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March 6, 2013

SAMHSA Prevention of Prescription Drug Abuse in the Workplace Listserv

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March 6, 2013 (PDF version)
Featured Article

PAW Webinar: Responding to the Nation's Prescription Abuse Crisis
February 28, 2013
Duration: 90 minutes

The Webinar was the second in a series presented by the SAMHSA-sponsored Preventing Prescription Abuse in the Workplace (PAW) program for SAMHSA grantees and prevention planners. This seminar focused on development and implementation of science-based prescription drug abuse/misuse prevention programs. Dr. Ted Miller, PAW project director, presented a continuum of available and possible responses and interventions. Next, he discussed how selected workplaces and communities are structuring their responses. Dr. Miller presented a range of program intervention types including evidence-based individual prevention programs, environmental prevention approaches, and various multifaceted approaches. Finally, the Webinar described SAMHSA's PAW Technical Assistance Center and the resources it offers.

To access the Webinar replay, click on link below.
To access Webinar PowerPoint slides, click on link below.
To access Webinar Fact Sheets, click on link below.
Journal Articles

S. Doyon, W. Klein-Schwartz, B.A. Anderson, and C. Welsh. 2013. "A Novel Approach to Informing the Public About the Risks of Overdose and Nonmedical Use of Prescription Medications." The American Journal on Addictions 22(2):108-22. doi:10.1111/j.1521-0391.2013.00305.x.
Researchers examined a telephone-based program of overdose prevention and screening for nonmedical use of prescription medications. Social workers with experience in substance abuse disorders were hired by a poison center to answer telephone calls from people asking for tablet identification. The social workers asked questions regarding demographics, provided the medications' ingredients, provided overdose prevention/safety information, and offered treatment referral to callers who requested it. During the 20-month study period, social workers answered 17,616 tablet identification calls from the public. The majority of callers were Caucasian with a median age of 33. Overdose prevention/safety information, aimed mostly at reducing polydrug use, was delivered to 6,635 callers (37.7 percent). Treatment resource information was provided to 3,775 callers (21.4 percent). This type of service can complement existing state/community efforts for education on nonmedical use of prescription medications.

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C.A. Jones. 2013. "Heroin Use and Heroin Use Risk Behaviors Among Nonmedical Users of Prescription Opioid Pain Relievers--United States, 2002-2004 and 2008-2010." Drug and Alcohol Dependence. doi:10.1016/j.drugalcdep.2013.01.007.
Researchers compared combined data from 2002-04 National Surveys on Drug Use and Health with combined data from 2008-10 surveys to examine patterns of heroin use and risk behaviors among past-year nonmedical users (PYNMU) of opioid pain relievers. Heroin use among PYNMU of opioid pain relievers increased between 2002 and 2004 and 2008 and 2010, but not among those reporting no PYNMU. In 2008-10, 82.6 percent of frequent nonmedical users who used heroin in the past year reported nonmedical use of opioid pain relievers prior to heroin initiation compared with 64.1 percent in 2002-2004.

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S.L. Peters, J.N. Lind, J.R. Humphrey, J.M. Friedman, M.A. Honein, M.S. Tassinari, C.A. Moore, L.L. Mathis, and C.S. Broussard. 2013. "Safe Lists for Medications in Pregnancy: Inadequate Evidence Base and Inconsistent Guidance From Web-Based Information, 2011." Pharmacoepidemiology and Drug Safety. doi:10.1002/pds.3410.
There has been a fundamental shift over the past decade in the ways in which the public obtains health information, with people tending to search online prior to consulting a healthcare provider. "Safe" lists are online lists of drugs deemed safe to take during pregnancy. In this study, researchers summarized an environmental scan that identified 25 active Internet sites listing safe medications for use during pregnancy. Researchers compared the consistency of information across sites and assessed the quality and quantity of scientific evidence on which the lists were based. Their findings highlight the inadequate evidence base and inconsistent guidance provided by these sites. The safe lists included 245 different products--of which 103 unique components had been previously evaluated in terms of fetal risk by the Teratogen Information System (TERIS), a resource that assesses birth defect risk after exposure under usual conditions. No medications from identified safe lists had evidence suggesting a moderate or high teratogenic risk. For 43 (42 percent) of the 103 components listed as "safe" on one or more of the Internet sites surveyed, TERIS experts were unable to determine fetal risk based on published scientific literature. For 40 (93 percent) of these 43, no data were available to assess human fetal risk, or available data were limited. The study identified inconsistencies in publicly available information on safety of medications used during pregnancy and showed that a large proportion of available information for such products lacks data to support safety claims. The authors concluded that women who see medication on a safe list are led to believe there is no increased risk for birth defects--therefore being reassured without scientific evidence.

