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October 23, 2013

SAMHSA Prescription Drug Abuse Weekly Update
The Prevention of Prescription Drug Abuse in the Workplace (PAW) TA Center addresses prescription drug abuse—a growing public health problem with increasing burdens on workers, workplaces, and our economy. To subscribe colleagues, family members, or friends to this listserv sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), please click here or send their e-mail addresses to paw@dsgonline.com.
Table of Content Featured Journal Articles and Reports News Other State and Local News Other Resources Videos Grant Announcement Take-Back Events and Drop Boxes Upcoming Conferences and Workshops

Featured Article

B.M. Kuehn. 2013. "Agency Report—SAMHSA: Pain Medication Abuse a Common Path to Heroin." Journal of the American Medical Association 310(14):1433–34.

National Survey on Drug Use and Health data from 2002 to 2011 show the incidence of heroin use is 19 times higher among people who have abused prescription pain medications than among those who have not. Although overall incidence of heroin use in the population is low, there was a substantial difference in heroin use rates between the two groups, with 0.39 percent of those who had a history of pain medication abuse reporting heroin use, compared with 0.02 percent of those who reported they had never used prescription opioid medications for nonmedical purposes. More than 79 percent of people who reported they began using heroin in the past year had previously abused prescription pain medications. Conversely only 3.6 percent of people who reported they recently began using pain medication for nonmedical purposes reported using heroin in the 5 years preceding their abuse of the prescription pain drug.

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Journal Articles and Reports

D. Alford. 2013. "Weighing In on Opioids for Chronic Pain: The Barriers to Change (Editorial)." Journal of the American Medical Association 310(13):1351–52.

Approximately 100 million U.S. residents have chronic pain, costing more than $600 billion per year in direct medical treatment and lost productivity costs. In the 1980s, several reports began to support opioid therapy for chronic non-cancer pain. Over the following decades, a fourfold increase in opioid prescribing occurred. This increase was associated with a fourfold increase in unintentional opioid overdose deaths and a sixfold increase in substance abuse treatment admissions for prescription opioid addiction. With such severe risks associated with opioid use, decreasing the need for chronic opioid therapy is a worthy clinical goal. Raebel and coauthors examined data from multicenter registries, including patients who underwent bariatric surgery, to determine if opioid use decreased following surgery. Because bariatric surgery–related weight loss has been associated with improvements in some pain syndromes, the authors hypothesized that this would result in reduced opioid use. However, they found that among the 933 patients who were chronic opioid users before surgery, 77 percent continued chronic use of opioids during the year following surgery, with increases in opioid use even among patients with significant weight loss.

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M. Anguita. 2013. "Hooked on Medicines: The Rise of the 'Respectable' Addict." Nurse Prescribing 11(10):474–76.

According to 2013 figures from the Office for National Statistics, Britons are becoming addicted to prescription and over-the-counter painkillers and tranquilizers. The data show deaths from abuse of these drugs have been steadily rising, while those from opiates used for recreational purposes have declined.

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T. Apantaku-Olajide and B.P. Smyth. 2013. "Non-Medical Use of Psychotropic Prescription Drugs Among Adolescents in Substance Use Treatment." Journal of Psychoactive Drugs 45(4):340–46. doi:10.1080/02791072.2013.825029.

Little is known about the extent of nonmedical use of prescription drugs among European adolescents with substance use disorders. This cross-sectional study examined nonmedical use of seven categories of psychotropic prescription drugs (opioid analgesics, attention deficit hyperactivity disorder stimulant, sleeping medication, sedative/anxiolytic, antipsychotic, antidepressant, and anabolic steroid medications) in a clinical sample of Irish adolescents with substance use disorders. Of the 85 adolescents (aged 13–18 years) invited to participate, 65 took part (response: 74 percent). Among respondents, 68 percent reported lifetime nonmedical use of any of the prescription drugs; sedative/anxiolytic (62 percent) and sleeping medications (43 percent) were more commonly abused. The most frequently reported motives for abuse were "seeking high or buzz" (79 percent), "having a good time" (63 percent), and "relief from boredom" (56 percent). Sharing among friends and street-level drug markets were the most readily available sources. Innovative solutions of control measures and intervention are required to address prescription drug abuse.

