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November 12, 2014


SAMHSA Prescription Drug Abuse Weekly Update
Issue 97  |  November 12, 2014
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 Other Journal Articles and Reports Professional Education News Other State and Local News Other Resources Webinars Grants Awarded Take-Back Events and Drop Boxes Upcoming Conferences and Workshops


P. Eastman. 2014. "Recommendations for Improved Opioid Use for Chronic Pain from NIH–Convened Panel." Oncology Times 36(21):1, 30–31, doi:10.1097/01.COT.0000457024.19101.b4.

The National Institutes of Health (NIH) Office of Disease Prevention, NIH Pain Consortium, National Institute on Drug Abuse, and National Institute of Neurological Disorders and Stroke convened the "Pathways to Prevention Workshop: The Role of Opioids in the Treatment of Chronic Pain." A panel of seven workshop participants drafted a report that points to problems with the U.S. healthcare system, including 1) poor support for team-based care and specialty pain clinics, 2) overburdened primary care providers, 3) lack of knowledge and decision support for chronic pain management, 4) financial misalignment favoring medication use, and 5) fragmentation of care across different healthcare providers. The report makes 10 recommendations focused on research and decision support.

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Journal Articles and Reports

L. Cluff, S. Tueller, K. Batts, T. Miller, and D. Galvin. 2014. "Industry and Occupation Variations in Nonmedical Prescription Pain Reliever Use." Journal of Workplace Behavioral Health 29(4):299–316, doi:10.1080/15555240.2014.956930.

Multivariate analysis of 2005–09 National Survey on Drug Use and Health data on adults indicated that being male, age 18 to 25, having less than a high school education, not having health insurance, and experiencing serious psychological distress in the past year were associated with increased risk of self-reported past-year prescription pain reliever misuse, as well as abuse or dependence. Being married and employed full time were associated with a decreased risk of past-year misuse, abuse, and dependence. Controlling for these covariates, the restaurant, arts, entertainment, and recreation industry group had the highest self-reported prescription misuse rate (9.6 percent of employees), followed by construction (6.9 percent) and retail (6.3 percent). Public administration, transportation, agriculture, and education had the lowest rates (3.2 to 3.3 percent). Service occupations had the highest level of past-year prescription misuse (7.7 percent), followed by construction occupations (7.5 percent). Teachers self-reported the lowest misuse rate (2.4 percent). Prevalence rate patterns for nonmedical use of prescription pain relievers and substance abuse were similar across industries and occupations.

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S. Imtiaz, K.D. Shield, B. Fischer, and J. Rehm. 2014. "Harms of Prescription Opioid Use in the United States." Substance Abuse Treatment, Prevention, and Policy 9:43, doi:10.1186/1747-597X-9-43.

This study used published 2001–10 data to reestimate known correlations between consumption levels of prescription opioids, nonmedical prescription opioid use, prescription opioid–related morbidity, and prescription opioid–related mortality. Consumption levels of prescription opioids were significantly correlated with prevalence of nonmedical prescription opioid use in the past month (r=0.741), past year (r=0.638), and lifetime (r=0.753), as well as average number of days per person per year of nonmedical prescription opioid use among the general population (r=0.900) and nonmedical prescription opioid users (r=0.720). Similar results were obtained for prescription opioid–related morbidity and prescription opioid–related mortality measures.

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S. Malek, J. Taylor, and K. Mansell. 2014. "A Questionnaire Examining Attitudes of Collegiate Athletes Toward Doping and Pharmacists as Information Providers." Canadian Pharmacists Journal 147(6):352–58, doi:10.1177/1715163514552559.

A survey of 331 Canadian Interuniversity Sport athletes from eight sports had a 92.7 percent response rate. These athletes generally did not feel pressured to dope or that doping was prevalent or necessary. Fear of doping violations largely did not alter medication and supplement use. The online doping education program administered by the Canadian Centre for Ethics in Sport was the most used information source (74.5 percent). Although pharmacists were used as an information source 37.7 percent of the time and were perceived as a good source of information on banned substances by 75.6 percent of participants, only 35 percent consulted a pharmacist each time they purchased a new nonprescription medication.

