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June 9, 2016

PAW Weekly Update

SAMHSA Prescription Drug Abuse Weekly Update
Issue 177  |  June 09, 2016
The Prevention of Prescription Drug Abuse in the Workplace (PAW) TA Center addresses prescription drug abuse—a growing public health problem with increasing burdens on workers, workplaces, and our economy. To subscribe colleagues, family members, or friends to this listserv sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), please click here or send their e-mail addresses to paw@dsgonline.com.
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National Center for Health Statistics. 2016. “Quarterly Provisional Estimates for Selected Causes of Death: United States, 2014—Quarter 4, 2015.” National Vital Statistics System, Vital Statistics Rapid Release Program.

The U.S. death rate increased to 729.5 deaths per 100,000 people in 2015, up from 723.2 in 2014, according to preliminary data. Drug overdose deaths increased 7.8 percent from 14.1 per 100,000 in the second quarter of 2014 to 15.2 in the second quarter of 2015. The rate for unintentional injuries, which includes drug overdoses, increased to 42.0 per 100,000 in the third quarter of 2015, up from 39.9 in the third quarter of 2014.

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Ohio May Foot Drug Treatment Bill for Injured Workers
Jona Ison, Gannett Ohio
May 27, 2016

The Ohio Bureau of Workers’ Compensation Board of Directors has approved a rule that would allow payment of drug addiction treatment for workers who become addicted to pain pills after a workplace injury. Treatment for dependence could include psychological counseling and medication assisted treatment for recovery. The bureau also will reject payment of prescription pain relievers if doctors are not trying alternative treatments. The goal is to prevent opioid dependence and encourage physicians to employ best medical practices when treating injured workers with opioids. The rule now moves to the Ohio General Assembly’s Joint Committee on Agency Rule Review. If approved there, it becomes effective October 1.

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Journal Articles and Reports

M.E. Buttram, and S.P. Kurtz. 2016. “Alternate Routes of Administration among Prescription Opioid Misusers and Associations with Sexual HIV Transmission Risk Behaviors.” Journal of Psychoactive Drugs, doi:10.1080/02791072.2016.1187319.

In 2011–14, baseline assessments for a behavioral intervention trial polled 446 people ages 18–39 who attended large local nightclubs in Miami, had heterosexual sex in the past 90 days, and misused substances recently and regularly. In multivariate analysis, participants who reported non-oral administration of prescription opioids (n = 209) were more likely to be Caucasian and report group sex participation history and severe mental distress.

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H-Y. Chang, T. Lyapustina, L. Rutkow, M. Daubresse, M. Richey, M. Faul, E.A. Stuart, and G.C. Alexander. 2016. “Impact of Prescription Drug Monitoring Programs and Pill Mill Laws on High-Risk Opioid Prescribers: A Comparative Interrupted Time Series Analysis.” Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2016.04.033.

Researchers used IMS Health’s LRx Lifelink database between July 2010 and September 2012 to identify 38,465 opioid prescribers in Florida (intervention state) and 18,566 in Georgia (control state). High-risk prescribers were in the top 5 percent of opioid volume during four consecutive calendar quarters. Researchers applied comparative interrupted time series models to evaluate policy effects on clinical practices and monthly prescribing measures for low-risk/high-risk prescribers. The 1,526 high-risk prescribers in Florida (4.0 percent) accounted for 67 percent of total opioid volume and 40 percent of total opioid prescriptions. Relative to their lower-risk counterparts, they wrote sixteen times more monthly opioid prescriptions (79 vs. 5), and had more prescription-filling patients receiving opioids (47 percent vs. 19 percent). After implementation of mandatory prescription drug monitoring program and pill mill laws, relative to their Georgia counterparts, Florida high-risk providers reduced opioid patients and prescriptions (−536 patients/month; −847 prescriptions/month), morphine equivalent dose (−0.88 mg/month/patient), and total opioid volume (−3.88 kg/month). Low-risk providers did not experience statistically significantly relative reductions. The prescribers in the high-risk cohort largely remained there even though they reduced their prescribing.

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S. Doyon, C. Benton, B.A. Anderson, M. Baier, E. Haas, L. Hadley, J. Maehr, K. Rebbert-Franklin, Y. Olsen, and C. Welsh. 2016. “Incorporation of Poison Center Services in a State-Wide Overdose Education and Naloxone Distribution Program.” American Journal on Addictions 25(4):301–6, doi:10.1111/ajad.12384.

This retrospective case series study examines the initial outcomes of Maryland’s overdose education and naloxone distribution program. After administration of naloxone, bystanders and law enforcement were asked to call the poison center within 2 hours and describe the outcomes they witnessed. Among 78 calls over 16 months, two people died. Positive naloxone response, defined as resumed ability to breathe, talk, or walk within minutes of administration was observed in 76 percent of cases, including 86 percent of heroin exposures and 71 percent of prescription opioid exposures.

