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June 5, 2013

SAMHSA Prevention of Prescription Drug Abuse in the Workplace Listserv

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June 5, 2013 (PDF version)

Featured Article

How OxyContin's Pain Relief Built 'A World of Hurt'
National Public Radio
May 29, 2013

This audio interview and article with New York Times reporter Barry Meier (27:42 minutes) discuss his new e-book, A World of Hurt: Fixing Pain Medicine's Biggest Mistake. The book explores opiate painkillers and the consequences of long-term use. It focuses on OxyContin and how it came to be prescribed for chronic pain, what the consequences have been, and how it became a street drug. Two quotes from the interview: "The more patients--workers--who are treated with these drugs for back strain, the longer and longer ... they stay away from work." "The first person who sounded the alarm ... was ... Jane Ballantyne, and she was the head of pain treatment at Massachusetts General. In 2003 she had accepted that these drugs were beneficial. She was a soldier in this war on pain, and as she ... walked around Mass General, she started seeing things that caught her attention. For example, chronic pain patients who were given these drugs started improving. They would improve for a while, and suddenly their improvement would stop. Their pain would return. They would lose function, or the improvement in function they had achieved would be lost, and she began to wonder why this was going on."

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Journal Articles

J.F. Buckman, S.G. Farris, and D.A. Yusko. 2013. "A National Study of Substance Use Behaviors Among NCAA Male Athletes Who Use Banned Performance Enhancing Substances." Drug and Alcohol Dependence 131(1):50-5. doi:10.1016/j.drugalcdep.2013.04.023.

This study compared substance use behaviors of male undergraduate student athletes who reported using ergogenic performance enhancing substances during college (PES users) with those who did not (PES non-users). Researchers used data from a large, national dataset collected by the National Collegiate Athletic Association. A consistent pattern of higher substance use rates was observed among PES users compared with non-users, including heavier drinking, higher prevalence rates of cigarettes, marijuana, amphetamines, narcotics, and a variety of permissible and impermissible dietary supplements. Unexpectedly large discrepancies existed in reported prevalence rates between similar or overlapping survey items (e.g., past-year use of "narcotics" versus "I have taken Vicodin, OxyContin, or Percocet with/without a prescription"). These findings suggest that male college athletes who use PES demonstrate a general tendency to engage in alcohol and drug use behaviors, regardless of whether these behaviors improve or impede athletic performance.

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H. Gjerdea, A.S. Christophersen, P.T. Normann, T. Assum, E.L. Øiestada, and J. Mørland. 2013. "Norwegian Roadside Survey of Alcohol and Drug Use by Drivers (2008-2009)." Traffic Injury Prevention 14(5):443-52. doi:10.1080/15389588.2012.728016.

Researchers examined alcohol and drug use among random drivers in different regions of Norway. Analyzing oral fluid, the researchers compared drivers in urban and rural areas, compared with results from a 2005-06 roadside survey in southeastern Norway, and roughly estimated the prevalence of driving with blood drug concentrations above the new Norwegian legislative limits among random drivers. Drivers were selected for a voluntary and anonymous study using a stratified multistage cluster sampling procedure in collaboration with the Mobile Police Service. Samples of oral fluid were taken using the Statsure Saliva Sample, and the drivers' gender, age, and nationality were recorded. Samples of oral fluid were analyzed for alcohol or drugs, for a total 28 psychoactive substances. One hundred eighty-four roadside survey sessions were conducted and 10,004 drivers were asked to participate. The refusal rate was 5.8 percent. Psychoactive substances were found in 4.8 percent of the 9,410 oral fluid samples analyzed. Alcohol was detected in 0.3 percent, medicinal drugs in 3.2 percent, and illegal drugs in 1.5 percent of the samples. Illegal drugs were significantly more frequently detected in samples from southeastern Norway, including the capital Oslo; medicinal drugs were more frequently detected in samples from southeastern Norway, excluding Oslo. Illegal drugs were significantly more frequently detected in samples from drivers in urban areas than in rural areas, though there were no significant differences for alcohol and medicinal drugs. Medicinal drugs were most commonly found in samples collected during weekdays (3.8 percent), and illegal drugs were most commonly found in samples collected late at night on weekdays or weekends (2.8-3.2 percent). The most commonly found substances were the sleeping agent zopiclone (1.4 percent), the main active substance in cannabis tetrahydrocannabinol (1.1 percent), and the sedative drug diazepam (0.7 percent). The prevalence of driving with drug concentrations above the Norwegian legislative limits for blood was estimated to be about 0.2 percent for alcohol, 0.6 percent for illegal drugs, and about 1.3 percent for medicinal drugs.

