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March 5, 2014


SAMHSA Prescription Drug Abuse Weekly Update
Issue 61  |  March 5, 2014
The Prevention of Prescription Drug Abuse in the Workplace (PAW) TA Center addresses prescription drug abuse—a growing public health problem with increasing burdens on workers, workplaces, and our economy. To subscribe colleagues, family members, or friends to this listserv sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), please click here or send their e-mail addresses to paw@dsgonline.com.
Table of Content Featured Article Journal Articles and Reports News Other State and Local News Other Resources Webinar Videos Grant Announcements Take-Back Events and Drop Boxes Save the Dates Upcoming Conferences and Workshops


United States Department of Defense Office of the Inspector General. Assessment of DoD Wounded Warrior Matters: Managing Risks of Multiple Medications. Special Plans and Operations Report, February 21, 2014.

DoD lacks overarching policies and procedures to ensure consistent medication management and reconciliation in the Wounded Warrior population. Reconciliation policies vary widely across Services. Additionally, Wounded Warriors lack a reliable, safe, accessible, and accountable method to dispose of medications that were no longer needed for treatment. The investigators recommend the Department of Defense create Military Health System policy to address the risks for Wounded Warriors who may use multiple medications in the course of their treatment; and update policies to address unique needs of the Wounded Warrior population. They also recommend the Secretary of Defense should ask the U.S. Attorney General to expedite implementation of the Drug Enforcement Administration decision to authorize Department of Defense medical treatment facility pharmacies to conduct routine take-back of unnecessary prescription medication. Finally, the investigators recommend the Department of Defense develop additional education and information initiatives on the proper disposal of expired or unneeded medications.

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Fighting Prescription Drug Abuse Among Wounded Soldiers Uneven, Report Says
USA Today
February 21, 2014

The Defense Department's inspector general reported that even after a dozen years of war, the Pentagon has not yet imposed uniform standards for fighting prescription medication abuse among soldiers. A thousand drug overdoses were reported in one year.

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Journal Articles and Reports

L. Alexander, R.O. Mannion, B. Weingarten, R.J. Fanelli, and G.L. Stiles. 2014. Development and Impact of Prescription Opioid Abuse Deterrent Formulation Technologies. Drug and Alcohol Dependence, doi: 10.1016/j.drugalcdep.2014.02.006.

The development of Abuse Deterrent Formulations (ADF) technologies was reviewed using peer reviewed journals describing opioid analgesics (OpA) post marketing studies, Web sites containing Food and Drug Administration (FDA) announcements on product approvals and manufacturer product use profiles. Reviewed is the FDA recent approval of a product label describing the abuse deterrent characteristics of Oxycontin (physical barrier formulation), and the FDA determination that studies were insufficient for an Opana (physical barrier) ADF label. Additional reviewed marketed OpAs with ADF technologies include: Suboxone and Embeda (opioid agonist/antagonist combinations), Oxecta (aversion technology), and Nucynta (physical barrier). Reviewed ADF technologies currently in development include: new physical barrier and aversion technologies, an innovative extended release formulation as well as novel polymer-opioid conjugates. As ADF technologies are part of a comprehensive intervention strategy to promote safe OpA use, additional components including governmental, community, and educational initiatives are reviewed. The outcomes of the recent ADF labeling applications for Oxycontin (Tier 3 approval) and Opana (nonapproval) suggest that the threshold for ADF labeling will be appropriately high.

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A. Ghosh and D. Basu. 2014. Restless Legs Syndrome in Opioid Dependent Patients. Indian Journal Psychological Medicine 36(1):85–87, doi: 10.4103/0253–7176.127262

Although frequently underdiagnosed, several epidemiological studies have estimated the prevalence of restless legs syndrome (RLS) in western countries at 5 percent to 15 percent of the general population. Case reports document transient RLS in opiate withdrawal. We describe three opiate (dextropropoxyphene (DPP)) dependent young male patients; two of them had DPP intoxication/withdrawal seizure developing RLS during opiate withdrawal. However, their RLS persisted even after the remission of other withdrawal symptoms. The cases responded well to a treatment with ropinirole. Hence, a causal association may exist. Sleep disturbances and use of benzodiazepines during withdrawal can be reduced by increasing clinician awareness of possible RLS side effects.

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K.R. Harris, G.L. Bradshaw, K. Koch, and J. Whyte IV. 2014. A Prescription for Misunderstanding: Opportunities for Misinterpretation Along the Information Flow From Physician to Patient. Journal of Nursing Education and Practice, doi: 10.5430/jnep.v4n5p1.

Researchers studied how healthcare consumer, nurse, and physician interpretations of prescription instructions differed. They conducted surveys at a large university, two hospitals, and various clinics in Mississippi and Florida with 74 young healthcare consumers, 34 registered nurses, and 36 physicians responding. Questionnaires asked for interpretations (i.e., what times would/should you take the drug) or various prescription instructions. Interpretation varied considerably within each group and between groups. None of the instructions were uniformly interpreted. Several consumer and nurse interpretations resulted in potentially unsafe schedules of drug administration. Some physicians and nurses also lacked awareness of the potential for misinterpretation.

