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October 8, 2014


SAMHSA Prescription Drug Abuse Weekly Update
Issue 92  |  October 8, 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 and Opinion News Other State and Local News Other Resources Twitter Chat Grant Awarded Request for Proposal Take-Back Events and Drop Boxes Upcoming Conferences and Workshops


That Flushing Sound: Pharma Must Pay for a Drug Take-Back Program
The Wall Street Journal
October 1, 2014

The Ninth U.S. Circuit Court of Appeals upheld a lower-court ruling affirming a law that requires drug manufacturers to pay for disposal of unused and unexpired medicines, passed by Alameda County 2 years ago. The court maintained the ordinance treats all drug makers equally and does not place a substantial burden on interstate commerce.

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R.A. Rudd, L.J. Paulozzi, M.J. Bauer, R.W. Burleson, R.E. Carlson, D. Dao, J.W. Davis, J. Dudek, B.A. Eichler, J.C. Fernandes, A. Fondario, B. Gabella, B. Hume, T. Huntamer, M. Kariisa, T.W. Largo, J.A. Miles, A. Newmyer, D. Nitcheva, B.E. Perez, S.K. Proescholdbell, J.C. Sabel, J. Skiba, S. Slavova, K. Stone, J.M. Tharp, T. Wendling, D. Wright, and A.M. Zehner. "Increases in Heroin Overdose Deaths—28 States, 2010 to 2012." Morbidity and Mortality Weekly Report 63(39):849–54.

Deaths resulting from prescription opioid pain reliever overdoses quadrupled in the United States during 1999 and 2010, while deaths resulting from heroin overdoses rose by less than 50 percent. Individual states and cities have reported substantial increases in heroin overdose deaths since 2010. In an early analysis of overdose mortality data for 2010–12 from 28 states, increases in heroin deaths were significantly associated with increases in opioid pain reliever deaths (r=0.47).

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Journal Articles and Reports

C.P. Bailey and S.M. Husbands. 2014. "Novel Approaches for the Treatment of Psychostimulant and Opioid Abuse—Focus on Opioid Receptor–Based Therapies." Expert Opinion on Drug Discovery, doi:10.1517/17460441.2014.964203.

The authors review the clinical need and animal models used to uncover potential novel treatments. Two fundamental challenges hamper the development of innovative drug addiction treatments. First, three key stimuli precipitate relapse of drug taking: stress, presentation of drug-conditioned cue, and taking a small dose of a drug. Second, a large number of drug users are polydrug users, taking more than one drug of abuse at a time. The ideal treatment would address these stimuli and be effective for all classes of abused drugs. Researchers are probing a broad range of "memory based" and "receptor based" treatment approaches and targets as potential anti-relapse therapies. Opioid receptors and ligands have been widely studied, and research on how different opioid subtypes affect addiction-related behaviors (reward, dysphoria, motivation) suggests they are tractable targets as anti-relapse treatments. Research indicates a "non-selective" approach to targeting opioid receptors will be the most effective.

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J.S. Bodenlos, A. Malordy, M. Noonan, A. Mayrsohn, and B. Mistler. 2014. "Prescription Drug Attitudes Questionnaire: Development and Validation." Psychology 5(14):1687–93, doi:10.4236/psych.2014.514176.

Researchers developed a 26-point Prescription Drug Attitudes Questionnaire measuring student attitudes toward prescription drug use for nonmedical reasons. They gave the questionnaire to 310 undergraduates at a small college in rural New York. Principal components analysis revealed a two-factor structure, with the factors representing recreational- and achievement-oriented attitudes. (Editor's note: Several articles summarized in recent issues of the Weekly Update identified the same factors.) The instrument had good internal consistency (.94). Since less than 10 percent of students reported misusing prescription drugs, the "validation" primarily assessed if the scale predicted other substance abuse, rather than prescription misuse. It was marginally effective at this task, with correlation coefficients around .35. Although the authors claim to have validated the questionnaire, they did not give it to students other than those used to scale it.

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B. Drapera, N. Ridleya, C. Johncoa, A. Withalla, W. Sima, M. Freemana, E. Continia, and N. Lintzerisa. 2014. "Screening for Alcohol and Substance Use for Older People in Geriatric Hospital and Community Health Settings." International Psychogeriatrics, doi:10.1017/S1041610214002014.

Researchers surveyed 210 people over age 60 (mean age 82; 63 percent female) without dementia or delirium who used geriatric or aged care psychiatry wards or associated community services at a teaching hospital. Seven reported nonmedical benzodiazepine use and admitted nonmedical opioid use.

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A.M. Secora, C.M. Dormitzer, J.A. Staffa, and G.J. Dal Pan. 2014. "Measures to Quantify the Abuse of Prescription Opioids: A Review of Data Sources and Metrics." Pharmacoepidemiology and Drug Safety, doi:10.1002/pds.3711.

