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March 17, 2016

PAW Weekly Update

    

                                          
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SAMHSA
           
SAMHSA Prescription Drug Abuse Weekly Update
         
         
WEEKLY
           
UPDATE
         
                             
          Issue 165  |  March 17, 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.                      
               
                                                                                                                 
                                                                                                                                                                     
Index                            
Featured                            
Journal Articles and Reports                            
Professional Development                            
National                            
Marijuana                            
International                            
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Featured

Presurgical Opioids Heighten Addiction Risk, Complications                        
Ingrid Hein, Medscape                        
March 4, 2016                        

Patients who take narcotics preoperatively for total knee arthroplasty could be at risk for being on opiates much longer and experience complications, reported Robert Westermann, M.D., at the recent American Academy of Orthopaedic Surgeons’ annual meeting. Dr. Westermann identified 112,569 patients who underwent total knee arthroplasty from 2007 to 2014 in insurance provider Humana’s administrative claims dataset. Of them, 44 percent had no history of opioid use, although 31 percent filled at least one opioid prescription in the 3 months before surgery and 25 percent more than 3 months before surgery. More presurgery opioid users than nonusers had filled an opioid prescription at 1-month follow-up (83 percent versus 52 percent) and at 12-month follow-up (24 percent versus 3 percent). Patients who filled an opioid prescription in the 3 months before surgery were more likely than nonusers to have medical comorbidities like diabetes, kidney disease, or coronary artery disease. Complication rates within 90 days were higher in presurgery opioid users than in nonusers.                         

Read more:                        
http://www.medscape.com/viewarticle/859871#vp_1                                                  

Senate Passes Bill to Combat Opioid Abuse                        
Dan Freedman, CTPost.com                        
March 10, 2016                         

The U.S. Senate has passed the Comprehensive Addiction and Recovery Act (CARA), which would create a grant program for states, local governments, and nonprofits to conduct culturally sensitive seminars to educate consumers about the dangers of taking too many prescription pain relievers. It would expand treatment and prevention programs aimed at preventing addiction to prescription pain relievers, giving priority to “communities with high incidence of addiction and addiction-related deaths.’’ It also authorizes Medicare Part D plans to require at-risk beneficiaries to use a single prescriber and pharmacy for frequently abused drugs. Finally, CARA would preempt states by giving physician assistants and nurse practitioners access to prescription drug monitoring program databases.                        

Read more:                        
http://www.ctpost.com/local/article/Senate-passes-bill-to-combat-opioid-abuse-6883251.php                         
http://www.pharmacist.com/senate-approves-medicare-lock-amendment-opioid-abuse                       
               
               

Journal Articles and Reports

L.C. Balmert, J.M. Buchanich, J.L. Pringle, K.E. Williams, D.S. Burke, and G.M. Marsh. 2016. “Patterns and Trends in Accidental Poisoning Deaths: Pennsylvania’s Experience 1979–2014.” PLoS ONE, doi:10.1371/journal.pone.0151655.                

Rate ratios for accidental poisoning mortality per 100,000 people in Pennsylvania increased from 2.04 in 1979 to 29.16 in 2014. The largest rate ratios were among people ages 35–44, women, and white adults. The highest accidental poisoning mortality rates were found in the counties of southwestern Pennsylvania, those surrounding Philadelphia, and those in northeast Pennsylvania near Scranton.                

Read more:                
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0151655                                  

C.M. Dewey, M.V. Ghulyan, and W.H. Swiggart. 2015. “Misprescribing Controlled Substances: An Evaluation of a Professional Development Program.” Substance Abuse, doi:10.1080/08897077.2015.1096318.                

The 174 participants in a 3-day Vanderbilt University professional development program on opioid prescribing between March 2011 and March 2013 were typically middle age (average age = 53), male (89 percent), physicians (82 percent), and other healthcare providers (18 percent) in primary care solo practices. In course evaluations completed by 89 percent, knowledge scores on pre/post assessments increased significantly from 58.7 to 78.3. Almost half of the participants (48 percent) completed a follow-up survey one to three months after course completion, with 93 percent of respondents reporting they made professional practice changes. Respondents with opioid prescribing privileges implemented changes to align practices with current guidelines (89 percent), used controlled prescription drugs more appropriately (87 percent), implemented office policies on prescribing (81 percent), identified and referred more substance abuse patients to treatment (80 percent), shared new information/experience from the course with other health professionals (93 percent), and felt the course positively impacted their behaviors personally and professionally (90 percent and 96 percent, respectively).                

Read more:                
http://www.tandfonline.com/doi/full/10.1080/08897077.2015.1096318                                  

E.S. Hall, B.T. Isemann, S.L. Wexelblatt, J. Meinzen-Derr, J.R. Wiles, S. Harvey, and H.T. Akinbi. 2016. “A Cohort Comparison of Buprenorphine Versus Methadone Treatment for Neonatal Abstinence Syndrome.” Journal of Pediatrics 170:39–44.e1, doi:10.1016/j.jpeds.2015.11.039.                

Thirty-eight infants with neonatal abstinence syndrome were treated with buprenorphine and 163 were treated with methadone at six hospitals in southwest Ohio from January 2012 through August 2014. Buprenorphine therapy was associated with a shorter course of opioid treatment (9.4 versus 14.0 days) and decreased hospital stay (16.3 versus 20.7 days).                 

Read more:                
http://www.jpeds.com/article/S0022-3476(15)01451-1/abstract                                  

N.A. Haug, J. Bielenberg, S.H. Linder, and A. Lembke. 2016. “Assessment of Provider Attitudes Toward #Naloxone on Twitter.” Substance Abuse, doi:10.1080/08897077.2015.1129390.                

For this study, researchers examined public comments about naloxone on Twitter made during three consecutive months to examine health professionals’ attitudes, with 368 individuals posting 467 tweets. Health professionals included first responders, such as emergency medical technicians (EMT), firefighters, and paramedics (n = 122); law enforcement officers (n = 70); nurses (n = 62); physicians (n = 48); other health professionals including pharmacists, pharmacy technicians, counselors, social workers (n = 31); naloxone-trained individuals (n = 12); and students (n = 23). Primary themes included burnout, education and training, information-seeking, news updates, optimism, policy and economics, stigma, and treatment. The highest levels of burnout, fatigue, and stigma regarding naloxone and opioid overdose were among nurses, EMTs, other healthcare providers and physicians. In contrast, individuals who self-identified as “naloxone-trained” had the highest optimism and the lowest amount of burnout and stigma.                

