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May 9, 2013

SAMHSA Prevention of Prescription Drug Abuse in the Workplace Listserv

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May 29, 2013 (PDF version)
Featured Article
Legal Clinic: Terminating an Addicted Employee
Human Resources Executive
May 22, 2013
The author, an attorney, provides an answer to the question: Does the ADA require that the employer keep an under-performing employee on its payroll just because he is enrolled in a drug rehabilitation program? The employee, a chronic prescription drug abuser, has not been performing at work. Each time the employer begins termination for cause, the employee enters a drug rehabilitation program seeking to avoid termination under the ADA by claiming he has a disability. Among other advice, the article states "So long as the employee's illegal drug use is 'sufficiently recent to justify the employer's reasonable belief that the drug abuse remain[s] an ongoing problem,' the employee is unprotected by the ADA, even if the employee enters treatment ... The ADA specifically provides that an employer 'may hold an employee who engages in the illegal use of drugs or who is an alcoholic to the same qualification standards for employment or job performance and behavior that such entity holds other employees, even if any unsatisfactory performance or behavior is related to the drug use or alcoholism of the employee.'" The article also explains when and how the ADA provides safe harbor for a prescription drug abuser in recovery.
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Journal Articles
N. Bavarian, B.R. Flay, P.L. Ketcham, and E. Smit. 2013. "Illicit Use of Prescription Stimulants in a College Student Sample: A Theory-Guided Analysis." Drug and Dependence. doi:10.1016/j.drugalcdep.2013.04.024.
Researchers aimed to understand 1) characteristics of illicit use of prescription stimulants (IUPS) and 2) theory-guided intrapersonal, interpersonal, and environmental correlates associated with use. Using one-stage cluster sampling, 520 students (96.3 percent response rate) at one Pacific Northwest university completed a paper-based, in-classroom survey on IUPS behaviors and expected correlates. Aim 1 was addressed using descriptive statistics; aim 2 was addressed via three nested logistic regression analyses guided by the Theory of Triadic Influence. The prevalence of ever engaging in IUPS during college was 25.6 percent. The majority (>50.0 percent) of users reported initiation during college, oral use, friends as the drug source, academic motives, and experiencing desired outcomes. Intrapersonal correlates associated with use included identifying as white, lower grade point average, diagnoses of attention deficit disorder, and lower avoidance self-efficacy. Interpersonal correlates of use included off-campus residence, varsity sports participation, IUPS perceptions by socializing agents, and greater behavioral norms. Exposure to prescription drug print media, greater prescription stimulant knowledge, and positive attitudes toward prescription stimulants were environmental correlates associated with use. In all models, IUPS intentions were strongly associated with use. IUPS was prevalent on the campus under investigation and factors from the intrapersonal, interpersonal, and environmental domains were associated with the behavior.
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K.R. Holloway, T.H. Bennett, O. Parry, and C. Gorden. 2013. "Consequences of Prescription Drug Misuse Among University Students in the United Kingdom." Journal of Substance Use. doi:10.3109/14659891.2013.765513.
Researchers conducted an online survey of students currently registered at a university in North Wales. Respondents completed a structured questionnaire covering topics related to characteristics and consequences of prescription drug misuse. Analysis was based on those students reporting prescription drug misuse. The most commonly misused medications were prescribed pain relievers, tranquilizers, and sedatives. Main motives for misuse were to obtain therapeutic benefits of the drug, recreational purposes, and mood enhancement. The main problems associated with prescription drug misuse were addiction, physiological and psychological disorders, and relationships. 
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D. Johnson and D. Jergler. 2013. "Opioid Epidemic Plagues Workers' Comp." Insurance Journal.
This article discusses prescription opioid use and abuse among injured workers and its effects on workers' compensation throughout the United States. For stories focused on particular regions, see the related articles below.
