Researchers examined factors associated with serious toxicity in patients dispensed an opioid by the Veterans Health Administration between October 2010 and September 2012. Cases (n=817) experienced life-threatening opioid-related respiratory/central nervous system depression or overdose. Ten controls with dispensed opioid were randomly assigned to each case (n=8,170). Logistic regression indicated adverse event risk was associated with maximum prescribed daily morphine equivalent dose ≥100 mg (odds ratio [OR]=4.1), history of opioid dependence (OR=3.9), and hospitalization during the 6 months before the serious toxicity or overdose event (OR=2.9). Liver disease, extended-release or long-acting opioids, and daily morphine equivalent dose of 20 mg or more were also significantly associated.

Read more:
http://onlinelibrary.wiley.com/doi/10.1111/pme.12480/abstract

Professional Education & Editorial

M.D. Cheatle and C. Barker. 2014. "Improving Opioid Prescription Practices and Reducing Patient Risk in the Primary Care Setting." Journal of Pain Research, 2014(7):301–11, doi:10.2147/JPR.S37306.

This paper reviews the role of opioids in managing chronic noncancer pain, including efficacy and risk for misuse, abuse, and addiction. It discusses several models for risk assessment, intervention, and monitoring of patients receiving opioids in a primary care setting.

Read more:
http://www.dovepress.com/improving-opioid-prescription-practices-and-reducing-patient-risk-in-t-peer-reviewed-article-JPR

C.S. Davis, S. Ruiz, P. Glynn, G. Picariello, and A.Y. Walley. 2014. "Access to Naloxone Among Firefighters, Police Officers, and Emergency Medical Technicians in Massachusetts." American Journal of Public Health, doi:10.2105/AJPH.2014.302062.

Several jurisdictions have expanded naloxone administration authority to nonparamedic first responders. This article reported on policy change in Massachusetts, where communities have equipped emergency medical technicians, law enforcement officers, and firefighters with naloxone.

Read more:
http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2014.302062

E.L. Garland. 2014. "Treating Chronic Pain: The Need for Non-Opioid Options." Expert Review of Clinical Pharmacology, doi:10.1586/17512433.2014.928587.

This article provides a selective review of cognitive, affective, and psychophysiological mechanisms implicated in chronic pain to be targeted by novel nonopioid treatments. It briefly details one such treatment approach, Mindfulness-Oriented Recovery Enhancement, and describes evidence suggesting this intervention can disrupt the risk chain linking chronic pain to prescription opioid misuse.

Read more:
http://informahealthcare.com/doi/abs/10.1586/17512433.2014.928587

M. Gross. 2014. "Self, Medicated." American Journal of Public Health, doi:10.2105/AJPH.2014.302091.

In the late 1990s, new medical practice guidelines addressing undertreatment of pain coincided with the initiation of oxycodone marketing, followed by increased use of various opiate products for analgesia. Although heroin use essentially remained unchanged in the following decade, prescribed and nonmedical prescription opioid consumption increased fourfold. In 2009, drug poisoning—accelerated by the rise in prescription pain relievers—became the leading cause of death from injury. Strategies introduced to reverse this trend included modification of practice guidelines in 2006 to address challenges in safe initiation of or switching to methadone from other opiates, and in late 2013 to curb overzealous prescribing of opiate analgesics, as well as dissemination and optimization of prescription monitoring programs to detect pill mills, curb doctor shopping, and reinforce the application of effective prescribing practices.

Read more:
http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2014.302091

News

Medicaid Will Cover Drug to Reverse Overdoses
Andrew Oxford, Taos News
June 18, 2014

New Mexico officials announced the state Medicaid program will cover naloxone. Patients will soon be able to enter a participating pharmacy to talk to a credentialed pharmacist and receive naloxone without visiting a physician. Participating physicians and medical practices will also continue to distribute intranasal naloxone as part of a Department of Health pilot program.

