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March 13, 2013

SAMHSA Prevention of Prescription Drug Abuse in the Workplace Listserv

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March 13, 2013 (PDF version)

Featured Article
California: Researchers Make Pitch for Payer Access to Monitoring Program
Risk & Insurance
March 4, 2013

The California Workers' Compensation Institute analyzed workers' compensation pharmacy data for accident year 2011 to estimate the volume of workers' compensation claims in which opioids are prescribed, the level of opioid use for these claims, and the estimated savings that could be generated by integrating third-party payer access to the Controlled Substance Utilization Review and Evaluation System (CURES) database. They determined no cost savings would be generated for claims with only one opioid prescription. Allowing third-party payer access to the CURES database would result in a 3 percent reduction in total benefits paid on claims with two to three opioid prescriptions; a 5 percent reduction in payments on claims with four to seven opioid prescriptions; and a 7 percent reduction in payments on claims with more than seven opioid prescriptions--the total estimated cost savings is $57.2 million. Stakeholders think access to the CURES database would improve quality of care, use and cost controls, and employer and payer efforts to more effectively address prescription drug fraud and abuse.

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Journal Articles

D.P. Alford. 2013. "Chronic Back Pain With Possible Prescription Opioid Misuse." The Journal of the American Medical Association 309(9):919-25. doi:10.1001/jama.2013.522.
To better understand safe opioid prescribing practices, researchers systematically reviewed studies on the effectiveness and safety of long-term opioid therapy for chronic noncancer pain, determining that informed consent and patient-prescriber agreements help patients understand treatment goals and potential opioid risks. Monitoring for benefits and opioid misuse is accomplished with frequent face-to-face assessments, performing urine drug tests, monitoring pill counts, and reviewing available prescription drug monitoring program data.

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I. Gustavsen. 2013. "Zopiclone and Traffic Safety: Introducing Legalized Blood Zopiclone Concentration Limits--Is it Evidence Based?" Norway: University of Oslo.

A case-crossover analysis of linked Norwegian Accident Registry and prescription data suggests the risk of crash rises when people take Imovane (zopiclone), a sleep medication.

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S.P. Monteiro, R. Huiskes, L. van Dijk, J.C.M. Van Weert, and J.J. de Gier. 2013. "How Effective Are Pictograms in Communicating Risk About Driving-Impairing Medicines?" Traffic Injury Prevention 14(3):299-308. doi:10.1080/15389588.2012.710766.
Researchers evaluated and compared the effectiveness of two pictograms (a rating model versus a triangle model) in communicating risk in terms of respondents' level of understanding, estimated level of driving risk, and intention to change driving behavior. They conducted two experiments among 270 drivers visiting a pharmacy. The first experiment exposed respondents to a condition in which the pictogram and risk category (one of three) were manipulated. Both pictograms were accompanied by the same side text. In the second study, the added value of the side text was examined. Here, respondents were exposed to the rating model pictogram with or without side text and one of the three risk categories. Although most respondents understood pictograms were related to driving behavior, less than 10 percent fully understood the triangle model and only 36 percent fully understood the rating model. Nevertheless, 78.8 percent of respondents said they would be likely to change their driving behavior if confronted with the pictogram. Side text had no effect.

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D.N. Juurlink, A.D. Irfan, and L.S. Nelson. 2013. "Improving Opioid Prescribing: The New York City Recommendations." The Journal of the American Medical Association 309(9):879-80. doi:10.1001/jama.2013.1139.
According to the author of this article, guidelines for prescribing opioid analgesics to patients discharged from New York City's emergency departments are necessary and important. The guidelines, developed by a panel of emergency physicians, aim to reduce opioid addiction and overdose deaths while preserving access to opioids for patients who need them.

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F. Zanjani, A.I. Hoogland, and B.G. Downer. 2013. "Alcohol and Prescription Drug Safety in Older Adults." Drug, Healthcare and Patient Safety 2013(5):13-27. 
Researchers investigated older adults' knowledge of prescription drug safety and interactions with alcohol, as well as pharmacists' willingness to disseminate prescription drug safety information to this population. A convenience sample of 48 adults ages 54-89 was recruited from a local pharmacy. They completed surveys addressing their alcohol consumption, understanding of alcohol and prescription drug interactions, and willingness to change alcohol consumption and prescription drug habits. Ninety pharmacists answered questions about their willingness to convey prescription drug safety information to older adults, who reported low knowledge of alcohol and prescription drug safety, with women having slightly more knowledge. Those who drank in the previous few months were less willing to talk to family and friends about how alcohol can have harmful interactions with prescription drugs, or to be an advocate for safe alcohol and prescription drug use than those who had recently consumed alcohol. Pharmacists were willing to convey prescription drug safety information to older adults in a variety of formats, including displaying a sign, distributing flyers, and administering a brief intervention.

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News and Reports

An Often Overshadowed Battle for Veterans
The Hill
March 8, 2013

Prescription drug abuse is rising among veterans. This blog post from the executive director of the Veterans Health Council for Vietnam Veterans of America states his support for proactive measures to educate veterans and encourage responsible prescribing by medical professionals. He opposes limiting access to quality medication.