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M.A. Steinman, K.D. Komaiko, K.Z. Fung, and C.S. Ritchie. 2014. "Use of Opioids and Other Analgesics by Older Adults in the United States, 1999–2010." Pain Medicine, doi:10.1111/pme.12613.

Between 1999 and 2000 and 2009 and 2010, the percent of clinic visits at which an opioid was used rose from 4.1 percent to 9 percent, according to analyzed data on adults 65 and older from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. Although use of all major opioid classes increased, the largest contributor to increased use was hydrocodone-containing combination opioids, which rose from 1.1 percent to 3.5 percent of visits over the study period. Growth in opioid use was observed across a wide range of patient and clinic characteristics—notably in visits for musculoskeletal problems (10.7 percent of visits in 1999–2000 to 17 percent in 2009–10).

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L. Zahlan, L. Ghandour, R. Afifi, and S.S. Martins. 2014. "Double Trouble: Exploring the Association Between Waterpipe Tobacco Smoking and the Nonmedical Use of Psychoactive Prescription Drugs Among Adolescents." Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2014.10.020.

A 2011 survey of 986 randomly selected students at public and private high schools in Beirut, Lebanon, found lifetime prevalence of nonmedical use of prescription drugs was 8.2 percent for pain relievers, 5.6 percent for sedatives/tranquilizers, 3.5 percent for stimulants, 2.5 percent for antidepressants, and 2.3 percent for sleeping pills. Forty-six percent had tried waterpipe tobacco smoking, compared with 25 percent who had ever smoked cigarettes. Controlling for sex, age, school type, and other substance use, waterpipe tobacco smoking was strongly associated with increased odds of all four types of nonmedical use (odds ratios 3.2 to 8.3). Associations with cigarette use were weaker or nonexistent, except with stimulant use (odds ratio=5.3).

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Professional Education

P.C. Gøtzsche. 2014. "Our Prescription Drugs Kill Us in Large Numbers." Polish Archives of Internal Medicine. Epub ahead of print.

Prescription drugs are the third-leading cause of death after heart disease and cancer in the United States and Europe. About half of those who died took their drugs correctly. The other deaths resulted from errors such as too-high dose or use despite contraindications. The author thinks drug agencies are not particularly helpful as they rely on "fake fixes," simply providing long lists of warnings, precautions, and contraindications for drugs while knowing no doctor could possibly learn all of this information. He suggests drug deaths are due to impotent drug regulation, widespread crime (including corrupt scientific evidence and bribery of doctors), and lies in drug marketing, which is harmful in ways similar to tobacco marketing and should be banned. He recommends that people take far fewer drugs, and that patients carefully study prescription package inserts and independent sources of drug information, such as Cochrane reviews.

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WHO Recommends Naloxone to Prevent 20,000 Overdose Deaths in U.S.
Tom Miles, Reuters
November 4, 2014

The World Health Organization said more than 20,000 deaths might be prevented each year in the United States alone if naloxone was more widely available. The organization estimates about 69,000 people around the world die annually from overdosing on heroin or other opioids. Last month, Scotland (the first country to introduce a national program providing naloxone) released results showing a marked reduction in opioid overdose deaths among people just released from prison—from 9.8 percent in 2006 and 2010 to 4.7 percent in 2013. Some cities and states in America, Europe, and Australia have already made naloxone available.

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Proliferation of Rogue Online Drug Sellers Feeds Prescription Drug Abuse Epidemic, NABP Reports
National Association of Boards of Pharmacy
November 5, 2014

Of 10,860 Internet drug outlets reviewed by the National Association of Boards of Pharmacy, 96 percent are not complying with U.S. pharmacy laws and practice standards. Eighty-eight percent do not require a valid prescription, 12 percent dispense controlled substances, and 91 percent appear to have affiliations with rogue networks of Internet drug outlets.