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K.R. McHugh, E.E. DeVito, D. Dodd, K.M. Carroll, J. Sharpe Potter, S.F. Greenfield, H. Connery Smith, and R.D. Weiss. 2013. "Gender Differences in a Clinical Trial for Prescription Opioid Dependence." Journal of Substance Abuse Treatment. doi:10.1016/j.jsat.2012.12.007.
Researchers examined gender variations in clinical characteristics and treatment outcomes from a large clinical trial on prescription opioid dependence. Despite no pretreatment differences in opioid dependence severity, women reported significantly greater functional impairment, greater psychiatric severity, and higher likelihood of using opioids to cope with negative effects and pain than men. Women were also likelier than men to have first obtained opioids via a legitimate prescription and to use opioids via the intended route of administration. Men reported significantly more alcohol problems than women. There were no significant gender differences in medication dose, treatment retention, or opioid outcomes. Thus, despite the presence of pretreatment gender differences in this population, once the study treatment was initiated, women and men exhibited similar opioid use outcomes.

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J.L. Pilgrim, M. McDonough, and O.H. Drummer. 2013. "A Review of Methadone Deaths Between 2001 and 2005 in Victoria, Australia." Forensic Science International. doi:10.1016/j.forsciint.2013.01.028.
This study examined methadone-associated deaths reported to the coroner in Victoria, Australia, between 2001 and 2005. There were 206 deaths involving methadone--attributed predominantly to drug toxicity (137 cases), in addition to natural disease (24 cases), external injuries (44 cases), and one case where the cause was unascertained. The number of deaths each year did not rise significantly. There were 38 cases involving Physeptone®, a drug prescribed for chronic pain; 36 cases (14 percent) regarded as diversion deaths; and 9 cases where the source of methadone was unknown. The remainder involved patients in opioid replacement therapy. Diversion deaths were characterized by an individual's nonprescription use of methadone. In these cases, the coroner also described illicit use of the drug. Fifty-one individuals (25 percent; 15 females and 36 males) died within 14 days of commencing opioid replacement therapy with methadone administered via syrup. Many of these cases involved rapid dose increases of up to 25mg per day. The median starting dose was 35mg and the median (mean; range) blood methadone concentration was 0.5mg/L (0.6mg/L; 0.1-3.0mg/L). A number of cases were identified as having too high a starting dose, with 44 percent starting on 40mg or more. The OD4-methadone index indicated a substantial increase in relative methadone toxicity, from about 28 per million dual drug delivery systems in the early 1990s to more than 60 in 2005. Ninety-eight percent of cases involved use of other central nervous system depressants, including opioids, antidepressants, antipsychotics, and ethanol. Benzodiazepine use was most common (88 percent confirmed positive).

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News and Reports

Tweaks to Prescription Drug Law Get Initial OK
Lexington Herald-Leader
February 25, 2013

The House Judiciary Committee voted to approve changes to a 1-year-old law designed to crack down on widespread prescription drug abuse in Kentucky. Patients in hospitals, nursing homes, and hospice centers could soon be exempt from many of the requirements doctors must follow before prescribing drugs. The article reports that the law had unintended consequences, making the seriously ill and elderly subject to the same level of scrutiny as would-be prescription drug traffickers. The bill also gives surgery patients a 14-day exemption.

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New York Law Targets Painkiller Abuse
Pain Medicine News
March 2013

This article discusses the prescription drug monitoring database program in New York. Although advocates call it a national model, critics say the program is unwieldy and unhelpful. The Internet System for Tracking Over-Prescribing (I-STOP) Act is a registry that doctors or their designees must consult before writing prescriptions for controlled substances. Pharmacists filling these prescriptions will be required to check the registry and update it in real time. Several physician and patient advocacy groups, including the Medical Society of the State of New York, expressed concern that the program would restrict access to care. The legislation takes effect on Aug. 27, 2013.

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Kansas Prescription Drug Monitoring Program Gets Boost
Kansas Health Institute
February 26, 2013

Kansas, Mississippi, and three other states will receive free software to run their prescription drug monitoring programs as part of a pilot project launched by the National Association of Boards of Pharmacy. Doctors and pharmacists will use the system to log on to a secure Web site to review patients' prescription histories. The system can prompt the transmission of letters to providers and pharmacists when it indicates potential prescription abuse. The software is scheduled to be ready in July.

