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November 26, 2014


SAMHSA Prescription Drug Abuse Weekly Update
Issue 99  |  November 26, 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 National News Northeast/Mid-Atlantic News Midwest News West News Other Resources Webinars Video Take-Back Events and Drop Boxes Upcoming Conferences and Workshops


A. Maeda, B. Bateman, C. Clancy, A. Creanga, and L. Leffert. 2014. "Opioid Abuse and Dependence During Pregnancy: Temporal Trends and Obstetrical Outcomes." Anesthesiology 121(6):1158–65, doi:10.1097/ALN.0000000000000472.

According to the Health Care Utilization Program Nationwide Inpatient Sample, the national prevalence of opioid abuse or dependence during pregnancy increased from 0.17 percent in 1998 to 0.39 percent in 2011. In multivariate regressions, compared with other deliveries, deliveries associated with maternal opioid abuse or dependence had an odds ratio of 4.6 for maternal death during hospitalization, 3.6 for cardiac arrest, 2.7 for intrauterine growth restriction, 2.4 for placental abruption, 2.2 for a hospital stay exceeding 6 days, 2.1 for preterm labor, 1.7 for oligohydramnios, 1.7 for transfusion, 1.5 for stillbirth, 1.4 for premature membrane rupture, and 1.2 for Cesarean delivery. The regressions controlled for age group, race, primary payer, previous Cesarean section, multiple gestations, and preexisting maternal conditions. In sensitivity analysis with non-opioid drug abusers as the comparison group, most identified complications remained statistically significant, with only modest differences in magnitude.

Read more:

Purdue Pharma Wins Approval for Abuse-Deterrent Pain Pill
Anna Edney and Caroline Chen, Bloomberg
November 20, 2014

The Food and Drug Administration approved Hysingla, a once-daily extended-release (ER) pure hydrocodone pain reliever manufactured by Purdue Pharma. The label on Hysingla ER indicates the tablet is difficult to abuse via injection or snorting. The drug is intended to be a liver-friendly alternative to medicines like Vicodin, which mixes hydrocodone with acetaminophen. Hysingla contains polyethylene oxide—a gel that absorbs fluid in the gastrointestinal tract and expands to extend the drug's release. The polymer makes the pain reliever tough to crush or dilute with water for injection. Hysingla's label cautions that abuse is still possible by injection, snorting, and taking orally. Purdue is required to conduct post-marketing studies to look at the impact on abuse.

Read more:

Workers' Compensation: Managing Prescription Painkiller Misuse
Live 60-Minute Webinar

National Safety Council
December 10, 2 p.m. CT

Painkillers are frequently prescribed to treat injured workers—often increasing costs and delaying recovery. According to the National Council on Compensation Insurance, prescription painkillers account for 25 percent of the total pharmacy spend and at least 35 percent of workers' compensation claims older than 3 years.

The National Safety Council presents Dr. Constantine Gean, regional medical director for Liberty Mutual Insurance, who will share the latest research on the impact of prescription painkillers. Register for this free Webinar to
  • Discover how painkiller use can affect your workers' compensation claims
  • Review major opioid guideline recommendations
  • Learn the secrets to monitoring prescription painkiller misuse in your workers' compensation claims data
  • Find out what providers and payers are doing about prescription painkillers
Dr. Gean is a board-certified occupational medicine physician with an M.S. in environmental toxicology, a B.S. in biochemistry, an MBA, and more than 20 years of experience in clinical occupational medicine, disability, and workers' compensation. He is also the lead author of two medical pharmacology books: The Pocket Drug Guide and The Index of Prescription Drugs. As a regional medical director with Liberty Mutual, Dr. Gean serves as the medical consultant for the company's national Pharmacy Benefit Management program and as medical advisor for Opioid Management and Early Alert programs.


Journal Articles and Reports

T. Gomes, D. Juurlink, Z. Yao, X. Camacho, J.M. Paterson, S. Singh, I. Dhalla, B. Sproule, and M. Mamdani. 2014. "Impact of Legislation and a Prescription Monitoring Program on the Prevalence of Potentially Inappropriate Prescriptions for Monitored Drugs in Ontario: A Time Series Analysis." CMAJ Open 2(4):E256–61, doi:10.9778/cmajo.20140027.

A time-series evaluation of Ontario's Narcotics Safety and Awareness Act and a centralized Narcotics Monitoring System (implemented in November 2011 and May 2012, respectively) found potentially inappropriate opioid prescriptions decreased from 1.6 percent in October 2011 to 1.4 percent in April 2012 and 1.0 percent in May 2013. Inappropriate benzodiazepine prescribing fell from 0.4 percent to 0.2 percent, and inappropriate stimulant prescribing decreased from 0.7 percent in April 2012 to 0.3 percent in May 2013. The time-series data began in January 2007. A prescription was defined as potentially inappropriate if dispensed within 7 days of an earlier prescription and if it included at least 30 tablets of a drug in the same class but originated from a different physician and pharmacy.