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Related Articles
New York, Pennsylvania Rank High for Opioids Among Injured Workers
Insurance Journal
May 20, 2013
New York and Pennsylvania have some of the highest percentages of injured workers who become long-term users of opioids. According to the Workers Compensation Research Institute, 14 percent of non-surgical workers' compensation claims with narcotics were identified as longer-term users of narcotics in New York; in Pennsylvania, 11 percent were identified as longer-term users of narcotics. New York has the highest percentage among all Northeastern states--of those who started taking opioids, one in seven were still taking the drugs 6 to 12 months later.
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Injured Workers Opioid Use on Rise in California, Washington
Insurance Journal
May 20, 2013
The California Workers' Compensation Institute (CWCI) tracked a 300 percent increase in opioids between 2002 and 2011, while payments for opioid prescriptions rose from 4 to 18 percent during that period. Injuries did not increase; instead, doctors were more frequently prescribing opioids. In a separate study, CWCI discovered the higher the opioid dose the higher the cost, more time out of work, and more litigation. The latest report in Washington shows there are 14.7 drug overdose deaths per 100,000 population--of those, 6.1 per 100,000 were opioid-related overdoses.
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Southeastern States Battle Against Prescription Drug/Opioid Abuse
Insurance Journal
May 17, 2013
In 2011, Florida prohibited physicians from dispensing Schedule II and III drugs, except in limited instances. Legislation in Alabama and Georgia targeted pain management clinics. The Georgia Pain Management Clinic Act mandated licensing of pain clinics as of July 2013. The act would prohibit hospital personnel from prescribing long-acting opioid pain relievers in emergency rooms, and prohibit them from refilling opioid pain relievers that have been lost, stolen, or destroyed. In Tennessee, a joint bill prohibiting pain management clinics from dispensing controlled substances failed. A pending bill in West Virginia would create the Unintentional Pharmaceutical Drug Overdose Fatality Review Team under the Office of the Chief Medical Examiner. North Carolina passed a bill that provides civil and criminal immunity to doctors who prescribe opioid antagonists to address overdoses.
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Ohio, Indiana Struggle with Impact of Opioids on Injured Workers
Insurance Journal
May 20, 2013
This article discusses what Ohio and Indiana are doing to address opioid use among injured workers. In 2011, Ohio's workers' compensation fund, the Bureau of Workers' Compensation (BWC), implemented a drug formulary and in 2012, it began centralizing drug-utilization reviews and introduced a pharmacy management program. According to the BWC, these moves have saved about $12 million and reduced the number of narcotics prescribed to injured workers by 12 percent. In Indiana, lawmakers passed the Senate Enrolled Act 246. Under the bill, clinic owners who prescribe, dispense, or administer controlled substances must hold an Indiana Controlled Substance Registration for each facility they own in Indiana.
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Texas, Oklahoma Battle Opioids with Legislation
Insurance Journal
May 20, 2013
Addressing opioid abuse among injured workers in Texas and Oklahoma, lawmakers in both states passed legislation that raised standards for use of evidence-based medicine and tighter regulation of drug-dispensing doctors and clinics. For example, Oklahoma passed a comprehensive workers' compensation reform bill that addresses the problem of controlled substances. Texas passed a "pill mill" law to better regulate pain management clinics and introduced a closed formulary on prescription drugs in the workers' compensation system.
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Related Podcast
CDC Expert Discusses Opioid Epidemic
Insurance Journal
May 20, 2013
This podcast (11:11 minutes) features Dr. Leonard J. Paulozzi, a medical epidemiologist with the Centers for Disease Control and Prevention who has been studying the impact of opioid overdoses and overuse. He discusses how the problem may be more prevalent among the injured worker population.
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A. Laudet. 2013. "Life in Recovery: Report on Survey Findings." Faces and Voices of Recovery. 
This report does not distinguish prescription drug abuse from illicit drug abuse. An online survey of a 3,208-person convenience sample of volunteers from social network Web sites documents the costs of active addiction to the individual and to society in terms of health, finances, work, family life, and criminal justice involvement. It also documents improvements people experience in all areas of life once they are in addiction recovery. These improvements continue over time as recovery is maintained. Survey findings show respondents in recovery are employed, pay bills and taxes, vote, volunteer in their communities, and take care of their health and families. The findings emphasize the need for policies, services, and funding to help more people initiate and sustain recovery, and call for additional research to identify effective and cost-effective recovery-promoting policies and services.
