West Virginia University Logo

May 12, 2016

PAW Weekly Update

    

                                          
          READ ARCHIVED ISSUES                     SUBSCRIBE TO THE WEEKLY UPDATE
   

     

 
         
                                    
         
SAMHSA
           
SAMHSA Prescription Drug Abuse Weekly Update
         
         
WEEKLY
           
UPDATE
         
                             
          Issue 173  |  May 12, 2016          
   
                                                                                                                    
                                                                                                                   
The Prevention of Prescription Drug Abuse in the Workplace (PAW) TA Center addresses prescription drug abuse—a growing public health problem with increasing burdens on workers, workplaces, and our economy. To subscribe colleagues, family members, or friends to this listserv sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), please click here or send their e-mail addresses to paw@dsgonline.com.                      
               
                                                                                                                 
                                                                                                                                                                     
Index                            
Featured                            
Journal Articles and Reports                            
Professional Development                            
National                            
Marijuana                            
International                            
Northeast/Mid-Atlantic News                            
South News                            
Midwest News                            
West News                            
Other Resources                            
Webinars                            
Grant Announcements                            
Take-Back Events & Drop Boxes                            
Upcoming Conferences and Workshops                                                         
                       

Featured

M. Neeper, J. Bennett, D. Galvin, and G. Lucas. 2016. “Workplace Prevention of Prescription Drug Abuse: Pilot Assessment of a New Psycho-Educational Program.” Journal of Addiction Research and Therapy 7:277, doi:10.4172/2155-6105.1000277.                        

The authors developed and pilot-tested a webinar slide deck with handouts and supporting materials that workplace health educators and wellness champions could use in advising employees to be more cognizant of prescription drug misuse and misuse disorders. Data were acquired prior to the webinar from 68 participants. After the webinar, 25 (37 percent) completed an online follow-up survey. Eighty percent of participants were familiar with the prescription drug problem and 90 percent wanted more tools to help themselves or their workplaces to deal with the problem. Participants said the top motivations for employees to learn about prescription drugs were a desire to be better educated as consumers and concern about coworker use. Only four (16 percent) currently provided services to employees. Over 90 percent of responding employees reported increased motivation to learn about prescription misuse or deal with prescription drug risks, or plans to use webinar content in their professional work.                         

Read more:                        
http://www.omicsonline.org/open-access/workplace-prevention-of-prescription-drug-abuse-pilot-assessment-of-a-newpsychoeducational-program-2155-6105-1000277.php?aid=71815                                                  

O. Rogeberg and R. Elvik. 2016. “The Effects of Cannabis Intoxication on Motor Vehicle Collision Revisited and Revised.” Addiction, doi:10.1111/add.13347.                        

This meta-analysis found driving after marijuana use was associated with a significant, modest increase in crash risk (odds ratio [OR] = 1.36 with a random-effects model or 1.22 with a meta-regression). [Editor’s note: this OR range is equivalent to driving at a blood alcohol level of .04 to .05 (Moskowitz et al. 2005).] The meta-analysis includes studies from 13 countries published in the period 1982–2015. It used regression-adjusted estimates where available that eliminated confounding effects of differences between treatment and control groups (e.g., driver sex, day versus night) (combined sample size of 222,511) and crude counts from the remainder (17,228 total counts). Subsample analyses found crash risk estimates were higher in studies that (1) failed to control for driver alcohol intoxication, (2) were low-quality, (3) had limited controls for confounders, (4) used medium rather than high quality data, or (5) used case-control designs. In the course of their coding, the authors discovered coding errors and internally inconsistent inclusion criteria in two prior meta-analyses on this topic (Asbridge et al. 2012, Li et al. 2012). They verified with authors of the original studies that the coding was in error. They also developed an updated meta-analysis for the 1982–2010 period covered collectively by those two studies. The corrections substantially revised the published risk estimates downwards, with both originally reported point estimates lying outside the revised confidence interval. Revised estimates were similar to those of the main study.                        

Read more:                        
http://onlinelibrary.wiley.com/doi/10.1111/add.13347/abstract                                                  

Prescription for Pot                        
Kevin Glennon, Risk Management Society                        
May 2, 2016                         

Colorado, Michigan, and Vermont regulations do not require workers’ compensation insurers to pay for medical marijuana. In contrast, New Mexico’s Court of Appeals has ruled three times since May 2014 that medical marijuana should be covered under workers’ compensation policies. The Court found medical marijuana constituted “reasonable and necessary” pain treatment. In response, the state’s 2016 fee schedule set maximum compensation for medical marijuana at $12.02 per gram and limited claimants to half a pound (224 grams) every three months. The Louisiana Court of Appeals recently upheld a ruling that an employee’s prescription for a drug containing tetrahydrocannabinol was a necessary medical expense. In December 2015, Minnesota’s health commissioner included intractable pain as a condition that could be treated with medical marijuana. That ruling prompted a lawsuit seeking workers’ compensation coverage.                         

Read more:                        
http://www.rmmagazine.com/2016/05/02/prescription-for-pot                      
               
               

Journal Articles and Reports

W. Eggleston, K.H. Clark, and J.M. Marraffa. 2016. Loperamide Abuse Associated with Cardiac Dysrhythmia and Death. Annals of Emergency Medicine, doi:10.1016/j.annemergmed.2016.03.047.                

Over-the-counter oral loperamide (Imodium) misuse as an opioid substitute is increasing among patients attempting to self-treat opioid addiction. This article describes two deaths from loperamide overdose. Loperamide has μ-opioid agonist activity.                 

Read more:                
http://www.annemergmed.com/article/S0196-0644(16)30052-X/abstract                                  

M.L. Griffin, K.A. McDermott, R.K. McHugh, G.M. Fitzmaurice, R.N. Jamison, and R.D. Weiss. 2016. “Longitudinal Association between Pain Severity and Subsequent Opioid Use in Prescription Opioid Dependent Patients with Chronic Pain.” Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2016.04.023.                

Among 148 prescription-opioid-dependent patients, greater pain severity in a given week significantly increased odds of relapsing to opioid use in the following week (odds ratio = 1.15). This finding comes from multivariate logistic regressions on data collected during 12 weeks of treatment with buprenorphine-naloxone plus counseling as part of a national, randomized, controlled trial. Despite literature reports of no association between baseline pain and subsequent opioid use, this study’s findings suggest that patients who experience flare-ups of pain during dependency treatment are prone to relapse.                

