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May 21, 2015

PAW Weekly Update

SAMHSA Prescription Drug Abuse Weekly Update
Issue 123  |  May 21, 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 Professional Education National News Marijuana International Northeast/Mid-Atlantic News South News Midwest News West News Grant Announcements Take-Back Events and Drop Boxes Upcoming Conferences and Workshops


R.E. Clark, J.D. Baxter, G. Aweh, E. O'Connell, W.H. Fisher, and B.A. Barton. 2015.
"Risk Factors for Relapse and Higher Costs Among Medicaid Members with Opioid Dependence or Abuse: Opioid Agonists, Comorbidities, and Treatment History." Journal of Substance Abuse Treatment, doi:10.1016/j.jsat.2015.05.001.

Analysis of Medicaid claims for 52,278 Massachusetts beneficiaries diagnosed with opioid abuse or dependence between 2004 and 2010 showed patients treated with methadone or buprenorphine had half the risk of relapse of those receiving behavioral treatment without opioid agonist therapy. Expenditures per month ranged from $153 to $233 less for opioid agonist therapy episodes. Relative to those without comorbidities, odds of relapse were roughly 4 with co-occurring alcohol use disorders, 2 with nonopioid drug use disorders, and 1.8 with severe mental illness. Longer current treatment episodes were associated with lower risk of relapse. ​Relapse risk increased with increased exposure to previous treatment, but prior treatment was associated with slightly lower total healthcare expenditures.

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Journal Articles and Reports

J. Bernstein, D.M. Cheng, N. Wang, C. Trilla, J. Samet, and R. Saitz. 2015. "Recreational Drug Use Among Primary Care Patients: Implications of a Positive Self-Report." Annals of Family Medicine 13(3):257–60, doi:10.1370/afm.1750.

From 2009 to 2011, 483 patients visiting Boston Medical Center for primary care enrolled in a trial of brief interventions for drug use, which did not detect differences by intervention status. Among the 52 patients using drugs recreationally only on weekends at baseline, 54 percent (28) were using drugs on weekdays 6 months later. Nevertheless, those who used only on weekends had lower odds than weekday users of increasing drug use frequency (odds ratio [OR] 0.48) and severity (OR 0.56). Patients were primarily male African Americans.

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G. Cochran, A.J. Gordon, C. Field, J. Bacci, R. Dhital, T. Ylioja, M. Stitzer, T. Kelly, and R. Tarter. 2015. "Developing a Framework of Care for Opioid Medication Misuse in Community Pharmacy." Research in Social Science and Administrative Pharmacy, doi:10.1016/j.sapharm.2015.05.001.

Experts attended an all-day meeting to discuss adapting screening, brief intervention, and referral to treatment to address opioid medication misuse in community pharmacy. They focused on patient identification, intervention, prevention, and treatment referral.

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M.L. Fleming, Y. Phan, E.A. Ferries, and M.D. Hatfield. 2015. "Educating Pharmacists on a Prescription Drug Monitoring Program." Journal of Pharmacy Practice, doi:10.1177/0897190015579448.

Most of the 24 pharmacists who completed an evaluative survey on a Texas prescription drug monitoring program education course reported gains in knowledge.

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D. Paone, E. Tuazon, J. Kattan, M.L. Nolan, D. Bradley O'Brien, D. Dowell, T.A. Farley, and H.V. Kunins. 2015. "Decrease in Rate of Opioid Analgesic Overdose Deaths—Staten Island, New York City, 2011–2013." Morbidity and Mortality Weekly Report 64(18):491–94.

From 2000 to 2011, the rate of unintentional drug poisoning deaths involving opioid analgesics increased 435 percent in Staten Island, N.Y., from 2.0 to 10.7 per 100,000 residents. During 2005–11, disparities widened between Staten Island and the other four New York City (NYC) boroughs, with Staten Island 3.0–4.5 times higher. In response, the NYC Department of Health and Mental Hygiene implemented 1) citywide opioid prescribing guidelines, 2) a data brief for local media highlighting Staten Island mortality and prescribing data, 3) Staten Island town hall meetings convened by the NYC commissioner of health and meetings with Staten Island stakeholders, 4) a Staten Island campaign to promote prescribing guidelines, and 5) citywide airing of public service announcements with additional airing in Staten Island. Concurrently, the state passed the I-STOP law requiring practitioners to review the prescription drug monitoring program before prescribing controlled substances. During 2011–13, the opioid analgesic overdose death rate in Staten Island declined 29 percent. In the other four boroughs, the rate stayed the same.