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S.E. Wakeman, M.V. Baggett, G. Pham-Kanter, and E.G. Campbell. 2013. "Internal Medicine Residents' Training in Substance Use Disorders: A Survey of the Quality of Instruction and Resident Self-Perceived Preparedness to Diagnose and Treat Addiction." Substance Abuse. doi:10.1080/08897077.2013.797540.
This study assesses internal medicine residents' self-perceived preparedness to diagnose and treat addiction; measures residents' perceptions of the quality of addictions instruction; and evaluates basic knowledge of addiction. A survey was emailed to 184 internal medicine residents at Massachusetts General Hospital in May 2012. Responses were obtained from 55 percent of the residents. Residents estimated that 26 percent of inpatients they cared for met criteria for a substance use disorder (SUD). Twenty-five percent of residents felt unprepared to diagnose and 62 percent felt unprepared to treat addiction. Only 13 percent felt very prepared to diagnose addiction. No residents felt very prepared to treat addiction. Preparedness to diagnose or treat addiction did not differ significantly across postgraduate level. Fifty-five percent rated the overall instruction in addictions as poor or fair. Seventy-two percent of residents rated the quality of addictions training as poor or fair in the outpatient clinical setting, and 56 percent in the inpatient setting. No resident answered all six knowledge questions correctly. Slightly more than half correctly identified the mechanism of buprenorphine and 19 percent correctly answered a question about naltrexone. Nine percent of residents responded that someone had expressed concern about the respondent's substance use. Despite providing care for a substantial population with addiction, the majority of internal medicine residents in this study feel unprepared to treat SUD. More than half rate the quality of addictions instruction as fair or poor.
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News and Reports
Expired or Unused Prescription Drugs Being Accepted
The Alternative Press
May 20, 2013
The Madison Police Department in New Jersey will now accept unwanted prescription drugs 24 hours a day, seven days a week. The prescription drug drop box is located in the lobby of the police department. It was donated by the Morris County Prevention Is Key.
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Parents Accused of Depriving Infant of Medicine to Treat Addiction
The Herald-Journal
May 20, 2013
A couple was arrested for child neglect after they failed to administer a newborn's methadone prescription. The baby was born with opioid withdrawal, so the hospital prescribed methadone to wean her off the drug. When she became sick, the parents took her to the hospital. The mother claimed that she had mistakenly given the baby a double dose of methadone and it was gone. However, when the baby was tested for drugs, there was no trace of a controlled substance in her system.
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Most Overdose Deaths in B.C. Due to Prescription Drugs: Study
Vancouver Sun
May 23, 2013
The British Columbia Coroners Service in Canada reported that 61 percent of overdose deaths between 2005 and 2010 were accidental and related to the use of prescription drugs. They classified 34 percent of deaths associated with prescription drugs as suicides. The majority (58 percent) of those who died from prescription drugs were between ages 40 and 59. The report showed the cause of death in many cases was the result of mixed drug toxicity or an opioid combined with other medications.
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Juvenile Drug Court
Bluefield Daily Telegraph
May 23, 2013
McDowell County, W.Va., opened a new Juvenile Drug Court. The circuit court, the McDowell County Board of Education, the West Virginia Department of Health and Human Resources, and the county probation office can refer youth, ages 12 to 18, to the program. They stay in the juvenile drug court for 8 months or longer. The goal is to help steer adolescents away from the dangers of prescription drug abuse before they become adult offenders.
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Prescription Drug Disposal Program
City of Champaign
May 23, 2013
Champaign, Ill., has launched the C-U Area Medicine Take-back Program. Residents can now properly dispose of unwanted prescription and over-the-counter medications in three locked collection boxes at local police departments.