Read more:                
http://www.tandfonline.com/doi/full/10.1080/08897077.2015.1129390                                  

S.C. Jacobs, E.K. Son, C. Tat, P. Chiao, M. Dulay, and A. Ludwig. 2015. “Implementing an Opioid Risk Assessment Telephone Clinic: Outcomes from a Pharmacist-Led Initiative in a Large Veterans Health Administration Primary Care Clinic, December 15, 2014 – March 31, 2015.” Substance Abuse, doi:10.1080/08897077.2015.1129527.                

The San Francisco Veterans Affairs (VA) Health Care System’s primary care clinic pilot-tested with 148 patients the integration of a telephone-based risk assessment by a clinical pain pharmacist into its chronic opioid therapy prescription renewal process. All patients had chronic nonmalignant pain and had received prescription opioid medications for at least 90 of the last 120 days. Pharmacists conducted risk assessment evaluations, which included checks in California’s prescription drug monitoring program (PDMP), urine drug test results, and for aberrant behaviors. Twenty-five (17 percent) patients had non-VA controlled substance prescriptions, of which 14 (56 percent) patients filled a non-VA controlled substance prescription within 3 months of the start of the pilot. Seventeen urine drug test results inconsistent with their prescribed regimens were identified from 12 patients (8 percent). Pharmacists recommended 66 changes to chronic opioid prescriptions in 48 patients (32 percent), including decreasing quantity of opioid(s) (33 percent), discontinuing chronic opioid therapy (23 percent), and delaying a fill (20 percent). Providers implemented 61 of the regimen changes, with chronic opioid therapy was discontinued in all 14 patients where it was recommended.                

Read more:                
http://www.tandfonline.com/doi/full/10.1080/08897077.2015.1129527                                  

M. Komaromy, D. Duhigg, A. Metcalf, C. Carlson, S. Kalishman, L. Hayes, T. Burke, K. Thornton, and S. Arora. 2016. “Project ECHO: A New Model for Educating Primary Care Providers About Treatment of Substance Use Disorders.” Substance Abuse, doi:10.1080/08897077.2015.1129388.                

Project ECHO is a distance education model that connects specialists with numerous primary care providers via simultaneous video link to facilitate case-based learning. An ECHO clinic based at the University of New Mexico’s health sciences center focuses on treatment of substance use and behavioral health disorders. Since 2005, they have offered a weekly 2-hour integrated addictions and psychiatry clinic, also used to recruit physicians to participate in buprenorphine waiver trainings. Since 2008, approximately 950 patient cases have been presented during ECHO clinic sessions, with more than 9000 hours of continuing education credits awarded. The focus of those cases most often was on opioids (31 percent), followed by alcohol (21 percent), and cannabis (12 percent). New Mexico is among those states with the most buprenorphine waivered physicians per capita. Perhaps coincidentally, it has had much more rapid growth in waivered physicians practicing in traditionally underserved areas since initiation of the ECHO clinic.                

Read more:                
http://www.tandfonline.com/doi/full/10.1080/08897077.2015.1129388                                  

J.L. McCauley, R.S. Leite, C.L. Melvin, R.B. Fillingim, and K.T. Brady. 2016. “Dental Opioid Prescribing Practices and Risk Mitigation Strategy Implementation: Identification of Potential Targets for Provider-Level Intervention.” Substance Abuse, doi:10.1080/08897077.2015.1127870.                

In South Carolina, only 87 dentists responded to a survey advertised statewide via listserv e-mail to the members of the statewide dental association (1,638 e-mails sent, 632 viewed, 164 linked to survey) and via e-mail to the membership of the state’s dental college alumni association (728 e-mails sent). Most respondents (66, 76 percent) prescribed opioids and 44 percent said they regularly screened for prescription drug misuse, although subsequent answers suggested that screening often was inadequate. Only 5 percent consistently used the prescription drug monitoring program (PDMP), 38 percent had ever accessed it, and 6 percent had ever requested opioid-related medical records. Prior training in drug diversion increased the likelihood of accessing the PDMP. Many in this self-selected group expressed interest in continuing education on assessment of prescription drug abuse/diversion.                

Read more:                
http://www.tandfonline.com/doi/full/10.1080/08897077.2015.1127870                                  

L. Mittal and J. Suzuki. 2015. “Feasibility of Collaborative Care Treatment of Opioid Use Disorders with Buprenorphine During Pregnancy.” Substance Abuse, doi:10.1080/08897077.2015.1129525.                

This case series describes 16 pregnancies in 14 women who started office-based opioid treatment with buprenorphine in a mental health service embedded in two Boston obstetric clinics. Average maternal age was 30 and average gestational age was 23.6 weeks at the time of referral. Treatment continued until delivery in 15 pregnancies (94 percent), with an average treatment duration of 14.5 weeks. Sixty percent had a cesarean delivery and 80 percent of infants were admitted to the neonatal intensive care unit for monitoring or treatment of neonatal abstinence syndrome. Women continued or resumed treatment with buprenorphine after 14 births, with 13 referred to a community prescriber.                

Read more:                
http://www.tandfonline.com/doi/full/10.1080/08897077.2015.1129525                                  

A.C.S. Pearson, J.S. Eldrige, S.M. Moeschler, and W.M. Hooten. 2016. “Opioids for Chronic Pain: A Knowledge Assessment of Nonpain Specialty Providers.” Dovepress 6(9):129–35, doi:10.2147/JPR.S98273.                

The KnowPain-50 survey was developed specifically to assess pain management education among physicians. The survey covers a range of chronic pain topics frequently encountered in the primary care setting, with 7 medicolegal and 11 clinical questions addressing opioid management. At a 3-day Mayo Clinic continuing medical education conference on pain medicine for non-pain specialists, 131 of 219 physicians, physician assistants, and nurse practitioners (60 percent) completed the survey at conference commencement. Most respondents were male physicians with mean age 52. The proportion of correct responses to the 18 opioid questions was 69 percent compared to 74 percent for the 32 non-opioid questions. The proportion of correct responses was 74 percent for the medicolegal opioid questions and 67 percent for the clinical opioid questions.                