Read more:
http://www.taosnews.com/news/article_5cdec2ca-f73c-11e3-9900-001a4bcf887a.html

N.E. Governors Convene, Discuss Opioid Abuse Crisis
Leah Burrows, Brandeis University
June 17, 2014

Massachusetts Governor Deval Patrick said Brandeis' Prescription Drug Monitoring Program Center of Excellence will partner with New England states to analyze data from each state's prescription monitoring program and recommend best practices for the region's fight against opioid abuse. Patrick and governors from Vermont, New Hampshire, Connecticut, and Rhode Island held a private roundtable discussion with Brandeis, Schneider Institutes for Health Policy, and state health officials to discuss strategies for addressing the growing opioid abuse epidemic.

Read more:
http://www.brandeis.edu/now/2014/june/governors.html

5 States to Jointly Combat Overdoses
Brian MacQuarrie, The Boston Globe
June 18, 2014

Five New England governors agreed to work across state borders to address a surge in drug overdoses, promising to better monitor the prescription of opioid pain relievers and expand access to addiction treatment. The governors said they would explore sharing prescription data on a broad scale—in part to curb doctor shopping by patients and small-time drug dealers who skirt prescription limits. They will also push for mandatory registration in the prescription monitoring program. The governors pledged to forge agreements among state Medicaid programs, allowing patients to cross borders for drug-abuse treatment. Under that plan, if one state does not immediately have available beds for treatment, an addict could turn to other New England states. The Prescription Drug Monitoring Program Center of Excellence, a Brandeis program, will help the governors find ways to put their proposals into place.

Read more:
http://www.bostonglobe.com/metro/2014/06/17/new-england-governors-meet-drug-summit-brandeis-university/skRDQ9qL3ZqS9M98CiwpSM/story.html

Why Are Blue Collar Workers Drug Tested but Not Surgeons?
Drew Hendricks, Digital Journal
June 19, 2014

This article argues that regulators and hospitals should hold doctors and nurses to the same drug-testing standards as safety-sensitive jobs, instead of to a Hippocratic code of ethics that provides little accountability. The author discusses a California ballot measure, the Troy and Alana Pack Patient Safety Act, which voters will consider in November 2014. This measure specifies numerous reforms aimed to increase accountability for medical negligence and raise damage caps awarded in such cases. One of the bill's primary goals is to "protect patients and their families from injury caused by doctors who are impaired by alcohol or drugs by requiring hospitals to conduct random drug and alcohol testing of the doctors who practice there and requiring them to test physicians after an unexpected death or serious injury occurs." The law would also require medical professionals to report any peers they suspect of abusing drugs, and to check a state prescription monitoring program before writing prescriptions for certain drugs. The physician-run California Medical Board, which handles all complaints and allegations against doctors, opposes this bill. The opposition has raised more than $33 million to fight the bill's passage.

Read more:
http://www.digitaljournal.com/news/odd+news/why-are-blue-collar-workers-drug-tested-but-not-surgeons/article/387112

Opiate Overdose Deaths Rising Across Canada
Maureen Brosnahan, CBC News
June 18, 2014

The Canadian Drug Policy Coalition released a report showing deaths linked to opiate overdoses are rising sharply across Canada because of over-prescribing. The report calls for more education for patients taking opiates, appropriate prescribing guidelines for physicians, and widespread training and use of naloxone. It also calls on governments to set up Good Samaritan laws that would ensure those who call for help are not implicated or penalized for using or possessing drugs.

Read more:
http://www.cbc.ca/news/canada/opiate-overdose-deaths-rising-across-canada-1.2678820

Feds Seek Ways to Expand Use of Addiction Drug
The Washington Post
June 18, 2014

Senator Carl Levin pressed officials from the White House, National Institute on Drug Abuse, and other agencies to increase buprenorphine access. Access remains limited by federal restrictions, inconsistent insurance coverage, and a lack of acceptance by physicians. Only 4 percent of the 625,000 U.S. doctors eligible to prescribe buprenorphine have received certification to use it. Government officials agreed that more training is needed to familiarize both medical students and experienced physicians with science showing addiction can be successfully treated with medication. Federal law caps the number of patients a provider can treat with buprenorphine at 100. Officials cautioned against raising that number, noting buprenorphine itself can be abused.