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N.C. Heck, N.A. Livingston, A. Flentje, K. Oost, B.T. Stewart, and B.N. Cochran. 2014. Reducing Risk for Illicit Drug Use and Prescription Drug Misuse: High School Gay–Straight Alliances and Lesbian, Gay, Bisexual, and Transgender Youth. Addictive Behaviors 39(4):824–28.

This study investigates whether the absence of a gay–straight alliance (GSA) is associated with risk for illicit drug use and prescription drug misuse in a sample of 475 lesbian, gay, bisexual, and transgender (LGBT) high school students (M age = 16.79) who completed an online survey. After controlling for demographic variables and risk factors associated with illicit drug use, logistic regression analyses revealed that LGBT youth attending a high school without a GSA evidenced increased risk for misuse of ADHD medication (adjOR = 2.00; 95 percent CI = 1.02–3.92) and prescription pain medication (adjOR = 2.00; 95 percent CI = 1.10–3.65). These findings are correlational and may not indicate causation.

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K.R. Holloway, T.H. Bennett, O. Parry, and C. Gorden. 2014. Characteristics and Consequences of Prescription Drug Misuse Among University Students in the United Kingdom. Journal of Substance Abuse, 19(1–2):156–63, doi:10.3109/14659891.2013.765513.

This study was based on an online survey of students currently registered at a university in north Wales. The survey probed characteristics and consequences of prescription drug misuse. The most common medications misused were prescribed pain relievers, tranquillizers and sedatives. The main motives for misuse were to obtain the therapeutic benefits of the drug, recreational purposes and mood enhancement. The main problems associated with prescription drug misuse were addiction, physiological and psychological disorders, and relationships.

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K. Lancaster and A. Ritter. 2014. Making Change Happen: A Case Study of the Successful Establishment of a Peer-Administered Naloxone Program in One Australian Jurisdiction. International Journal of Drug Policy, doi: 10.1016/j.drugpo.2014.02.003.

This paper describes and analyzes the process leading to the successful establishment of Australia's first peer-administered naloxone program. Central to policy development in this case was formation of a committee structure to provide expert guidance and support. The collective, collaborative and relational features of this group are consistent with governing by network. The Committee served more than a consultative role. It was critical to stakeholder engagement, communication strategy, program development, and implementation planning that led to the enactment of the naloxone program. The article analyzes the roles of actors involved, the goodwill and volunteerism which characterized the group's processes, the way the Committee was used as a strategic legitimizing mechanism, the strategic framings used to garner support, emergent tensions, and the evolving nature of the Committee.

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Maine Center for Disease Control and Prevention. Maine CDC Releases New Guidelines to Help Practitioners Care for Drug-Affected Babies. Association of State and Territorial Health Officials, Accessed February 27, 2014.

Maine CDC released Snuggle ME, a practitioner's comprehensive guide to caring for drug-affected babies and their families from the prenatal period through the first year of life. Maine CDC Snuggle ME is the product of a workgroup of volunteer stakeholders who came together to try to standardize care and ease frustrations. It includes screening for substance use in pregnancy; provider checklist for care; antepartum care by trimester; intrapartum care; postpartum care; newborn care; family educational materials, including a trifold and longer family packet; and resource lists for providers.

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L.A. Milner, L.S. Ham, and B.L. Zamboanga. 2014. Adolescents Misusing Prescription Drugs: Who's the Riskiest Users of Them All? Journal of Substance Abuse 19(1–2):68–74, ddoi:10.3109/14659891.2012.734541.

This small study examined differences in risky behaviors (hazardous drinking and externalizing symptoms) and impulsivity among adolescents (N = 111) who reported current prescription drug misuse (PDM) and underage alcohol use (i.e., PDM and alcohol use in past 30 days; n = 37), current underage alcohol use only (i.e., past-30-day alcohol use but no PDM in past 30 days; n = 37) and those who reported no alcohol or drug use in past 30 days (n = 37). Adolescents who reported current PDM also reported higher levels of hazardous alcohol use and impulsivity than adolescents in the current alcohol-only and current nonuser groups. They also reported more externalizing symptoms than current nonusers.

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A.H. Oliveto, M.J. Mancino, J. Thostenson, S. Ingerman, S. Day, and T.L. Kramer. 2014. Acceptability of Shamanic Healing for Treating Psychostimulant Dependence: A Pilot Survey. Focus on Alternative and Complementary Therapies, 19(1):16–21, doi: 10.1111/fct.12092.

Psychostimulant users in central Arkansas interested in participating in ongoing treatment research were surveyed to determine willingness to participate in research involving shamanic healing. Of 103 respondents, 74.8 percent were willing to participate, with women being more likely than men to participate (χ2=4.21, P=0.04). Religious affiliation, age, race, primary drug problem and prior experience with an alternative therapy were not associated with willingness to participate (P>0.1). Respondents stating that participation would be against their religious beliefs always had an evangelical religious affiliation (χ2=6.32, P=0.04). Respondents stating that they needed more information were most likely to have a traditional religious affiliation (χ2=7.54, P=0.02). Those reporting time commitment as the reason for refusal were more likely to have experienced an alternative therapy (χ2=7.88, P=0.005).