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J. O'Brien. 2013. "A Review and Evaluation of Indiana's INSPECT System and Governing Legislation: Maximizing Potential Impact on Public Health." Indiana Health Law Review 10:701.

The number of Americans injured or killed as a result of drug abuse and misuse has increased at an alarming rate. The largest source of this increase has come not from use of illicit drugs, but from abuse and misuse of prescription drugs. The very wide array of drugs appears to have become something of an ailment itself. In a relatively short time, prescription drug abuse and misuse has become one of the most pervasive problems facing healthcare systems throughout the country. Forty-nine states now have legislation in place allowing for collection and supervision of prescription drug–related data; 42 states have functional prescription drug monitoring programs (PDMPs). These programs are seen as "highly effective tools utilized by government officials for reducing prescription drug abuse and diversion."

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C. Stannard. 2013. "Opioids in the UK: What's the Problem?" BMJ 347:f5108  doi:http://dx.doi.org/10.1136/bmj.f5108.

Extensive prescription drug misuse in the United States has brought into sharp focus the role of opioids for persistent pain. The marked and progressive rise in opioid analgesic prescriptions over the past two decades has been paralleled by an increase in deaths from these drugs—now a leading cause of accidental death. Prescription data from the United Kingdom show comparable trends in the use of opioids for noncancer pain. However, prescribing statistics don't tell the entire story. Examining UK statistics on addiction and opioid-related mortality will expand the understanding of the problem.

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Y. Zhang and T.C. Kwong. 2013. "Utilization Management in Toxicology." Clinica Chimica Acta.

This review discusses challenges faced by clinical laboratories to manage use of toxicology tests, particularly those ordered in managing poisoned patients in the emergency department and chronic pain patients on opioid therapy. Optimal utilization of toxicology tests to support the emergency department relies on selecting appropriate tests for the patient and the availability of the results in a timely fashion. In patients with chronic pain, urine drug testing, including screening and confirmation testing, are used extensively to monitor patient compliance. A thorough understanding of the performance characteristics of the test methodologies and drug metabolism is essential for making a proper analytical and clinical interpretation of the test results, and will contribute to effective use of these tests. In addition, the reimbursement system is an important factor in the decision-making process for test selection utilization, as significant costs can be incurred by both payers and patients. Collaboration, trust, and effective communication among clinicians, patients, and clinical laboratory professionals are necessary for effective utilization of toxicology testing.

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Active Military, Veterans Susceptible to Prescription Drug Abuse
October 17, 2013

This brief newsletter item indicates the fatal overdose rate among Veterans Affairs patients is nearly double the national average. Concern is rising about overmedication and prescription drug abuse among veterans and active members of the military, many of whom struggle with diverse health issues following tours of duty in Iraq or Afghanistan. According to a U.S. Army Inspector General report obtained by The New York Times, as many as 25 percent to 35 percent of individuals in warrior transition units—meant to help wounded and sick soldiers transition back into uniform or into a civilian life—are "dependent on or addicted to drugs." A report on Texan veterans of the wars in Iraq and Afghanistan showed that of 266 veterans with a known cause of death, 20% died unintentionally from reactions to prescription medication combinations. 

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Rogue Online Drug Sellers Prey on US Consumers, ABC World News Reports
October 17, 2013

According to the National Association of Boards of Pharmacy (NABP) Internet Drug Outlet Identification Program Progress Report for State and Federal Regulators, nearly 97 percent of more than 10,500 Web sites selling prescription medications appear to operate out of compliance with pharmacy laws and practice standards that have been established to protect public health. Consumers who purchase drugs from these online drug outlets are at risk of receiving counterfeit, contaminated, or otherwise unsafe products. NABP encourages consumers to consult the list of recommended sites that have been accredited by the NABP Verified Internet Pharmacy Practice SitesCM (VIPPS®) accreditation program. The list of VIPPS–accredited sites is available at www.awarerx.org.