This review summarizes strengths and weaknesses of frequently used numerators and denominators in "abuse ratios." Researchers critically evaluated the various measures to quantify drug availability and data sources to assess prescription opioid abuse. Currently, no commonly adopted metrics exist for measuring the prevalence of opioid abuse or abuse relative to drug availability. Because the settings, manifestations, and severity of abuse can vary from person to person, no one measure of abuse, abuse-related outcome, or drug exposure is ideal. Each measure captures a specific facet of abuse, but not the entire spectrum. Reliable estimation of population-adjusted or utilization-adjusted rates of abuse can be accomplished with a prescription opioid abuse ratio. This metric estimates the prevalence of abuse in a given population or abuse relative to how much drug is available and, in certain cases, can be used to compare abuse among various opioid drugs. Abuse ratio measurements in the literature vary in the inclusion of specific abuse and availability measures, with little field consensus regarding which measures allow for the most appropriate approximation of the extent of abuse, and for comparisons among opioids. Crude numbers of outcomes related to abuse (e.g., emergency department visits, treatment admissions, and overdoses) cannot be properly understood without context, as these may overestimate or underestimate the true scope and severity of prescription opioid abuse. They can, however, serve as numerators in properly constructed abuse ratios. The denominator of the abuse ratio provides the necessary context by accounting for populations at risk or drug availability (e.g., prescriptions or tablets dispensed, unique recipients of dispensed drug, total patient days of therapy, or kilograms sold), and each comes with its own set of assumptions.

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Professional Education and Opinion

G.M. Franklin. 2014. "Opioids for Chronic Noncancer Pain: A Position Paper of the American Academy of Neurology." Neurology 83(14):1277–84, doi:10.1212/WNL.0000000000000839.

The American Academy of Neurology's Patient Safety Subcommittee requested a review of the science and policy issues surrounding prescription opioid–related morbidity and mortality in the United States. This article explores the key initiating causes of the epidemic, the evidence of opioids' safety and effectiveness for chronic pain, federal and state policy responses, and recommendations for neurologists to increase best practices and universal precautions likely to improve effective and safe opioid use. It also provides suggestions for doctors to more safely and effectively prescribe opioids, including use of one's state prescription monitoring program, which can make physicians more aware of prescription drugs the patient may already be taking.

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C.M. Jones, P. Lurie, and Janet Woodcock. 2014. "Addressing Prescription Opioid Overdose: Data Support a Comprehensive Policy Approach." JAMA, doi:10.1001/jama.2014.13480.

This article discusses the ruling to approve Zohydro ER, despite a recommendation from the Food and Drug Administration's advisory committee against approval. It also includes the committee's suggestions, such as incorporating abuse-deterrent technologies. The authors argue that policies focusing on a single drug can divert focus from broader, further-reaching interventions, such as maximizing prescription monitoring program (PMP) use. They suggest revising PMP rules to make them applicable to all opioids as a new standard of care for appropriate pain management.

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P. Madadi and N. Persaud. 2014. "Suicide by Means of Opioid Overdose in Patients with Chronic Pain." Current Pain and Headache Reports 18:460, doi:10.1007/s11916-014-0460-1.

Although most opioid prescribing tools focus on identifying risk factors for potential abuse, diversion, and propensity for addiction, physicians who consider prescribing these drugs should also screen and optimize chronic pain treatment for patients with suicide risk.

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L. Paul, M.M. John, and C.N. Nguyen. 2014. "Prescription Drug Monitoring Programs: A Tool for Pharmacists." University of the Incarnate Word Pharmacy Review 3(1).

This overview of prescription monitoring programs (PMPs) looks at their effectiveness and explains how the Texas Department of Public Safety operates its PMP.

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B.J. Turner. 2014. "Strategies to Reduce Non-Medical Use of Opioids: Few Successes but Many Opportunities." University of the Incarnate Word Pharmacy Review 3(1).

The article discusses four strategies that have been developed to manage nonmedical use of opioids. The author says only a few strategies have been effective, and suggests physicians, prescribers, pharmacies, insurers, and policymakers collaborate to create systems of care that promote and support evidence-based nonpharmacologic therapies for pain.

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Maker of Painkiller Tries to Curb Abuse
Thomas M. Burton, The Wall Street Journal
October 1, 2014

Zohydro ER's maker, Zogenix, submitted an application to the Food and Drug Administration for a new version of the drug that will be less susceptible to abuse. Its capsule contains viscous gel that will make it difficult for addicts to inject or snort.

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Soon You Can Send Your Expired Painkillers Through the Mail
Alexandra Sifferlin, TIME
September 29, 2014

The Drug Enforcement Administration held its final National Take-Back event on September 27. Soon, Americans will be able to drop off unwanted prescription drugs at pharmacies or police departments. Patients will also be able to pick up mailing envelopes from hospitals and send pills to authorized collectors.