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Safe Harbor Bill to Protect Infants Wins Passage in Senate Health and Welfare Committee
February 28, 2013

Senate Bill 459, which aims to improve health outcomes for infants born to drug-addicted mothers, won passage in the Tennessee Senate Health and Welfare Committee. The bill encourages pregnant women who misuse prescription opioids to access early prenatal care and drug rehabilitation. In exchange, they would be given a safe harbor from having their parental rights terminated through a petition filed by the Department of Children's Services. The article reports that the safe harbor only applies when a mother meets requirements specified in the bill to protect the health of the fetus.

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Federal Rules Eased for Opioid Addiction Treatment Drug
American Medical News
February 25, 2013

In a speech delivered at the American Medical Association's National Advocacy Conference, the Director of the Office of National Drug Control Policy discussed his efforts to curb addiction and opioid pain reliever overdoses. A federal rule offers doctors and opioid treatment programs greater flexibility when dispensing buprenorphine--a drug used to wean patients off opiates. The article reports that the Secretary of Health and Human Services will continue to monitor abuse while applying specific buprenorphine-abuse-reduction interventions.

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Number of DUIs Involving Drugs Increasing
February 22, 2013

This article and video (2:13 minutes) discuss the rise in impaired drugged drivers in Southwest Virginia and East Tennessee. In January 2013, 11 of 14 driving-under-the-influence (DUI) arrests in Hawkins County involved drugs; nearly 80 percent were prescribed medications. Most drug-related DUI arrests occur during the day, according to the article. In 2012, Wise County, Virginia, had 105 DUIs. Ninety percent involved drugs.

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Rising Stimulant Abuse Raises Concerns on Campus
The Student Life
February 15, 2013

The Claremont Colleges are concerned about abuse of attention deficit-hyperactivity disorder stimulants such as Adderall and Ritalin. They plan to address prescription drug abuse prevention by expanding their alcohol program for first-year students. In addition, they will provide programming throughout the year for all students.

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Hamlin M.S. Continues to Investigate Prescription Drugs at School
February 27, 2013

This article and video (2:09 minutes) discuss the behavior of seven students after taking a prescription sleep aid provided by a seventh grader. Students were lethargic and unusually sleepy. The school immediately alerted parents about the incident.

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Deputy Accused of Taking Prescription Drugs From Drop Box
February 27, 2013

A Washington County sheriff's deputy faces multiple charges after he was videotaped stealing Amoxicillin, Hydroxyzine, Trazodone, and other prescription drugs from a drug take-back bin. He admitted to taking the drugs for personal use and making a copy of the key to the bin.

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Database Aids Pharmacies in Overdose Prevention Efforts
February 25, 2013

This article and video (1:05 minutes) briefly describe South Dakota's efforts to use the prescription drug monitoring database.

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VIDEO: Wisconsin Readies Narcotics Database to Fight Fraud
February 26, 2013

This article and video discuss the launch of the Wisconsin prescription drug monitoring program database designed to identify narcotic addicts and dealers. Wisconsin is one of the last states to develop a method for dispensers and doctors to coordinate prescriptions. Pharmacists will report weekly which prescriptions they fill; doctors can check the same system before writing a prescription. The article says pharmacists and hospitals are already collecting data for the system. They will enter the information in April, with a full launch planned for June.

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The Danger and Availability of Prescription Drugs
Business 2 Community
February 22, 2013

This business blog describes the growing prescription drug abuse problem, access to prescription drugs, and a brief case study about OxyContin.

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Misuse: ADHD Prescription Drug Abuse
February 26, 2013

This article and video (3:27 minutes) discuss prescription drug addiction with a 30-year-old male who was diagnosed with attention deficit-hyperactivity disorder and prescribed Ritalin at age 6. He started crushing the drug when he was in the sixth grade and used Ritalin with methamphetamines in college.

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Bill Proposes Tracking Users of Some Prescription Pills
York Dispatch
February 27, 2013

A Pennsylvania bill could result in a database designed to reduce prescription drug misuse. Its goal is to help physicians, pharmacists, and law enforcement officers identify pill seekers who may be doctor shopping. The article reports that the current database covers a limited number of drugs with high potential for addiction, and can only be accessed by the attorney general for law enforcement officers. The proposed expanded database would include more drugs and be managed by the Department of Drug and Alcohol Programs.

