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May 15, 2013

SAMHSA Prevention of Prescription Drug Abuse in the Workplace Listserv


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May 15, 2013 (PDF version)
 
 
Featured Articles
 
D. Dowell, H.V. Kunins, and T.A. Farley. 2013. "Opioid Analgesics-Risky Drugs, Not Risky Patients." The Journal of the American Medical Association 1-2. doi:10.1001/jama.2013.5794.

This opinion piece suggests opioid risks stem from the drugs, not from patients. Low-risk patients given large enough doses will have a high overdose risk. Patients given moderate doses for prolonged periods will have a high risk of dependence. When risks outweigh benefits, opioid use should be avoided in favor of other treatments. 
 
Read more:
http://jama.jamanetwork.com/article.aspx?articleid=1686609
 
J. Pham, P.J. Pronovost, and G.E. Skipper. 2013. "Identification of Physician Impairment." The Journal of the American Medical Association 1-2. doi:10.1001/jama.2013.4635.

The authors of this Viewpoint suggest clinician alcohol-drug testing should be required after a patient unexpectedly dies. Physicians are as susceptible as others to the effects of prescription drugs and alcohol. Most states have a designated physician health program to identify and assist potentially impaired physicians before they may cause harm; however, programs vary by mandate, authority, reporting requirements, and activities. The authors outline a model physician impairment regulation.

Read more:
http://jama.jamanetwork.com/article.aspx?articleid=1682565
 
 
Journal Articles
V. Blake. 2013. "Fighting Prescription Drug Abuse with Federal and State Law." Virtual Mentor 15(5):443-48.

This article reviews federal and state legislation that targets prescription drug abuse, including laws for prescribers and dispensers of controlled substances.

Read more:
http://virtualmentor.ama-assn.org/2013/05/hlaw1-1305.html
 
R. Kathryn McHugh, E.E. DeVito, D. Dodd, K.M. Carroll, J. Sharpe Potter, S.F. Greenfield, Connery H. Smith, and R.D. Weiss. 2013. "Gender Differences in a Clinical Trial for Prescription Opioid Dependence." Journal of Substance Abuse Treatment 45(1):38-43.

This study examined gender differences in clinical characteristics and treatment outcomes in a large clinical trial for prescription opioid dependence. Despite no pre-treatment differences in opioid dependence severity, women reported significantly greater functional impairment, greater psychiatric severity, and higher likelihood of opioid use to cope with negative effects and pain than men. Women were also likelier than men to have first obtained opioids through a legitimate prescription and to use opioids as intended. 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 pre-treatment gender differences in this population, once the study treatment was initiated, women and men exhibited similar opioid use outcomes.

Read more:
http://www.journalofsubstanceabusetreatment.com/article/S0740-5472(12)00455-2/abstract
 
L. Manchikanti, M.V. Boswell, and J.A. Hirsch. 2013. "Lessons Learned in the Abuse of Pain-Relief Medication: A Focus on Health Care Costs." Expert Review Neurotherapeutics 13(5):527-44.

This manuscript describes lessons learned from the misuse, abuse, and diversion of opioids, escalating healthcare costs, and a means to control the epidemic.

Read more:
http://www.medscape.org/viewarticle/803051
 

News and Reports
 
Clinton and Kelly Declare War on Prescription Drug Abuse
York Daily News
May 6, 2013

The Clinton Foundation vows to reduce the number of overdose deaths over the next 5 years. Geared toward 18- to 26-year-olds who abuse prescription drugs, the initiative aims to raise awareness, work with agencies to improve drug monitoring programs, and encourage universities to join campus initiatives.

Read more:
http://www.nydailynews.com/new-york/clinton-fight-prescription-drug-abuse-article-1.1336453?localLinksEnabled=false
 
CU Cracking Down on Adderall on Campus
CBS4
May 4, 2013

This article and video (2:13 minutes) discuss the University of Colorado's crackdown on students who abuse prescription drugs. Students could be charged with a felony if they buy Adderall to help study during finals.