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Drug Addiction and Baby Boomers—An Escalating Problem
The Blog, The Huffington Post
October 11, 2013

Dr. Krantz, Director of Medical Services and Medical Director of Research at Hanley Center, describes how addiction is different among boomers. For people in this age group, prescription pills are more common as surgeries and health ailments become more frequent. However, said Dr. Krantz, an addict will use anything he or she can to feel better, and the drug of choice may change over time. In patients over 50, she most frequently sees a combination of opiates (pain pills) and benzodiazepines (tranquilizers) with alcohol. This combination is the largest contributor to the high level of unintentional prescription drug overdoses and death.

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Teen Misuse and Abuse of Prescription Drugs Up 33 Percent Since 2008
Health Impact News Daily
October 18, 2013

One in four teens has misused a prescription drug at least once in his or her lifetime, according to survey results from The Partnership at Drugfree.org and MetLife Foundation (see summary in the August 28, 2013, Weekly Update). This represents a 33 percent increase in the past 5 years. Among the most commonly abused class of drugs are stimulants like Ritalin and Adderall, which one in eight teens (13 percent) said they had taken (even though they were not prescribed). Prescription drugs do not necessarily hold the same stigma as illegal recreational drugs, even though they can be just as deadly, leading teens to regard them as a "safe" way to get high. In many cases, parents only add to this assumption, both because they may take multiple prescription drugs themselves and because close to one third of parents believe prescription stimulants can improve their teens’ academic performance. One in six parents believes using prescription drugs to get high is safer than using street drugs. This is one of the reasons why parents of 86 percent of teenagers had not talked with those children about the risks of abusing prescription drugs.

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ASA Launches Opioid Overdose Resuscitation Card to Help People Who Abuse Prescription Drugs
October 14, 2013

The American Society of Anesthesiologists (ASA) launched an Opioid Overdose Resuscitation card to identify and treat individuals suspected of an opioid overdose. The card lists symptoms to look for when an opioid overdose is suspected. It also details step-by-step instructions for assisting a person suspected of an overdose prior to the arrival of emergency medical personnel. The card can be downloaded at http://asahq.org/WhenSecondsCount/resources.

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More States Focusing on Prescription Drug Problem
USA Today
October 13, 2013

Michael Israel's death from a self-inflicted gunshot wound in 2011 was a tragedy. The Buffalo 20-year-old had become despondent about his addiction to the powerful painkillers prescribed for his Crohn's disease. Avi Israel has been a frequent and vocal advocate since 2011 for tackling the growing problem of prescription drug abuse, including testimony in 2012 before the U.S. Senate Caucus on International Narcotics Control. His advocacy helped lead New York lawmakers to unanimously pass the Internet System for Tracking Over-Prescribing law, or "I-STOP," which went into effect in August.

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Other State and Local News

Police Say Teens Caught Dealing Prescription Drugs
ABC57 News
October 17, 2013

A teen was arrested for allegedly selling prescription drugs last week at Battell Park in Mishawaka, Indiana. According to the police report, officers were at a 7-Eleven when they spotted two teens allegedly making a drug deal at the park across the street. The teens were purportedly selling Adderall. Mishawaka Police Lieutenant Tim Williams, who also heads up the D.A.R.E. program, says he can't give exact numbers about how common prescription drug use is among local teens, but he does see it regularly. "They are taking the drugs like Xanax and Adderall and Ritalin and Vicodin and they are taking it to school … one of the hardest things to do is for us to catch them dealing prescription drugs," he said.

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Macomb Leaders Discuss Growing Problem of Prescription Drug Abuse
CBS Detroit
October 18, 2013

Healthcare professionals and community leaders met at the Clinton Township campus of Macomb County Community College to discuss what they say is a quickly growing crisis: prescription drug abuse. For Macomb District Judge Linda Davis, who sees prescription drug cases every day and once served as a county drug prosecutor, the problem is all too familiar. Her daughter struggled with addiction to prescription opiates and heroin, but has been in recovery for more than 4 years.

