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March 12, 2014

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SAMHSA Prescription Drug Abuse Weekly Update
Issue 62  |  March 12, 2014
The Prevention of Prescription Drug Abuse in the Workplace (PAW) TA Center addresses prescription drug abuse—a growing public health problem with increasing burdens on workers, workplaces, and our economy. To subscribe colleagues, family members, or friends to this listserv sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), please click here or send their email addresses to paw@dsgonline.com.
Table of Content Featured Article Journal Articles and Reports News Other State and Local News Other Resources Webinars Audio Grant Announcements Take-Back Events and Drop Boxes Save the Dates Upcoming Conferences and Workshops


This week's listing is chockfull of notable studies, more so than any prior issue. Two are featured here up top, but six others are starred below and we could have starred more.

Christopher M. Jones, Leonard J. Paulozzi, and Karin A. Mack. 2014. Sources of Prescription Opioid Pain Relievers by Frequency of Past-Year Nonmedical Use: United States, 2008–11. JAMA Internal Medicine, doi:10.1001/jamainternmed.2013.12809

The commonly cited statistic that most nonmedical users obtain prescription opiates from friends or family for free often serves as the basis for interventions focused on patients. This statistic, however, is misleading. It reflects sources among infrequent users (63.9 percent of all users). The more frequent the usage, the more likely nonmedical users are to get their drugs from multiple doctors or buy them from drug dealers (strangers, friends, or family). Among the 7 percent of misusers using on 200 or more days a year, 27.3 percent got their drugs by prescription, 38.4 percent bought them from dealers, and 26.4 percent were given their drugs for free by family and friends. Theft was most common among infrequent misusers at 5.3 percent compared with 2.9 percent of the most frequent misusers.

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Stacy Andes, Jenny Wyatt, Alison Kiss, and Michele Mucellin. 2014. Employing Strategic Campus–Community Partnerships to Address Nonmedical Prescription Drug Use on College and University Campuses. Journal of Social Work Practice and Addiction 14(1):27–41, doi:10.1080/1533256X.2014.872956.

In September 2011 the Clery Center for Security on Campus organized a National Summit that identified three key areas of need around nonmedical prescription drug use (NMPDU): responding to the increasing availability of prescription drugs on campus, engaging the pharmaceutical industry and schools of pharmacy in prevention and response, and discontinuing ineffective prevention strategies at colleges and universities. In 2013, a follow-up NMPDU Summit convened in the greater Philadelphia area to examine the scope of the regional problem, determine gaps in campus practitioner knowledge and practice, and create a cadre of professionals interested and engaged in policy development, enforcement, and prevention. The Summit format included 15-minute presentations on three key areas of interest: policy, prevention, and enforcement aspects of NMPDU. Each presentation was followed by a focus group discussion to assess research, prevention, and policy and enforcement implications.

The primary research need identified was to identify risk factors that might serve as red flags for NMPDU, especially ones that might fit into existing models of identifying and supporting students who are high-risk drinkers. In terms of prevention, many institutions implement harm reduction strategies similar to those used for high-risk drinking, but it is unclear whether the same strategies will work equally well with NMPDU. Bystander intervention strategies were identified as potential opportunities for integrative prevention that links NMPDU with other high-risk substance use, particularly as they present an opportunity to engage students in developing an investment in preventing NMPDU. The primary challenge reported was the need for those in institutional leadership positions to engage in a strategic plan to prevent NMPDU. The main enforcement challenge with NMPDU lies in detection. Unlike illicit drug use, the presence of a prescription medication does not by itself indicate problematic use.

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Journal Articles and Reports

Joshua S. Barclay, Justine E. Owens, and Leslie J. Blackhall. 2014. Screening for Substance Abuse Risk in Cancer Patients Using the Opioid Risk Tool and Urine Drug Screen. Supportive Care in Cancer, doi:10.1007/s00520–014–2167–6.

This study aimed to evaluate the frequency of risk factors for substance abuse, diversion, and abnormal urine drug screens in cancer patients receiving palliative care. A retrospective chart review was performed for patients seen in the University of Virginia Palliative Care Clinic during September 2012. Among 114 patients, the mean Opioid Risk Tool score was 3.79, with 43 percent of patients defined as medium to high risk. Age (16–45 years old, 23 percent) and a personal history of alcohol misuse (23 percent) or illicit drug use (21 percent) were the most common risk factors identified. Urine drug screens on 40 percent of patients revealed abnormal findings in 45.65 percent of screenees. Opioids are an effective treatment for cancer-related pain, yet substantial risk for substance abuse exists in the cancer population.