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New Jersey's Fight Against Opiate Diversion Has Led to 50 Disciplinary Cases Against Doctors, Pharmacists, Pharmacies, Under Ongoing Focus on Prescription Drug Abuse
The State of New Jersey
October 31, 2014

Since July 2013, the New Jersey Attorney General has filed 50 public actions related to indiscriminate prescribing or dispensing of Controlled Dangerous Substances. Of these, 23 cases sought disciplinary action against licensees of professional boards within the Division of Consumer Affairs, including actions against 15 physicians, 7 pharmacies or pharmacists, and 1 dentist. The state filed 27 additional orders pertaining to prescribers' or dispensers' New Jersey Controlled Dangerous Substances registrations. These disciplinary actions led to revocation, surrender, or temporary suspension of the licenses of 13 physicians; 7 pharmacists, pharmacies, or pharmacy technicians; and 1 dentist, and to revocation or temporary suspension of 26 Controlled Dangerous Substances registrations. The remaining actions are still pending. Eight physicians were responsible for writing more than 45,000 prescriptions, representing 3.2 million doses of Controlled Dangerous Substances in 2012.

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Verde Technologies® Presents Data on Abuse Deterrent Technology for the Destruction of Unwanted Drugs
November 4, 2014

At the American Association of Pharmaceutical Scientists Annual Meeting, Verde Technologies announced that their Medsaway SP® In-Home Deactivation System was able to deactivate six prescription psychoactive medications in a variety of forms. Within 8 hours, a vast majority of medication was adsorbed by activated carbon. On average, only 0.3 percent of the adsorbed drug was water-leachable.

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Life-Saving Meds Not Reaching Users
Michael Mui, 24 Hours Vancouver
November 6, 2014

Responding to the British Columbia Centers for Disease Control, Health Canada has requested a review of the "potential risks and benefits of making naloxone available in home or community settings" where nonhealth professionals would administer the medication. A government committee also recommended that Health Canada consider the merits of legislation that would exempt the drug from criminal prosecution for trafficking and possession. British Columbia's naloxone program has only reached 2 percent of people who could potentially use it, with 1,300 kits distributed to opioid users by prescription since August 2012.

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Other State and Local News

Energy Pipeline: Companies Work to Prevent the Plague of Drugs in the Oil Patch
Sharon Dunn, The Greely Tribune
November 4, 2014

Weld County, Colo., is not exempt from pipeline workers using methamphetamines, marijuana, heroin, and prescription drugs in the workplace. Local oil and gas companies have taken a zero-tolerance approach to drugs in the workplace, and randomly test employees. Chuck Marting, a former police officer who runs Colorado Mobile Drug Testing, said methamphetamines are rising in random screens. On one site, more than half the crew came back positive, forcing the company to suspend operations. Marting said he sees more marijuana and prescription drug abuse than anything else. Absent a valid prescription, there is now little tolerance for any drugs. Most companies, such as Halliburton and Encana, will fire employees on the spot if they test positive. Both perform pre-employment screening and reasonable suspicion, post-incident, and random drug testing. Halliburton sometimes conducts unit sweeps where all employees at a location are tested. Some allow workers to go through the company's employee assistance program to find treatment and return to their jobs.

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Some Prescription Drugs Now Subject to Oklahoma Drug Trafficking Laws
Matt Trotter, Tulsa Public Radio
November 3, 2014

Effective November 1, 2014, the list of substances in Oklahoma's drug trafficking laws includes morphine, oxycodone, hydrocodone, and benzodiazepines. Illegally distributing these drugs is punishable by fines of $100,000 to $500,000. State Mental Health and Substance Abuse Commissioner Terri White said to be fined, individuals would have to distribute much larger quantities than the amount in a typical prescription.

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Colorado Warns Pharmacies of Potential 'Doctor Shoppers'
John Daley, Colorado Public Radio
October 31, 2014

Colorado distributed 600 notices warning medical facilities about people attempting to fill duplicate prescriptions in multiple places. New legislation allows the state to use information from its prescription monitoring program to send "push notices" to pharmacies where doctor shopping may be a problem. Other states have implemented such notices and seen a 74 percent decline in doctor shopping.

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RI Dept. of Health to Monitor Prescriptions with CT
Diana Pinzon, WPRI
November 6, 2014

The Rhode Island Department of Health launched a prescription monitoring program (PMP) data link with Connecticut through the National Association of Boards of Pharmacy PMP InterConnect program. The link between states will increase interoperability and data sharing.