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M.J. Elzey, S.M. Barden, and E.S. Edwards. 2016. “Patient Characteristics and Outcomes in Unintentional, Non-fatal Prescription Opioid Overdoses: A Systematic Review.” Pain Physician 19(4):215–28.

Researchers conducted a systematic review of the literature for unintentional, non-fatal opioid overdose using the MEDLINE, CINAHL, PsycINFO, and Web of Science databases. Preferred reporting items for systematic reviews and meta-analyses guidelines were used in constructing this systematic review. This systematic review analyzed 24 articles (21 retrospective descriptive analyses, 2 prospective analyses, 1 phase III trial, and 1 meta-analysis). Articles were reviewed by authors and relevant data examined. Results show that opioid overdose morbidity is significantly more prevalent than mortality and sequelae of nonfatal events should be studied in more detail.

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D.S. Festinger, K.L. Dugosh, N. Clements, A.B. Flynn, M. Falco, A. Thomas McLellan, and A.M. Arria. 2016. “Use of the Internet to Obtain Drugs without a Prescription Among Treatment-Involved Adolescents and Young Adults.” Journal of Child & Adolescent Substance Abuse, doi:10.1080/1067828X.2015.1103345.

Surveying a convenience sample of 1,860 adolescents and young adults from 24 residential and outpatient treatment programs in Maryland and Pennsylvania revealed only 2.3 percent bought drugs – primarily pain relievers – from the internet.

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J. Goesling, S.E. Moser, B. Zaidi, A.L. Hassett, P. Hilliard, B. Hallstrom, D.J. Clauw, and C.M. Brummett. 2016. “Trends and Predictors of Opioid Use After Total Knee and Total Hip Arthroplasty.” Pain 157(6):1259–65, doi:10.1097/j.pain.0000000000000516.

Preoperatively, 574 total knee arthroplasty (TKA) and total hip arthroplasty (THA) patients completed validated, self-report measures of pain, functioning, and mood. The patients were longitudinally assessed for 6 months after surgery. Among patients who were opioid naïve (not chronically receiving opioid analgesics on a daily basis) the day of surgery, 8.2 percent of TKA and 4.3 percent of THA patients were using opioids at 6 months. In comparison, 53.3 percent of TKA and 34.7 percent of THA patients who reported opioid use the day of surgery continued to use opioids at 6 months. Patients taking >60 mg oral morphine equivalents preoperatively had an 80 percent likelihood of persistent use postoperatively. Day of surgery predictors for 6-month opioid use by opioid-naive patients included greater overall body pain, greater affected joint pain (knee/hip), and greater catastrophizing. In both groups, decreases in overall body pain from baseline to 6 months were associated with decreased odds of being on opioids at 6 months but changes in affected joint pain were not.

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P.M. Grace, K.A. Strand, E.L. Galer, D.J. Urban, X. Wang, M.V. Baratt, T.J. Fabisiak, N.D. Anderson, K. Cheng, L.I. Greene, D. Berkelhammer, Y. Zhang, A.L. Ellis, H.H. Yin, S. Campeau, K.C. Rice, B.L. Roth, S.F. Maier, and L.R. Watkin. 2016. “Morphine Paradoxically Prolongs Neuropathic Pain in Rats by Amplifying Spinal NLRP3 Inflammasome Activation.” Proceedings of the National Academy of Sciences, doi:10.1073/pnas.1602070113

A short course of morphine, starting 10 days after injury in male rats, doubled the duration of chronic nerve pain months after morphine ceased. Using pharmacologic and genetic approaches, researchers discovered that the initiation and maintenance of this multi-month prolongation of neuropathic pain was mediated by a previously unidentified mechanism for spinal cord and pain—namely, morphine-induced spinal NOD-like receptor protein 3 inflammasomes and associated release of interleukin-1β. The authors used a designer drug to enduringly reverse this morphine-induced persistent sensitization.

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C. Tjagvad, T. Clausen, M. Handal, and S. Skurtveit. 2016. “Benzodiazepine Prescription for Patients in Treatment for Drug Use Disorders: A Nationwide Cohort Study in Denmark, 2000–2010.” BMC Psychiatry 16:168, doi:10.1186/s12888-016-0881-y.

