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March 5, 2015



SAMHSA Prescription Drug Abuse Weekly Update
Issue 112  |  March 5, 2015
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 Medical Marijuana International News Northeast/Mid-Atlantic News South News Midwest News West News Other Resources Videos Upcoming Webinars Grant Received Grant Announcements Take-Back Events and Drop Boxes Upcoming Conferences and Workshops The Weekly Update has added a section with limited coverage of medical marijuana issues.


DEA on Fentanyl
February 21, 2015

Because of rising fentanyl deaths, the Drug Enforcement Administration (DEA) has issued a nationwide public safety alert. The DEA suspects the problem will next surface in New Mexico. (Duration: 1:37 minutes)


T.W. Park, R. Saitz, D. Ganoczy, M.A. Ilgen, and A.S.B. Bohnert. 2015. "Benzodiazepine Prescribing Patterns and Drug Overdose Mortality Among Individuals Receiving Opioid Analgesics." Addiction Science and Clinical Practice 10(Supplement 1):A48, doi:10.1186/1940-0640-10-S1-A48.

A case-cohort study of fiscal years 2004–09 Veterans Health Administration claims data compared 2,325 people who the National Death Index indicated died from a drug overdose while receiving opioid analgesics and a random sample of 404,725 others with analgesics prescriptions. Twenty-seven percent of the comparison group received benzodiazepines during the study period. Half of overdose deaths (n = 1,162) occurred when individuals were concurrently receiving benzodiazepines and opioids (adjusted hazard ratio [HR] 2.2 for formerly prescribed versus not prescribed and 3.6 for currently prescribed versus not prescribed). Overdose death risk increased as the daily benzodiazepine dose increased. When compared with clonazepam, temazepam was associated with a decreased overdose risk (HR = 0.7). Benzodiazepine dosing schedule was not associated with overdose risk.

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C. Delcher, A.C. Wagenaar, B.A. Goldberger, R.L. Cook, and M.M. Maldonado–Molina. 2015. "Abrupt Decline in Oxycodone-Caused Mortality After Implementation of Florida's Prescription Drug Monitoring Program." Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2015.02.010.

In October 2011, Florida implemented a prescription drug monitoring program (PDMP). A monthly time series analysis covering 2003–12 showed oxycodone overdose deaths declined 25 percent in the month after Florida implemented the PDMP. Monthly PDMP queries rose from 55 per registered provider 2 months after implementation to 92 per provider 4 months after implementation. An increase of one PDMP query per healthcare provider over 1 month was associated with 0.23 fewer deaths. The PDMP was also associated with a significant decline in alprazolam (Xanax, a benzodiazepine) overdose deaths (often in combination with oxycodone), but not with deaths from other prescription opioids or heroin. In January 2010, Florida increased regulatory oversight of pain management clinics, and in February 2011, the Drug Enforcement Administration took action against illegitimate Florida pain management clinics through "Operation Pill Nation." Monthly overdose deaths declined by 0.06 per clinic shutdown, with closings averaging 30 per month. To account for the effects of tamper-resistant extended-release oxycodone reaching market in August 2010, the analysis used the New York City overdose rate as a control variable.

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Journal Articles and Reports

S.M. Frenk, K.S. Porter, and L.J. Paulozzi. 2015. "Prescription Opioid Analgesic Use Among Adults: United States, 1999–2012." National Center for Health Statistics Data Brief 189.

National Health and Nutrition Examination Survey data show prescription opioid analgesic use in the past 30 days at ages 20 and over increased from 3.4 percent during 1988–94 to 5 percent during 1999–2002 and 6.9 percent during 2003–06 and 2011–12. From 1999–2002 to 2011–12, the percentage of opioid analgesic users who took an opioid analgesic stronger than morphine increased from 17 percent to 37 percent. During 2007–12, opioid analgesic use was higher among women (7.2 percent) than among men (6.3 percent) and higher among non-Hispanic white adults (7.5 percent) than among Hispanic adults (4.9 percent). Use was 6.5 percent among non-Hispanic black adults.