Read more:

J.R. Kilmer, I. Markman Geisner, M.L. Gasser, and K.P. Lindgren. 2014. "Normative Perceptions of Non-Medical Stimulant Use: Associations with Actual Use and Hazardous Drinking." Addictive Behaviors, doi:10.1016/j.addbeh.2014.11.005.

Like similar evaluations, this online survey of 1,106 University of Washington undergraduates (conducted during an unstated time) found students overestimated nonmedical use of prescription stimulants by other students, and those normative estimates were associated with higher nonmedical use of prescription stimulants and more hazardous drinking. Living in a fraternity or sorority was related to higher perceived norms and nonmedical use of prescription stimulants. Of respondents, 19 percent reported ever using prescription drugs nonmedically, including 11 percent who had used stimulants.

Read more:

A.S. Shah, J. Young, and K. Vieira. 2014. "Long-Term Suboxone Treatment and Its Benefit on Long-Term Remission for Opiate Dependence." Journal of Psychiatry, doi:10.4172/1994-8220.1000174.

Clinical studies have consistently found Suboxone® therapy is superior to methadone, naltrexone, or clonidine for treating opioid dependence. Long-term Suboxone® treatment in an office-based setting for a minimum of 4 weeks yields the largest percentages of opioid-free urine samples, opioid detoxification, and treatment retention rates.

Read more:

H. Stewart, A. Malinowski, L. Ochs, J. Jaramillo, K. McCall III, and M. Sullivan. 2014. "Inside Maine's Medicine Cabinet: Findings from the Drug Enforcement Administration's Medication Take-Back Events." American Journal of Public Health, doi:10.2105/AJPH.2014.302207.

In 11 Maine cities, six national medication take-back events from 2011 to 2013 resulted in 1,049 participants returning 13,599 individual medications. Researchers cataloged 553,019 units (capsules, tablets, milliliters, patches, or grams), representing 69.7 percent medication waste. Noncontrolled prescription medications accounted for 56.4 percent of returns, followed by over-the-counter medications (31.4 percent) and controlled prescription medications (9.1 percent). To compile this information, pharmacy doctoral student volunteers collected data under the supervision of law enforcement and entered it into the Pharmaceutical Collection Monitoring System through an interface with Micromedex.

Read more:

National News

Federal Drug Agents Launch Surprise Inspections of NFL Teams Following Games
Sally Jenkins and Rick Maese, The Washington Post
November 16, 2014

The Drug Enforcement Administration conducted surprise inspections of the San Francisco 49ers, Tampa Bay Buccaneers, and Seattle Seahawks as part of an ongoing investigation into prescription drug abuse in the National Football League. Agents searched bags and interviewed doctors and trainers. (Includes video: 2:24 minutes)

Read more:

Scientists Close In on Non-Addictive Opioid Painkillers
Laura Unger, USA Today
November 17, 2014

Connecticut-based Cara Therapeutics released research showing its opioid drug has less potential to be addictive. Cara's compound, called CR845, works on different nerve-ending receptors than traditional treatments and is not believed to enter a patient's brain. In addition, it does not cause side effects such as nausea or respiratory depression. Cara has tested an intravenous formulation of the drug for post-operative pain in the hospital and is developing an oral version. The company expects to submit approval applications for the intravenous drug and oral tablet in 2016 and 2017, respectively.

Read more:

Why EMS Managers Must Plan for Narcotic Thefts
Brian LaCroix, EMS1.com
November 18, 2014

Brian LaCroix, a former paramedic and board member of the National Emergency Medical Services Management Association, talks about one of his paramedics—a man who became addicted to prescription opioids after an injury. After returning to work, the paramedic sifted small remnants of drugs from near-empty vials of morphine and Dilaudid®. He also stole drugs sanctioned for the ambulance and replaced them with water. The paramedic confessed and LaCroix's organization sponsored his attendance at a long-term, inpatient chemical dependency facility. Weeks after being discharged, he was discovered by two other paramedics hiding on the ambulance's apparatus floor. Police were called, and the man was arrested. LaCroix suggests all services authorized to carry controlled substances should have prevention, detection, and investigation policies to help mitigate narcotic diversion. Management should also train staff to recognize and report impairment among co-workers and offer strong and supportive treatment programs.