Read more:                
http://www.drugandalcoholdependence.com/article/S0376-8716(16)30050-3/abstract                                  

H. Hansen, C. Siegel, J. Wanderling, and D. DiRocco. 2016. “Buprenorphine and Methadone Treatment for Opioid Dependence by Income, Ethnicity and Race of Neighborhoods in New York City.” Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2016.03.028.                

Buprenorphine treatment in New York City between 2004 to 2013 increased in all neighborhood clusters. A significantly higher rate of increase occurred in the cluster with the highest income and the lowest percentage of black, Hispanic, and low-income residents. Methadone treatment rates decreased slightly in all clusters until 2011, then returned to 2004 levels.                

Read more:                
http://www.drugandalcoholdependence.com/article/S0376-8716(16)30074-6/abstract                                  

Y. Liang, M.W. Goros, and B.J. Turner. 2016. “Drug Overdose: Differing Risk Models for Women and Men among Opioid Users with Non-Cancer Pain.” Pain Medicine, doi:http://dx.doi.org/10.1093/pm/pnw071.                

Nationwide, 206,869 Aetna Health Maintenance Program private insurance patients had no cancer diagnoses and filled at least two opioid prescriptions from January 2009 through July 2012. Women comprised 57 percent of users. They were younger than men on average and more likely to be diagnosed with headache, anxiety, posttraumatic stress disorder, depression, or psychotic disorder. They were more likely to take antidepressants, benzodiazepines, or zolpidem. During an average of 1.6 years after the first opioid prescription, 1,386 users (0.67 percent) were diagnosed with a drug overdose. Incidence of drug overdose was significantly greater for women than men (0.76 percent vs. 0.56 percent) even though average daily opioid dose was significantly lower. Half of the overdoses occurred within 1 year after the first opioid prescription, with 33 percent from years 1 to 2, 13 percent from years 2 to 3, and the remainder from years 3 and on. The largest risk factor was a history of medically treated substance use disorder.                 

Read more:                
http://painmedicine.oxfordjournals.org/content/early/2016/04/28/pm.pnw071.abstract                                  

S.E. McCabe, P. Veliz, and C.J. Boyd. 2016. “Early Exposure to Stimulant Medications and Substance-Related Problems: The Role of Medical and Nonmedical Contexts.” Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2016.03.019.                

Web-based annual surveys polled students at five public middle and high schools in southeastern Michigan during 2009–13. Of 4,755 respondents, 11.7 percent had been diagnosed with attention deficit hyperactivity disorder. A smaller 6.7 percent had used prescription stimulants medically, and 2.6 percent had used them nonmedically. Odds of other substance use and use disorders were significantly lower among those who initiated medical use before age 12 relative to later medical initiation. In contrast, those odds predictably were significantly greater for early than late initiators of nonmedical use.                

Read more:                
http://www.drugandalcoholdependence.com/article/S0376-8716(16)30006-0/abstract                                  

R.P. McCombie and H. Slanina. 2016. “Non-Medical Use of Cognitive Enhancing Prescription Medications among Occupational Therapy and Speech Language Pathology Health Care Students: A Pilot Study.” Internet Journal of Allied Health Sciences and Practice 14(2), Article 4.                

Researchers mailed surveys to 150 occupational therapy students and 150 speech language pathology students. The students were randomly selected from national association member lists. Only 51 responded (a17 percent response evenly balanced between the groups). Five (9.8 percent) reported using attention deficit hyperactivity disorder (ADHD) medications. Four had a legal prescription, including one who admitted faking ADHD symptoms to get the prescription. Motives for use included to improve attention/concentration, reduce hyperactivity/impulsivity, provide recreational enjoyment, or raise grades. Forty percent of respondents said misuse of prescription medications was a problem at their schools, with 30 percent saying it was easy get ADHD drugs. Students were divided about whether nonmedical use was academic cheating.                

Read more:                
http://nsuworks.nova.edu/ijahsp/vol14/iss2/4                                  

S.G. Morgan, D. Weymann, B. Pratt, K. Smolina, E.J. Gladstone, C. Raymond, and B. Mintzes. 2016. “Sex Differences in the Risk of Receiving Potentially Inappropriate Prescriptions among Older Adults.” Age and Ageing, doi:10.1093/ageing/afw074.                

Analysis of 2013 prescription data for all 660,679 British Columbia, Canada, residents ages 65 and older applied the American Geriatrics Society criteria to identify potentially inappropriate medication use. More women (31 percent) than men (26 percent) filled one or more potentially inappropriate prescriptions in the community. In multivariate regression, community-dwelling women were more likely than men to receive a potentially inappropriate prescription (odds ratio = 1.16). Women were more likely to have inappropriate prescriptions for benzodiazepines, other hypnotics, tertiary tricyclic antidepressants, and non-selective nonsteroidal anti-inflammatory drugs.                

Read more:                
http://ageing.oxfordjournals.org/content/early/2016/04/28/ageing.afw074.abstract?sid=3708f43a-6b86-49c3-b718-a9731ceeba5b                                                   

P. Pade, P. Fehling, S. Collins, and L. Martin. 2016. “Opioid Overdose Prevention in a Residential Care Setting: Naloxone Education and Distribution.” Substance Abuse, doi:10.1080/08897077.2016.1176978.                

A survey following overdose prevention training polled 47 opioid dependent Colorado inpatients and their family members. Thirty-two percent of family members were aware that the patient had overdosed. Post-training, both patients and families were significantly better at recognizing an opioid overdose and more comfortable to assist in reversing it.                

Read more:                
http://www.tandfonline.com/doi/full/10.1080/08897077.2016.1176978                                                   

M.V. Ronan and S.J. Herzig. 2016. “Hospitalizations Related to Opioid Abuse/Dependence and Associated Serious Infections Increased Sharply, 2002–12.” Health Affairs 35(5):832–7, doi:10.1377/hlthaff.2015.1424.                

