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June 4, 2014

 

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SAMHSA
SAMHSA Prescription Drug Abuse Weekly Update
WEEKLY
UPDATE
Issue 74  |  June 4, 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 Take-Back Events Save the Date Upcoming Conferences and Workshops

Featured

Emilie Clay, Amine Khemiri, Vladimir Zah, Samuel Aballéa, Jane Ruby, and Carl V. Asche. 2014. "Persistence and Healthcare Utilization Associated With the Use of Buprenorphine/Naloxone Film and Tablet Formulation Therapy in Adults With Opioid Dependence." Journal of Medical Economics, doi:10.3111/13696998.2014.925463.

Using longitudinal U.S. private insurance claims data, patients who initiated treatment with buprenorphine/naloxone were classified into groups initially prescribed a film versus a tablet formulation. Film and tablet groups included 2,796 and 1,510 patients enrolled in the health plans over an average of 9.76 and 13.76 months, respectively, after treatment started. Mean prescribed doses were 14.62 and 14.26 mg/day in film and tablet groups. Persistence was defined as the proportion of patients continuing treatment for at least six months. Among patients in the health plan for at least six months from the initial treatment, persistence rates were 63.8 percent with film versus 58.1 percent with tablet. Time to treatment discontinuation was longer in the film group, with a hazard ratio of 0.82 (p<0.001) adjusted for baseline characteristics. Patients treated with film had 4 percent more outpatient visits (p=0.0185) but a 17 percent lower probability of hospital admission (p=0.0158), resulting in 27 percent lower total healthcare costs over the 12-month period after initiation (p<0.001). Thus, the film formulation of buprenorphine/naloxone was superior to the tablet formulation.

Read more:
http://informahealthcare.com/doi/abs/10.3111/13696998.2014.925463

Journal Articles and Reports

Brian K. Ahmedani, Edward L. Peterson, Karen E. Wells, David E. Lanfear, and L. Keoki Williams. 2014. "Policies and Events Affecting Prescription Opioid Use for Noncancer Pain Among an Insured Patient Population." Pain Physician 17(3):205–16.

Implementation of health organization accreditation criteria requiring assessment and treatment of pain in all patients beginning January 2001 was associated with consistent and continuing increases in the rate of opioid fills by adults without cancer, their proportion of chronic use, the average strength of their opioid fills, and their annual rate of adverse events. Study patients were 523,623 members served between 1997 and 2011 by a large health maintenance organization in southeast Michigan. Their longitudinal pharmacy records included 1,066,700 opioid fills for noncancer pain.

Read more:
http://www.painphysicianjournal.com/crrent_issue_vw.php?journal=82&code=2093&issue=current_issue

Theodore J. Cicero, Matthew S. Ellis, Hilary L. Surratt, and Steven P. Kurtz. 2014. "The Changing Face of Heroin Use in the United States: A Retrospective Analysis of the Past 50 Years." JAMA Psychiatry, doi:10.1001/jamapsychiatry.2014.366

Researchers analyzed data from an ongoing study that includes self-administered surveys of patients entering substance abuse treatment programs across the country because of heroin use/dependence (n=2,797, response rate 85 percent) and unstructured qualitative interviews with 54 respondents. Respondents who began using heroin in the 1960s were predominantly young men (82.8 percent; mean age, 16.5 years) whose first opioid of abuse was heroin (80 percent). More recent users were slightly older (mean age, 22.9 years) men and women living in less urban areas (75.2 percent) who were introduced to opioids through prescription drugs (75.0 percent). Whites and nonwhites were equally represented in those initiating use before the 1980s, but nearly 90 percent of respondents who began use in the last decade were white. Although the "high" produced by heroin was described as a significant factor in its selection, it was often used because it was more readily accessible and much less expensive than prescription opioids.

Read more:
http://archpsyc.jamanetwork.com/article.aspx?articleid=1874575

Natasa Gisev, Louisa Degenhardt, Sarah Larney, Briony Larance, Amy Gibson, Jo Kimber, and Lucy Burns. 2014. "A Comparative Study of Opioid Substitution Therapy Utilization Among Opioid-Dependent Men and Women." Drug and Alcohol Review, doi: 10.1111/dar.12151.

Researchers linked New South Wales, Australia, data on opioid substitution therapy entry in 2001–10 and custody episodes in 2000–2012. The cohort included 15,600 opioid substitution therapy entrants, with 70 percent of them men and 81 percent starting treatment in the community. A greater proportion of men than women (24.0 percent versus 8.3 percent) started treatment in custody. Of those starting treatment while in custody, 57.5 percent of men versus 41.8 percent of women received opioid substitution therapy only in custody. Women were retained longer in their first opioid substitution therapy treatment episode in both treatment settings.