Read more:

Sudbury Fentanyl Patch Abuse Surpasses Oxycodone as Drug of Choice
CBC News
November 17, 2014

Sudbury, Ontario, and a few other communities require fentanyl users to return used patches before they can get new ones. In Sudbury, fentanyl has surpassed oxycodone as the drug of choice. Detective Sergeant Barry Ramsay said drug traffickers are turning in counterfeit fentanyl patches and prescriptions to pharmacies, and importing the drug from other cities where the patch return policy is not in place. The Minister of Health is evaluating the program. (Includes audio: 5:32 minutes)

Read more:

CompPartners Publishes White Paper on Opioid Management
The Herald
November 17, 2014

CompPartners published a white paper, "Opioid Management—a Realistic Approach to Change," written by its medical director, Joyce Ho, M.D. Dr. Ho stressed the importance of a two-pronged approach, working with injured employees and physicians at the onset of opioid treatment to explain the risks. She examined the complexity of pain and its treatment and called for more education and involvement of injured workers. Dr. Ho favors a patient contract to identify terms under which opioids are prescribed, to help educate the patient, and to identify circumstances that would dictate discontinuation of medication.

Read more:

Northeast/Mid-Atlantic News

R.I. Health Department: 188 Have Died from Accidental Drug Overdoses This Year
Gregory Smith, Providence Journal
November 18, 2014

The Rhode Island Department of Health reported that accidental drug overdoses in 2014 have reached 188, with 90 percent involving at least one opioid or medicine and at least 36 percent involving fentanyl. Emergency medical personnel have administered 1,413 doses of Narcan® in 2014, and from April through October, hospital emergency departments reported administering the drug 95 times.

Read more:

Thieves Go to Great Lengths to Steal Prescription Pills
Erin Logan, WTNH
November 19, 2014

A 27-year-old Connecticut man broke into Hamden's Apex Pharmacy—setting off the alarm—and stole oxycodone, valium, and cough syrup with codeine. Police arrested him minutes later at a nearby school. In a separate case, a man was arrested for presenting pharmacists with fraudulent oxycodone prescriptions. He had been arrested four other times in the past 5 months for similar incidents. (Includes video: 2:36 minutes)

Read more:

Illegal Prescription Drug Use Can Push Kids Toward Heroin
Ben Allen, WITF
November 20, 2014

East Pennsboro High School Principal Craig Robbins knows how quickly a student can go from alcohol to marijuana to pain relievers and finally heroin. The district is giving out free drug tests to any parent who asks—anonymity guaranteed. Geoffrey Kolchin, a program analyst at the Pennsylvania Commission on Crime and Delinquency, said children are stealing medications from their parents, family members, or friends, or buying them on the street. The commission's 2013 survey of more than half the state's 500 school districts found 12 percent of high school seniors have misused prescription pain relievers at least once. (Includes audio: 4:05 minutes)

Read more:

Training Helps Doctors Weigh Risk of Prescribing Opioids
Annie Russell, Vermont Public Radio
November 17, 2014

Boston University's School of Medicine held a training course for Vermont prescribers called SCOPE (Safe and Competent Opioid Prescribing Education) of Pain. Dr. Daniel Alford, course director, advises looking at a patient's risk factors for addiction when making decisions about whether to prescribe opioids, and closely monitoring patients with prescriptions. (Includes audio: 3:22 minutes)

Read more:

Weymouth Hospital Doctor Warns of Jump in Fatal Drug Overdoses
Christian Schiavone, The Patriot Ledger
November 21, 2014

South Shore Hospital, Mass., has witnessed an alarmingly high number of fatal opiate overdoses: three in 1 week. The hospital typically sees about three fatal overdoses a month. There has also been a recent uptick in non-fatal overdoses at the hospital.

Read more:

Midwest News

Grants Target East Tenn. Prescription Drug Abuse
WMC Action News 5
November 20, 2014

Tennessee community drug coalitions are spending $7 million in federal grants on a social media campaign to fight prescription drug abuse among young people in 10 counties. Commissioner Doug Varney said the goal is to reduce prescription drug abuse among 12- to 25-year-olds by at least 4 percent.

Read more:

Police Sergeants Hitting Streets with Anti-Overdose Drug After Narcan Training
Nico Savidge, Wisconsin State Journal
November 20, 2014

The Madison Police Department has equipped its sergeants with Narcan®. Police officials would ultimately like the entire department to carry the medication.

Read more:

M.E.: No 2014 Heroin Overdose Deaths in La Crosse Co.
November 20, 2014

La Crosse County, Wis., has seen no heroin overdose deaths this year—a change from 12 in 2010 and 2 in 2012. The La Crosse County medical examiner credits Narcan® and educational efforts by groups like the county's Heroin Task Force.

Read more:

West News

MCSO Trains Officers in Drug Recognition
Troy Hayden, Fox 10 Phoenix
November 20, 2014

Maricopa County Sheriff's Office (Arizona) uses volunteers who have been arrested and are admittedly under the influence, to train officers on impairment. All volunteers are pulled from the jail intake and assigned numbers. No names are used, and volunteers do not face additional charges, even after admitting to being under the influence. Officers in training are not told what inmates are using—they must figure it out in a series of tests. They measure the size of inmates' pupils in full light and low light and have them walk straight lines. Inmates are also asked to measure time in their heads—an especially effective technique for assessing stimulant use. The program has trained hundreds of officers throughout the country.

