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October 1, 2014


SAMHSA Prescription Drug Abuse Weekly Update
iissue 91  |  October 1, 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 Featured Article Journal Articles and Reports Professional Education News Other State and Local News Other Resources Grant Awarded Request for Proposal Take-Back Events and Drop Boxes Upcoming Conferences and Workshops


Workforce Drug Test Positivity Rate Increases for the First Time in 10 Years, Driven by Marijuana and Amphetamines, Finds Quest Diagnostics Drug Testing Index™ Analysis of Employment Drug Tests
Quest Diagnostics
September 11, 2014

Fueled by a rise in marijuana and amphetamines, the percentage of positive drug tests among American workers increased for the first time since 2003, according to the Quest Diagnostics Drug Testing Index. The positivity rate for 7.6 million urine drug tests in the U.S. workforce increased from 3.5 percent in 2012 to 3.7 percent in 2013. Oxycodone positivity decreased from 0.96 percent in 2012 and 1.1 percent in 2011 to 0.88 percent in 2013. Florida, Massachusetts, New Jersey, and Ohio experienced double-digit percentage declines in oxycodone positivity rates in 2013 and 2012. Hydrocodone positivity remained at 1.3 percent between 2012 and 2013. In contrast, workforce methamphetamine positivity in urine drug tests increased from 0.11 percent to 0.14 percent, and oral fluid methamphetamine positivity increased from 0.16 percent to 0.24 percent. Amphetamine positivity rates are now at their highest levels on record, and methamphetamine positivity rates are at their highest levels since 2007. Driven by growth in Colorado and Washington, in the safety-sensitive workforce, marijuana positivity increased from 0.63 percent to 0.67 percent. In the general U.S. workforce, the positivity rate increased from 2.0 percent in 2012 to 2.1 percent in 2013.

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B.M. Kuehn. 2014. "AHRQ: Little Evidence for Opioids in Managing Long-Term Chronic Pain." JAMA 312(12):1185, doi:10.1001/jama.2014.12752.

Patients taking opioids long term for chronic pain have an increased risk of serious dose-dependent harms, according to a draft review of the evidence on long-term opioid use by the Agency for Healthcare Research and Quality (AHRQ). In addition, AHRQ found little evidence supporting benefits of long-term use of opioids for chronic pain. No study evaluated the effects of long-term opioid therapy versus no opioid therapy. In 10 uncontrolled studies, opioid abuse rates were 0.6 percent to 8 percent, and rates of dependence were 3.1 percent to 26 percent in primary care settings, but studies varied in methods used to define and ascertain outcomes. Rates of aberrant drug–related behaviors ranged from 5.7 percent to 37.1 percent. Compared with nonuse, long-term opioid therapy was associated with increased risk of overdose (one cohort study), fracture (two observational studies), myocardial infarction (two observational studies), and markers of sexual dysfunction (one cross-sectional study), with several studies showing a dose-dependent association. One randomized trial found no difference between a more liberal opioid dose escalation strategy and maintenance of current dose in pain or function, but differences between groups in daily opioid doses at the end of the trial were small. A propensity score–adjusted statistical analysis found mortality risk was lower for methadone users than for long-acting morphine users in a Veterans Affairs population (adjusted hazard ratio 0.56). Estimates of diagnostic accuracy for the Opioid Risk Tool were extremely inconsistent, and other risk assessment instruments were evaluated in only one or two studies. No study evaluated effectiveness of risk mitigation strategies in outcomes related to overdose, addiction, abuse, or misuse. There was insufficient evidence to evaluate benefits and harms of long-term opioid therapy in high-risk patients or other subgroups.

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Journal Articles and Reports

S. Darke, C. Marela, K.L. Millsa, J. Rossa, T. Sladea, L. Burns, and M. Teesson. 2014. "Patterns and Correlates of Non-Fatal Heroin Overdose at 11 Year Follow-Up: Findings from the Australian Treatment Outcome Study." Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2014.09.001.

