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May 28, 2015

PAW Weekly Update

SAMHSA Prescription Drug Abuse Weekly Update
Issue 124  |  May 28, 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 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


D.M. Bush. The DAWN Report: Emergency Department Visits for Drug Misuse or Abuse Involving the Pain Medication Tramadol. 2015. Rockville, Md.: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality.

According to Drug Abuse Warning Network (DAWN) surveillance, emergency department visits involving tramadol misuse or abuse increased 250 percent—from 6,255 visits in 2005 to 21,649 in 2011. Twenty percent involved one other drug, 26 percent involved two other drugs, and 26 percent involved tramadol combined with three or more drugs. Forty-seven percent involved only tramadol and other pharmaceuticals, 14 percent involved alcohol, and 12 percent involved illicit drugs. Among patients admitted to the hospital, 34 percent were 34 or younger, and 31 percent were 55 or older.

Read more:

Drug Testing Pregnant Women Could Help Heroin Issues
Steven Brown, WGRZ
May 19, 2015

Between 2009 and 2011, the number of babies born with neonatal abstinence syndrome (NAS) tripled in Cincinnati, Ohio. Infants were exposed to a range of opiates, from prescription pain medications to heroin. In response, a Health Collaborative of area hospitals, insurance companies, drug manufacturers, nonprofit organizations, and employers drug tested every pregnant woman, and county prosecutors agreed not to pursue criminal charges for positive tests. Universal testing led to earlier identification of NAS infants, which in turn led to new treatment standards at Cincinnati area hospitals. Unexpected benefits have resulted, including shorter hospital stays. (Includes video: 5:47 minutes)

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Journal Articles and Reports

P. Adogu, I. Njelita, N. Egenti, C. Ubajaka, and I. Modebe. 2015. "Awareness, Knowledge, Perception and Attitude Towards Prescription Medicines Abuse Among Medicines Prescribers and Dispensers in Nnewi, Nigeria." Pharmacology and Pharmacy 6:254–66, doi:10.4236/pp.2015.65028.

In early 2014, 375 pharmacists, retail pharmacy staff, licensed patent medicines vendors (chemical sellers), and doctors in Nnewi, Nigeria, completed a survey. Most (78 percent) said "prescription medicines abuse" was a problem in the community, but far fewer were concerned about early detection. This survey was poorly designed: Whenever a question asked which of a list of items, for example, were indicators of abuse or health problems resulting from abuse or nonmedical reasons causing abuse, the correct response was checking "yes" for all listed possibilities.

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D.T. Bouland, E. Fine, D. Withers, and M. Jarvis. 2015. "Prescription Medication Obtainment Methods and Misuse." Journal of Addiction Medicine, doi:10.1097/ADM.0000000000000130.

In an inpatient rehabilitation program, a physician surveyed 36 patients. The average patient saw 2.1 providers and filled 50.2 prescriptions; 78 percent used more than one pharmacy. Seventy-five percent feigned symptoms to get prescriptions. Two patients used a falsified (via mislabeling) magnetic resonance image of injury, two paid a physician for the prescription, and three physically harmed themselves to get prescriptions.

Read more:

R.J. Desai, K.F. Huybrechts, S. Hernandez–Diaz, H. Mogun, E. Patorno, K. Kaltenbach, L.S. Kerzner, and B.T. Bateman. 2015. "Exposure to Prescription Opioid Analgesics in Utero and Risk of Neonatal Abstinence Syndrome: Population Based Cohort Study." BMJ 350:h2102, doi:10.1136/bmj.h2102.

According to 2000–07 Medicaid data from 46 states and the District of Columbia, 290,605 (21 percent) of 1,379,450 pregnant women filled at least one personal prescription for an opioid analgesic. Twelve percent were long-term users, and 2 percent had a history of opioid misuse. In propensity score matched analyses, odds of late use were 2.9 for those using other psychotropics in the third trimester, 1.7 for those with a history of alcohol or nonopioid drug misuse, and 1.8 for smokers. Use led to 1,705 cases of neonatal abstinence syndrome (NAS)—a rate of 5.9 per 1,000 deliveries. Relative risks of NAS were 200 with a history of opioid use disorder, 12 with a history of other substance use disorders, and 4 for third trimester users of other psychotropics.

