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November 27, 2013


SAMHSA Prescription Drug Abuse Weekly Update
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 Articles Journal Articles and Reports News Other State and Local News Other Resources Webinar Video Grant Announcement Grant Received Take-Back Events and Drop Boxes Upcoming Conferences and Workshops

Featured Articles

United States Department of Justice, Drug Enforcement Administration. 2013. "National Drug Threat Assessment Summary: 2013." Accessed November 20, 2013.

The 2013 National Drug Threat Assessment Summary addresses emerging developments related to trafficking and use of primary illicit substances of abuse and nonmedical use of controlled prescription drugs. In preparing this report, Drug Enforcement Administration (DEA) intelligence analysts considered data from various sources, including information from 1,307 state and local law enforcement agencies responding to the 2013 National Drug Threat Survey (NDTS).

DEA analysts concluded that "prescription drug abuse continues to be the nation's fastest growing drug problem. The abuse of controlled prescription drugs (CPDs) poses a significant drug threat to the United States and places a considerable burden on law enforcement and public health resources. Nationally, 28.1 percent of law enforcement agencies responding to the 2013 NDTS reported CPDs as the greatest drug threat, up from 9.8 percent in 2009. Law enforcement agencies in the Florida/Caribbean, New England, New York/ New Jersey, and Southeast Organized Crime Drug Enforcement Task Force regions all report that CPDs posed the greatest drug threat at a higher percentage than the national rate. … Further, CPD–related treatment admissions rose 68 percent between 2007 and 2010 and prescription opiate/opioid–related emergency department visits rose 91.4 percent between 2006 and 2010."

"The number of other opiate-related treatment admissions (not including heroin) to publicly funded facilities increased 97 percent from 2006 (84,196) to 2010 (166,233). Further, the number of treatment admissions for other opiates in 2010 was greater than the number of admissions for cocaine (155,290) and for amphetamines (115,360). Data indicate availability of CPDs is increasing. There are no conclusive estimates as to the total amount of illegally diverted prescription narcotics, depressants, and stimulants available in domestic drug markets." Legally distributed product volume, however, "increased steadily over the past five years … 2013 NDTS data reveal that the percentage of state and local law enforcement agencies reporting high availability of CPDs increased from 40.7 percent in 2007, to 75.4 percent in 2013."

"Several treatment providers report the majority of opioid addicts will eventually end up abusing heroin and will not switch back to another drug because heroin is highly addictive, relatively inexpensive, and more readily available. Those abusers who have recently switched to heroin are at higher risk for accidental overdose. Unlike with prescription drugs, heroin purity and dosage amounts vary, and heroin is often cut with other substances, all of which could cause inexperienced abusers to accidentally overdose."

According to the National Survey on Drug Use and Health, the number of self-reported new heroin users increased from 91,000–118,000 annually in 2002–08 to 142,000 in 2010 and 178,000 in 2011. Age of heroin initiation is dropping rapidly. "In 2011, the average age at first use among heroin abusers aged 12 to 49 was 22.1 years and in 2010 it was 21.4 years, significantly lower than the 2009 estimate of 25.5 years. … Heroin availability continued to increase in 2012, most likely due to an increase in Mexican heroin production and Mexican traffickers expanding into east and midwest US markets traditionally supplied with white heroin."

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Increased Use of Anti-Overdose Drug May Give Addicts False Sense of Security, Says Reza Ghorbani, MD, APIPP, FIPP
November 19, 2013

Reza Ghorbani, president and medical director of the Advanced Pain Medicine Institute of Greater Washington, D.C., shares his views about using naloxone as an anti-overdose drug. Ghorbani says such efforts may actually enable drug use while diverting attention from much-needed prevention programs. He calls it a Band-Aid approach and says it's not good public policy.

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Journal Articles and Reports

M.A. Levi–Minzi, H.L. Surratt, S.P. Kurtz, and M.E. Buttram. 2013. "Under Treatment of Pain: A Prescription for Opioid Misuse Among the Elderly?" Pain Medicine 14(11):1719–29. doi:10.1111/pme.12189.