According to linked data on all 33,203 patients ages 18–67 years who were admitted for outpatient treatment for drug use disorders in Denmark in 2000–10, during the first year after admission to treatment, 26 percent were prescribed benzodiazepines. Of these, 35 percent were prescribed benzodiazepines at dose levels that might indicate inappropriate use (more than one daily dose per day) and 35 percent were prescribed more than one type of benzodiazepines. Diazepam was the most commonly prescribed type. Thirty percent of users of prescribed benzodiazepines first used post-treatment, and of these, 28 percent continued into very long-term use (≥4 years after admission). Among patients with opioid use, 43 percent were prescribed benzodiazepines, which was much higher than the 12 percent for patients with cannabis as their primary drug use and 14 percent with stimulants. Admitting to treatment for a drug use disorder did not increase specialized psychiatric treatment use.

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B.K. Zedler1, A.L. Mann, M.M. Kim, H.R. Amick, A.R. Joyce, E.L. Murrelle, and H.E. Jones. 2016. “Buprenorphine Compared with Methadone to Treat Pregnant Women with Opioid Use Disorder: A Systematic Review and Meta-Analysis of Safety in the Mother, Fetus and Child.” Addiction, doi:10.1111/add.13462.

A meta-analysis of three randomized controlled trials (RCT; n = 223) and 15 cohort studies (COH; n = 1923) found that, compared to methadone treatment during pregnancy, buprenorphine treatment was associated with lower risk of preterm birth (RCT risk ratio [RR] = 0.40; COH RR = 0.67), greater birth weight (RCT 277 g; COH 265 g) and larger head circumference (RCT 0.90 cm; COH 0.68 cm). No treatment differences were observed for spontaneous fetal death, fetal/congenital anomalies, and other fetal growth measures, although the power to detect such differences may be inadequate due to small sample sizes.

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Professional Opinion

E. Huber, R.C. Robinson, C.E. Noe, and O. Van Ness. 2016. “Who Benefits from Chronic Opioid Therapy? Rethinking the Question of Opioid Misuse Risk.” Healthcare 4(2):29, doi:10.3390/healthcare4020029.

The authors suggest that focusing on opioid misuse risk may inadvertently lead to the assumption that individuals who are not at high risk of misusing opioids would benefit from chronic opioid therapy. The two questions are independent.

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Professional Development

W.C. Becker, and J.M. Tetrault. 2016. “Medical Marijuana in Patients Prescribed Opioids.” Mayo Clinic Proceedings, doi:10.1016/j.mayocp.2016.04.008.

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A.R. Ducoffe, A. York, D.J. Hu, D. Perfetto, and R.D. Kerns. 2016. “National Action Plan for Adverse Drug Event Prevention: Recommendations for Safer Outpatient Opioid Use.” Pain Medicine, doi:10.1093/pm/pnw106.

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P. Holland. 2016. “Drug Testing in the Australian Workplace: Still a Contested Terrain.” Journal of Industrial Relations, doi:10.1177/0022185616648031.

This article examines ongoing issues associated with workplace drug testing through a recent case which has resulted in revaluation of the customs, practices and standards around the use of illicit drugs inside and outside the workplace.

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J. James. 2016. “Dealing with Drug-Seeking Behaviour.”Australian Prescriber 39:96–100, doi:10.18773/austprescr.2016.022.

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A. Lligoña, P. Barrio, A. Lopez, A. Fauli, and L Ortega. 2016. “Factors Increasing Addiction Risk in Non-Cancer Pain Patients Receiving Prescription Opioids. A Descriptive Study.” Journal of Psychosomatic Research, doi:10.1016/j.jpsychores.2016.03.178.

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I. Thong, and V. Miller. 2016. “Chronic Pain, Opioids and Dependence. A Role for Every GP.” Medicine Today 17(5): 53-56.

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FDA Approves First Buprenorphine Implant for Treatment of Opioid Dependence
May 26, 2016

The FDA has approved Probuphine, an implant designed to provide a constant, low-level dose of buprenorphine for 6 months in patients who are already stable on low-to-moderate doses of other forms of buprenorphine. Probuphine should be used as part of a complete treatment program that includes counseling and psychosocial support. The safety and efficacy of Probuphine have not been established in people less than age 16 and over age 65.

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Senators Call on Health Agency to Increase Opioid Addiction Treatment Access
Office of Sen. Ed Markey (D-Mass.)
June 1, 2016

A bipartisan group of 22 senators is calling on the U.S. Department of Health and Human Services to raise the cap per physician on prescribing buprenorphine to 500 patients. In the meantime, the Senate is considering legislation that would increase the cap.