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K.L. Huffman, E.R. Shella, G. Sweis, S.D. Griffith, J. Scheman, and E.C. Covington. 2015. "Nonopioid Substance Use Disorders and Opioid Dose Predict Therapeutic Opioid Addiction." Journal of Pain, doi:10.1016/j.jpain.2014.10.011.

Among 199 chronic noncancer patients already undergoing long-term opioid therapy through a pain rehabilitation program, daily mean opioid dose averaged 133 mg. Addition odds rose by 1.7 for each 50 mg increase in dose. Patients with nonopioid substance use disorders had 28 times the odds of having opioid addiction.

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S. Lake, E. Wood, J. Buxton, H. Dong, J. Montaner, and T. Kerr. 2015. "Prescription Opioid Use and Non-Fatal Overdose in a Cohort of Injection Drug Users." The American Journal of Drug and Alcohol Abuse, doi:10.3109/00952990.2014.998366.

Among 1,641 injection drug users in Vancouver, Canada, interviewed between December 2005 and May 2013, 526 (32.6 percent) reported using prescription opioids, and 118 (7.3 percent) reported experiencing an overdose in the previous 6 months. In multivariate analysis, overdose odds were 1.6 for prescription opioid users compared with illicit-only opioid users.

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K.A. Mack, K. Zhang, L. Paulozzi, and C. Jones. 2015. "Prescription Practices Involving Opioid Analgesics Among Americans with Medicaid, 2010." Journal of Health Care for the Poor and Underserved 26(1):182–98, doi:10.1353/hpu.2015.0009.

Researchers examined claims from enrollees ages 18–64 in the 2010 Truven Health MarketScan® Multi-State Medicaid database, which covered 12 states. Pharmaceutical claims were used to identify 359,368 enrollees with opioid prescriptions. Indicators of potential inappropriate use or prescribing included overlapping opioid prescriptions, overlapping opioid and benzodiazepine prescriptions, long-acting/extended-release opioids for acute pain, and high daily doses. Enrollees with opioid prescriptions obtained an average of 6.3 prescriptions; 40 percent had at least one indicator of potential inappropriate use or prescribing.

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M.E. Menendez, D. Ring, and B.T. Bateman. 2015. "Preoperative Opioid Misuse Is Associated with Increased Morbidity and Mortality After Elective Orthopaedic Surgery." Clinical Orthopedics and Related Research, doi:10.1007/s11999-015-4173-5.

According to Healthcare Cost and Utilization Program Nationwide Inpatient Sample data, among patients undergoing major elective orthopaedic surgery, opioid abuse and dependence comorbidity rose from 0.095 percent in 2002 to 0.24 percent in 2011. Opioid abuse and dependence were associated with increased inpatient mortality (odds ratio [OR] 3.7), prolonged length of hospital stay (OR 2.5), more surgical complications, and nonroutine discharge (OR 2.2). Some portion of the difference results from spinal surgery patients more often being abusers than patients with less invasive surgery.

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National Safety Council: Opioid Prescription Painkillers Have Hidden, Deadly Side Effects
PR Newswire
February 26, 2015

The National Safety Council released a white paper, "The Psychological and Physical Side Effects of Pain Medications," debunking the belief that opioid pain relievers are safer options than over-the-counter pain medications. Hidden side effects of opioid pain relievers include rapidly developing addiction, withdrawal, constipation, permanent changes to brain chemistry, nausea, respiratory depression, increased sensitivity to pain, driving impairment, and lower sex drive.

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To download the full report:

S. Nielsen, A. Roxburgh, R. Bruno, N. Lintzeris, A. Jefferson, and L. Degenhardt. 2015. "Changes in Non-Opioid Substitution Treatment Episodes for Pharmaceutical Opioids and Heroin from 2002 to 2011." Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2015.02.004.

According to Australia's Alcohol and Other Drug Treatment Services National Minimum Data Set, the percentage of treatment for prescription opioids rose from 7 percent in 2002–03 to 20 percent in 2010–11. Average age at treatment commencement rose for heroin and oxycodone. Codeine and oxycodone had the lowest current or past injection rates.