Read more:                
https://www.dovepress.com/opioids-for-chronic-pain-a-knowledge-assessment-of-nonpain-specialty-p-peer-reviewed-article-JPR                                  

K.R. Press, G.Z. Zornberg, G. Geller, J. Carrese, and M.I. Fingerhood. 2015. “What Patients with Addiction Disorders Need from Their Primary Care Physicians: A Qualitative Study.” Substance Abuse, doi:10.1080/08897077.2015.1080785.                

Eighteen semi-structured interviews of patients with current or prior debilitating addictive disease recruited from a primary care practice in east Baltimore focused on provider characteristics that were essential for successful relationships. Providers needed to be knowledgeable about addiction, feel responsible for treating these patients, emphasize overall health, and engage patients in their own care. Additionally, participants strongly desired providers who treated them as “people” that they cared about. Interviewees also frequently described patient characteristics that could affect the strength of patient-provider relationships. These included being concerned about their health, feeling deserving of care, and having appropriate psychiatric care for concomitant mental health conditions. Practical obstacles and a disorganized mindset impeded patient-provider relationships.                

Read more:                
http://www.tandfonline.com/doi/full/10.1080/08897077.2015.1080785                                  

A. Sacarny, D. Yokum, A. Finkelstein, and S. Agrawal. 2016. “Medicare Letters to Curb Overprescribing of Controlled Substances Had No Detectable Effect on Providers.” Health Affairs 35(3):471–9, doi: 10.1377/hlthaff.2015.1025.                

A randomized controlled trial evaluated a low-cost, light-touch intervention aimed at reducing the inappropriate provision of Schedule II controlled substances in the Medicare Part D program. Of 1,518 providers who prescribed an average of four times more opioids than their peers in the same state and specialty during at least two of the three years 2011, 2012, and 2013, 758 were randomly selected to receive a letter that explained that their practice patterns were highly unlike those of their peers. The letters did not affect prescribing. The article describes ongoing efforts to improve on this null result with alternative interventions.                 

Read more:                
http://content.healthaffairs.org/content/35/3/471.abstract                                  

K.H. Seal, S. Maguen, D. Bertenthal, S.L. Batki, J. Striebel, M.B. Stein, E. Madden, and T.C. Neylan. 2016. “Observational Evidence for Buprenorphine’s Impact on Posttraumatic Stress Symptoms in Veterans with Chronic Pain and Opioid Use Disorder.” Journal of Clinical Psychiatry, doi:10.4088/JCP.15m09893.                

Administrative data review of Iraq and Afghanistan veterans who received Veterans Affairs health care in San Francisco between October 1, 2007, and July 29, 2013, identified 382 patients with ICD-9-CM co-occurring diagnoses of posttraumatic stress disorder, chronic pain, and substance use disorders. Of these, 177 had received sublingual buprenorphine and 205 were maintained on moderately high-dose opioid therapy. It is unclear how often those in the opioid therapy group were prescribed methadone versus opioids with higher misuse potential like oxycodone and hydrocodone. Twice as many veterans in the buprenorphine group (24 percent) compared to those in the opioid therapy group (12 percent) experienced improvement in posttraumatic stress disorder (PTSD) symptoms. Those receiving buprenorphine showed significant improvement after 8 months, with increasing improvement up to 24 months. There were no differences in the longitudinal course of pain ratings between groups. [Editor’s note: The study did not assess how often patients in the opioid therapy group resumed opioid misuse or the PTSD rate among those who did not relapse in the opioid therapy group. It also did not control for disorder severity; the most severely disordered cannot use buprenorphine therapy.]                

Read more:                
http://www.psychiatrist.com/jcp/article/Pages/2016/aheadofprint/15m09893.aspx                                  

C. Timko, N.R. Schultz, M.A. Cucciare, L. Vittorio, and C. Garrison-Diehn. 2016. “Retention in Medication-Assisted Treatment for Opiate Dependence: A Systematic Review.” Journal of Addictive Diseases 35(1):22–35, doi:10.1080/10550887.2016.1100960.                

This systematic review (55 articles published between 2010–14) found randomized controlled trials varied widely in retention rates for medication assisted treatment (19–94 percent at 3 months, 46–92 percent at 4 months, 3–88 percent at 6 months, and 37–91 percent at 12-months). Only one study examined retention beyond 1 year. Contingency management motivational incentives that use positive reinforcement showed promise to increase retention. Other behavioral therapies including supervision of medication consumption, counseling, education, and support did not significantly increase retention. The review suggested lack of significance might result from inadequate sample sizes but did not attempt a meta-analysis to address that problem.                

Read more:                
http://www.tandfonline.com/doi/full/10.1080/10550887.2016.1100960                                  

J.D. Wilson, N. Spicyn, P. Matson, A. Alvanzo, and L. Feldman. 2016. “Internal Medicine Resident Knowledge, Attitudes and Barriers to Naloxone Prescription in Hospital and Clinic Settings.” Substance Abuse, doi:10.1080/08897077.2016.1142921.                

As part of a needs assessment, 97 internal medicine residents at an academic medical center in Baltimore were surveyed in 2015. Most residents were aware of naloxone (80 percent) and willing to prescribe it (72 percent). Yet, despite a high proportion of residents who had treated patients at increased overdose risk (79 percent), few had prescribed naloxone (15 percent). Almost half (47 percent) had discussed overdose prevention strategies with at least one patient. The most common barriers to naloxone prescribing were related to knowledge gaps in how to prescribe and how to assess risk of overdose and identify candidates for naloxone, with 52 percent reporting low confidence in their ability to identify at-risk patients.                

Read more:                
http://www.tandfonline.com/doi/full/10.1080/08897077.2016.1142921                 
               

Professional Development

T. Calás, M. Wilkin, and C.M. Oliphant. 2016. “Naloxone: An Opportunity for Another Chance.” Journal of Nurse Practitioners 12(3):154–60, doi:10.1016/j.nurpra.2015.10.025.                

