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June 4, 2015

PAW Weekly Update

SAMHSA Prescription Drug Abuse Weekly Update
Issue 125  |  June 4, 2015
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 and Policy Debate National Marijuana International Northeast/Mid-Atlantic News South News Midwest News West News Other Resources Grant Announcements Take-Back Events and Drop Boxes Upcoming Conferences and Workshops


This issue is packed with gems of information. In addition to the featured items, the starred articles and news are at the cutting edge. For a chilling picture of how the opioid problem continues to explode, read Midwest News.

Pharmaceutical Industry Must Pay for Drug Take-Back Programs
Ed Silverman, The Wall Street Journal
May 26, 2015

The U.S. Supreme Court denied a request to review a 9th Circuit Court of Appeals ruling upholding the Alameda County, Calif., ordinance that requires drug makers to underwrite costs of the county's drug take-back program. Three other counties—two in California and one in Washington—have adopted similar ordinances. All injunctions blocking those ordinances have been cleared. The federal appeals court that upheld the ordinance has jurisdiction over Alaska, Arizona, California, Hawaii, Idaho, Montana, Nevada, Oregon, and Washington. Other jurisdictions in those states are expected to quickly adopt similar ordinances. The ruling would not prevent using manufacturers on similar grounds to challenge ordinances passed outside the nine states.

Read more:

Heroin Abuse Bill Passes Illinois House (and Senate)
Seth Richardson, The State Journal-Register
May 28, 2015

On May 28, the Illinois House unanimously passed HB1, the Heroin Crisis Act. Two days later, the bill was passed by the Illinois Senate in a 46-to-4 vote. Hailed as a potential model for comprehensive state drug legislation, the bill establishes a prescription disposal service run by Illinois and administered at the county level. It requires the Department of Public Health's medical director to write a standing order on July 1 enabling all pharmacies to dispense naloxone to drug users and their loved ones without discrimination. Among a long list of provisions, the act requires medical examiners and coroners to report drug overdoses to the health department, amends drug court programs to keep users in treatment and out of jails, allows drug courts to hear simple possession cases, expands Medicaid funding to cover drug rehabilitation, establishes drug education programs in schools, and requires other consumer education campaigns. The bill heads to the governor, who is concerned about costs.

Read more:

Read the bill:

Journal Articles and Reports

**T. Agarin, A.M. Trescot, A. Agarin, D. Lesanics, and C. Decastro. 2015. "Reducing Opioid Analgesic Deaths in America: What Health Providers Can Do." Pain Physician 18(3):E307–E322.

A comprehensive review of literature from 1998 to 2013 concluded that prescriber practices associated with greater risks of opioid analgesic deaths include high total-dose opioid prescriptions; prescribing initial doses that are too potent for opioid-naïve patients; overzealous opioid titration (in methadone-naïve individuals, it takes about 2 weeks for enzymatic systems to convert methadone into its inactive metabolites, creating the potential for greatly increased plasma levels with repeated dosing during phase-in); insufficient use and knowledge of urine drug testing; obsolete knowledge of drug metabolism/interactions; inadequate patient monitoring; and suboptimal risk stratification of patients, rotation practices, and use of opioid analgesics in chronic noncancer pain. Concomitant use of benzodiazepines, illicit substances, unemployment status, and psychiatric disorders are the strongest risk factors for opioid analgesic overdose and death. Prescription drug monitoring program use is an evidence-based practice. The article reviews five largely overlapping sets of professional association guidelines for opioid use in chronic noncancer patients and the weak evidence supporting them. Additionally, the authors provide their own research-informed take on appropriate procedures. Notably, they summarize the evidence prescribers need to establish medical necessity at an initial visit and subsequent visits, with risk of problems acute if a slow taper (a 10 percent weekly reduction in total dose) does not start at or before the 90-day visit following surgery.

Read more:

G. Campbell M. Crim, S. Nielsen, B. Larance, R. Bruno, R. Mattick, W. Hall, N. Lintzeris, M. Cohen, K. Smith, and L. Degenhardt. 2015. "Pharmaceutical Opioid Use and Dependence Among People Living with Chronic Pain: Associations Observed Within the Pain and Opioids in Treatment (POINT) Cohort." Pain Medicine, doi:10.1111/pme.12773.