Read more:
http://denver.cbslocal.com/2013/05/04/cu-cracking-down-on-adderall-on-campus
 
U.S. High School Students Report Relaxation, Having Fun, and Feeling Good as Top Reasons for Misusing Prescription Drugs
CESAR Fax, Center for Substance Abuse Research
May 6, 2013

Nearly 24 percent of high school students reported using prescription drugs without a prescription to get high or alter their mood, according to the Partnership Attitude Tracking Study: Teens and Parents, 2011. (See the May 1, 2013, listserv issue.) Nearly 18 percent of the students said they misused a prescription drug to relax. Sixteen percent cited "having fun" and 14 percent cited "feeling good" as reasons for misuse.

Read more:
http://www.cesar.umd.edu/cesar/cesarfax/vol22/22-18.pdf
 
Prescription Drug Use Among Teens a Crisis in Missoula
The Montana Standard
May 6, 2013

This article discusses prescription drug abuse among Montana high school students. The 2012 Montana Prevention Needs Assessment Survey asked 1,816 Missoula teenagers about using prescription drugs without a doctor's permission. Eleven percent had used narcotic prescription drugs, 11 percent had used sedatives, and 7 percent had used stimulants. About 75 percent of the 150 Montana students seeing an addiction intervention counselor during the school year had experimented with prescription medication. About 10 percent used the meds on a regular basis without a prescription.

Read more:
http://mtstandard.com/news/state-and-regional/prescription-drug-use-among-teens-a-crisis-in-missoula/article_ecde3585-201b-53f9-add2-297d04b94979.html
 
Valley Employers Express Concern over Prescription Drug Abuse
WFMJ
May 3, 2013

Some Ohio companies are testing prospective employees for prescription pain reliever use. If an individual tests positive for drugs such as Vicodin and OxyContin during pre-employment drug screening, a medical review doctor will request proof for the prescription. When employees provide evidence, their prospective employer is not told they are taking the drug. The Trumbull County Mental Health Board recently surveyed businesses in Mahoning and Trumbull counties--50 percent said they were concerned that people returned to work after an injury without reporting prescription drug use.

Read more:
http://www.wfmj.com/story/22145012/valley-employers-express-concern-over-prescription-drug-abuse
 
Viewpoints: Program Aims to Reduce Teenage Prescription Drug Abuse
Sacramento Bee
May 8, 2013

The Sacramento County Sheriff's Department launched GenerationRX, a program designed to curb prescription drug abuse among children and adolescents. GenerationRX involves doctoral pharmacy students leading multifaceted educational interventions in area schools. According to the sheriff's department, prescription drug abuse has spread throughout the Sacramento Valley.

Read more:
http://www.sacbee.com/2013/05/08/5402846/viewpoints-program-aims-to-reduce.html
 
Agency Explains Why It's Hard to Count Deaths from Prescription Drug Overdoses
The Missoulian
May 4, 2013

State and federal agencies often extract statistics on prescription drug overdoses from coroners' reports. However, less than 10 percent of people who die in Montana are autopsied, according to the Montana Department of Public Health and Human Services. The Department's Lead Vital Records Epidemiologist, Bruce Schwartz, said "even people abusing prescription drugs might have been able to do so safely but for, say, adding alcohol or different drugs to the mix. At that point, it's a judgment call to note on a death certificate whether the booze, the drugs, maybe a heart attack brought on by that combination, or perhaps a car accident caused by driving [impairment] was the ultimate cause of death." State Crime Lab statistics list prescription drugs found in "unattended deaths"--those without a doctor on call or nearby. They report check-all-that-apply statistics, but not the unique number of people involved.

Read more:
http://missoulian.com/special-section/addiction/agency-explains-why-it-s-hard-to-count-deaths-from/article_ed1fd7ee-b4f7-11e2-86ad-0019bb2963f4.html
 
Getting Help with Prescription Drug Addiction in Western Montana
The Missoulian
May 7, 2013

This article provides a list of resources for Montana residents who need help with prescription drug addiction.