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A. Porath–Waller, J. Brown, and A. Frigon. 2015. Perceptions Among Alberta Healthcare Professionals of Prescription Drug Misuse. Ottawa, Ontario: Canadian Centre on Substance Abuse.

Postcard invitations to almost 16,500 healthcare professionals in Alberta, Canada, yielded 1,063 responses. Respondents said adult and senior patients and patients with mental health diagnoses were misusing sedatives or tranquillizers more frequently than opioids or stimulants. They also said patients with chronic pain or a history of substance abuse were more likely to misuse prescription opioids compared with other drug classes. Pharmacists said patient requests that medications not be billed through their routine insurance plan or be dispensed in the original manufacturer's container were indicators of prescription misuse.

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G.K. Welle–Strand, S. Skurtveit, L. Tanum, H. Waal, B. Bakstad, L. Bjarkø, and E. Ravndal. 2015. "Tapering from Methadone or Buprenorphine During Pregnancy: Maternal and Neonatal Outcomes in Norway 1996–2009." European Addiction Research 21:253–61, doi:10.1159/000381670.

In a national cohort of 123 Norwegian pregnant women in opioid maintenance treatment (OMT) and their neonates, two women came off the OMT medication, and another 15 percent tapered their dose by more than 50 percent. (Editor's note: Although the article reports on birth weights and prenatal births, its samples of less than 25 in almost all cells were too small to support accurate assessments of differences between groups.)

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Professional Education

M.A. Moreno. 2015. "The Misuse of Prescription Pain Medicine Among Children and Teens." JAMA Pediatrics 169(5):512, doi:10.1001/jamapediatrics.2014.2128.

This review stresses how adults who care for children and take prescription pain relievers should practice safe storage. It provides tips for proper disposal and lists signs of overdose.

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Role of Dentists in Reducing Prescription Drug Abuse
California Dental Association
May 14, 2015

A lecture at the California Dental Association Presents discussed frequent misuse of controlled substances initially obtained through legitimate means, as well as pharmaceutical options for managing acute dental pain. In the United States, dentists prescribe 12 percent of all immediate-release opioids sold. An alternative is a combination of nonsteroidal anti-inflammatory drugs and acetaminophen. If a patient still complains of discomfort 1 week after a dental procedure, his or her dentist should schedule another appointment, instead of refilling the prescription.

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Painkiller Abuse Is Costing Your Company
May, 2015

In a review of Healthentic employer-sponsored medical and dental insurance claims data for 2011–14, 13 percent of those prescribed an opioid over a 4-year period received at least 10 opioid prescriptions, a prescribed supply for 120 days or longer, or 1 week or more of overlapping opioid or benzodiazepine prescriptions. That group was responsible for 92 percent of employers' opioid-related claims costs; the 7 percent of users with two or more opioid prescriptions accounted for more than 80 percent of costs. This white paper cites estimates that opioid abuse is costing U.S. businesses close to $26 billion per year, including $10 billion for lost work and productivity. It recommends employers 1) insist on conservative pain treatment prescribing guidelines for providers participating in their medical, workers' compensation, and occupational health programs, 2) determine who is at risk in their covered population, 3) educate employees about opioid drug risks and proper medication disposal, and 4) expand and ensure confidential access to support and treatment for employees who become opioid dependent.

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Ayotte Co-Sponsors Protecting Our Infants Act
Political News
May 12, 2015

U.S. Senator Kelly Ayotte is co-sponsoring the Protecting Our Infants Act, which would direct the Department of Health and Human Services to address the growing number of infants experiencing withdrawal after exposure to opioids in the womb. Such an effort would include recommendations for preventing and treating prenatal opioid abuse and treating infants born opioid dependent. The legislation would also encourage the Centers for Disease Control and Prevention to work with states, collaborating on a public health response to this problem.

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Pew Supports Provisions to Address Prescription Drug Abuse in 21st Century Cures Bill
The Pew Charitable Trusts
May 14, 2015

Pew and eight other organizations support provisions in the 21st Century Cures Act, legislation that would authorize Medicare plans to implement programs for preventing prescription drug misuse.

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N. Lau. P. Sales, S. Averill, F. Murphy, S.O. Sato, and S. Murphy. 2015. "A Safer Alternative: Cannabis Substitution as Harm Reduction." Drug and Alcohol Review, doi:10.1111/dar.12275.

In semi-structured interviews, San Francisco Bay Area marijuana users born during 1946–64 described cannabis as a safer alternative to alcohol, illicit drugs, and pharmaceuticals, based on their perceptions that marijuana has fewer adverse effects, a lower addiction risk, and more effectiveness in relieving symptoms such as chronic pain.