An 11-year follow-up of the Australian Treatment Outcome Study cohort interviewed 431 (70.1 percent) of the original 615 participants. Of respondents, 67.5 percent had non-fatally overdosed, and 24.4 percent had experienced five or more overdoses. In the past year, 42 percent had used heroin, and 5 percent had overdosed. Of the 21 participants who had recently overdosed, 19 were not enrolled in a treatment program. Compared with other respondents, those who had recently overdosed reported higher levels of use of opiates other than heroin (57 vs. 25 percent), benzodiazepines (62 vs. 30 percent), methamphetamine (38 vs. 17 percent), and cocaine (19 vs. 4 percent). They also had higher levels of heroin and other drug use at baseline and at the 12- and 24-month follow-ups.

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J.A. Ford and J. Ong. 2014. "Non-Medical Use of Prescription Stimulants for Academic Purposes Among College Students: A Test of Social Learning Theory." Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2014.09.011.

In a survey, 17 percent of 521 undergraduate students at the University of Central Florida reported nonmedical use of prescription stimulants for academic reasons during the past year. Logistic regression showed use rose for respondents who reported that more of their friends used, and for those with the perception that stimulants were an effective study aid.

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D.R. Gastfriend. 2014. "A Pharmaceutical Industry Perspective on the Economics of Treatments for Alcohol and Opioid Use Disorders." Annals of the New York Academy of Sciences, doi:10.1111/nyas.12538.

Cost/utilization data consistently show greater savings for substance abuse treatment with pharmacotherapies (despite their costs) than with psychosocial treatment alone. All Food and Drug Administration–approved addiction pharmacotherapies (oral naltrexone, extended-release naltrexone, acamprosate, disulfiram, buprenorphine, buprenorphine/naloxone, and methadone) are intended for use in conjunction with psychosocial management, not as standalone therapeutics. Patient persistence is problematic, and (despite its cost) extended-release pharmacotherapy may be associated with lower or no greater total healthcare cost—mostly due to reduced hospitalization. The reviewed studies use rigorous case-mix adjustment to balance treatment cohorts, but lack the randomization that clinical trials use to protect against confounding. Unlike trials, however, these studies can offer generalizability to diverse populations, providers, and payment models—and are of particular salience to payers.

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J. Harman Ehrentraut, K.D. Kern, S.A. Long, A. Qi An, L.G. Faughnan, and D.L. Anghelescu. 2014. "Opioid Misuse Behaviors in Adolescents and Young Adults in a Hematology/Oncology Setting." Journal of Pediatric Psychology, doi:10.1093/jpepsy/jsu072.

Researchers reviewed charts of 398 adolescent and young adult patients accepted for active treatment at a large pediatric hematology/oncology institution over a 17-month period. Of 94 patients prescribed opioid therapy, 11.7 percent exhibited aberrant opioid-associated behavior. Of these misusers, 91 percent had at least one psychosocial risk and used multiple opioids.

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A. Kecojevic, K. Silva, R.L. Sell, and S.E. Lankenau. 2014. "Prescription Drug Misuse and Sexual Risk Behaviors Among Young Men Who Have Sex with Men (YMSM) in Philadelphia." AIDS and Behavior, doi:10.1007/s10461-014-0898-5.

This study analyzed interviews with 191 18- to 29-year-old males in Philadelphia who reported misusing prescription drugs in the past 6 months and having sex with men. Controlling for sociodemographic variables and illicit drug use, misuse of prescription pain pills and muscle relaxants were significantly associated with engaging in receptive unprotected anal intercourse. No prescription drug class was associated with a high number of sex partners.

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A.M. Reid, P.A. Graziano, A.M. Balkhi, J.P. McNamara, L.B. Cottler, E. Meneses, and G.R. Geffken. 2014. "Frequent Nonprescription Stimulant Use and Risky Behaviors in College Students: The Role of Effortful Control." Journal of American College Health, doi:10.1080/07448481.2014.960422.

