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May 14, 2015

 PAW Weekly Update

SAMHSA Prescription Drug Abuse Weekly Update
Issue 122  |  May 14, 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 Conference Abstracts National News Marijuana International Northeast/Mid-Atlantic News South News Midwest News West News Other Resources Video Grant Awarded Grant Announcements Take-Back Events and Drop Boxes Upcoming Conferences and Workshops


Responding to the Prescription Misuse Epidemic: Promising Prevention Programs and Useful Resources
Substance Abuse and Mental Health Services Administration
May 20, 2015, 2 p.m. EDT



Puerto Rico Governor Signs Executive Order to Legalize Medical Marijuana
Alexandra Sifferlin, Time
May 4, 2015

The governor of Puerto Rico signed an executive order permitting medical marijuana use, effective immediately. Puerto Rico's health secretary has 3 months to report on how the executive order will be implemented and what its impact will be.

Read more:

Journal Articles and Reports

G. L. Cochran, D.G. Klepser, M. Morien, and L. Lander. 2015. "Health Information Exchange to Support a Prescription Drug Monitoring Program." University of Minnesota, College of Pharmacy. Retrieved from the University of Minnesota Digital Conservancy.

In a pilot study, self-reported use of prescription drug monitoring program data by 17 emergency room prescribers was very low. Providers said prescription history was rarely available when queried. Problem lists and laboratory reports were available about 60 percent of the time.

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H.R. Davies, I. Nazareth, and I. Petersen. 2015. "Trends of People Using Drugs and Opioid Substitute Treatment Recorded in England and Wales General Practice (1994–2012)." PLoS One 10(4):e0122626, doi:10.1371/journal.pone.0122626.

From 1994 to 2012 in The Health Improvement Network (THIN) primary care database in England and Wales, 33,508 people ages 16–64 were diagnosed with drug misuse disorders, including 10,869 individuals who received opioid substitution treatment. Relative risk of opioid substitution treatment was elevated for men (2.0), people ages 16–24 (6.7), and people with low income (4.2).

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J.A. Hoppe, L.S. Nelson, J. Perrone, and S.G. Weiner. 2015. "Opioid Prescribing in a Cross Section of US Emergency Departments." Annals of Emergency Medicine, doi:10.1016/j.annemergmed.2015.03.026.

Over a 1-week period in October 2012, 19 geographically spread emergency departments—most at academic centers—logged 27,516 patient visits, including 19,321 patients who were treated and released. In pooled hand-abstracted chart reviews on the 17.0 percent of discharged patients (3,284) prescribed an opioid pain reliever (excluding tramadol), the most common diagnoses were back pain (10.2 percent), abdominal pain (10.1 percent), extremity fracture (7.1 percent), and sprain (6.5 percent). The most commonly prescribed opioid pain relievers were oxycodone (52.3 percent), hydrocodone (40.9 percent), and codeine (4.8 percent). More than 99 percent of pain relievers were immediate release, and 90.0 percent were combination preparations. Mean and median number of pills were 16.6 (SD 7.6) and 15.

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N.Y. Kirson, A. Shei, J. Bradford Rice, C.J. Enloe, K. Bodnar, H.G. Birnbaum, P. Holly, and R. Ben–Joseph. 2015. "The Burden of Undiagnosed Opioid Abuse Among Commercially Insured Individuals." Pain Medicine, doi:10.1111/pme.12768.

Among 3,928 continuously eligible Optum Health patients treated for DSM–IV prescription pain reliever abuse or dependence, monthly medical payments plus co-pay and deductibles fluctuated from $600 in months 7–12 pretreatment to $1,150 in the 6 months prior to treatment, $3,000 in the first 3 months of treatment, $1,300 in the next 3 months, and $1,100 in the following 6 months.

These figures omit any self-paid expenditures that did not involve insurance claims. Rates of diagnosed DSM–IV abuse or dependence rose from 0.07 percent in 2006 to 0.19 percent in 2011. The data come from 60 large self-insured companies with locations across the United States. Applying rates of DSM–IV prescription pain reliever abuse/dependence among privately insured individuals in the 2006–11 National Survey on Drug Use and Health to people in Optum Health, undiagnosed abuse rates were around 0.4 percent.