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Prescription Drug Overdoses Have Become an Epidemic
October 17, 2013

Kent Obert was a student at Arizona's Paradise Valley Community College. Since his death, Kent's mother Kim has raised awareness about prescription drug abuse. She became involved with DrugFreeAZ.org, an advocacy group that conducts research on the problem. A new national survey that ranked states based on fatal overdoses and misuse of legal, prescribed drugs indicated Arizona isn't doing enough to stop prescription drug abuse. Now a statewide campaign is under way to encourage doctors to do more to prevent deaths. It may be as easy as checking a computer database. "Five hundred eighty five million pills were dispensed last year in Arizona," said Shana Malone, a senior research analyst at the Arizona Criminal Justice Commission. "That's enough to medicate every single adult around the clock for two weeks."

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Q&A: Ohio's Prescription Drug Abuse Problem Growing
The News Record
October 16, 2013

Ohio saw a 440 percent increase in the number of deaths by unintentional overdose from 1999 to 2011, according to a recent report issued by the Ohio Department of Health. Drug overdoses were the cause of 1,765 Ohio resident deaths in 2011 alone—the highest number of overdose deaths on state record.

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Guidelines Will Curb Drug Abuse
The Marietta Times
October 17, 2013

Those who prescribe medication are being encouraged to use a new set of guidelines adopted in Ohio last week. The guidelines, which include use of a new tool built into Ohio's online prescription medication monitoring system, are aimed at curbing opiate abuse, which has surpassed vehicle crashes as the leading cause of death in the state. Although medication prescribers are not required to do anything new under the new guidelines, Gov. John Kasich and more than 40 groups involved in crafting the document hope it will prompt healthcare professionals to be much more vigilant about prescribing addictive opiate medications. Prescribers can monitor a patient's total opiate intake using new and already existing tools in the Ohio Automated Rx Reporting System.

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Prescription Drug Abuse Rising, California Fights Back
NBC Bay Area
October 15, 2013

California is handing out the most prescriptions in the country, according to the Kaiser Foundation, with 3.9 million scripts filled in 2011. Agent Bruce Goldberg, of the Drug Enforcement Administration's San Francisco field office, believes increased availability of drugs has made them more easily accessible to young people. Nineteen-year-old Alec "AJ" Torchon suddenly died last December after taking a prescription drug at college in Santa Barbara. Deaths from prescription drug abuse are on the rise throughout the country. That is why California lawmakers are taking a first-of-its-kind approach to tracking prescription drugs.

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Pa.'s Pill problem: Police See Link in Rise of Prescription Abuse, Heroin
The Patriot News
October 18, 2013

Throughout the country, the rise in prescription drug abuse has served as a warning sign that heroin use will soon spike. In Pennsylvania's Dauphin County, heroin use is up 20 percent in the last 2 years, according to Mavis Nimoh, director of the county's Drug and Alcohol program. The chemical gateway from prescription drugs to heroin is both provable and obvious. The most frequently prescribed pain prescriptions like OxyContin are opioids, as is heroin. The difference is manufacturing, delivery, cost, legality, and effect. Nimoh said a user rarely knows how pure heroin is, and its effect does not last like OxyContin's does. But street-bought heroin costs a fraction of patented prescriptions, which can sell for $80–$100 per pill on the street. If you're cut off or priced out of pain pills, heroin can suddenly seem like a sensible alternative to an addict. It's rare for adults to reach Dauphin County Drug and Alcohol treatment with a pill problem alone, said Nimoh. But cases where prescription use preceded heroin are almost common.

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Pharmacy Board Says Monitoring Program Has Cut Prescription Drug Abuse
Radio Iowa
October 11, 2013

Iowa's Prescription Drug Monitoring Program is now 5 years old. Before the program was launched, Terry Witkowski, with the Iowa Board of Pharmacy, said it was easy to go to a dozen or more doctors or pharmacies and get a prescription at each one. The numbers were fairly high, especially in the 15 or more pharmacies/prescribers that were being used. The next year, those numbers dropped dramatically.

