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October 15, 2014


SAMHSA Prescription Drug Abuse Weekly Update
Issue 93  |  October 15, 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 Twitter Chat Video Request for Proposal Take-Back Events and Drop Boxes Upcoming Conferences and Workshops


C.M. Jones, L.J. Paulozzi, and K.A. Mack. 2014. "Alcohol Involvement in Opioid Pain Reliever and Benzodiazepine Drug Abuse–Related Emergency Department Visits and Drug-Related Deaths—United States, 2010." Morbidity and Mortality Weekly Report 63(40):881–85.

When taken with opioid pain relievers or benzodiazepines, alcohol increases central nervous system depression and overdose risk. Analysis of 2010 Drug Abuse Warning Network data from 13 states revealed alcohol was involved in 18.5 percent of emergency department (ED) visits and 22.1 percent of deaths resulting from opioid abuse. It was also involved in 27.2 percent of ED visits and 21.4 percent of deaths resulting from benzodiazepine abuse.

Read more:

D.D. Jeffery, L. May, B. Luckey, B.M. Balison, and K.L. Klette. 2014. "Use and Abuse of Prescribed Opioids, Central Nervous System Depressants, and Stimulants Among U.S. Active Duty Military Personnel in FY 2010." Military Medicine 179(10):1141–48, doi:10.7205/MILMED-D-14-00002.

Nearly one third of all U.S. active duty service members received at least one prescription for opioids, central nervous system (CNS) depressants, or stimulants in fiscal year 2010, and 26.4 percent of those were prescribed opioids. Of the total force, 0.7 percent received >90-day prescriptions for opioids, 1.4 percent received >90-day prescriptions for CNS depressants, and 0.6 percent received >90-day prescriptions for stimulants. Battlefield injury, receipt of psychotropic medications, and substance abuse adverse events were predictive of >90-day supplies of opioids. About 0.7 percent of the total force had documented abuse of prescribed drugs, compared with 0.4 percent documenting illegal drug abuse.

Read more:

Journal Articles and Reports

T. Abrahamsson and A.S. Hakansson. 2014. "Nonmedical Prescription Drug Use (NMPDU) in the Swedish General Population—Correlates of Analgesic and Sedative Use." Substance Use and Misuse, doi:10.3109/10826084.2014.962047.

Researchers analyzed a 2008–09 Swedish national household survey of people ages 15 to 64 (response rate 38.3 percent). Mirroring findings in other countries, logistic regression showed nonmedical use of analgesics and sedatives, alone or in combination, was higher for females, hazardous alcohol users (an AUDIT score of six or more for women and eight or more for men), habitual smokers, and cannabis users.

Read more:

E.L. Garland and M.O. Howard. 2014. "Opioid Attentional Bias and Cue-Elicited Craving Predict Future Risk of Prescription Opioid Misuse Among Chronic Pain Patients." Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2014.09.014.

Chronic pain patients taking long-term opioid analgesics (n=47) completed a task designed to assess opioid attentional bias, and then participated in behavioral treatment. The task was a series of trials. Each started with a computer screen displaying a cross for 0.5 seconds, followed by two images for 0.2 seconds or 2 seconds. One image was of an opioid—showing pills, bottles, or powder. The other was a household product (e.g., a napkin or pencil). After .005 seconds, one image was replaced by a large dot for 0.1 seconds. Participants clicked on a keypad to indicate where the dot was. The trial measure was the delay from the dot's appearance to the participant's click. In less than 2 minutes, each participant completed 76 trials: 64 that included one of 12 opioid photos, and 12 that included only household items. Before and after the task, participants used a 10-point scale to rate how much they "wanted their opioids." Regression analyses showed opioid attentional bias (longer time from stimulus to click) for 0.2-second cues and cue-elicited craving significantly predicted opioid misuse risk 20 weeks later, even after controlling for pretreatment opioid dependence diagnosis, opioid misuse, and pain severity. The gain in explanatory power (r-squared) was from 0.33 to 0.5.