Read more:
http://www.washingtonpost.com/business/feds-seek-ways-to-expand-use-of-addiction-drug/
2014/06/18/eb8a503a-f713-11e3-9e63-ec28e320b8bf_story.html


Five Ways to Combat Prescription Drug Abuse
Robert M. Wah, The Boston Globe
June 18, 2014

President Robert M. Wah, M.D., discusses the American Medical Association's recommendations for governors to pursue a five-pronged approach to prescription drug abuse emphasizing treatment and prevention: 1) continued balance and state flexibility to guide policy and effectively curb prescription drug abuse, overuse, misuse, and death; 2) state licensing boards, public health agencies, state medical and pharmacy associations, and other stakeholders working together toward solutions that will reduce prescription drug abuse, overdose, and death; 3) discussions with stakeholders on how to incorporate prescription monitoring programs into their state strategies; 4) recognizing substance abuse and addiction demands medical treatment; and 5) proceeding with extreme caution when it comes to mandates.

Read more:
http://www.bostonglobe.com/opinion/2014/06/18/five-ways-combat-prescription-drug-abuse/ssrsvBeu0RdHwNK904M2bN/story.html

3 Surprising (and Dangerous) Truths About Opiate Addiction
Eric Schmidt, PsychCentral
June 18, 2014

Eric Schmidt, chief executive officer of New Roads Treatment Centers, discusses three truths about opiates and opiate addiction: 1) long-release pills offer extra overdose opportunity, 2) dependence is a multifaceted disease, and 3) prescription drugs cause more deaths than heroin and cocaine combined.

Read more:
http://blogs.psychcentral.com/addiction-under-30/2014/06/3-surprising-and-dangerous-truths-about-opiate-addiction

Heroin Abuse: Ayotte–Donnelly Bill Looks to Combat Heroin, Prescription Pain Medication Abuse
Casey Weldon, WCPO
June 19, 2014

U.S. Senator Joe Donnelly and Representative Kelly Ayotte introduced bipartisan legislation that creates an interagency task force to develop prescribing practices for pain medication that will work to ensure "proper pain management for patients, while also preventing prescription opioid abuse." The bill would give law enforcement greater access to important tools for fighting heroin use, and calls for a well-coordinated drug awareness campaign with a focus on the links between prescription opioid abuse and heroin addiction.

Read more:
http://www.wcpo.com/news/national/ayotte-donnelly-bill-looks-to-comabt-heroin-prescription-pain-medication-abuse

Is Your Doctor Stoned? Physicians with Substance Abuse Problems Continue to Work
Jeff Rossen and Charlie McLravy, TODAY News
June 16, 2014

This article and video (5:35 minutes) discuss doctors who are addicted to drugs or alcohol. TODAY national investigative correspondent Jeff Rossen found numerous cases of doctors penalized for substance abuse. The video features stories of two abusers—one in recovery, one whose license was revoked.

Read more:
http://www.today.com/news/your-doctor-stoned-physicians-substance-abuse-problems-continue-work-1D79801891

Minister Ambrose to Consult Canadians on Regulating Tamper-Resistant Properties for Prescription Drugs
Government of Canada
June 16, 2014

The Canadian Ministry of Health will soon request public comment on a proposal to regulate tamper-resistant properties for prescription drugs that have a high risk of abuse. The ministry will also seek input from provinces and territories on prescribing practices for drugs with a high risk of abuse.