In U.S. Healthcare Cost and Utilization Project nationwide inpatient sample data, inpatient hospitalizations related to opioid misuse disorders without serious infection increased from 301,707 in 2002 to 520,275 in 2012. Hospitalizations with serious infection increased from 3,421 to 6,535. Inpatient charges—but possibly not costs—for both types of hospitalizations almost quadrupled over the same time period. In 2012, charges totaled $15 billion without infection and $700 million with infection. Medicaid was the most common payer for both types of hospitalizations.                 

Read more:                
http://content.healthaffairs.org/content/35/5/832.abstract                                  

M.Y. Takeda, J.G. Katzman, E. Dole, M.H. Bennett, A. Alchbli, D. Duhigg, and H. Yonas. 2016. “Co-prescription of Naloxone as a Universal Precautions Model for Patients on Chronic Opioid Therapy—Observational Study.” Substance Abuse, doi:10.1080/08897077.2016.1179704.                

The University of New Mexico Pain Center educated 164 chronic pain patients about the risks of opioid overdose and gave them naloxone rescue kits. None of those trained overdosed during the following year. The median morphine equivalent dose prescribed was 90 mg/day.                

Read more:                
http://www.tandfonline.com/doi/full/10.1080/08897077.2016.1179704                 
               

Professional Development

R.S. Hudspeth. 2016. “Standards of Care for Opioid Prescribing: What Every APRN [Advanced Practice Registered Nurse] Prescriber and Investigator Need to Know.” Journal of Nursing Regulations 7(1):15–20, doi:10.1016/S2155-8256(16)31036-5.                

Read more:                
http://www.journalofnursingregulation.com/article/S2155-8256(16)31036-5/abstract                 
               

National

‘You Want a Description of Hell?’ OxyContin’s 12-Hour Problem                
Harriet Ryan, Lisa Girion and Scott Glover, Los Angeles Times                
May 5, 2016                

Purdue Pharma 2 decades ago launched OxyContin, boasting its 12-hour pain relief—more than twice as long as generic medications. OxyContin soon became America’s bestselling pain reliever, and Purdue netted $31 billion in revenue. This Los Angeles Times investigation, based on thousands of pages of confidential Purdue documents, found that OxyContin wears off hours earlier in many people, and patients experience withdrawal symptoms. Purdue knew about the problem for decades before OxyContin went on the market. Clinical trials showed many patients were not getting 12 hours of relief. Since the drug’s debut in 1996, the company has been confronted with complaints from doctors, reports from its own sales reps, and independent research. “The company has held fast to the claim of 12-hour relief, in part to protect its revenue.” When many doctors began prescribing OxyContin at shorter intervals in the late 1990s, Purdue executives mobilized hundreds of sales reps to “refocus” physicians on 12-hour dosing. Purdue tells doctors to prescribe stronger doses, not more frequent ones, when patients complain that OxyContin does not last 12 hours. But the more potent the dose, the greater the possibility of overdose and death. More than half of long-term OxyContin users are on doses that public health officials consider dangerously high, according to an analysis of nationwide prescription data conducted for the Times.                

Read more:                
http://static.latimes.com/oxycontin-part1                                  

FDA Panel Urges Mandatory Opioid Training for Doctors                
Thomas M. Burton, Wall Street Journal                
May 4, 2016                

Following 2 days of hearings, an FDA advisory panel has “overwhelmingly” endorsed mandatory training for doctors who prescribe opioids, in an effort to stem what has become a national epidemic of deaths and addiction from the drugs. The committee voted unanimously to recommend an overhaul of current federal requirements to train doctors and patients about the risks of overusing the pain drugs.                

Read more:                
http://www.wsj.com/articles/fda-panel-urges-mandatory-opioid-training-for-doctors-1462405146                                  

Physicians Warn Mandatory Opioid Prescription Training Could Have Unintended Effects                
Stephen Loiaconi, KRNV                
May 5, 2016                

The American Medical Association has opposed mandatory physician education on pain management and opioid misuse in the past because concerns about burdening physicians who do not prescribe these drugs, over-regulation, and federal government encroachment on patient care. The American Academy of Family Physicians has also opposed additional mandatory training on pain reliever prescription. The organization argues that family physicians already undergo extensive training on drug prescribing and are required to complete 150 credits of continuing medical education every three years. More training requirements will burden overextended physicians and leave doctors who do not have time to take the classes unable to prescribe pain medication to patients who legitimately need them. The California Academy of Family Physicians is concerned about the unintended effects that mandatory training could have. Some doctors may decide not to provide pain treatment.                

Read more:                
http://mynews4.com/news/nation-world/physicians-warn-mandatory-opioid-prescription-training-could-have-unintended-effects                                  

Poll: Majority Say Government Not Doing Enough to Combat Opioid and Heroin Abuse                
Henry J. Kaiser Family Foundation                
May 3, 2016                

In a Kaiser Family Foundation telephone survey on April 12–19 of a nationally representative random sample of 1,201 adults, 58 percent said lack of access to care for those with substance abuse issues is a major problem. A third called heroin abuse an extremely serious health problem in the United States, while a quarter put abuse of strong prescription pain relievers in that category. Sixty percent of respondents faulted federal efforts as too little, were dissatisfied with state governments’ actions and those of doctors who prescribe pain relievers. Seventy percent believed drug users themselves are not doing enough. Forty percent said they know someone who has been addicted to pain relievers, and 20 percent said that person was a family member. When asked about potential policy actions, more than 80 percent called the following steps very or somewhat effective: increasing pain management training for medical students and doctors; increasing access to addiction treatment programs; increasing public awareness and education programs; increasing research about pain and pain management; and monitoring the habits of doctors who prescribe prescription pain relievers. Most respondents were unaware the federal government requires insurance plans to provide mental health benefits and substance use disorder treatment under the same rules they apply to other medical services.                