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Francesca L. Beaudoin, Steven Straube, Jason Lopez, Michael J. Mello, and Janette Baird. 2014. Prescription Opioid Misuse Among Emergency Department Patients Discharged With Opioids. The American Journal of Emergency Medicine, doi:10.1016/j.ajem.2014.02.030.

This observational study enrolled 103 emergency department patients ages 18–55 who were discharged with a prescription opioid. Participants completed surveys at baseline in the ED, then 3 and 30 days later. Follow-up surveys contained questions about opioid use and misuse, including screening questions from the National Epidemiologic Survey on Alcohol and Related Conditions. Patients were categorized as misusers if they 1) self-escalated their dose, 2) obtained additional prescription opioids without a prescription, or 3) used for a reason besides pain. Of 85 patients who completed follow-ups, 36 (42 percent) reported misuse at either 3 or 30 days. Demographic variables, pain scores, analgesic treatment, and discharge diagnoses did not differ between misusers and nonmisusers. Self-escalation of dose was the most common category of misuse (33/36, 92 percent). Taking prescription opioids without a doctor's prescription was reported by 39 percent (14/36), and taking pain medications for a reason other than pain was reported by 36 percent (13/36). Presence of disability or chronic pain, preexisting prescription opioid use, oxycodone use, and past-year substance abuse were associated with misuse.

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Gregory S. Brigham, Theresa M. Winhusen, Daniel F. Lewis, Xiamei Guo, and Eugene Somoza. 2014. A Randomized Pilot Clinical Trial to Evaluate the Efficacy of Community Reinforcement and Family Training for Treatment Retention (CRAFT–T) for Improving Outcomes for Patients Completing Opioid Detoxification. Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2014.02.013.

This study tested the efficacy of a psychosocial intervention, Community Reinforcement Approach and Family Training for Treatment Retention (CRAFT–T), relative to psychosocial treatment as usual (TAU). A randomized, 14-week trial with follow-up visits at six and nine months’ postrandomization conducted at two substance use disorder treatment programs. Opioid-dependent adults enrolled in a residential buprenorphine-detoxification program and their significant others were randomized to CRAFT–T (n=28 dyads) or TAU (n=24 dyads). CRAFT–T consisted of 2 sessions with the dyad together and 10 with the significant other alone, over 14 weeks. TAU for significant others was primarily educational and referral to self-help. All patients received substance abuse treatment. The primary outcome was time to first patient drop from treatment lasting 30 days or more. Opioid and other drug use were key secondary outcomes. CRAFT–T moderate increased treatment retention (p=0.058, hazard ratio=0.57). When the significant other was a parent, CRAFT–T more strongly influenced treatment retention (p < 0.01, hazard ratio=0.040). CRAFT–T reduced patient opioid and other drug use (p < 0.0001)

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C.A. Field, G. Cochran, R. Caetano, M. Foreman, and C.V. Brown. 2014. Postdischarge Nonmedical Use of Prescription Opioids in At-Risk Drinkers Admitted to Urban Level-1 Trauma Centers. Journal of Trauma Acute Care Surgery 76(3):833–39, doi: 10.1097/TA.0000000000000100.

This secondary analysis examined nonmedical prescription opioid use (NMPOU) in two separate randomized trials that delivered brief alcohol interventions to patients in urban level-1 trauma centers. The first study collected data from 1,493 injured patients at a single trauma center, while the second collected data from 596 injured patients at two trauma centers. All participants were admitted for an alcohol related injury as indicated by a positive blood alcohol concentration and/or self-reported heavy drinking. In Study 1, NMPOU rose from 5.2 percent before admission to 9.8 percent at six months after discharge. In Study 2, NMPOU increased from 5.2 percent before admission to 6.8 percent at 12 months after discharge. Illicit drug use was a risk factor for beginning NMPOU.

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M. Gahr, R.W. Freudenmann, J. Eller, and C. Schönfeldt–Lecuona. 2014. Abuse Liability of Centrally Acting Nonopioid Analgesics and Muscle Relaxants—A Brief Update Based on a Comparison of Pharmacovigilance Data and Evidence From the Literature. International Journal of Neuropsychopharmacology :1–3.

Researchers compared data from the German BfArM pharmacovigilance database and the literature concerning abuse risk of nonopoiod analgesics and muscle relaxants approved in Germany. BfArM reported cases of abuse only for clonidine and paracetamol. The literature reports abuse of baclofen, clonidine, ketamine, metamizole, methocarbamol, orphenadrine, paracetamol, propyphenazone, and tizanidine. The low number of detected cases in the BfArM–database suggests underreporting.

