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October 22, 2014


SAMHSA Prescription Drug Abuse Weekly Update
Issue 94  |  October 22, 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 Audio Grants Awarded Request for Proposal Take-Back Events and Drop Boxes Upcoming Conferences and Workshops


Drug Use at Work Roils Firms
Arian Campo–Flores, The Wall Street Journal
October 12, 2014

Growing use of opioids in the workplace has taken a financial toll on companies and threatens to stifle local economic growth. In the greater Cincinnati area, employees have tested positive for opioids after being involved in a range of incidents (damaging property with forklifts and crashing company vehicles are two examples). The president of the Lima/Allen County Chamber of Commerce said Allen County employers have had difficulty filling positions because 70 percent of applicants fail drug tests. Mark Jurman, who manages 1,000 employees at KS Kolbenschmidt in Wisconsin, has discovered empty plastic bags at the factory stamped with caricatures indicative of heroin envelopes. Employees tell him about peers who are high during work hours, and dealers hang out in the parking lot selling drugs to employees. Drug abuse is causing more accidents, theft, and absenteeism overall, while some drug-free employees are dealing with family members battling addiction. Many businesses are addressing the problem by expanding drug testing, introducing zero-tolerance policies, and establishing Employee Assistance Programs to help those seeking addiction treatment. Chambers of Commerce are trying to guide companies—particularly small businesses.

Read more:

M.D. King, J. Jennings, and J.M. Fletcher. 2014. "Medical Adaptation to Academic Pressure: Schooling, Stimulant Use, and Socioeconomic Status." American Sociological Review, doi:10.1177/0003122414553657.

In IMS Health Prescription LRx data, middle and high school students are 30 percent more likely to have a stimulant prescription filled during the school year than in summer. Socioeconomically advantaged children are more likely than their less-advantaged peers to selectively use stimulants only during the academic year. These differences persist when researchers compare higher- and lower-socioeconomic-status children seeing the same doctors. The difference between school year and summer stimulant use was positively correlated with levels of pressure for state educational system accountability.

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Journal Articles and Reports

A. Ambekar, R. Rao, A.K. Mishra, and A. Agrawal. 2014. "Type of Opioids Injected: Does It Matter? A Multicentric Cross-Sectional Study of People Who Inject Drugs. " Drug and Alcohol Review, doi:10.1111/dar.12208.

Among 902 randomly selected men in India who inject drugs and were recruited at harm-reduction sites, 65 percent injected pharmaceutical opioids (buprenorphine: 30.8 percent, pentazocine: 21.8 percent, and dextropropoxyphene: 11.9 percent), and 34 percent injected heroin. In the northeast region, only dextropropoxyphene was injected (not buprenorphine or pentazocine). Compared with heroin injectors, pharmaceutical opioid injectors were more likely to consume alcohol and pharmaceutical opioids orally, inject frequently, share needles and syringes, and develop injection-site complications. Buprenorphine injectors were most likely to inject frequently, share needles and syringes, and develop local complications.

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D.B. Clemow and D.J. Walker. 2014. "The Potential for Misuse and Abuse of Medications in ADHD: A Review." Postgraduate Medicine, doi:10.3810/pgm.2014.09.2801.

This article reviews the literature on nonmedical use of attention deficit hyperactivity disorder (ADHD) medication. It covers stimulants (methylphenidate and amphetamine) and nonstimulants (α-adrenergic agonists and atomoxetine). ADHD medication misuse and diversion are common with stimulant medications—prevalence estimates across studies range from 5 to 10 percent for high school students, and 5 to 35 percent for college students. Conversely, the data suggest a lack of abuse potential and lack of medication misuse for nonstimulant medications. Although they can be effective for ADHD treatment, the nonstimulants lack desirable effects (speed of action, stimulant feel) that make such drugs susceptible to nonmedical use.

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C.S. Davis, J.K. Southwell, V. Radford Niehaus, A.Y. Walley, and M.W. Dailey. 2014. "Emergency Medical Services Naloxone Access: A National Systematic Legal Review." Academic Emergency Medicine 21(10):1173–77, doi:10.1111/acem.12485.