In an August 2010–February 2012 Internet survey of 555 psychology or pre-med undergraduate students at a Florida university (not the one surveyed in Ford and Ong, above), students who reported more frequent nonprescription stimulant use were likelier to engage in all types of high-risk behavior. Reduced impulsivity, which the authors define as "effortful control," weakened the link between nonprescription stimulant use and risky behaviors.

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Z. Schuman–Oliviera, M.C. Greene, B.G. Bergman, and J.F. Kelly. 2014. "Is Residential Treatment Effective for Opioid Use Disorders? A Longitudinal Comparison of Treatment Outcomes Among Opioid Dependent, Opioid Misusing, and Non-Opioid Using Emerging Adults with Substance Use Disorder." Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2014.09.009.

Emerging adults aged 18 to 24 attending 12-step–oriented residential treatment (n=292; 74 percent male, 95 percent white) were categorized into opioid-dependent (25 percent), opioid-misuse (20 percent), or no-opiate use (55 percent) groups. Longitudinal multilevel models found all groups experienced similar during-treatment increases in therapeutic targets (e.g., abstinence self-efficacy). Psychiatric symptoms declined more in the opioid-dependent group. The no-opiate use and opioid-dependent groups had significantly more days abstinent and significantly less cannabis use than opioid misusers. The opioid-dependent group attended significantly more outpatient treatment sessions than other groups. Twenty-nine percent of the opioid-dependent group were completely abstinent at the 12-month follow-up.

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S.I. Shehnaz, A.K. Agarwal, and N. Khan. 2014. "Systematic Review of Self-Medication Practices Among Adolescents." Journal of Adolescent Health 55(4):467–83, doi:10.1016/j.jadohealth.2014.07.001.

A systematic review of global trends and factors influencing self-medication among adolescents found self-medication prevalence ranged from 2 percent to 92 percent between countries. The most frequently self-medicated over-the-counter and prescription-only medicines were analgesics and antibiotics, respectively. Headache, allergies, and fever were the most commonly reported self-medicated health complaints. Female gender, older age, maternal education, and familial practices were associated with self-medication among adolescents. The primary sources of drug information, recommendation, and procurement included pharmacists, parents, and friends. Most studies revealed gaps in drug knowledge, although adolescents self-rated their knowledge as satisfactory.

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L.L. Weyandt, D.R. Oster, M.E. Marraccini, B.G. Gudmundsdottir, B.A. Munro, B. Martinez Zavras, and B. Kuhar. 2014. "Pharmacological Interventions for Adolescents and Adults with ADHD: Stimulant and Nonstimulant Medications and Misuse of Prescription Stimulants." Psychology Research and Behavior Management 7:223–49, doi:10.2147/PRBM.S47013.

This systematic review found both prostimulant and stimulant medications are effective at reducing attention deficit hyperactivity disorder (ADHD). People diagnosed with ADHD may also have higher rates of stimulant misuse than those who do not have the disorder. Young adults, college students, and white adults are most likely to misuse stimulants, and short-acting agents are more likely to be misused than long-acting agents.

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Professional Education

PhRMA Helps Combat Prescription Drug Abuse
Pharmaceutical Research and Manufacturers of America
September 24, 2014

The Pharmaceutical Research and Manufacturers of America makes policy recommendations to combat prescription drug abuse. The recommendations are intended to inform policy proposals at the state and federal levels.

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NIH and VA Address Pain and Related Conditions in U.S. Military Personnel, Veterans, and Their Families: Research Will Focus on Nondrug Approaches
National Center for Complementary and Alternative Medicine
September 25, 2014

This article summarizes 13 newly funded research projects that will explore nondrug approaches to managing pain and related health conditions, such as post-traumatic stress disorder, drug abuse, and sleep issues among military personnel, veterans, and their families. The National Center for Complementary and Alternative Medicine, the National Institute on Drug Abuse, and the U.S. Department of Veterans Affairs' Health Services Research and Development have awarded $21.7 million in funding over 5 years.