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R.J. Smith, A.S. Kilaru, J. Perrone, B. Paciotti, F.K. Barg, S.M. Gadsden, and Z.F. Meisel. 2015. "How, Why, and for Whom Do Emergency Medicine Providers Use Prescription Drug Monitoring Programs?" Pain Medicine, doi:10.1111/pme.12700.

Predictably given state variations in prescription drug monitoring program (PDMP) rules and capabilities, semi-structured interviews with 61 physicians at an October 2012 national academic conference found emergency physician use varies in pattern and frequency. Physicians find PDMP data facilitates patient education and discussions about addiction.

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C. Wilder, D. Lewis, and T. Winhusen. 2015. "Medication Assisted Treatment Discontinuation in Pregnant and Postpartum Women with Opioid Use Disorder." Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2015.02.012.

Published discontinuation rates for medication-assisted treatment (methadone or buprenorphine) in pregnant and postpartum women range from 0 to 33 percent. In a Cincinnati cohort of 229 women not on Medicaid, 251 pregnancies were reported, with a prenatal methadone discontinuation rate of 11 percent. Probability of methadone discontinuation at or before 6 months postpartum was 56 percent. Duration of methadone treatment prior to delivery was inversely associated with risk for treatment discontinuation postpartum.

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E.L. Winstanley, A.K. Clark, and J. Feinberg. 2015. "Implementation of Nasal Naloxone Across Health-Care Settings: A Case Report from Ohio." Addiction Science and Clinical Practice 10(Supplement 1):A72, doi:10.1186/1940-0640-10-S1-A72.

Snowball sampling identified 21 opioid overdose prevention programs in Ohio. Nineteen programs serving 14 cities completed a brief survey in October 2014. The programs have distributed 1,935 naloxone kits and reported 152 confirmed overdose reversals. Primary funding sources were 1) the Ohio Department of Health; 2) Interact for Health (a foundation serving Southwest Ohio); and 3) local public and private agencies. Identified barriers included 1) cost of providing naloxone kits and operational costs associated with prescribing the drug; 2) stigma surrounding addiction and perceptions of naloxone as a harm-reduction strategy that would enable continued drug use; 3) legal/administrative concerns related to possession and distribution of naloxone; and 4) lack of standardized protocols or models that would facilitate operational integration into existing programming.

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Medical Marijuana

Pot Is Increasingly Legal. Employers Need to Stop Screening for It
Gina Tron, The Washington Post
February 26, 2015

This article advocates banning employee drug testing for marijuana, since the drug is already legal in some form in 23 states, and recreational use is allowed in four states. The author argues that drug tests do not measure impairment, and marijuana can show up in urine tests weeks or months after use. Testing is also expensive and a poor indicator of workplace performance. People prescribed marijuana for a disability or injury can still be fired or denied employment if they test positive for tetrahydrocannabinol (THC)—even in states where medical marijuana is legal.

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Medical Marijuana in the Workplace
Julie C. Fortier and Guylaine Lacerte, McCarthy Tétrault LLP
February 17, 2015

The authors discuss medical marijuana in Canadian workplaces, addressing how employers should deal with employees who use prescribed marijuana in the workplace, which measures should be put in place, and if parameters should be established to supervise medical marijuana use at work.

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Utah Bill Would Legalize Medical Marijuana
David Downs, Smell the Truth
February 25, 2015

Utah Senator Mark B. Madsen introduced Senate Bill 259, which would create a state registry of medical cannabis patients who could possess and use the botanical drug. The bill would also direct the state to issue licenses for cultivators, processors, and dispensaries.

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Medical Marijuana's Future Looks Hazy in the Pa. House
Wallace McKelvey, The Patriot-News
February 24, 2014

Medical marijuana will be the focus of a Pennsylvania Senate committee hearing. Representative Jim Cox said he was only able to secure about 50 co-sponsors of the 102 votes needed for his version of Senate Bill 3. The state has to ensure the distribution system is tightly regulated, and the bill's definitions must be specific and legally sound.