Read more:
http://onlinelibrary.wiley.com/doi/10.1111/dar.12151/abstract;jsessionid=
B7A8DAFA4B9AF3A58C958A3C32575D21.f03t02?denied
AccessCustomisedMessage=&userIsAuthenticated=false


Nicholas E. Hagemeier, Matthew Michael Murawski, Nicolas C. Lopez, Arsham Alamian, and Robert P. Pack. 2014. "Theoretical Exploration of Tennessee Community Pharmacists' Perceptions Regarding Opioid Pain Reliever Abuse Communication." Research in Social and Administrative Pharmacy 10(3):562–75, doi: 10.1016/j.sapharm.2013.07.004.

Researchers polled a stratified sample of 2,000 licensed Tennessee community pharmacists, with 40 percent responding in late 2012. The great majority (87.5 percent) of respondents said opioid pain reliever abuse was a problem in their settings. They estimated that only 53 percent of opioid pain reliever prescriptions were for patients with medical need. Thirteen percent had addiction treatment facility information available for customers. Few felt very comfortable communicating with customers about prescription misuse. Job-related time constraints were the primary barrier.

Read more:
http://www.ncbi.nlm.nih.gov/pubmed/23981913

Madeline Hall. 2014. "The Effectiveness of State Policy in Combating Prescription Drug Abuse and Overdose." Claremont McKenna College Senior Theses. Paper 833.

States with a high prevalence of prescription drug overdose in 2008 had adopted stronger drug control policies by 2013 and strengthened their prescription drug monitoring plans (PDMPs). PDMPs that provide unsolicited reports to users and are accessible to law enforcement seem to slow the problem. (Editor's note: Or do they shift it to heroin?)

Read more:
http://scholarship.claremont.edu/cmc_theses/833/

Riley J. Hedin, Anna Fondario, and Michael Friedrichs. 2014. "Does the Timing of Naloxone Administration Affect Discharge Disposition?" An Analysis of Opioid Overdose Hospitalizations in Utah, 2011. Presentation at the 2014 Council of State and Territorial Epidemiologists Annual Conference, Nashville Convention Center, Nashville, Tenn., June 23.

Among opioid overdose hospitalizations in Utah in 2011, suicide attempters were much less likely to receive naloxone. In multivariate regression, unintentional overdose patients were twice as likely to be discharged home if emergency medical services administered naloxone. Conversely, unintentional overdose patients were less likely to be discharged home if naloxone was administered at the hospital (OR=0.81).

Read more:
https://cste.confex.com/cste/2014/webprogram/Paper3679.html

Alexandra A. N'Goran, Stéphane Deline, Yves Henchoz, Stéphanie Baggio, Joseph Studer, Meichun Mohler–Kuo, and Gerhard Gmel. 2014. "Association Between Nonmedical Prescription Drug Use and Health Status Among Young Swiss Men." Journal of Adolescent Health, doi:10.1016/j.jadohealth.2014.04.004.

Researchers examined the relationship between nonmedical prescription drug use and health, using two waves of data on young adults from the Cohort Study on Substance Use Risk Factors (n=4,958). They scored mental and physical health with the Medical Outcomes Study Short Form 12-Item Instrument (SF–12). In multivariate analysis, mental health at wave 2 was better among wave 1 nonmedical users of sedatives and anxiolytics; poor mental health was associated with nonmedical use of opioid analgesics and antidepressants but not vice versa. Poor physical health increased the risk of subsequent nonmedical use of anxiolytics and opioid analgesics, with opioid analgesic use also increasing the risk of worsening health.

Read more:
http://www.jahonline.org/article/S1054-139X(14)00181-5/abstract

Kimberly New and Mary Kennedy. 2014. "Diversion and Abuse of Prescription Opioids – Undermining Health and Health Care." Presentation at the 2014 Council of State and Territorial Epidemiologists Annual Conference, Nashville Convention Center, Nashville, Tenn., June 23.

Although no reliable national estimates exist of the prevalence of drug diversion activities by U.S. healthcare personnel, access to narcotics may represent an underappreciated occupational hazard and patient safety risk. Harms to patients from healthcare personnel who divert opioids may take many forms, including infection risks stemming from tampering with injectable drugs. For example, four hepatitis C outbreaks since 2004 were associated with infected healthcare workers who diverted fentanyl, involving more than 25,000 potentially exposed patients.