In 2012, Australian pharmacists were paid to recruit a nationwide sample of 1,424 people who had been prescribed at least one 6-week course of opioids for noncancer pain and who were not currently prescribed medication-assisted therapy for opioid use disorder. Respondent demographics were median age 58, 55 percent female, and having experienced pain for a median of 10 years. Current opioid consumption varied widely: Nine percent were taking < 20 mg morphine equivalents (MME) per day, 52 percent were taking 21–90 MME, 24 percent were taking 91–199 MME, and 15 percent were taking >= 200 MME. (Editor's note: Refusal rate and demographic and dosage information were not available for those who declined to participate, so this sample may not be representative.) Greater daily MME consumption was associated with higher odds of multiple physical and mental health issues, aberrant opioid use, serious side effects, and opioid dependence. Of the respondents, 8.5 percent met criteria for lifetime ICD-10 pharmaceutical opioid dependence, and 4.7 percent met criteria for past-year dependence. In multivariate analysis, past-year dependence was associated with being younger, exhibiting more aberrant behavior, and having a history of benzodiazepine dependence.

Read more:

B. Drimalla, A. Wagner, L. Volino, D. Feudo, and M. Toscani. 2015. "New Jersey Pharmacists' Perceptions of the New Jersey Prescription Monitoring Program." Pharmacy Times.

A 2013 online survey with usable responses from one third (163) of 495 licensed New Jersey pharmacists practicing in community, mail order, or hospital/clinic outpatient pharmacy settings assessed perceptions of the state's prescription drug monitoring program (PDMP). Ninety-two percent were registered to use the PDMP, 99.4 percent were aware of the program, and 81.3 percent frequently used it. Suggested improvements included increased prescriber use, regional interconnectivity of data, and real-time data reporting.

Read more:

M.J. Edlund, V.L. Forman–Hoffman, C.R. Winder, D.C. Heller, L.A. Kroutil, R.N. Lipari, and L.J. Colpe. 2015. "Opioid Abuse and Depression in Adolescents: Results from the National Survey on Drug Use and Health." Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2015.04.010.

In 2008–12 National Survey on Drug Use and Health data on adolescents, 6 percent reported past-year nonmedical prescription opioid use (NMPOU), and 8 percent reported past-year major depressive episode (MDE). Among adolescents with both conditions, MDE usually preceded NMPOU. Of adolescents with NMPOU, 15 percent reported past-year DSM–IV opioid misuse/use disorder, and 20 percent reported a past-year MDE. In logistic regression, MDE was associated with both NMPOU (odds ratio [OR] = 1.5) and opioid misuse/use disorder (OR = 2.2).

Read more:

D.S. Fink, R. Hu, M. Cerdá, K.M. Keyes, B.D.L. Marshall, S. Galea, and S.S. Martins. 2015. "Patterns of Major Depression and Nonmedical Use of Prescription Opioids in the United States." Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2015.05.010.

In 2011–12 National Survey on Drug Use and Health (NSDUH) data, separate logistic regressions on adolescent and adult data showed females were more likely than males to report major depression comorbid with nonmedical prescription opioid use (NMPOU). Polydrug use and alcohol use disorders were more pronounced among those with comorbid NMPOU and major depression than among people who had only one of the conditions. People with independent and comorbid NMPOU and major depression were more likely to report lower income and unemployment.

Read more:

**R.E. Giglio, G. Li, and C.J. DiMaggio. 2015. "Effectiveness of Bystander Naloxone Administration and Overdose Education Programs: A Meta-Analysis." Injury Epidemiology 2:10, doi:10.1186/s40621-015-0041-8.

Pooled data from four studies showed naloxone administration by bystanders significantly increased odds of recovery compared with no naloxone administration (odds ratio = 8.6). Across five studies of naloxone education—relative to controls—trained participants knew more about naloxone administration, overdose recognition, and overdose response.

Read more:

T.C. Green, S. Bowman, C. Davis, C. Los, K. McHugh, and P.D. Friedmann. 2015. "Discrepancies in Addressing Overdose Prevention Through Prescription Monitoring Programs." Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2015.05.009.