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***J.A. Gwira Baumblatt, C. Wiedeman, J.R. Dunn, W. Schaffner, L.J. Paulozzi, and T.F. Jones. 2014. High-Risk Use by Patients Prescribed Opioids for Pain and Its Role in Overdose Deaths. JAMA Internal Medicine, doi:10.1001/jamainternmed.2013.12711

A matched case-control study identified risk factors associated with opioid-related overdose deaths from January 2009 through December 2010. Case patients were ascertained from death certificate data. Age- and sex-matched controls were randomly selected from live patients in Tennessee Controlled Substances Monitoring Program data. Increased risk of opioid-related overdose death was associated with 4 or more prescribers (adjusted odds ratio [aOR], 6.5; 95 percent CI, 5.1–8.5), 4 or more pharmacies (aOR, 6.0; 95 percent CI, 4.4–8.3), and daily dosages exceeding 100 morphine milligram equivalents (MMEs) (aOR, 11.2; 95 percent CI, 8.3–15.1). During 2007 through 2011, one third of Tennessee residents filled an opioid prescription each year. Annual opioid prescription rates increased from 108.3 to 142.5 per 100 population. Among patients in Tennessee prescribed opioids during 2011, 7.6 percent used more than four prescribers, 2.5 percent used more than four pharmacies, and 2.8 percent had a mean daily dosage exceeding 100 MMEs.

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***Jennifer Rochussen Havens, Carl G. Leukefeld, Angela M. DeVeaugh–Geiss, Paul Coplan, and Howard D. Chilcoat. 2014. The Impact of a Reformulation of Extended-Release Oxycodone Designed to Deter Abuse in a Sample of Prescription Opioid Abusers. Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2014.02.018

This study assessed the effects of reformulated extended-release oxycodone (ERO) on patterns of opioid abuse among a sample of individuals from rural Appalachia with a history of ERO abuse. Structured interviews assessed current and past opioid abuse of 189 individuals. The past 30-day prevalence and frequency of reformulated ERO abuse through any route (33 percent, 1.9 days/month), snorting (5 percent, 0.2 days/month), and injecting (0.5 percent, <0.1 days/month) were low and infrequent compared with that of instant-release oxycodone (any route: 96 percent, 19.5 days/month; snorting: 70 percent, 10.3 days/month; injecting: 51 percent, 10.5 days/month) and retrospectively reported abuse of original ERO (any route: 74 percent, 13.4 days/month; snorting: 39 percent, 6.0 days/month; injecting: 41 percent, 8.6 days/month). After the reformulation, prevalence of original ERO abuse significantly declined. Abuse of reformulated ERO was low. Heroin abuse was rare in this sample.

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***Anupam B. Jena, Dana Goldman, Leonard D. Schaeffer, Lesley Weaver, and Pinar Karaca–Mandic. 2014. Opioid Prescribing by Multiple Providers in Medicare: Retrospective Observational Study of Insurance Claims. BMJ 348:g1393, doi:10.1136/bmj.g1393.

Researchers analyzed prescription drug and medical claims in a 20 percent random sample of Medicare beneficiaries. Among 1,208,100 beneficiaries with an opioid prescription in 2010, 418,530 (34.6 percent) filled prescriptions from two providers, 171,420 (14.2 percent) from three providers, and 143,344 (11.9 percent) from four or more providers. Among beneficiaries with four or more opioid providers, 110,671 (77.2 percent) received concurrent opioid prescriptions from multiple providers. The dominant provider prescribed less than half of the mean total prescriptions per beneficiary (7.9/15.2 prescriptions). Multiple provider prescribing was highest among beneficiaries who were also prescribed stimulants, nonnarcotic analgesics, and central nervous system, neuromuscular, and antineoplastic drugs. Hospital admissions related to opioid use increased with multiple provider prescribing: the annual unadjusted rate of admission was 1.63 percent (95 percent CI 1.58 to 1.67 percent) for beneficiaries with one provider, 2.08 percent (2.03 percent to 2.14 percent) for two providers, 2.87 percent (2.77 percent to 2.97 percent) for three providers, and 4.83 percent (4.70 percent to 4.96 percent) for four or more providers.

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***M. Kan, J.A. Gall, A. Latypov, R. Gray, D. Alisheva, K. Rakhmatova, and A.S. Sadieva. 2014. Effective Use of Naloxone Among People Who Inject Drugs in Kyrgyzstan and Tajikistan Using Pharmacy- and Community-Based Distribution Approaches. International on Journal Drug Policy, doi:10.1016/j.drugpo.2014.01.005.