Read more:
http://missoulian.com/special-section/addiction/getting-help-with-prescription-drug-addiction-in-western-montana/article_b796dd90-b789-11e2-b51c-001a4bcf887a.html
 
In Missoula County Evidence Locker, Potentially Deadly Prescription Drugs Pile Up
The Missoulian
May 7, 2013

The majority of medications in Missolua County's evidence locker come from coroner cases. Missolua's sheriff's department collects the drugs so they don't end up in the wrong hands.

Read more:
http://helenair.com/news/state-and-regional/in-missoula-county-evidence-locker-potentially-deadly-prescription-drugs-pile/article_f6c58f82-b7ef-11e2-8d8a-0019bb2963f4.html
 
Pharmacists Are Often on the Front Line Against Prescription Drug Abuse
The Missoulian
May 9, 2013

Drugstores and pharmacists deal with prescription drug abuse on a regular basis when people present fake prescriptions or prescriptions obtained from different doctors. Addicts have also broken into pharmacies or robbed them at gunpoint.

Read more:
http://missoulian.com/news/local/pharmacists-are-often-on-the-front-line-against-prescription-drug/article_80a3ed5e-b90b-11e2-8c68-001a4bcf887a.html
 
Prescription Drug Abuse a 'Silent Epidemic' in Montana
The Missoulian
May 4, 2013

Prescription drug abuse often goes unnoticed in Montana when users obtain drugs from doctors or pharmacies. Some people believe medication provided by a doctor is safe, regardless of side effects and other risks. Reporters interview physicians, law enforcement officers, students, counselors, people battling addiction, and families who lost loved ones.

Read more:
http://missoulian.com/special-section/addiction/prescription-drug-abuse-a-silent-epidemic-in-montana/article_1ef6f382-b503-11e2-a7dc-0019bb2963f4.html
 
House May Roll Back Bill Expanding Drug Monitoring Program
The Lund Report
May 9, 2013

An Oregon representative opposes the Board of Pharmacy's right to add certain drugs to the state's tracking system. Rep. Mitch Greenlick introduced an amendment that will remove the pharmacy board's power to add new drugs. He also introduced a modification to remove the provision whereby doctors would receive an electronic alert for a potentially problematic prescription, based on the patient's record.

Read more:
http://www.thelundreport.org/resource/house_may_roll_back_bill_expanding_drug_monitoring_program
 
Prescription Drug Deaths Overtake State Road Toll
The Age
May 7, 2013

More Victorians died from prescription drug overdoses last year than from auto accidents, according to the Coroner's Court. Prescription drugs contributed to the deaths of 304 Victorians in 2012--a 13 percent increase from 270 in 2011. A total of 282 people died on Victoria's roads last year.

Read more:
http://www.theage.com.au/victoria/prescription-drug-deaths-overtake-state-road-toll-20130506-2j3lp.html
 
Veterans Vulnerable to Drug Overdoses
NBC4i
May 9, 2013

This article and video (3:55 minutes) discuss drug overdoses among veterans. When NBC4 reviewed Ohio death certificates from 2009 to 2011, they discovered 390 veterans died from unintentional drug overdose. In this video, a reporter talks to a widow whose husband died after taking antidepressants and pain medications. After four tours of duty in Iraq and Afghanistan, he suffered from back pain, foot pain, migraine headaches, and posttraumatic stress disorder.

Read more:
http://www.nbc4i.com/story/22210001/veterans-vulnerable-to-drug-overdoses
 
'Oxyana'--Many Oceana Residents Unhappy with Message Film Sends, Plan Meeting
The Register-Herald
May 9, 2013

In response to the documentary film Oxyana, several Oceana residents are planning a town hall meeting to discuss solutions to the prescription drug epidemic. The meeting will be held May 31 at Oceana Middle School to address misconceptions the documentary may have propagated about the town and bring community leaders, law enforcement, and local residents together to solve the ever-growing drug problem.