A 2013 review of Web-based materials on 47 state prescription drug monitoring program sites found 29 sites did not use overdose or related terms in online materials, 6 offered overdose-oriented messaging, and 2 had overdose prevention tools for providers.

Read more:

**E. Jozaghi and A. Jackson. 2015. "Examining the Potential Role of a Supervised Injection Facility in Saskatoon, Saskatchewan, to Avert HIV Among People Who Inject Drugs." International Journal of Health Policy and Management 4(6):373–79, doi:10.15171/ijhpm.2015.73.

Considering only medical cost savings as benefits, a conservative cost–benefit ratio of starting two Supervised Injection Facilities in Saskatoon, Saskatchewan, would be 1.35 from the health systems perspective. The study estimated the current needle-sharing rate to be 24 percent and anticipated each facility would host 315,000 injections annually.

Read more:

B.C. Kelly, M. Vuolo, M. Pawson, B.E. Wells, and J.T. Parsons. 2015. "Chasing the Bean: Prescription Drug Smoking Among Socially Active Youth." Journal of Adolescent Health 56(6):632–38, doi:10.1016/j.jadohealth.2015.02.008.

Continuing their reports on interviews with 404 young adults recruited from nightlife venues in New York City via time-space sampling, the authors estimated that odds of smoking prescription drugs were higher for males than for females (odds ratio [OR] = 3.4), for heterosexuals than for sexual minority youth (OR = 2.3), and for those involved in electronic dance music nightlife (OR = 2.1). Those interviewed at college bar scenes had lower odds (OR = 0.4) of having smoked prescription drugs than those interviewed at other nightlife venues. Prescription drug smokers reported more drug problems and greater symptoms of dependence, but not greater mental health problems.

Read more:

A.H. Kral, L. Wenger, S.P. Novak, D. Chu, K.F. Corsi, D. Coffa, B. Shapiro, and R.N. Bluthenthal. 2015. "Is Cannabis Use Associated with Less Opioid Use Among People Who Inject Drugs?" Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2015.05.014.

During 2011–13, Los Angeles and San Francisco injection drug users were recruited using targeted sampling methods. Among 653 people who used opioids in the past 30 days, half also used cannabis. The mean number of opioid use in the past 30 days was significantly lower among those who also used cannabis (58.3 vs. 76.4).

Read more:

S.O. Lasopa, C.W. Striley, and L.B. Cottler. 2015. "Diversion of Prescription Stimulant Drugs Among 10–18-Year-Olds." Current Opinion in Psychiatry, 28(4):292–98, doi:10.1097/YCO.0000000000000172.

In 2012, the authors recruited 11 ,048 people 10–18 years old from 10 U.S. cities using an entertainment venue intercept study. (Editor's note: According to a 2013 publication, among respondents, 7.3 percent had taken prescription stimulants in the past 30 days, with 3.9 percent using those stimulants nonmedically.) Half of prescription stimulant users involved in the club scene had sold their drugs or purchased someone else's drugs. Involvement in illegal sales increased with age, nonmedical use, marijuana use, and among 16–18-year-olds with a friend who used prescription stimulants.

Read more:

F. Noble, M. Lenoir, and N. Marie. 2015. "The Opioid Receptors as Targets for Drug Abuse Medication." British Journal of Pharmacology, doi:10.1111/bph.13190.

Based on a review of preclinical and clinical studies, the authors conclude that opioid peptide and opioid receptor regulation in different brain structures following acute or chronic exposure to the drugs means the opioid system is a potential target for a new pharmacotherapy to effectively treat addiction and prevent relapse.

Read more:

E.D. Riley, M. Shumway, K.R. Knight, D. Guzman, J. Cohen, and S.D. Weiser. 2015. "Risk Factors for Stimulant Use Among Homeless and Unstably Housed Adult Women." Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2015.05.023.