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J. Gauntlett–Gilbert, D. Gavriloff, and P. Brook. 2015. "Benzodiazepines May Be Worse Than Opioids: Negative Medication Effects in Severe Chronic Pain." Clinical Journal of Pain, doi:10.1097/AJP.0000000000000253.

A survey of a biased sample of 229 patients with disabling chronic pain who were about to start rehabilitation found higher Diazepam Equivalent (DE) doses were associated with worse mood and functioning. Higher Morphine Equivalent (ME) doses were more narrowly associated with worse functioning. The study found no evidence for any benefit of these drugs among people seeking to discontinue them. Higher doses were not associated with less pain, fear, or disability. Among those seeking treatment, higher ME doses were not more problematic. The combination of opioids and benzodiazepines was associated with poor mood outcomes.

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M. Laudenbach, F. Baruffaldi, J.S. Vervacke, M.D. Distefano, P.J. Titcombe, D.L. Mueller, N.J. Tubo, T.S. Griffith, and M. Pravetoni. 2015. "The Frequency of Naive and Early-Activated Hapten-Specific B Cell Subsets Dictates the Efficacy of a Therapeutic Vaccine Against Prescription Opioid Abuse." The Journal of Immunology, doi:10.4049/jimmunol.1500385.

A vaccine against oxycodone was effective in some mice. Efficacy was tightly correlated with the size of the CD4+ T cell population. Frequency of naive or early-activated vaccine-specific B and T cells can account for individual responses to and may predict the clinical efficacy of a vaccine.

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B.E. Perron, K. Bohnert, A.K. Perone, M.O. Bonn–Miller, and M. Ilgen. 2015. "Use of Prescription Pain Medications Among Medical Cannabis Patients: Comparisons of Pain Levels, Functioning, and Patterns of Alcohol and Other Drug Use." Journal of Studies on Alcohol and Drugs, 76(3):406–13.

Among 273 patients at a medical cannabis clinic in southwestern Michigan, prescription pain medication users tended to be older and reported higher levels of pain and lower levels of functioning. This biased sample (those who had chosen to use cannabis) rated the efficacy of cannabis higher than that of prescription pain medication for pain management and indicated a strong desire to reduce prescription pain medication use. Use did not predict lifetime or past-3-month use of other drugs, including cocaine, sedatives, street opioids, and amphetamines. Forty percent of all patients reported combining cannabis with alcohol.

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K. Rizzo, P. Dominici, A. Rowden, J. Abraham, K.T. Kopec, H. Swoboda, M.A. Mirre–Gonzalez, A. Khalid, K. Damiron, and C. Villaflor. 2015. "Case Series of Overdosed Patients Managed in an Observation Unit." Journal of Clinical Toxicology 5:246, doi:10.4172/2161-0495.1000246.

This study was a chart review of a biased sample of 112 patients admitted to a Philadelphia trauma center observation unit after overdose or poisoning between July 2010 and December 2012. Patients were not transferred to a psychiatric unit or admitted to a hospital. The mean age was 38, 59 percent were female, 65 percent were African American, and 26 percent had taken more than one intoxicant. Overdoses most often involved sedative hypnotics (60 percent) and antipsychotics (20 percent). The most common medical interventions in the emergency department were sedatives (16 percent) and naloxone (11 percent). The most common medical interventions in the observation unit were sedatives (21 percent), oxygen (9 percent), and naloxone (5 percent). No intubations or cardiac arrests occurred.

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A. Ung, Y. Salamonson, W. Hu, and G. Gallego. 2015. "Assessing Knowledge, Perceptions and Attitudes to Pain Management Among Medical and Nursing Students: A Review of the Literature." British Journal of Pain, doi:10.1177/2049463715583142.

Searching peer-reviewed literature published between 1993 and 2014 yielded 26 articles on medical and nursing student knowledge and attitudes toward pain, including 9 that used the Knowledge and Attitudes Survey Regarding Pain, and 4 that used clinical skills examinations to assess pain management. Student knowledge of pain management was consistently low.

Read more:


Only 1.4 Percent of Physicians Are Ready to E-Prescribe Controlled Substances, Report Finds
CJ Arlotta, Forbes
May 19, 2015

Surescriptis, a health information network provider, reported that nearly 75 percent of U.S. pharmacies are ready to receive electronic prescriptions for controlled substances. Only 1.4 percent of controlled substance prescribers are set up for electronic prescribing of these substances, but they wrote 1.67 million controlled substance e-prescriptions in 2014. In rankings based on percentages of enabled pharmacies, enabled prescribers, and controlled substances prescribed electronically, Nebraska, California, and Michigan are best equipped to handle e-prescribing of controlled substances.