Read more:
http://www.register-herald.com/todaysfrontpage/x730872925/-Oxyana-Many-Oceana-residents-unhappy-with-message-film-sends-plan-meeting
 
Drugs Are Made for Treating Disorders, Not for Improving Grades
Daily Titan
May 7, 2013

This article discusses Adderall abuse among college students. Some campus health services have strict rules for prescribing the drug to students, including formal contracts, tests, and lengthy paperwork.

Read more:
http://www.dailytitan.com/2013/05/69762
 
Heroin Use Rises Locally--A Cheap Fix for Prescription Pill Addicts
Observer-Dispatch
May 4, 2013

People addicted to prescription pain medication often reach a point where they cannot get enough from their doctor or friends. They may then turn to street drugs like heroin, which provides a similar high. The amount of heroin seized by New York's Rome Police Department tripled from 2011 to 2012; seized prescription pills increased by 500 percent. People regularly tell police they became hooked on prescription drugs after taking the medicine for an injury.

Read more:
http://www.uticaod.com/news/x1506806268/Police-Heroin-a-cheap-fix-for-pill-abusers?zc_p=0
 
Unmeltable, Uncrushable: The Holy Grail in Painkillers
The Wall Street Journal
May 5, 2013

More than a dozen pharmaceutical companies are vying to create abuse-resistant painkilling drugs since the Food and Drug Administration rejected the manufacturing and sale of generic versions of OxyContin. Anti-abuse formulations make it difficult for drug addicts to crack or snort and there is no instant high due to a chemical bonding unlocked by stomach enzymes.

Read more:
http://online.wsj.com/article/SB10001424127887323798104578453210799151732.html
 
Purdue Pharma Continues to Fight Pain Pill Abuse
Kentucky.com
May 6, 2013

Purdue Pharma is working with healthcare professionals, law enforcement, and community groups to combat prescription drug abuse. The company has supported independent medical education and offered free programs to help healthcare professionals understand proper medicine use and spot attempts to fraudulently obtain prescriptions. Through the Safeguard My Meds program, Purdue is educating parents and grandparents about storing, monitoring, and disposing of prescription medication.

Read more:
http://www.kentucky.com/2013/05/06/2629042/purdue-pharma-continues-to-fight.html
 
Brown Supports Drug Plan
The Morning Journal
May 9, 2013

U.S. Senator Sherrod Brown announced a plan to reintroduce the Stop Trafficking of Pills Act, which would crack down on fraudulent use of Medicaid cards to obtain and fill prescriptions for pain relievers. The legislation targets criminals and addicts who "doctor shop" and recommends a "lock-in" program to limit the number of doctors and pharmacies that can be visited by convicted prescription drug abusers or high-risk users. The General Accounting Office found about 65,000 cases in which Medicaid beneficiaries visited six or more doctors and up to 46 different pharmacies to obtain prescriptions and exceed the legal limit of drugs. Sixty-five doctors or pharmacists wrote or filled prescriptions after being banned from Medicaid, 1,800 prescriptions were written for deceased patients, and 1,200 were "written" by deceased physicians.

Read more:
http://morningjournal.com/articles/2013/05/09/news/doc518b14c5592bc557606058.txt
 
The Wrong Way to Dispose of Drugs
Huffington Post
May 8, 2013

The author of this blog post says mandatory take-back programs will result in few environmental benefits and less participation. Collecting all drugs at once may increase the risk of theft or improper use.

Read more:
http://www.huffingtonpost.com/peter-j-pitts/drug-disposal-methods_b_3239832.html
 
2 Investigates: Trading Addictions
WSBTV
May 9, 2013

Some people who use Suboxone to curb pain pill and heroin addictions end up dependent on the drug, trading one addiction for another. In this article and video (3:24 minutes), two women share their stories with a reporter.