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G. Loheswaran, S. Soklaridis, P. Selby, and B. Le Foll. 2015. "Screening and Treatment for Alcohol, Tobacco and Opioid Use Disorders: A Survey of Family Physicians Across Ontario." PLoS One 10(4):e0124402, doi:10.1371/journal.pone.0124402.

An online survey of Ontario family physicians found little screening for prescription drug, alcohol, or tobacco misuse. Screening among adolescents was even less common.

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M.E. Menendez, J.J. Mellema, and D. Ring. 2015. "Attitudes and Self-Reported Practices of Hand Surgeons Regarding Prescription Opioid Use." Hand, doi:10.1007/s11552-015-9768-5.

In an online survey with responses from 502 U.S. hand surgeons (16 percent of those invited), 76 percent said prescription opioid abuse was a big or moderate problem in their communities, and 89 percent said opioids are overused to treat pain. Although 94 percent were confident about their clinical skills regarding opioid prescribing, only 40 percent reported often asking about a history of opioid misuse before scheduling surgery. Three in four were very or moderately comfortable refilling opioid prescriptions following fracture surgery, while only 13 percent were comfortable doing so after minor elective surgery. Half reported being less likely to prescribe opioids than they were 1 year ago. Two thirds believed the best way to reduce postoperative opioid use is to discuss pain management and expectations with the patient before surgery. Compared with primary care physicians, hand surgeons were less likely to be concerned about potential adverse patient outcomes (opioid-related addiction [67 vs. 84 percent], death [37 vs. 70 percent], sedation [57 vs. 71 percent) or prescriber outcomes (malpractice claim [22 vs. 46 percent], prosecution [15 vs. 45 percent], or censure by state medical boards [16 vs. 44 percent]).

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National Association of Boards of Pharmacy® (NABP®). 2015. Internet Drug Outlet Identification Program Progress Report for State and Federal Regulators: April 2015.

National Association of Boards of Pharmacy data since 2008 indicate 10,544 of 11,000 Internet drug outlets reviewed (96.2 percent) are out of compliance with U.S. pharmacy laws and practice standards. Currently, 88.3 percent of "Not Recommended" sites sell prescription drugs without requiring a valid prescription; 62 percent do not provide a valid address; and half offer drugs that are foreign or not approved by the Food and Drug Administration. Among Not Recommended sites, 91 percent can be traced to affiliate networks of rogue Internet drug outlets, and more than 12 percent dispense possibly fake controlled substances in violation of U.S. laws and regulations.

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C. Rowe, G–M. Santos, E. Vittinghoff, E. Wheeler, P. Davidson, and P.O. Coffin. 2015. "Predictors of Participant Engagement and Naloxone Utilization in a Community-Based Naloxone Distribution Program." Addiction, doi:10.1111/add.12961.

A San Francisco program initiated in 2003 prescribed naloxone to 2,500 opiate users during 2010–13. Of that group, 613 (25 percent) received a refill, and 257 (10 percent) reported 405 overdose reversals. Odds of renewal and reversal were higher (typically 1.7 to 2.1) among people who had witnessed an overdose or used heroin or methamphetamine. African American and Latino participants had lower odds of obtaining a refill (around 0.65).

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S.G. Weiner, P.F. Yannopoulos, and C. Lu. 2015. "Chronic Pain Patients' Impressions of an Emergency Department Opioid Prescribing Guideline Poster." Pain Medicine, doi:10.1111/pme.12776.

A Boston chronic craniofacial pain clinic in an academic emergency department (ED) asked 100 patients ages 18 and older with pain lasting 12 weeks or longer to evaluate a poster on pain medication prescribing guidelines. All but three said the poster's recommendations were reasonable and thought the poster should be displayed. Seven said seeing the poster in the ED waiting room or triage area would intimidate them.