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Medical Marijuana Registry in Quebec Called World's 1st
CBC News
May 11, 2015

McGill University has launched the world's first medical marijuana registry. The registry allows doctors and medical marijuana users to assess safety concerns and investigate which variations of medical marijuana might work best for which conditions. It will remain active for at least 10 years. (Includes video: 1:23 minutes)

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Pennsylvania Senate Sends Medical Marijuana Legislation to House
Times Leader
May 12, 2015

The Pennsylvania Senate approved SB 3, the Medical Cannabis Act, which would legalize various forms of medical marijuana sold by a limited number of licensed, regulated dispensaries. Smoking would not be permitted, but patients could consume marijuana in edible form, and patients with certain conditions could consume it through vaporization. Home cultivation would not be allowed, and parental consent would be required for patients under 18. The bill heads to the House.

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Medical Marijuana Set for September Hearings
Sam Stockard, Murfreesboro Post
May 10, 2015

The Tennessee House and Senate will hold a special session in September for testimony and public hearings on medical marijuana legalization. Proposed legislation would allow for "narrow delivery" of medical cannabis for people diagnosed with cancer, Parkinson's disease, multiple sclerosis, epileptic seizures, Huntington's disease, or serious spinal cord damage.

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Vic Government Support of Real-Time Prescription Monitoring a Good First Step Says Pharmaceutical Society
May 10, 2015

The Andrews government has set aside $300,000 for a real-time prescription drug monitoring program as part of Victoria's state budget. The Pharmaceutical Society of Australia said more needs to be done.

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NRL Extends Tests for Prescription Drug Use Amid Rumours It Is Still Happening
Daniel Lane, The Sydney Morning Herald
May 11, 2015

Amid allegations some footballers were still using the sleeping pill Stilnox to "chill out" after games, the National Rugby League has extended prescription drug misuse testing for another year. Players must also take an online course to learn the potential consequences of irresponsible prescription drug use.

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Fentanyl Exchange Program Decreasing Potential for Prescription Drug Abuse
Alex Brockman, The Windsor Star
May 12, 2015

Almost 30 pharmacies in Windsor–Essex County, Canada, are participating in a fentanyl exchange program that safely disposes of patches. The voluntary program began in November.

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Northeast/Mid-Atlantic News

Senate Passes Bill to Help Stop Prescription Drug Abuse by Preventing the Theft and Sale of Blank Prescription Forms
New York State Senate
May 12, 2015

The New York State Senate approved S3402, which defines three crimes: grand larceny for stealing a blank prescription form; criminal possession of stolen property for possessing a blank prescription form, knowing it is stolen, and intending to benefit from it; and criminal possession of a prescription form for knowingly and unlawfully possessing a blank official state prescription form. The bill goes to the Assembly.

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Report: Massachusetts Needs to Step Up Opioid Abuse Battle
May 15, 2015

The Massachusetts Health Council recommends strategies to fight opioid abuse, from startup grants encouraging community substance abuse prevention activities to increased treatment options, including more detox beds. The council's report also suggests enforcing the state's prescription drug monitoring program, releasing community-level data on fatal and nonfatal opioid overdoses quickly, developing prevention education programs for students of all ages and their parents, and discouraging legalization of marijuana. It said the state should pay for the opiate-blocking drug Vivitrol, so inmates can reduce heroin cravings and remain drug free.

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Report Confirms York County's Rank as One of Worst for Overdose Deaths
Erin James, York Dispatch News
May 9, 2015

A statewide report revealed more people died from drug overdoses in York County last year than in practically any other Pennsylvania county. York first responders have administered naloxone since early April, reviving seven people.

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Canonsburg Police Pilot Heroin Antidote Program
The Almanac
May 8, 2015

Canonsburg Police Department is the first in Washington County, Pa., to carry naloxone in patrol cars. (Includes video: 24 seconds)

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New Castle County Police Get Narcan to Fight Heroin ODs
Robin Brown and Jessica Masuli Reyes, The News Journal
May 14, 2015

The New Castle County Police Department announced its officers will carry Narcan®. Last year, paramedics used the drug to revive more than 100 residents.

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CVS to Pay $22M Penalty for Unlawful Prescription Drug Distribution in Sanford
Desiree Stennett, Orlando Sentinel
May 13, 2015

CVS Health agreed to pay a $22 million penalty after a Drug Enforcement Administration (DEA) investigation found employees at two Sanford, Fla., pharmacies distributed controlled substances without legitimate prescriptions. In 2012, the DEA banned the stores from dispensing several controlled substances. Pharmacists filled prescriptions for customers who asked for the "M's" or the "blues"—street slang for oxycodone. The pharmacists also repeatedly dispensed oxycodone to customers who lived in Kentucky, obtained prescriptions from South Florida doctors, and then bought the drugs in Seminole County.

