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March 27, 2013

SAMHSA Prevention of Prescription Drug Abuse in the Workplace Listserv

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March 27, 2013 (PDF version)
Featured Article
Drug Diversion and Abuse: VA Agrees to PMP Database Dump
Pharmacy Times
March 18, 2013

By April 2013, state prescription monitoring programs will be able to access pharmaceutical histories stored at Veterans Affairs hospitals or have the information transferred to their databases.

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Journal Articles
P.H. Earley and T. Finver. 2013. "Addiction to Propofol: A Study of 22 Treatment Cases." Journal of Addiction Medicine 00:1-8.

Abuse of propofol--an anesthesia drug that has a fast recovery time, with fewer side effects than other anesthetics--is on the rise among healthcare professionals. This case study examined 22 healthcare professionals treated for propofol abuse between 1990 and 2010. The cases included 13 doctors, 8 nurses, and one dentist. Most of the doctors and all of the nurses were anesthesia providers and most had been diagnosed with depression--in addition to a history of childhood sexual or physical abuse. A higher-than-expected number of cases involved family members with schizophrenia. Most patients began addiction treatment within a few months after they started using the drug; five sought treatment after just one propofol binge. About half of the studied population began treatment after experiencing a dramatic event.

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T. Furst. 2013. "Suboxone Misuse Along the Opiate Maintenance Treatment Pathway." Journal of Addictive Diseases 32(1):53-67. doi:10.1080/10550887.2012.759860.

This study explores strategies of suboxone misusers in drug treatment. Ethnographic interviews were conducted with 14 patients who had cycled into and out of suboxone treatment. The study identified strategies implemented by patients who intermittently used opiates/opioids during treatment. Some patients serially started and stopped treatment in a harm-reduction setting in New York City. Many patients managed opiate/opioid dependency through sequential use of suboxone and heroin to avoid withdrawal. The author discusses inherent difficulties of substance abuse treatment and offers suggestions for improvement.

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M. Levine, B. Froberg, A.M. Ruha, M. Burns-Ewald, M. Yen, I.A. Claudius, A.O. Arthur, L. Tormoehlen, and S.H. Thomas. 2013. "Assessing the Toxicity and Associated Costs Among Pediatric Patients Admitted With Unintentional Poisonings of Attention-Deficit/Hyperactivity Disorder Drugs in the United States." Clinical Toxicology 51(3):147-50. doi:10.3109/15563650.2013.772623.

Researchers attempted to determine the incidence of toxicity from unintentional poisonings of attention deficit hyperactivity disorder (ADHD) medications and the corresponding financial impact in the United States. They chose four geographically different centers. Cases of serious unintentional poisoning from ADHD medications were included in the study if the patient was under 18 and hospital admission dates were between 2000 and 2003 (cohort A) or 2009 and 2010 (cohort B). U.S. estimates were extrapolated using data from participating hospitals and the number of monitored beds in each corresponding county. Sixty-three subjects were admitted at four hospitals (18 in cohort A, 45 in cohort B). Of these, 35 percent had prescriptions for the drug; many other overdoses involved siblings of children with prescriptions. The crude incidence rate ratio increased between 2000 and 2003 and 2009 and 2010. Median charges per patient (adjusted for inflation) were $4,780 ($3,895-$8,287) and $5,912 ($3,432-$9,433) for cohorts A and B, respectively. Estimated annual charges in the United States were at most $5,694,232 for 2000-01 and $24,126,640 for 2009-10.

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M.A. Sembower, M.D. Ertischek, C. Buchholtz, N. Dasgupta, and S.H. Schnoll. 2013. "Surveillance of Diversion and Nonmedical Use of Extended-Release Prescription Amphetamine and Oral Methylphenidate in the United States." Journal of Addictive Diseases 32(1):26-38. doi:10.1080/10550887.2012.759880.

This article examines rates of nonmedical use and diversion of extended-release amphetamine and extended-release oral methylphenidate in the United States. Prescription dispensing data were sourced from retail pharmacies. Data on nonmedical prescription medication use were collected from the Researched Abuse, Diversion and Addiction-Related Surveillance System Drug Diversion Program and Poison Center Program. From 2007 to 2011, intentional exposures resulting in moderate or major medical outcomes for extended-release oral methylphenidate rose from 0.063 to 0.093 per 1,000 unique recipients of the dispensed drug, whereas those for extended-release amphetamines rose from 0.043 to 0.069 per 1,000. Drug diversion rates, however, were stable over time.

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S.L. Stewart, P. Baiden, and W. den Dunnen. 2013. "Prescription Medication Misuse Among Adolescents With Severe Mental Health Problems in Ontario, Canada." Substance Use & Misuse 48(5):404-14. doi:10.3109/10826084.2013.765482.

Researchers examined the prevalence of prescription medication misuse among adolescents with severe mental health problems in Ontario, Canada, and explored factors that influence prescription medication misuse. With data from the Resident Assessment Instrument for Mental Health, they analyzed 2,677 adolescents ages 12 to 18 who were admitted to adult mental health beds. Overall, 17 percent of adolescent inpatients misused prescription medication. Logistic regression showed misuse of prescription medication was less likely among adolescents with a diagnosis of schizophrenia and adolescents who were admitted as a result of posing a threat or danger to others.