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J.E. Zibbell, K. Iqbal, R.C. Patel, A. Suryaprasad, K.J. Sanders, L. Moore–Moravian, J. Serrecchia, S. Blankenship, J.W. Ward, and D. Holtzman. 2015. "Increases in Hepatitis C Virus Infection Related to Injection Drug Use Among Persons Aged ≤ 30 Years—Kentucky, Tennessee, Virginia, and West Virginia, 2006–2012." Morbidity and Mortality Weekly Report 64(17):53–458.

In the National Notifiable Disease Surveillance System, risk factor information was coded for only 265 of 616 confirmed cases under age 30 of acute hepatitis C (HCV) infection in Kentucky, Tennessee, Virginia, and West Virginia during 2006–12.

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Conference Abstracts

K.A. Bradley, G.T. Lapham, R. Caldeiro, and L. Marx. 2015. "Single-Item Screens for Prescription and Illicit Drug Misuse Largely Identify Primary Care Patients with Unrecognized Drug Use." Abstract from the 21st Annual HMO Research Network Conference, March 11–13, 2015, Long Beach, Calif. Journal of Patient-Centered Research and Review 2:132, doi:10.17294/2330-0698.1176.

In a 3-week feasibility test, 409 of 667 patients seen by a Puget Sound, Wash., primary care clinic completed a one-page behavioral health survey that included a single item on prescription or illicit drug use. Of 16 patients who reported drug misuse, 4 reported daily drug misuse, and 7 reported alcohol misuse. Six had been prescribed opioids in the past year, including two who were also prescribed benzodiazepines. None had a past-year substance use disorder diagnosis.

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C.T. Oleka and C. Morosky. 2015. "Maternal Characteristics of Neonates Admitted with Neonatal Abstinence Syndrome." Abstract, 62nd Annual Meeting of the American College of Obstetricians and Gynecologists, Obstetrics and Gynecology, doi:10.1097/01.AOG.0000463124.87957.4d.

Among the 48 neonates admitted to the Special Care Nursery at the Hospital of Central Connecticut from August 2006 to July 2012, mean maternal age was 27 years. Mean gestational age was 38.2 weeks. One third were positive for hepatitis C.

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Should Companies Have to Pay for Disposal of Unwanted Drugs?
Ed Silverman, Wall Street Journal
May 1, 2015

San Mateo County, Calif., became the fourth local government to adopt an ordinance requiring the pharmaceutical industry to underwrite take-back programs. At least 12 other local governments are considering similar legislation, including nine California counties. The industry believes the laws are unconstitutional and has petitioned for a Supreme Court hearing.

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CDC Chief Decries Overuse of Pain RX
Boston Herald
May 2, 2015

Addressing the Massachusetts Medical Society, Thomas Frieden, director of the Centers for Disease Control and Prevention, warned that the nation is "awash in opiates," and some doctors have ignored the risks in prescribing pain medications. Frieden said the drugs have a place in treatment, but doctors have miscalculated their risk–benefit ratio.

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Colorado Lawmakers Approve Medical Marijuana for Students in School
Brooke Singman, Fox News
May 5, 2015

Colorado lawmakers approved a bill that would allow students to have medical marijuana in schools. Children living with conditions like epilepsy, cerebral palsy, and seizures would be allowed to take doses of low-THC medical marijuana. The bill would allow parents or caregivers with a doctor's note to come into schools and administer marijuana in patch form. (Includes video: 5:36 minutes)

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Keeping Legalized Marijuana Out of Hands of Kids
John Hopkins Bloomberg School of Public Health
May 4, 2015

A recently published Pediatrics commentary, "Policy Strategies to Reduce Youth Recreational Marijuana Use," suggests regulators could learn from tobacco and alcohol industries in keeping legalized marijuana away from young people. First, regulators should use tax policy to keep prices high. Second, retail availability of marijuana should be tightly regulated, including the number of sales locations. Third, states should regulate the appearance of foods containing marijuana and reduce the amount of THC they contain. Fourth, advertising should be restricted.

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Responsible Ohio's Marijuana Legalization Issue Wouldn't Trump Employers' Drug Policies, Legal Analysis Finds
Robert Higgs, Northeast Ohio Media Group
May 8, 2015

The Dickinson Wright law firm reported to ResponsibleOhio that their proposed constitutional amendment legalizing medical marijuana "will not compel an employer to loosen their standards on drug testing or consumption in the workplace."