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RxStat Program Uses Multiple Data Sources to Reduce Opioid Overdoses
Celia Vimont, Partnership for Drug-Free Kids
November 5, 2014

RxStat, housed at the New York City Department of Health and Mental Hygiene, uses data to pinpoint and reduce opioid overdoses. When RxStat staff saw the overdose rate was three times higher in Staten Island than in the city's other boroughs, they visited 1,000 physicians, nurse practitioners, and physician assistants to explain judicious prescribing. In one-on-one meetings, they made prescribing recommendations and delivered clinical tools and patient education materials. The program has expanded to other city areas.

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Group Preparing Proposals to Address, Stem Drug Abuse Epidemic Across Maine
Nick McCrea, Bangor Daily News
November 6, 2014

Bangor-area healthcare leaders, law enforcement officials, educators, and politicians have identified ways to address drug abuse in the city. Their recommendations include a social detox facility, a bill allowing federally qualified health centers to administer methadone, educational training for medical professionals on prescription monitoring program use, and a partnership with media organizations to address the stigma surrounding addiction treatment.

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North Dakota Tries to Slow Prescription Drug Abuse
John Michaelson, Public News Service
November 6, 2014

North Dakota has seen an upward trend in the rate of prescription drug abuse. Pamela Sagness, administrator of N.D.'s Division of Mental Health and Substance Abuse Services, said the state will examine the problem, along with strategies to fight it. North Dakota has already seen success with its safe-disposal program and prescription drug monitoring. Overdose prevention is its next strategy. (Includes audio: 1:31 minutes)

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Ferndale Housing Commission Director Accused of Stealing Prescription Drugs from Tenants
November 6, 2014

Deborah Wilson, housing commission director in Ferndale, Mich., was arrested and charged with two counts of second-degree home invasion and one count of possessing a controlled substance—both felonies. The sheriff's office said it received a tip Wilson was stealing prescription drugs from tenants' apartments. When investigators searched her office, they found 21 Percocet tablets. Wilson admitted to stealing medication from tenants over the past several months and replacing it with generic Tylenol. If convicted, she could get up to 34 years in prison.

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Las Cruces Public Schools: Prescription Abuse Is Our Biggest Drug Problem
Kim Schulmeister, Las Cruces Sun-News
November 5, 2014

Kim Schulmeister, a nurse at Vista Middle School, provides an overview of prescription drug abuse among students. She tells parents to monitor and secure their medications and safely dispose of expired drugs.

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Proposition 46, on Medical Malpractice Awards, Fails
Melanie Mason, Los Angeles Times
November 4, 2014

Voters did not pass Proposition 46, which would have raised California's limit on lawsuit awards for pain and suffering from $250,000 to about $1.1 million. The measure would also have required hospitals to randomly test physicians for alcohol and drug use and test doctors after making certain medical mistakes. In addition, checking the state's prescription monitoring program database would have been mandatory for doctors.

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Governor: State Troopers Now Equipped with Narcan
The Ridgefield Press
November 1, 2014

Connecticut Governor Dannel P. Malloy announced that the state's police troopers are now equipped with Narcan. Troopers completed training to successfully administer the drug. A recently trained trooper saved a man's life after he overdosed on an opiate-based narcotic.

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New Life-Saving Tool: First Responders Get Opioid Overdose Kits
Dale Denwalt, Enid News and Eagle
November 1, 2014

Oklahoma's Enid Police Department, Enid Fire Department, and Garfield County Sheriff's Office received naloxone kits from the Austin Box "12" Foundation. Each kit contains two doses of nasal-delivery naloxone. First responders must undergo training before using the kits.

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Cramerton Police Get New Tool to Fight Overdose Deaths
Lauren Baheri, Gaston Gazette
November 5, 2014

North Carolina's Cramerton Police Department is the first in Gaston County to carry naloxone. Officers and paramedics took a 3-hour class on administering the nasal spray.