Researchers examined demographic, physical, and mental health characteristics; current drug use patterns; motivations for use; and diversion sources among elderly prescription opioid misusers. Using a mixed methods design at research field offices or senior and community center offices in South Florida, their subjects included individuals aged 60 and over who reported past 90-day prescription opioid misuse (N = 88). The Global Appraisal of Individual Needs was the main survey instrument. Thirty elderly people (mean age 63.3) who reported substantial prescription drug misuse were chosen for an in-depth interview. Fifty percent reported ever being admitted to a drug treatment program. Several reported recent illicit drug use: powder cocaine or crack (35.2 percent), marijuana (30.7 percent), or heroin (14.8 percent). Most reported past-year severe physical pain and discomfort (86.4 percent) and misuse of their primary opioid for pain (80.7 percent). More than half (52.3 percent) obtained the primary opioid from their regular doctors. Qualitative data highlight prescription opioid misuse due to untreated or undertreated pain. Participants with primary opioid misuse for pain had 12.2 times higher odds of obtaining the medication from their regular doctors (P = 0.002) and lower odds of using a dealer (OR = 0.20, P = 0.005).

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The National Alliance for Model State Drug Laws and The National Safety Council. 2013. "Prescription Drug Abuse, Addiction and Diversion: Overview of State Legislative and Policy Initiatives, a Three Part Series, Part 2: State Regulation of Pain Clinics and Legislative Trends Relative to Regulating Pain Clinics." Accessed November 21, 2013.

This report outlines the status of state laws, regulations, and policies on three key initiatives undertaken by state officials to address prescription drug issues: 1) implementation and improvement of state prescription drug monitoring programs, 2) regulation of pain clinics, and 3) establishment and enhancement of policies and guidelines for prescribing controlled substances for non-cancer pain. The overview summarizes practices for initiatives that various organizations and institutions recommend, and identifies which states are following those practices.

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Quest Diagnostics. 2013. "Prescription Drug Misuse in America: A Report on Marijuana and Prescription Drugs." Accessed November 21, 2013.

This Quest Diagnostics Health Trends report focuses partly on use and misuse of prescription drugs, based on de-identified results of medically ordered drug tests in 2011 and 2012. It excludes data from employer drug testing and drug treatment facilities. According to the report, about 60 percent of patients failed to use their prescription drugs as indicated by an ordering physician in 2012, compared with 63 percent in 2011. Among this physician-targeted cohort, nearly half (45 percent) of patients who used marijuana recreationally also used other prescribed drugs non-medically—most commonly sedatives and narcotic pain relievers—compared with approximately one third (36 percent) of non-marijuana users. Similar to findings for 2011, in 2012, among all patients tested, 20 percent tested positive for the prescribed drug(s) and at least one additional drug; 15 percent tested positive for a drug (but not the one they were prescribed); and 25 percent showed no drug was detected, including medications specified by the ordering physician. Misuse rates were around 70 percent for Medicaid patients and 60 percent for private payer and Medicare patients.

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Related News
Drug Use on Decline at Work, Except Rx
The Wall Street Journal
November 19, 2013

A new report from Quest Diagnostics showed the number of U.S. workers who test positive for drugs has decreased since 1988; however, employers are worried about prescription drug abuse. Quest found that positive tests for amphetamines, which include prescription drugs, more than doubled between 2002 and 2012. Methamphetamine rates fell after 2005, but recently rose again, especially among workers in safety-sensitive industries such as trucking and railroads. Positive tests for Vicodin and OxyContin rose 172 percent and 71 percent, respectively, from 2005 to 2012. The data also showed higher levels of pain reliever use when testing workers after involvement in a job-related accident.

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M. Soyka. 2013. "Opioids and Traffic Safety—Focus on Buprenorphine." Pharmacopsychiatry. doi:10.1055/s-0033-1358707.

Recent epidemiological and road surveys indicate opioids have a moderate risk for causing accidents compared with other drugs of abuse, such as alcohol. Several neuropsychological studies—a few of them prospective with a randomized control group—used standardized test batteries to measure domains relevant to psychomotor functioning and driving ability. Single doses of buprenorphine have been shown to induce some impairment in healthy volunteers, but less than that found among chronic users. Certain non-randomized studies indicate somewhat better cognitive performance from patients taking buprenorphine than from ones taking methadone, but this finding has not been demonstrated in randomized controlled trials. Opioids as a class of drugs induce some driving impairment, but less than other psychotropic agents or drugs of abuse do. Personality features of opioid users such as impulsivity, sensation seeking, low risk perception and antisocial behavior, comorbid psychiatric and neurological disorders, and additional substance use are relevant to traffic safety. Buprenorphine does not cause more cognitive impairment than methadone and may even cause less. Caution is required when initiating treatment with buprenorphine. The risk for driving impairment is probably lower under steady-state conditions. Finally, higher doses of buprenorphine are probably not associated with greater impairment.