In 2011, Population Services International (PSI) launched two pilot naloxone distribution programs in Kyrgyzstan (pharmacy-based approach) and Tajikistan (community-based approach). People who inject opioids were trained on opioid overdose (OD) prevention and naloxone use. Upon returning for more ampoules, the patients completed a brief survey on their OD experience and naloxone use. The questionnaire was completed by 158 respondents in Kyrgyzstan and 59 in Tajikistan. Usage and wastage rates were calculated based on responses. A four-year model wastage rate that takes into account the shelf life of naloxone for both countries was then calculated. Researchers discovered that 51.3 percent of respondents in Kyrgyzstan and 91.5 percent in Tajikistan reported having ever experienced an OD; and 82.9 percent of respondents in Kyrgyzstan and all respondents in Tajikistan had witnessed an OD. Among those who experienced or witnessed OD, 81.5 percent in Kyrgyzstan and 59.3 percent in Tajikistan reported having been injected with naloxone, and 83.2 percent in Kyrgyzstan and 50.9 percent in Tajikistan reported injecting another individual with naloxone. Of ampoules received, 46.5 percent in Kyrgyzstan and 78.1 percent in Tajikistan were used. In both countries, 3.1 percent of these ampoules were wasted. The four-year model wastage rates for Kyrgyzstan and Tajikistan were 13.8 percent and 3.9 percent respectively.

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Zahra Karami, Alireza Pirkhaefi, Aminollah Kowsarnia, Omid Massah, and Ali Farhoodian. 2014. Comparison of Personality Traits Based on Temperament and Character Inventory (TCI) in Opiate and Stimulant Abusers. Journal of Rehabilitation, Addiction Special Issue.

This descriptive study analyzed a convenience sample of 91 opiate abusers and 24 stimulant abusers admitted to substance abuse treatment centers (MMT centers), addiction treatment camps and self-help groups and Narcotics Anonymous (NA) in Yasuj, Iran. The two abuser groups differed significantly in novelty seeking, harm avoidance, persistence, cooperativeness, self-directiveness, and self-transcendence, with the mean value for stimulant abusers always higher.

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Samantha J. Lookatch, Todd M. Moore, and Elizabeth C. Katz. 2014. Effects of Gender and Motivations on Perceptions of Nonmedical Use of Prescription Stimulants. Journal of American College Health, doi:10.1080/07448481.2014.891593.

College students (n=695) from two universities in different regions of the United States read a vignette describing a college student who used a prescription stimulant for a nonmedical purpose and rated their perception of that individual using a semantic differential. Use as a study aid was viewed less negatively than use to get high.

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***Louis F. Rossiter, Noam Y. Kirson, Amie Shei, Alan G. White, Howard G. Birnbaum, Rami Ben–Joseph, and Edward Michna. 2014. Medical Cost Savings Associated With an Extended-Release Opioid With Abuse-Deterrent Technology in the United States. Journal of Medical Economics, doi:10.3111/13696998.2014.897628)

This study analyzed health insurance claims to estimate how medical costs changed after introduction of extended-release oxycodone with abuse-deterrent technology in the United States. Reformulation was associated with reductions in rates of diagnosed opioid abuse of 22.7 percent (p<0.001) and 18.0 percent (p=0.034) among commercially insured and Medicaid patients, respectively. No significant change occurred among Medicare-eligible patients. Regressions with propensity score matching approach suggested that after reformulation, in 2011 U.S. dollars, excess annual medical costs per diagnosed opioid abuser were $9,456 (p<0.001), $10,046 (p<0.001), and $11,501 (p<0.001) for commercially insured, Medicare-eligible, and Medicaid patients, respectively. Overall, reformulated ER oxycodone was associated with annual medical cost savings of approximately $430 million in the United States.

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Grant E. Sara, Philip M. Burgess, Gin S. Malhi, Harvey A. Whiteford, and Wayne C. Hall. 2014. Cannabis and Stimulant Disorders and Readmission Two Years After First-Episode Psychosis. British Journal of Psychiatry, doi: 10.1192/bjp.bp.113.135145

Predictors of readmission were examined with Cox regression in 7,269 people ages 15–29 with a first psychosis admission. A stimulant disorder diagnosis before index psychosis admission predicted readmission, but a prior cannabis disorder diagnosis did not. Ongoing problem drug use predicted readmission.

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Edward M. Wojtys. 2014. Childhood Challenges. Sports Health 6(2):105–06, doi: 10.1177/1941738114524355.

Editor in Chief Edward M. Wojtys raises questions about the necessity to diagnose children with Attention Deficit Hyperactivity Disorder (ADHD) and to treat them with stimulant medications. He believes it teaches children to deal with social and behavioral challenges with a pill. Moreover, he is not surprised by the abuse potential of drugs such as Adderall and Ritalin. He cites survey results that show that one in eight children admitted taking stimulants (Ritalin or Adderall) not prescribed for them and 29 percent of parents believe that ADHD medications can improve their child's academic performance even if they do not have ADHD. Some colleges and universities will not perform diagnostic evaluations for ADHD in their attempt to limit access to these prescriptions. Dr. Wojtys believes the answer to this problem starts with education at home at an early age.