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Details on Death Certificates Offer Layers of Clues to Opioid Epidemic
Jeff Cohen, WNPR
June 3, 2016

James Gill, M.D., chief medical examiner for Connecticut, has seen more than a 50 percent increase in autopsies due to mostly accidental drug overdoses. The increase is forcing the state to expand its autopsy facilities. Dr. Gill explained death certificates need to say more than something vague to help law enforcement and public health officials curb the distribution and abuse of opioids. When Gill took the job, only 63 percent of Connecticut’s drug deaths had specific drugs listed on the death certificate; today, 99 percent do. In 2014, only Rhode Island did better than Connecticut in getting and passing along comprehensive details. At the low end, only about half of deaths in Pennsylvania, Indiana, Mississippi, and Louisiana had specific information on the death certificates. Variation can come from people who certify deaths not having the same training. Some people may not be comfortable singling out one or two drugs as the cause of death. (Includes audio: 4:37 minutes)

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Six Steps for Hospitals to Take to Prevent Prescription Drug Abuse, Diversion
Sherry Umhoefer and Marvin Finnefrock, Hospitals & Health Networks
May 31, 2016

Hospital administrators can help reduce their institution’s risk of prescription drug inventory diversion and reduce the risk of fines by federal drug agencies by reviewing their policies and oversight. Hospital staff and administrators can also help inform employees about the opioid abuse epidemic and the dangers of pharmaceutical addiction. An effective hospital or health system controlled substance diversion prevention program should contain six steps: review policies and procedures that are in place to minimize diversion; create standards for ordering and prescribing controlled substances; establish education and training across multiple disciplines to educate staff on controlled substance diversion; place camera surveillance in high-risk areas; when something does go wrong, have procedures ready to launch to investigate potential cases of diversion and discrepancies in controlled substance inventory; and review staff practices that can help avoid the problem on the front end by reducing the number of opioid prescriptions written.

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Navy Developing Mobile App to Help Prevent Prescription Medication Misuse
United States Navy
May 31, 2016

The Naval Health Research Center has begun the second phase of development of a smartphone application aimed at preventing prescription medication misuse by military personnel. The app is intended to support patients in situations where they do not have immediate access to their health care providers, but have questions about appropriate use of their prescription medication.

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Stop Abuse of Substances, Support Marines
Lance Cpl. Brendan King, Defense Media Activity
June 3, 2016

Updated Marine Administrative Message 579/10 states “there has been a surge in Marines and sailors using both legal and illegal substances, which affects efficiency, discipline and good order of Marine units.” It provides information on the dangers of misusing legal and illegal substances, compounds, controlled substances and mixtures to get intoxicated. It describes the legal consequences of misuse and provides leaders with guidance to combat substance abuse. The Department of Defense has a zero-tolerance policy regarding substance misuse, and policies for mentorship and leadership to address misuse. The guidelines also help to determine how and when to provide treatment for Marines afflicted by dependence.

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The Biggest Loser Under Investigation for Alleged Drug Use on Set
Merrill Barr, TV Guide
May 31, 2016

The Los Angeles County Sheriff’s Department is investigating The Biggest Loser, a weight-loss television competition, over reports of illegal and prescription drug use on the NBC set. A former contestant claims that participants were encouraged to take drugs. NBC says it prohibits the use of weight-loss and illegal substances.

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Legal But Deadly
Harry Haroutunian, AARP Bulletin
June 2016

AARP discusses how the United States became dependent on prescription drugs, including pain relievers, and recommends steps to take if a loved one is struggling with drug dependency.

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The Hefty Price of ‘Study Drug’ Misuse on College Campuses
Lina Begdache, New Boston Post
June 1, 2016

This article discusses the impact of attention-deficit/hyperactivity disorder (ADHD) drug misuse (e.g., Adderall, Ritalin, Concerta, and Vyvanse) among college students. The National Institutes of Health reported that abuse of prescription drugs among college students increased from 8.3 percent in 1996 to 14.6 percent in 2006. Students claim these drugs help them concentrate. However, college students who take ADHD drugs without a medical need could risk developing drug dependence, brain rewiring, and behavior changes, such as aggression and suicidal thoughts. Nonmedical ADHD drug abuse might also prime the brain for use of other substances such as alcohol, cocaine, and marijuana.

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M.H. Meier, A. Caspi, M. Cerdá, R.J. Hancox, H. Harrington, R. Houts, R. Poulton, S. Ramrakha, W.M. Thomson, and T.E. Moffitt. 2016. “Associations Between Cannabis Use and Physical Health Problems in Early Midlife: A Longitudinal Comparison of Persistent Cannabis vs Tobacco Users.” JAMA Psychiatry, doi:10.1001/jamapsychiatry.2016.0637.