Read more:
http://www.wsbtv.com/news/news/local/2-investigates-trading-addictions/nXmxs
 
Fight Against Prescription Drug Abuse in Tennessee a Constant Battle for Officers, Lawmakers
The Republic
May 4, 2013

Tennessee requires pain clinics to use a prescription drug monitoring database to track commonly abused drugs. Additionally, lawmakers have passed stricter regulations the governor is expected to sign.

Read more:
http://www.therepublic.com/view/story/721ad227cf314ec5ad0277163d8ab463/TN--Prescription-Pills
 
Solving the Prescription Drug Misuse Tragedy
Huffington Post
May 8, 2013

This article discusses the uptick in prescription drug overdoses on college campuses. The author applauds the Clinton Foundation's commitment to address the problem by looking at best practices, including the Prescription Safe Campus program, workplace wellness efforts, and a program that will improve the supply and affordability of naloxone/Narcan overdose antidotes.

Read more:
http://www.huffingtonpost.com/david-sheff/solving-the-prescription-_1_b_3231649.html
 
Biden Unveils New Measures to Combat Prescription Drug Abuse
News.Delaware.Gov
May 2, 2013

Delaware's Attorney General announced new legislative proposals to address prescription drug abuse. The first bill creates a criminal offense of "Medication Diversion" for people who intentionally divert prescription narcotics from patients under the care of a healthcare program or 24-hour facility (hospital, group home, nursing home). The second bill enhances prescription monitoring efforts.

Read more:
http://news.delaware.gov/2013/05/02/biden-unveils-new-measures-to-combat-prescription-drug-abuse
 
Last-Minute Legislative Move Saves Pain Pill Database
The Daytona Beach News-Journal
May 7, 2013

Florida lawmakers made a one-time appropriation of $500,000 to fund its prescription drug monitoring database for at least another year. The last-minute decision saved the database from shutting down.

Read more:
http://www.news-journalonline.com/article/20130506/NEWS/305069991?Title=Last-minute-legislative-move-saves-pain-pill-database&tc=ar
 
Chronic Pain Program Focuses on Education for Patients with Addiction
The Partnership at Drugfree.org
May 7, 2013

The Neurological Center for Pain's Chronic Pain Rehabilitation Program at the Cleveland Clinic created a Chemical Education Track designed for patients with chronic noncancer pain who have therapeutic opioid addictions. Patients who completed the program reported low opioid resumption rates 12 months later. They also reported sustained improvements in pain severity, mood, and pain-related functional impairment.

Read more:
http://www.drugfree.org/join-together/healthcare/chronic-pain-program-focuses-on-education-for-patients-with-addiction?utm_source=Join%20Together%20Daily&utm_campaign=82f4d6d13b-JT_Daily_News_Chronic_Pain_Program&utm_medium=email&utm_term=0_97f4d27738-82f4d6d13b-221990529
 
Southern Indiana Lawmakers Laud Passage of Bill to Curb Prescription Drug Abuse
Courier-Journal
May 7, 2013

This article and video (3:01 minutes) discuss the legislative approval of a "pill mill bill" and other laws to help curb prescription drug abuse in Indiana. If signed by the governor, the state Medical Licensing Board could enact new rules to allow the Attorney General's office to quickly obtain investigative records and act against practitioners who overprescribe. Other legislation requires pain clinics that prescribe, dispense, or administer controlled substances to obtain a state Controlled Substance Registration for each Indiana facility.

Read more:
http://www.courier-journal.com/article/20130507/BETTERLIFE03/305070143/Indiana-new-laws-prescription-drugs-school-safety
 
Increasing Number of Local College, High School Students Abuse Adderall
WPXI
May 3, 2013

This article and video (2:25 minutes) discuss Adderall abuse among high school and college students. Up to 35 percent of college students abuse Adderall, according to a University of Pittsburgh professor.