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One in Ten Teens Using 'Study Drugs,' But Are Parents Paying Attention?
National Poll on Children's Health
May 20, 2013
Only 1 in 100 parents believe their teens have used "study drugs," while recent studies report 1 in 10 tenth graders and 1 in 8 twelfth graders have used these drugs. Fifty percent of all parents say they are "very concerned" about teens using "study drugs" in their communities. More than 75 percent of parents support school policies aimed at stopping abuse of study drugs in middle and high schools.
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Heroin Task Force Presents First Public Forum on Prescription Drug Abuse
Delaware County News Network
May 20, 2013
Delaware County Heroin Task Force in Philadelphia, Pa., hosted its first community forum on prescription drug abuse. The Task Force offers the presentation "Realities of Prescription Drugs and Heroin Abuse" to all school communities.
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History of Drug Abuse: Missoula Woman Fights Prescription Addiction for Years Before Her Death
The Montana Standard
May 19, 2013
A family shares stories about their loved one who overdosed on a combination of alcohol and prescription drugs. Her family first noticed the change while she was in high school. Though she struggled with addiction, she graduated from high school and college. She died at age 27.
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THE Surgical Hospital of Phoenix Announces Partnership in the Fight Against Prescription Drug Abuse
Fort Mills Times
May 22, 2013
THE Surgical Hospital of Phoenix has partnered with PeaceHealth Laboratories to adopt its Patient Protect (PtProtect) test panel to manage and monitor use and potential abuse of prescription pain medication. PtProtect offers the industry's highest levels of accuracy and lowest detection thresholds to identify the potential for negative drug interactions before they occur, including 38 prescribed medications and illicit substances.
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TRAFFIC ROUNDUP: Even Prescription Drugs Can Lead to DUIs
The Morning News
May 19, 2013
This article discusses South Carolina laws for driving under the influence of drugs as well as the growing problem of prescription drug use and vehicle operation. Officers throughout the state are completing training for drug impairment recognition. All drivers are required to know prescription drugs' effects on one's ability to operate a motor vehicle, according to the retired inspector for the Florence Police Department.
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Charleston Doctor is W.Va.'s Top Prescriber of Hydrocodone
The Charleston Gazette
May 20, 2013
In 2010, a Charleston neurologist prescribed more hydrocodone than any other doctor in the state. The West Virginia Board of Medicine disciplined him twice. He wrote 4,032 prescriptions for hydrocodone to Medicare patients, according to a study released by ProPublica, and prescribed more hydrocodone than any other drug that year.
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Assembly to Vote on Bill That Promotes Recycling of Unused Prescriptions
NJ Spotlight
May 20, 2013
The New Jersey legislature is considering a bill (S-2615) that would create a central repository to redistribute drugs to low-income residents who are struggling to pay for the same medication. The state Department of Health would collect sealed medication and redistribute it to pharmacies, hospitals, and other healthcare facilities enrolled in the program.
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Pill Doctors Eye State
The Missourian
May 19, 2013
Doctors in other states sent drug addicts to Missouri to fill illegal prescriptions because the state does not have a prescription monitoring program. Now, some of those doctors are looking to locate Missouri pain clinics to dispense prescription medications, according to head of the Franklin County Narcotics Enforcement Unit. The author gathered this information from interviews with suspects from Kentucky and narcotics investigators in states where the doctors were located. An executive board member with the National Methamphetamine and Pharmaceutical Initiative heard similar information from investigators during a recent conference.
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Xanax Abuse Prompts Push for Tougher Regulation of the Anti-Anxiety Medication
May 22, 2013
This article, video (1:37 minutes), and audios (3:25 minutes and 2:56 minutes) discuss the potential of new rules designed to halt overprescribing of Xanax in Australia. The drug is likely to be rescheduled by regulators soon. Previous attempts to restrict its use have failed. Xanax abuse is an epidemic in Australia, according to the Australian Medical Association, with a supply that has increased by more than 1,400 percent.