This longitudinal study followed a representative birth cohort of 1,037 people born in Dunedin, New Zealand, in 1972 and 1973 up to age 38, with 95 percent retention. Among them, 484 had ever used tobacco daily and 675 had ever used cannabis. Tobacco use, but not cannabis use, was associated with worse lung function, systemic inflammation, and metabolic health at age 38, as well as within-individual decline in health from ages 26–38. Cannabis use was associated with poorer periodontal health at age 38 and within-individual decline in periodontal health from ages 26–38. Cannabis joint-years from ages 18–38 was associated with poorer periodontal health at age 38, even after controlling for tobacco pack-years.

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Y. Shi, K. Meseck, and M.M. Jankowska. 2016. “Availability of Medical and Recreational Marijuana Stores and Neighborhood Characteristics in Colorado.” Journal of Addiction, doi:10.1155/2016/7193740.

In Colorado, spatial regressions showed marijuana stores were more likely to locate in census tracts with a larger population size, larger land area, lower proportion of young people, higher crime rate, greater density of on-premise alcohol outlets, higher proportion of racial and ethnic minority population (recreational stores only), and lower household income (medical stores only). Within a 1,000-feet radius, 1.7 percent of schools had at least one marijuana store; within a 1,000 feet–1 mile radius, 32.7 percent of schools had at least one marijuana store.

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Workplace Questions Raised By Pot Bill
Laura A. Bischoff, Dayton Daily News
May 29, 2016

If Ohio legalizes medical marijuana under the provisions of a bill passed by its general assembly, workers who use the drug even during off hours and under a doctor’s prescription will risk losing their job and may not be able to collect unemployment insurance. Also, workers fired for violating those policies will not be able to sue their employer. Workplaces will be allowed to enforce policies that regulate drug activity, including use of marijuana. Employees should check their workplace polices and with their employer before using medical marijuana. Employers should make sure their drug-free workplace policy is clear and follows state and federal laws, educate workers, train supervisors, reassess their drug testing choices, and offer assistance to workers who need it.

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[Video] Legalization of Marijuana Could Lead to Trafficking of High-Grade Marijuana
June 1, 2016

Mark Woodward with the Oklahoma Bureau of Narcotics discusses why prescription drug misuse is such a big problem in the state, and the movement to legalize marijuana. Transcript included. (Duration: 6:30 minutes)


St. Cloud’s (Minn.) First Medical Marijuana Dispensary Set to Open
Lee Voss, WJON
May 31, 2016

St. Cloud, Minn., will open its first medical marijuana dispensary this month. Leafline Labs also has plans to open clinics in Hibbing and St. Paul by July.

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British Columbia Doctors Fight Opioid Deaths with New Prescription Rules
Canadian Press
June 1, 2016

The College of Physicians and Surgeons of British Columbia, Canada, have adopted a professional standard intended to reduce opioid-related deaths. It requires documenting discussions with patients about the benefits of non-opioid treatments, prescribing the lowest effective dosage, and ongoing patient checks including routine urine testing. Doctors must also review a patient’s medication history on the PharmaNet prescription drug monitoring program before prescribing opioids, sedatives or stimulants. If that history is unavailable, physicians must consult with colleagues and pharmacists about the patient’s background and prescribe only immediately required drugs until the record turns up.

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New Opioid Prescription Guidelines in Place for Nova Scotia (Canada) Physicians
Natasha Pace, Global News
June 2, 2016

The College of Physicians and Surgeons of Nova Scotia, Canada, have adopted the opioid prescribing guidelines from the U.S. Centers for Disease Control and Prevention. (Includes video: 2:16 minutes)

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Drug Driving: Almost 8,000 Arrests in England and Wales
Rowan Bridge, BBC
June 1, 2016

After imposing driving limits for eight illegal and nine prescription drugs, England and Wales arrested 7,796 people for drugged driving between March 2015 and April 2016. Those convicted face a minimum 12-month driving ban, up to 6 months in prison, an unlimited fine, and a criminal record. People are not penalized if they use prescription drugs within recommended amounts. Law enforcement roadside drug testing kits also check for cocaine and cannabis. (Includes two videos: 0:59 minutes | 1:48 minutes)

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Fentanyl, Other Opioids Put Patients on a Dangerous Slope in Canada
CBC News
June 3, 2016

Fentanyl-related deaths have increased in Canada. In British Columbia alone, deaths involving fentanyl increased from 13 in 2012 to 480 in 2015. In Alberta, fentanyl-detected deaths increased from 29 in 2012 to 274 last year. This increase made Dr. Perry Kendall, the British Columbia’s provincial health officer, to declare an emergency last month. Several factors have contributed to the fentanyl overdose crisis: use shifted to fentanyl and other more potent opioids after Oxycontin was pulled from the market in 2012 and replaced with tamper-resistant OxyNeo; Fentanyl patches for cancer pain have been diverted for illicit use; and smaller doses of higher potency bootleg fentanyl from China that are more easily smuggled flooded the illicit market. Education is needed for those who turn to the black market when a physician will no longer prescribe an opioid.