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Medical Cannabis Bill Sent to PA Senate
May 4, 2015

The Pennsylvania Senate Appropriations Committee approved Senate Bill 3, which would legalize medical marijuana. The bill could come up for a Senate vote soon, and the governor vowed to sign it if approved. (Includes video: 1:13 minutes)

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Groene: Approve Research into Medicinal Marijuana
George Lauby, North Platte Bulletin
May 2, 2015

State Senator Groene supports LB 390, which would create a medical marijuana pilot study at the University of Nebraska Medical Center. The study would test low-THC oil for patients who suffer from severe, hard-to-treat epileptic seizures. The bill would also allow two licensed growers of marijuana in the state.

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Government of Canada Invests in Research to Tackle Prescription Drug Abuse and Addiction
May 1, 2015

The Minister of Health announced the $7.2 million, 5-year Canadian Research Initiative in Substance Misuse (CRISM) aimed at improving the health of Canadians living with prescription drug use disorders or substance misuse. Four CRISM teams will identify and promote implementation of evidence-based interventions and programs tailored to individuals, applicable in clinical and community intervention settings, and quickly and easily implemented by health service providers and users.

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Northeast/Mid-Atlantic News

NH Prisons Implement New Restrictions on Mail Sent to Inmates
May 1, 2015

The New Hampshire Department of Corrections tightened restrictions on mail sent to inmates after finding Suboxone strips sealed in greeting cards, postcards, and layered crayon drawings. Now, all incoming mail must be written in ink or pencil or typewritten on standard stock stationery or plain postcards. Greeting cards or postcards featuring designs or pictures are no longer allowed. Drawings and stickers are also prohibited, but photos are permissible.

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Massachusetts Police Department Changes Up Drug Policies
Samantha Schoenfeld, Fox CT
May 5, 2015

Starting June 1, 2015, addicts who walk into the Gloucester Police Station in Massachusetts with drug paraphernalia asking for help will not be charged with a crime. The police department will explain the detox and recovery system and assign an "angel" to guide the person through recovery.

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DDAP and Health Release Joint Statement on PA Coroners' Overdose Death Statistics Report
May 7, 2015

In 2014, 2,489 people died from drug-related overdoses in Pennsylvania—a 20 percent increase from the previous year.

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Anonymous Donor Funds Narcan Distribution in Morris County
William Westhoven, Daily Record
May 2, 2015

An anonymous donor funded an effort in Morris County, N.J., to provide Narcan® kits to families of heroin and opiate addicts. Community Coalition for a Safe and Healthy Morris and the Partnership for Drug-Free Kids will distribute kits along with instructions and materials.

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East Texans Weigh in on Adderall Use During College Finals
Erika Bazaldua, KTRE
May 4, 2015

This article discusses Adderall use among students at Stephen F. Austin State University in Texas. Students admitted Adderall is available on campus from kids with and without prescriptions. They use the drug to study longer. (Includes video: 2:18 minutes)

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Midwest News

Work to Prevent Opiate Drug Abuse
Michael Botticelli and Chuck Porucznik, Indy Star
May 2, 2015

The director of the Office of National Drug Control Policy and executive director of the Lake County Indiana High Intensity Drug Trafficking Area praised Indiana officials for their quick response to the state's HIV outbreak and use of an evidence-based approach (needle exchange) for containment. They urged increased efforts to confront the primary source—injection drug use, particularly through prescription opioid misuse.

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DHS Commissioner Jesson Outlines State Response to Opioid Addiction Crisis
Andy Steiner, MinnPost
May 6, 2015

The Minnesota Department of Human Services and governor's office proposed legislative initiatives to address opioid addiction. Their proposals include a community-based work group to recommend improvements throughout the opioid-prescribing cycle, addressing neonatal opioid exposure with grants targeting addiction among Native American women of child-bearing age, and expanding medication-assisted treatment for opioid addiction.