Read more:
http://news.gc.ca/web/article-en.do;jsessionid=2931212f6a90453af65ed239d4731183885
f2dbc505a862daf653dc8f3a95118.e38RbhaLb3qNe34RbNr0?mthd=tp&crtr.page=
4&nid=858089&crtr.tp1D=1


Prescription Drug Abuse Increases Among 50+ Group
Dr. Bruce Hensel and Crystal Muguera, NBC4
June 18, 2014

This article and video (2:22 minutes) discuss prescription drug abuse among people over 50. The reporter recommends asking one's doctor or pharmacist about side effects and dangers of taking anxiety and pain medications. He suggests getting help if experiencing memory problems or other symptoms.

Read more:
http://www.nbclosangeles.com/news/local/prescription-drug-abuse-addiction-senior-263713411.html

A Heroin User's Story: Naloxone Gives a Mother Back Her Son, but Can't Cure Addiction
Alessandra Malito, The Wall Street Journal
June 16, 2014

This article discusses how naloxone can save lives but cannot cure addiction or prevent relapse.

Read more:
http://online.wsj.com/articles/a-heroin-users-story-naloxone-gives-a-mother-back-her-son-but-cant-cure-addiction-1402967626

Optimizing Pain Management While Preventing Opiate Withdrawal in Postoperative Newborns
A. Schwartz, Science of Caring
June 2014

A recently launched study by Linda Franck, an expert in pediatric pain management at the University of California San Francisco School of Nursing, is aimed at optimizing and standardizing weaning protocols for postoperative infants on pain medications.

Read more:
http://scienceofcaring.ucsf.edu/acute-and-transitional-care/optimizing-pain-management-while-preventing-opiate-withdrawal#sthash.tYuzryFa.dpuf

Other State and Local News

Burlington County Real Estate Agents Fight Drug Theft
David Levinsky, Burlington County Times
June 17, 2014

Prevention Plus of Burlington County and Century 21 Alliance are urging New Jersey homeowners to clean out their medicine cabinets. Homes for sale are being targeted during open houses and tours by people who steal prescription and over-the-counter medications. The group created a pamphlet warning sellers of this issue and advising them to take simple precautions. Century 21 has started distributing lockable zipper bags for sellers to store prescription drugs and valuables.

Read more:
http://www.burlingtoncountytimes.com/news/local/burlington-county-real-estate-agents-fight-drug-theft/article_23ce5f4b-cad3-58e2-89d4-8324759864e9.html

'Jaidon's Law' to Protect Children from Drug-Abusing Parents Signed into Law in SC
Felicia Kitzmiller, Herald-Journal
June 14, 2014

South Carolina legislators passed Jaidon's Law, named for Jaidon Morris, who died from a prescription overdose in 2008. The bill requires parents whose children are taken in for substance abuse issues by the Department of Social Services to be drug tested before a judge can consider returning the child to their custody. The law also instructs Department of Social Services staff to seek termination of parental rights if a parent fails to follow family court orders twice within a year, or is convicted of homicide by child abuse.

Read more:
http://www.goupstate.com/article/20140614/ARTICLES/140619823?Title=-8216-Jaidon-8217-s-Law-8217-to-protect-children-from-drug-abusing-parents-signed-into-law-in-SC

'Project Lazarus' Making Headway on Opioid Overdoses
Megan Brooks, Medscape
June 17, 2014

This article discusses the success of Project Lazarus, a community-based opioid overdose prevention program that has dramatically cut overdose deaths in Wilkes County, North Carolina. The Kate B. Reynolds Charitable Trust is contributing $1.3 million for a statewide rollout of the program, with matching grants from the North Carolina Office of Rural Health and Mountain Area Health Education Center CMS Innovations grant program.