During 2008–10, a sample of 260 women with a history of unstable housing were recruited from free-meal programs, homeless shelters, and a probability sample of low-cost single-room occupancy hotels in San Francisco. At baseline, median age was 47; 70 percent were women of color; 47 percent reported having unmet subsistence needs; and 53 percent reported being abstinent from stimulant use. Analyses adjusting for baseline sociodemographics and drug treatment found the risk of starting stimulants within 6 months was significantly higher among women who reported recent sexual violence (Relative Risk [RR] = 4.3), sleeping in a shelter or public place (RR = 2.8), and using nonprescribed opioid analgesics (RR = 2.5).

Read more:

K. Roussos–Ross, G. Reisfield, I. Elliot, S. Dalton, and M. Gold. 2015. "Opioid Use in Pregnant Women and the Increase in Neonatal Abstinence Syndrome: What Is the Cost?" Journal of Addiction Medicine, doi:10.1097/ADM.0000000000000122.

Between December 2008 and November 2011, 168 newborns were diagnosed with neonatal abstinence syndrome (NAS) at the University of Florida's Shands Hospital. Compared with costs of hospital care for newborns without NAS, an additional $4.1 million (about $25,000 per infant) was charged. (Editor's note: The difference in charges might not be attributable to NAS, as the analysis did not assess differences in maternal smoking or alcohol use during pregnancy, receipt of prenatal care, prematurity, or birth defects unrelated to NAS.)

Read more:

B. Setnik, C. Bramson, A. Bass, N. Levy–Cooperman, B. Malhotra, K. Matschke, K.W. Sommerville, G. Wolfram, and P. Geoffroy. 2015. "Intranasal Administration of Crushed ALO-02 (Extended-Release Oxycodone with Sequestered Naltrexone): A Randomized, Controlled, Abuse Potential Study in Nondependent Recreational Opioid Users." The Journal of Clinical Pharmacology, doi:10.1002/jcph.552.

This randomized, double-blind, placebo/active-controlled, four-way crossover study examined misuse potential for crushed extended-release oxycodone with sequestered naltrexone (OxyNal) administered intranasally to 32 healthy, nondependent, recreational opioid users. In random order over 4 days, each participant was given a crushed single dose of two placebos, OxyNal 30 mg and oxycodone immediate release (OxyIR) 30 mg. Primary endpoints were drug liking and high measured on visual analog scales summarized as maximum effect and effect occurring over 2 hours postdose. Crushed OxyNal resulted in significantly lower scores than did OxyIR on drug liking and high, suggesting less misuse potential (Editor's note: If drugs are simply crushed without trying to defeat the naltrexone core). Adverse events occurred most frequently with OxyIR, followed by OxyNal and placebo, and were considered mild and consistent with opioid therapy.

Read more:

**W. Wakeland, A. Nielsen, and P. Geissert. 2015. "Dynamic Model of Nonmedical Opioid Use Trajectories and Potential Policy Interventions." The American Journal of Drug and Alcohol Abuse, doi:10.3109/00952990.2015.1043435.

A system dynamics model was constructed to represent the population that initiates nonmedical pharmaceutical opioid analgesic use. The model incorporates use trajectories, including development of use disorders, transitions from reliance on informal sharing to paying for drugs, transition from oral administration to tampering to facilitate nonoral routes of administration, and transition to heroin use by some users, as well as movement into and out of the population through quitting and mortality. Empirical support was drawn from national surveys (National Survey on Drug Use and Health, Treatment Episode Data Set, Monitoring the Future, and ARCOS) and published studies. The model was able to replicate patterns seen in the historical data for each user population and associated overdose deaths. Model runs suggested both tamper-resistant formulations and interventions to reduce informal sharing could significantly lessen nonmedical user populations and overdose deaths in the long term. Examined interventions to reduce sharing included removing 100 million dosage units of prescription opioids available for nonmedical use per year through drug take backs or modified prescribing practices (which would halve the supply of leftover drugs) or halving willingness to share prescription opioids. The model suggests 70 percent market penetration of tamper-resistant formulations saves 160 deaths annually (accounting for those who shift to heroin) and that halving medicine-cabinet diversion would save 960 lives annually. The authors caution that the modeled effect sizes require additional empirical support.

Read more:

Professional Education and Policy Debate

N.A. Duncan, R.J. Mahan, and S.J. Turner. 2015. "Non-Opiate Pharmacotherapy Options for the Management of Pain in Older Adults." Mental Health Clinician: May 2015—Alternatives in Pain Management 5(3):91–101.