Read more:
https://cste.confex.com/cste/2014/webprogram/Paper3658.html

Cornelia Reichert, P. Reichert, F. Monnet–Tschudi, Hugo Kupferschmidt, Alessandro Ceschi, and Christine Rauber–Lüthy. 2014. "Seizures After Single-Agent Overdose With Pharmaceutical Drugs: Analysis of Cases Reported to a Poison Center." Clinical Toxicology, doi:10.3109/15563650.2014.918627.

Researchers aimed to identify the pharmaceutical drugs most commonly associated with seizures after single-agent overdose, the seizure potential of these pharmaceuticals, the age-distribution of the cases with seizures and the ingested doses. In Swiss Toxicological Information Centre data for 1997–2010, of 15,441 single-agent exposures, seizures occurred in 313. Drugs with a high seizure potential were bupropion, maprotiline, venlafaxine, citalopram, and mefenamic acid. The probability of seizures generally increased as the ingested dose increased. Adolescents might be more susceptible than adults to seizures after mefenamic acid overdose.

Read more:
http://informahealthcare.com/doi/abs/10.3109/15563650.2014.918627

Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. 2014. The DAWN Report: "Emergency Department Visits Involving Nonmedical Use of the Antianxiety Medication Alprazolam." Rockville, Md., May 22.

Alprazolam-related emergency department visits involving nonmedical use more than doubled, from 57,419 visits in 2005 to 124,902 visits in 2010, then remained stable in 2011 (123,744 visits). Between 2005 and 2011, visits by patients ages 25 to 34 tripled, with one third of all visits in 2011occurring in this age group. Alprazolam alone was used in 19 percent of visits, in combination with one other drug in 39 percent, with two drugs in 21 percent, and with three or more drugs in 21 percent.

Read more:
http://www.samhsa.gov/data/2K14/DAWN153/sr153-alprazolam-2014.pdf

Zev Schuman–Olivier, Roger D. Weiss, Bettina B. Hoeppner, Jacob Borodovsky, and Mark J. Albanese. 2014. "Emerging Adult Age Status Predicts Poor Buprenorphine Treatment Retention." Journal of Substance Abuse Treatment, doi:10.1016/j.jsat.2014.04.006.

Among 294 adults, 71 ages 18–25, followed in treatment with buprenorphine, nurse care management, and an intensive outpatient program followed by weekly psychosocial treatment, the younger adults remained in treatment at a significantly lower rate at 3 months (56 percent versus 78 percent) and 12 months (17 percent versus 45 percent) and were significantly more likely to test positive for illicit opioids, to relapse, or to drop out of treatment.

Read more:
http://www.journalofsubstanceabusetreatment.com/article/S0740-5472(14)00081-6/abstract

Erin L. Winstanley, Greg S. Brigham, Dean Babcock, and Theresa M. Winhusen. 2014. "Improving Treatment for Opioid Dependence: A Perspective From the Ohio Valley Node of the NIDA Clinical Trials Network." Progress in Community Health Partnerships: Research, Education, and Action 8(1):99–107, doi:10.1353/cpr.2014.0002.

Community-based treatment providers' involvement with the Ohio Valley Node of the National Institute on Drug Abuse's clinical trials network built professional relationships that may have increased the rate of evidence-based practice adoption and improved outcomes for patients with opioid dependence

Read more:
http://muse.jhu.edu/login?auth=0&type=summary&url=/
journals/progress_in_community_health_partnerships_
research_education_and_action/v008/8.1.winstanley.html


Karen H. Wang, David A. Fiellin, and William C. Becker. 2014. "Source of Prescription Drugs Used Nonmedically in Rural and Urban Populations." American Journal of Drug and Alcohol Abuse, doi:10.3109/00952990.2014.907301.

In National Survey on Drug Use and Health 2008–10 data on respondents reporting past-year nonmedical use of prescription medications, 18.9 percent of urban residents and 17.5 percent of rural residents had a physician source for drugs. Likelihood of a physician source was higher among Hispanics, insured individuals, and those with a prescription drug dependence. Rural residents who had a nonphysician source were more likely than urban residents with a nonphysician source to use hydrocodone, morphine, tramadol, and methadone.

Read more:
http://informahealthcare.com/doi/abs/10.3109/00952990.2014.907301

Professional Education & Editorial

Eric L. Garland. 2014. "Disrupting the Downward Spiral of Chronic Pain and Opioid Addiction With Mindfulness-Oriented Recovery Enhancement: A Review of Clinical Outcomes and Neurocognitive Targets." Journal of Pain and Palliative Care Pharmacotherapy, doi:10.3109/15360288.2014.911791.