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International News

Nearly Half of Brits Oblivious to New Drug Driving Laws
Fleet World
February 24, 2015

A survey conducted by Kwit Fit Insurance Services showed 48 percent of United Kingdom drivers are unaware of the new drug driving law, which set very low limits for the presence of drugs such as clonazepam, diazepam, flunitrazepam, lorazepam, oxazepam, temazepam, methadone, and morphine. Sixty-five percent think more should be done to make drivers aware of the limits or which legal drugs could land them in trouble. Nevertheless, 78 percent view the measures as a positive step, with 18 percent reporting as neutral and only 4 percent saying the law is excessive.

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GMP Will Not Be Enforcing Tough New Drug-Driving Law over Concerns About the Equipment
Charlotte Cox, Manchester Evening News
February 24, 2015

Greater Manchester Police will not enforce the United Kingdom's new drug driving law. Their roadside saliva-test kits only screen for cocaine and cannabis. A driver would have to be taken to the police station to undergo a blood or urine test for the 14 other substances. Officers and medical experts have expressed concerns about the testing device and upholding the new legislation in court. There is also concern that officers have been insufficiently trained to use the device.

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VIDEO: How Prescription Drug Abuse Is Slowly Killing India
Indrani Basu, The Huffington Post
February 23, 2015

This article discusses India's prescription drug abuse problem, which was exposed in a 2014 United Nations report. The biggest concern is the unchecked over-the-counter sale of prescription drugs. According to the latest data available, in 2004, India accounted for 10 percent of total pharmaceuticals produced in the world. At that time, the law required all drugs with "abuse potential" to be sold with a prescription. This caused significant diversion. Injecting drugs were more closely linked to abuse of licit opiate pharmaceuticals than to illicit drugs. The government recently announced plans for another national survey. (Includes video: 11:31 minutes)

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Northeast/Mid-Atlantic News

Legislation to Encourage Safe Disposal of Prescription Drugs Approved by Assembly
Gina Wilder, Politicker NJ
February 25, 2015

The New Jersey Assembly and Senate have approved Bill A-2859, which would provide a safe way for residents to dispose of prescription drugs. It requires the Division of Consumer Affairs to install a prescription medicine drop-off receptacle at every state police barracks, county sheriff's department, county police department, and full-time municipal police department that agrees to participate. Police departments without receptacles would be required to post notice of the closest one.

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Federal Judge Overturns Maine Prescription Drug Law
Ed Silverman, The Wall Street Journal
February 25, 2015

Judge Nancy Torresen of the U.S. District Court in Portland, Maine, overturned a state pharmacy act that allowed residents to buy prescription drugs from foreign pharmacies. Judge Torresen said the act was preempted by federal law.

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State Legislators Approve Delay of E-Prescribing Mandate
Tracey Drury, Buffalo Business First
February 27, 2015

The New York Assembly and Senate passed legislation delaying implementation of the e-prescribing mandate until March 2016.

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Amendment Proposed to Limit Opiates Access
Wicked Local Media Solutions
February 21, 2015

A proposed amendment to Section 18 of Chapter 94C for the 2015 Massachusetts Legislative session would restrict emergency room practitioners from issuing a controlled substance prescription for a dose exceeding the amount customary for a 72-hour period.

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Dukes County Ranks High in State Study on Opiate Use
Olivia Hall, Vineyard Gazette
February 26, 2015

Massachusetts Department of Public Health data show that during 2013, 2,537 people received prescriptions for Schedule II opioids in Dukes County, Martha's Vineyard. The county ranks second in the state, with 14.7 percent of the population receiving opioid prescriptions.

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Cranston Cops Will Carry Narcan to Save Overdose Victims
Mark Schieldrop, Cranston Patch
February 20, 2015

In Cranston, R.I., police officers have been trained to carry and administer naloxone. The drug was donated by Kaléo, a pharmaceutical company based in Virginia.