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Y. Olsen and J. M. Sharfstein. 2014. [Viewpoint] Confronting the Stigma of Opioid Use Disorder—and Its Treatment. Journal of the American Medical Association, doi:10.1001/jama.2014.2147.

Researchers argue that it is time to confront the stigma associated with opioid use disorder and its treatment with medications. They discuss four factors contributing to stigma. They suggest health care practitioners counter stigma by adopting accurate, nonjudgmental language to describe this disorder, those it affects, and its therapy with medications. States, they suggest, can promote provision of comprehensive health services in opioid treatment programs and expand access to effective therapies in the criminal justice system. The public can support broad access to effective treatment with medications.

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C. Saveland, L. Hawker, B. Miedema, and P. Macdougall. 2014. Abuse of Family Physicians by Patients Seeking Controlled Substances. Canadian Family Physician 60(2):e131–36.

Researchers examined career prevalence and monthly incidence of verbal or physical abuse of family physicians by controlled substance prescription seekers. They distributed a four-page survey to 316 family physicians attending a continuing medical education event in Halifax, Nova Scotia. Fifty-six percent (n=178) of the surveys were returned. Half the respondents were men and participants had practiced 20 years on average. Most were in private practice, and half practiced in urban settings. Overall, 95 percent of study participants reported having experienced at least 1 incident of minor abuse; 48 percent had experienced at least 1 incident of major abuse; and 17 percent had experienced at least 1 incident of severe abuse during their careers. Further, 30 percent reported having been abused in the past month; among those, the average number of abusive encounters was 3. Most (82 percent) of the abusers were male with a history of addiction (85 percent) and mental illness (39 percent). Most abusers wanted opioids. Respondents complained of a lack of police support in rural areas.

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J. Strang, S.M. Bird, and M.K.B. Parmar. 2014. Take-Home Emergency Naloxone to Prevent Heroin Overdose Deaths after Prison Release: Rationale and Practicalities for the N–ALIVE Randomized Trial. Journal of Urban Health 90(5):983–96.

The naloxone investigation (N–ALIVE) randomized trial commenced in the United Kingdom in May 2012, with the preliminary phase involving 5,600 prisoners on release. The trial is investigating whether heroin overdose deaths postprison release can be prevented by prior provision of a take-home emergency supply of naloxone. Overdoses are usually witnessed, so drug users and family members are a vast intervention workforce who can intervene, but whose responses are currently often inefficient or wrong. Approximately 10 percent of provided emergency naloxone is thought to be used in subsequent emergency resuscitation. One in 200 prisoners with a previous history of heroin injecting will die of a heroin overdose within 4 weeks of release. That means overdose death is a relatively rare event: hence, large numbers of prisoners need to enter a trial to assess whether take-home naloxone significantly reduces the overdose death rate. The full N–ALIVE trial will involve 56,000 prisoners on release.

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V. Trezza, P.J.J. Baarendse, and L.J.M.J. Vanderschuren. 2014. On the Interaction Between Drugs of Abuse and Adolescent Social Behavior. Psychopharmacology, 10.1007/s00213–014–3471–z.

This article reviewed the interaction between drugs of abuse and juvenile/adolescent social behavior. Social play behavior has reinforcing properties and is affected by drugs of abuse. Social risk factors for drug use and addiction include antisocial personality traits and early social insults. Social play behavior is highly rewarding in laboratory animals, and it is affected by low doses of opioids, cannabinoids, ethanol, nicotine, and psychostimulants. In humans, antisocial personality traits, most prominently in the form of conduct disorder, are a prominent risk factor for drug addiction. Preclinical studies consistently show altered sensitivity to drugs as a result of social isolation during postweaning development. A person's social environment has a profound, but complex, influence on drug use. Perinatal drug exposure markedly alters later social interactions.

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A.W. Van Zyl. 2014. Substance Abuse and Oral Health—An Overview: Clinical Review. South African Dental Journal 69(1):8, 10–14.

Substance abuse may involve licit and illicit drugs, with licit substances claiming more lives than illicit drugs. Illicit substance abuse is increasing. New drugs emerge faster than scientific studies can determine their possible detrimental influences on health. Many abused drugs have oral health complications.

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Veterans Administration's Lack of Pain Treatment Options Led to Opiate Addiction, Vet Says
ABC News
February 25, 2014

This article and video (4 minutes, 54 seconds) discuss Justin Minyard's prescription drug addiction and the Veterans Administration's lack of options to help most veterans. The 34-year-old Army infantryman, who served in Iraq and Afghanistan, received help when a doctor at Fort Bragg helped him obtain a spinal cord stimulator. He has been clean for more than two years. The Veterans Administration started an Opioid Safety Initiative to increase access to alternative therapies. The principal deputy undersecretary for health said the agency previously employed 115 pain specialists in the entire country, or one for every 50,000 veterans in pain.

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VA Cites Drop in Opiate Prescriptions, but Some Lawmakers Skeptical of Progress
ABC News
February 26, 2014

U.S. Department of Veterans Affairs senior officials told a panel of House lawmakers that the VA has reduced the number of veterans receiving opiates by 20,000 since October in response to congressional pressure and media scrutiny. Representative Dan Benishek said it remains to be seen whether alternative therapies will generate meaningful results for veterans. In October, the VA officials promised to develop a plan to combat the problem. As a result, it created an Opioid Safety Initiative which builds on pilot programs already under way in various cities. The VA spokeswoman said that between September and December, patients receiving an opioid prescription declined from 665,786 to 646,234.

