West Virginia University Logo

November 5, 2014


SAMHSA Prescription Drug Abuse Weekly Update
Issue 96  |  November 5, 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 Request for Proposal Take-Back Events and Drop Boxes Upcoming Conferences and Workshops


Driver Use of Schedule II Drugs Gets Scrutiny/
FMCSA Wants Stricter Prescription Narcotics Restrictions

Oliver Patton, Trucking Info
October 24 and 28, 2014

The Federal Motor Carrier Safety Administration's (FMCSA's) Medical Review Board and Safety Advisory Committee recommended that FMCSA ban heavy vehicle operation by drivers taking Schedule II prescription opioids. Drivers are currently permitted to work while taking these drugs, provided they are prescribed by a doctor familiar with the driver's condition. The board also recommended revising the questionnaire used by certifying medical examiners to require listing all medications and dosages the driver has been prescribed by any healthcare provider, to indicate which conditions the medications are intended to treat, and to state whether the medication prescribed would adversely affect the driver's performance.

Having reviewed the relevant literature, the board found drivers using opioids have at least a moderately higher level of crash risk, that stimulants used to counteract attention deficit reduce the crash risk associated with the condition but can substantially increase crash risk if not closely monitored, and that other medications not on the Schedule II list may affect driver performance but are not well studied. Rob Abbott, vice president of safety policy at the American Trucking Associations, is concerned the questionnaire might encourage examiners to decline certification for drivers taking opioids. He worries it could prevent drivers from taking medications they need.

Read more:

U.S. Judge Says Google Settlement over Pharma Ads Is Fair
Dan Levine, Reuters
October 29, 2014

U.S. District Court Judge Phyllis Hamilton said Google's plan to create a $250 million internal program to disrupt rogue online pharmacies is a fair way to end shareholder litigation over accusations the company allowed ads from non–U.S. drug sellers. Under the terms of the deal, Google said it would make content on prescription drug abuse more visible and work with legitimate pharmacies to counter marketing by rogue sellers. Google will allocate and spend at least $50 million per year on this effort for a minimum of 5 years. The company has also agreed to pay $9.9 million in fees and expenses to plaintiff attorneys. Judge Hamilton did not formally rule from the bench, but said she was prepared to preliminarily approve the settlement.

Read more:

Journal Articles and Reports

J.A. Ford and K.K. Rigg. 2014. "Racial/Ethnic Differences in Factors that Place Adolescents at Risk for Prescription Opioid Misuse." Prevention Science, doi:10.1007/s11121-014-0514-y.

In the 2012 National Survey on Drug Use and Health, among youth ages 12 to 17, African Americans had the highest prevalence of prescription opioid misuse (6.1 percent), followed by Hispanics at 5.6 percent, and whites at 5.4 percent. In multivariate analysis, usage rates did not differ significantly by race. The likelihood of misuse rose significantly with age and was higher for youth whose families moved often. Misuse was also higher among youth who were less religious, more delinquent, reported a major depressive episode, or perceived little risk from drug use. Odds of prescription opioid misuse were much higher for youth who misused other substances, especially other drugs.

Read more:

M. Häkkinen, E. Vuori, and I. Ojanperä. 2014. "Prescription Opioid Abuse Based on Representative Postmortem Toxicology." Forensic Science International, doi:10.1016/j.forsciint.2014.10.028.

Among deaths recorded in Finland's medical examiner system during 2010–11, 2,088 (2 percent of all deaths) involved opioids, with 2,499 opioids identified. The study defined abuse as a case with a drug-abuse history, drug injecting, or laboratory findings of illicit drugs. (Editor's note: This is not a sound definition. It does not classify prescription opioid use without a valid prescription or with contemporaneous prescriptions from multiple sources as abuse, but defines overdose during medication-assisted opioid treatment as abuse, even if the person in treatment was using, e.g., methadone, as prescribed.) Abuse and fatal poisonings were concentrated in men ages 20 to 49. One fourth of opioid deaths (545 cases) resulted from abuse. The proportion of abuse among all opioid-related cases was 85.5 percent for buprenorphine, 82.4 percent for methadone, 29.4 percent for tramadol, 16.3 percent for codeine, 14.5 percent for fentanyl, and 6.9 percent for oxycodone. Involvement of a second opioid was more frequent in abuser deaths than in other deaths for codeine, oxycodone, and tramadol, while alcohol involvement was more frequent in buprenorphine, codeine, and fentanyl abuse deaths.