This article highlights the need for naloxone, how opioids and naloxone work in the body, what an overdose looks like, the forms of naloxone with directions for use, and what needs to be done in an overdose.                

Read more:                
http://www.npjournal.org/article/S1555-4155(15)01102-2/abstract                                 

R.S. Hudspeth. 2016. “Safe Opioid Prescribing for Adults by Nurse Practitioners: Part 1. Patient History and Assessment Standards and Techniques.” Journal of Nurse Practitioners 12(3):141–8, doi:10.1016/j.nurpra.2015.10.012.                

The opioid prescribing process begins with a comprehensive history and multiple assessments that use opioid misuse risk assessment and other tools, urine drug tests, prescription reviews, informed consents, and patient provider agreements. This article presents common behavioral red flags that can alert providers to a potential misuse problem and discusses mitigation strategies for safe opioid prescribing to problem patients. Nurse practitioners have a professional responsibility to follow state and national guidelines for safe opioid prescribing to protect patients, the public and themselves if they become the subject of an investigation.                

Read more:                
http://www.npjournal.org/article/S1555-4155(15)01042-9/abstract                                 

R. King. 2016. “Science over Stigma: Saving Lives-Implementation of Naloxone Use in the School Setting.” NASN School Nurse 31(2):96–101, doi:10.1177/1942602X16628890.                

This article discusses the successful implementation of naloxone use in the school setting in Delaware public high schools.                

Read more:                
http://www.ncbi.nlm.nih.gov/pubmed/26929211                                  

J. Strang, R. McDonald, A. Alqurshi, P. Royall, D. Taylor, and B. Forbes. 2016. “Naloxone Without the Needle—Systematic Review of Candidate Routes for Non-Injectable Naloxone for Opioid Overdose Reversal.” Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2016.02.042.                

Besides injectables, products using three routes of naloxone administration are in use or under study: nasal, sublingual (under the tongue) and buccal (between the guns and cheek). Pharmacokinetic data exist only for nasal naloxone, where product development is more advanced and FDA has licensed one concentrated spray. However, buccal naloxone may also be viable and may have different characteristics.                

Read more:                
http://www.drugandalcoholdependence.com/article/S0376-8716(16)00141-1/abstract                
               

National

This Canadian Drug Policy is Killing Americans Too                
Nansen Malin, Huffington Post                
March 10, 2016                

Four senators and eight representatives, including the entire New Hampshire delegation, have sent a letter to Canadian health officials, urging them to ban the sale of abusable oxycodone. Six years ago, the FDA began requiring makers of oxycodone to adopt abuse-deterrent technology. American officials and experts begged Canada to likewise ban the production and sale of the old abusable formula of oxycodone. However, Canada’s department of health has continued approving new generic forms of the old abusable formula. Canadian generics have been found in 49 of 50 states.                 

Read more:                
http://www.huffingtonpost.com/nansen-malin/this-canadian-drug-policy_b_9431362.html                 
http://www.ayotte.senate.gov/?p=press_release&id=2529                                  

Nine Ways to Use Your Hospital’s Emergency Department to Curb Opioid Epidemic                
Hospitals and Health Networks                
March 9, 2016                

A task force formed by the Massachusetts Hospital Association has developed a list of nine best practices to improve management of opioid use in hospital emergency departments. All 51 Massachusetts Hospital Association members with emergency departments have put the recommendations in place.                

Read more:                
http://www.hhnmag.com/articles/7024-ways-to-use-your-hospitals-emergency-department-to-curb-the-deadly-opioid-epidemic                                  

What to Do When an Employee Enters Long-Term Rehab                
Brian Hughes, Huffington Post                
March 7, 2016                

The author urges employers to show compassion and support for employees who enter treatment for substance use. Beachway Therapy Center in Florida recommends understanding legal responsibilities as an employer, such as the Americans with Disabilities Act (ADA) and the Family and Medical Leave Act (FMLA). Employers can fire an employee whose performance has declined because of drugs or alcohol misuse. They also have the right to test for drugs and fire for drug use under the ADA. FMLA protects employees from job loss while on leave for treatment of misuse disorders. If an employee does not want to make a treatment decision public, the employer cannot disclose that decision. When any employee leaves for treatment, Beachway recommends that employers set up a return-to-work agreement, a written document outlining an employer’s expectations for an employee who has completed use disorder treatment.                 

Read more:                
http://www.huffingtonpost.com/brian-hughes/what-to-do-when-an-employee-enters-long-term-rehab_b_9390250.html?                                  

U.S. Health Agency Estimates 2015 Prescription Drug Spend Rose to $457 Billion                
Fox News                
March 8, 2016                

The U.S. Department of Health and Human Services has estimated that spending on prescription drugs rose to $457 billion in 2015, up 8 percent from 2014. Retail drugs accounted for $328 billion and drugs administered by healthcare providers for $128 billion. Prescription drug spending accounted for 16.7 percent of 2015 healthcare spending. Drug spending is expected to grow to $535 billion in 2018.                 

Read more:                
http://www.foxnews.com/health/2016/03/09/us-health-agency-estimates-2015-prescription-drug-spend-rose-to-457b.html                 
                 

Marijuana

W.A. Mason, C.B. Fleming, J.L. Ringle, K. Hanson, T.J. Gross, and K.P. Haggerty. 2016. “Prevalence of Marijuana and Other Substance Use Before and After Washington State’s Change from Legal Medical Marijuana to Legal Medical and Non-Medical Marijuana: Cohort Comparisons in a Sample of Adolescents.” Substance Abuse, doi:10.1080/08897077.2015.1071723.                  

Across two consecutive cohorts of students enrolled in targeted Tacoma, Wash., public schools, 238 children completed a baseline survey in the 8th grade and a follow-up survey after the 9th grade. Recreational marijuana was legalized in Washington before the second follow-up. Growth in marijuana use from 8th to 9th grade was higher for the second cohort than the first, but this difference was not statistically significant in this extremely small sample.                  

Read more:                  
http://www.tandfonline.com/doi/full/10.1080/08897077.2015.1071723                                      

A.R. Williams, M. Olfson, J.H. Kim, S.S. Martins, and H.D. Kleber. 2016. “Older, Less Regulated Medical Marijuana Programs Have Much Greater Enrollment.” Health Affairs 35(3):480–8, doi:10.1377/hlthaff.2015.0528.                  