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Policy Focuses on Misuse of Prescription Medication
Bayonet and Saber
February 26, 2014

Officials say prescription drug abuse on Fort Benning accounted for 19 percent of criminal drug investigations in 2013. The most common types of prescription abuse include using a drug prescribed to a person by a doctor beyond 6 months of issue, use of another person's prescription drugs by a person who does not have a prescription, sales of prescription drugs that were legally issued to an individual on a valid prescription, theft of prescription drugs, and use of a valid prescription in excess of recommended dosage. Policy changes include requiring soldiers to lock up prescription drugs in barracks rooms and vehicles; making out a police report for lost, stolen or destroyed prescription drugs; informing leaders of label warnings; and informing soldiers of ways to discard of unused prescription drugs. Soldiers who test positive through urinalysis for prescription drugs but lack a valid prescription dispensed within the past six months will violate the Uniform Code of Military Justice.

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K. Blum. 2014. IT Upgrades Bolster PDMP in Fight Against Opioid Misuse. Pain Medicine News 12(3).

A Panel of experts who presented at the American Medical Informatics Association meeting said health information technology improvements can more easily enable physicians and other providers to access patient data from state-run prescription drug monitoring programs (PDMPs), preventing narcotics abuse. The Office of the National Coordinator for Health IT, the Substance Abuse and Mental Health Services Administration and The MITRE Corporation organized 13 short-term pilot programs to improve access to PDMP data for ambulatory care providers, emergency department physicians, and pharmacists.

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Antiaddiction Groups to Food and Drug Administration: Reverse Approval of New Painkiller
February 27, 2014

Antiaddiction groups signed a petition warning the Food and Drug Administration (FDA) that if Zohydro is released to pharmacies next month, it will lead to more drug addiction and more drug-related death. The FDA approved Zohydro for patients who suffer "pain severe enough to require daily, around-the-clock, long-term treatment." Dr. Andrew Kolodny, chief medical officer of Phoenix House, said the drug is dangerous even to people who are trying to use it as directed. He believes as soon as this drug hits the market, many people will die from it. Supporters call the drug essential for patients who suffer nonstop pain from cancer, back problems, or arthritis. The FDA said it approved Zohydro because so many patients need it and because the product's benefits outweigh its risks when used as approved.

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Prescription Sleep Aid Ambien Is Newest Date Rape Drug
CBS 42
February 21, 2014

This article and video (1 minutes, 51 seconds) discuss Ambien being used in connection with date rape. Pharmacist Jim Parekh said Ambien alone can cause memory loss and hallucinations. When it is combined with alcohol or other drugs, it can be catastrophic.

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Alameda County's Safe Medication Disposal Ordinance—First in United States!
Community Anti-Drug Coalitions of America
February 27, 2014

When focus groups and local data identified the improper disposal of unused/expired medications as a significant public health concern in Alameda County, the ACT coalition enacted policy change to address the problem. Combining the expertise of various stakeholders, from waste management to the local elected officials, the coalition drafted the Safe Medication Disposal Ordinance. The ordinance, passed in July 2012, required pharmaceutical companies to create and pay for a stewardship program for the collection and disposal of unwanted and expired prescription drugs throughout the county.

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4Thought Products Releases Pill Pod to Help Protect Families and Save Lives
Digital Journal
February 28, 2014

This press release announces the Pill Pod, an addition to the array of lock boxes for securing medications at home. It comes with a preassigned four-digit code requiring no set up. It fits into standard depth medicine cabinets .The container can store up to eight pill bottles and accept taller liquid bottles

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Prescription Addiction: What Can Be Done About Rising Rx Overdoses?
February 27, 2014

This article discusses facts about drug overdose; the history of opioids; and the shift to using opioids to treat pain. The author said physicians need to assess whether a patient is at risk for drug dependence, addiction, abuse, and overdose. They must exercise caution when prescribing opioids and take greater care in prescribing the minimal number of tablets necessary for the specific medical situation.

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PRIUM Guarantees ROI on Workers' Compensation Medical Intervention Services
Fort Mills Times
February 26, 2014

PRIUM has announced a return-on-investment guarantee on its workers' compensation medical intervention services for reducing inappropriate medications on a book of claims. During a two-year ROI pilot program, PRIUM generated quarterly reports that showed hard savings from the discontinuation or reduction of clinically inappropriate medications. When compared to the cost of PRIUM's services, the aggregate ROI (actual medication cost savings versus PRIUM's fees) consistently exceeded three to one. To participate in the ROI guarantee, payers agree to use PRIUM and Ameritox medical management services. If payers in the program do not attain the agreed-on ROI on a book of claims, PRIUM will refund a portion of fees paid to achieve the guaranteed return.