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J. Worley and S.P. Thomas. 2014. Women Who Doctor-Shop for Prescription Drugs. Western Journal of Nursing Research 36(4):456–74, doi: 10.1177/0193945913509692.

This study sought to describe why women doctor shop and the strategies they use . Four themes emerged in-depth interviews with 14 female doctor shoppers: a) feeding the addiction, b) networking with addicts, c) playing the system, and d) baiting the doctors.

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***Ohio Bill Would Force Hospices to Find, Dispose of Unused Painkillers
February 28, 2014

Ohio legislators passed House Bill 366 that would require hospice program to find and dispose of unused pain relievers. Also, it would require hospice programs that provide in-home care to establish written procedures and recordkeeping requirements to better track and eventually collect and dispose of unused medicine. Care providers also would have to report suspected diversion of prescription drugs to law enforcement. Patients or family members who refuse to relinquish unused drugs could face criminal charges; and hospice programs that fail to comply with the new rules could face license-suspensions and fines. The Bill now heads to the senate for further consideration.

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Funeral Directors Can Help Prevent Prescription Drug Abuse
Alcohol and Drug Prevention Team, Essex Prevention Coalition
March 5, 2014

This article discusses the importance of funeral directors providing information to clients on how to dispose of medications and lists what funeral directors can do.

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New Survey From Caron Treatment Centers Finds More Than 50 Percent of Women Sought Treatment for Prescription Drugs and Heroin
Digital Journal
March 6, 2014

The Caron Treatment Centers reveal in a new survey that heroin and prescription drug addiction are on the rise among affluent women. The online survey polled 102 former female addictions patients. Respondents cited alcohol and prescription drugs as the leading legal causes for seeking treatment. Seventy percent of respondents who abused prescription drugs were initially prescribed the medication legally for an emotional or physical ailment. In addition, 55 percent of the respondents who entered treatment for addiction to illegal drugs were abusing heroin. Women cited anxiety (65 percent), depression (67 percent), and a critical internal voice (69 percent) as significant factors that contributed to their addiction. Although a majority of the women polled were married with children, they were most likely to abuse alcohol or drugs when they were alone.

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Coordinated Approach Reduces Illicit Prescription Drug Use
March 3, 2014

This article discusses the findings from a study conducted on the British Protectorate Channel Island of Guernsey by psychiatrist Greg Lydall at the Health and Social Services Department. Of his substance abuse clients, 96 percent were using prescription medications as well as over-the-counter (OTC) medications, with a significant amount of buprenorphine abuse. The use of buprenorphine, diazepam, and benzodiazepines were very high. Fentanyl misuse also high. Investigators tracked the number of drug- and alcohol-related referrals to the Community Drug and Alcohol Team (CDAT) between 2003 and 2013 and audited unnatural deaths from 2002 to 2011. Drug-related referrals rose from 41 in 2003 to 103 by 2013. Up to half of referrals were for primary drug dependency with reported patterns of use following local availability. Dr. Lydall took a multidimensional approach involving the public health service, the pain service, lead family physicians, the prison service, specialists, the police, and the border agency to address the problem. The first step was to raise awareness of the issue in 2012. An initial audit of prescribing practice revealed relatively high levels of fentanyl and other potent opioid prescribing. A postintervention audit found that fentanyl prescribing rates went down by 18 percent over a one-year period, and morphine substitutes increased. Dr. Lydall cautioned that the postintervention data are still just for one year. He advises physicians to be conscious about making the best decisions in what they prescribe and retail pharmacists to be aware of patterns of OTC drug purchases.

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Opinion: Drug Addiction an Urgent Priority Among Mental Health Professionals
March 5, 2014

Albert Greenwood, a psychiatrist who specializes in drug addiction and alcoholism, shares his views about opioid addiction. He thinks it is unethical for a physician to prescribe substances that can alter brain tissue for superficial reasons. He is concerned about the increasing number of adolescents who come to him with a long history of prescription drug abuse. He has seen adolescents and adults with short-term memory deficits from using opioids for one year or more. He suggests using individualized treatment regimens combined with increased legal oversight of certain drug prescriptions, innovative intervention programs, and greater attention from the general public to help resolve this health crisis.