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Addiction Curtails Health of Many Marion Businesses
Jona Ison, The Marion Star
May 3, 2015

Businesses in Marion, Ohio, are concerned with marijuana, heroin, pain pills, and methamphetamine. Adena Occupational Health in Chillicothe reported that 3.5 percent of more than 4,000 tests each year come back positive, mostly for marijuana, opiates, and oxycodone. Drug issues are cited across industries, from restaurants to law enforcement. Ohio's Bureau of Workers' Compensation encourages businesses to have an extensive drug-free workplace program by offering a premium rebate of up to 7 percent. The requirements include a written policy, drug testing, education, and employee assistance.

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Hydrocodone Use High in Missouri, No Patient Monitoring Required
Amanda LaBrot, KOMU
May 7, 2015

Hydrocodone is the second most prescribed drug in Missouri. Pharmacists said they see legitimate hydrocodone prescriptions and fake ones every day. The supervising pharmacist at one drug store said a monitoring program would reduce the amount of time she spends policing narcotic use, allowing her more interaction with patients. The director of Jefferson City Preferred Family Health Care said monitoring would decrease the number of people in treatment.

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Drug Lets Waunakee Police Stop Overdose Deaths
Roberta Baumann, The Waunake Tribune
May 5, 2015

In Waunakee, Wisc., police officers carry naloxone in squad cars. They have already reversed three overdoses this year.

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Narcan Stocked in Cincinnati Area Walgreens Pharmacies
Curtis Fuller, WLWT 5
May 7, 2015

Walgreens stocks Narcan® in the Cincinnati area, and a prescription is required. Pending legislation in Ohio would allow people to get the drug without a prescription.

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Program Aims at Preventing Prescription Drug Abuse
Amy L. Knapp, The Independent
May 1, 2015

Quest Recovery and Prevention Services launched pHarming Effects, a program that uses peers to help students in fourth through eighth grade understand the dangers of abusing prescription drugs. Recently, the program visited five elementary schools in Ohio. Students from Oakwood Middle School and East Canton, Minerva, and Marlington High Schools tested fourth grade students' knowledge of prescription drug misuse by performing vignettes. (Editor's note: This program is not evidence based.)

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New Overdose Drug Treatment to Be Used by Arizona First Responders
Cooper Rummel, KTAR
May 4, 2015

Governor Ducey signed a bill into law allowing Arizona first responders to administer naloxone. The state's Department of Health will train emergency service providers on use in overdose cases.

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Governor Plans to Sign Bill Fighting Prescription Drug Abuse
May 5, 2015

Nevada's governor plans to sign Senate Bill 459, the "Good Samaritan Drug Overdose Act," which will reduce criminal penalties for reporting drug overdoses and make it easier for people to access naloxone.

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Medication Lock-Boxes Available to Elderly
Muskogee Phoenix
May 5, 2015

The Oklahoma Bureau of Narcotics is partnering with the Department of Human Services' Area Agencies on Aging program to provide 500 free medication lock boxes to seniors.

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DEA: Expired Rx Medication Drop Boxes Not Allowed at Fire Stations
Kayne Crison, Arizona City Independent
May 6, 2015

The Drug Enforcement Administration informed officials that medication drop boxes are not allowed at fire stations. Eight drop boxes will be removed from fire stations in Arizona City, Gold Canyon, Apache Junction, Oracle, Mammoth, and San Tan.

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Other Resources

Canadian Centre on Substance Abuse. 2014. Prescription Drop-Off Initiative: Evaluation Toolkit. Ottawa, Ontario.

The Prescription Drop-Off Initiative (PDoI) Evaluation Toolkit provides a detailed description of PDoIs, an overview of PDoIs across Canada, and a resource to facilitate PDoI evaluations. The evaluation can be integrated into existing PDoIs while helping to promote safe storage and disposal of unused drugs, reduce the harms of nonmedical use of prescription drugs, and prevent illegal diversion.