A review of 67 methodologically rigorous studies including thousands of chronic pain patients concluded that 11.5 percent of these patients evidence signs of opioid misuse such as aberrant drug-seeking behaviors and unauthorized dose escalation. This paper reviews the evidence supporting Mindfulness-Oriented Recovery Enhancement (MORE) as a behavioral treatment for chronic pain. MORE integrates elements from mindfulness training, cognitive–behavioral therapy, and positive psychology. Randomized clinical findings indicated that MORE significantly reduced pain severity and pain-related functional interference with gains maintained three months following the end of the treatment. MORE also significantly decreased opioid craving.

Read more:
http://informahealthcare.com/doi/abs/10.3109/15360288.2014.911791

Sarah Gopman. 2014. "Prenatal and Postpartum Care of Women With Substance Use Disorders." Obstetrics and Gynecology Clinics 41(2):213–28, doi:10.1016/j.ogc.2014.02.004

This article outlines key aspects of prenatal and postpartum care, with a brief overview provided of intrapartum care. Issues covered include screening, opioid replacement therapy, comorbid medical and psychiatric conditions, environmental stressors, parenting preparation, pain management in labor and postpartum, breastfeeding guidance, prevention of relapse, and assistance with postpartum transition to primary care.

Read more:
http://www.obgyn.theclinics.com/article/S0889-8545(14)00011-4/abstract

Mary Beth Sutter, Lawrence Leeman, and Andrew Hsi. 2014. "Neonatal Opioid Withdrawal Syndrome." Obstetrics and Gynecology Clinics 41(2):317–34, doi:10.1016/j.ogc.2014.02.010.

Neonatal opioid withdrawal syndrome is common because of the current opioid addiction epidemic. Infants born to women covertly abusing prescription opioids may not be identified as at risk until withdrawal signs present. Buprenorphine is a newer treatment for maternal opioid addiction and appears to result in a milder withdrawal syndrome than methadone. Initial treatment is with nonpharmacological measures, including decreasing stimuli; however, pharmacological treatment is commonly required. Opioid monotherapy is preferred, with phenobarbital or clonidine uncommonly needed as adjunctive therapy. Rooming-in and breastfeeding may decrease the severity of withdrawal.

Read more:
http://www.obgyn.theclinics.com/article/S0889-8545(14)00017-5/abstract

News

Twenty-Five States' Prescription Data Now Linked Through Prescription Monitoring Program InterConnect
National Association of Boards of Pharmacy
May 28, 2014

The National Association of Boards of Pharmacy prescription drug monitoring program InterConnect program now has 25 active state programs. Idaho, Nevada, and New Jersey are the programs to go live on the system. Several other states have signed memorandums of understanding to participate and plan to connect in 2014.

Read more:
http://www.nabp.net/news/twenty-five-states-prescription-data-now-linked-through-nabp-pmp-interconnect

Medicare Paid Millions of Dollars for Wrongdoings, Report Finds
MSNBC
May 29, 2014

A sharp rise in prescription drug abuse among older Americans has caused a nationwide increase in urine and blood tests, which are potential areas of fraud among providers. Medicare paid doctors $457 million in 2012 for 16 million tests to detect drugs—from prescription narcotics to heroin. Three Connecticut doctors collected $1.4 million by billing in 2012 for 24,000 drug tests—for only 145 patients.

Read more:
http://www.msnbc.com/msnbc/medicare-paid-millions-misrepresentation

Does 'Nurse Jackie' Work in a Hospital Near You?
Washington Post
May 27, 2014

Lisa J. Merlo, an assistant professor of psychiatry at the University of Florida, says that lifetime rates of substance use disorders range from 10 percent to 15 percent among physicians. Psychiatrists, anesthesiologists, primary care providers, emergency room doctors, and surgeons seem to be at higher risk. Alcohol and prescription drugs (especially opiates and benzodiazepines) are the most likely drugs of choice among physicians, and access likely plays a role. Some physicians who develop addiction to prescription drugs admit to diverting from work. Others may self-prescribe or find a colleague to write prescriptions for them. In focus groups, physicians addicted to prescription drugs reported using them primarily for pain management, psychiatric distress, stress relief, and recreational purposes. The primary difference between physicians and individuals from the general population with addiction is the quantity and quality of treatment they receive. Physicians are typically mandated to 90 days of residential treatment, followed by five years of monitoring with random drug tests. As a result, rates of recovery exceed 80 percent, even five years after treatment. By contrast, individuals in the general population are frequently unable to obtain residential treatment until they "fail" lower levels of care by relapsing. Even if they participate in treatment, they typically have no follow-up monitoring. Thus, rates of recovery in the general population are closer to between 20 percent and 50 percent one year after treatment.