Twenty-three states and the District of Columbia have passed laws to implement medical marijuana programs. Fourteen of the 24 programs defined medical need generously and collectively enrolled 99.4 percent of participants nationwide, with enrollment rates 20 times greater than in the remaining programs.                  

Read more:                  
http://content.healthaffairs.org/content/35/3/480.abstract?=right                                      

Utah House Committee Approves One Medical Marijuana Bill, Second Fails                  
Katie England, Daily Herald                  
March 7, 2016                   

Utah’s senate has rejected a medical marijuana bill but sent a revised version of a narrower competing bill to the state’s house of representatives that would allow doctors to prescribe cannabidiol oils and specialists to prescribe products with tetrahydrocannabinol.                  

Read more:                  
http://www.heraldextra.com/news/local/govt-and-politics/legislature/utah-house-committee-approves-one-medical-marijuana-bill-second-fails/article_294095b3-fdde-5a03-8baf-abf318ae2630.html                                      

Emergency Medical Services Employers Can Restrict Employees’ Medical or Recreational Marijuana Use                  
Page, Wolfberg & Wirth                  
March 4, 2016                  

This article discusses what employers in states with legalized recreational and medical marijuana can do with drug-free workplace policy. The author recommends emergency medical services employers keep their drug-free workplace policy, publicize the policy and its requirements to all employees, and conduct annual training on the policy for staff and supervisors. If an ambulance service is a federal contractor or grantee, it is required under federal law to have a drug-free workplace policy. Providers should enlist legal counsel to draft a policy to ensure employees are not coming to work under the influence of drugs or alcohol. This article includes two questions employers can ask themselves if an employee is suspected of being high at work.                   

Read more:                  
https://www.ems1.com/paramedic-chief/articles/67559048-EMS-employers-can-restrict-the-use-of-medical-or-recreational-marijuana-on-or-off-duty                                      

Concerns Stall Maine Marijuana Operating Under the Influence Bill in Committee                  
Kevin Miller, Portland Press Herald                  
March 8, 2016                  

A joint committee within Maine’s legislature has postponed a vote on a bill that would establish how much tetrahydrocannabinol drivers could have in their bloodstream in order to be charged with operating under the influence. The committee is expected to continue discussing the bill, another provision of which involves license cancellation for medical marijuana users between ages 18 and 20 who were not impaired but were found to have marijuana in their bloodstream after they were stopped for another driving infraction.                  

Read more:                  
http://www.pressherald.com/2016/03/08/marijuana-oui-bill-stalls-in-committee                                      

Massachusetts Senate Committee on Marijuana Releases Its Official Report                  
Massachusetts Senator Richard J. Ross                  
March 8, 2016                  

A special senate committee on marijuana in Massachusetts’ legislature has released a report that reviews current marijuana laws in the state and analyzes public policy considerations if the state were to legalize recreational use and sale of marijuana. It covered possession, use, and consumption issues; product and packaging issues; and growth, distribution, sales and marketing issues.                  

Read more:                  
http://www.richardjross.com/2016/03/08/special-senate-committee-on-marijuana-releases-its-official-report                                      

Is It Time for Football to Reconsider Marijuana?                  
Nadia Kounang, CNN                  
March 9, 2016                  

The National Football League (NFL) and NFL Players Association currently prohibit the use of marijuana. Players argue that marijuana can be used to manage pain and they would like to use it. Some retired players admitted using the drug while playing. The NFL has no plans to lift the ban even though some states have legalized marijuana. (Includes video: 1:39 minutes)                  

Read more:                  
http://www.cnn.com/2016/03/09/health/nfl-marijuana-ban-eugene-monroe/index.html?eref=rss_health                 
               

International

Tennis Player Maria Sharapova Failed Drugs Test at Australian Open                
BBC Sports                
March 8, 2016                

Tennis player Maria Sharapova has failed a drug test at the Australian Open for the prescription drug meldonium (a drug manufactured in the former Soviet Union and not legally available in the United States). Sharapova says she has been taking the drug since 2006 for health issues. The International Tennis Federation suspended her provisionally. The World Anti-Doping Agency banned the drug on January 1, 2016. (Includes video: 2:53 minutes)                 

Read more:                
http://www.bbc.com/sport/tennis/35750285                 
               

Northeast/Mid-Atlantic News

Officials: Maine Recorded 272 Overdose Deaths in 2015                
David Sharp, Associated Press                
March 7, 2016                

Maine has recorded 272 overdose deaths in 2015, a 31 percent increase from 2014. Deaths included 157 due to heroin and fentanyl and 111 were caused by prescription opioids. About 78 percent of the overdose deaths occurred in Maine’s five most populous counties, with Cumberland County recording nearly a third.                

Read more:                
http://www.bellinghamherald.com/news/article64598187.html                                 

Vermont Fentanyl Overdoses Surged in 2015, Report Shows                
Taylor Dobbs, Vermont Public Radio                
March 7, 2016                

Vermont’s health department has recorded 72 opiate overdose deaths in 2015. Sixty involved prescription opiates, 34 involved heroin, and 29 involved fentanyl. In 2014, of 56 overdose deaths, 44 deaths prescription drugs, 34 involved heroin, and 18 involved fentanyl. Of 48 deaths that involved prescription opiates attended by first responders, 47 were in cardiac arrest and beyond the reach of naloxone, including 8 who were administered the drug, and one person who refused medical transport. (Includes audio: 2:54 minutes)                

Read more:                
http://digital.vpr.net/post/vermont-fentanyl-overdoses-surged-2015-report-shows                
http://legislature.vermont.gov/assets/Legislative-Reports/Final-draft-as-approved-by-AHS.-2.25.18.pdf                                  

Massachusetts House, Senate Panel Approves Final Version of Opioid Bill                
Associated Press, Boston Herald                
March 8, 2016                

Massachusetts’s house and senate have reached agreement on a final version of a bill that would limit initial opiate pain reliever prescriptions to a seven-day supply and set an evaluation requirement within 24 hours for overdose victims seeking help at hospital emergency rooms. It also would allow patients to fill only a portion of their pain reliever prescriptions at a time. The conference committee rejected the governor’s proposal to commit patients involuntarily to drug treatment facilities for up to 72 hours. It also rejected his proposal to limit initial opiate pain reliever prescriptions to a 3-day supply. The state’s house will now debate the bill.                