Read more:                
http://kff.org/health-reform/press-release/most-americans-say-federal-and-state-governments-are-not-doing-enough-to-combat-prescription-painkiller-and-heroin-abuse-large-majorities-believe-wide-range-of-strategies-would-be-effective                 
http://khn.org/news/more-action-needed-against-drug-abuse-poll                                  

Programs that Manage Opioid Prescriptions Save Lives and Protect Patients                
Celia Vimont, Partnership for Drug-Free Kids                
May 4, 2016                

At the Rx Drug Abuse and Heroin Summit, Jennifer Welch of the Pew Charitable Trusts reviewed findings about the effectiveness of patient review and restriction (PRR) programs. These insurer-based drug management programs require at-risk individuals to use designated pharmacies or physicians for opioid prescriptions Most state Medicaid programs and some private insurance and pharmacy management companies use PRR programs. In 2014, the number of beneficiaries enrolled in Medicaid PRR programs ranged from 19 in Oregon to over 5,700 in New York. Welch found many differences in how state programs operate. Tennessee’s program enrolled 96 patients in 2010. They saw a 51 percent decrease in pharmacies visited, a 33 percent decrease in prescribers visited, and a 46 percent decrease in the number of paid prescriptions among that group. Minnesota saved $1.2 million in one year after enrolling 245 patients. Oklahoma saw decreases in narcotics claims, emergency department visits, the number of pharmacies visited, and the number of prescribers seen. Welch reported that 72 percent of programs said no beneficiaries appealed their placement. Twenty-two Medicaid PRR programs lacked access to their state’s prescription drug monitoring program.                

Read more:                
http://www.drugfree.org/join-together/programs-manage-opioid-prescriptions-save-lives-protect-patients-expert                                  

U.S. Drug Enforcement Administration Involved in Prince’s Death Investigation                
KSTP                
May 4, 2016                

The U.S. Drug Enforcement Administration (DEA) and U.S. Attorney’s Office are now involved in Prince’s death investigation. They want to know where the musician got his prescription drugs, what type he was getting, and whether he was doctor shopping before he was found dead in his home. The DEA is reviewing records with the prescription drug monitoring program. Prince’s representatives had arranged for the musician to meet with a doctor to help him address his pain reliever addiction prior to his death. This article includes a timeline of key developments in Prince’s death investigation. (Includes videos: 4:36 | 13:24 minutes)                

Read more:                
http://kstp.com/news/prince-doctor-meet-painkillers-death/4126294                                  

House Committee Approves Bill to Address Opioid and Drug Abuse Epidemic                
Debra A. McCurdy, Reed Smith LLP                
May 2, 2016                

The House Energy and Commerce Committee has approved several public health bills intended to combat opioid misuse and drug addiction. H.R. 4586, Lali’s Law, authorizes grants to states for developing standing orders for naloxone prescriptions and educating health care professionals on dispensing naloxone without person-specific prescriptions; H.R. 4641 authorizes the Department of Health and Human Services (HHS) Secretary to establish an inter-agency task force to review and disseminate best practices for pain management and prescribing pain medication; H.R. 4981, the Opioid Use Disorder Treatment Expansion and Modernization Act, amends the Controlled Substances Act to expand access to medication-assisted treatment while minimizing the potential for drug diversion. H.R. 4969, James Thomas Decker Act, directs HHS to report on the resources available to youth athletes and their families regarding the dangers of opioid use and abuse, non-opioid treatment options, and how to seek addiction treatment. The legislation awaits consideration by the full House.                 

Read more:                
http://www.lexology.com/library/detail.aspx?g=9dd29fe9-a686-4426-8373-498fc021392b                                  

Safe Disposal of Prescription Medications Faces a Cost Barrier                
Surabhi Dangi-Garimella, American Journal of Managed Care                
May 4, 2016                

Safe disposal of prescription drugs is costly. Local governments including Alameda County and the San Francisco passed ordinances that require manufacturers of all prescription or over-the-counter drugs for sale in their community to fund safe disposal. Alameda County estimated annual disposal costs at $330,000, while the trade group Pharmaceutical Research and Manufacturers of America estimated the costs could cross $1 million. A national trade association that represents manufacturers of over-the-counter medications and dietary supplements is calling residents of Los Angeles County warning them about a “tax increase” due to the take-back program. Callers do not disclose take-back will be funded by manufacturers. Some trade groups proposed to fund a nonprofit organization at $1 million annually for five years to educate California residents about disposal of drugs, if local governments manage and fund the actual disposal.                 

Read more:                
http://www.ajmc.com/newsroom/safe-disposal-of-prescription-medications-the-cost-barrier                                  

Walgreens Collaborates to Fight Prescription Drug Abuse                
Businesswire                
May 3, 2016                

Walgreens has expanded its efforts to address prescription drug misuse by supporting the American Pharmacists Association Institute on Alcoholism and Drug Dependencies. The Institute is a four-day educational program that provides the pharmacy profession with vital information and resources on the disease of addiction. Through the Institute, Walgreens hopes to raise the public’s awareness of substance use disorders and take action with local communities.                

Read more:                
http://www.businesswire.com/news/home/20160503006491/en/Walgreens-Expands-Effort-Fight-Prescription-Drug-Abuse                                  

Novus Medical Detox Center Warns of Memory Loss Linked to Medications                
PR Rocket                
May 2, 2016                

Novus Medical Detox Center cautions that some anti-anxiety drugs, pain relievers, antidepressants and cholesterol-lowering drugs can cause cognitive impairment and memory loss.                 

Read more:                
http://www.pressreleaserocket.net/novus-medical-detox-center-cautions-patients-to-beware-of-prescription-medications-linked-to-memory-loss/442093                 
                 

Marijuana

J.N. Ablin, O. Elkayam, and M.A. Fitzcharles. 2016. “Attitudes of Israeli Rheumatologists to the Use of Medical Cannabis as Therapy for Rheumatic Disorders.” Rambam Maimonides Medical Journal 7(2), doi:10.5041/RMMJ.10239.                  

An e-mail survey of all 119 members of the Israeli Society of Rheumatology drew 23 responses, a 19 percent response rate. Three-quarters of respondents saw some role for cannabinoids in the management of rheumatic disease. However, three-quarters also were not confident about their knowledge of cannabinoid molecules or their ability to write a prescription for herbal cannabis.                   

Read more:                  
http://www.ncbi.nlm.nih.gov/pubmed/27101219                                      

F.R. Lamy, R. Daniulaityte, A. Sheth, R.W. Nahhas, S.S. Martins, E.W. Boyer, and R.G. Carlson. 2016. “Those Edibles Hit Hard”: Exploration of Twitter Data on Cannabis Edibles in the U.S.” Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2016.04.029.                  