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K.L. Humphreys, T. Eng, and S.S. Lee. 2013. "Stimulant Medication and Substance Use Outcomes: A Meta-Analysis." Journal of the American Medical Association Psychiatry:1-9. doi:10.1001/jamapsychiatry.2013.1273.

Researchers meta-analyzed the longitudinal association between treatment with stimulant medication during childhood and later substance use outcomes (i.e., lifetime substance use and substance abuse or dependence). They identified studies published between January 1980 and February 2012 using review articles, PubMed, and pertinent listservs, and selected studies with longitudinal designs in which medication treatment preceded measurement of substance outcomes. Odds ratios were extracted or provided by the study authors. Odds ratios were obtained for lifetime use (ever used) and abuse or dependence status for alcohol, cocaine, marijuana, nicotine, and nonspecific drugs for 2,565 participants from 15 different studies. Random-effects models estimated overall association, and potential study moderators were examined. Random-effects analyses were conducted for each substance outcome, with the number of studies ranging from three to 11 for each outcome. Results suggested comparable outcomes between children with and without medication treatment history for any substance use and abuse or dependence outcome across all substance types.

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K.A. King, R.A. Vidourek, and A.L. Merianos. 2013. "Sex and Grade Level Differences in Lifetime Nonmedical Prescription Drug Use Among Youth." The Journal of Primary Prevention. doi:10.1007/s10935-013-0308-1.

This study examined nonmedical prescription drug (NMPD) use among students in 7th through 12th grade. A total of 54,631 students participated in the study, which used the PRIDE Questionnaire. A total of 13.6 percent of youth reported lifetime NMPD use. Hispanic youth were more likely than white or African American youth to report use of NMPDs. Engaging in high levels of prosocial behaviors and having high levels of parent and teacher/school protective factors decreased the odds of use among males, females, 7th and 8th grade students, and 9th through 12th grade students. Conversely, engaging in risky behaviors and having friends who used other substances increased the odds for use.

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A.F. Manini, M.M. Jacobs, D. Vlahov, and Y.L. Hurd. 2013. "Opioid Receptor Polymorphism A118G Associated with Clinical Severity in a Drug Overdose Population." Journal of Medical Toxicology 9(2):148-54.

Researchers studied whether the common A118G (rs1799971) mu-opioid receptor single nucleotide polymorphism (SNP) was associated with overdose severity in humans. In addition, they examined an SNP responsible for alternative splicing of OPRM1 (rs2075572). They assessed allele frequencies of the above SNPs and associations with clinical severity in patients presenting to the emergency department (ED) with acute drug overdose. This work was designed as an observational cohort study over a 12-month period at an urban teaching hospital. Participants consisted of consecutive adult ED patients with suspected acute drug overdose for whom discarded blood samples were available for analysis. Specimens were linked with clinical variables (demographics, urine toxicology screens, clinical outcomes) then de-identified prior to genetic SNP analysis. Blinded genotyping was performed after standard DNA purification and whole genome amplification. In-hospital severe outcomes were defined as either respiratory arrest (RA; defined by mechanical ventilation) or cardiac arrest (CA; defined by loss of pulse). The researchers analyzed 179 patients (61 percent male, median age 32) who overall suffered 15 RAs and 4 CAs, of whom three died. The 118G allele conferred 5.3-fold increased odds of CA/RA (p<0.05), while the rs2075572 variant allele was not associated with CA/RA. The 118G variant allele in the OPRM1 gene is associated with worse clinical severity in patients with acute drug overdose.

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News and Reports

Can an Employer Not Let You Work if You Have a Prescription for Xanax?
Houston Chronicle
May 28, 2013

Many companies have policies concerning drug use in the workplace. If an employer believes certain medications could be a safety risk, the employee can be prevented from working while taking the medication. Under the Americans with Disabilities (ADA) Act, job applicants are not required to reveal they are taking prescription medications, and the interviewer may not ask questions about medication history. The employee is not required to disclose a prescription for Xanax or any other prescribed medication to the employer. If the employer becomes aware that the employee has a prescription, the employee cannot be fired because of it. According to the ADA, an employer cannot discharge a worker who tests positive because of medications prescribed for an injury, nor can the employer fire someone because of a disability revealed by the medication.

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Heroin on the Rise in Maine As State Crackdown on Prescription Opiates Paves the Way
Bangor Daily News
May 26, 2013

This article discusses growth in heroin use in Maine since the state started focusing its efforts on prescription opiates. Heroin trafficking arrests have increased, as well as admissions for opiate addiction treatment. In the first quarter of 2012, the Maine Department of Health and Human Services saw an increase of 16 percent in the number of patients seeking treatment for heroin when compared with the first quarter of 2011. Admissions for the first four months of 2013 were up nearly 18 percent over the same period in 2012.