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Heroin on the Rise in the Midlands
Mary Sturgill, WLTX
May 14, 2015

South Carolina has seen an increase in heroin use and arrests. (Includes video: 3:26 minutes)

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Midwest News

TBI Warns of Dangerous Drug Disguised as Oxycodone
May 14, 2015

The Tennessee Bureau of Investigation issued a warning about pills that look like 33 mg oxycodone. These pills, seized at a traffic stop, were the same size as oxycodone and featured the signature A/215 stamp, but an analysis showed they contained fentanyl.

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Proposed Prescription Drug Monitoring Program Excludes Teens
Jasmine Lee, KOMU
May 13, 2015

The Missouri Senate passed SB 111, which would establish a prescription drug monitoring program. People under 18 would not be registered in the system.

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Health Authorities Confirm 153 Cases of HIV in Indiana Outbreak
Rex Macadangdang, Tech Times
May 15, 2015

In southeastern Indiana, public health experts confirmed 153 HIV cases linked to needle sharing among intravenous drug addicts.

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HIV Outbreak Warning to Rural KY, Officials Say
Laura Ungar and Chris Kenning, The Courier-Journal
May 15, 2015

Austin, Ky., has all the conditions for a potential HIV outbreak: poverty, doctor shortages, and pain pill addiction. State officials asked rural providers to alert them if more HIV cases crop up.

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Lake County Sheriff: Heroin Epidemic Worsening
Chicago Tribune
May 13, 2015

Lake County officials said the heroin problem is getting worse. In less than 5 months, county law enforcement has saved 12 overdose victims with naloxone. The local sheriff's office is partnering with federal agencies and targeting high-level drug distributors. It also encouraged community leaders and residents to get involved by attending antidrug forums and reporting suspicious activities.

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SFBRHS to Implement Random Drug Testing
Susan Miller, Missourian
May 9, 2015

This fall, Missouri's St. Francis Borgia Regional High School will implement mandatory random drug testing (by hair) and an action plan to help students who test positive. If a positive test results from prescription drug use, a copy of the prescription must be given to the vice principal. (Editor's note: We are reporting on this story, not providing an opinion on legality.)

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Heroin Sends More Young Adults to California Emergency Rooms
Sharon Bernstein, Reuters
May 8, 2015

About 1,300 people ages 20 to 29 were treated and released from California emergency rooms with heroin poisoning in 2014—up from 200 in 2005. Cases rose during the same period from 300 to 600 for adults ages 30 to 39 and from 250 to 367 for teens.

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Arizona Seeing Decline in Prescription Overdose Deaths
Mark Remillard, KTAR
May 12, 2015

Fatal overdoses of prescription opioid pain relievers fell from 476 in 2009 to 328 in 2013. The Arizona Department of Health Services encourages doctors, pharmacies, and other healthcare providers to use best-practice guidelines when prescribing drugs. The department also promotes use of the prescription drug monitoring program.

Read more:

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 Program
Department of Justice, Bureau of Justice Assistance
Deadline: June 16, 2015

Take-Back Events and Drop Boxes

20,000+ Pounds of Medications Turned in During Prescription Drug Take Back Event
ArkansasMatters.com (Arkansas)
May 15, 2015

Onestone Students Organize Prescription Drug Take Back Event
Idaho Business Review (Idaho)
May 14, 2015

More Drugs Turned in than Before in Bucks
Philly.com (Pennsylvania)
May 12, 2015

Kingston Police Collect Hundreds on Drug Drop Off Day
CKWS (Kingston, Ontario)
May 11, 2015

Drug Drop-Off Event a Success
Ashley Thompson, The Kings County Advertiser/Register (New Minas, Nova Scotia)
May 9, 2015

Bucket of Prescription Drugs Collected During Drop-Off Day
Truro Daily News (Truro, Nova Scotia)
May 12, 2015

Prescription Drug Drop Off Tally
Constable Les Jones, Sarnia Police Services (Sarnia, Ontario)
May 12, 2015

Prescription Drug Drop-Off Boxes Available at Town of Tonawanda Police Station
The Buffalo News (New York)
May 14, 2015

Georgetown PD Receives Drug Collection Unit
Jobina Fortson, WMDT (Maryland)
May 11, 2015

Drop Box in Maywood Is for Prescription Drugs
Susan Joy Clark, NorthJersey.com (New Jersey)
May 14, 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
New York, New York


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
Seattle, Washington

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.