Read more:

Lawmakers Urge for Reinstatement of National Drug Take-Back Days
May 21, 2015

Lawmakers nationwide sent a letter to the U.S. Attorney General requesting reinstatement of National Drug Take-Back days. The letter highlighted the Drug Enforcement Administration's successful track record of reducing the prescription drug supply.

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Rep. Jenkins Secures Funding for Drug Courts, Treatment
May 21, 2015

The fiscal year 2016 Commerce, Justice and Science Appropriations bill approved by the House Appropriations Committee provides additional funding for drug courts, veterans treatment courts, and the prescription drug monitoring program. U.S. Representative Evan Jenkins pushed for funding above levels requested by the president. The bill includes an additional $33 million for Edward Byrne Memorial Justice Assistance Grants to support local law enforcement.

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Community Policing and Drug Overdose: Where You Live Doesn't Have to Determine Whether You Survive an Overdose
Michael Botticelli, The Huffington Post
May 19, 2015

In his blog, the director of the U.S. Office of National Drug Control Policy names states and localities that have saved lives with naloxone. Camden County police reversed 68 overdoses in a year. From October 2010 to April 2015, Massachusetts police officers administered naloxone in 382 overdose events, which resulted in 360 reversals. The Department of Justice has a naloxone toolkit for law enforcement—an online clearinghouse of more than 80 resources, such as sample policies and training materials designed to support naloxone programs. To build on these efforts, the President's FY 2016 budget directs the Department of Health and Human Services to permit use of block grant funds for naloxone, and separately provides funding for law enforcement to purchase the drug. A federal goal is to make naloxone available in every community where overdose deaths are prevalent.

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Doctors Among Dozens Held in Raids Against Illegal Sales of Prescription Drugs
Alan Schwarz, The New York Times
May 20, 2015

Seven doctors and 41 others in Alabama, Arkansas, Louisiana, and Mississippi were recently arrested in what the Drug Enforcement Administration is calling its largest operation pursuing prescription drug trafficking—specifically pain relievers. The arrests followed 230 others made during the investigation, which targeted doctors, pharmacists, and street-level dealers, among others. One Arkansas pharmacist used fake prescriptions to sell 93,000 hydrocodone pills for about $500,000 in 2013.

Read more:


University of Maryland. 2015. "New CDEWS Study Finds Synthetic Cannabinoids (SC) in Adults and Juveniles in Washington, DC, Denver and Tampa." Center for Substance Abuse Research (CESAR) FAX 24(2).

The second Community Drug Early Warning System study collected specimens from adult parolees/probationers in Washington, D.C., and analyzed specimens from juveniles at criminal justice system sites, including Denver, Colorado (adults); and Tampa, Florida (juveniles). The study found the types of synthetic cannabinoid metabolites detected vary considerably by site. While synthetic cannabinoid-positive specimens for Tampa juveniles contained only one metabolite (UR-144), specimens from adults and juveniles in D.C. and adults in Denver contained as many as 10 different metabolites. D.C. juveniles appear to be using different formulations of synthetic cannabinoids than the ones adults are using in the District.

Read more:

Nebraska Senators Back Study of Medical Cannabis Benefits
May 18, 2015

Nebraska lawmakers approved a bill that would allow a study examining effectiveness of a cannabis extract in epilepsy treatment. The state would procure the low-potency drug from GW Pharmaceuticals, and neurologists would monitor the study to determine the number of participants.

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Pharmacy Inspections Aimed at Stemming Prescription Drug Abuse
Trevor Robb, Edmonton Sun
May 20, 2015

The Canadian government has committed to an additional $13 million over the next 5 years for 1,000 annual pharmacy inspections, including 180 inspections conducted on an ongoing basis, which will help reduce diversion of legal prescription pain drugs.

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Ottawa Announces Plan to Monitor Prescription Drug Abuse
Carly Weeks, The Globe and Mail
May 15, 2015

The Health Ministry will give the Canadian Institute for Health Information nearly $4.3 million over 5 years to develop a coordinated national monitoring and surveillance program. The Ministry also announced funding to update national opioid prescribing guidelines and create an educational program for physicians, pharmacists, and nurse practitioners.