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Advocates for Human Potential and Carnevale Associates Announce the Drugged Driving Reporting System: A Private/Government Effort to Understand Drug Use and Driving
February 27, 2014

This press release discusses the development of the National Drugged Driving Reporting System, a minimum data set designed to assess the prevalence of drugged driving in the United States, by Advocates for Human Potential, Inc., and Carnevale Associates, LLC. They will begin by collecting data through an anonymous and confidential online survey instrument that will ask drivers to self-report on their use of drugs while driving. The two companies will work with the American Association of Motor Vehicle Administrators to select and work with up to five states interested in collecting anonymous data on drugged driving. Drivers in those five states will receive a sticker on their receipts while conducting regular business at the Department of Motor Vehicles. The sticker will direct them to the online survey; some stickers will allow drivers to receive a gift card after completing the survey. Once the project has collected data from 5,000 individuals, analysis will identify trends.

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Official: Philip Seymour Hoffman Died of Accidental Overdose
February 28, 2014

The New York City Chief Medical Examiner said actor Philip Seymour Hoffman died of an accidental overdose of drugs. The cause of death was acute drug intoxication, including heroin, cocaine, benzodiazepines, and amphetamine.

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Drug Misuse, Abuse: No Excuse
United States Air Force
February 28, 2014

This article discusses the difference between medication misuse and medication abuse. In addition, it explains why it is important to properly dispose of prescription medications.

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Experts: Officials Missed Signs of Prescription Drug Crackdown's Effect on Heroin Use
Washington Post
March 6, 2014

State and federal crackdowns on prescription drugs helped reduce the illegal use of some medications and raised awareness of their dangers. As a result, some addicts switched to heroin. Experts say the government's actions contributed to the problem it is now confronting and it should have responded sooner. John Walters, who ran the Office of National Drug Control Policy, said he does not recall "anyone raising" the prescription drugs–heroin link; the Post states that reports warning of the link were screened by people in his office. Gil Kerlikowske, who took over as President Obama's drug czar in 2009, said the connection between prescription drugs and heroin "was not on the radar screen" during most of President Obama's first term. Department of Justice (DOJ) officials reject any direct linkage between the crackdown on prescription drugs and rising heroin use; even though nearly every year between 2002 and 2011, the National Drug Intelligence Center, a unit of the DOJ, warned that the campaign against illegal use of prescription drugs was fueling heroin use. Joseph T. Rannazzisi, who runs the Drug Enforcement Administration's Office of Diversion Control, denied that the spike in arrests for prescription drug misuse has affected their cost and driven users to heroin. Since 2009, the DEA has widely circulated a slide called "circle of addiction" that shows the linkage between pain medications and heroin.

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Other State and Local News

Alaska State Troopers Release Annual Drug Report Montana Attorney General Announces $5.9 Million Pharmaceutical Settlement, Launches New Rx Drug Abuse Prevention Program
Montana Department of Justice
March 6, 2014

This press release announces that the Montana's Attorney General Office settled a lawsuit with a Janssen Pharmaceuticals over its illegal unfair and deceptive marketing of Risperdal. About one fourth of the settlement, $1.5 million, will be used for a Prescription Drug Abuse Prevention Program that builds on work initiated by the previous administration. A public education specialist will be hired to create and implement a student education program, expand prescription drug drop box locations across the state, and create a public awareness campaign on the dangers of prescription drug addiction.

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ABC 6 Investigates: Nurse Prescription Thefts
March 5, 2014

This article and video (3minutes, 7 seconds) discuss Minnesota nurses stealing prescription drugs from their employers and patients. In 2009–13, the Minnesota Board of Nursing disciplined 24 nurses for drug diversion in the four-county southeast Minnesota area, making diversion the second most common reason local nurses were disciplined. Only one license was permanently revoked. If a nurse is suspected of stealing drugs from the hospital, the Minnesota Nursing Board will get a complaint usually from a family member, patient or employer. The allegation is investigated; the board reviews the case and decides if discipline is needed. Many times the nurse is referred to the Health Professional Services Program which monitors those with health issues. Senator Carla Nelson says there is a problem with the reporting process. Employers do not have to report drug theft to the nursing board. Under her proposed law that would change.

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Revamp of Colorado's Pain Pill Monitoring Systems Moves Ahead
FOX 31
March 6, 2014

This article and video (2 minutes, 5 seconds) discuss House Bill 1283 which aims to modernize Colorado's Prescription Drug Monitoring Program. It also aims to broaden doctor and pharmacist access. The revised system would alert practitioners when behaviors by patients seeking prescription drugs trigger red flags. The legislation is part of a larger effort to curb prescription drug abuse that focuses on awareness, education, and treatment.