This article reports on the authority of emergency medical services (EMS) personnel to administer naloxone to reverse opioid overdose in November 2013. It distinguishes the authority of emergency medical responders, emergency medical technicians, intermediate/advanced emergency medical technicians, and paramedics. Where available, protocols governing route and dose of administration were also analyzed. All 53 jurisdictions—the United States, District of Columbia, Guam, and Puerto Rico—permit licensed or certified paramedics to administer naloxone. All but one of 48 jurisdictions with intermediate-level EMS personnel authorized them to administer naloxone. Twelve jurisdictions explicitly permitted emergency medical technicians and two permitted emergency medical responders to administer naloxone. Five jurisdictions modified law or policy to expand emergency medical technician access to naloxone in 2013.

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S. Vrecko. 2014. "Everyday Drug Diversions: A Qualitative Study of the Illicit Exchange and Non-Medical Use of Prescription Stimulants on a University Campus." Social Science & Medicine, doi:10.1016/j.socscimed.2014.10.016.

This article reports on 38 semi-structured interviews with people who said they used prescription stimulants to improve academic performance. It identifies four sources of diverted medications (friends, family members, black-market vendors, and deceived clinicians) and describes perception, practices, and experiences that arise in relation to each source.

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Professional Education

V.J. Dzau and P.A. Pizzo. 2014. "Relieving Pain in America: Insights from an Institute of Medicine Committee." JAMA 312(15):1507–08, doi:10.1001/jama.2014.12986.

An Institute of Medicine committee estimates 100 million Americans have chronic pain. The committee sees a need for better data to create the cultural transformation required for reducing the effects of pain in America.

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H.J. Gould III and D. Paula. 2014. "Hydrocodone Extended-Release: Pharmacodynamics, Pharmacokinetics and Behavioral Pharmacology of a Controversy." Pharmacological Research, doi:10.1016/j.phrs.2014.09.006.

One year ago, against the recommendation of its Expert Panel, the U.S. Food and Drug Administration (FDA) approved Zohydro—an extended-release formulation of hydrocodone that contains no acetaminophen. The authors rehash the pharmacokinetics, pharmacodynamics, safety, and abuse liability of the drug and how it relates to the Expert Panel's opinion and FDA decision.

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Painkiller Deaths Drop for First Time Since 1999
Donna Leinwand Leger, USA Today
October 15, 2014

According to the Office of National Drug Control Policy (ONDCP), prescription opiate–related deaths declined in 2012—the first time since 1999 (although total opiate deaths continued to rise). Prescription opiate overdose deaths quadrupled from 4,030 in 1999 to 16,917 in 2011 before dropping to 16,007 in 2012. Federal officials are crediting crackdowns on overprescribing and the expansion of prescription monitoring programs. An apparent shift to heroin by some prescription opiate abusers caused an offsetting surge in heroin overdose deaths—from 4,397 in 2011 to 5,927 in 2012. (Editor's note: Checking federal websites, we could not find the ONDCP announcement or the data underlying it. The Centers for Disease Control and Prevention has not yet released the 2012 mortality data underpinning this article.) (Includes video: 2:29 minutes)

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TN Ranks Top Five in Nation for Pharmacy Robberies
Heidi Wigdahl, WBIR
October 13, 2014

Statistics from the Drug Enforcement Administration show the top 10 states for pharmacy robberies in 2013 were Arizona: 77, Indiana: 71, California: 60, Pennsylvania: 41, Tennessee: 37, North Carolina: 33, Massachusetts: 30, Ohio: 28, Texas: 24, and Washington: 2. Alaska, North Dakota, and South Dakota had no reported pharmacy robberies in 2013.