Read more:

R.K. Khary and S.M. Monnat. 2014. "Urban vs. Rural Differences in Prescription Opioid Misuse Among Adults in the United States: Informing Region Specific Drug Policies and Interventions." International Journal of Drug Policy, doi:10.1016/j.drugpo.2014.10.001.

In the 2011 and 2012 National Surveys on Drug Use and Health, multivariate regression showed urban adults were more likely than rural adults to misuse prescription opioids. Urban adults also had higher use of other substances, including alcohol, marijuana, and illicit and prescription drugs, and were more likely to have initiated substance use before age 18. These factors were associated with prescription opioid misuse. (Editor's note: This study misreports correlation as causation.)

Read more:

A. Nielsen, W. Wakeland, and A. Zimam. 2014. "A Public Health Model for Simulating Policy Interventions to Reduce Nonmedical Opioid Use." Simulation and Modeling Methodologies, Technologies and Applications (Advances in Intelligent Systems and Computing) 319(2015):239–54.

Based on historical trend data and expert panel recommendations, the authors built a model that simulates initiation and nonmedical use of opioids and estimates the impact of selected public health interventions. Interventions that reduce the likelihood of informal sharing of leftover medicine could significantly reduce initiation and nonmedical use. Supply restrictions such as drug take-back days, which modestly reduce informal sharing, are less effective, as are interventions aimed at reducing the likelihood that interactions with nonmedical users would prompt peers to initiate nonmedical use.

Read more:

Prescription Drug Monitoring Program Center of Excellence at Brandeis University. 2014. "Using PDMP Data to Guide Interventions with Possible At-Risk Prescribers."

This report describes programs initiated or planned in several states to intervene with possible at-risk prescribers, using prescription drug monitoring program (PDMP) data to help identify these individuals and track changes in their prescribing behavior. PDMP data can single out healthcare professionals who frequently prescribe "drug cocktails" or high doses of opioids, have high proportions of possible doctor shoppers, see patients coming from long distances, and have high proportions of prescriptions paid for in cash, among other indicators of risky behavior. Interventions range from "report cards" comparing prescribers' behavior with norms for their specialty (Arizona) to review and possible referral of individual cases to medical licensing boards for further action (Kentucky).

Read more:

Prescription Drug Monitoring Program Center of Excellence at Brandeis University. 2014. "Mandating PDMP Participation by Medical Providers: Current Status and Experience in Selected States." Revision 2.

This revised briefing describes the status of state mandates and the implementation and outcomes of mandates in Kentucky, Tennessee, New York, and Ohio. Experience in these states indicates mandates can quickly increase registration for and use of prescription drug monitoring programs, with subsequent reductions in prescribing of some commonly abused controlled substances and measures of multiple provider episodes (doctor shopping). It also highlights policy and implementation issues for states considering mandates.

Read more:

R. Simeone. 2014. "Doctor Shopping Behavior and the Diversion of Opioid Analgesics: 2008–2012." IMS Government Solutions.

For the Office of National Drug Control Policy, IMS analyzed its database on 11 billion prescriptions dispensed during 2008–12. The data include encrypted identifiers for doctor, pharmacy, and patient. Analysis revealed sustained downward trends in the proportion and number of prescriptions and milligrams diverted.

Read more:

K. Wolff and R. Perez–Montejano. 2014. "Opioid Neonatal Abstinence Syndrome: Controversies and Implications for Practice." Current Drug Abuse Reviews. Epub ahead of print.

This review identified a variety of neonatal abstinence syndrome (NAS) scales used to assess the severity of withdrawal symptoms. The scales differ in timing, duration, and frequency of administration; reliability training for observers; and acceptance of using scales designed for term neonates, to assess preterm neonates who may have a qualitatively different expression of abstinence symptoms. Unrecognized NAS symptoms can lead to underreporting and inappropriate early discharge from the hospital. Research is needed to investigate the effects of observer bias on NAS scoring, the basis for treatment decisions, and the influence of concomitant maternal use of nonopioid drugs late in pregnancy.

Read more:

M.A. Yokell, M.K. Delgado, N.D. Zaller, N.E. Wang, S.K. McGowan, and T.C. Green. 2014. "Presentation of Prescription and Nonprescription Opioid Overdoses to US Emergency Departments." Research Letter. JAMA Internal Medicine, doi:10.1001/jamainternmed.2014.5413.