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South News

Painkiller Addicted Babies on the Rise in Southeast Texas
Leah Durain, KBMT
February 19, 2015

Southeast Texas is seeing more babies born addicted to drugs—due in part to prescription drug use. The Texas Department of State Health Services said most drug-addicted babies are born in Houston, Dallas, and San Antonio. The department asked the state for $7.7 million in the 2016 budget to fund screenings, intervention tactics, and treatment referral and outreach programs for pregnant women. (Includes video: 3:37 minutes)

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Lawmakers Want Two-State Task Force to Stop Heroin
Gary A. Harki, The Virginian-Pilot
February 22, 2015

A Virginia bill sponsored by Delegate Dave Albo requests a memorandum of agreement between the governors of Virginia and Maryland to allow the states' law enforcement agencies to collaboratively stop the flow of heroin. The bill passed the Virginia House and is currently with the Senate Rules Committee.

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Midwest News

HIV Outbreak in SE Indiana Linked to Prescription Drug Abuse
Pat LaFleur, WCPO
February 25, 2015

The Indiana State Department of Health linked an HIV outbreak in Southeastern Indiana to prescription opioid abuse needles used to inject Opana. Doctors have confirmed 26 cases of HIV since mid-December. (Includes video: 54 seconds)

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Missouri House Votes in Favor of Program to Monitor Prescription Drugs
Steven Anthony, KBIA
February 26, 2015

The Missouri House passed a bill that would create a prescription drug monitoring program.

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Ohio Bill Would Expand Access to Drug Overdose Antidote
February 25, 2015

The House Health and Aging Committee approved a bill that would allow Ohio pharmacies to distribute naloxone without a prescription. The bill would also permit an individual who administered the drug to call 911 "as soon as practical" instead of "immediately before or after."

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Illinois Battles Prescription Pain-Pill Epidemic
Chris Coffey, NBC Chicago
February 20, 2015

Every week, eight people in Illinois die from prescription drug overdoses. Of 418 overdose deaths in 2012, 81 percent involved opioid pain relievers. The National Safety Council said Illinois law must be updated to improve the prescription drug monitoring program. The Illinois State Medical Society is collaborating with state legislators to address this issue. (Includes video: 3:18 minutes)

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Doctors Offer Narcotics Abuse Report to Illinois Lawmakers
February 24, 2015

The Illinois State Medical Society (ISMS) made recommendations to the Illinois House Task Force to address the state's heroin crisis. In its 30-page report are ideas for strengthening Illinois's prescription drug monitoring program. The Society wants alerts when a patient has been identified as having three or more prescribers or four or more pharmacies within a 30-day period.

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West News

Hydrocodone Is No Longer Oklahoma's Top Prescribed Drug
Public Radio Tulsa
February 26, 2015

Zyrtec allergy medication has displaced hydrocodone as the top drug prescribed to Oklahoma Medicaid patients. Hydrocodone was the most prescribed drug for more than 5 years. The drop is due to changes in state and federal guidelines that reclassified hydrocodone as a more restrictive drug.

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Hickenlooper Effort Targets Prescription Drug Overdoses in Colorado
Electa Draper, The Denver Post
February 24, 2015

The Colorado Consortium for Prescription Drug Abuse Prevention launched a statewide "Take Meds Seriously" education campaign focused on safe use, storage, and disposal of prescription drugs. The campaign features television ads and a new website.

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Other Resources

Do You Know How to Decode a Fake Pharmacy Website?
The Partnership for Safe Medicines
February 16, 2015

The Partnership for Safe Medicines released a resource to help consumers identify a fake online pharmacy. This infographic highlights five common tactics used by rogue online drug sellers to make a website appear safe and legal.

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Real Sports with Bryant Gumbel: Hooked
February 20, 2015

HBO's Real Sports with Bryant Gumbel correspondent Soledad O'Brien talks to former athletes who used heroin as a cheaper alternative to pain relievers prescribed during their playing days. (Duration: 3:16 minutes)


Upcoming Webinars

Lessons Learned from Implementing Project Lazarus in North Carolina—A Clinical and Community Based Intervention to Prevent Prescription Drug Overdose
Society for Advancement of Violence and Injury Research
Part 1: March 18, 2015, 2 p.m. (ET)
Part 2: April 1, 2015, 2 p.m. (ET)

Part 1 Registration:

Part 2 Registration:

Grant Received

Cuomo: New York Awarded More Than $8 Million to Combat Heroin, Prescription Drug Abuse
Robert Harding, Auburn Citizen
February 27, 2015

New York will receive $8.1 million from the Substance Abuse and Mental Health Services Administration to raise awareness and prevent heroin and prescription drug abuse among young adults. Funds will also be used to increase public awareness and offer training sessions on administering naloxone.