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Prescription Drug Abuse Epidemic Demands Mandatory Physician Education
Christopher Gharibo, The Hill
September 22, 2014

Christopher Gharibo, director of pain medicine at New York University Langone Medical Center and the Hospital for Joint Diseases, stresses the need for mandatory physician education on opioids. Education can drive appropriate prescribing, monitoring, and patient knowledge to help reduce misuse and abuse. Gharibo recommends a national, government-developed program that is tied to Drug Enforcement Administration registration, and a national prescription monitoring program.

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Will Efforts to Halt Prescription Drug Abuse Affect Students?
Canton Winter, USA Today
September 24, 2014

As organizations across the country prepare to take back prescription drugs, it is unclear whether college and university pharmacies will participate. Joseph Moses, a special agent with the Drug Enforcement Administration, said campus pharmacies would need to apply to become authorized collectors, and already handle Schedule II controlled substances.

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Good Teens Turned Drug Addicts
Elizabeth Foy Larsen, Choices Magazine
October 2014

This article discusses prescription pain reliever use and how people (especially young people) can get addicted. It shares the story of Brittany, a young woman who started using Percocet when she was 16 after having her wisdom teeth removed. When the pain subsided, she used the leftover medication to get high.

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Other State and Local News

Center for Rural Pennsylvania Releases Report on Growing Heroin Epidemic
Pennsylvania State Senator Gene Yaw
September 23, 2014

The Center for Rural Pennsylvania released a report summarizing findings of four statewide hearings on the growing numbers of heroin- and opioid-related deaths and arrests across Pennsylvania. Report recommendations under consideration by the General Assembly would expand the drugs monitored by the prescription monitoring program, expand access to naloxone, and provide immunity to those who contact authorities about a drug overdose. Additional recommendations focus on education, prevention, law enforcement, and treatment. State Senator Gene Yaw, the center's board chair, discusses the findings in a video.

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Michigan Tapped by National Governors Association to Focus on Reducing Prescription Drug Abuse; LARA, MDCH to Partner on Improving State's Pain Management
State of Michigan
September 24, 2014

The Michigan Departments of Licensing and Regulatory Affairs (LARA) and Community Health (MDCH) announced their partnership to improve pain management for citizens. The departments received recommendations from the Advisory Committee on Pain and Symptom Management, whose goal is to reduce the incidence of overdose among individuals with five or more prescribers per year. The advisory committee has already delineated a core curriculum on pain for Michigan's medical and health professional schools. The departments will work with care providers and pharmacists to improve residents' quality of life.

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Gov. Shumlin, Substance Abuse Community Highlight Progress in Battle Against Opiate Addiction Since January
State of Vermont
September 23, 2014

Governor Peter Shumlin and other Vermont officials outlined the state's progress this year in the battle against opiate addiction. Since January, Vermont has increased the number of people in treatment from 1,704 to 2,519, expanded use of pre-trial risk-assessment programs to more counties, co-hosted a statewide Community Forum on Opiate Addiction, received a $300,389 competitive Harold Rogers Prescription Drug Monitoring Program enhancement grant, distributed 1,175 Overdose Rescue Kits, and created a pilot project allowing inmates to remain on maintenance doses of Suboxone and methadone.

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Governor McAuliffe Signs Executive Order Establishing the Governor's Task Force on Prescription Drug and Heroin Abuse
State of Virginia
September 26, 2014

Virginia Governor Terry McAuliffe signed Executive Order 29 establishing the Governor's Task Force on Prescription Drug and Heroin Abuse. The order asks the task force to suggest strategies that will raise public awareness about the dangers of prescription drug abuse and misuse, train healthcare providers on best practices for pain management, identify treatment options and alternatives to incarceration for people with addiction, and promote safe storage and disposal of prescription drugs. The task force will also seek to expand naloxone use and leverage the prescription monitoring program to reduce widespread abuse.