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The Case for Taking Drugs at Work
James Adonis, The Sydney Morning Herald
May 21, 2015

Employees are taking prescription drugs in the workplace to increase productivity. The author of this article says he is undecided about the appropriateness of using performance-enhancing drugs at work. He highlights one study supporting the concept and another that questions use.

Read more:

Northeast/Mid-Atlantic News

Bill to Ensure Safe Disposal of Prescription Drugs Gains Final Legislative Approval
New Jersey Life Sciences Vendors Alliance
May 17, 2015

The New Jersey Assembly approved bill A709, which would require pharmacies and prescribers to supply patients with a notice on available drug take-back programs and provide suggestions for safe disposal with each controlled substance dispensed. The measure heads to the governor's desk.

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Poll Finds Great Awareness—and Fear—of Opioid Abuse
Brian MacQuarrie, The Boston Globe
May 16, 2015

A new poll by The Boston Globe and Harvard T.H. Chan School of Public Health showed a majority of adults in Massachusetts think abuse of heroin and strong prescription pain relievers is an "extremely serious" or "very serious" problem. More than one third of adults in the state and country have known someone who has abused prescription pain relievers in the past 5 years. Only 36 percent of adults in Massachusetts said they have been warned by doctors about the risk of pain relievers prescribed to them. Adults in the state favored pharmacy sales of naloxone (54 percent for, 35 percent against). In the rest of the nation, 42 percent supported public sales of naloxone. Separate surveys were conducted in Massachusetts and nationwide between April 7 and 19.

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MMS Launches Effort to Educate Prescribers and Patients About Prescription Drug Abuse
Massachusetts Medical Society
May 21, 2015

The Massachusetts Medical Society launched a comprehensive campaign to educate physicians and patients about safe prescribing, storage, and disposal of prescription pain medications. Educational materials will be available on the society's website in early June.

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West Virginia Court Allows Illegal Prescription Drug Addicts to Seek Damages from Healthcare Providers
May 22, 2015

The West Virginia Supreme Court ruled that healthcare providers can be sued for enabling prescription drug addicts. Nearly 30 patients sued Mingo County's Mountain Medical Center, claiming its doctors helped feed their addictions with prescription meds. In a 3–to–2 decision, Chief Justice Margaret Workman said the plaintiffs were entitled to seek damages, even though they behaved illegally or immorally. Most of the plaintiffs admitted abusing controlled substances before they sought help at the center.

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Rx Safes Announces Agreement for the Purchase of 10,000 Rx DrugSAFEs
May 20, 2015

RXRXRx Safes, Inc. executed an agreement with Advocare Solutions, Inc. to purchase 10,000 units of the company's Rx DrugSAFE product at $100 per unit—contingent on the expected award of a grant from the Broward County Human Services Department, Community Partnership Division. The fingerprint-activated home storage units would be distributed to at-risk families, in partnership with the sheriff's department, which is expected to host various prescription drug awareness events throughout the year.

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First Responders Get Trained on Administering Naloxone
Mike Marut, WBOY
May 19, 2015

Later this month, West Virginia first responders will be allowed to administer naloxone. Health officials are holding training sessions to prepare them. (Includes video: 1:53 minutes)

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Midwest News

Heroin Overdose Reversal Drug Now Available in Ky. Without Prescription
Emily Mieure, WDRB
May 18, 2015

The Kentucky Board of Pharmacy approved an emergency regulation allowing pharmacists to dispense naloxone to customers without a prescription (but with a doctor's approval). Pharmacists must be certified by the Kentucky Board of Pharmacy before they can distribute the drug.

Read more:

HIV Outbreak Has Multiple Causes, Indiana Health Chief Tells Congress
Bill Theobald, Indy Star
May 21, 2015

The Indiana State Health Commissioner testified at a congressional hearing, saying the recent HIV outbreak has multiple causes. There are now 160 confirmed cases of HIV caused by needle sharing among opioid pain reliever addicts. To manage the problem, said the commissioner, a comprehensive approach is required, including stopping the opioid flow into communities, dealing with personal and public health problems caused by the influx of opioids, and providing opportunities for addiction recovery. He also called for expanded education for the public, patients, and prescribers; greater ability to quickly gather and access data through prescription drug monitoring programs; and more ways for people to dispose of unused opioids.