Read more:
http://www.washingtonpost.com/news/to-your-health/wp/2014/05/27/does-nurse-jackie-work-in-a-hospital-near-you/

Use of Stimulant Drug Modafinil Labeled a 'Dangerous Development' by CPSU
News.com.Au
May 27, 2014

Public servants in Australia are taking stimulants to cope with long work hours. Staff at the Finance and Treasury departments took Modafinil, a prescription drug for treating narcolepsy, to cope with shifts up to 20 hours long. The Community and Public Sector Union is fighting for "manageable workloads," but workloads seem likely to increase with 16,500 public service job cuts under way.

Read more:
http://www.news.com.au/finance/work/use-of-stimulant-drug-modafinil-labelled-a-dangerous-development-by-cpsu/story-e6frfm9r-1226933190312

Blackburn Bill on Prescription Drug Abuse Advances
Tennessean
May 28, 2014

The health subcommittee of the U.S. House Energy and Commerce Committee approved the Ensuring Patient Access and Effective Drug Enforcement Act, which aims to balance the need to keep drugs away from abusers while ensuring continued access to patients with a genuine need. The bill was introduced by Representatives Tom Marino and Marsha Blackburn. It now goes to the full Energy and Commerce Committee, for which Blackburn is vice chairman. The proposed legislation clarifies the Controlled Substances Act, making it easier for the Drug Enforcement Administration to suspend narcotics licenses of those in the supply chain whose actions have shown they pose an "imminent danger" to public health. It also would establish a working group of industry officials, pharmacists, and representatives of federal and state enforcement agencies to develop strategies for reducing drug diversion and abuse.

Read more:
http://www.tennessean.com/story/news/politics/2014/05/28/blackburn-bill-prescription-drug-abuse-advances/9690739/

Doctors Split on Zohydro, a Longer-Lasting Painkiller
Wall Street Journal
May 26, 2014

Some doctors are prescribing Zohydro because they say it fills a gap in patient care by providing long hours of relief. Pain specialists acknowledge that Zohydro carries risks of abuse and addiction and preferably should have abuse-deterrent features. James Patrick Murphy, who operates a pain center in Louisville, Ky., says some patients do better on drugs with hydrocodone than on other types of opioids. He considers patients with chronic pain who take short-acting versions of hydrocodone suitable candidates for switching to Zohydro.

Read more:
http://online.wsj.com/news/articles/SB10001424052702303749904579580301603189022?mg=reno64-wsj

Sen. Chuck Schumer Asks for $100 Million in Federal Funds to Fight Heroin Trafficking
New York Daily News
May 26, 2014

U.S. Sen. Chuck Schumer asked for $100 million in federal funds to curb heroin trafficking. He said the money should be allocated to the federal High-Intensity Drug Trafficking Areas program to give authorities in New York and New Jersey the boost they need to better assess heroin trafficking patterns in the region. The money would be included in the Senate appropriation bill that is being considered within the coming weeks.

Read more:
http://www.nydailynews.com/news/politics/sen-chuck-schumer-asks-100m-curb-heroin-trafficking-article-1.1806197

Other State and Local News

20,000 NYPD Cops to Carry Drug Able to Revive Victims Suffering a Heroin Overdose
New York Daily News
May 27, 2014

New York state will spend $1 million collected in drug forfeiture cases to provide naloxone, nasal injectors, and training to 20,000 New York City police officers, more than half of the entire New York Police Department.

Read more:
http://www.nydailynews.com/new-york/nyc-crime/20-000-nypd-cops-carry-drug-revive-victims-suffering-heroin-overdose-article-1.1807051

New Oklahoma Law Makes Prescription Drug Trafficking a Crime
KXII
May 29, 2014

This article and video (1 minute 50 seconds) discuss a bill signed into law by Oklahoma's governor that would make it a crime to carry 1,000 grams of morphine, 400 grams of oxycodone, 3,750 grams of hydrocodone, or 500 grams of benzodiazepine. This trafficking charge would result in a $100,000 to $500,000 fine and prison time. The law becomes effective Nov. 1.

Read more:
http://www.kxii.com/home/headlines/New-law-makes-prescription-drug-trafficking-a-crime-261032411.html?ref=411

Open Houses Attract Thieves Looking for Prescriptions
WZZM
May 29, 2014

Michigan real estate agents are staying vigilant during open houses following the theft of prescription medications by persons posing as interested buyers. Thieves have hit homes in several Kent County communities, including Cannon and Plainfield Townships. Julie Rietberg, CEO of the Grand Rapids Association of Realtors, said one or two individuals will keep the realtor occupied while another goes through the drawers and the cupboards. Drugs stolen during open houses include pain relievers, antianxiety drugs, ADHD drugs, Xanax, and Valium. The Kent County Sheriff's Department recently arrested a 43-year-old woman who admitted to stealing prescription medication from about 10 open houses over the past several months.