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$100K Grant Puts Focus on Fighting Opiates
Bill Kirk, The Andover Townsman
February 25, 2015

The Massachusetts Department of Public Health awarded a $100,000 grant to the Lawrence–Methuen Community Coalition to reduce abuse of heroin and other opiates. The coalition will focus its efforts on Lawrence, Methuen, Andover, North Andover, and Haverhill.

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Grant Announcements

Strategic Prevention Framework Partnerships for Success: State and Tribal Initiative
Substance Abuse and Mental Health Services Administration
Deadline: March 16, 2015

Drug-Free Communities Support Program
Substance Abuse and Mental Health Services Administration
Deadline: March 18, 2015

Drug-Free Communities Mentoring Program
Substance Abuse and Mental Health Services Administration
Deadline: April 14, 2015

Translational Avant-Garde Award for Development of Medication to Treat Substance Use Disorders
National Institutes of Health
Deadline: April 15, 2015

Take-Back Events and Drop Boxes

Municipal Alliance and Bernards Twp. Police Sponsor Medicine Drop Off Drive Through March 28
The Messenger-Gazette (New Jersey)
February 23, 2015

Prescription Drug Drop Box in Use Again at Police Station
Andrew Gorosko, The Newtown Bee (Connecticut)
February 23, 2015

Drive Through and Drop Off Unused Medications at Bernards Police Department
Emily Everson, Basking Ridge Patch (New Jersey)
February 23, 2015

Gloucester Township Drop Box Part of County's Battle Against Opiate Abuse
Anthony Bellano, Gloucester Township Patch (New Jersey)
February 21, 2015

Cherry Hill Drop Box Part of County's Battle Against Opiate Abuse
Anthony Bellano, Cherry Hill Patch (New Jersey)
February 21, 2015

Prescription Drug Drop Boxes Available Throughout Camden County
CBS (Pennsylvania)
February 20, 2015

IPD Offers Prescription Drop Off Box
Irondequoit Post (New York)
February 23, 2015

Medication Drop Box Installed at Russells Point
Jeff Kelly and Bill Tipple, WBLL/WPKO (Ohio)
February 24, 2015

La Crosse County Holds Only 2015 Medication Drop Off
WKBT (Wisconsin)
February 21, 2015

Upcoming Conferences and Workshops

Pharmacy Diversion Awareness Conferences
Drug Enforcement Administration, Office of Diversion Control
March 28–29, 2015: Birmingham, Ala.
May 30–31, 2015: Norfolk, Va.
June 27–28, 2015: Oklahoma City, Okla.

2015 AATOD Conference—Address a Public Health Crisis: Opioid Dependence
American Association for Treatment of Opioid Dependence, Inc. (AATOD)
March 28–April 1, 2015
Atlanta, Georgia

Marijuana Advocacy and Policy Summit
Drug-Free Action Alliance
March 31, April 1–2, 2015
Columbus, Ohio

This conference will explore progress in advancing sound marijuana policies at the local, regional, and national levels.

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National Rx Drug Abuse Summit
April 6–9, 2015
Atlanta, Georgia

48th Annual Communicating Nursing Research Conference—Equity and Access: Nursing Research, Practice, and Education
Western Institute of Nursing
April 22–25, 2015
Albuquerque, New Mexico

Fourth Annual Generation Rx University Conference for Collegiate Prevention and Recovery
The Ohio State University College of Pharmacy
August 4–6, 2015
Columbus, Ohio

University of Michigan Injury Center Prescription Drug Overdose Summit
University of Michigan Injury Center
November 9, 2015
Ann Arbor, Michigan
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.