Read more:                
http://www.bostonherald.com/news/local_coverage/2016/03/house_
senate_panel_approves_final_version_of_opioid_bill
                                

New York Senate Passes Bill to Prevent Theft and Sale of Blank Prescription Forms                
New York State Senate                
March 8, 2016                

New York’s senate has passed a bill that would increase penalties for the theft and unauthorized possession of blank prescription forms. Senators also passed two bills related to the implementation of the mandatory electronic prescribing law, which takes effect March 27, 2016. One bill would exempt healthcare practitioners who order only a few prescriptions a year from mandatory electronic prescribing and the other would exempt most prescriptions written on-site at nursing homes. The bills head to the state’s assembly for consideration.                

Read more:                
http://www.nysenate.gov/newsroom/press-releases/senate-passes-bill-help-stop-prescription-drug-abuse-preventing-theft-and-0                                  

Maine Labor Department, Union Leaders at Odds over Employee Drug Testing Law                
Jim Keithley, WMTW                
March 10, 2016                

Maine’s labor department is asking for changes to the state’s employer drug testing laws. A bill would allow employers to use a single-work related accident as probable cause to test if an employee is under the influence of drugs. It also would expand businesses authorized to have company-wide random drug testing from those with 50 or more employees to those with 10 or more employees. The legislature is expected to take up the proposed changes in the coming weeks. (Includes video: 1:11 minutes)                

Read more:                
http://www.wmtw.com/politics/labor-department-union-leaders-at-odds-over-employee-drug-testing-law/38445878                                  

Maine Labor Department Issues Annual Report on Drug Use in the Workplace                
WorkersCompensation.com                
March 8, 2016                

Maine’s labor department has issued the 2015 Annual Report on Substance Abuse Testing by Maine Employers. The report covers testing of job applicants and employees, with the majority being applicant testing. The highest percentage of positive tests on record occurred in 2015, at 5 percent. Cannabinoids accounted for 84 percent of all positive test results.                

Read more:                
http://www.workerscompensation.com/compnewsnetwork/news/23478-maine-dol-issues-annual-report-on-drug-use-in-the-workplace.html                 
http://www.maine.gov/labor/labor_stats/publications/substanceabuse/index.html                                  

Rhode Island State Legislator Sponsors Bills Related to Prescription Drugs, Narcan                
State of Rhode Island General Assembly                
March 7, 2016                

Five bills related to access to prescription drug monitoring program databases and the purchase of the overdose drug naloxone for cities and towns have been introduced in Rhode Island’s legislature.                 

Read more:                
http://www.rilin.state.ri.us/pressrelease/_layouts/RIL.PressRelease.ListStructure/Forms/
DisplayForm.aspx?List=c8baae31-3c10-431c-8dcd-9dbbe21ce3e9&ID=11457
                                  

Rhode Island Bill Would Require Healthcare Workers to Undergo Addiction Risk Training                
WPRI                
March 7, 2016                

A bill has been introduced in Rhode Island’s legislature that would require healthcare workers who treat patients to undergo at least five hours of training every two years on addiction risks associated with prescription pain medications. Some physicians would also be required to complete training necessary to obtain a DATA 2000 waiver to prescribe buprenorphine.                 

Read more:                
http://wpri.com/2016/03/07/bill-would-require-healthcare-workers-undergo-addiction-risk-training                                  

Pennsylvania’s New Drug Monitoring Program Should Start in August                
Robert Swift, Scranton Times-Tribune                
March 9, 2016                

Pennsylvania’s new prescription drug monitoring program should be operating by August. Healthcare professionals writing prescriptions will be required to submit information within 72 hours on patients who are prescribed controlled substances.                 

Read more:                
http://thetimes-tribune.com/news/new-drug-monitoring-program-should-start-in-august-1.2016488                                  

Panel: Finding New Ways in Vermont to Manage Pain Will Cut Down Veterans’ Opioid Abuse                
Andy Hershberger, WMUR                
March 4, 2016                

Veterans Affairs hospitals in White River Junction, Vt., and Manchester, N. H., have introduced programs to manage pain through chiropractic treatment, low-powered laser therapy, and acupuncture. Lawmakers expressed the importance of having enough people to provide these alternative treatments and having them readily available. (Includes video: 2 minutes)                

Read more:                
http://www.wmur.com/health/panel-finding-new-ways-to-manage-pain-will-cut-down-veterans-opioid-abuse/38346084                 
               

South News

Virginia Opioid Overdose Deaths Spur Action on Tracking Who Gets Prescriptions                
Tammie Smith, Richmond Times-Dispatch                
March 10, 2016                 

Virginia’s general assembly has passed legislation that requires prescribers to check the state’s prescription drug monitoring program (PDMP) database before writing an opioid prescription for longer than 14 consecutive days. It also approved two other PDMP bills. One requires the state’s department of health professions to develop criteria to identify unusual patterns of prescribing and dispensing of certain covered substances. That information then can be provided to the department’s enforcement division for investigation and action. The other bill shortens the time allowed for pharmacies and other dispensers to report to the PDMP from 7 days to the later of 24 hours or the next business day.                 

Read more:                
http://www.richmond.com/life/health/article_36472e46-27ba-538b-ae78-d43b510471d7.html                                  

Naloxone Now Available Over the Counter in Florida                
Deirdra Funcheon, Broward Palm Beach New Times                
March 4, 2016                

Florida’s legislature has passed a bill that allows pharmacists to dispense naloxone without a prescription.                

Read more:                
http://www.browardpalmbeach.com/news/naloxone-antidote-to-heroin-overdose-now-available-over-the-counter-in-florida-7629555                 
               

Midwest News

Indiana Veterans Affairs Centers will Join Monitoring Program                
Brian Francisco, The Journal Gazette                
March 10, 2016                

The Department of Veterans Affairs (VA) will start reporting controlled substances dispensed by its Indiana facilities to that state’s prescription drug monitoring program. The agreement will pilot the program at the Richard L. Roudebush VA Medical Center in Indianapolis. Medical centers in Fort Wayne, Marion, and Crown Point will also eventually participate.                