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Peoria County Tests Drug Collection
Journal Star
May 24, 2013

The Peoria County Substance Abuse Prevention (SAP) Coalition in Illinois is testing a prescription drug disposal program. Dropoff will begin June 1 outside the Peoria Heights Police Department, and officers will be available to pick up medications from residents who are unable to drive. The SAP Coalition's goal is to limit access to commonly abused prescription drugs and reduce the risk of theft or accidental poisoning.

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U.S. Attorney for Colorado: 'Epidemic' Abuse of Prescription Drugs
May 24, 2013

The U.S. Attorney for Colorado called prescription drug abuse an epidemic as two Denver doctors face criminal charges for illegally distributing prescription drugs. One of the doctors and five others have been indicted for money laundering and dispensing oxycodone, Adderall, and Ambien.

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Governor Calls Opiates Biggest Threat to Vermont Quality of Life
Vermont Public Radio
May 25, 2013

Vermont Governor Peter Shumlin says heroin and opiates are the biggest threat to the state's downtowns, quality of life, and low crime rate. The U.S. Attorney for Vermont calls heroin and opiate abuse the largest public safety risk in the state right now. Prescription drug abuse has led to increased use of heroin.

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Health Practitioners in Ghana Suffering from Drug Addiction
Citi FM
May 24, 2013

Doctors, nurses, and pharmacists in hospitals and clinics across Ghana are working under the influence of a prescription pain reliever called pethidine. Some have been caught stealing the drug or altering patient records to fuel their addiction. In a 4-day period, six nurses from the same hospital were caught altering patients' prescriptions to get the drug. The problem is widespread and is threatening health delivery in Ghanaian hospitals, according to health professionals. As a result, one hospital set up a rehab center for addicted staff.

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Single Tip Led to Osceola Drug Case With More Than 400 Suspects in 18 Counties
Orlando Sentinel
May 24, 2013

An anonymous tipster reported that Kissimmee, Fla., residents were dealing prescription pain relievers. The Osceola County Investigative Bureau (OCIB) identified more than 400 suspected dealers and drug runners. OCIB ran one of the defendant's names through the Florida Prescription Drug Monitoring Database and found that in less than 1 year, he had received more than 2,300 oxycodone, hydromorphone, methadone, and Alprazolam pills. All of his prescriptions had been signed by four doctors who practiced outside of Central Florida. The database also identified 35 Kissimmee-St. Cloud residents who received 17,046 pain relievers and tranquilizers. The information led to an investigation in 18 counties. The group used laptop computers and a special grade of watermarked paper to print prescriptions. They set up phone lines to answer calls from pharmacies to confirm prescriptions.

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Fallin Signs Prescription Drug Abuse Prevention Measures into Law
The Daily Ardmorette
May 28, 2013

Oklahoma Governor Mary Fallin signed House Bill 1783 into law. It prohibits a written or oral prescription containing the pain reliever hydrocodone from being refilled. She also signed House Bill 1782, which permits emergency responders to administer lifesaving medication to counteract a prescription drug overdose. Additionally, Fallin signed House Bill 1781, allowing the Oklahoma Department of Mental Health and Substance Abuse Services to access information regarding prescription drug use from the Oklahoma Bureau of Narcotics and Dangerous Drugs for research purposes, including identifying areas where drugs are being overprescribed and abused to aid in the prevention of prescription drug abuse.

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Senate Rejects Bill on Prescription Monitoring Program
Los Angeles Times
May 28, 2013

California lawmakers did not pass a bill that would increase fees for pharmacists and doctors and a tax on drug makers to improve the Controlled Substance Utilization Review and Evaluation System's prescription monitoring database. The bill would have taxed drug makers to allow the attorney general to hire investigators to crack down on patients' doctor shopping and doctors who over prescribe. The tax would have raised $5 million from pharmaceutical companies that sell nearly $1 billion worth of OxyContin, Vicodin, and other narcotics every year, according to estimates from a state senator's office.

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Bad Message in a Bottle
May 29, 2013

Iowa State University and Penn State University formed a partnership known as Promoting School-Community-University Partnerships to Enhance Resilience (PROSPER). It delivers scientifically proven family-focused and school-based prevention programs to 28 communities throughout Iowa and Pennsylvania. The success of the programs was measured through follow-up surveys to teens and their families for 6 years after they had completed PROSPER prevention programs (an evaluation by Richard Spoth and colleagues was recently covered in the listserv). The program aims to help youth make better choices about prescription drugs.