Read more:

S. Lenton, P. Dietze, A. Olsen, N. Wiggins, D. McDonald, and C. Fowlie. 2014. "Working Together: Expanding the Availability of Naloxone for Peer Administration to Prevent Opioid Overdose Deaths in the Australian Capital Territory and Beyond." Drug and Alcohol Review, doi:10.1111/dar.12198.

Australia considered a trial of peer naloxone in 2000, but a decline in heroin availability and harm kept the trial from proceeding. Overseas programs without randomized designs have found trained injecting drug–using peers can successfully administer naloxone to reverse heroin overdose with few, if any, adverse effects. Australia's first prescription naloxone program rolled out in Canberra, followed over 18 months by programs in four other Australian states.

Read more:

L.J. Paulozzi, K.A. Mack, and J.M. Hockenberry. 2014. "Variation Among States in Prescribing of Opioid Pain Relievers and Benzodiazepines—United States, 2012." Journal of Safety Research, doi:10.1016/j.jsr.2014.09.001.

According to 2012 commercial IMS Health data, prescribers wrote 82.5 opioid pain reliever scripts and 37.6 benzodiazepine scripts per 100 persons in the United States. State rates varied 2.7-fold for opioid pain relievers and 3.7-fold for benzodiazepines. For both drug classes, rates were higher in the South, with three southern states at least two standard deviations above the mean. Rates for extended-release and high-dose opioid pain relievers were highest in the Northeast. Rates varied 22-fold for oxymorphone.

Read more:

C.M. Vander Weele, K.A. Porter–Stransky, O.S. Mabrouk, V. Lovic, B.F. Singer, R.T. Kennedy, and B.J. Aragona. 2014. "Rapid Dopamine Transmission Within the Nucleus Accumbens: Dramatic Difference Between Morphine and Oxycodone Delivery." European Journal of Neuroscience 40(7):3041–54, doi:10.1111/ejn.12709.

In drug-naïve rats, oxycodone evoked a sizable and stable increase in dopamine concentration and a sizable increase in the frequency and amplitude of phasic dopamine release events. Conversely, morphine evoked a 1-minute increase in dopamine that coincided with a surge in GABA concentration. Then, both transmitters returned to baseline levels.

Read more:

Professional Education

B. McCarberg and S. Nalamachu. 2014. "A New Emergency Treatment for Life-Threatening Opioid Overdose." Pain Medicine News 12(10).

This monograph discusses unintentional opioid overdose and use of a naloxone auto-injector to mitigate overdose risk during opioid therapy.

Read more:


Hardly Anyone Uses Heroin. So Why Do We Keep Freaking Out About It?
Christopher Ingraham, The Washington Post
October 8, 2014

Relatively few people regularly use heroin—roughly 0.5 percent of the U.S. population. Prescription pain relievers kill far more people each year. The author says overreaction produces ill-targeted legislation, and offers a few examples. He doesn't believe it makes sense to call heroin use an "epidemic," because use remains fairly low.

Read more:

Employers Rewarded for Drug-Testing Employees
October 8, 2014

The Georgia Council on Alcohol and Drugs held "Drugs Don't Work," an event that encourages business owners to give their employees drug tests. Businesses will receive a 7.5 percent discount on their insurance and workers' compensation payments for drug-testing employees, providing training and education on drugs, and working with a counseling service that offers assistance to employees who have drug-related issues. Event speakers said they are seeing prescription drugs abused at their highest rate, and it's not limited to one occupation.