Read more:                
http://www.journalgazette.net/news/local/indiana/Indiana-VA-centers-will-join-monitoring-program-11936882                                  

Three Detroit Doctors Allegedly Ran $5.7 Million Drug Ring                
Tresa Baldas, Detroit Free Press                
March 10, 2016                

Federal prosecutors have reported that 10 defendants took part in a prescription drug-trafficking scheme between 2013 and 2015 that pushed roughly 1 million pain relievers onto the streets in Detroit. Chiropractor Boris Zigmond led the $5.7 million operation. He secured prescriptions for pain relievers that could be filled at various pharmacies and then funneled them into the black market. Zigmond did not see patients himself or write prescriptions. He set up office suites in several locations, where Jennifer Franklin, M.D., and Carlos Godoy, M.D., would “see” fake patients and write prescriptions.                

Read more:                
http://www.khou.com/story/news/nation-now/2016/03/10/detroit-doctors-prescription-pill-drug-ring-addiction/81574274                                  

Former Akron (Ohio) Children’s Hospital Nurse Accused of Stealing Fentanyl, Morphine from Work                
Nick Glunt, Beacon Journal                
March 10, 2016                

Caitlin Abramovich, a former Akron Children’s Hospital nurse, is facing felony charges for stealing prescription pain relievers while on duty. She admitted to stealing fentanyl, morphine, and hydromorphone. She also told her supervisors she took and used the hospital’s syringes. She was immediately fired from her position at the hospital and her nursing license was suspended.                

Read more:                
http://www.ohio.com/news/break-news/former-akron-children-s-hospital-nurse-accused-of-stealing-fentanyl-morphine-from-work-1.667635                                  

Prescription Drug and Opioid Abuse Deaths in Michigan Continue to Rise                
State of Michigan                
March 8, 2016                

The Michigan Department of Health and Human Services has reported that the number of drug overdose deaths increased by 14 percent from 1,535 in 2013 to 1,745 in 2014.                

Read more:                
http://www.michigan.gov/mdhhs/0,5885,7-339--378272--,00.html                                  

Missouri Paper Editorial  Board Says to Tailor Drug Fight to the Workplace                
News-Press & Gazette Company                
March 8, 2016                

This news outlet argues that the drug misuse fight should target those in the workplace. It highlights the benefits of an education and awareness campaign, limits and alternatives to pain medications, and drug testing.                 

Read more:                
http://www.newspressnow.com/opinion/editorials/article_766e85c0-b3f5-538f-b983-b971f493c89e.html                                  

Elkhart (Indiana) School Bus Overdoses Leave Parents with Important Message                
Kasey Chronis, WNDU                
March 7, 2016|                 

Four students between the ages of 12 and 14 from Elkhart Academy in Elkhart, Ind., recently overdosed on prescription drugs while on a school bus. The type of medication taken has not been confirmed. The police believe the drugs did not belong to any of the children and were stolen from a relative. The students have been released from the hospital. (Includes video: 3:09 minutes)                

Read more:                
http://www.wndu.com/content/news/Update-Elkhart-students-released-from-hospital-after-school-bus-overdoses-371334281.html                 
               

West News

Arizona Police Board Relaxes Policy on Recruits’ Adderall Use                
Megan Cassidy, The Republic                
March 11, 2016                

The Arizona Peace Officer Standards and Training Board has adopted new guidelines that relax the policy on hiring applicants who admit to previous illegal use of Adderall or related drugs. It opens a loophole for those who took the drug as a study aid. The policy only allows one or two usages after the age of 21 but is more liberal about use at younger ages. It views the prescription stimulants less like street drugs and more along the lines of borrowing someone else’s prescription pain reliever. The latter is generally allowed on a limited basis.                

Read more:                
http://www.azcentral.com/story/news/local/arizona/2016/03/11/arizona-police-board-relaxes-policy-recruits-adderall-use/81613998                                  

Opioid Overdose Protection Act in Alaska Becomes Law                
Jeanne Devon, Alaska Native News                
March 8, 2016                

Alaska’s legislature has approved legislation that gives providers the ability to dispense naloxone over the counter to friends and families without fear of civil liability.                

Read more:                
http://alaska-native-news.com/opioid-overdose-protection-act-becomes-law-21873                                  

New Data Indicate Progress in Campaign to Prevent Opioid Deaths in Marin (California)                
Richard Halstead, Marin Independent Journal                
March 8, 2016                

The number of overdose deaths from pain relievers in Marin County, Calif., has decreased from 27 in each of 2012 and 2013 to 10 in 2014. County statistics reported to the state on overdose deaths may not capture all of the deaths because the coroner’s division of the Marin County Sheriff’s Office investigates far fewer than half of the deaths that occur each year.                

Read more:                
http://www.marinij.com/article/NO/20160308/NEWS/160309815                                  

Acupuncture to Stem Opioid Crisis? Oregon Tries It, NPR Says                
Jed Lipinski, Times-Picayune                
March 4, 2016                 

Oregon in January began funding alternative treatments—acupuncture, massage therapy and chiropractic care among them—for people who get their health care through the state’s Medicaid program. The state hopes to reduce the number of Oregonians who become addicted to or misuse opioids, saving money in the long run.                

Read more:                
http://www.nola.com/health/index.ssf/2016/03/to_fight_opioid_epidemic_orego.html                 
               

Other Resources

Ten Leading Causes of Death and Injury Charts                
Centers for Disease Control and Prevention                
February 25, 2016                

The Centers of Disease Control and Preventions recently updated its Leading Causes of Death Charts with 2014 fatality data that show the impact of injury-related deaths in the United States compared to other leading causes of death.                

Read more:                
http://www.cdc.gov/injury/wisqars/leadingcauses.html                 
               

Webinars

Understanding the Relationship Between Prescription Opioid Misuse and Heroin Abuse                
National Drug Early Warning System, University of Maryland                
Monday, March 28, 2016                 
2:00 p.m. (ET)                 

Presenters include Wilson M. Compton, M.D., deputy director of the National Institute on Drug Abuse, and Daniel Ciccarone, M.D., professor of family and community medicine at the University of California San Francisco.                