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55 Universities Join Jed and Clinton Health Program to Address Mental Health, Student Safety
Priscilla Alvarez, USA Today
October 15, 2014

More than 55 colleges and universities have joined the Jed and Clinton Health Matters Campus Program—a collaborative effort to address the two leading causes of student death: accidents, including those caused by prescription drug overdoses or alcohol poisoning, and suicide. The first step will be evaluating mental health, substance abuse, and suicide prevention programming at participating colleges and universities, which have all made a 4-year commitment to the initiative. The program will create a central repository for gathering information to enhance existing efforts and provide assessment tools, feedback reports, and technical assistance.

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Getting Through the Day with a Little Help from Medication
Helsinki Times
October 12, 2014

In Finland, overworked employees are relying on prescription drugs to keep their jobs. Many suffer from depression, insomnia, and aches and pains, so they self-medicate for temporary relief. An expert from the Finnish Institute of Occupational Health says prolonged physical discomfort causes depression. On the other hand, people suffering from depression are more sensitive to pain. Overwork also leads to misuse of attention deficit hyperactivity disorder medications.

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Senate Dem Calls for Prescription Drug Regs
Tim Devaney, The Hill
October 14, 2014

Massachusetts Senator Ed Markey is calling on federal regulators to address growing prescription drug abuse problems. In letters to the Departments of Justice and Health and Human Services, Markey asked agencies to combat the "opioid epidemic." His policy recommendations include a series of preventive measures, treatment options, and enforcement actions intended to tackle prescription drug abuse. Markey urged the surgeon general to report on the state of prescription drug addiction around the country.

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The Ineffectiveness of Opioids for Chronic Pain
Richard Taite, Psych Central
October 17, 2014

Richard Taite, founder and CEO of an addiction treatment center, discusses why opioids are ineffective for chronic pain. He believes patients should seek help from a specialist if their pain is not under control, and encourages them to consider alternative therapies.

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Mother's Little Helper or Prescription Drug Abuse?
Shannon Symonds, FamilyShare
October 15, 2014

This article describes a woman's overdose death and a pharmacist's perspective on the prescription drug abuse epidemic.

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Other State and Local News

Utah DUI Deaths Rise as Arrests Fall
Lee Davidson, The Salt Lake Tribune
October 15, 2014

In the past 2 years, Utah's driving-under-the-influence (DUI) deaths resulting from illegal and prescription drug use have outnumbered alcohol-related DUIs nearly two to one.

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Prescription Cough Syrup Added to Concern List
Lily Wu, KAKE
October 16, 2014

The Kansas Pharmacy Board proposed to add prescription pseudoephedrine products and promethazine with codeine to its Drugs of Concern List. Amended regulations will take effect in 90 days. Medical professionals recommend monitoring these drugs in the prescription monitoring program database. (Includes video: 2:01 minutes)

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Update: Seven Students Overdose at Douglas High School
Jessica Prokop, The News-Review
October 10, 2014

Oregon's Winston Police Department said seven Douglas High School students overdosed on Ambien, seizure medication, and Robitussin, also known as "robotripping." Students were taken to Mercy Medical Center and have since been released. When police arrived at the school, one student was drooling and could barely walk or talk. Other drugged students were carried by classmates and teachers. The student who reportedly brought the medications from home and gave them to peers during a break between classes faces possible criminal charges.

Read more:

HEALTH Announces Updated Drug Overdose Numbers
State of Rhode Island
October 15, 2014

So far in 2014, Rhode Island has recorded 162 accidental drug overdose deaths—9 of which occurred in October. Ninety percent of the deaths involved at least one opioid or medication. Since January, Rhode Island Emergency Medical Services has administered 1,267 doses of Narcan.

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Pa. House Approves Prescription Drug Database Bill
Wallace McKelvey, The Patriot-News
October 14, 2014

In a 194–2 vote, Pennsylvania's House passed a bill that would create a statewide database for medical professionals and law enforcement to combat prescription drug abuse. State law enforcement would only be able to access the database for active investigations. The bill has a 7-year retention period for records and includes prescriptions that have a lower likelihood of addiction (but which can be used to manufacture illicit drugs). It will likely pass in the Senate.

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Governor Hassan Announces Launch of New Hampshire Prescription Drug Monitoring Program
State of New Hampshire
October 16, 2014

New Hampshire launched its prescription monitoring program, covering providers and pharmacists authorized to prescribe or dispense Schedule II–IV controlled substances.