Read more:
http://www.wpxi.com/news/news/local/increasing-number-local-college-high-school-studen/nXgKL
 
Prescription Misuse Leads to Serious Penalties
The Chippewa Herald
May 6, 2013

The Chippewa County Assistant District Attorney noticed an increase in drug offenses involving prescription drugs. Offenders can be fined up to $10,000 or spend 6 years in prison--or both. Chippewa County sends the highest-risk offenders to drug court.

Read more:
http://chippewa.com/news/local/prescription-misuse-leads-to-serious-penalties/article_d9fd5d36-b64f-11e2-b0e7-001a4bcf887a.html
 

Other Resources

Born Drug-Free Florida
Florida Department of Children and Families
Accessed May 10, 2013

This Web site educates expectant mothers about the importance of discussing prescription drug use with their doctors.

Read more:
http://borndrugfreefl.com
 

Grant Announcements

Strategic Prevention Framework Partnerships for Success II SEOW Supplements
FY 2013 Grant Request for Applications
Deadline: May 31, 2013

Read more:
http://www.samhsa.gov/grants/2013/sp-13-007.aspx

Cooperative Agreements for Electronic Health Record (EHR) and Prescription Drug Monitoring Program (PDMP) Data Integration
Deadline: June 12, 2013

The purpose of this program is to reduce prescription drug misuse and abuse by providing healthcare providers with access to PDMP data to make sound clinical decisions, without disturbing their regular clinical workflow. SAMHSA expects grantees to 1) improve the quality of prescription drug information available to healthcare providers by integrating PDMP data into existing technologies, e.g., EHRs, Health Information Exchanges; and 2) support real-time access to prescription drug information by integrating PDMP data into existing clinical workflows. Grant funds will assist states in addressing prescription drug misuse and abuse strategies by integrating PDMP data into EHRs and other Health Information Technology systems.

Read more:
http://www.grants.gov/search/search.do?mode=VIEW&oppId=233533
 

Upcoming Conferences and Workshops
 
National Prevention Week 2013
May 12-18, 2013
Various locations nationwide
http://www.samhsa.gov/preventionweek

Community Awareness Workshop on Prescription Medication Abuse
May 22, 2013
6:30 p.m.- 8:30 p.m.
College of Southern Maryland
Prince Frederick Campus
115 J.W. Williams Road
Prince Frederick, MD 20678

Sponsored by the Prescription Drug Abuse Abatement Council, this event will feature four break-out sessions focusing on signs of abuse, treatment options, the view from the ER, and effects on local businesses. Resource information will be available from local organizations.

Read more:
http://smnewsnet.com/archives/61727

Prescription Drug Training
May 23, 2013
Reading, Pennsylvania
http://www.councilonchemicalabuse.org/training-prescription-drugs.html

2013 Symposium for Medical Professionals: Kentucky Medical Communities UNITEd
June 8
Manchester, Kentucky
http://www.cecentral.com/live/6653
 
Pharmacy Diversion Awareness Conference
June 22 and 23: Chicago, Illinois
July 13 and 14: Portland, Oregon
August 3 and 4: Baton Rouge, Louisiana
August 16 and 17: San Diego, California
August 18 and 19: San Jose, California
September 21 and 22: Boston, Massachusetts
http://www.deadiversion.usdoj.gov/mtgs/pharm_awareness

The Generation Rx University Conference for Prescription Drug Abuse Prevention and Recovery
August 7-8, 2013
Columbus, Ohio
http://pharmacy.osu.edu/outreach/rxabuseconference

2013 National Safety Council Congress and Expo
Congress: September 28-October 4, 2013
Expo: September 30-October 2, 2013
Chicago, Illinois
http://congress.nsc.org/nsc2013/public/enter.aspx
 
 
 
Please e-mail Rekaya Gibson at rgibson@pire.org with questions or comments about the SAMHSA Prevention of Prescription Drug Abuse in the Workplace Listserv.  
 
 
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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