Register:                
https://zoom.us/webinar/register/6f81ba5a009695b97c24e00bf0acd2b8                                  

Weed in Your Workplace: What You Need to Know                
National Safety Council                
Wednesday, April 20, 2016                
2:00 p.m. (ET)                
http://eventcallregistration.com/reg/index.jsp?cid=59487t11                 
               

Grant Award

HHS Awards $94 Million to Health Centers to Help Treat the Prescription Opioid Abuse and Heroin Epidemic in America                
U.S. Department of Health and Human Services                
March 11, 2016                

The U.S. Department of Health and Human Services announced $94 million in Affordable Care Act funding to 271 health centers in 45 states, the District of Columbia, and Puerto Rico to improve and expand the delivery of substance abuse services in health centers, with a specific focus on treatment of opioid use disorders in underserved populations.                

Read more:                
http://www.hhs.gov/about/news/2016/03/11/hhs-awards-94-million-to-health-centers.html                 

List of award winners:                
http://bphc.hrsa.gov/programopportunities/fundingopportunities/substanceabuse/fy16awards.html                 
               

Grant Announcements

FY 2016 Harold Rogers Prescription Drug Monitoring Program                
Bureau of Justice Assistance                
Due: April 26, 2016                

This grant program provides support to state prescription drug monitoring programs and tribal organizations seeking to engage with prescription monitoring activities, and to state/county agencies seeking to address drug misuse and diversion challenges.                

Read more:                
http://www.grants.gov/web/grants/search-grants.html                
https://www.bja.gov/funding/PDMP16.pdf                                  

Prescription Drug Overdose Prevention for States                
Centers for Disease Control and Prevention                
Due: April 1, 2016                
http://www.grants.gov/web/grants/search-grants.html                                  

SP-16-003: Strategic Prevention Framework—Partnerships for Success                
SAMHSA                
Due: April 12, 2016                
http://www.grants.gov/web/grants/search-grants.html                                  

NIJ-2016-9090: Research and Evaluation on Drugs and Crime                
National Institute of Justice                
Due April 20, 2016                
http://www.grants.gov/web/grants/search-grants.html                                  

National Institute on Drug Abuse Challenge: Addiction Research: There’s an App for That                
National Institute on Drug Abuse                
Submission Period begins November 3, 2015, 9:00 a.m. (ET)                
Submission Period ends April 29, 2016, 11:59 p.m. (ET)                
http://nida.ideascale.com/a/pages/addiction-research-theres-an-app-for-that                                  

Bottle Tracking Program                
National Association of Drug Diversion Investigators                
Due: None Specified                
http://www.naddi.org/aws/NADDI/pt/sp/programs_grants                 
http://naddibottletracking.org/law-enforcement                 
               

National Take-Back Initiative

National Prescription Drug Take-Back Day                
Drug Enforcement Administration                
April 30, 2016                
10:00 a.m. – 2:00 p.m.                
http://www.deadiversion.usdoj.gov/drug_disposal/takeback                 
               

Take-Back Events & Drop Boxes

Rx Drive-Thru Medicine Drop-Off Set March 19 in Basking Ridge (New Jersey)                
Echoes-Sentinel                
March 11, 2016                
http://www.newjerseyhills.com/echoes-sentinel/news/rx-drive-thru-medicine-drop-off-set-march-in-basking/article_f42051a2-e791-11e5-9e9b-e7a58fb79824.html                                  

Prescription Drug Take-Back Day to be March 26 in Calvert County (Maryland)                
Southern Maryland News Net                
March 7, 2016                
http://smnewsnet.com/archives/400704/prescription-drug-take-back-day-to-be-held-on-saturday-march-26-in-calvert-county                                  

Leadington (Missouri) Police Plans Drug Take-Back Program                
Kevin Jenkins, Daily Journal                
March 9, 2016                
http://dailyjournalonline.com/news/local/leadington-police-plans-drug-take-back-program/article_062b699e-374f-5801-bbaa-dcb3048516a1.html                                  

Hamilton (New Jersey) Unveils Prescription Medicine Drop Box                
Lindsay Rittenhouse, NJ.com                
March 9, 2016                 
http://www.nj.com/mercer/index.ssf/2016/03/hamilton_unveils_permanent_
prescription_drug_drop.html
                 
               

Upcoming Conferences and Workshops

Pharmacy Diversion Awareness Conference                
U.S. Drug Enforcement Administration                
March 19–20, 2016                
Wilmington, Delaware                
April 17–18, 2016                
Towson, Maryland                
http://www.deadiversion.usdoj.gov/mtgs/pharm_awareness                                 

Marijuana and Cannabinoids: A Neuroscience Research Summit                
National Institute on Drug Abuse, National Institute on Alcohol Abuse and Alcoholism, National Center for Complementary and Integrative Health, National Institute of Mental Health, National Institute of Neurological Disorders and Stroke                
March 22–23, 2016                
Bethesda, Maryland                
http://apps1.seiservices.com/nih/mj/2016                                  

Register:                
http://apps1.seiservices.com/nih/mj/2016/Registration.aspx                                  

2016 National Rx Drug & Heroin Summit                
March 28–31, 2016                
Atlanta, Georgia                
http://nationalrxdrugabusesummit.org                                  

Third Annual Smart Approaches to Marijuana Education Summit                
March 31, 2016                
Atlanta, Georgia                
http://nationalrxdrugabusesummit.org/sam-summit-2                                  

Register:                
https://www.123contactform.com/form-1486587/2016-National-Rx-Drug-Abuse-Summit                                  

Medical Marijuana Seminar                
Private Motor Truck Council of Canada                
May 3, 2016                
Alberta, Canada                

Read more:                
http://www.todaystrucking.com/alberta-hosting-spring-talk-on-medical-marijuana-in-trucking                 
http://www.pmtc.ca/News.asp?a=view&id=113                                  

2016 Annual Conference                
International Health Facility Diversion Association                
September 13–14, 2016                
Duke Energy Convention Center                
Cincinnati, Ohio                 
https://ihfda.org/2016-annual-conference                                  

Register:                
https://www.regonline.com/Register/Checkin.aspx?EventID=1803476                 
         
                                 
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.