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B.C. Health Care Workers Put on Alert after 23 Fentanyl-Related Deaths in Four Months
The Vancouver Sun
May 30, 2013

In British Columbia, Canada, health workers were warned to watch for potential overdoses involving fentanyl because it has been linked to 23 deaths so far this year. In 2012, there were 20 fentanyl-related deaths and eight in 2011.

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Group Refines Existing Opioid Misuse Risk Assessment Tool
Clinical Psychiatry News
May 28, 2013

A pain management practice analyzed data from more than 13,000 patients. A self-reported history of sexual abuse and issues with anger, impairment of life control, marital status, and level of education were among predictors of patients' tendency to misuse opioids. The practice plans to use the findings to help refine the specificity and sensitivity of the Opioid Risk Tool (ORT), an existing opioid risk-assessment tool. The ORT aims to identify patients at risk of misusing opioids. The questionnaire seeks personal and family history of substance abuse, history of preadolescent sexual abuse, and history of certain psychological disorders. After refinement, the ORT might expand to 15 questions. If the questionnaires are fed into electronic medical records, doctors can find out whether the patient is someone they should be concerned about or someone they can trust when it comes to prescribing opioids.

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Time to Change Thinking on Prescription Drug Abuse
The News
May 27, 2013

The government of Nova Scotia, Canada, released findings of the 2012 Nova Scotia Student Drug Use Survey. The survey asked students if they used pain relievers for non-medicinal reasons. Of 3,148 students surveyed, 11.7 percent said they used pain pills for which they did not have a prescription. The article suggests Nova Scotia schools need to teach life lessons on prescription drug use and abuse, and parents should keep an eye on their pills in the medicine cabinet or dispose of them.

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2012 Annual Report: Arrestee Drug Abuse Monitoring Program II
Office of National Drug Control Policy
May 2013

In 2012, data were collected from adult male booked arrestees on 21 consecutive days between April 1 and July 15, at five sites: Atlanta, Chicago, Denver, New York, and Sacramento. Of the 2,107 sampled cases of people who were physically in facilities and eligible to be interviewed, 92 percent (1,938) were interviewed; urine specimens were collected from 90 percent of respondents (1,736) within 48 hour of their arrest. Although more than 60 percent of Arrestee Drug Abuse Monitoring Program (ADAM) II arrestees in all five sites had at least one drug in their system at the time of arrest, 70 percent of those testing positive for any drug had never been in any form of drug or alcohol treatment. There was a statistically significant, increasing trend in the percentage of ADAM arrestees testing positive for opiates at all sites except Chicago and New York .

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Trends in Prescription Drug Abuse: 'Bridging Medications'
Medscape Today
May 28, 2013

This article discusses "bridging" medications and which drugs may be involved in this practice. Bridging occurs when individuals use other prescription medications to minimize physiologic withdrawal until individuals can obtain their next "chemical high" with their drug of choice. Opiate addicts may bridge with methadone, buprenorphine, or tramadol. Benzodiazepine addicts often bridge with gabapentin.

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State Police Trying New Program to Help Protect Kids
May 30, 2013

State police districts in West Virginia will launch the Drug Endangerment Children Tracking System on July 1. It encourages officers and child protection workers to share information so situations where children are being neglected or abused can be more easily identified. State police started the new program because they saw a large number of cases of child neglect associated with prescription drug abuse by caregivers.

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Greenville Center to Offer N.C.'s Only Inpatient Opioid Addiction Treatment
May 24, 2013
This article and video (:36 seconds) announce that the Walter B. Jones Alcohol and Drug Abuse Treatment Center in Greenville, N.C., will offer the state's only comprehensive inpatient services for opioid addiction.

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Putting Addictions in the Spotlight
The Guardian
May 29, 2013

Prince Edward Island, Canada, is experiencing an alarming rate of prescription drug addiction. Health and law enforcement professionals have described youth rates of addiction to prescription pain relievers as an epidemic in Prince Edward Island. The standing committee on health and social development asked experts and community groups who work and live with Islanders affected by prescription drug addiction to testify at a series of public meetings.

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Other Resources

Prescription Drugs in the Workplace: An Employers Guide for Screening and Prevention
P.P. Greaney
May 22, 2013

This PDF presentation provided employers with insight into the latest street drugs, facts about commonly abused prescription medications, and a guide for prevention and effective drug screening. It was presented by an occupational healthcare physician and a forensic laboratory doctor at WorkCare, Inc., during the 2013 American Industrial Hygiene Conference and Exposition.