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Zohdryo: The FDA–Approved Prescription for Addiction
Huffington Post
February 26, 2014

Andrew Kolodny, Chief Medical Officer of Phoenix House and President of Physicians For Responsible Opioid Prescribing, urges readers to call their United States senator's office and let the staff member know how they feel about the upcoming release of Zohydro. In addition, he wants them to ask for a Senate investigation of the FDA's decision to approve the drug. He encourages people to participate in the upcoming FED UP! Rally in the District of Columbia. A letter signed by more than 40 organizations was already sent to FDA Commissioner Hamburg, urging her to keep Zohydro off the market. Zohydro contains up to 50 milligrams of pure hydrocodone; and it can be easily crushed. Dr. Kolodny believes Zohydro's risks will outweigh benefits when taken by chronic-pain patients.

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Senators Investigate Alleged Zohydro Pay to Play
MedPage Today
February 27, 2014

Sens. Joe Manchin and David Vitter say they want answers about a long-running series of private meetings between drug company executives and federal regulators. They also want to know specifics on when and where the meetings were held, who was in attendance, how much each person was paid, food and beverage expenses, and other operational costs. The senators sent a letter to Mark Taubman, dean of the medical school at the University of Rochester, asking for financial records on two groups connected to the university—IMMPACT and ACTTION—that facilitated meetings between drug makers and FDA officials. The letter also cited concerns about the Zohydro which was approved by the Food and Drug Administration last year. Representatives from pharmaceutical companies paid between $20,000 and $35,000 to send one representative to the meetings with staffers from FDA and NIH, raising questions about potential pay to play in the industry.

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Bill to Curb Prescription Drug Abuse, Safeguard Patients Supported by NACDS
National Association of Chain Drug Stores
February 25, 2014

The National Association of Chain Drug Stores (NACDS) supports the Ensuring Patient Access and Effective Drug Enforcement Act of 2013 (H.R. 4069), which calls for a collaborative, coordinated approach to curbing prescription drug abuse and safeguarding patients. The bill would establish a workgroup to explore opportunities to reduce prescription drug abuse without compromising access to medications for patients who legitimately need them. It would include representatives of the FDA, the DEA and the White House Office of National Drug Control Policy, as well as organizations representing patients, pharmacies, prescribers, hospitals, wholesalers, state attorneys general, and law enforcement officials.

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Prescription Drug Abuse Focus of Governors' Winter Meeting Session
National Governors Association
February 23, 2014

The National Governors Association (NGA) conducted a yearlong Prescription Drug Abuse Reduction Policy Academy. NGA released an issue brief detailing lessons learned from the Academy. Findings included leadership matters; prescribing behavior needs to change; disposal options should be convenient and cost effective; prescription drug monitoring programs are underused; public education is critical; treatment is essential; and data, metrics and evaluation must drive policy and practice. Seven states—Alabama, Arkansas, Colorado, Kentucky, New Mexico, Oregon, and Virginia—worked to develop comprehensive, coordinated plans to combat this public health and safety crisis.

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M. Prasad. When Opiate Abuse Complicates Pregnancy. Contemporary OB/GYN, ModernMedicine, February 1, 2014.

The author said pregnancy may be the point of entry to the healthcare system that allows medical professionals to initiate screening women for opiate abuse. However, only 20 percent of OB/GYNs effectively screen patients for illicit drug use. Barriers to screening include physician embarrassment with posing appropriate questions, fear that patients will change practitioners if they are offended by the questions, and uncertainty about where to turn when a woman screens positive. This article discusses general instruments for screening pregnant women for substance abuse. It suggests that the most effective approach may be through a series of nonjudgmental questions, brief intervention, and referral to treatment.

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Prescription Drugs Abound on Vancouver Streets
February 26, 2014

This article discusses how easy it is to obtain prescription drugs in Vancouver, B.C. One addict listed drugs, prices, and the street corners to purchase them. Royal Canadian Mounted Police Corporal Heather Dickinson said the number of dealers is growing while police resources to deal with the problem are not. Prescription drugs are responsible for overdose deaths, home invasions and break-and-enters, pharmacy robberies, assaults, impaired driving, and fraud in the health care system.

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British Columbia Hospitals Lax in Stemming 'Explosion' of Prescription Drug Abuse, Expert Warns
February 27, 2014

Benedikt Fischer, an expert on prescription opioid abuse, says hospitals and their pharmacies are not doing enough to help reduce prescription drug abuse. The Province obtained documents under freedom of information legislation to support his claim. The documents show Vancouver-area hospitals could not account for narcotics, provided access to automated drug dispensers to ex-employees, and stored drugs with high street value in a wooden cupboard that could be easily pried open. A November 2013 internal audit of narcotics and controlled drugs at two Vancouver Coastal Health hospitals revealed lax record-keeping, storage, and disposal of drugs. High-risk findings included shortcomings in the way narcotics given to patients were recorded, how narcotics were handled and controlled in operating rooms, how access to automated drug dispensers was managed, and how narcotics designated for destruction were controlled. Moderate-risk findings included inconsistent inventory counts at hospital pharmacies, improper physical safeguards of drugs, and inadequate reporting of losses.

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Rx Pain Pills Are the Real Gateway Drugs
Ring of Fire
February 26, 2014

This article discusses how rising prices of prescription pain relievers led to increased heroin use in the United States.

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Drug Awareness of the Month: Prescription Drug Misuse
Southwest Booster
February 27, 2014

This article provides an overview of prescription drug misuse.