According to the Nationwide Emergency Department Sample, 135,971 emergency department visits in 2010 involved opioid overdoses, with 50.6 percent of patients admitted as inpatients. Prescription opioids (including methadone) were involved in 67.8 percent of all overdoses, heroin was involved in 16.1 percent, unspecified opioids were involved in 13.4 percent, and multiple opioids were involved in 2.7 percent. Most prescription overdoses occurred in urban areas (84.1 percent), in the South (40.2 percent), and among women (53.0 percent). Common comorbidities included chronic mental diseases (33.9 percent), circulatory diseases (29.1 percent), and respiratory diseases (25.6 percent).

Read more:

E.L. Zale, M.L. Dorfman, W.M. Hooten, D.O. Warner, M.J. Zvolensky, and J.W. Ditre. 2014. "Tobacco Smoking, Nicotine Dependence, and Patterns of Prescription Opioid Misuse: Results from a Nationally Representative Sample." Nicotine and Tobacco Research, doi:10.1093/ntr/ntu227.

In 2009 National Survey on Drug Use and Health data, adjusting for sociodemographic factors (age, marital status, education, employment status, gender, race/ethnicity) and major depressive/alcohol use disorders, both daily and intermittent smokers were three times more likely to report past-year nonmedical prescription opioid use than never-smokers. Daily smokers were five times more likely than never-smokers to meet past-year abuse/dependence criteria; intermittent smokers were three times more likely. These findings persisted when analyses were stratified by gender.

Read more:

Professional Education

Rita Rubin. 2014. "Analysis Reveals Large Increase in Hospitalizations in Recent Years Among Older Patients Prescribed Opioids." JAMA 312(16):1621–623, doi:10.1001/jama.2014.13249.

The author summarizes an Agency for Healthcare Research and Quality report on adult hospitalization trends related to prescription opioid pain reliever use from 1993 to 2012. (See August 20 Weekly Update.)

Read more:


Oklahoma Health Commissioner Describes Efforts of States to Curb Prescription Drug Abuse
John Skendall, Association of State and Territorial Health Officials
October 27, 2014

Under Oklahoma Commissioner of Health Terry Cline's leadership, the Association of State and Territorial Health Officials (ASTHO) challenged health agencies in each state and territory to make a strong and concerted effort to stem the rampant rate of abuse and deaths associated with prescription drugs. Forty-six states and two U.S. territories have pledged to meet the 2014 ASTHO President's Challenge to reduce prescription drug abuse and the number of resulting deaths in their states by 15 percent before 2015.

Read more:

FDA Zeros In on Abuse-Deterrent Opioids
Kristina Fiore, Medpage Today
October 29, 2014

At an off-site public meeting last week, the Food and Drug Administration (FDA) met with stakeholders to discuss draft guidance released in January 2013 for abuse-deterrent opioids. The FDA said it is not ready to banish non-abuse–deterrent opioid formulations from the market. It will continue to take a case-by-case approach to approval "with a goal of incentivizing an incremental, sponsor-driven market transition from conventional opioid formulations to formulations with meaningful abuse-deterrent properties." The agency gave some indication that it may eventually call for all opioids to have abuse-deterrent properties.

Read more:

State Responses to Increasing Rates of Neonatal Abstinence Syndrome: Alternatives to Prosecution and Incarceration
Sarah Kelsey, Partnership for Drug-Free Kids
October 29, 2014

Sarah Kelsey, chief executive officer of the National Alliance for Model State Drug Laws, discusses states that address neonatal abstinence syndrome, including Tennessee, which became the first to statutorily criminalize drug use during pregnancy. Kelsey believes states should take a comprehensive approach focusing on educating pregnant women about the effects drug use can have on their unborn children, and on providing treatment, but stop short of charging, prosecuting, and incarcerating these women.

Read more:

NFL Seeks to Dismiss Ex-Players' Painkillers Suit
Paul Elias, ABC News
October 30, 2014

The National Football League (NFL) asked a judge to throw out a lawsuit filed by former players alleging team officials gave them pain relievers and other drugs to keep them on the field without regard for their long-term health. The NFL's lawyer argued the league is not responsible for the medical decisions of its 32 teams. He also said the issue should be addressed by the Players Association, which negotiated a collective bargaining agreement that covers player health. The judge ordered the lawyers to contact the association.

Read more:

Adderall in the Workplace: Why Some Turn to Stimulants for a Career Boost
Todd Essig, Forbes
October 25, 2014

The author thinks stimulant medications are popular for emotional and motivational reasons. He believes people who use these pills are taking "drive drugs," not "smart drugs." Taking them may be an ill-advised attempt to self-medicate to solve problems related to work, depression, low self-esteem, and lack of confidence.