Read more:

Drug Czar: Teen Pot Use Could Fuel Opioid Abuse
David Sharp, Seacoastonline.com
October 8, 2014

Michael Botticelli, acting director of the White House Office of National Drug Control Policy, said the nationwide trend toward marijuana legalization is making it harder for healthcare and law enforcement officials to fight rampant prescription opioid abuse. One in nine marijuana users will become addicted, and early marijuana use increases the likelihood users will develop dependency on other drugs, including prescription opioids and heroin. Botticelli was in Maine, where voters in Portland, South Portland, and Lewiston will soon decide whether to legalize marijuana for adult recreational use. Marijuana advocates hope to use the municipal referendums as stepping stones to a statewide vote for the adoption of marijuana legalization.

Read more:

Painkiller Changes Hit Patients, Doctors, Pharmacists
Beth LeBlanc, Times Herald
October 8, 2014

Federal reclassification of hydrocodone combination products (e.g., Vicodin, Norco, and Lortab) from a Schedule III drug to a stricter Schedule II drug took effect October 6, 2014. That means hydrocodone combination pain relievers are limited to a 30-day supply with no refills, and doctors must handwrite prescriptions rather than call them in or fax them. Older prescriptions are no longer refillable.

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Some South Shore Hospital Doctors Curb Painkiller Prescriptions
Christian Schiavone, The Patriot Ledger
October 4, 2014

To prevent abuse by patients or addicts seeking unused medications, 22 doctors at South Shore Hospital in Weymouth, Massachusetts, are scaling back the number of narcotic pain relievers they prescribe. Dr. Michael Ayers, director of joint replacement, and Leslie Stenbeck, a registered nurse, formed a pain advisory committee in April to address this issue. The committee polled orthopedics doctors about drugs they prescribed for patients after surgery. They discovered the physicians were prescribing 60 to 90 pills, with a follow-up visit 7 days later. Now, the department gives patients a sheet with information on addiction and what to do with leftover medication, and doctors prescribe only 20 pills. Stenbeck hopes other departments in the hospital will replicate the initiative.

Read more:

Perverse U.S. Drug Policies Promote Drug Addiction and Deaths
Allen Frances, The Huffington Post
October 5, 2014

Allen Frances, a professor emeritus at Duke University and former chairman of the DSM–IV task force, argues the United States is fighting the wrong war on drugs. He suggests tightening drug company oversight, re-educating physicians, disciplining doctors who run pill mills, educating patients, and developing real-time computerized pharmacy control.

Read more:

14 Days: Dying for Pain Relief in the Opioid Epidemic
Parvati Shallow, CBS News
October 10, 2014

In an interview on the prescription opioid abuse epidemic, Dr. Chinazo Cunningham, a professor of family and social medicine at Albert Einstein College of Medicine and Montefiore Medical Center, said most doctors receive little education about addiction and are poorly equipped to treat it. Multiple studies, she noted, have found discrimination in prescribing and monitoring opioids. She says it's important to maintain very standardized practices. (Includes three videos)

Read more:

Kara Malitsky: Beware of Prescription Drug Misuse, Especially Among Senior Citizens and Teens
Times Leader
October 9, 2014

Kara Malitsky, director of pharmacy at Blue Cross of Northeastern Pennsylvania, discusses prescription drug safety among teenagers and older adults. She provides a statistical overview of the problem and discusses polypharmacy, which can lead to prescription drug misuse. Malitsky explains why misuse occurs more frequently among older adults. Finally, she lists the signs and symptoms of prescription drug abuse and misuse.

Read more:

New Bill Authorizes Grants to Combat Prescription Drug Abuse
Michael Petruzzelli, National Council for Behavioral Health
October 7, 2014

U.S. Representatives Bill Foster and Sean Patrick Maloney introduced the Opioid Abuse Prevention and Treatment Act (H.R. 5587), which would create a 1-year pilot program for states to analyze prescribing behavior and share information on questionable or inappropriate prescribing and pharmacy dispensing patterns; award 5-year grants for training more personnel to increase patient screening, brief interventions, and referral to treatment; require the Secretary of Health and Human Services to determine if naloxone should be available as an over-the-counter drug; and encourage state and local governments to implement and increase drug take-back programs.