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Georgia Weighs 'Medical Amnesty' in Drug Overdoses
Gainesville (Ga.) Times
March 3, 2014

Georgia's House Bill 965, also known as the Georgia 911 Medical Amnesty Law, passed the House and now awaits consideration in the Senate. Under the bill, a person can seek medical assistance for someone else or receive assistance without fear of prosecution on possession charges in cases when small amounts of drugs are involved. Current Medical Amnesty legislation did not give immunity to enough types of drug violations, including prescription opioids.

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Partying With Adderall—Experts: Combining Drug With Alcohol Is Common
Jamestown Sun
March 3, 2014

This article interviews college students at the University of North Dakota (UND) about mixing alcohol with Adderall. Health officials worry the practice endangers student health. Dr. Christopher Boe, an emergency room physician, said he has seen misusers with psychotic features that combine anxiety, headaches, and decreased motor skills. Student health officials restrict Adderall prescriptions for students with ADHD. Prescriptions cover only a month's supply and refills must be spaced by at least 25 days. Staff members check a pharmaceutical notification registry to see if a student visited another clinic to get another prescription.

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New Program to Take Aim at Prescription Drug Abusers
New Hampshire Union Leader
March 1, 2014

The New Hampshire prescription monitoring program is expected to be up and running July 1. The Legislature approved the program in 2012, but it was not funded with state money. The Board of Pharmacy, which oversees the program, received a grant from the U.S. Department of Justice to establish a program director's position and extend a parttime administrator's position to run the monitoring program.

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Ballot Initiative Addresses Study Finding Doctors Are Single Largest Supplier of Prescription Drugs to Chronic Abusers, Says Consumer Watchdog Campaign
March 7, 2014

This press release discusses a California ballot initiative that addresses a study that finds doctors are the biggest suppliers for chronic prescription drug abusers. The Troy and Alana Patient Safety Act requires that doctors check the state's electronic CURES prescription drug database before prescribing narcotics. A CDC study released this week (Jones et al., featured above) confirms that physician overprescribing is the principle source of drugs for chronic abusers. The Pack Safety Act deals with this problem.

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2014 Overdose Death Toll in Rhode Island Reaches 56
Providence Journal
March 3, 2014

The Rhode Island Department of Health reported that the number of overdose deaths has risen to 56 for 2014. Some cases were recently reclassified as overdose deaths. Of the 56 deaths, 19 have been confirmed with laboratory tests. The rest are considered "likely" overdoses based on evidence at the scene and early screening tests. Only one of 19 involved prescription drugs alone. The rest involved illicit drugs and 15 of the dead had fentanyl (editor's note: often not of pharmaceutical origin) in their systems. The 19 confirmed deaths occurred in 12 cities and towns.

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Bill: Allow Wide Use of Emergency Drug for Overdose Victims
Salt Lake Tribune
March 3, 2014

Utah passed House Bill 19 that would allow Naloxone to be prescribed to a third party who is in a position to administer the drug to overdose victims. The bill comes as a companion to HB11 which grants immunity to family, friends, and bystanders for reporting drug overdoses. HB11 passed both houses earlier in the session and is on the way to the governor for signature.

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Florida Office of the Attorney General: Statewide Task Force on Prescription Drug Abuse and Newborns: 2014 Progress Report. Accessed March 6, 2014.

This report outlined the problem of Neonatal Abstinence Syndrome (NAS), examined the costs to Florida from NAS, and identified strategies to reduce the problem of prescription drug addiction among pregnant women. It provided a brief status update on the task force's 15 policy recommendations.

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Popping Pills to Make the Grade: Illegal Adderall Use Surfaces as 'Study Drug' at University of South Dakota
March 5, 2014

This article discusses Adderall abuse among students at the University of South Dakota. Lauren Schuur, a coordinator of prevention services for the Student Counseling Center, said 15 percent to 20 percent of clients the Center sees have been caught either distributing or misusing prescription drugs. A videoclip (3 minutes, 5 seconds) from Today Show is included with this article. The reporter interviews a former Columbia student who was arrested for distributing and abusing Adderall.

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North Carolina Leads South With Drug Overdose Reform
Huffington Post
March 5, 2014

This article discusses drug reform in Wilkes County, N.C., by Project Lazarus. In three years, it cut overdose deaths nearly in half from 2009, according to North Carolina Department of Health and Human Services data. Fred Wells Brason, the founder of Project Lazarus, now advocate for the use of naloxone. The organization combines naloxone availability, public and physician awareness, and other local efforts aimed at helping prevent opioid overdoses. Brason is now expanding Project Lazarus statewide with grants from the Kate B. Reynolds Charitable Trust and the state Office of Rural Health and Community Care.