A random sample of geo-located tweets collected between May 1 and July 31, 2015, was manually coded to evaluate Twitter users’ perceptions regarding edibles. Of 100,182 tweets mentioning cannabis edibles, 27 percent contained state-level geolocation. Posting was concentrated in states that allow recreational or medical use of cannabis. Most tweets were positive about cannabis edibles. Others complained of unreliability due to variability in effect intensity and duration.                  

Read more:                  
http://www.drugandalcoholdependence.com/article/S0376-8716(16)30056-4/abstract                                      

California Gearing Up to Rein in Medical Marijuana                  
Brooke Edwards Staggs, San Jose Mercury News                  
May 2, 2016                  

California legalized medical marijuana 20 years ago. Now, it will begin coordinating and enforcing consumer safety regulations and business practices across a dozen state agencies. Starting January 1, 2018, the state is expecting cannabis businesses to begin seeking one or more of its 17 types of licenses. Three agencies will issue licenses. Nine more have been charged with various oversight and review responsibilities. The Medical Board will step up procedures to investigate and discipline doctors who are not adhering to ethical standards in recommending marijuana for patients. The Department of Justice will conduct background checks on all licensees, and the Board of Equalization will issue seller permits to all retailers, oversee tax collections and help develop a system to trace the movement of all cannabis products. The Department of Fish and Game and the State Water Resources Control Board will each get more than 30 new positions to help mitigate impacts that marijuana cultivation has on the state’s waterways. The state expects to add a total of 126 jobs and spend $24.6 million on the new regulatory effort in the coming year alone.                  

Read more:                  
http://www.mercurynews.com/ci_29839704/californias-gearing-up-rein-medical-marijuana                                      

Pennsylvania Employees Protected from Discrimination After Medical Marijuana Legalized                  
Russell Boniface, Penn Record                  
May 2, 2016                  

In Pennsylvania, employers do not have to accommodate those who use medical marijuana. They cannot discriminate against an employee or applicant if they are certified to use medical marijuana. The law does not restrict an employer from disciplining an employee who is under the influence of medical marijuana when the employee’s conduct is below standards. Becky Dansky, a legislative analyst Medical Marijuana Project, noted that employers may prohibit employees from performing a task while under the influence of medical marijuana if it threatens the life to the employee or others. This includes prohibiting employees using medical marijuana from performing mining or any other employment duties at heights or in confined spaces. In addition, patients who have in their blood more than 10 nanograms per milliliter of THC may not operate or be in physical control of chemicals that require a federal or state permit, high-voltage electricity, or other public utilities. The Pennsylvania law does not require an employer to take any action violating federal law. Employers and applicants who use medical marijuana are not protected under the Americans with Disabilities Act. [Editor’s note: Weekly Update has not verified the accuracy of the legal opinions stated in this article.]                  

Read more:                  
http://pennrecord.com/stories/510718442-pa-employees-protected-from-discrimination-after-medical-marijuana-legalized                                      

Bipartisan Medical Marijuana Legislation Introduced in Ohio                  
Andrew M. Kaplan and Michael C. Griffaton, Vorys, Sater, Seymour and Pease LLP                  
May 2, 2016                  

Legislation introduced in Ohio’s house of representatives would establish a medical marijuana control commission to regulate the state’s medical marijuana policies. The bill would not permit home-growing of marijuana. The bill includes several important protections for employers. First, the legislation does not require an employer to accommodate an employee’s use of medical marijuana. Second, an employer is not prohibited from refusing to hire, discharging, or otherwise taking an adverse employment action against a person with respect to hire, tenure, terms, conditions, or privileges of employment because of that person’s use of medical marijuana. Third, the bill does not affects the authority of workers’ compensation programs to grant rebates or discounts on premium rates to employers that participate in a drug-free workplace program. Fourth, a person who is discharged from employment because of his or her use of medical marijuana would be considered to have been discharged for just cause, which disqualifies the individual from collecting unemployment. Fifth, the bill maintains the rebuttable presumption that an employee is ineligible for workers’ compensation if he or she was under the influence of marijuana and this was the proximate cause of the injury, regardless of whether the marijuana use was recommended by a physician.                  

Read more:                  
http://www.lexology.com/library/detail.aspx?g=7e69ba9d-5ed2-499d-b473-b04e0f74fb08                                      

Study: One in Six Colorado Children with Lung Inflammation Test Positive for Marijuana Exposure                  
American Academy of Pediatrics                  
April 30, 2016                  

In a presentation at the Pediatric Academic Societies 2016 Meeting, Karen Wilson, M.D., reported that she surveyed parents of previously healthy children between one month of age and two years old as part of intake when they were admitted to Children’s Hospital Colorado between January 2013 and April 2014 with bronchiolitis. (Recreational marijuana became legal in Colorado on January 1, 2014.) Urine samples showed traces of a metabolite of tetrahydrocannabinol (THC) in 16 percent of children who parents reported were exposed to marijuana smokers. More children were THC positive after legalization (21 percent compared with 10 percent). Nonwhite children were more likely to be exposed than white children. Most states that have legalized medical and recreational marijuana do not restrict its combustion around children.                  

Read more:                  
http://bit.ly/1SRILxg                                      

Vermont House Kills Marijuana Legalization, Keeps Debating Decriminalization                  
Stewart Ledbetter, WPTZ                  
May 4, 2016                  

Vermont’s house of representatives has voted against a senate-passed plan to legalize, tax and regulate recreational marijuana. Some argued the senate-proposed plan to license and tax growers and retailers—while banning home-grown plants—was too commercial. The House debated decriminalizing possession and cultivation of up to two marijuana plants, then rejected that idea. (Includes video: 2:35 minutes)                  

Read more:                  
http://www.wptz.com/news/vermont-house-kills-marijuana-legalization-but-keeps-debating-decriminalization/39361276                 
               

International

New Zealand Warriors Players Stood Down from National Team over Prescription Drug Abuse                
ABC                
May 2, 2016                

Six New Zealand Warrior players were recently banned from the National Rugby League. Five of them admitted they took a cocktail of sleeping pills and energy drinks.                