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Maryland Can Prevent Overdose Deaths
The Baltimore Sun
February 25, 2013

New legislation would allow family members to keep and administer Naloxone--a drug that counters opioid overdose effects. Normally, Emergency Medical Technicians administer Naloxone when they respond to an overdose call. The bill, introduced by Maryland senators, would help create a program making Naloxone available to people who can identify overdose symptoms and administer the medication. It could increase the chances of survival for people suffering from opioid overdose.

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Prescription Drug Monitoring and Distracted Driving
Iowa Public Radio
February 25, 2013

This audio recording (45:57 minutes) emphasizes how monitoring prescription drugs can help reduce abuse but might interfere with the patient/doctor relationship. Legislators are discussing a bill that would require physicians to check a database before prescribing certain medications. Prescription drug abuse is one of the fastest-growing substance abuse problems in Iowa.

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Mom Driving on a Mixture of Prescription Drugs Might Have Led to Child's Death
February 22, 2013

This video (2:21 minutes) is about a Texas mother who may have been impaired by the prescription drugs Soma and Oxymorphone when her car crashed, killing her 4-year-old daughter and injuring two of her other children.

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Other Resources

Ever Been Scammed? Learn How to Protect Yourself From Those Seeking to Abuse Medication
Pennsylvania Medical Society
Accessed February 25, 2013

This 12-page brochure is a helpful resource for physicians. Receive the free download after submitting your contact information.

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Upcoming Conferences and Workshops
Prescription Drug Misuse Roundtable Discussions
March 8, 2013
8 a.m.-3 p.m.

University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences
This meeting will focus on developing recommendations to reduce prescription drug misuse in Colorado. Key issues include prescription drug monitoring programs, provider and prescriber education, public awareness, safe disposal of prescription drugs, and data and analysis. Colorado Governor John Hickenlooper and Alabama Governor Robert Bentley co-chair the year-long policy academy designed to help states reduce prescription drug abuse.

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Preventing Prescription Drug Overdoses: A National Strategy
March 13-14, 2013
The Loudermilk Center
40 Courtland Street NE
Atlanta, Georgia
REGISTER at nsc.org/RxDrugSymposium

Are you concerned that prescription drug overdose has become one of the leading and fastest growing causes of unintentional death in the United States? More than 15,000 Americans die each year from prescription overdoses. The problem has reached epidemic proportions and now is the time to act. Join the National Safety Council as they partner with local and federal policymakers, healthcare professionals, prevention experts, and drug and alcohol treatment specialists to craft a national strategy for reducing injuries and fatalities associated with prescription drug misuse.

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National Rx Drug Abuse Summit
April 2-4, 2013
Omni Orlando Resort
1500 Masters Blvd
ChampionsGate, Florida

The 2013 National Rx Drug Abuse Summit will focus on ways to Make an Impact in the fight against prescription drug abuse. The summit is the largest national collaboration of professionals from local, state, and federal agencies; businesses; and academia, including clinicians, treatment providers, counselors, educators, state and national leaders, and advocates affected by Rx drug abuse. Through this type of collaboration, Americans can find more effective solutions to the issue the Centers for Disease Control and Prevention declared a public health crisis in 2012.
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Maryland Workers' Comp Prescription Drug Abuse Summit
April 12, 2013
8:30 a.m.-1 p.m.
BWI Marriott
1743 Nursery Rd
Linthicum, Maryland

Tentative topics include prescription narcotics abuse in Maryland's workers' compensation system, general narcotics abuse and the problem in the community, and safe prescribing. Admission is free and includes breakfast and lunch.

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Drug Enforcement Administration's Sixth National Prescription Drug Take-Back Day
April 27, 2013
10 a.m.-2 p.m.
Various Locations Nationwide

This is a great opportunity for people who have accumulated unwanted, unused prescription drugs to safely dispose of those medications. National Prescription Drug Take-Back Day aims to provide a safe, convenient, and responsible means for disposal, while educating the public about the potential for abuse of prescription medication. In the four previous Take-Back events, the Drug Enforcement Administration--in partnership with state, local, and tribal law enforcement partners--collected more than 2 million pounds (1,018 tons) of prescription medication.
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The Generation Rx University Conference for Prescription Drug Abuse Prevention and Recovery
August 7-8, 2013
The Ohio State University Blackwell Inn & Conference Center
2110 Tuttle Park Place
Columbus, Ohio

This second annual 2-day conference will provide information and resources for collegiate prescription drug abuse prevention and recovery. College students, faculty, student life staff members, administrators, counselors, student health professionals, and others are invited to participate, with a goal to develop take-home plans for prevention/recovery programs at their colleges or universities.

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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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