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Lawmakers Consider New Law to Address Spike in Overdose Deaths
March 2, 2013

House Bill 317 would establish the Pennsylvania Accountability Monitoring System--a narcotics database that alerts doctors and pharmacies when patients who have already received an adequate supply of opioids try to obtain another prescription.

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The Painful Truth About Prescriptions
March 3, 2013

In 2010, 16,651 people overdosed on opioid pain reducers--drugs that cause more fatalities than heroin and cocaine combined. For every death, there are 35 emergency room visits and 161 other reports of abuse or dependence. More than 70 percent of abusers get their prescription drugs from family or friends. The government is tightening rules for prescribing pain reducers such as hydrocodone. States also are using prescription drug monitoring programs to combat abuse and diversion.

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Former Dot-Com Millionaire Guilty of Selling Drugs
The New York Times
March 1, 2013

A dot-com millionaire who became addicted to prescription pain reducers pleaded guilty to selling prescription medications and conspiring to sell a firearm. She was sentenced to 4 years in prison.

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Mother Says Mix of Cocaine, Dilaudid Killed Son
CBC News
March 2, 2013

A mother lost her 21-year-old son after he combined cocaine with Dilaudid, a prescription opiate in the same narcotics class as heroin. The mother is angry she didn't know more about the drug, which her son obtained from his aunt.

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The Competition Drug
The New York Times
March 4, 2013

An op-ed columnist discusses Adderall abuse at a Boston college. The columnist attended a school lecture with his son about the dangers of binge drinking; however, the lecture never mentioned Adderall. He reports how easy it is to get Adderall from a doctor or other students. In addition, he shares a story about a 24-year-old student who abused Adderall throughout college and combined it with the sleep aid Ativan.

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Narcotic Painkiller Prescriptions Leveled Off in 2012, New Figures Show
Journal Sentinel
March 6, 2013

A new study by IMS Health, a drug market research firm, shows opioid prescriptions flattened to 241 million in 2012, down slightly from 243 million in 2011. The Centers for Disease Control and Prevention warns readers to view the data with caution because it does not look at the number of pills in each prescription. Other research indicates a fourfold increase in opioid sales since 1999.

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Opana, Alcohol and Adderall: More Reasons Why Prescription Meds and Booze Make a Fatal Cocktail
The Daily Nexus
March 4, 2013

A physician answers readers' questions about drinking alcohol while taking Opana, Adderall, and other prescription medications. He discusses the dangers and side effects of each.

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Physician Liability: When an Overdose Brings a Lawsuit
American Medical News
March 4, 2013

Physicians can identify potential prescription drug abusers by asking questions and verifying medical history. According to this article, doctors can reduce legal risks of prescribing opioids and other drugs by monitoring and documenting use.

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Aetna Study Shows Decrease in Prescription Drug Misuse, Waste and Abuse Through Increased Monitoring
The Herald
March 8, 2013

A recent study of Aetna's Pharmacy Management Programs, which are designed to address prescription drug misuse, waste, and abuse, showed opioid use among 4.3 million members declined 15 percent between January 2010 and 2012. The program works in four phases to ensure member safety and offer support to those who need it:

  1. Control - Access to prescription drugs with high potential for abuse is controlled at the pharmacy by
    • Placing a limit on how much of a drug is covered at a given time 
    • Verifying medical need before coverage of a drug is approved
    • Advising the pharmacist if a drug's dosage amount appears unsafe
  2. Find - Each member's prescription drug history is reviewed before a new prescription is filled. This review allows patterns of frequent use or suspicious dispensing to be identified.
  3. Help - Extra support is offered to members who may be using a prescription drug unsafely. This includes
    • Referral to a pain specialist.
    • Encouragement to enroll in a pain management program
    • Referral to Aetna Behavioral Health for emotional support
    • Referral to Aetna Case Management for additional support 
  4. Limit - Members who don't respond to support when it's offered may have limited access to their prescription drug benefits, such as
    • Becoming restricted to only one health care provider
    • Having reduced refill frequency and coverage
    • Getting referred to appropriate state and federal agencies

Read more:
http://www.heraldonline.com/2013/03/08/4678253/aetna-study-shows-decrease-in.html or www.aetnapharmacy.com

Never Too Late to Quit: Elderly Prescription Drug Abuse
Health Club
February 24, 2013

This article claims that 17 percent of Americans age 65 and older are addicted to prescription drugs or alcohol. Certain natural factors, notably chronic pain, make older adults prone to addictive behavior. Nearly 30 percent of seniors take at least five medications regularly. The article highlights warning signs of addiction.

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Prescription Drug Abuse Prevention in Grandparents' Hands
Delmar-Carmel Valley Patch
March 1, 2013

The North Coastal Prevention Youth Coalition, the Vista Sheriff's Department, and the Vista Community Clinic presented
"The Power of Grandparents: How Seniors Can Play an Important Role Preventing Prescription Drug Abuse" to 70 seniors at a senior center. Youths discussed the dangers of prescription drug abuse and how to properly dispose of their old or unused medications. Seniors were encouraged to bring their pills to the event to properly dispose of them in a drop box provided by the sheriff's department and were informed about the permanent drop box.
Read more:

DWI's Caused by Prescription Drugs Are on the Rise
March 6, 2013

This article and video (2:10 minutes) focus on increased arrests in Central Texas for driving while impaired by prescription drugs.