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Northeast/Mid-Atlantic News

New Hampshire Passes Bill to Upgrade Prescription Drug Monitoring Program Technology
State of New Hampshire
June 1, 2016

New Hampshire’s legislature has passed a bill that includes funding to upgrade the state’s prescription drug monitoring program. Upgrading the program’s technology will ensure that more prescribers can use it in a timely fashion.

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At ‘Pain School,’ Veterans in Massachusetts Learn to Manage With Fewer Pills
Martha Bebinger, WBUR
May 31, 2016

Bedford (Mass.) Veteran Affairs (VA) Medical Center has a “pain school” for patients, a 5-week, 15-hour course that covers nutrition, sleep, exercise, breathing, visualization, relaxation, and stress. Students set weekly goals and activities to manage their pain. The school helps veterans reduce or stop using opioids and other drugs to control pain. Bedford has the third-lowest opioid prescribing rate among VA medical facilities in the country. However, each time pain school is offered, about half of the students drop out before it ends. Many veterans are scared to try something besides pain medications. Bedford is one of 67 VA pain schools across the country. (Includes audio: 7:20 minutes)

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South News

Georgia to Overhaul Prescription Drug Monitoring Program
Michell Eloy, WABE
June 1, 2016

Georgia’s prescription drug monitoring program will get an overhaul in July. Prescription data will be tracked for 2 years instead of just 1 year. Doctors and pharmacists will now be able to inform law enforcement of potential misuse. A search warrant will no longer be the only means federal and state law enforcement have to access the data. Although the goal is to get more doctors and pharmacists to use the system, doctors are still not required to check the database before writing a prescription. Pharmacists will still have 10 days to update the database. (Includes audio: 2:05 minutes)

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Tennessee Making Progress Reducing Prescription Drug Abuse
Portland Sun
June 1, 2016

In 2014, Tennessee launched an initiative, Prescription for Success, to get a handle on the availability and misuse of prescription pain medications. Since then, the state’s mental health and substance abuse services department has reduced patient doctor shopping for prescription opioids by 50 percent; increased funding to counties with high overdose deaths and neonatal abstinence syndrome births; increased funding to community anti-drug coalitions; reduced prescription drug poisonings and overdose deaths; and reaching more than 6 million with the “Take Only as Directed” commercial. Tennessee has also increased permanent prescription drug collection boxes from 36 to 155; 460,000 fewer opioid prescriptions have been reported to the controlled substance monitoring database; and 563,000 fewer opioid morphine milligram equivalents have been dispensed.

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Medical Professionals Connected to Maryville (Tenn.) Pill Mill Plead Guilty
Wes Wade, Daily Times
June 1, 2016

One doctor, a physician assistant, and four nurse practitioners employed at Breakthrough Pain Therapy Center in Maryville, Tenn., have pled guilty in federal court to a charge of conspiracy to distribute oxycodone, morphine, oxymorphone, and alprazolam. Each defendant admitted writing prescriptions “outside the course of professional practice.” Most were paid $700–$800 a day to see patients and write prescriptions. The clinic did not have examination tables, medical equipment, hospital gowns, or examination gloves. Also, drug dealing and use occurred in the parking lot of the clinic. All six defendants remain free on bond.

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More North Carolina Police Trained to Recognize Drivers Impaired by Drugs
Marissa Hundley, WNCN
May 31, 2016

North Carolina now has more than 180 drug recognition experts—law enforcement officers trained to identify drivers impaired by drugs other than alcohol. These officers conduct 12-step evaluations on drivers to determine their level of impairment and the category of drug that caused the impairment. Training is in high demand because of marijuana legalization in several states and an increase in prescription drug misuse.

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Tennessee Officers Arrest Almost as Many Drug Users as DUIs Over Holiday Weekend
Bill Mitchell, WDEF
May 31, 2016

Over the Memorial Day weekend, 42 people were arrested in Tennessee for either driving under the influence or being intoxicated in public, and 37 people were found to be under the influence of drugs or trying to sell them. Tennessee Highway Patrol troopers are drug recognition experts and find most drivers arrested for being under the influence of prescription medication or illegal drugs.