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Broken Arrow Police Train to Combat Overdose Cases
Brittany Jeffers, Fox 23
November 6, 2014

The Broken Arrow Police Department is taking the Oklahoma Department of Mental Health's training on Narcan, and will put a kit in each patrol car. (Includes video: 1:49 minutes)

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Other Resources

Disposal Act: General Public Fact Sheet
United States Department of Justice
Accessed November 6, 2014

On September 9, 2014, the Drug Enforcement Administration published its final rule on disposal of controlled pharmaceutical substances in accordance with the Controlled Substances Act (as amended by the Secure and Responsible Drug Disposal Act of 2010) in the Federal Register. This fact sheet summarizes the new rule's effects on the general public.

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Prescription Drug Abuse: Understanding the National and Local Picture
Community Anti-Drug Coalitions of America
November 18, 2014

The Rx to Heroin Connection
The Partnership for a Drug-Free America, Arizona Affiliate
November 19, 2014

Prescription Drug Abuse
Center for the Application of Substance Abuse Technologies, University of Nevada–Reno
December 9, 2014

Grants Awarded

War on Addiction: Suffolk Awarded $847K Federal Grant, Sole NY Recipient, One of 18 Nationally
Long Island Exchange
November 3, 2014

Suffolk County Community College was awarded $847,059 by the Health Resources and Services Administration. The Behavioral Health Workforce Education and Training for Paraprofessionals grant will go toward annual tuition and books for 120 students enrolled in the college's Chemical Dependency Counseling program. Funds will also expand the college's capacity to train certified behavioral health paraprofessionals, and increase the capacity of the Chemical Dependency Counseling certificate and associate degree programs by 71 percent.

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Take-Back Events and Drop Boxes

NYPD: Staten Islanders Have Been Stuffing 'Drop-Off Boxes' with Their Unwanted Rx Pills
John M. Annese, Staten Island Advance (New York)
November 3, 2014

Boardman's Prescription Drop-Off Program Is a Success, Township Officials Say
Jordyn Grzelewski, Vindy.com (Ohio)
November 4, 2014

North Carolina Drug Terminator Incinerates Prescription Drugs on the Spot
Justin Ward, WDBJ (North Carolina)
November 5, 2014

Drop Off Prescription Drugs at Troop C
Daily Comet (Louisiana)
November 5, 2014

Drug Drop Off Site Added in Dundee
The Chronicle-Express (New York)
November 6, 2014

Windsor Police Department Installs Drug Collection Unit
Jennifer Coe, Hartford Courant (Connecticut)
November 4, 2014

24-Hour Drug Drop Box Now Available for Rockwall Residents
Herald Banner (Texas)
November 4, 2014

Colts Neck Installs Drop-Off Box to Discard Prescription Drugs
Jeremy Grossman, News Transcript (New Jersey)
November 6, 2014

Medication Drop-Off Box Installed at Messiah College
The Sentinel (Pennsylvania)
October 31, 2014

Medicine Collection Box Set Up in West View
Bill Zlatos, Trib Total Media (Pennsylvania)
November 5, 2014

Upcoming Conferences and Workshops

142nd Annual Meeting and Exposition
American Public Health Association
November 15–19, 2014
New Orleans, Louisiana

SAMHSA's 11th Prevention Day
Substance Abuse and Mental Health Services Administration
February 2, 2015
Gaylord National Hotel and Convention Center
201 Waterfront Street
National Harbor, Maryland

SAMHSA will convene its 11th Prevention Day in conjunction with the Community Anti-Drug Coalitions of America National Leadership Forum. This annual gathering provides a venue for participants to receive training and technical assistance on substance abuse prevention, and network with SAMHSA grantees and partners. Attendees can share information and participate in workshops to develop strategic organizational skills.

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25th Anniversary National Leadership Forum
Community Anti-Drug Coalitions of America
February 2–5, 2015
Gaylord National Hotel and Convention Center
201 Waterfront Street
National Harbor, Maryland

This 4-day event is the premier and largest training conference for community-based substance abuse prevention professionals, coalition leaders, and prevention and addiction researchers. Packed with opportunities to learn the latest strategies for fighting substance abuse, attendees will hear from nationally recognized prevention experts, federal administrators, and policymakers.

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National Rx Drug Abuse Summit
April 6–9, 2015
Atlanta, Georgia
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.