Read more:                
http://www.abc.net.au/news/2016-05-02/pill-cocktail-behind-new-zealand-players-test-ban/7376880                                  

                                                                                                
Related Article                    

Former Warriors Coach Matthew Elliot: I Always Suspected Prescription Drug Abuse                    
New Zealand Herald                    
May 5, 2016                    

A former New Zealand Warriors coach said he had suspicions that players were misusing prescription drugs during his tenure from 2012 to 2014. He lacked the proof at the time to take his concerns to the National Rugby League.                    

Read more:                    
http://www.nzherald.co.nz/sport/news/article.cfm?c_id=4&objectid=11633901                     
               
               

Northeast/Mid-Atlantic News

Opioid-Related Overdoses Increased in 2015                
Tom Relihan, The Recorder                
May 3, 2016                

Opioid-related overdose deaths increased for a fifth consecutive year in Massachusetts. In 2015, 1,379 people died of opioid-related overdoses, up 7 percent from 1,282 in 2014. Suspected opioid-related ambulance transports included 11,887 statewide in 2015. Narcan was deployed more than 12,000 times.                

Read more:                
http://www.recorder.com/Opioid-related-overdoses-continue-to-climb-in-2016-1884479                                  

Maine Passes Law to Further Regulate Opioid and Benzodiazepine Prescribing                
National Association of Boards of Pharmacy                
May 4, 2016                

Maine governor’s has signed legislation that requires prescribers and dispensers to check prescription drug monitoring program data when prescribing and dispensing a benzodiazepine or an opioid medication. Prescribers may not prescribe to a patient any combination of opioid medication in an aggregate amount in excess of 100 morphine milligram equivalents per day. Prescribers may not prescribe within a seven-day period more than a 7-day supply of an opioid medication to a patient under treatment for acute pain, and prescribers may not prescribe within a 30-day period more than a 30-day supply of an opioid medication to a patient under treatment for chronic pain. The law also requires all opioid medication to be prescribed electronically by July 1, 2017.                 

Read more:                
http://www.nabp.net/news/maine-to-require-providers-use-e-prescribing-and-check-prescription-monitoring-data-for-opioids-benzodiazepine-law-includes-new-limits-for-opioid-prescribing                                 

Committee Recommends Protocols to Combat Prescription Drug Abuse in New Jersey                
Greg Tufaro, MyCentralJersey.com                
May 2, 2016                

The New Jersey State Interscholastic Athletic Association’s Medical Advisory Committee made nine recommendations to address prescription medication misuse. Notable recommendations encouraged physicians to exercise extreme caution when prescribing opioid medications to student-athletes; and to make every effort to use non-narcotic medications. The protocols recommend educating student-athletes and their parents/guardians about the potential for addiction through physical and psychological dependence when youth take prescription opioids. They also recommend student-athletes’ treating physicians notify the school nurse and/or athletics trainer when opioids have been prescribed. The committee also recommends that school districts develop policies for student-athletes taking opiates. (Includes video: 38 minutes)                

Read more:                
http://www.mycentraljersey.com/story/sports/high-school/2016/05/02/njsiaa-recommends-protocols-combat-prescription-drug-abuse/83822662                                  

New Opioid Prescription Rules Take Effect in New Hampshire                
Mark Hayward, New Hampshire Union Leader                
May 3, 2016                

Effective May 3, New Hampshire doctors must follow rules that dictate when a physician must query the prescription drug monitoring program, what must be in written treatment agreements for long-term opioid users, and what documentation a physician must undertake when a patient’s daily opioid use exceeds 100 morphine milligrams equivalents.                 

Read more:                
http://www.unionleader.com/New-opioid-prescription-rules-in-effect-today                                  

Pennsylvania Lacks Prescription Drug-Monitoring Program Despite Law                
WPXI                
May 4, 2016                

Pennsylvania still does not have a working prescription drug monitoring program despite passing a bill in October 2014. A 6-month-long budget impasse is partially to blame. Pennsylvania’s health department expects the program to be up and running by August.                

Read more:                
http://www.wpxi.com/news/pa-still-lacks-prescription-drug-monitoring-program-despite-bill-passing-over-year-ago/259318247                                  

Most Massachusetts Doctors Do Not Check Database for Abusers                
Matt Stout, Boston Herald                
May 6, 2016                

Massachusetts’s health department reported that three out of four doctors and dentists enrolled in the state’s mandatory prescription drug monitoring program (PDMP) are not checking it. Just under 25 percent of the nearly 25,000 doctors, dentists and others enrolled in the PDMP used it to search a patient’s history in the last half of 2015. In March, the governor signed a bill requiring physicians to check the database before writing a prescription for narcotics. The state also started allowing medical residents to access the program in December 2015. Doctors blame the low numbers on a user-unfriendly system. The state plans to launch a new vendor and online system this summer.                 

Read more:                
http://www.bostonherald.com/news/local_coverage/2016/05/most_
docs_dont_check_database_for_abusers
                                  

New Jersey Governor Announces Expanded Prescription Monitoring Program                
Samantha Karas, NorthJersey.com                
May 5, 2016                

Englewood Hospital and Medical Center in New York is joining New Jersey’s prescription drug monitoring program.                 

Read more:                
http://www.northjersey.com/news/health-news/effort-to-curb-addiction-grows-1.1566735                 
               

South News

Why West Virginia’s Opioid Epidemic Is so Bad                
Harrison Jacobs, Business Insider                
May 1, 2016                

This article discusses two reasons why the opioid epidemic has hit West Virginia so hard: a disproportionate number of jobs that involve manual labor like coal mining, timbering, and manufacturing; and high rates of joblessness. Though the state’s coal mines have lost more than 7,000 jobs since 2011, the mining industry as a whole has continued to grow in the state. Workers in the mining industry use opioid to cope with injuries and some become addicted. Doctors are onsite to give people pills to treat their pain and get them back to work rather than give them rest or therapy. As of March 2016, West Virginia has the second-highest unemployment rate in the U.S., at 6.5 percent.                 