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Wheeling (W.Va.) Hospital Announces New Guidelines for Prescribing Opioids
Sean Eiler, WTOV
May 31, 2016

Wheeling Hospital in West Virginia is adopting opioid prescription guidelines that will help monitor how much is being prescribed, how often, and use of alternative pain control methods. (Includes video: 1:13 minutes)

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Midwest News

Lessons from Tragedy: Senate Report Slams Wisconsin VA Handling of Overdose Cases
Fox News
June 1, 2016

A U.S. Senate report blamed a “culture of fear” at Tomah Veterans Affairs (VA) Medical Center in Wisconsin for “overprescription and other abuses” that allegedly ran rampant at the facility. The hospital’s chief of staff and director were fired after an investigation into an overdose death of one patient. Investigators had said the chief of staff and a nurse practitioner “appeared to be impaired” when they were interviewed in 2012, but no action was taken. Frasher resigned. The report also singled out the VA’s inspector general’s office for “failure to identify and prevent the tragedies” at Tomah, including not publicly releasing findings from its probe that could have saved lives and improved operations. Three deaths at Tomah remain under investigation. (Includes video: 6:05 minutes)

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Related Article

Update: VA Official Takes Blame for Tomah Problems, Says Opioid Prescriptions Down
Chris Hubbuch, La Crosse Tribune
June 1, 2016

Sloan Gibson, deputy secretary of Veterans Affairs (VA), testified before a congressional hearing that the agency was to blame for problems linked to the deaths of at least two patients at the Tomah VA Medical Center in Wisconsin. Gibson outlined steps taken to reform the facility and reduce the reliance on opioid pain relievers. The number of veterans who receive opioids has dropped by nearly a quarter, to just over 9 percent, below the national rate of about 13 percent.

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St. Louis Mayor Signs Prescription Drug Monitoring Bill
May 31, 2016

St. Louis Mayor Francis Slay has signed a bill to create a prescription drug monitoring program (PDMP) for the city. The surrounding county has a similar law. Missouri is the only state that does not have a statewide PDMP.

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Minnesota Governor Signs Bill Expanding Drug Monitoring Program
June 1, 2016

Minnesota’s governor has signed a bill into law that expands the state’s prescription drug monitoring program by requiring prescribers and pharmacists to register and maintain a user account with the program. The bill also allows medical boards to investigate complaints regarding prescribing amounts and habits to ensure overprescribing or diversion is not happening. The law takes effect July 2017. (Includes audios: 0:30 minutes | 0:27 minutes)

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University of Minnesota Wrestling Coach Said He Tried to Report Drug Abuse
Farrah Fazal, KSTP
May 31, 2016

The University of Minnesota’s head wrestling coach said he has electronic communication that show he tried to report wrestlers misusing Xanax. He also notified the interim athletic department director of his desire to have specific wrestlers tested. Some were tested but not for Xanax. The university confirmed that 10 wrestlers were using the drug and four of them were selling Xanax for $5 a pill. They are all under investigation. (Includes video: 2:04 minutes)

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Prince’s Death Casts Light on America’s Soaring Prescription Drug Abuse
Quentin Fottrell, Market Watch
June 4, 2016

The Midwest Medical Examiner’s Officer reported that musician Prince died from an accidental overdose of fentanyl. The report did not list any other cause of death or conditions. Prince was pronounced dead April 21, a day before he was scheduled to meet with a California doctor about his opioid addiction. Prescription drug misuse is soaring in this country and no one is immune. More people died from drug overdoses in the United States in 2014 than during any previous year on record, and more than half (61 percent) involved pain medication. There has been a 15-year increase in overdose deaths involving prescription opioid pain relievers. The percentage of American workers testing positive for prescription drugs has also risen over the last decade. The increase is due to people with a genuine need for pain medication developing an addiction after being prescribed pain medication for an injury or ailment.

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West News

California Hospital Cuts Opioid Prescriptions by Half
Paige Minemyer, Fierce Healthcare
May 31, 2016

The Community Hospital of Monterey (Calif.) Peninsula has cut opioid prescriptions by 50 percent and reduced recurrent emergency department visits for opioid misuse by close to 60 percent since it developed Prescribe Safe 2 years ago. The initiative established strong guidelines for prescribing opioid pain relievers in the emergency department. The staff supplied patients with handouts and resources about prescribing safe pain medications, drug and alcohol counseling, and ways to seek alternative treatments, such as acupuncture. This article lists three important interventions for a successful substance diversion prevention program.

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Nevada Pharmacists Learn Warning Signs of Prescription Drug Abuse
Teri Vance, Nevada Appeal
June 2, 2016

Partnership Carson City (Nev.), an organization dedicated to community wellness, hosted a “Last Set of Eyes” symposium to educate pharmacists and technicians about prescription drug misuse. Deputy Josh Chaney of the Carson City Sheriff’s Office listed warning signs of prescription drug misuse. Lieutenant Andy Rasor from the Nevada Division of Investigation encouraged attendees to remain vigilant by verifying customer’s driver licenses; making sure the doctor writing the prescription really exists; and working with law enforcement officials.