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Counterfeit Oxycontin Like 'Loaded Gun,' Says Family of Dead Teen
Charles Hamilton, The StarPhoenix
September 24, 2014

Police said the recent overdose death of Logan Jamieson is one of two in Saskatoon connected to counterfeit OxyContin. Though he struggled with addiction, Jamieson's family thinks he was poisoned by the drug, which has been known to contain fentanyl. His brother-in-law said Jamieson did not know he was taking counterfeit drugs on the night of his death. Dr. Matthew Young with the Canadian Centre on Substance Abuse said with the absence of true OxyContin, organized crime groups are selling illicit substitutes.

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Kentucky Doctors See Surge of Babies Treated for Drug Addiction Withdrawal
Justin Madden, Kentucky.com
September 22, 2014

The Kentucky Cabinet for Health and Family Services reported that neonatal abstinence syndrome (NAS) hospitalizations rose from 67 in 2001 to 955 in 2013. The University of Kentucky Children's Hospital Neonatal Intensive Care Unit has discharged 204 NAS babies so far this year—up from 154 in 2013 and 130 in 2012. Kentucky health officials plan to create standardized treatments to improve outcomes for mothers and babies.

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Illegal Drug Use Identified as Top Problem in Blount
Linda Braden Albert, The Daily Times
September 22, 2014

The Blount County Community Health Initiative and University of Tennessee have collaborated with the Community Assessment and Education to Promote Behavioral Health Planning and Evaluation (CAPE) project to assess behavioral health priorities and how leaders access and use information about such health issues. Blount County, one of only 10 communities across the nation selected to participate in the CAPE survey, identified illegal drug use, alcohol abuse, and nonmedical prescription drug use as major behavioral health issues. Of the 22 conditions listed in the survey, alcohol abuse was selected as a primary health concern by 67.2 percent of community leaders, while nonmedical prescription drug use was a top priority for 65.7 percent.

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Prescription Drug Abuse Targeted by Health Officials, Law Enforcement
CBS Denver
September 24, 2014

Arapahoe County, Colo., has created a task force to raise awareness about drug-related deaths. The task force will work to educate doctors, pharmacists, and the public about the dangers of prescription drug abuse, and step up enforcement. Since 2004, drug-related deaths rose 86 percent in Arapahoe County. According to the article, experts are seeing a significant surge in prescription drug abuse among women, with those 26 to 35 in the highest population dying of overdoses.


Heroin and Prescription Drug Addiction Resources a Click Away on State Website
Staten Island Advance
September 23, 2014

"Combat Heroin and Prescription Drug Abuse" is New York's new website for families struggling with heroin and prescription drug addiction.

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Health Officials Release New Plan to Prevent Prescription Drug Abuse
Tim Slover, KUER
September 25, 2014

The Utah Department of Health has released a prescription drug abuse prevention plan including a toolkit of information on symptoms of abuse; prevention tips for parents, healthcare workers, and law enforcement officials; a list of substance abuse treatment centers in Ogden; and places where prescription drugs may be dropped off. The toolkit is available on the Utah Health Department's website. (Includes audio: 1:35 minutes)

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The Drug That Turned a Heroin User's Life Around
Wesley Robinson, The Washington Post
September 20, 2014

An Annapolis, Md., police officer saved Danielle Hall's life by administering naloxone spray. Hall, a 30-year-old mother of two, once overdosed on heroin. Since that time, she entered a 12-step program with intensive outpatient therapeutic and educational treatment. The Annapolis Police Department is one of the first in the Washington area to issue naloxone to its officers.

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Prescription Drug Registry Aids Police Investigation
Lauren Bradley, NBC Montana
September 23, 2014

The Missoula Police Department said Montana's prescription monitoring program has benefitted several criminal investigations. For example, a 25-year-old man was charged with a felony for faking injuries and requesting pain relievers at local hospitals. Brent Dehring, a pharmacist who uses the registry, recalled four times when the database was useful in changing prescribing habits.