Read more:
http://www.wzzm13.com/story/news/investigations/13-on-your-side/watchdog/2014/05/28/prescription-thefts/9684575/

Doctors Vulnerable to Prescription Drug Abuse Crisis
KUSA
May 27, 2014

This article and video (2 minutes 13 seconds) discuss prescription drug abuse among physicians. Addiction to opiate pain relievers is the no. 1 cause of death of anesthesiologists under 40. Paul Wischmeyer, a professor of anesthesiology at University of Colorado Hospital, knows firsthand about addiction. He was prescribed oxycodone a decade ago after a series of surgeries. Three months after recovery, he was hooked. When Dr. Wischmeyer asked for help, he entered into a Colorado physician's health program. Now, he has 10 years of sobriety. Some hospitals have failed to secure new drugs of addiction that are killing or impairing physicians. He said that, until they do, accessibility feeds the addiction.

Read more:
http://www.9news.com/story/news/health/2014/05/27/addict-drug-abuse-opiate-doctors-colorado/9646851/

Terry Bunn, Svetla Slavova, and Ashley M. Bush. 2014. "Fatal Drug Overdoses: What Specific Drug Types Were Involved? What Industries and Occupations Were the Decedents Employed in?" Presentation at the 2014 Council of State and Territorial Epidemiologists Annual Conference, June 24, Nashville Convention Center, Nashville, Tenn.

Researchers analyzed death certificates for all 1,110 fatal drug overdoses in 2011 in Kentucky. Half involved pharmaceutical opioids, and 42 percent involved benzodiazepines. The greatest number of deaths was among workers in the services and construction industries, and in construction, repair, and food preparation occupations.

Read more:
https://cste.confex.com/cste/2014/webprogram/Paper3280.html

James W. Davis. 2014. "Reporting Time to the Prescription Monitoring Program and Total Drug Overdose Death, 2006–11, New Mexico." Presentation at the 2014 Council of State and Territorial Epidemiologists Annual Conference, June 24, Nashville Convention Center, Nashville, Tenn.

This study examined active prescriptions among New Mexicans who died of a drug overdose and who filled multiple prescriptions within a seven-day time in the month before their death. Individuals in the prescription drug monitoring program were matched by partial name and date of birth to deaths classified as drug overdoses by the Office of Medical Investigator in 2006–11. The analysis was limited to persons with an active prescription for a drug that contributed to their death (i.e., where date filled plus days supply ended no more than seven days before the date of death). Nine overdose deaths in 2011 and 68 in 2006–10 had multiple active prescriptions in their overdose drug class. Half filled multiple prescriptions within five days of their death. Directing pharmacies to report filled prescriptions within one day instead of seven days would identify at-risk individuals in a timelier fashion.

Read more:
https://cste.confex.com/cste/2014/webprogram/Paper3028.html

Jonah Long, Kirsten Waller, Virginia Dato, Ronald A. Tringali, Kumar Nalluswami, and Allison Longenberger. 2014. "Syndromic Surveillance of Drug and Alcohol Abuse–Related Emergency Department Visits—Pennsylvania, 2003–12." Presentation at the 2014 Council of State and Territorial Epidemiologists Annual Conference, Nashville Convention Center, Nashville, Tenn., June 25.

Researchers analyzed 2003–12 surveillance data from 152 emergency departments to describe the epidemiology of drug and alcohol abuse–related visits in Pennsylvania. In univariate analyses, visits referencing prescription opioids were more likely among patients living in rural zip codes (OR=1.54; 95 percent CI: 1.35–1.76), and visits for all substances except prescription depressants were more likely among males.

Read more:
https://cste.confex.com/cste/2014/webprogram/Paper3567.html

Matthew J. Lozier, L. Ogilvie, C. Martin, and L. Lewis. 2014. "Novel, Illicit Fentanyl-Analog Causes 14 Overdose Deaths—Rhode Island, 2013." Presentation at the Epidemic Intelligence Service Conference 2014, Atlanta, Ga., April 28 through May 1.

Using 2012–13 data from the Rhode Island Medical Examiner Database and from postmortem toxicology reports, researchers compared acetyl fentanyl overdose deaths with other illicit drug overdose deaths. No notable risk factor differences were identified.