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Drug, Alcohol Survey Shows Community Education Is Working
Charlotte Tallman, Las Cruces Sun-News
October 12, 2014

Data from the New Mexico Community Survey showed alcohol, drug, and prescription drug abuse education is making a difference. In 2014, 84 percent of 381 surveyed adults said using prescription pain relievers for a nonmedical reason was harmful or posed a great risk.

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Cahill Releases Five-Point Plan to Combat Heroin
Matthew Hamilton, Capitol Confidential
October 15, 2014

New York attorney general candidate John Cahill released a five-point plan to combat the heroin epidemic. His ideas include increasing penalties for heroin traffickers, creating more beds and pushing mandated inpatient treatment for heroin addiction, and improving the medical profession's approach to pain management and prescription drug abuse prevention.

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Snyder Signs Heroin-Antidote Bill Package in Macomb County
Jameson Cook, The Macomb Daily
October 13, 2014

Governor Rick Snyder signed a package of bills that will allow Michigan residents to obtain a Narcan prescription. Families Against Narcotics plans to conduct training sessions for addicts' family members and friends on injecting Narcan. The new law also requires ambulances to carry the drug.

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Firefighters to Carry Heroin Overdose Antidote
Kay Fate, Post Bulletin
October 13, 2014

In Rochester, Minn., firefighters will soon carry Narcan spray.

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SBI and ALE Agents to Be Trained in Drug Used to Counter Overdoses
B.J. Drye, Stanly News and Press
October 14, 2014

North Carolina's State Bureau of Investigation and Alcohol Law Enforcement agents will attend training for naloxone administration. Project Lazarus of Wilkes County has donated kits containing two naloxone dosage units.

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Could This Drug Prevent More Overdose Deaths?
Lee Hermiston, The Gazette
October 17, 2014

Mike Hensch, administrator of the Johnson County, Iowa, Medical Examiner's Office, advocates providing heroin and opioid addicts with a naloxone prescription.

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Task Force Looks to Educate Public About Driving and Drugs
Steve Bauer, State College
October 13, 2014

The Centre County, Pa., Alcohol Task Force says driving under the influence (DUI) is still a serious issue, with more people driving while high on drugs. Ferguson Township Police Sergeant Ryan Hendrick said the task force will soon be focusing on drug-related DUI arrests. It will train officers and educate the public about this problem.

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Pa. Addiction Crisis: You or Someone You Love Could Become an Addict; It's Happening Everywhere, to All Kinds of People
David Wenner, The Patriot-News
October 13, 2014

This article discusses overdose deaths and addiction among youth from various backgrounds. Mothers share stories of their children's struggles with opioids and discuss how their families cope. Gary Tennis, secretary of the Pennsylvania Department of Drug and Alcohol Programs, said the prevalence of prescription pain relievers has expanded the pool of people addicted to drugs. The crisis affects everyone, regardless of race, finances, education, or geographical area.

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Prescription Stimulant Misuse Needs More Publicity
Cassandra Holloway, Battle Reformer
October 13, 2014

Cassandra Holloway, coalition coordinator for the Brattleboro Area Prevention Coalition, provides an overview of prescription stimulant abuse among Vermont's youth. She would like the media to pay as much attention to prescription stimulant misuse as it does to prescription opiates.

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California Ballot Measure Pits Doctors Against Lawyers
April Dembosky, NPR
October 14, 2014

California Proposition 46 requires doctors to check the state's prescription monitoring program database, lifts caps on malpractice awards, and mandates drug and alcohol testing for doctors. Supporters say the law would enhance patient safety, but doctors say the cost is too high. (Duration: 5:05 minutes)


Grants Awarded

BJA Grant Announcements
Prescription Drug Monitoring Program Training and Technical Assistance Center at Brandeis University
Accessed October 14, 2014