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State Lawmaker's Plan to Curb Heroin Abuse Moves Forward
Erin Hegarty, Daily Herald
May 20, 2015

An Illinois House committee approved a bill to increase naloxone use, provide better drug education, and improve the state's prescription drug monitoring program. The bill was sent to the full House.

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VA on Board with OARRS
Frank Lewis, Portsmouth Daily Times
May 18, 2015

The Department of Veterans Affairs Health Administration announced final integration with the Ohio prescription drug monitoring program.

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Heroin, Fentanyl Deaths Climb in Clark County
Michael Cooper, Springfield News Sun
May 16, 2015

Clark County, Ohio, is facing a public health crisis, as the number of people dying from heroin and fentanyl overdoses continues to climb. Over the past 16 months, there were 53 accidental drug deaths. Heroin caused more than half of overdose deaths last year, and fentanyl has been involved in 75 percent of overdose deaths this year. Through May 11, the Springfield Fire/Rescue Division used 360 doses of Narcan® to revive overdose patients. The hospital emergency department has treated 236 overdoses this year.

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Twin Cities Orthopedics Joins Deterra Partnership Program to Reduce Prescription Drug Abuse and Misuse
May 19, 2015

RXVerde Technologies announced that Twin Cities Orthopedics—the largest orthopedic group in Minnesota—will provide surgery patients at its Edina location with Deterra System drug deactivation and disposal pouches. When discharged, patients will also receive educational information. Twin Cities plans to expand the program to other locations.

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West News

Prevention Network Provides Pharmacies with Lock Boxes
Rachel Snyder, The Duncan Banner
May 20, 2015

The Wichita Mountains Prevention Network delivered prescription drug lock boxes to pharmacies in Stephens County, Okla., as part of its National Prevention Week efforts.

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Health Department Expands Use of Drug to Treat Overdose
Fox 23
May 20, 2015

Oklahoma House Bill 1782 authorized basic- and intermediate-level first responders to administer intranasal naloxone. Twelve weeks later, naloxone had been used 13 times. Since January 2015, the state health department trained about 600 prehospital medical providers to use the drug, giving an additional 28,000 square miles of Oklahoma access to trained providers.

Read more:

Grant Announcements

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

DOJ Takes Back More Than 550 Pounds of Prescription Drugs
WKBT-TV (Wisconsin)
May 19, 2015

Operation Medicine Cabinet Nets 271 Pounds of Medications
Tampa Bay Newspaper (Florida)
May 18, 2015

Drive Up Drug Drop Off Initiative Nets 102 Pounds of Drugs
Jamie Sumersille, Riverhead Patch (New York)
May 18, 2015

Spectracare Holds Prescription Drug Take Back Event in Dale County
Rosanna Smith, WSFA (Alabama)
May 22, 2015

Local Authorities Get Assist from GBI in Drug Disposal
Bianca Cain Johnson, The Augusta Chronicle (Georgia)
May 20, 2015

Dodge City Police Receive Grant for Drug Collection Unit
HutchNews.com (Kansas)
May 18, 2015

Ypsilanti Police Install Prescription Drug Disposal Unit
Darcie Moran, MLive.com (Michigan)
May 20, 2015

Collection of Unneeded Prescription Narcotics to Be Held at West Grange's Annual Yellow Jug Day
The News-Herald (Michigan)
May 20, 2015

Lyon Township Sheriff's Substation Newest Rx Drug Drop-Off Site
WHMI (Michigan)
May 22, 2015

Big Sky High School Senior Organizes Prescription Drug Drop-Off
Nessa Wright, Fox Montana
May 21, 2015

Police Agencies to Collect Prescription Drugs Year-Round
Don Lehnman, The Post Star (New York)
May 17, 2015

Farmers Branch Police Help Residents Get Rid of Old Prescription Drugs
Clayton Youngman, The Dallas Morning News (Texas)
May 21, 2015

Six Medication Take-Back Locations Offered Across Grant County
Richard Byrd, Columbia Basin Herald (Washington)
May 21, 2015

You Can Now Drop Off Your Unused, Unwanted Prescription Drugs at West Bend Police Department
Katie Delong, Fox 6 (Wisconsin)
May 19, 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
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.