Read more:

AMA Foundation Awards Healthy Living Grant to Roseman University DAAT
Roseman University
November 17, 2014

The Drug Abuse Awareness Team at Roseman University was awarded an American Medical Association Foundation Healthy Living Grant. Roseman pharmacy students will use the grant to implement the Interactive Module to Halt Abuse of Prescription Drugs by Preteens and Youth (I'M HAPPY). The program uses a digital interactive module to educate youths about the dangers of prescription drug abuse. It will be installed on computers at afterschool care centers in and around South Jordan, Utah.

Read more:

Williston Police Fight Against Illegal Drugs in the Mail
November 19, 2014

The Williston Police Department in North Dakota is working with national and local mail services to limit drug transports in the greater Williston area. The department has seen an increase in arrests for heroin, methamphetamines, cocaine, marijuana, and prescription drugs. Criminals are sending pharmaceuticals through the United States Postal Service, United Parcel Service, and FedEx. The Federal Bureau of Investigation will set up an office in Williston, and the local police department will work with the bureau on drug cases. (Includes video: 57 seconds)

Read more:

North Olympic Peninsula Health Officials Ask Pharmacies to Stock Heroin Overdose Antidote
Rob Ollikainen, Peninsula Daily News
November 20, 2014

In a letter, the Clallam County Board of Health (Washington) asked pharmacies to stock naloxone for patients with a prescription, and dispense the antidote under a standing order from the health officer. Only one pharmacy in the county currently keeps a naloxone supply. The Jefferson County Board of Health recently approved a similar letter.

Read more:

Report: Cowlitz County's Rate of Opioid Overdoses Tops in State
Brooks Johnson, Longview Daily News
November 18, 2014

The Washington Department of Health reported that Cowlitz County had the highest rate of combined heroin and prescription opioid–related deaths between 2011 and 2013: 17.9 per 100,000. That was more than twice the state's average of 8.6, and slightly higher than the county rate of 17.6 deaths per 100,000 in 2009–11.

Read more:

Other Resources

Above the Influence Toolkit
The Partnership for Drug-Free Kids
Accessed November 18, 2014

The Above the Influence Toolkit features individual and group activities that can help teens make healthier decisions, boost confidence, and prevent risky behaviors. A 10-minute video in the toolkit titled Not Prescribed tells four real-life stories of families affected by medicine abuse.

Read more:


Learn About Effective Programs for Preventing Prescription Drug Misuse Among Youth
Substance Abuse and Mental Health Services Administration, Preventing Prescription Abuse in the Workplace Technical Assistance Center
December 2, 2014
2–4 p.m. (EST)

To register for the Webinar, send your name, e-mail address, and phone number to Lauren Thompson at lthompson@econometricainc.com.

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

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

The Community Anti-Drug Coalitions of America launched a four-part Webinar series to help communities reduce prescription drug misuse and abuse. This Webinar explored national prescription drug abuse trends, the types of prescription drugs adults and youth use nonmedically, and how to gather local data on this issue to inform strategies and interventions. The Webinar also featured a case study from a Kentucky coalition that reduced prescription drug abuse by 80 percent.

Read more:


NFL Faces Investigation into Painkiller Distribution
ABC News
November 17, 2014

The Drug Enforcement Administration launched an investigation to find out if pain relievers were inappropriately distributed to players. (Duration: 2:31 minutes)


Take-Back Events and Drop Boxes

Over 400 Pounds of Unwanted Prescription Drugs Discarded Locally
Teresa Salizzoni, Logan Daily News (Ohio)
November 20, 2014

Cuyahoga County Reaches Drug Drop Box Milestone
Cuyahoga County, Office of the Executive (Ohio)
November 14, 2014

Bedford Co. Sheriff's Office Gets CVS Drug Drop Box
Angela Hatcher, WSET (Virginia)
November 17, 2014

Bring Old Medicines to Barnegat Police
Erik Larsen, Asbury Park Press (New Jersey)
November 20, 2014

Hopewell Township: Town Joins Project Medicine Drop
Hopewell Valley News (New Jersey)
November 19, 2014

Upcoming Conferences and Workshops

Opiate Symposium
Mental Health and Recovery Services Board of Stark County
December 15, 2014
Canton, Ohio

SAMHSA's 11th Prevention Day
Substance Abuse and Mental Health Services Administration
February 2, 2015
National Harbor, Maryland

25th Anniversary National Leadership Forum
Community Anti-Drug Coalitions of America
February 2–5, 2015
National Harbor, Maryland

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.