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Getting Prescription Drugs off the Streets of MO
Anne Allred, KSDK
September 22, 2014

When Andrew Eigles was injured in a high school football injury, he started taking OxyContin. Eigles' family said he immediately became addicted and continued abusing prescription drugs in college. Eventually, the drugs became too expensive and Eigles turned to heroin. At 22, he died from an overdose. His mother testified before the Missouri Senate, asking legislators to pass a bill enacting a prescription drug program. However, Representative Keith Frederick, who is also an orthopedic surgeon, said he no longer thinks the benefits of such a program outweigh the risks to privacy. (Includes video: 4:58 minutes)

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Other Resources

SCOPE of Pain Combats Opioid Abuse Through Prescriber Education
September 26, 2014

Safe and Competent Opioid Prescribing Education (SCOPE) of Pain, a Boston University School of Medicine program, provides opioid prescribers with validated tools, skills, and confidence in safely prescribing opioids and implementing systems that minimize risks of misuse. SCOPE of Pain educates prescribers at live seminars in cities throughout the country and a three-part online educational series based on real-world, case-derived patient scenarios. Upcoming meetings will be held in Virginia, Massachusetts, Vermont, and Connecticut.

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Grant Awarded

FY 2014 Drug-Free Communities Grant Announcement
Office of National Drug Control Policy
Accessed September 22, 2014

The Drug-Free Communities Support Program announced its 2014 grant award recipients. This funding will support 197 new Drug-Free Communities grants, 463 continuation grants for coalitions in a 5-year cycle, three new mentoring grants, and 17 continuation mentoring grants. The awards, totaling $84 million, provide support to community coalitions for preventing and reducing youth substance use, including nonmedical use of prescription drugs.

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Patrick Administration Awarded $400,000 Federal Grant to Expand Prescription Drug Monitoring Program
State of Massachusetts
September 19, 2014

The Massachusetts Department of Public Health won a $400,000 Department of Justice grant to expand prescription monitoring program (PMP) training and community outreach. This includes development of Web-based and other training curricula for healthcare providers on how best to use the PMP and incorporate patient prescription records into clinical decisions. The funding will also help create provider-based "how to" videos, pamphlets, quick reference guides, and toolkits to improve community understanding of PMP effectiveness.

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Request for Proposal

Chronic Pain Management Research Grant
Milbank Foundation
Postmarked by November 1, 2014

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

Waseca County Sheriff's Department Hauls in 500 Pounds of Unused Prescriptions
Samantha Maranell, Waseca County News (Minnesota)
September 25, 2014

Sacramento Area Receives New Medication Collection Bin on Eve of National Prescription Drug Take Back Day
City of Rancho Cordova (California)
September 24, 2014

Orange County Health Officials Offer Drug Disposal Program
Sam James, The Daily Tar Heel (North Carolina)
September 22, 2014

Allen Park Police Offering New 24-Hour Medication Disposal Program
Jenny Kalish, The News–Herald (Michigan)
September 20, 2014

Upcoming Conferences and Workshops

5th Annual Prescription Drug Abuse Symposium: Reversing the Tide of Opioid Abuse
Office of the Indiana Attorney General
October 16–17, 2014
Indianapolis, Indiana

Commissioner's Medical Grand Rounds: Prescription Drug Abuse and Pain Management
The New York Academy of Medicine
October 23, 2014
6 to 8 p.m.
1216 Fifth Avenue at 103rd Street
New York, New York

The Prescription Drug Abuse and Pain Management Grand Rounds will focus on the basic science behind opioid prescriptions, understanding the scope of prescription drug abuse, factors contributing to the epidemic's spread, and strategies for containment, including New York State's prescription monitoring program and I-STOP initiative.

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Empowered Health Consciousness and Prescription Drugs: Facilitator Certification Training with Special Focus on Workplace and Parents
Organizational Wellness
November 4, 2014

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.