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Painkiller-Abuse Proposal Divides Healthcare Community, Even in Same Hospitals
The Plain Dealer
March 3, 2013

This article discusses medical professionals' opposing views regarding a pain reducer-abuse proposal. Doctors at the Cleveland Clinic and University Hospitals want the U.S. Food and Drug Administration to toughen rules for prescribing powerful pain reducers. Medical professionals at the hospitals claim it could lead to patients lying to their physicians about pain, just to meet higher thresholds. It could also lead to increased illegal street sales or even suicide, if untreated pain becomes unbearable.

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Camp Kids Given Prescription Drugs
WOWT Channel 6
March 6, 2013

While at an overnight church function, a 59-year-old Nebraska man gave five teenage boys Ambien, a prescribed sleep aid. The sheriff was called after others observed the boys acting peculiar, but the kids did not suffer any health or physical problems. The man pleaded no contest to child abuse.

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Designer Drugs on the Rise, Serious Health Risk, UN Reports
Medical Xpress
March 5, 2013

A United Nations-affiliated report calls for international efforts to stem the spread of designer drugs. It also raised concerns about the rise in prescription drug abuse, including pain reducers, sedatives, and drugs used to treat epilepsy, attention deficit-hyperactivity disorder, and mental illness. It condemned easy drug availability and poor prescription policies in North America.

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Drug Disposal Program Marks 2-Year Milestone
The Enid News and Eagle
March 1, 2013

The Oklahoma Bureau of Narcotics and Dangerous Drugs celebrated its 2-year anniversary as the nation's first statewide and year-round drug disposal program. A total of 126 take-back boxes have been installed in 77 counties statewide and nearly 30,000 pounds of drugs have been collected.

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Prescription Drug Abuse: An Addict's Journey to Recovery
February 18, 2013

In this article and video (4:11 minutes), a reporter interviews three recovering prescription drug addicts from Maine. The state saw 56 pharmacy robberies in 2012, compared with 24 in 2011.

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Measure Would Create Liability for Addictive Drugs
Houston Chronicle
March 6, 2013

Nevada SB75 would allow a patient addicted to prescription drugs to sue the doctor who prescribed the medication as well as the drug's maker. If the judge rules in favor of the patient, defendants would have to pay for his or her rehabilitation, along with possible punitive damages and attorney fees.

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Prescription Drug Abuse Prevention Project Launched on Social Media
WorldNow and WVNS
March 4, 2013

A West Virginia senator launched a new, interactive social media project that asks residents to post ideas on Facebook and Twitter (using #StopRxDrugAbuseWV) for preventing prescription drug abuse.

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Other Resources
C.A.R.E.S. Alliance Drug Take-Back Day Toolkit
C.A.R.E.S. Alliance
Accessed February 28, 2013

This comprehensive toolkit helps communities plan and organize drug take-back days. It includes roles and responsibilities for event organizers, how to partner with law enforcement, working with a pharmacy to host the event, engaging the community, developing promotional materials/signage, conducting media outreach, and day-of-event tips.

Read more:
National Rx Drug Abuse Summit, April 2-4, 2013, Orlando, Florida, http://nationalrxdrugabusesummit.org; see March 6 issue for more information.
Maryland Workers' Compensation Prescription Drug Abuse Summit, April 12, 2013, Linthicum, Maryland, http://marylandassociationofcounties.files.wordpress.com/2013/02/marylands-prescription-drug-abuse-summit-april-12th-invitation-flyer-pdf-2.pdf; see March 6 issue for more information.
2013 Symposium for Medical Professionals: Kentucky Medical Communities UNITEd
April 13-June 8, 2013
Various Cities, Kentucky

This symposium will educate medical providers about prescription drug abuse and increase awareness of the growing epidemic in the medical community--aiming to minimize or eliminate over-prescribing of medications, especially opiates. Participants are eligible for continuing education credit. Attendance is free, but registration is required.

Read more:
Drug Enforcement Administration's Sixth National Prescription Drug Take-Back Day, April 27, 2013, Various Locations Nationwide, http://www.deadiversion.usdoj.gov/drug_disposal/takeback; see March 6 issue for more information.

National Prevention Week 2013
May 12-18, 2013
Various Locations Nationwide

Supported by SAMHSA, National Prevention Week is dedicated to increasing public awareness of substance abuse and mental health issues and building support for wellness and prevention practices. It is an opportunity to join with people, organizations, and coalitions in your community to promote prevention efforts, educate others about behavioral health issues, and create and strengthen community partnerships. 
Read more:
Generation Rx University Conference for Prescription Drug Abuse Prevention and Recovery, August 7-8, 2013, Columbus, Ohio, http://pharmacy.osu.edu/outreach/rxabuseconference; see March 6 issue for more information.

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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