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New Device Could Be Key to Keeping Kids Off Heroin
Kay Quinn, KSDK
May 7, 2015

Deterra is a new drug deactivation system that could keep drugs out of kids' hands. When pills and water are added to the bag, activation carbons destroy the contents, and the bag can be discarded. The large bags can destroy up to 90 pills. (Includes video: 3:15 minutes)

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Rural Indiana Struggles with Drug-Fueled HIV Epidemic
May 1, 2015

In collaboration with Kaiser Health News, special correspondent Sarah Varney reports on how health officials, lawmakers, and Indiana residents are grappling with the drug-fueled HIV epidemic. (Duration: 6:32 minutes, includes transcript)


Grant Awarded

County Receiving Funding to Fight Prescription Drug Abuse
Cass Rains, Enid News
May 6, 2015

PreventionWorkz Regional Prevention Center was awarded $90,000—with a 3-year renewal option—by the Oklahoma Department of Mental Health and Substance Abuse Services. The center will work to address nonmedical use of prescription drugs in Garfield County.

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Grant Announcements

Harold Rogers Prescription Drug Monitoring Program FY 2015
United States Department of Justice
Deadline: May 28, 2015

Rural Opioid Overdose Reversal Grant Program
Department of Health and Human Services, Health Resources and Services Administration
Deadline: June 8, 2015

Edward Byrne Memorial Justice Assistance Grant (JAG) Program
Department of Justice, Bureau of Justice Assistance
Deadline: June 16, 2015

Take-Back Events and Drop Boxes

Montgomery County Collects 3,656 Pounds of Unused Drugs
Margaret Gibbons, The Intelligencer (Pennsylvania)
May 6, 2015

2,500 Pounds of Prescription Drugs Collected by Erie County Sheriff's Office
The Buffalo News (New York)
May 6, 2015

Harford Collects Over 800 Pounds of Unwanted Meds for Disposal
Cecil Daily (Maryland)
May 4, 2015

Partnership Carson City's Prescription Drug Roundup Collects 166 Pounds of Pills
Emily Ammerman, Nevada Appeal
May 2, 2015

100 Pounds of Old Drugs Get Tossed
The Columbus Dispatch (Ohio)
May 2, 2015

The Easiest Way Ever to Safely Get Rid of Unused Meds: Drive-Through Drug Take-Back Day Set for May 16
Denise Civiletti, RiverheadLOCAL (New York)
May 3, 2015

Prescription Take-Back Day Set for May 16
Walworth County Today (Wisconsin)
May 6, 2015

New Prescription Drug Collections Set for Wisconsin
Sarah Thomsen, WBAY (Wisconsin)
May 4, 2015

Jefferson District Attorney's Office Brings PA Medreturn to Four Locations
Courier Express (Pennsylvania)
May 7, 2015

New Prescription Drop-Off Site in Amherst County
Eleanor Roy, The News and Advance (Virginia)
May 7, 2015

Drug Drop Box for Unwanted Medications in Place
Beth Sergent, Civitas Media (West Virginia)
May 6, 2015

Drug Disposal Days Coming to Portage County
Chris Mueller, Stevens Point Journal (Wisconsin)
May 1, 2015

Upcoming Conferences and Workshops

Pharmacy Diversion Awareness Conferences
Drug Enforcement Administration, Office of Diversion Control
May 30–31, 2015: Norfolk, Virginia
June 27–28, 2015: Oklahoma City, Oklahoma

International Conference on Opioids
Harvard Medical School
June 7–9, 2015
Boston, Massachusetts


Second Annual Medical Marijuana Regulatory Summit
International Cannabis Association
June 18, 2015
Jacob K. Javits Convention Center
655 West 34th Street
New York, New York

New York State Senator Diane Savino will lead a summit addressing regulatory issues, implementation challenges, and business opportunities in the cannabis industry.

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

28th Annual National Prevention Network Conference: Bridging Research to Practice
National Prevention Network
November 17–19, 2015
Sheraton Seattle
1400 Sixth Avenue
Seattle, Washington

This conference provides a forum for prevention professionals, coalition leaders, researchers, and federal partners to integrate research into practice. Conference presentations will address alcohol, marijuana, opioid, and prescription drug misuse; workforce development; and substance abuse prevention and collaboration with related fields.

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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.