Read more:
http://www.medscape.com/viewarticle/826865

Secretary of State Signs Emergency Rule to Place Requirements on Prescription of Hydrocodone
State of Delaware
June 18, 2014

Following recommendations from the Delaware Controlled Substance Advisory Committee, Secretary of State Jeffrey Bullock has put emergency regulations on any extended-release hydrocodone (Zohydro) that lacks an abuse-deterrent formulation feature. The regulations require best practices in assessment, prescribing, and monitoring of patients for whom the drug has been prescribed. Restrictions and requirements provide additional security in fulfilling obligations to protect the public. Before prescribing an extended-release hydrocodone that is manufactured without an abuse-deterrent formulation, the medical practitioner shall conduct and document a thorough medical evaluation and physical examination.

Read more:
http://news.delaware.gov/2014/06/18/secretary-of-state-signs-emergency-rule-to-place-requirements-on-prescription-of-hydrocodone

Panel Probes 'Doctor Shopping'
Eric Eyre, Charleston Gazette
June 15, 2014

The West Virginia Board of Pharmacy Review Committee sent more than 2,500 letters to medical professionals across the state, warning that their patients could be doctor shopping to obtain prescription drugs. They identified 176 people who had received opioid prescriptions from 13 or more doctors over the past 12 months. The committee also notified law enforcement agencies about dozens of people who visited an excessive number of doctors and obtained prescriptions for pain pills. A recent report revealed 40 people received prescriptions from 18 or more different medical providers, and 262 individuals got prescriptions from a dozen or more doctors during the past year. Additionally, 8,000 people picked up pain pill prescriptions from six or more physicians. The panel plans to review controlled substance prescriptions at least every 6 months.

Read more:
http://www.wvgazette.com/article/20140615/GZ01/140619561/1419

Rejected Applicants for Pittsburgh Civil Service Jobs Can Appeal, Tell Side
Margaret Harding, Pittsburgh Tribune-Review
June 15, 2014

This article discusses applicant outcomes of Pittsburgh police and firefighter recruits who confess to smoking marijuana and abusing alcohol and prescription drugs. Disqualified applicants can tell their side of the story in an appeal to the Civil Service Commission, which can vote to put them back on police and fire department hiring lists. Criteria for disqualification include being a habitual drug or alcohol user, engaging in "notoriously disgraceful conduct," or falsifying records. This year, records showed seven police and five firefighters appealed disqualifications. The commission granted appeals from three police applicants and one fire bureau applicant.

Read more:
http://triblive.com/news/allegheny/6127533-74/commission-police-conduct#axzz34oL2cJns

Summit to Address Issue of Newborns Addicted to Prescription Drugs
Amanda Ober, WESH
June 17, 2014

This article and video (3:05 minutes) discuss how Florida hospitals are seeing more babies born addicted to prescription drugs. Winnie Palmer Hospital will host a summit on the growing problem. The drug-dependent newborn unit of the Orange County Department of Child and Families—the only one of its kind in Florida—consulted on 203 cases in 2013 and 104 to date in 2014.

Read more:
http://www.wesh.com/health/summit-to-address-issue-of-newborns-addicted-to-prescription-drugs/26535994#!0ygda

Statement from Governor Hassan on Executive Council Approval of Contract to Help Implement Prescription Drug Monitoring Program
State of New Hampshire
June 18, 2014

New Hampshire's governor applauded the Executive Council's approval of a Board of Pharmacy contract to purchase and install a software system and associated services for the prescription monitoring program.

Read more:
http://www.governor.nh.gov/media/news/2014/pr-2014-06-18-prescription-drug.htm

Police Train to Combat Drug Abuse
Cody Neff, Register–Herald Reporter
June 18, 2014

Officers gathered at the University of Charleston's Beckley Campus to learn more about prescription drugs, and what they can do to address West Virginia's prescription drug problem. The third annual training, which focused on everything from doctor shopping to identification, was coordinated by Beckley Police, the FBI Law Enforcement Executive Development Association, and Purdue Pharma.