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Heroin Antidote Stirs Debate in United States as Deaths Rise
February 26, 2014

This article discusses what officials are doing worldwide to put naloxone in the hands of emergency personnel and the community. The executive director for Trust for America's Health said at least 17 states and the District of Columbia allow naloxone to be distributed to the public; and at least 10 of those states allow distribution to third parties, such as a family member or friend. Bills are pending in at least seven states to increase access to naloxone. In Tennessee and Utah, doctors would be allowed to prescribe it, and civil liability for those who administer it would be dropped. A Wisconsin bill seeks to broaden access to naloxone and provide legal immunity to drug users reporting an overdose. Naloxone is available by prescription in the United Kingdom, but an advisory council has called for over-the-counter distribution. Prescription take-home programs are in place in Australia, Canada, Estonia, and Russia. Norway plans to distribute nasal spray kits to drug users in its two largest cities.

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Other State and Local News

Alaska State Troopers Release Annual Drug Report
Alaska Dispatch
February 27, 2014

The 2013 Alaska State Trooper Annual Drug Report found a resurgence of heroin use and abuse of other opiates. Alcohol and marijuana continue to be the drugs of choice in rural areas but methamphetamine, heroin, and prescription drugs have been seized in smaller communities too. The Anchorage Police Department reported a 94 percent increase in heroin seizures. Seizures of synthetic cannabinoids and bath salts also rose.

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Buffalo Police Officers to Carry Heroin Antidote
Buffalo News
February 22, 2014

Buffalo police officers will soon carry Narcan. So far, 48 officers have been trained to dispense the drug using a nasal spray. Erie County Department of Health writes officers a prescription to carry the drug once their training is complete. Officers report Narcan use to the Department of Health.

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'Study Drugs' Dangers on the Rise at Florida Schools
CBS Miami
February 25, 2014

This article and video (4 minutes, 19 seconds) discuss stimulant abuse among college students in Miami. One student started using Vyvanse two years ago with a prescription from her doctor. This prescription drug is similar to Adderall. Another student got her pills from a friend without a prescription. South Florida universities have a zero tolerance policy for study drugs.

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Naloxone, Drug That Combats Heroin Overdoses, Unavailable to Most New Hampshire Emergency Responders
Concord Monitor
February 24, 2014

In New Hampshire, only emergency workers with advanced training can administer naloxone. Most emergency medical technicians are not allowed to deliver naloxone. Doctors can prescribe naloxone, but only to the person who will use it. New Hampshire law does not specifically permit police officers, public health workers or trained bystanders to administer the drug. Concord's acting police chief said he does not see Narcan coming to Concord anytime soon; and he does not see equipping Concord officers with the drug as a necessity. In 2012, the Concord Fire Department used naloxone on 40 patients; and in 2013, they used it on 59 patients. Thus far this year, the department has used naloxone on 11 patients.

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Worcester Reports 37 Suspected Drug Overdose Deaths in 2014
February 27, 2014

Worcester County, Mass., has 37 drug overdose deaths thus far in 2014, according to a report by the city police department. Local treatment providers reported that one in 200 Worcester County residents checked into substance abuse treatment for an injected drug addiction in 2013. Officials are concerned with heroin combined with Fentanyl. Since state police implemented a new case management and tracking system in Nov. 1, 2013, they have recorded 185 fatal heroin-related overdoses. That number reflects the entire state minus the three largest cities: Boston, Worcester, and Springfield. In Worcester, police reported 42 suspected overdose deaths in November and December of 2013.

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Critics Frustrated With Progress of State Drug Strategy
February 27, 2014

The Minnesota Department of Human Services released its first year report about the state's strategy to reduce drug abuse. The state said it has made progress, but critics feel that progress is minimal. The state recommended requiring doctors to get more training on spotting drug abuse as a condition of recertification, but it is not mandatory. Dr. Mark Eggen, an anesthesiologist, doubts mandating training will help. He admits that sometimes doctors prescribe too much, but he also does not want to penalize patients with chronic pain. The state says it has increased participation in the state's prescription monitoring program with more than 3,000 prescribers and dispensers added in 2013. The Minnesota Board of Pharmacy is pushing legislation this session that would strengthen the database, but will not propose to require checking it.

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Nebraska Known for Black-Market Prescription Drugs
February 25, 2014

This article and video (2 minutes, 45 seconds) discuss Nebraska as a regional source for black-market prescription drugs, in part because it has no mandatory tracking system. A bill that would establish a mandatory prescription monitoring program database in Nebraska likely will not make it out of the legislature this year.

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Bills Aimed at Cracking Down on Prescription Drug Abuse Advance to the Senate
February 25, 2014

Oklahoma committee members approved a bill that would help reduce prescription drug abuse. The bill will now be heard in the full Senate. The bill would require doctors to check Oklahoma's online prescription database before prescribing highly abused drugs. This would help prevent people from seeing multiple doctors just to get the drugs they want.

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'Doggy Doctor Shopping' Case Has Police Cautioning Veterinarians to Be Aware
February 22, 2014

This article and video (2 minutes, 19 seconds) discuss an arrest of a Utah man who went "doggy doctor shopping" for tramadol. The police department believes the man gave some medication to his dog and he took some for himself. The dog owner admitted to visiting about six veterinarian clinics since July. He was charged with prescription fraud.