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Unite for Youth Takes Aim at Keeping Illegal Prescription Drugs from Teens
The Western News
October 16, 2013

In Lincoln County, Mo., alcohol is still the drug of choice for students in grades 8 to 12. But according to the 2010 Montana Prevention Needs Assessment and 2013 Youth Risk Behavioral Survey data, prescription drug misuse has tripled from less than 5 percent in 2010 to 16 percent in 2013. Michelle Boltz, Lincoln County Unite for Youth (UFY) Coalition member and nurse practitioner helped coordinate UFY's efforts with local medical providers. "Discussion at a recent medical staff meeting centered on prescription drug abuse in the community, and local care providers voiced concern about how prescription drug misuse affects the safety of community members, especially youth," she said.

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Other Resources

The Fentanyl Family of Opioids
National Laboratory Certification Program, Drug Testing Matters
October 2013

Drug Testing Matters is a continuing education newsletter produced by the National Laboratory Certification Program (NLCP) on topics of interest to laboratories, laboratory staff, and inspectors. Laboratories may use these short sessions as part of their internal staff training programs. Part six of the NLCP's continuing series on opioids was initiated in December 2011. This article on the fentanyl family of opioids and the remaining articles on other opioids are written by Richard Hilderbrand, Ph.D. For a free email subscription to Drug Testing Matters, please send an email with your name and the subject "Subscribe-DTM" to NLCP@rti.org.

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The Dangers of Teen Pharm Parties
HuffPost Video
October 18, 2013

Some teens raid their parents' medicine cabinets for prescription and over-the-counter drugs to supply "Pharm Parties" (aka Skittles Parties). Kids take drugs out of their labeled bottles, dump them in a bowl, and pass them around to guests. The Doctors discuss the dangers of these parties and what parents can do to safeguard their children. Duration: 1:20 minutes


Prescription Drug Abuse: A Public Health Epidemic
Robert Wood Johnson Foundation
October 7, 2013

Approximately 6.1 million Americans abuse or misuse prescription drugs. Since 1999, overdose deaths involving prescription painkillers have quadrupled, and now outnumber those from heroin and cocaine combined. "Prescription Drug Abuse: Strategies to Stop the Epidemic" by the Trust for America's Health scores each state's use of policy strategies to help curb prescription drug abuse and highlights key programs making an impact in communities. Visit http://www.rwjf.org/RxReport to find state-by-state prescription drug overdose death rates and learn how your state scores on the 10 key steps to curb abuse. Duration: 1:00 minute


Grant Announcement

Under 21 Substance Abuse Prevention Activity Mini-Grants
Many Voices for Smart Choices—Montgomery County Alliance to Prevent Youth Substance Abuse
Announced: October 7, 2013
Application Deadline: October 31, 2013

Funded by Montgomery County Government (Md.), the purpose of these mini-grants is to support youth alcohol use and substance abuse prevention activities throughout the county. Funds must be used to provide direct prevention activities serving youth who are at risk for substance use and/or abuse. The grants are intended to be combined with other local funds for community-based substance abuse prevention activities for youth. This application provides the opportunity for community groups to apply for funds to partially support their planned activities.

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Take-Back Events and Drop Boxes

DEA's 7th National Prescription Drug Take-Back Day
October 26, 2013
10 a.m. to 2 p.m.

Find local events by using the Drug Enforcement Administration's (DEA's) National Take-Back Initiative Collection Site Search database.

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Prescription Drug Take Back Oct. 26 at Good Samaritan Hospital
Central Nebraska News
October 16, 2013

From 10 a.m. to 2 p.m. on October 26, 2013, the Buffalo County, Neb., Community Partners' Positive Pressure coalition, along with Good Samaritan Hospital, the Elks, Two Rivers Public Health Department, and local law enforcement, will give the public its seventh opportunity in 3 years to prevent pill abuse and theft by ridding their homes of potentially dangerous expired, unused, and unwanted prescription drugs. Participants can bring their medications for disposal to Good Samaritan Hospital at the north parking lot. The service is free and anonymous—no questions asked.