Read more:

Other State and Local News

Livingston Teens Shunning Drugs, Survey Says
Daily Press and Argus
October 6, 2014

Michigan's online Profile for Health Youth Survey revealed that most Livingston County middle and high school students do not use alcohol, tobacco, or other drugs. The survey found 94 percent of high school students and 97 percent of middle school students had not misused prescription drugs in the past 30 days. (Editor's note: This press release is a fine example of establishing norms of nonuse rather than headlining usage rates.)

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Christie Announces Expansion of Prescription Drug Monitoring Program to Other States
Susan K. Livio, New Jersey Advance Media
October 8, 2014

New Jersey Governor Chris Christie announced that the state's prescription monitoring program (PMP) began sharing prescription drug records with doctors and pharmacists in Delaware. In May, New Jersey started sharing records with Connecticut; it's now negotiating a sharing arrangement with New York. Pennsylvania has been approached about sharing, but legal compatibility issues first need to be addressed. The PMP requires in-state pharmacies and those outside the state authorized to dispense in New Jersey to submit weekly information on who has received pain relievers, controlled substances, and human growth hormone. (Includes video: 1:50 minutes)

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Whelan/Kyrillos Bill to Promote Safe Disposal of Prescriptions Passes Senate Health Committee
New Jersey Senator Joe Kyrillos
October 9, 2014

New Jersey's Senate Health, Human Services and Senior Citizens Committee approved Bill S-2370, which requires pharmacies and prescribers to distribute with each controlled substance a notice about drug take-back programs and directions on locating where unused prescription drugs can be dropped off for disposal.

Read more:

State Drug Enforcement Leaders in Vermont for Conference
Jack Thurston, NECN.com
October 6, 2014

The National Alliance of State Drug Enforcement Agencies attracted top police officials from across the country to learn about Vermont's approach to combating heroin and prescription drug abuse. The state's plan emphasizes expanding treatment offerings and pretrial risk-assessment programs. Vermont's governor said a grant to enhance the prescription monitoring program should help, and a pilot project in two state prisons is allowing inmates to keep taking their maintenance drugs. The Vermont Health Department has distributed 1,175 naloxone rescue kits. (Includes video: 2:42 minutes)

Read more:

Drug Court Program Established in Van Wert
Times Bulletin
October 8, 2014

Ohio's Van Wert County Court of Common Pleas announced a specialized drug court to address the prescription opiate and heroin epidemic. The program, called "A New Day, the Right Way," serves as intensive outpatient drug treatment. Presumably preceded by managed opiate withdrawal, the court will use Vivitrol (long-acting naltrexone, injected at 28-day intervals). Those involved in the drug court must participate in an evidence-based, intensive outpatient substance abuse treatment program; attend existing community-based support programs; and go through intensive drug testing and supervision.

Read more:

Attorney General, Indiana Prescription Drug Abuse Prevention Task Force Team Up with the Colts to Prevent Prescription Drug Abuse
October 7, 2014

The Indiana Attorney General, Indiana Prescription Drug Abuse Prevention Task Force, and Indianapolis Colts are urging the state's high school students to take an online pledge against abusing or sharing prescription drugs. The school with the highest percentage of pledges will win a $5,000 award from the Colts. The initiative's goal is to educate young people about the dangers associated with prescription drug abuse. (Editor's note: Evidence for effectiveness of pledging strategies is weak at best.)

Read more:

Oklahoma's Overdose Deaths Drop Slightly
Warren Vieth, Oklahoma Watch
October 4, 2014

Oklahoma had 821 overdose deaths in 2013, compared with 850 in the previous year. About three fourths of all overdose deaths involve prescription drugs. Hydrocodone was involved in 182 overdose deaths in 2013, followed by oxycodone with 168, methamphetamine with 167, alprazolam with 118, and morphine with 93.