Read more:
http://www.cdc.gov/media/dpk/2014/docs/eis/Novel-Illicit%20Fentanyl-Analog.pdf

Denise Paone, Ellenie Tuazon, and Daniella Bradley O'Brien. 2014. "Unintentional Drug Poisoning Deaths in New York City, Opioid Analgesic and Heroin Trends, 2000–2012." Presentation at the 2014 Council of State and Territorial Epidemiologists Annual Conference, Nashville Convention Center, Nashville, Tenn., June 24.

Researchers linked New York City death certificates with death files from the Office of the Chief Medical Examiner. During 2000–2012, drug overdose deaths totaled 9,085; 95 percent involved multiple substances. Fifty percent involved heroin only, 18 percent involved an opioid analgesic only, and 7 percent involved both heroin and opioid analgesics. During 2000–2012 the death rate involving opioid analgesics without heroin increased annually by 10 percent, while deaths involving heroin without opioid analgesics decreased annually by 5.3 percent.

Read more:
https://cste.confex.com/cste/2014/webprogram/Paper3545.html

Prescription Drug Deaths in Florida on the Decline
Ocala Star–Banner
May 29, 2014

Prescription drug deaths in Florida decreased during the first half of 2013 compared with the same period during 2012. The most significant drop was in deaths caused by oxycodone and alprazolam, from 731 deaths to 548. Hydrocodone deaths increased to 158 from 122.

Read more:
http://www.ocala.com/article/20140529/WIRE/140529631?tc=ar

Holly Springs Police Take Charge in Preventing Drug Overdose Deaths
Cherokee Ledger–News
May 28, 2014

Officers from the Holly Springs (Ga.) Police Department will receive training and begin carrying naloxone starting in June.

Read more:
http://www.ledgernews.com/news/top_stories/holly-springs-police-take-charge-in-preventing-drug-overdose-deaths/article_ba745dfc-e5d3-11e3-b8be-0017a43b2370.html

Prescription Addiction Epidemic Taking Toll on Newborns
Tampa (Fla.) Tribune
May 25, 2014

More Florida newborns are suffering from neonatal abstinence syndrome. In 2012, Hillsborough County had 125 reported cases of drug-addicted newborns, up from 24 in 2007; 43 cases in 2007 rose to 140 in 2012 in Pinellas County; Pasco County went from 6 to 34. Florida lacks a statewide reporting system but has set a goal to begin counting babies born with neonatal abstinence syndrome this year. The Healthy Start Coalition of Hillsborough County started the Substance Exposed Newborn Task Force in 2006. In 2009 it found the number of newborns addicted to prescription opiates was fewer than 20. By 2013 the number was more than 120.

Read more:
http://tbo.com/news/crime/prescription-addiction-epidemic-taking-toll-on-newborns-20140525/

Drugs Missing at Department of Corrections: Prison Problems Detailed at Federal Court Hearing
Pacific Daily News
May 28, 2014

Medical Director Raja Saad told U.S. District Court of Guam that prescription drugs at the Department of Corrections (DOC) have repeatedly gone missing while being distributed to prison inmates. As a vendor of the prison, Dr. Saad testified that the prison loses medication every week. He said the problem with controlling medication is a result of having DOC officers administering the drugs to inmates and detainees. Further, the officers have no supervision when they are distributing the drugs and medical staff have no control over the drugs once they leave their sight. DOC Director José San Agustin said he was aware of the missing drugs, adding that the situation is under investigation.

Read more:
http://www.guampdn.com/article/20140529/NEWS01/305290001/Drugs-missing-DOC-Prison-problems-detailed-federal-court-hearing

Other Resources

Monitoring the Future 2013 Survey Results
National Institute on Drug Abuse

January 2014

The National Institute on Drug Abuse created a ready-to-use infographic of the Monitoring the Future 2013: Teen Drug Use. It is available as a PDF or a Web page with a text description of the infographic. Monitoring the Future is an annual survey of 8th, 10th, and 12th graders that measures drug, alcohol, and cigarette use and related attitudes. Overall, 41,675 students from 389 public and private schools participated in the 2013 survey.

Read more:
http://www.drugabuse.gov/related-topics/trends-statistics/infographics/monitoring-future-2013-survey-results
http://www.drugabuse.gov/sites/default/files/nida_mtf2013_infographic_f.pdf

Federal Pain Research Database Launched
National Institutes of Health
May 27, 2014

The National Institutes of Health launched the Interagency Pain Research Portfolio, a database that provides information about pain research and training activities supported by the federal government. Users of the database easily can search more than 1,200 research projects in a multitiered system. The database also can be helpful in identifying potential collaborators by searching for topic areas of interest or for investigators.