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#EndMedicineAbuse: Why Prescription Drug Abuse Is So Personal to Me
The Huffington Post
November 19, 2103

Cyrus Stove, a high school senior, discusses his film Out of Reach, which was selected by The Partnership at Drugfree.org and Genart to address prescription drug abuse among teens. Stove's goal was to raise awareness about the many teens abusing medicine. He did not realize the true extent of the problem before talking to friends during the film's creation.

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Related Video
Prescription Drug Abuse Documentary
November 21, 2013

This report discusses and features video clips from Out of Reach, a documentary produced by teenager Cyrus Stove. Stove interviews other teens who have abused prescription drugs. (Duration: 2:40 minutes)

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AMA Will Urge Greater CDC Role in Combating Prescription Drug Abuse
Market Wired
November 19, 2013

Physicians at the Interim Meeting of the American Medical Association voted to endorse a proposal for a more constructive public health approach to preventing prescription pain medication deaths. The proposal will urge the Centers for Disease Control and Prevention to help fill the gap for actionable information needed to develop appropriate solutions.

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Store Your Medications Properly and Keep the Holidays Merry
Market Wired
November 20, 2013

The AWARxE Consumer Protection Program encourages families to lock up their medications this holiday season. Remove prescription drugs from medicine cabinets or drawers and place them in a secure location.

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NACDS Cites Pharmacy's Collaborative Commitment in Curbing Prescription Drug Abuse, Diversion
National Association of Chain Drug Stores
November 20, 2013

Before a hearing of the Subcommittee on Health of the U.S. House of Representatives Committee on Energy and Commerce, the National Association of Chain Drug Stores (NACDS) wrote a statement that they are committed to collaborating with others to prevent prescription drug abuse and better integrate prescription drug monitoring programs in pharmacies nationwide. NACDS emphasized the importance of reporting requirements consistency to improve interstate operability, providing sufficient time for pharmacies to comply with prescription drug monitoring program integration requirements, establishment of a national aggregated controlled substance database as opposed to a patchwork of state databases, and expanding and accelerating use of electronic prescribing for controlled substances. The association also reiterated its support for legislation that would reauthorize the National All-Schedules Prescription Electronic Reporting Act.

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The Double-Edged Drug: At Clinics, Tumultuous Lives and Turbulent Care
The New York Times
November 17, 2013

A reporter interviews people struggling with prescription drug addiction. The article includes several brief video clips.

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Whitfield Pushes for Additional Resources to Help States Combat Prescription Drug Abuse
Congressman Ed Whitfield
November 21, 2013

During a House Health Subcommittee hearing, U.S. Representative Ed Whitfield pushed for reauthorization of his bipartisan legislation, H.R. 3528, the National All Schedules Prescription Electronic Reporting (NASPER) Reauthorization Act. The legislation authorizing NASPER, which expired in 2010, provides state grants to establish and improve prescription drug monitoring programs (PDMPs). Whitfield introduced NASPER to foster the establishment of state-administered PDMPs.

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I-Team: Drug Companies Court Doctors with Gifts, Vacations
8 News NOW
November 19, 2013

This article and video (6:20 minutes) discuss drug companies that pay doctors millions to guarantee they keep writing prescriptions, regardless of a patient's health. Direct kickbacks to doctors are illegal, so some drug companies give gifts such as free samples, lavish meals, and speaking fees. ProPublica compiled a database of the amount of money provided to doctors over the past 3 years. They were able to obtain financial records from 15 major drug companies because the firms were charged with crimes by federal authorities. But because industry does not disclose this information, the database is incomplete. Companies paid billions to settle kickback lawsuits in which they encouraged doctors to prescribe drugs for unapproved uses. In 2014, a sunshine law takes effect, requiring companies to make public all the money they give to medical providers.

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Other State and Local News

Drug-Addicted Babies Focus of New U.P. Health Campaign
ABC 10
November 18, 2013

The Superior Health Foundation is launching a multiyear campaign about babies born addicted to drugs in the Upper Peninsula (UP). The campaign will raise awareness through education and offer support and resources to those affected, stressing the importance of prenatal care for addicted pregnant women. The Marquette General Neonatal Intensive Care Unit (NICU), the only NICU in the UP, has seen a 378 percent increase in drug-addicted infants over the past 6 years. In 2012, 67 infants were treated for neonatal abstinence syndrome.