Read more:

2013 Statistics Show Increase in Fatal Overdoses Among Pregnant Women, New Mothers; DHMH Reaching Out to Providers to Refer Patients at Risk to Treatment
Maryland Department of Health and Mental Hygiene
October 3, 2014

In Maryland, pregnancy-associated deaths linked to substance use rose from 4 in 2012 to 12 in 2013. Prescription opioids have been involved in more than half of pregnancy-associated overdose deaths since 2007, and heroin has factored into nearly one third. The Department of Health and Mental Hygiene issued a guidance to Maryland obstetricians and gynecologists to help combat this problem by 1) encouraging referral to treatment, 2) registering with and using the prescription monitoring program, and 3) using clinical tools to identify and address addiction during and after pregnancy.

Read more:

Heroin Overdose Deaths Up 164 Percent in Northern Virginia
Gregg McDonald, Fairfax County News
October 9, 2014

On Oct. 2, 2014, a daylong summit of law enforcement leaders, prosecutors, and health professionals assessed the legislative and tactical changes needed to address Virginia's prescription opiate and heroin problems. More than 800 Virginians died from drug overdoses in 2012, with heroin overdose deaths nearly doubling from 103 in 2011 to 197 in 2013. Every region of the state experienced an increase in heroin fatalities during those 2 years, but Northern Virginia led the trend with a 164 percent increase.

Read more:

Drug, Alcohol Use Declining Among Local Youths
Spencer Roush, Lancaster Eagle-Gazette
October 5, 2014

A recent survey analyzing drug and alcohol use among Fairfield County, Ohio, youths showed prescription drug use decreased among high school seniors. Toni Ashton, director of Prevention Works, said prescription drug use decreased from 9.3 percent in 2004—when the survey first started—to a new low of 0.4 percent this year. In the 2014 substance abuse survey, more than 2,500 sophomores and seniors shared their responses.

Read more:

Who's Overdosing in Orange County? You Might Be Surprised
Jenna Chandler, Orange County Register
October 8, 2014

In Orange County, California, among 1,156 drug and alcohol overdose deaths in 2011–12, men died at nearly twice the rate of women. The highest death rate was among those ages 45 to 64 and white. Women, however, were more likely than men to accidentally die after using prescription medication. After age 44, prescription drugs were the predominant drug type leading to overdose death. The vast majority of overdose deaths under age 65 were unintentional. A combination of alcohol, illicit, and prescription drugs was responsible in 19 percent of overdose deaths.

Read more:

Painkiller Abuse Leads to Rise in Drug Thefts Across N.D. and Minnesota
Robin Huebner, Grand Forks Herald
October 5, 2014

When thieves broke into pharmacies in Moorhead and Larimore, North Dakota, and Starbuck, Minnesota, during a 2-week span in September, they targeted prescription narcotics. Three women have been arrested for the Larimore break-in, which net prescription pills with a street value of nearly $50,000. Pharmacists said realtors have also gone on alert for suspicious people at open houses.

Read more:

Other Resources

Evidence for the Efficacy of Pain Medications
National Safety Council
Accessed October 6, 2014

The National Safety Council released "Evidence for the Efficacy of Pain Medications." This report examines evidence on the effectiveness of opioid and nonsteroidal anti-inflammatory drugs and considers the associated implications for physicians as well as the broader healthcare system.

Read more:

Prescription Drug Monitoring Programs Map
American College of Emergency Physicians
Accessed October 6, 2014

The prescription drug monitoring programs (PDMPs) map claims it makes it easier to use state PDMPs. In reality, the map simply provides a link to the state's PDMP website, connecting to a helpful index or sign-up screen in some states, but just an overview description in others.

Read more:

Get Smart About Drugs: A DEA Resource for Parents, Educators, and Caregivers
Drug Enforcement Administration
Accessed October 10, 2014

The Drug Enforcement Administration launched a new and improved drug education website: GetSmartAboutDrugs.com.