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Grant Announcements

Cooperative Agreements for Electronic Health Record and Prescription Drug Monitoring Program Data Integration
Deadline: June 12, 2013
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Prize Competitions/Challenges in Area of Drug Abuse and Addiction
Deadline: June 16, 2013 (Challenge #1)
Deadline: June 14, 2012 (Challenge #2)
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Healthy Living Grant Program
Deadline: July 16, 2013
The Healthy Living Grant Program, sponsored by the American Medical Association Foundation, supports health education programs to develop school and community-based solutions to behavioral health challenges. This year's focus is Prescription Medication Safety, to raise awareness and educate children, parents, or schools about the dangers of prescription drug abuse.
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Upcoming Conferences and Workshops

11th Annual Middlesex County Prevention Education Summit
June 7, 2013
New Brunswick, New Jersey

2013 Symposium for Medical Professionals: Kentucky Medical Communities UNITEd
June 8, 2013
Manchester, Kentucky

International Conference on Opioids
June 9-11, 2013
The Joseph B. Martin Conference Center at Harvard Medical School
Boston, Massachusetts
This conference is designed to inform primary care physicians, pain specialists, pharmacists, and other opioid prescribers about the uses, abuses, and legal ramifications of opioids.
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Prescribing Solutions: Staten Island Opioid Summit 2013
June 14, 2013
Staten Island University Hospital, Ocean Breeze
Staten Island, New York
The New York City Department of Health and Mental Hygiene, Staten Island Borough President's Office, and Tackling Youth Substance Abuse Initiative will hold forums with physicians, physician assistants, nurse practitioners, and dentists to discuss ways to stem prescription drug misuse and abuse on Staten Island.
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Pharmacy Diversion Awareness Conference
June 22 and 23: Chicago, Illinois
July 13 and 14: Portland, Oregon
August 3 and 4: Baton Rouge, Louisiana
August 16 and 17: San Diego, California
August 18 and 19: San Jose, California
September 21 and 22: Boston, Massachusetts

The Generation Rx University Conference for Prescription Drug Abuse Prevention and Recovery
August 7-8, 2013
Columbus, Ohio

National Conference on Addiction Disorders 2013
September 21-25, 2013
Anaheim, California
This national conference provides a diverse educational curriculum on the prevention, intervention, treatment, and recovery management of addictions that affect various genders, generations, and cultures.
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2013 National Safety Council Congress and Expo
Congress: September 28-October 4, 2013
Expo: September 30-October 2, 2013
Chicago, Illinois
Please e-mail Rekaya Gibson at rgibson@pire.org with questions or comments about the SAMHSA Prevention of Prescription Drug Abuse in the Workplace Listserv.  
About PAW and the Listserv
The PAW TA Center addresses prescription drug abuse--a growing public health problem with increasing burdens on workers, workplaces, and our economy. Prescription drug abuse affects workplace productivity and increases employee absenteeism, employee presenteeism, and workers' compensation claims. On a wider scale, overdose deaths linked to prescription opioids tripled from 1999 to 2006, and prescription drug abuse killed more Americans in 2009 than died that year in auto crashes.
Send your request for PAW technical assistance to PAW-TA@pire.org or contact Rekaya Gibson at 504.261.8107 or Deborah Galvin at 240.276.2721. Requests are subject to SAMHSA approval. You will be notified of the status of your request.
We aim to conduct systematic and inclusive searches of professional journals, leading newspapers and magazines, and federal websites, as well as contributions from listserv subscribers (please e-mail suggestions to rgibson@pire.org). We will send links to articles along with brief descriptions of those articles. As we develop the listserv, however, we hope to add commentary and invite feedback from subscribers. Our goal is to expand the listserv to become a widely used and recognized source of the most current and authoritative information on prescription drug abuse--especially in workplaces.
The "SAMHSA Prevention of Prescription Drug Abuse in the Workplace Listserv" 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 viewpoints or opinions and are not assessed for validity, reliability, or quality. The "SAMHSA Prevention of Prescription Drug Abuse in the Workplace Listserv" 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 journal articles.
The Injury Control Research Center at West Virginia University (WVU-ICRC) archives past Listserv issues at http://www.hsc.wvu.edu/icrc/Pages/SAMHSA-Prevention-of-Prescription-Drug-Abuse-in-th. The partnership efforts of WVU-ICRC are supported by Grant Number 1 R49 CE002109 from the Centers for Disease Control and Prevention (CDC). The contents of the Listserv archive are solely the responsibility of the authors and do not represent the official views of CDC or SAMHSA.
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