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State Lacks 'Prescription Drug Abuse Strategy,' Official Says
Greenville News
May 20, 2013
South Carolina's Inspector General reports the state does not have a systematic strategy to fight prescription drug abuse. State authorities also do not have a rigorous, systematic understanding of South Carolina's pain reliever problem. He says South Carolina needs a proactive approach to the problem because current efforts are reactionary and fragmented. His recommendations include mandating physicians' use of the prescription drug database to catch doctor shoppers; monitoring the database to search for unusual variations; putting specific safeguards in place for prescribing long-term opiates to noncancer chronic pain patients; and physician training.
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Parents Advised to Safely Get Rid of Unused Prescription Drugs as Summer Vacation Nears
MLive Media Group
May 20, 2013
Health officials in Kent County, Mich., want residents to dispose of unused prescription medication before school summer vacation and have requested residents bring controlled substances to law enforcement agencies. Pharmacies will accept other drugs, such as antibiotics, cold and flu medicine, pet medications, and ointments. Officials hope to prevent abuse or misuse among teens during summer break.
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Hawaii Rx Drug Summit Examines the State's Prescription Drug Problem
May 15, 2013
This press release discusses the May 29, 2013, Hawaii Rx Drug Summit, which will focus on the impact of prescription drug abuse on patients, businesses, and society. The summit will examine prescription drug trends, cost drivers, and dangers of using long-term opioids for chronic pain management, including addiction, overdose, and death. It will also discuss the health risks of long-term opioid therapy for chronic pain management and pain treatment practices in Hawaii.
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One In Ten Teens Using 'Study Drugs,' But Parents Aren't Paying Attention
University of Michigan Health System
May 20, 2013
This video (3:40 minutes) discusses recent findings from the University of Michigan's National Poll on Children's Health. Only 1 in 100 parents believe their kids have used prescription stimulants to boost grades. Study drugs refer to stimulant medications typically prescribed for the treatment of attention deficit hyperactivity disorder. The most commonly prescribed medicines include Adderall, Concerta, Ritalin, and Vyvanse.
Grant Announcements
Strategic Prevention Framework Partnerships for Success II SEOW Supplements
FY 2013 Grant Request for Applications
Deadline: May 31, 2013
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Cooperative Agreements for Electronic Health Record (EHR) and Prescription Drug Monitoring Program (PDMP) Data Integration
Deadline: June 12, 2013
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Prize Competitions/Challenges in Area of Drug Abuse and Addiction
Deadline: June 16, 2013 (Challenge #1)
Deadline: June 14, 2013 (Challenge #2)
The National Institute on Drug Abuse announced two Challenge/Prize Competitions for research and non-research communities, encouraging potential applicants to submit proposals that: 1) help find a way to reduce or eliminate risk of harm from accidentally or intentionally swallowing too many pain prescription pills at the same time and 2) use primary data sources relevant to substance use and abuse to create an infographic to inform and educate the general public about prescription drug abuse dangers.
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Upcoming Conferences and Workshops
11th Annual Middlesex County Prevention Education Summit
June 7, 2013
9 a.m.-1:45 p.m.
Rutgers University Student Center
126 College Avenue, New Brunswick, NJ
This summit, sponsored by the National Council on Alcoholism and Drug Dependence of Middlesex County, will offer four breakout sessions: Prescription Drug Abuse Panel; Adolescent Trends; Medication Assisted Treatment; and Marijuana: Societal Trends Change the Prevention Dialogue. Nurses, law enforcement, educators, municipal alliances, and local communities and parents are encouraged to attend.
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2013 Symposium for Medical Professionals: Kentucky Medical Communities UNITEd
June 8, 2013
Manchester, Kentucky
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
The Generation Rx University Conference for Prescription Drug Abuse Prevention and Recovery
August 7-8, 2013
Columbus, Ohio
2013 National Safety Council Congress and Expo
Congress: September 28-October 4, 2013
Expo: September 30-October 2, 2013
Chicago, Illinois
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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