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Number of Drug-Affected Babies in Maine Skyrockets
The Boston Globe
November 15, 2013

Maine's governor said the number of babies affected by or dependent on drugs will reach 800 by the end of the year—the largest number recorded in the state and about five times the rate nearly 10 years ago. The Department of Health and Human Services reported that more than 160 Maine newborns were affected by drugs in 2005; about 770 have been born in Maine so far this year. Officials are working on a strategic plan to address drug-affected infants and fetal alcohol spectrum disorder.

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Increased Use of Prescription Monitoring Program May Save Lives, Advocates Say
The Express-Times
November 17, 2013

Between October and December 2012, Lisa received 660 prescription pills from 24 doctors in Pennsylvania and New Jersey. On December 23, she was found dead in her bedroom with several medication bottles beside her. Lisa died from an accidental overdose of an eight-drug cocktail, including Valium, Xanax, and oxycodone. Her prescription drug monitoring record showed she had been prescribed more than 1,600 pills and 900 synthetic opiates in the 10 months before her death, paid for by Medicaid. Only two of 12 pharmacies flagged her record, but the database was rarely checked. Many advocates would like to see an improvement in prescription monitoring programs that encourages or mandates increased participation from health care professionals and includes the ability to share information with other states.

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Tiny Addicts Reach Alarming Numbers
The Herald Bulletin
November 19, 2013

State officials urged legislators to create laws protecting babies born with neonatal abstinence syndrome (NAS). These babies are given morphine and kept in the hospital until they can be weaned off the drugs. The Attorney General's Prescription Drug Abuse Task Force comprises Indiana medical and legal experts pushing for a law to allow closer monitoring of mothers using NAS–causing drugs. The law would also provide protection for expectant mothers who voluntarily seek and stay in treatment for addiction. The task force hopes to pass legislative measures including mandatory reporting of cases to the state health department by all health providers, regulation of prescription pain relievers like Tramadol, and increased penalties for abusing or giving the drugs to others.

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Boise Police to Parents: Educate Yourself Now About Drugs
Idaho Statesman
November 20, 2013

Boise's police department provides information for parents to talk with their kids about prescription and illicit drugs. Alcohol and prescription drugs are most popular among local teens, police say. The article tells parents which new drugs they should watch out for and defines terms such as "bath salts." Parents will learn what to look for in their kids' bedrooms by watching the corresponding video (9:15 minutes).

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Doctors Get Order to Limit Painkiller Prescriptions
Indy Star
November 18, 2013

A new state law requires the Indiana Medical Licensing Board to develop an emergency opioid prescribing rule. The law, which will be enforced beginning December 15, includes regulations to tighten prescribing practices; close down pill mills; and reduce abuse, diversion, and opioid-related deaths. Physicians must follow certain guidelines if they prescribe patients more than 60 opioid pills per month or have patients taking a dose greater than the equivalent of 15 milligrams of hydrocodone daily for more than 3 consecutive months.

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Improvements Suggested for MT Prescription Drug Registry
November 19, 2013

A legislative panel heard from doctors, pharmacists, and law enforcement officials about ways to improve the Montana Prescription Drug Registry. Bill Gallea, an emergency medicine physician at St. Peter's Hospital, said one improvement would be accessing the data in real time and letting people other than doctors access the registry. Montana's Board of Crime Control recently received a federal grant to work toward sharing the registry with other states.

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Ohio AG: State Has Heroin Epidemic
November 18, 2013

Ohio's attorney general said the state is making progress in its battle against prescription drug abuse, but now heroin use is an epidemic. Eleven Ohioans die each week from overdoses of heroin, which is cheaper, more potent, and easier to get than prescription pain pills. In 2012, over 600 heroin overdose deaths occurred in the state—more than double the toll in 2010.

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Letter—Prescription Monitoring: Missouri Needs to Improve Tracking
November 17, 2013

Don Teater, medical advisor for the National Safety Council (NSC), urges Missouri citizens and policymakers to recognize the important role of prescription drug monitoring programs (PDMPs). When it comes to addressing the issue, Missouri is ranked in the bottom 10 states. It's the only state in the nation without a PDMP, according to "Prescription Nation," a new report from NSC.

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Opana Painkiller Abuse Common in East Tennessee
November 18, 2013

In one year, Claiborne County narcotics worked 100 drug cases. Almost half were for Opana, surpassing OxyContin cases. Drug addicts try to crush the drug, heat it up, and convert it to injectable form to shoot through a syringe, which can lead to overdose or death. Opana is prescribed only 1 month at a time.