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Health Survey: Ohio Teens Abuse Some Drugs Less, Text More
March 6, 2014

The Ohio Department of Health's 2013 Ohio Youth Risk Behavior Survey reveals that fewer teens are abusing prescription pain relievers and using heroin. Close to 13 percent of students reported using prescription pain relievers at least once last year, down from about 21 percent in 2012. Teens reporting they used heroin decreased from 3.1 percent to 2 percent.

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Other Resources

Combined Distributors Inc. Announces Launch of New Pill Disposal Product: Pill Terminator
Digital Journal
February 28, 2014

This press release announces the launch of the Pill Terminator by Combined Distributors Incorporated. It is a drug disposal jar that can eliminate up to 300 medium sized pills. Individuals or institutions can pour the unwanted medications into the container; add warm water, shake, and then throw it into the trash.

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Smiths Detection Launches New Portable Identification Technology Targeting Illicit Drugs
Wall Street Journal
March 3, 2014

This press release discusses Smiths Detection's Target–ID(TM), a handheld identifier, developed for narcotics identification in 10 language configurations including Spanish, Portuguese, and Chinese. It provides a quick and accurate field analysis of a wide range of illicit drugs and controlled substances such as opioids, amphetamines, prescription medications, and synthetic cathinones and cannabinoids. Target–ID also allows users to define their own library matches to help identify trafficking rings and localized varieties of narcotics.

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Prescription Drugs
Maryland Department of Health and Mental Hygiene, Center for Injury and Sexual Assault Prevention
Thursday, March 27, 2014
3:00 p.m. to 4:00 p.m. (EST)

Girls and Substance Use: Trends, Challenges, and Opportunities
Tuesday, April 22, 2014
3:00 p.m. to 4:30 p.m.


Colorado Among the Worst States for Prescription Drug Abuse
Colorado Public Radio
March 4, 2014

Dr. Jason Hoppe, an emergency room physician at the University of Colorado Hospital, spoke with host Ryan Warner about improving the state's prescription drug monitoring database. (Duration: 15 minutes, 7 seconds.)


Grant Announcements

Research to Prevent Prescription Drug Overdoses and Research on Integration of Injury Prevention in Health Systems
Centers for Disease Control and Prevention, Department of Health and Human Services
Proposal Deadlines: 5:00 p.m. (EST), March 19, 2014
http://www.grants.gov/search-grants.html?agencies percent3DHHS percent7CDepartment percent20of percent20Health percent20and percent20Human percent20Services

2014 Drug-Free Communities Support Program Grants
White House Office of National Drug Control Policy and Substance Abuse and Mental Health Services Administration
Deadline: March 24, 2014

Take-Back Events and Drop Boxes

Prescription Drug Drop Box Installed in Mays Landing
Galloway (N.J.) Patch
March 6, 2014

Prescription Drug Drop-Off Box Available In San Rafael
Marin (Calif.) Independent Journal
March 4, 2014

Hackettstown Police Department to Conduct Drug Disposal Day April 26
March 5, 2014

Drug Take Back Day Aims to Keep Topeka Safe
WIBW (Kansas)
March 2, 2014

Save the Dates

National Take-Back Initiative
Drug Enforcement Administration
10:00 a.m. to 2:00 p.m.
April 26, 2014

Twenty-Seventh Annual NPN Prevention Research Conference
National Prevention Network
September 15–18, 2014

Sixth Annual American Medicine Chest Challenge National Day of Awareness and Safe Disposal of Rx and Over-the-Counter Medicine
American Medicine Chest Challenge
November 8, 2014

Upcoming Conferences and Workshops

Pharmacy Diversion Awareness Conference
U.S. Department of Justice, Drug Enforcement Administration
April 5–6, 2014—Hilton St. Louis (Mo.) at the Ballpark
June 28–29, 2014—Renaissance Phoenix (Ariz.) Downtown
July 12–13, 2014—Sheraton Philadelphia (Pa.) Downtown Hotel
August 2–3, 2014—Denver (Colo.) Marriott Tech Center

The Drug Enforcement Administration is offering two regional one-day Pharmacy Diversion Awareness Conferences. Each one-day conference is open to pharmacy personnel who are employed by pharmacies or hospitals/clinics that are registered with DEA. The conference is designed to assist pharmacy personnel in identifying and responding to potential diversion activity.

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Eleventh Annual World Health Care Congress
April 7–9, 2014
National Harbor, Maryland

National Rx Drug Abuse Summit
April 22–24, 2014
Atlanta, Georgia

2014 Harold Rogers Prescription Drug Monitoring Program National Meeting
Brandeis University, Prescription Drug Monitoring Program Training and Technical Assistance Center
September 23–25, 2014
Marriot Metro Center
Washington, D.C.
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.