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Medication-Assisted Treatment Programs for Justice-Involved Populations
Office of National Drug Control Policy
Tuesday, June 14, 2016
2–3 p.m. (ET)

This webinar will highlight examples of Medication Assisted Treatment programs for individuals with opioid use disorder in correctional settings and reentry programs in California, Connecticut, and Massachusetts.


Other Resources

Community Toolkit to Combat Opioid Addiction Created Through Bipartisan Effort
Brett Barron, DeKalb Neighbor
June 2, 2016

Rep. Hank Johnson (D–Ga.) has made “Fighting the Opioid Crisis: A Community Resource Toolkit” available on his website. The toolkit, which a state task force developed, includes resources such as online courses and tips concerning prevention; links to support networks and treatment groups and services; heroin and opioid factsheets and videos; ebooks on intervention and treatment; and telephone numbers to national helplines. Additional resources will be added as they become available. The print version of the toolkit will be available for those without Internet access.

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A.K. Erickson. 2016. “Planes, Trains, and Automobiles: Tips for Traveling with Medications.” Pharmacy Today 22(5):22.

This article discusses how to travel with prescription opioids and why travelers cannot bring home prescription drugs purchased overseas.

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National Institute on Drugs Creates Online Resource to Raise Awareness About Naloxone
National Institute on Drugs
June 2, 2016

The National Institute on Drug Abuse (NIDA) has created a section on its website dedicated to resources about naloxone. The section includes information about the medication, how and by whom it can be given, and where to obtain it. It also contains information about dosage, precautions, and side effects; links to pharmacies that offer naloxone (with and without a prescription); related NIDA resources; and related federal and private sector websites.

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Grant Announcements

Enhanced State Surveillance of Opioid-Involved Morbidity and Mortality
National Center for Injury Prevention and Control
Due: June 27, 2016

Bottle Tracking Program
National Association of Drug Diversion Investigators
Due: None Specified

Take-Back Events & Drop Boxes

Shelby Township (Mich.) Collects 315 Lbs. of Medications Through Challenge
Sean Delaney, The Source (Michigan)
June 2, 2016

Adair County (Mo.) Sheriff’s Office Collects 260 Lbs. of Unused Medication
Kirksville Daily Express
June 2, 2016

Ontario (Canada) Prescription Drug Drop-Off Numbers More Than Triple From a Year Ago
May 31, 206

Lafourche, Thibodaux (La.) Get Prescription Drug Drop-Off Boxes
Bridget Mire, Houma Today
May 29, 2016

Pittsburgh Sheriff: We’ll Pick Up Unneeded Pain Meds
Pittsburgh Post-Gazette
June1, 2016

Town of Chapin (S.C.) Sets Up Prescription Drug Drop-Off Location
Matthew Stevens, WACH
June 2, 2016

Upcoming Events, Conferences, & Workshops

Our Workplaces and the Opioid Epidemic
Massachusetts Health Council
Thursday, June 16, 2016
7:30 a.m. – 12 p.m.
Westin Waltham
70 Third Avenue
Waltham, Mass.

This conference will cover the nature and scope of opioid addiction and what makes the opioid epidemic different. It will also cover the impact opioids have on businesses. Other topics include managing and supporting employees while keeping the workplace safe and productive; employee assistance programs and substance use education in the workplace; and legal considerations that protect the employer and employee.


Harold Rogers Prescription Drug Monitoring Program National Meeting
Bureau of Justice Assistance, and Prescription Drug Monitoring Program Training and Technical Assistance Center at Brandeis University
August 17–19, 2016
Washington Marriott Metro Center
775 12 Street NW
Washington, D.C.

This meeting will assist government agencies and partnering organizations to better understand prescription drug monitoring program (PDMP), their capabilities, interstate data sharing, and how to use PDMPs most efficiently to address prescription drug misuse and diversion.


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


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


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


Bridging the Gaps: Reducing Prescription Drug and Opioid Abuse and Misuse Summit
National Association of Attorneys General and the Association of State and Territorial Health Officials
November 14–16, 2016
Arlington, Va.

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

Call for Presentations
Submission Deadline Date: Friday, Aug. 5, 2016
The Weekly Update is a service provided by the SAMHSA Preventing Prescription Abuse in the Workplace Technical Assistance Center (PAW) to keep the field abreast of recent news and journal articles to assist in forming policy, research, and programs to reduce prescription drug misuse or abuse. Please note, the materials listed are not reflective of SAMHSA's or PAW's viewpoint or opinion and are not assessed for validity, reliability or quality. The Weekly Update should not be considered an endorsement of the findings. Readers are cautioned not to act on the results of single studies, but rather to seek bodies of evidence. Copyright considerations prevent PAW from providing full text of journal articles listed in the Weekly Update.