Read more:
http://www.nih.gov/news/health/may2014/ninds-27.htm

Take-Back Events and Drop Boxes

Northfield Township (Ill.) Road District Provides Seasonal Recycling Opportunities
Chicago Tribune
May 27, 2014
http://www.chicagotribune.com/news/local/suburbs/northbrook/community/chi-ugc-article-northfield-township-road-district-provides-se-2014-05-27,0,4854192.story

Drug Drop Box Set Up by Chautauqua County (N.Y.) Sheriff's Office
Buffalo News
May 29, 2014
http://www.buffalonews.com/city-region/chautauqua-county/drug-drop-box-set-up-by-chautauqua-county-sheriffs-office-20140529

Dedham (Mass.) Police Issue Reminder About Prescription Drug Disposal
Dedham Patch
May 28, 2014
http://dedham.patch.com/groups/police-and-fire/p/dedham-police-issue-reminder-about-prescription-drug-disposal

Operation Medicine Drop Reaches Milestone in York County, S.C.
Herald
May 28, 2014
http://www.heraldonline.com/2014/05/28/6005420/operation-medicine-drop-reaches.html?sp=/100/101/&ihp=1

Hagerstown (Md.) Sets Up Drop Box for Unwanted Prescription Drugs
Herald Mail Media
May 29, 2014
http://www.heraldmailmedia.com/news/local/hagerstown-sets-up-drop-box-for-unwanted-prescription-drugs/article_53ea0d52-9e55-5b12-a64d-4a3a94001f09.html

You Can Dispose of Unused or Expired Prescription Drugs at Local Police Offices
Ludington (Mich.) Daily News
May 29, 2014
http://m.shorelinemedia.net/ludington_daily_news/news/local/article_c9b89a06-e76f-11e3-a56f-0019bb2963f4.html?mode=jqm

Drug Take-Back Yields 71 Pounds
North Fulton (Ga.)
May 27, 2014
http://www.northfulton.com/Articles-COMMUNITY-NEWS-c-2014-05-27-203905.114126-sub-Drug-takeback-yields-71-pounds.html

Collection Events Net Almost 1,300 Pounds of Drugs for Safe Disposal
Reflector (Washington state)
May 28, 2014
http://www.thereflector.com/good_for_you/article_4f2acf26-e5cf-11e3-abc4-001a4bcf887a.html

How to Dispose of Prescription Drugs That Have Expired
Waurika (Okla.) News–Democrat
May 28, 2014
http://www.waurikanewsdemocrat.com/local/x611386239/How-to-dispose-of-prescription-drugs-that-have-expired

Save the Date

Sixth Annual American Medicine Chest Challenge National Day of Awareness and Safe Disposal of Prescription and Over-the-Counter Medicine
American Medicine Chest Challenge
November 8, 2014
http://www.americanmedicinechest.com

Upcoming Conferences and Workshops

Prescription for Prevention: Preventing and Responding to Prescription Drug Abuse on Campus
Temple University, Villanova University, U.S. Attorneys' Office, and the Clery Center
June 11, 2014
Philadelphia, Pennsylvania
http://clerycenter.org/event/2014-06-11-000000/rx-prevention-preventing-responding-prescription-drug-abuse-campus

Orange County (Fla.) Prescription Drug Abuse Summit
Orange County Drug-Free Coalition
June 18, 2014
Orlando, Florida
https://www.eventbrite.com/e/orange-county-prescription-drug-abuse-summit-tickets-11543048569

2014 Council of State and Territorial Epidemiologists Annual Conference
June 22–26, 2014
Nashville Convention Center
601 Commerce Street
Nashville, Tennessee

This conference connects more than a thousand public health epidemiologists with workshops, plenary sessions with leaders in the public health field, oral breakout sessions, roundtable discussions, and poster presentations. Attendees from across the country meet and share their expertise in surveillance, epidemiology, and best practices in a broad range of areas such as informatics, infectious diseases, immunizations, environmental health, occupational health, chronic disease, injury control, and maternal and child health.

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

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. SAMHSA
Friday, July 11, 2014
Cable Center
2000 Buchtel Blvd.
Denver, Colorado

This course will provide specific knowledge and skills associated with safe prescribing. It will also address epidemiology, legal and regulatory issues, clinical strategies for reducing the risk of opioid misuse and overdose, and managing difficult patient situations.

Read more:
http://peerassistanceservices.org/events/clinical-challenges-in-opioid-prescribing/

CADCA's Midyear 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/

Twenty-Seventh 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
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.