This paper describes risks and benefits of nonopioid medication for pain management after age 65. Nonopiate pharmacologic therapies, such as acetaminophen, nonsteroidal anti-inflammatory drugs, topicals, and antidepressants, can play an important role in pain treatment. Clinicians should take an individualized approach that considers a patient's functional status, comorbidities, and treatment goals.

Read more:

R.P. Ogeil, C. Heilbronn, B. Lloyd, and D.I. Lubman. 2015. "Benefits and Challenges to the Implementation of Real-Time Prescription Monitoring." Medicine Today 16(4):65–68.

Increased opioid and benzodiazepine prescribing in Australia challenges governments at all levels to increase awareness of misuse potential and implement mechanisms promoting quality use of medicine and minimizing harm. This challenge is multifaceted and requires both system-level actions (e.g., policies related to prescribing, dispensing, and monitoring systems) and individual-level actions (e.g., screening for appropriate behavioral markers, referral, and treatments).

Read more:


**DEA Report: Heroin Use Growing Faster Than Any Other Illicit Drug; Overdose Deaths Highest in a Decade
Lynn Arditi, Providence Journal
May 22, 2015

The Drug Enforcement Administration's "National Heroin Threat Assessment" shows heroin use and availability are rising, with heroin-related deaths at a 10-year peak. Although fewer people use heroin than they do other illicit drugs, the heroin user population is growing at a faster rate than any other drug of abuse. In the assessment's surveys of more than 1,100 law enforcement agencies, the percentage of agencies reporting heroin as their greatest concern steadily increased, from 8 percent in 2007 to 38 percent in 2015. Heroin seizures nationwide rose 81 percent from 2010 through 2014, according to data from the National Seizure System. During that time, the average size of a heroin seizure more than doubled—to 1.74 kilograms.

Read more:

Read the report:

Manchin and Scott Launch Prescription Drug Abuse Caucus
Political News
May 23, 2015

In an effort to raise awareness about prescription drug misuse, U.S. Senators Manchin and Scott launched the Prescription Drug Abuse Caucus. Its mission is to work with stakeholders toward innovative and effective policy solutions that address prevention, treatment, and other important areas.

Read more:

**Proposed Medical-Research Law Raises Safety Concerns
Thomas M. Burton, The Wall Street Journal
May 26, 2015

The 21st Century Cures Act, a bipartisan House bill aimed at boosting medical research funding, is drawing scrutiny over provisions that would relax drug and device safety regulations. The bill would allow Food and Drug Administration (FDA) approval of drugs based on "clinical experience" rather than full studies. It would also permit drug and device companies to market their products for uses not approved by the FDA by disseminating "truthful and non-misleading" information.

Read more:


**Map: The Price of Marijuana in Every State
Ana Swanson, The Washington Post
May 26, 2015

A U.S. map by Frank Bi of Forbes shows marijuana is much cheaper in states that have legalized the drug than in states that have not. The map lists the average cost of an ounce of high-quality marijuana in each state, using crowd-sourced data from PriceofWeed.com—a website where local weed costs are submitted anonymously. Nationally, the average price for an ounce of marijuana is $324. In Washington, Oregon, Colorado, and Alaska, the price of an ounce has fallen below $300. An ounce of high-quality marijuana in Oregon sells for only $204—almost half the cost in North Dakota, the most expensive state.

Read more:

**Uncle Sam to Feds: No, You Still Can't Smoke Pot
Kellie Lunney, Government Executive
May 27, 2015

The Office of Personnel Management (OPM) reminded federal employees that using marijuana is still forbidden. This applies to both medicinal and recreational use. Although several states have relaxed their policies on cannabis, wrote OPM's director in a memo to agency leaders, the government is not following suit. The director of National Intelligence sent a similar memorandum in October 2014.

Read more:

A Victory for Medical Marijuana
Lawrence Downes, The New York Times
May 22, 2015

A U.S. Senate Appropriations Committee is considering the Compassionate Access, Research Expansion and Respect States, or CARERS, Act, a bill that would legalize medical marijuana. The committee amended the bill to allow Veterans Affairs doctors in states where medical marijuana is legal to sign recommendation forms for patients who want to use cannabis.