Read more:                
http://www.businessinsider.com/why-the-opioid-epidemic-is-so-bad-in-west-virginia-2016-4                                  

From Nurse to Addict: The Dangers of Opioid Abuse in Louisiana                
KATC-TV                
May 2, 2016                

Jeanne Turner, a former registered nurse, talks about battling opioid addiction for 17 years. She has been sober for five years and is now helping other Louisianans get into treatment. (Includes video: 2:12 minutes)                 

Read more:                
http://www.katc.com/story/31870604/from-nurse-to-addict-the-dangers-of-opioid-abuse                                  

North Carolina State Senators Seek to Expand Access to Overdose Drug                
Kirk Ross, Carolina Public Press                
May 3, 2016                 

The North Carolina State Health Care Committee has approved legislation authorizing the state health director to issue a statewide prescription for naloxone. It will expand access to the drug and allow people to have it on hand in the event of an overdose. The bill next heads to the Senate floor.                

Read more:                
http://carolinapublicpress.org/24785/state-senators-seek-to-expand-access-to-overdose-drug                                 

New Tool Launches in Fight Against Heroin, Prescription Opioid Use in Virginia                
Frances Hubbard, Daily Press                
May 4, 2016                

Gloucester’s Emergency Management Office launched a new website and app to address misuse of prescription opioids and use of heroin. The “Sink or Swim” campaign, a statewide initiative, builds awareness of the problem across Virginia. The website offers drug facts, drug disposal options, and testimonials from people who have been affected by drug addiction. An interactive map on the site allows visitors to type in their zip code to find hospitals, treatment centers, and support meetings.                 

Read more:                
http://www.dailypress.com/news/gloucester-county/dp-nws-mid-drug-free-va-launch-20160504-story.html                                  

Houston Sees Increase in Deaths from Abuse of Prescribed Medications                
Damali Keith, Fox 26 Houston                
May 2, 2016                 

Fox 26 News spoke to U.S. Drug Enforcement Administration (DEA) agents about the increase in prescription drug misuse and their efforts to address the problem. An estimated 129 people die every day due to a drug overdose. More people die from an overdose than car accidents and misuse prescription drugs more than cocaine, heroin, and hallucinogens combined. In Houston alone, the DEA collected 14,000 lbs. of prescription drugs during its recent drug take-back day. The DEA increasingly focuses its efforts on enforcing, educating and encouraging parents to talk with their children about the dangers of drugs. (Includes video: 2:46 minutes)                

Read more:                
http://www.fox26houston.com/health/healthworks/135970120-story                 
               

Midwest News

Central Indiana Nurses and Addiction                
Charlie De Mar, WTTV                
May 5, 2016                

Indiana has about 125,000 nurses and about 12,000 of those are in recovery or struggling with addiction. The Indiana State Nurses Assistance Program helps nurses who suffer from addiction. It oversees and monitors nurses who are impaired on the job. It also conducts random drug screens, therapy, and recovery meetings. (Includes video: 1:34 minutes)                

Read more:                
http://cbs4indy.com/2016/05/05/central-indiana-nurses-and-addiction                                  

St. Louis Could Green Light Regional Prescription Drug Database                
Camille Phillips, St. Louis Public Radio                
May 5, 2016                

The Board of Aldermen’s Health and Human Services Committee approved a bill that would allow the City of St. Louis to partner with St. Louis County, Mo., in creating a regional prescription drug monitoring program database. The bill could get a final vote from the Board of Aldermen as early as May 13.                

Read more:                
http://news.stlpublicradio.org/post/city-st-louis-could-green-light-regional-prescription-drug-database                                  

Prince’s Death Puts Spotlight on Opioid Epidemic in Minnesota                
Jeremy Olson, Star Tribune                
April 30, 2016                 

In 2015, 336 people in Minnesota died from opioid overdose, up from 313 in 2014, and six times the number in 2000. Two-thirds of the deaths involved legal pain relievers or methadone administered during addiction treatment. Half of the deaths involved victims ages 36 to 55.                 

Read more:                
http://www.startribune.com/prince-s-death-a-reminder-of-state-opioid-problem/377649911                                  

Oklahoma Emergency Responders Save 42 Lives with Naloxone                
The Oklahoman                
May 4, 2016                

Oklahoma’s health department has reported that 42 Oklahomans have been revived with Naloxone by emergency medical personnel since November 2014. More than 800 emergency medical personnel have been trained to use the drug.                

Read more:                
http://newsok.com/article/5496053                                  

North Dakota Launches ‘Stop Overdose’ Campaign                
Kelsie McMahon, WDZA                
May 5, 2016                

North Dakota launched a “Stop Overdose” campaign that encourages residents to obtain Narcan, participate in community forums, and drop-off medications at take-back events.                 

Read more:                
http://www.wdaz.com/news/north-dakota/4026200-north-dakota-launches-stop-overdose-campaign                 

West News

Reno (Nev.) Doctor, Eight Others Charged with Illegal Prescription Distribution                
U.S. Attorney’s Office, District of Nevada                
April 29, 2016                

Federal authorities have arrested Robert Rand, M.D., and eight other Reno-area residents for conspiracy to unlawfully distribute addictive prescription drugs to persons who lack a medical necessity for them. Dr. Rand is also charged with distribution of a controlled substance resulting in death.                

Read more:                
https://www.justice.gov/usao-nv/pr/reno-doctor-and-eight-others-charged-illegal-prescription-drug-distribution-case                 

Other Resources

[Film] Breaking Points                
Partnership for Drug-Free Kids                
Accessed May 4, 2016                

Breaking Points is a 30-minute documentary that explores the stress and pressure teens face every day, and the unhealthy ways they cope, including misuse of prescription stimulants not prescribed to them. It serves as a catalyst to inform discussions about what parents and communities can do to support teens struggling to manage stress.                

Watch Trailer:                
http://www.drugfree.org/breakingpoints/?utm_source=Partnership%20email%20--%20General%20%2B%20MAP&utm_medium=email&utm_campaign=Breaking%20Points                

Webinars

Human Rights, Accommodation and Medical Marijuana in the Workplace                
Canadian HR Compliance & Management                
Wednesday, June 8, 2016                 
12–1 p.m. (ET)                

This webinar will help participants to understand how medical marijuana use can affect the employer-employee relationship. It will cover: what is medical marijuana; Canadian medical marijuana laws; discrimination in employment; accommodating medical marijuana; creating policies for medical marijuana in the workplace; and drug testing.                