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Drug Enforcement Administration Addresses Increased Student Use of Prescription Drug
February 26, 2014

This article and video (1 minute, 54 seconds) discuss the increase in the use of Xanax by students in North Texas. Four students at Thomas Jefferson High School were rushed to the hospital after using Xanax this month. The DEA said Xanax can often lead to less expensive, more dangerous heroin abuse. DEA agents continue to warn schools about the problem as they work to arrest dealers. Pharmacies in Texas are now sharing information about people looking for Xanax and other prescription drugs.

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Cheaper, More Available Than Prescription Drugs, Heroin Addiction Now an 'Epidemic' Says DHHS
New Hampshire Union Leader
February 26, 2014

New Hampshire Department of Health and Human Services, Bureau of Drug and Alcohol Services said heroin use across the state has reached epidemic proportions. It said, in an issue brief, the increase may be due to people addicted to pain medication buying heroin because it is cheap and easily accessible. The brief provides strategies and resources for communities, professionals, and the public to learn more about heroin abuse in the state and what they can do.

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Column: Guard Against Misuse of ADHD Medications
Salem News
February 25, 2014

This article discusses Adderall, the most misused drug among all prescription stimulants. Widespread misuse occurs on high school and college campuses because students with legitimate ADHD diagnoses and prescriptions share their medication. DanversCARES encourages parents to speak with their child's physician about all of the child's medications. Also, parents should speak with their children about the importance of using medication only as prescribed and only to treat specific and diagnosed medical conditions.

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Sen. Ed Markey and Chris Herren to Combat Recent Spikes in Overdose Deaths
February 25, 2014

Massachusetts Sen. Ed Markey outlined a three-part plan for the opiate drug epidemic including an expansion of naloxone programs for bystanders and first responders, greater access to addiction treatments, and modernizing America's treatment system. Markey introduced legislation of the "Opioid Overdose Reduction Act" that will create a federal 'Good Samaritan' provision to shield people who administer naloxone in an emergency.

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State Police Tackle Trio of Drug Problems
February 26, 2014

This article discusses Pennsylvania State Police efforts to address the heroin epidemic, illegal use of prescription drugs, and the proliferation of meth labs. State police are focused on dismantling large drug trafficking organizations and obstructing drug transport routes in Northeast Pennsylvania and across the state. Drug Strike Force units have been established in six regions to address traffickers using electronic interceptions. Undercover units have intercepted drugs being shipped through commercial rail, buses, and airports.

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Western Pennsylvania Emergency Rooms Altering Policies on Painkillers
Trib Total Media
February 24, 2014

A patient who arrives at an Excela hospital complaining of pain is allowed only 24 to 48 hours of medication. There are no refills. Doctors can use electronic records to chart how many times a patient has been to any Excela emergency room seeking medication. West Penn–Allegheny Hospital recommends no opioids to any first-time patient in an emergency room except for cancer-related pain.

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Dept. of Health and Social Services Makes the Case for Funds to Battle Addiction
WDDE 91.1 FM
February 27, 2014

The Rhode Island Department of Health and Social Services wrapped up its testimony before the budget writing Joint Finance Committee (JFC) asking for about $3.6 million to reduce opioid addiction. The proposed funding would put about 20 new addiction treatment specialists in the community and strengthen employment programs. The governor asked for another $2 million, but did not outline how it would be spent. The funding request will receive further consideration in early June during JFC budget markup hearings.

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Watchdog Report: Heroin Abuse Soars in West Michigan
February 24, 2014

This article and video (5 minutes, 55 seconds) discuss a comeback in heroin use in West Michigan. Nearly 20 percent of all overdose deaths in Kent County last year were from heroin. Officials say people addicted to prescription pain relievers turn to heroin when pills run out. A Grand Rapids Police Lieutenant said a nationwide crackdown on "doctor shopping" has had the unintended consequence of fueling more heroin use. Since May, Grand Rapids police have responded to 21 heroin overdose cases, 8 resulting in death. The number of people checking into Michigan rehabilitation facilities for heroin addiction has more than tripled over the last 20 years.

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Sen. Casey Pushes for Legislation that Puts in Place Robust Plan to Address Opioid Abuse
February 27, 2014

U.S. Sen. Bob Casey pushed for passage of legislation that would include new training for prescribers, establish grants for states to educate residents on the dangers of prescription drug abuse, and promote safe medication disposal.

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Other Resources

S. Feinberg, M. Leong, J. Christian, C. Pasero, A. Fong, and Rachel Feinberg. ACPA Resource Guide to Chronic Pain Medication and Treatment: 2014 Edition. American Chronic Pain Association, Accessed February 27, 2014

The American Chronic Pain Association published this guide to help consumers become better informed about the interventions available to them. It offers information about how medications work in the body, the types of medications used to manage pain including over-the-counter medications, nonopioids, opioids, antidepressants, and anticonvulsants, and much more. Complementary and alternative medicines are also discussed. An important feature of the Resource Guide is the attention given to using medications safely. The Guide discusses passive therapies and physical modalities, such as hyperbaric oxygen, acupuncture, manipulation and mobilization, electrical stimulation devices, and trigger point injections. Also, it describes active interventions, including education, exercise, tai chi, yoga, graded motor imagery, psychological and behavioral approaches, and mind–body interventions.