Read more:
http://www.register-herald.com/local/x1669973805/Police-train-to-combat-drug-abuse

Police Better Equipped to Nab Drug-Impaired Drivers
Beverly Ware, Herald News
June 20, 2014

Five Lunenburg County, Nova Scotia, police officers received special training to spot drivers under the influence of prescription drugs. Staff Sergeant Jean-Guy Richard said drug recognition experts are now at work and will be called to the scene if an officer suspects a driver is drug impaired. The five officers took a 3-week course in Jacksonville, Fla., and Phoenix, Ariz., where they assessed drug-impaired prisoners brought to detention centers.

Read more:
http://thechronicleherald.ca/novascotia/1217104-police-better-equipped-to-nab-drug-impaired-drivers

Other Resources

Smart Moves, Smart Choices
National Association of School Nurses, Janssen Pharmaceuticals
Accessed June 18, 2014

Smart Moves, Smart Choices is a national awareness program designed to inform parents, teens, and educators about the risks of teen prescription drug misuse and abuse. It features a website, videos, and tool kit to assist educators in conducting school assemblies on prescription drug abuse. The program encourages parents and relatives to monitor their medicine cabinets and have open and honest conversations with their children.

Read more:
http://www.smartmovessmartchoices.org

Painkillers: A Brief History
John Tozzi, Bloomberg
June 19, 2014

This timeline outlines the history of pain relievers from 1916 to June 2014.

Read more:
http://www.businessweek.com/articles/2014-06-19/painkillers-a-brief-history

A Hidden Workplace Epidemic: Opioid Prescription Painkillers' Impact on Employers and Their Employees
National Safety Council
Accessed June 19, 2014

This infographic illustrates how prescription pain relievers affect employers.

Read more:
http://www.nsc.org/safety_home/PrescriptionDrugOverdoses/Documents/NSC
%201311%20Painkillers-Employers-Final.pdf

Webinar Archive

Hidden Workplace Epidemic: Prescription Painkillers' Impact
National Safety Council
June 5, 2014

Learn how prescription pain reliever use is affecting workplace safety and driving up workers' compensation and other costs. In this Webinar, Dr. Don Teater, medical advisor for the National Safety Council, explained how to update drug-free workplace and health plans to address prescription drug use and misuse. (59 minutes)

Webinar:
http://www.nsc.org/safety_home/PrescriptionDrugOverdoses/Pages/Employer-Policies.aspx?utm_source=900005568+ADV+Rx+Webinar+Follow+up&utm_campaign=900005568
&utm_medium=email


Slides:
http://www.nsc.org/safety_home/PrescriptionDrugOverdoses/Documents/
Hidden%20Worplace%20Epidemic%20Prescription%20Painkillers%20Impact
%20PPT%20June%205%202014.pdf


Questions/Answers:
http://www.nsc.org/safety_home/PrescriptionDrugOverdoses/Documents/QA
%20Webinar%20June%205%202014.pdf

Request for Proposal

Colorado Consortium for Prescription Drug Abuse Prevention Public Awareness Workgroup: Prescription Drug Safe Use, Storage and Disposal Statewide Social Marketing Campaign
Colorado Governor's Office
Deadline: July 1, 2014
https://www.bidscolorado.com/co/portal.nsf/xpSolicitationView.xsp?action=openDocument&documentId=8CF92B6124937CD487257CE80077695E

Chronic Pain Management Research Grant
Milbank Foundation
Postmarked by November 1, 2014
http://foundationforpmr.org/milbank-foundation-chronic-pain-management-research-grant-application-criteria-and-conditions

Take-Back Events and Drop Boxes

Blue Hill Memorial Hospital Prescription Drug Take-Back Day
Blue Hill Memorial Hospital (Maine)
June 16, 2014
http://bhmh.org/News/2014/Blue-Hill-Memorial-Hospital-Prescription-Drug-Take.aspx

Prescription Drug Take-Back Offered Year Round
Daily Messenger (New York)
June 18, 2014
http://www.mpnnow.com/article/20140618/NEWS/140619569/1994/NEWS