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The Rise of Overdose Deaths in Rural America
Popular Science
November 12, 2013

A new study shows maps of Age-Adjusted Death Rates from Drug Poisoning per 10,000 People; Drug Deaths, 2004–05; and Drug Deaths, 2008–09. (See November 15, 2013, Weekly Update.)

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Other Resources

Parent Guide: Teens and Prescription Drugs
Accessed November 19, 2013

This slide presentation shows parents how to spot signs of abuse, get help, and prevent abuse.

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Children's Safety Network: Delivering the Scientific Facts About Drug Abuse to Teens
December 9, 2013
2–3 p.m. (EST)

Speakers will discuss how to organize an event for National Drug Facts Week and how easy it is to use the National Institute on Drug Abuse's free materials, such as the "Shatter the Myths" booklet and National Drug IQ Challenge. More than 500 educational events and activities will be held throughout the country to shatter myths about drugs and addiction.

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Signs and Symptoms of Xanax Addiction
Addiction Blog
November 20, 2013

This video discusses the signs and symptoms of Xanax addiction, including loss of control when taking the drug, cravings and compulsion to use, and continued use despite negative life consequences. (Duration: 1:42 minutes)

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Grant Announcement

Medical Toxicology Foundation Research Award: Prescription Drug Abuse Prevention
American College of Medical Toxicology
Deadline: February 14, 2014

The Medical Toxicology Foundation is accepting proposals for innovative research projects designed to mitigate harm associated with prescription drug abuse. The Foundation will support outstanding research and other initiatives with the potential to reduce prescription drug misuse and abuse, particularly among young people. A major goal is to support the development and/or analysis of innovative prevention, treatment, and/or harm-reduction strategies.

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Grant Received

State Grant to Help Local Colleges with Substance Abuse Prevention
The Keene Sentinel
November 21, 2013

The New Hampshire Bureau of Drug and Alcohol Services awarded a $571,617 grant to Cheshire County on behalf of Franklin Pierce University, Keene State College, Monadnock Voices for Prevention, and Anna Adachi–Mejia, a doctor and professor at Dartmouth College. The schools will work with community partners for the next 2 years to develop, implement, and evaluate strategies for preventing drinking and drug use—particularly prescription drugs on their campuses.

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Take-Back Events and Drop Boxes

Olmsted County Places Permanent Drug Drop-Off Box
November 21, 2013

Prescription Drug Drop-Off Box Unveiled at Maryland State Police Barracks
The Dagger Press
November 20, 2013

Wisconsin Collects 19+ Tons of Expired, Unused Prescription Drugs
Fox6 News
November 18, 2013

Lock Boxes Fine with Chief
The Morning Journal News
November 21, 2013

Taos Drug Take-Back Campaign Nets 59 Pounds of Medication
The Taos News
November 20, 2103

Upcoming Conferences and Workshops

Monroe County Drug Summit
December 3, 2013
Monroe, Michigan

Staten Islanders Looking for Rx Abuse Epidemic Answers Can Attend Dec. 10 Forum
December 10, 2013
Staten Island, New York

Lecture: Prescription Drug Use-The Dos and the Don'ts
January 29, 2014
Huntley, Illinois

24th National Leadership Forum: The Power of Movement
February 3–6, 2014
National Harbor, Maryland

SAMHSA's 10th Prevention Day:
The Power of Prevention: Strengthening Behavioral Health and Public Health for the Next Decade
February 3, 2014
National Harbor, Maryland

Collaborative Perspectives on Addiction: 'Changing Addictive Behavior: Bench to Bedside and Back Again'
February 28–March 1, 2014
Atlanta, Georgia

Pain Management Through a Wide Lens: Balancing Safety and Effectiveness
March 8, 2014
St. Louis, Missouri

11th Annual World Health Care Congress
April 7–9, 2014
National Harbor, Maryland

National Rx Drug Abuse Summit
April 22–24, 2014
Atlanta, Georgia

Prescription Drug Abuse and Diversion Crimes
June 10, 2014
St. Charles Community College
4601 Mid Rivers Mall Dr., Student Center Room #209
Cottleville, Missouri

Sponsored by the Eastern Missouri Police Academy, this course will provide a national overview of prescription drug abuse and an understanding of prescription drug crimes and their victims. Officers will receive suggestions for targeting, investigating, and reporting these crimes, and actual cases will be used throughout the program. A packet containing resource materials on the diversion of prescription drugs will be provided to students.

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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.