Read more:

**Legalized Marijuana in the United States: Resulting Policy Implications (Video)
RTI International
May 22, 2015

At a May 20, 2015, policy forum hosted by RTI International at the National Press Club in Washington D.C., experts explored the positive and negative consequences of marijuana legalization in terms of medical and recreational use. (Duration: 1:29:32 minutes)


Science Seeks to Unlock Marijuana's Secrets
Hampton Sides, National Geographic
June 2015

This article provides a historical overview of cannabis—from the charred seeds found inside burial mounds dating back to 3000 BC to the U.S. legalization of medical and recreational marijuana use. Other countries have reexamined their marijuana laws: Uruguay has voted to legalize cannabis, and Portugal has decriminalized it. Israel, Canada, and the Netherlands have medical marijuana programs. People are using cannabis for many medical purposes—some with a stronger evidence base than others. Scientists hope to learn more about the drug's benefits. The article shares perspectives of a chemist, a botanist, a biochemist, a caregiver, and a geneticist.

Read more:


**New Video Campaign Targets Youth Prescription Drug Abuse
Heather Yourex, Global News
May 28, 2015

Canada's Minister of Health unveiled a video series aimed at increasing awareness of prescription drug misuse. Each video tells the story of a Canadian who has been directly affected by misuse. (Includes videos: 4:51 minutes, 2:44 minutes)

Read more:

Provincial Regulator Expanding Prescription Drug Monitoring Program to Combat Abuse
Jason Van Rassel, Calgary Herald
May 28, 2015

Beginning this fall, Alberta's prescription drug monitoring program will include a wider range of drugs. Pain relievers containing codeine, such as Tylenol 3 and 4, and two anti-anxiety drugs will be among medications added to the province's triplicate prescription program.

Read more:

GEM Motoring Assist Releases Illegal and Prescription Drug-Driving Videos
Claire Lawson, Caravan Times
May 22, 2015

GEM Motoring Assist, a UK road safety organization, launched a video campaign outlining laws on drug driving. It informs drivers of the dangers and consequences of driving under the influence of illegal and legal drugs and lists prescription drugs that fall under the new UK measure. A shorter version of the video focused on illicit drugs targets younger motorists. (Includes videos: 6:02 minutes, 6:41 minutes)

Read more:

Illicit Use of Prescription Drugs a Bigger Problem than Methamphetamines in Rural Areas
Nathan Coates and Lisa Herbert, ABC
May 28, 2015

Dr. Julaine Allan said illicit fentanyl use has become a significant problem in rural Australia, where it is used as a heroin replacement. More people are dying from fentanyl overdoses in rural areas than in urban areas. In northwest New South Wales, arrests for fentanyl or opioid misuse are rapidly rising. (Includes audio: 4:17)

Read more:

Drug Blitz Ineffective, Test Entire Workplace: Union
Blanca Clare, Sunshine Coast Daily
May 26, 2015

The union representing construction workers at Australia's Sunshine Coast Public University Hospital said random drug tests will not eradicate illicit substance use in the workplace, and that mandatory blanket testing is a better deterrent. Police conducted a drug-driving blitz outside the Kawana hospital. Three male drivers were charged after testing positive for drugs, and a fourth was charged with cannabis possession. Workers have the perception that cannabis, methamphetamines, and prescription or self-medicated drugs are safe.

Read more:

Lufthansa to Propose Unannounced Drug Checks for Pilots
Accessed May 27, 2015

Lufthansa Airlines' chief executive said conducting unannounced tests to check pilots for prescription drugs might improve air safety. Lufthansa will propose the checks to a task force set up by Germany's airline industry after a co-pilot deliberately steered a passenger jet into the French Alps. The pilot had been hiding psychological problems from his employer.