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C.T. Sweeney, M.A. Sembower, M.D. Ertischek, S. Shiffman, and S.H. Schnoll. 2013. "Nonmedical Use of Prescription ADHD Stimulants and Preexisting Patterns of Drug Abuse." Journal of Addictive Disease 32(1):1-10. doi:10.1080/10550887.2012.759858.

Researchers used a cross-sectional, population-based survey of the U.S. civilian, non-institutionalized population (age 12 and older) to analyze lifetime nonmedical use of prescription attention deficit hyperactivity disorder (ADHD) stimulants, lifetime nonmedical use of another prescription drug, illicit drug use, and drug use initiation patterns. The study included 443,041 respondents from the 2002-09 National Survey on Drug Use and Health. Lifetime nonmedical use of prescription ADHD stimulants was reported by 3.4 percent of respondents. Of these, 95.3 percent also reported illicit drug use or nonmedical use of another prescription drug. In 77.6 percent of cases, such use preceded nonmedical use of prescription ADHD stimulants. On average, 2.4 drugs were used prior to the first nonmedical use of prescription ADHD stimulants.

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News and Reports
Medication-Assisted Treatment Can Save Lives
The Partnership at Drugfree.org
March 20, 2013

The Partnership at Drugfree.org sent a letter to the Food and Drug Administration to discuss Probuphine, a new formulation for buprenorphine hydrochloride delivery to treat opioid addiction. The Partnership strongly supports development and availability of medications that can help in the treatment of opioid addiction and are resistant to diversion and abuse.

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Death Toll Rises as Prescription Drug Abuse Grows
March 17, 2013

Opioid overdose deaths are increasing in Australia, according to the former alcohol and drug service director at Sydney's St. Vincent Hospital. In 2012, the National Drug and Alcohol Research Centre reported that 500 Australians ages 15-54 died due to accidental opioid overdoses in 2008. Nationally, there were 705 opioid deaths in 2010, compared with 360 in 2007.

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UNC: N.C.'s Prescription Drug Abuse Reporting System Working
Triangle Business Journal
March 21, 2013

The University of North Carolina at Chapel Hill reported that the statewide system designed to curb prescription drug abuse is effective, even if it is underused. The N.C. Controlled Substances Reporting System was enacted in 2008 to collect data on prescription drugs as they are dispensed. By 2012, patients with the most severe drug-seeking behaviors--those who used 10 prescribers and 10 pharmacists within 6 months--decreased from 217 to 115. Only one third of the 34,000 physicians registered with the Drug Enforcement Agency to prescribe controlled substances use the system.

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Changes to Trafficking Law Proposed in Florida Legislature; Orlando Drug Charges Lawyer Comments on Possible Effects
Digital Journal
March 19, 2013

This press release discusses two bills in the Florida Legislature that would make certain drug trafficking laws less punitive. House Bill 193 would increase the quantities necessary for possession to constitute trafficking. House Bill 159 would give the court discretion to drop mandatory minimum sentences if dealing with a prescription drug or some variation of a prescription drug, and if the defendant attends a drug court program.

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American Association of Poison Control Centers Urges Safe Use of Prescription Painkillers
Digital Journal
March 22, 2013

The American Association of Poison Control Centers warns Americans about the importance of carefully and correctly using and storing prescription pain medication. Experts offer tips to keep families as safe as possible around these drugs.

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FDLE: Drop in Prescription Drug Deaths
March 22, 2013

This press release discusses the results of the Florida 2012 "Interim Drugs Identified in Deceased Persons Report." The report showed a decrease in oxycodone deaths in the state during the first 6 months of 2012, compared with the second half of 2011. Oxycodone deaths decreased 29.1 percent--all prescription drug deaths dropped by more than 100. Death occurrences of methadone and hydrocodone decreased 18.3 percent and 16.4 percent, respectively.

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Businesses Hurt by Productivity, Health Care Costs of Employees Addicted to Pain Pills
Phoenix Business Journal
March 22, 2013

This article discusses addiction with a woman who worked 5 years at a company before being fired for problems related to prescription drug abuse.

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Docs' Licenses Under Fire After Several Prescription Overdoses
March 20, 2013

Four Indiana doctors from the same practice were accused of overprescribing medication to their patients. The Indiana Attorney General's office filed an emergency petition to have the physicians' licenses suspended. Fourteen patients are named in the petition--12 of them are now deceased. At least seven died from drug overdoses.

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Legislation Targets Opiate Abuse in Surprising Ways
Burlington Free Press
March 21, 2013

Vermont legislators voted 137 to 1 for a multipart bill that seeks to reduce prescription drug abuse. The bill requires doctors to sign up for a prescription drug registry if they prescribe opiates. It regulates precious-metal dealers to whom addicts fence stolen goods, and grants immunity to drug users who help an overdosing friend.