Read more:

Twitter Chat

Misuse of Prescription Drugs and Over-The-Counter Medicines
Community Anti-Drug Coalitions of America and Office of National Drug Control Policy
October 20, 2014
2 p.m. EST


Video Shows UPS Worker Allegedly Stealing Prescription Drugs
WISN (Wisconsin)
October 3, 2014

A UPS worker is accused of stealing prescription drugs from packages (video: 2:30 minutes). When confronted, the worker admitted he damaged packages to remove pain reliever medication at least once a week for the past 8 months. Last month, another UPS worker was apprehended and accused of taking prescription pain relievers from packages. Both men have since been fired and face more than 3 years in prison.


Prescriptions Regulations Cause Problems for Oklahomans
Brian Shlonsky, KOCO
October 7, 2014

This video (2:09 minutes) discusses new prescription regulations that some experts say are causing problems for Oklahomans in need of pain relievers. Others say it is a way to cut down on pain pill abuse. (Includes transcript)


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

Sheriff's Office Drug Take Back Set for Nov. 8
Space Coast Daily (Florida)
October 6, 2014

17 Tons of Drugs Dropped Off During Wisconsin's Drug 'Take Back' Day
Stacy Shones, WXOW (Wisconsin)
October 8, 2014

Iowans Have Now Dropped Off 25 Tons of This …
Tad Anderson, KCCI (Iowa)
October 7, 2014

On Take Back Day, Vermont Collected 3,349 Pounds of Prescription Drugs
Amy Kolb Noyes, Vermont Public Radio
October 9, 2014

KSP: More Than 1,000 Pounds of Prescription Drugs Turned in During 'Take Back' Initiative
Austin Ramsey, Murray Ledger and Times (Kentucky)
October 4, 2014

Naval Medical Center 'Takes Back' Prescription Drugs
Mass Communications Specialist 1st Class Gary Johnson, United States Navy (Virginia)
October 8, 2014

Shelby County Cops Offer Easy Way to Get Rid of Unwanted Prescription Drugs
Martin J. Reed, Alabama Media Group
October 9, 2014

Drug Collection Unit Installed at Sikeston DPS
Amber Ruch, KFVS (Missouri)
October 8, 2014

Madison PD Receives New Prescription Drug Unit
Madison County Journal (Mississippi)
October 8, 2014

On-Campus Prescription Drug Drop Box to Be Unveiled at KSU
The Marietta Daily Journal (Georgia)
October 8, 2014

New Rx Drug Drop Box Located in B.C. Office Building
WIVT (New York)
October 7, 2014

Cordele Police Department Gets Help to Combat Drug Abuse, Safer Medication Disposal
Cordele Dispatch (Georgia)
October 6, 2014

Cove Has New Option to Safely Dispose of Prescription Medication
Chris McGuinness, Killeen Daily Herald (Texas)
October 6, 2014

Beach Police to Install Drug Collection Unit
The News Herald (Florida)
October 6, 2014

Drug Disposal Program in Wicomico County
Rachel Rea, WBOC (Maryland)
October 7, 2014

Winchester Police Set Up 24/7 Drug Collection Box
Merris Badcock, WHAG (Virginia)
October 8, 2014

La Vista Police Provide Means to Dispose of Unused Medication
WOWT (Nebraska)
October 5, 2014

Upcoming Conferences and Workshops

Commissioner's Medical Grand Rounds: Prescription Drug Abuse and Pain Management
The New York Academy of Medicine
October 23, 2014
New York, New York

Solutions Summit Prescription Drug Abuse Epidemic in Missouri
Poplar Bluff Police Department and We Can Be Drug Free Coalition
October 23, 2014
9 a.m. to 12:30 p.m.
Black River Coliseum
301 South 5th Street
Poplar Bluff, Missouri

This summit will address prescription drug abuse in Missouri. It will feature national and local speakers, including a representative from the Drug Enforcement Administration.

Read more:

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.