Register                
https://attendee.gotowebinar.com/register/5342181027592229636                                  

National Prevention Week 2016 Kick-Off Webcast                
SAMSHA and Morgan State University                
Monday, May 16, 2016                 
11–11:45 a.m. (ET)                
http://apps1.seiservices.com/samhsa/npw                                  

Preventing Youth Marijuana Use: Changing Perceptions of Risk                
Center for the Application of Prevention Technologies                
Thursday, May 19, 2016                 
2 p.m. (ET)                
https://captconnect.edc.org/event/preventing-youth-marijuana-use-changing-perception-risk                 

Grant Announcements

Prescription Drug Overdose: Data-Driven Prevention Initiative                
National Center for Injury Prevention and Control                
Due: May 27, 2016                 
http://www.grants.gov/web/grants/view-opportunity.html?oppId=282529                                  

Enhanced State Surveillance of Opioid-Involved Morbidity and Mortality                
National Center for Injury Prevention and Control                
Due: June 27, 2016                 
http://www.grants.gov/view-opportunity.html?oppId=283253                                  

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

Take-Back Events & Drop Boxes

Canadian National Prescription Drug Drop-Off Day 2016 [May 21]                
Canadian Association of Chiefs of Police                
Accessed May 5, 2016                
https://www.cacp.ca/cacp-national-prescription-drug-drop-off-day-2015.html                                  

Walgreens Opens Two San Diego Drug Drop-Off Locations                
Paul Sisson, San Diego Union-Tribune                
May 5, 2016                
http://www.sandiegouniontribune.com/news/2016/may/05/walgreens-san-diego-dropoffs                                  

Wisconsin Attorney General: Record 30 Tons of Prescription Drugs Collected                
Bill Novak, Wisconsin State Journal                
May 4, 2016                
http://host.madison.com/wsj/news/local/health-med-fit/tons-of-prescription-drugs-collected-smashes-record-state-ag-says/article_35b7ca29-5de3-5f0c-ace8-544e1f39a267.html                                  

Ohioans Dispose of Estimated 18 Tons of Pills on Prescription Drug Take-Back Day                
Jackson County Times-Journal                
May 6, 2016                
http://www.timesjournal.com/news/article_ac3c3895-a5b8-5181-8b38-76a1b3b07012.html                                  

Maine Police Collect Over 31,000 Lbs. of Medication; Drop Boxes Still Available                
Ben Hanstein, Daily Bulldog                
May 5, 2016                
http://www.dailybulldog.com/db/features/maine-law-enforcement-collects-more-than-31000-pounds-of-medication-drop-boxes-still-available                                  

Montco (Penn.) District Attorney’s Office Collects 3 Tons of Prescription Drugs                
Justin Heinze, Norristown Patch                
May 2, 2016                
http://patch.com/pennsylvania/norristown/3-tons-prescription-drugs-collected-montco-das-office-0                                  

Nearly 2.5 Tons of Drugs Turned in as Part of Drug Take-Back Day in Central Ohio                
Nick Bechtel, NBC4i                
April 30, 2016                
http://nbc4i.com/2016/04/30/more-than-2-5-tons-of-drugs-turned-in-as-part-of-drug-take-back-day                                  

Over 5,800 Lbs. of Prescription Drugs Collected on Take-Back Day in West Virginia                
MetroNews                
May 04, 2016                 
http://wvmetronews.com/2016/05/04/over-5800-pounds-of-prescription-drugs-collected-on-take-back-day                                  

Minneapolis Prescription Drug Take-Back Day Nets Over 5,000 Lbs. of Pills                
U.S. Attorney’s Office, District of Minnesota                
April 30, 2016                
https://www.justice.gov/usao-mn/pr/prescription-drug-take-back-day-nets-more-5000-pounds-unwanted-and-unused-pills                                  

3,300 Lbs. of Unwanted Prescription Drugs Collected in Omaha                
Theresa Ibekwe, Omaha World-Herald                
April 30, 2016                
http://www.livewellnebraska.com/health/pounds-of-unwanted-prescription-drugs-collected-in-omaha/article_8c936118-0f42-11e6-ac0e-13846504b98c.html                                  

Hoover (Ala.) Collects 920 Lbs. of Unwanted Drugs                
Carol Robinson, Alabama Media Group                
May 2, 2016                
http://www.al.com/news/birmingham/index.ssf/2016/05/hoover_collects_920_pounds_of.html                                  

Ellis County (Texas) Drug Take-Back Event Collects 860 Lbs. of Medication                
Midlothian Mirror                
May 4, 2016                
http://www.midlothianmirror.com/news/20160504/ellis-county-drug-take-back-event-collects-860-pounds-of-medication                                  

Twentynine Palms (Calif.) Marine Corps Base Holds Prescription Drug Take Back                
Cpl. Thomas Mudd, Marine Corps Air Ground Combat Center                
May 4, 2016                
https://www.dvidshub.net/news/197262/pmo-holds-prescription-drug-take-back#.VypYCmkUXoZ                

Upcoming Conferences and Workshops

American Pharmacists Association Institute on Alcoholism and Drug Dependencies                
American Pharmacists Association                
June 3–6, 2016                 
University of Utah                
University Guest House & Conference Center                
110 Fort Douglas Blvd                
Salt Lake City, Utah                

This 4-day educational program will provide vital information and resources on the disease of addiction. It also will provide attendees with the latest methods and techniques for working effectively toward assisting individuals in finding treatment and supporting them in ongoing recovery. Attendees will learn ways to recognize and address misuse of prescription medications and other addictive substances.                

Read more:                
http://www.pharmacist.com/apha-institute-alcoholism-and-drug-dependencies                                  

National Prevention Week—Strong as One. Stronger Together.                
SAMSHA                
May 15–21, 2016                
Nationwide                
http://www.samhsa.gov/prevention-week                                 

Twenty-Fourth Annual Meeting                
Society for Prevention Research                
May 31–June 3, 2016                
San Francisco, Calif.                
http://www.preventionresearch.org/2016-annual-meeting                                 

International Conference on Opioids                
Journal of Opioid Management                
June 5-7, 2016                
Boston, Mass.                
http://www.opioidconference.org                                  

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

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

Twenty-Ninth Annual National Prevention Network Conference                
National Prevention Network                
September 13–15, 2016                
Buffalo, N.Y.                
http://www.npnconference.org                                 

Register:                
http://www.npnconference.org/registration                  
         
                                 
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.