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Prescription Drug Abuse Among Grand Forks Area Youth 'Out of Control'
Grand Forks Herald
March 17, 2013

Law enforcement officials in Grand Forks, North Dakota, describe prescription drugs as a form of currency among young people. Hydrocodone pills are being traded for marijuana, favors, gas money, and other pills. A member of Polk County's drug task force said the trade and abuse of such drugs in the region is "out of control." The task force reported 24 prescription drug-related arrests from January 2011 to January 2012, with one third involving teenagers.

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Number of Iowa Patients 'Locked-In' to Single Drug Sources Skyrockets
The Gazette
March 21, 2013

Iowa Medicaid recipients who were required to use one doctor, one pharmacy, and one hospital to prevent prescription drug abuse increased sevenfold from 200 in 2010 to 1,430 in January. The state saved an estimated $14.8 million from July 2010 through September 2012 in the cost of drugs and doctor visits.

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Prescription Drug Deaths: Bill Would Tighten Rules on Hydrocodone
Los Angeles Times
March 20, 2013

A bipartisan group of legislators introduced the Safe Prescribing Act of 2013, a law that proposes to place medications containing hydrocodone in the same category as OxyContin. If enacted, fewer hydrocodone pills would be dispensed to patients at one time and restrictions on refills would increase. In addition, pharmacies would be required to follow stricter procedures for handling and storing the drug.

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Student Use Above 2009 Results, Below National Average
Dublin Villager
March 20, 2013

Dublin Adolescents and Community Together (Ohio) reported results from the Primary Prevention Awareness, Attitude and Use Survey taken by 3,040 Dublin 8th, 10th, and 12th graders in fall 2011. One percent of 8th graders, 5 percent of 10th graders, and 6 percent of 12th graders said they had used someone else's prescription drugs to get high at least once a month.

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Personalized Medicine Hopes to Reduce Addiction
March 20, 2013
Genotox Labs has developed a personalized medicine system--a DNA test that matches people with the right prescription. A saliva sample is analyzed to determine how patients metabolize medications. The result can lead to better pain management without negative side effects or risk of drug abuse, according to doctors. This article includes a 3:28-minute video.

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Virginia Prescription Drug Database Expected to Hit 1M Annual Queries This Year
The Republic
March 17, 2013

This article discusses the Virginia prescription drug database that contains nearly 85 million prescription records. The Virginia Department of Health Department expects the database to receive more than one million requests for information this year.

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Finals Drive Undergraduates to Illegal Adderall Use
The Triangle
March 15, 2013

This article discusses Adderall abuse on Drexel University's campus--particularly during finals week.

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Other Resources
Controlled Substances: Delaware Prescription Monitoring Program
Delaware Department of State, Division of Professional Regulations
Accessed March 22, 2013

Watch practitioner and pharmacist video tutorials for the Delaware prescription monitoring program.

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Attention Prescribers: FDA Seeks Your Help in Curtailing the U.S. Opioid Epidemic
United States Food and Drug Administration
Accessed March 22, 2013

The Food and Drug Administration urges prescribers to take advantage of the agency's free training opportunities on opioid therapy. It sees three key roles for prescribers in curtailing the opioid epidemic:

  1. Ensuring prescribers have adequate training in opioid therapy
  2. Knowing the content of the most current opioid drug labels (examples of the important information found in the labeling of two opioid drugs, OxyContin and Dolophine, are provided in the Key Label Examples tab)
  3. Educating patients about the appropriate use of opioids, potential risks, and proper disposal techniques

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Grant Announcement
Harold Rogers Prescription Drug Monitoring Program FY 2013 Competitive Grant Announcement
Deadline: May 2, 2013

The Harold Rogers Prescription Drug Monitoring Program (HRPDMP) allows for states' discretion as they plan, implement, or enhance a PDMP. The program aims to expand the capacity of regulatory and law enforcement agencies and public health officials to collect and analyze controlled substance prescription data and other scheduled chemical products through a central, state agency-administered database.

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Upcoming Conferences and Workshops
Maryland Workers' Comp Prescription Drug Abuse Summit
April 12, 2013
8:30 a.m.-1 p.m.
Linthicum, Maryland
2013 Symposium for Medical Professionals: Kentucky Medical Communities UNITEd
April 13-June 8, 2013
Various Cities; Kentucky
Drug Enforcement Administration's Sixth National Prescription Drug Take-Back Day
April 27, 2013
10 a.m.-2 p.m.
Various Locations Nationwide
National Prevention Week 2013
May 12-18, 2013
Various Locations Nationwide
The Generation Rx University Conference for Prescription Drug Abuse Prevention and Recovery
August 7-8, 2013
The Ohio State University Blackwell Inn and Conference Center
2110 Tuttle Park Place
Columbus, Ohio
2013 National Safety Council Congress and Expo
Congress: September 28-October 4, 2013
Expo: September 30-October 2, 2013
McCormick Place (West Building)
Chicago, Illinois

The National Safety Council Congress and Expo is the world's largest annual event for safety, health, and environmental professionals. The expo was designed to build awareness of available professional tools.

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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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