Cleveland County Officials Hosting Drug Roundup
KRMG (Oklahoma)
June 19, 2014
http://www.krmg.com/ap/ap/oklahoma/cleveland-county-officials-hosting-drug-roundup/ngNr5

Do Good Detroit: Prescription Drug Drop Box Available at Hamtramck Police Dept.
Gina Brintley, Detroit Free Press (Michigan)
June 13, 2014
http://www.freep.com/article/20140613/BLOG41/140613008/Do-Good-Detroit-Prescription-drug-drop-box-available-Hamtramck-Police-Dept-

Drop Box Helps Keep Prescription Drugs off Street
The Kearney Courier (Missouri)
June 19, 2014
http://www.kearneycourier.com/news/article_026859da-b02a-57af-a6e1-672be3f29841.html

Belgrade PD to Get Prescription Drug Drop Box
Jordan Moore, KTVM (Montana)
June 17, 2014
http://www.nbcmontana.com/news/belgrade-pd-to-get-prescription-drug-drop-box/26537208

Belton: Prescription Drug Drop Box Installed At Police Dept.
KWTX-TV (Texas)
June 16, 2014
http://www.kwtx.com/ourtown/home/headlines/Belton--Prescription-Drug-Drop-Box-Installed-At-Police-Dept-263363571.html

Almost 400 Pounds of Prescription Drugs Delivered to DEA
Heather Asiyanbi, Racine County Eye (Wisconsin)
June 18, 2014
http://racinecountyeye.com/2014/06/18/almost-400-pounds-prescription-drugs-delivered-dea

Three Prescription Drug Drop Off Boxes Operational in San Tan Valley
San Tan Valley News (Arizona)
June 19, 2014
http://www.santanvalley.com/news/san-tan-valley-news/item/11852-three-prescription-drug-drop-off-boxes-operational-in-san-tan-valley

Police HQ Gets Drug Drop Box
WestportNow Media (Connecticut)
June 18, 2014
http://www.westportnow.com/index.php?/v2_5/comments/49113

Prescription Drug Drop Box Now Located in Indy
WISHTV (Indiana)
June 16, 2014
http://wishtv.com/2014/06/16/prescription-drug-drop-box-now-located-in-indy

Save the Date

Sixth Annual American Medicine Chest Challenge: National Day of Awareness and Safe Disposal of Rx and OTC Medicine
American Medicine Chest Challenge
November 8, 2014
http://www.americanmedicinechest.com

Upcoming Conferences and Workshops

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

Clinical Challenges in Opioid Prescribing: Balancing Safety and Efficacy
Colorado Prescription Drug Abuse Prevention Program of Peer Assistance Services, Inc. and SAMHSA
July 11, 2014
Denver, Colorado
http://peerassistanceservices.org/events/clinical-challenges-in-opioid-prescribing

CADCA's Mid-Year Training Institute 2014
July 20–24, 2014
Orlando, Florida
http://www.cadca.org/events/detail/mid-year-training-institute-2014

Prevention of Youth Substance Abuse in Rural Communities Conference: Bringing Hope to Communities in Despair
Coalition for Healthy Youth
August 6–8, 2014
Lancaster, South Carolina
http://www.lcpartnersforyouth.org/Coalition

Preventing Prescription Drug Abuse—Non-Members
New Jersey Pharmacists Association
August 7, 2014
Secaucus, New Jersey
http://njpharmacists.org/events/event-info#id=107&cid=955&wid=201

27th Annual NPN Prevention Research Conference
National Prevention Network
September 15–18, 2014
Hartford, Connecticut
http://swpc.ou.edu/npn

2014 Harold Rogers PDMP National Meeting
Brandeis University, Prescription Drug Monitoring Program Training and Technical Assistance Center
September 22–24, 2014
Washington, D.C.
http://www.pdmpassist.org/content/events

142nd Annual Meeting and Exposition
American Public Health Association
November 15–19, 2014
New Orleans, Louisiana
http://www.apha.org/meetings/annual
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.