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Hawaii Prescription Drug Take Back Initiative on October 26
Hawaii News Now
October 16, 2013

The Department of the Attorney General, in partnership with the Drug Enforcement Administration and State Narcotics Enforcement Division, is coordinating the 7th National Take-Back Initiative on the islands of Oahu, Kauai, Maui, and Hawaii. Anyone with expired or unused prescription medications is encouraged to bring the medications to a collection site on October 26, 2013.

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Kirkland Police Department Hosts National Prescription Drug Take-Back Event, October 26
Kirkland Views
October 16, 2013

On October 26, 2013, Washington's Kirkland Police Department and the Drug Enforcement Administration will host a "Drug Take-Back Event" where expired, unused, and unwanted prescription drugs will be accepted. The service is free and anonymous. Kirkland residents can bring medications for disposal to the Kirkland Police Department Lobby located at the south entrance of City Hall, 123 Fifth Avenue.

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Letter: Drop Off Unused Prescription Drugs Oct. 26
Main Line Media News
October 15, 2013

On October 26, from 10 a.m. to 2 p.m., the public will again have an opportunity to prevent pill abuse and environmental damage caused by drugs in the waterways by bringing unwanted, expired, and unused medications to disposal centers at Upper Merion Township Police Department, Tredyffrin Township Police Department, and West Conshohocken Police Department.

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Cranford Police to Hold Prescription Drug Disposal Program
October 16, 2013

For the seventh time, the Cranford Police Department will host a local medication collection site as part of the National Take-Back Initiative medicine disposal day. The event will take place between 10 a.m. and 2 p.m. on October 26 at the Cranford Community Center, 220 Walnut Ave. This initiative, open to all residents, was organized to encourage the local community to properly dispose of their unused, unwanted, and expired medicine.

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Local Law Enforcement Agencies to Take Back Unwanted Prescription Drugs
The Reporter
October 11, 2013

Local California law enforcement agencies and the U.S. Drug Enforcement Administration will provide another opportunity to prevent pill abuse and theft by helping people rid their homes of potentially dangerous expired, unused, and unwanted prescription drugs from 10 a.m. to 2 p.m. on October 26, 2013.

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Police to Take Part in Drug Take Back
October 17, 2013

As part of National Prescription Drug Take-Back Day on October 26, New Jersey's Monroe Township Police Department and the Drug Enforcement Administration invite residents to drop off their unused, unwanted, and expired prescription medications at Monroe police headquarters, 3 Municipal Plaza.

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County-Wide Prescription Drug Take Back Day
Southern Maryland News Net
October 15, 2013

Along with its partnering agencies, the local Prescription Drug Abuse Abatement Council, headed by the Calvert Alliance Against Substance Abuse, Inc., will sponsor a countywide prescription medication drop-off event in conjunction with the Drug Enforcement Administration's National Take-Back Day on October 26.

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Oct. 26 Prescription Drug Take-Back Day
Victorville Daily Press
October 11, 2013

In partnership with the Drug Enforcement Administration, the San Bernardino County, Calif., Sheriff's Department will give the public its seventh opportunity in 3 years to prevent pill abuse and theft by ridding their homes of potentially dangerous expired, unused, or unwanted prescription drugs. Residents should bring in their medications for disposal on October 26, from 10 a.m. to 2 p.m.

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Lawrence County Police Will Gather Unwanted Prescription Drugs Oct. 26
October 16, 2013

The Lawrence County, Indiana, Police Department and the Drug Enforcement Administration will hold their 7th Taking Back Unwanted Prescription Drugs Drive on October 26 at the Security Center on I Street from 10 a.m. to 2 p.m.

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Upcoming Conferences and Workshops

Heroin in Kentucky Headlines
October 24, 2013
Richmond, Kentucky

CFPC's Annual Substance Abuse Conference: Our Drug Epidemic
November 1, 2013
Andover, New Jersey

2013 American Association for Treatment of Opioid Dependence Conference
November 9–13, 2013
Philadelphia, Pennsylvania

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

National Rx Drug Abuse Summit
April 22–24, 2014
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.