Read more:

Northeast/Mid-Atlantic News

House Passes Scaled Back Opioid Abuse Bill
Daniela Altimari, Hartford Courant
May 28, 2015

The Connecticut House of Representatives passed House Bill 6856, which will allow pharmacists to dispense Narcan® and grant pharmacists immunity that currently applies to other Narcan® prescribers. The bill also requires that physicians, dentists, and other medical providers who dispense narcotic pain relievers complete a continuing education program on pain management and opioids. The House deleted a provision to reduce mandated prescription drug monitoring program reporting from a 7-day opioid supply to a 72-hour supply, claiming the provision would cost the state $331,874 in fiscal year 2016 and $205,874 the following year. The bill heads to the Senate.

Read more:

Massachusetts Senate Adopts Anti-Pharmacy Shopping Amendment to Fight Opioid Abuse
Shira Schoenberg, MassLive
May 22, 2015

The Massachusetts Senate passed a budget bill including amendments that would require pharmacies to report opioid drug purchases to the prescription drug monitoring program within 1 day rather than a week; allow creation of a bulk purchasing system for the anti-overdose drug Narcan®; and earmark funds to create two high schools supporting teens in recovery, add 150 post-detox treatment beds, and add $10 million to a substance misuse trust fund focused on treatment services.

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Fla. Bill Would Expand Use of Antidote for Drug Overdose
Lloyd Dunkelberger, Ocala StarBanner
May 28, 2015

The Florida House has passed Bill 751, the Emergency Treatment and Recovery Act, which will allow law enforcement officers and other first responders to administer naloxone and individuals, family, and friends to obtain naloxone prescriptions.

Read more:

Midwest News

At Least 11 Overdoses in Two Days Might Point to Tainted Heroin Batch
Dean Narciso, The Columbus Dispatch
May 22, 2015

The Fire and Emergency Medical Service Department in Marion County, Ohio, used almost its entire stock of Narcan® in one day. State authorities said a lethal batch of heroin laced with fentanyl or a synthetic drug could be responsible for at least 11 overdoses—two fatal—within 24 hours.

Read more:

**Memo: Narcan Cost Draining Cincinnati's Budget
Todd Dykes, WLWT
May 22, 2015

A budget-planning memo shows the Cincinnati Fire Department lacks funds to address the heroin epidemic. Fire officials need $386,950 in additional 2016 funding for Narcan® because use and cost per dose keep rising. (Includes video: 2:44 minutes)

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First Lady, Attorney General Announce Program at St. E. Healthcare to Reduce Heroin Overdose Deaths
Northern Kentucky Tribune
May 26, 2015

Kentucky First Lady Jane Beshear and Attorney General Jack Conway announced the state is giving 500 naloxone kits to St. Elizabeth Healthcare in Northern Kentucky for overdose patients discharged from the hospital.

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Heroin Overdoses Averaging 1 a Day in Muskegon County, Linked to Prescription Drug Use
Heather Lynn Peters, MLive Media Group
May 27, 2015

The West Michigan Enforcement Team is investigating an average of one heroin-related overdose a day in Muskegon County. As of April, about one third of all drug-related deaths in Washtenaw and Wayne Counties were fentanyl related. The medical examiner's office said fentanyl and heroin use are on the rise in Muskegon County.

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Heroin Ring Centered on Two Big Minnesota Indian Reservations
Liz Sawyer, Star Tribune
May 28, 2015

A federal grand jury indicted 41 people in a drug trafficking conspiracy that distributed heroin, methamphetamine, oxycodone, hydromorphone, hydrocodone, and methadone across the Upper Midwest and on Red Lake and White Earth Indian reservations in Minnesota. About two dozen defendants have direct ties to the reservations.

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Feds Target Rogue Indiana Doctors and Pharmacists After State's HIV Epidemic
Matt Smith, WTTV
May 26, 2015

U.S. Attorney Josh Minkler has assigned an assistant U.S. attorney to work full time with three Drug Enforcement Administration agents to curb prescription writing and filling in Indiana. Federal agents will track the number of prescriptions doctors write, as well as the number filled by pharmacies. (Includes video: 2:16 minutes)

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Drug Abuse Task Force Supports Naloxone Training for ISU Campus Law Enforcement
Greensburg Daily News
May 28, 2015

The Indiana Prescription Drug Abuse Prevention Task Force supports naloxone training for Indiana State University law enforcement.

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Deputies First in Macomb County to Be Equipped with Drug Overdose Antidote
Jameson Cook, The MaComb Daily
May 27, 2015

In Michigan, 81 Macomb County deputies have been trained and equipped with naloxone.