Read more:

States Expand Access to Lifesaving Drug After Philip Seymour Hoffman's Death
Matt Sledge and Emily Kassie, The Huffington Post
October 28, 2014

States have expanded naloxone access since the February death of actor Philip Seymour Hoffman resulting from a drug overdose. Thus far, eight states have passed laws allowing firefighters, police, and members of the public to more easily administer naloxone. Three more have passed Good Samaritan laws protecting 911 callers from being prosecuted for drug crimes. Rhode Island, New York, and Washington now allow pharmacists to dispense naloxone to anyone who needs it, as long as he or she has authorization from a physician. New York also permits community programs to dispense naloxone without a medical professional physically present. Twenty-five states and the District of Columbia have some form of naloxone access law, according to LawAtlas.

Read more:

Other State and Local News

Survey Details New Levels of Prescription Drug Abuse Among Youth in AZ
Som Lisaius, KOLD
October 29, 2014

One in three eighth, tenth, and twelfth graders who took the Arizona Youth Survey said they abused prescription drugs in the past 30 days. In Pima County, 47 percent of surveyed youth said they use drugs to deal with stress or sadness. Use rose among eighth graders, while sophomores and seniors reported a slight decrease compared with the last survey. (Includes video: 3:34 minutes)

Read more:

Q&A: Physician Assistants Play Important Role in Prescription Drug Addiction Debate in Oklahoma
Jaclyn Cosgrove, The Oklahoman
October 26, 2014

Dan McNeill, clinical professor at Oklahoma City University and president of the Oklahoma Academy of Physician Assistants, answered questions about the organization's efforts to curb prescription drug abuse in the state.

Read more:

Governor Corbett Signs Legislation Establishing Prescription Drug Monitoring Program and Physician Dispensing Reform
Pennsylvania Office of the Governor
October 27, 2014

Pennsylvania Governor Tom Corbett signed Senate Bill 1180 into law, establishing the Achieving Better Care by Monitoring All Prescriptions Program (ABC-MAP) database within the Department of Health. The electronic data monitoring system will maintain a record of controlled substances prescribed and dispensed in the Commonwealth. An interagency board will oversee the program's establishment and management.

Read more:

Mercer County Deploys 600 Heroin Overdose Antidote Kits to Police Departments
Keith Brown, Times of Trenton
October 30, 2014

Mercer County, N.J., spent $19,000 of the Attorney General's office drug arrest seizure fund to buy 600 naloxone kits, including kits for every detention facility and patrol and detective car in the county.

Read more:

Prescription Drug Registry Looks to Expand Outside State Lines
Lauren Bradley, KECI
October 29, 2014

Marcie Bough, head of Montana's Prescription Drug Registry, said the pharmacy board is working to share prescription drug information with other states. Bough hopes all Montana prescribers and distributors will eventually register to use the prescription drug monitoring program, but only 29 percent are currently registered. (Includes video: 1:46 minutes)

Read more:

VA Silent over 'Pill Mill' Concerns; Charleston Team to Study Veteran Pain Management
Lauren Sausser, The Post and Courier
October 26, 2014

The South Carolina congressional delegation has been awaiting a response from the Department of Veterans Affairs (VA) about its concerns that hospitals are overprescribing pain relievers. Congressman Trey Gowdy said his office would continue working to get answers. The VA is still in the process of preparing a response.

Read more:

Porter County Cops to Begin Carrying Anti-OD Drug
Bob Kasarda, The Times Media
October 27, 2014

The Porter County, Ind., sheriff's department will soon become the second in the county to carry naloxone. The Porter County Community Foundation provided the funding for the effort, and Porter Regional Hospital has agreed to keep the medication kits up to date.

Read more:

Prescription Drug Use Is a Problem in Schools
Ricky Leroux, The Marietta Daily Journal
October 25, 2014

As part of Georgia's "Think About It" campaign, Attorney General Sam Olens spoke to students at Walton High School about the dangers of prescription drug abuse. Atty. Gen. Olens also explained the new medical amnesty law to students. The law states a person who calls 911 to report a drug overdose cannot be arrested; nor can the person overdosing. Chris Ragsdale, interim superintendent of the Cobb School District, said the school system should "take every opportunity" to make students aware of the problem.