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Killing Pain: Tranquilizer Nation Timeline
MedPage Today
February 26, 2014

This interactive timeline covers three decades of advertisements placed by the makers of leading tranquilizers. The ads appeared in the New England Journal of Medicine and the Journal of the American Medical Association. Many of the ads suggest a "bias" for prescribing these drugs for women to "help" as they faced the stressful life of the 1950s housewife or the anxieties of menopause. Benzodiazepine manufacturers also promoted the drugs for treatment of ulcers, heart disease, and alcoholism.

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Webinar Archive

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

This Webinar will explore various perspectives on local and national roles on prescription drug abuse and prevention.

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#1. Rx for Understanding: The Basics About Teen Prescription Drug Abuse
#2. Rx for Understanding: Getting to Know the Guide on Prescription Drug Abuse Prevention
#3. Prescription Drug Abuse Prevention: Providing Standards-Based Health Education in Your School

National Education Association
Accessed February 28, 2014

The National Education has on-demand Webinars on prescription drug abuse useful for educators and the community.

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

This Webinar will discuss current trends in adolescent girl substance use as well as effective strategies for intervention, treatment, and support for girls. After completing this Webinar, participants will have a working understanding of how the terms gender-responsive, trauma-informed, culturally relevant, recovery-oriented, family-centered, and age-appropriate apply to effective services for girls.

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Papantonio: Big Pharma's War on Women (Video)
Ring of Fire
August 26, 2013

Host Mike Papantonio talks about Big Pharma's war on women with Linda Lipsen from the American Association for Justice. (Duration: 12 minutes, 1 second)


Video: Protecting Teens From Prescription Drug Abuse
February 25, 2014

A dramatic increase in overdoses at Thomas Jefferson High School in Dallas prompted the school to take action. The school has already had 30 incidents involving prescription drug abuse this semester. Jason Wheeler talked with a pharmacy expert about steps parents can take to keep young people safe. (Duration: 3 minutes, 46 seconds)


Grant Announcements

Research to Prevent Prescription Drug Overdoses
Centers for Disease Control and Prevention, Department of Health and Human Services
Letter of Intent Deadline: February 14, 2014
Proposal Deadline: 5:00 p.m. (EDT), March 19, 2014
http://www.grants.gov/search-grants.html?agencies percent3DHHS percent7CDepartment percent20of percent20Health percent20and percent20Human percent20Services

Research on Integration of Injury Prevention in Health Systems
Centers for Disease Control and Prevention, Department of Health and Human Services
Letter of Intent Deadline: February 14, 2014
Proposal Deadline: 5:00 p.m. (EDT), March 19, 2014
http://www.grants.gov/search-grants.html?agencies percent3DHHS percent7CDepartment percent20of percent20Health percent20and percent20Human percent20Services

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

Take-Back Events and Drop Boxes

Drug Drop Draws 200 Pounds of Dope a Year: Prescription Drop-Off Box Available at Bemidji LEC
The Bemidji Pioneer
February 22, 2014

Aransas Pass Offers Year-Round Disposal of Expired Prescription Drugs
February 21, 2014

Oneonta Tackles Prescription Drug Abuse With Safe Disposal Option
CNY News
February 24, 2014

Altoona Police Install Year-Round Drug Drop-Off Box
Des Moines Register
February 21, 2014

Drop-Off Prescription Boxes Coming Soon to San Patricio County
February 28, 2014

Prescription Drop-Off Program Now Full Time in Lacey, Toms River, Manchester
Lacey Patch
February 22, 2014

400 Pounds of Drugs and Needles End Up at L.A. Cop Station Each Week
LA Weekly
February 27, 2014

Pennsylvania Launches Drug Take-Back Program
Public Opinion
Accessed February 25, 2014

Marquette Police Report Increase in Drug Drop-Offs
Upper Michigan's Source.com
February 24, 2014

Beaufort County to Host Prescription Drug Disposal Events
February 27, 2014

Save the Dates

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

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

Sixth Annual American Medicine Chest Challenge National Day of Awareness and Safe Disposal of Rx and OTC Medicine
American Medicine Chest Challenge
November 8, 2014

Upcoming Conferences and Workshops

Pain Management Through a Wide Lens: Balancing Safety and Effectiveness
March 8, 2014
St. Louis, Missouri

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

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

2014 Harold Rogers PDMP National Meeting
Brandeis University, Prescription Drug Monitoring Program Training and Technical Assistance Center
September 23–25, 2014
Marriot Metro Center
Washington, D.C.
The Weekly Update is a service provided by the SAMHSA Preventing Prescription Abuse in the Workplace Technical Assistance Center (PAW) to keep the field abreast of recent news and journal articles to assist in forming policy, research, and programs to reduce prescription drug misuse or abuse. Please note, the materials listed are not reflective of SAMHSA's or PAW's viewpoint or opinion and are not assessed for validity, reliability or quality. The Weekly Update should not be considered an endorsement of the findings. Readers are cautioned not to act on the results of single studies, but rather to seek bodies of evidence. Copyright considerations prevent PAW from providing full text of journal articles listed in the Weekly Update.