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West News

California Senate Approves Legislation Requiring Physicians to Check State Database Before Prescribing Powerful, Addictive Medications, Says Consumer Watchdog
May 28, 2015

The California State Senate approved SB 482, which would require doctors to check the prescription drug monitoring program before initially prescribing Schedule II and III drugs to patients, and each year thereafter. The bill goes to the state Assembly.

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Rogers County Deputies Train with Life-Saving Drug
Allison Harris, News on 6
May 27, 2015

Rogers County sheriff's deputies now carry Narcan® to reverse opioid overdoses. The drug has already saved more than 15 lives in Tulsa, Okla. (Includes video: 2:21 minutes)

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Other Resources

Pathways to Safer Opioid Use
Department of Health and Human Services, Office of Disease Prevention and Health Promotion
May 29, 2015

"Pathways to Safe Opioid Use," a Web-based training tool, was designed using the opioid-related recommendations outlined in the National Action Plan for Adverse Drug Events. This training incorporates the principles of health literacy and a multimodal, team-based approach to promote appropriate, safe, and effective use of opioids for chronic pain management. It allows participants to assume the role of four playable characters who make decisions about preventing opioid-related adverse drug events.

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Grant Announcements

Rural Opioid Overdose Reversal Grant Program

Department of Health and Human Services, Health Resources and Services Administration
Deadline: June 8, 2015

Edward Byrne Memorial Justice Assistance Grant Program
Department of Justice, Bureau of Justice Assistance
Deadline: June 16, 2015

COPS–AHTF Application 2015
Community-Oriented Policing Services, Department of Justice
Deadline: June 19, 2015

This program's goals include increasing efforts through statewide collaboration to investigate illicit activities related to heroin distribution and trafficking or unlawful prescription opioid distribution. Strong applications will demonstrate a multijurisdictional reach and participation in interdisciplinary team structures (i.e., task forces) and include multiyear state-level primary treatment admissions data for heroin and other opioids.

Read more:

Take-Back Events and Drop Boxes

Drop Off Your Drugs
The Oshawa Express (Oshawa, Ontario)
May 26, 2015

Island Business Helps Sault Cops Collect 37 Pounds of Drugs
Donna Schell, SooToday.com (Sault Ste. Marie, Ontario)
May 28, 2015

Hazardous Waste Collection Site Accepts Prescription Medications
The Business Times (Colorado)
May 26, 2015

THPD Holding Another Prescription Drug Take Back Day on June 6
Sara Schaefer, WTHITV (Indiana)
May 27, 2015

Passaic County Officials Unveil Newest Prescription Drug Drop-Off Box in Passaic
Richard Cowen, NorthJersey.com (New Jersey)
May 27, 2015

Georgetown County Sheriff's Office Offers Safe Disposal for Unwanted Medications
Whitney Hill, WMBF (South Carolina)
May 28, 2015

Bridgeport Police Looking to Create Prescription Drug 'Take-Back' Program; Council Appears on Board
Jeff Toquinto, Connect Bridgeport (West Virginia)
May 28, 2015

Upcoming Conferences and Workshops

International Conference on Opioids
Harvard Medical School
June 7–9, 2015
Boston, Massachusetts


Second Annual Medical Marijuana Regulatory Summit
International Cannabis Association
June 18, 2015
New York, New York


Pharmacy Diversion Awareness Conference
Drug Enforcement Administration, Office of Diversion Control
June 27–28, 2015: Oklahoma City, Oklahoma

Mid-Year Training Institute
Community Anti-Drug Coalitions of America
August 2–6, 2015
JW Marriott
10 S. West Street
Indianapolis, Indiana

The training institute will address topics ranging from planning and evaluation for prevention specialists to cultural implications for coalitions in rural communities.

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Fourth Annual Generation Rx University Conference for Collegiate Prevention and Recovery
The Ohio State University College of Pharmacy
August 4–6, 2015
Columbus, Ohio

28th Annual National Prevention Network Conference: Bridging Research to Practice
National Prevention Network
November 17–19, 2015
Seattle, Washington

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.