Read more:

Ex-Fairview Pharmacist Stole 67,000 Painkiller Doses to Feed Addiction
Paul Walsh, Star Tribune
October 29, 2014

Anissa J. Shores admitted in federal court that she fraudulently obtained controlled substances while working as a pharmacist at Minnesota's Fairview Pharmacy. Shores stole 67,000 doses of oxycodone, hydrocodone, carisoprodol, tramadol, and diazepam over a 2-year period. Her employer discovered the theft in spring of 2013 and fired her. The plea agreement calls for a federal guideline sentence of 0 to 6 months in prison.

Read more:

Other Resources

DOJ Launches Law Enforcement Naloxone Toolkit
Department of Justice
October 27, 2014

The Justice Department launched a Law Enforcement Naloxone Toolkit—an online clearinghouse of 80 resources designed to support law enforcement agencies in establishing a naloxone program. Training and technical assistance may also be requested through the clearinghouse. Developed by the Bureau of Justice Assistance, the toolkit was initiated by the U.S. Attorney General's expert advisory panel, which included leaders from law enforcement, the public health community, academia, and the federal government.

Read more:


Prescription Drug Abuse: Understanding the National and Local Picture
Community Anti-Drug Coalitions of America
November 18, 2014
3 to 4 p.m. EST

This 1-hour Webinar, one of a four-part series, will explore prescription drug misuse and abuse in the United States. Participants will learn about national trends, types of prescription drugs adults and youth use nonmedically, the unintended consequences of prescription drug abuse on communities, and links to other problems. In addition, presenters will discuss gathering local data on this problem to inform strategies and interventions. The Webinar will feature a case study from a Kentucky coalition that reduced prescription drug abuse by 80 percent.

Read more:

To Register: https://www.surveymonkey.com/s/RxWebinar1

Rx to Heroin Connection
The Partnership for a Drug-Free America, Arizona Affiliate
November 19, 2014
12 p.m. MST

Program Director Thalia Williams will discuss the connection between prescription drugs and heroin and how parents and caregivers can educate youth about these dangerous substances.

Read more:

Prescription Drug Abuse Webinar
Center for the Application of Substance Abuse Technologies
December 9, 2014
9 to 10:30 a.m.

This Webinar will examine the scope of prescription drug abuse in the United States and demonstrate how the problem is deeply rooted in U.S. culture. It will take into account the many legal, societal, and educational obstacles in finding a remedy.

Read more:

Grants Awarded

Nassau Police to Get $200,000 Grant to Fight Opiate Abuse
Kevin Deutsch, Newsday
October 28, 2014

New York awarded the Nassau Police Department a $200,000 grant to fight opiate abuse on Long Island. The funds will help with overtime spending on overdose cases.

Read more:

Request for Proposal

Interventions for Youth Who Misuse/Abuse Prescription Stimulant Medications in High School and/or College-Attending Youth (U01)
National Institutes of Health
Deadline: November 13, 2014, by 5 p.m.

Take-Back Events and Drop Boxes

Morris Sheriff's Office Collects 4,000 Lbs. of Prescription Drugs
Michael Izzo, Daily Record (New Jersey)
October 28, 2014

Stoneham Police Took Back 370 Pounds of Drugs at Two Events This Year
Les Masterson, Stoneham Patch (Massachusetts)
October 27, 2014

Police Take Back More Than 200 Pounds of Prescription Pills
Jack Molitor, The Herald Bulletin (Indiana)
October 27, 2014

From the Community: Prescription Drug Drop Box Program Successfully Disposing of Unused Medications in the Community
Community Contributor City of Naperville, Chicago Tribune (Illinois)
October 27, 2014

DuBois City Police Receive Grant for Drug Collection Unit
Gant Daily (Pennsylvania)
October 27, 2014

State Unveils 100th 'Project Medicine Drop' Box in Teaneck
Myles Ma, New Jersey Advance
October 27, 2014

UAPD Acquires Prescription Meds Disposal Box
Brianna Cole, The Arkansas Traveler
October 28, 2014

Pleasanton Police Open 24-Hour Prescription Drugs Disposal Site
Amanda Aguilar, Pleasanton Weekly (California)
October 28, 2014

Upcoming Conferences and Workshops

The Role of the Prescriber in Prescription Drug Abuse 2014
The Academy of Medicine of Cleveland and Northern Ohio
November 8, 2014
Independence, Ohio

Sixth Annual American Medicine Chest Challenge: National Day of Awareness and Safe Disposal of Rx and OTC Medicine
American Medicine Chest Challenge
November 8, 2014

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

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.