The Bureau of Justice Assistance has announced the 2014 Harold Rogers Prescription Drug Monitoring Program Grants. Implementation and Enhancement Grants totaling $2,734,741 were awarded to Alabama, Arkansas, Maine, Massachusetts, New Mexico, Ohio, Vermont, and Wisconsin. A Tribal Prescription Drug Monitoring Program Data Sharing Grant totaling $150,000 was awarded to the Ho-Chunk Nation in Wisconsin. Data-Driven Multi-Disciplinary Approaches to Reducing Rx Abuse Grants totaling $2,106,135 were awarded to the Arizona Criminal Justice Commission, Governor of Delaware Executive Office, University of Kentucky Research Foundation, Massachusetts's Northwestern District Attorney, and New York County District Attorney's Office.

Read more:
http://grants.ojp.usdoj.gov:85/selector/title?solicitationTitle=BJA FY 14 Harold Rogers Prescription Drug Monitoring Program: Implementation and Enhancement Grants&po=BJA

http://grants.ojp.usdoj.gov:85/selector/title?solicitationTitle=BJA FY 14 Harold Rogers Prescription Drug Monitoring Program: Tribal Prescription Drug Monitoring Program Data Sharing Grants&po=BJA

http://grants.ojp.usdoj.gov:85/selector/title?solicitationTitle=Data-Driven Multi-Disciplinary Approaches to Reducing Rx Abuse Grants&po=BJA

NIH Announces 11 Awards Funded Across Three Institutes
National Institute on Drug Abuse
October 16, 2014

The Collaborative Research on Addiction—a National Institutes of Health consortium involving the National Institute on Alcohol Abuse and Alcoholism, National Institute on Drug Abuse, and National Cancer Institute—awarded more than $11 million to support research exploring the use of social media to advance scientific understanding, prevention, and treatment of substance use and addiction. Researchers will analyze social media interactions to gain insights into patterns of use, risk factors, and behaviors associated with substance use. They hope to learn more about how changing technologies affect interpersonal communications and knowledge about tobacco, alcohol, and illicit drugs, including nonmedical use of prescription drugs.

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ACMT ToxIC Registry to Receive NIH Funding to Investigate Drug Abuse and Overdose
October 14, 2014

The American College of Medical Toxicology (ACMT) received two subcontracts from the National Institutes of Health to conduct research on drugs of abuse and poisoning using its toxicology patient registry. Grant funds, totaling more than $3 million, will support research studies using the Toxicology Investigators Consortium (ToxIC) Patient Registry. ToxIC is ACMT's multicenter, multinational network of medical toxicologists, who provide bedside evaluation of patients experiencing adverse effects of drugs, chemicals, and environmental toxins.

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Batavia Receives Grant for Naloxone Kits
City of Batavia, New York
October 10, 2014

The New York Office of the Attorney General awarded the Batavia Police Department a $720 grant from the Community Overdose Prevention Program (COPP) to purchase naloxone kits for 12 first responders. Each kit consists of a bag with two vials of naloxone, two mucosal atomization devices for nasal administration, one pair of latex gloves, and a booklet on naloxone use. COPP has dedicated $5 million seized from joint federal and state criminal investigations to fund the purchase of a naloxone kit for every sworn officer in the state.

Read more:

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

Putnam County's Fall Medication Take Back Event on November 1, 2014
The Harlem Valley News (New York)
October 14, 2014

Prescription Drug Turn-In Program Hits 5-Ton Mark
Katie Anderson, The Medina-Gazette (Ohio)
October 16, 2014

Take-Back Event Nets Over 400 lbs of Medication
Mary Calhoun, The Sun Times (Arkansas)
October 11, 2104

Drug Take Back Program Expanded in Belmont County
WTOV (Ohio)
October 16, 2014

Prescription/OTC Drug Disposal
City of Pelham (Alabama)
October 16, 2014

Brazoria County Establishes Permanent Rx Drug Drop Boxes
The Silver Creek Tribune (Texas)
October 13, 2014

County Installing Permanent Unit for Drug Disposals
Debbie Hall, Martinsville Bulletin (Virginia)
October 12, 2014

Upcoming Conferences and Workshops

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.