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White House Drug Policy Acting Director Announces Designation of 26 Cities and Counties as High Intensity Drug Trafficking Areas
White House Office of National Drug Control Policy
September 29, 2014

Michael Botticelli, acting director of National Drug Control Policy, designated 26 counties and cities in 11 states as High Intensity Drug Trafficking Areas. These areas will receive federal resources to extend coordination and development of drug control efforts among federal, state, local, and tribal law enforcement officials.

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FDA Undermines Painkillers Fight: Our View
USA Today
September 29, 2014

USA Today's editorial board shares its opinion on the Food and Drug Administration's (FDA's) approval of Zohydro. The board thinks the FDA should reconsider its decision and encourage other approaches to curbing pain reliever abuse.

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PCMA: How Congress Can Fight Prescription Drug Fraud and Abuse
PR Newswire
September 29, 2014

During a Capitol Hill briefing, "Prescription Opioid Abuse: Fighting Back on Many Fronts," the Pharmaceutical Care Management Association outlined policy solutions that could reduce prescription fraud and abuse in Medicare Part D. One option is to create "Safe Pharmacies," or a "Lock-In" program for controlled substances, allowing Part D plans and beneficiaries to choose a pharmacy that dispenses controlled substances.

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Shire Pays $56.5M to Settle Federal Case
Michael N. Price, Mainline Media News
September 29, 2014

Shire Pharmaceuticals will pay a $56.5 million settlement to resolve allegations that it violated the False Claims Act while marketing and promoting several prescription medications over the last decade. Federal officials said the settlement stems from marketing efforts made between 2004 and 2007, with specific claims about the effectiveness of Adderall XR compared with industry competitors. The Department of Justice eventually concluded the claims were not supported by Shire's clinical data. Officials said the settlement also resolves separate allegations that Shire improperly marketed several other drugs, including Vyvanse, Daytrana, Lialda, and Pentasa, between 2006 and 2010.

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At White House, Prescription Drug Protesters Call for New FDA Chief
Chris Good, ABC News
September 28, 2014

Hundreds gathered outside the White House to demand tighter regulation of prescription pain medicines and the removal of Food and Drug Administration Commissioner Margaret Hamburg. Demonstrators marched up Pennsylvania Avenue and stood outside the White House. Many held signs displaying names, faces, and death dates of loved ones. The rally was organized under the name "Fed Up!" and sponsored by addiction-care treatment providers and anti-abuse organizations.

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Other State and Local News

Surge in Minnesota Drug Overdose Deaths Worries Health, Public Safety Officials
Kevin Giles, Star Tribune
October 2, 2014

In Minnesota, overdose deaths far exceed deaths from motor vehicle crashes. In 2013, 507 Minnesotans died from drug overdoses and 374 Minnesotans died in crashes. Two hundred people died after overdosing on prescribed pain relievers; 91 died from heroin overdoses. A growing number of cases were prosecuted as third-degree murder when investigators found the sale of a drug led to an overdose death.

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U.S. Attorney Heroin Overdose Task Force Report Issued
Scott Beveridge, Observer-Reporter
September 29, 2014

U.S. Attorney David J. Hickton's Pennsylvania committee on drug overdose and addiction reported that physicians need to be better educated about prescription drug and heroin overdoses. The Pennsylvania group asked community leaders and county commissioners to read its report and help coordinate recommendations. It also wants lawmakers to overhaul the state's prescription monitoring program. The report urges implementation of an overdose-prevention program for the incarcerated, and creation of a program to educate law enforcement officials about addiction and treatment. It recommends a commitment to increase local drug and alcohol treatment programs.

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Rash of Pharmacy Robberies Highlight Growing Problem
Justin Corr, KTVB
October 1, 2014

Twin Falls, Idaho, police have seen a recent rash of pharmacy robberies, with three in 1 week. Robbers are demanding opiate pain relievers. (Includes video: 2:58 minutes)

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Corbett Signs Bill that Backer Says Will Reduce Heroin Overdoses in State
Reading Eagle Company
October 1, 2014

Pennsylvania Governor Tom Corbett signed a bill that will allow physicians to prescribe naloxone to friends and relatives of addicts and offer immunity from criminal prosecution to those who help overdose victims. The law will take effect in 60 days.

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Md. Law Protects People Seeking Help for Overdose Victims
Dick Uliano, WTOP
October 2, 2014

Maryland became the 20th state to enact a "Good Samaritan Law" providing certain immunity to people who summon medical help for someone overdosing on drugs or alcohol. The state's law makes the call for help a mitigating factor at sentencing.

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Naloxone Helping Port Prevent Drug Overdoses
Jessica Cohen, Times Herald-Record
October 3, 2014

The Port Jervis Police Department is being equipped with and trained to use naloxone as a drug-overdose antidote. Training will be provided on October 14 by Restorative Management Incorporated, Operation P.J. Pride, and Mid-Hudson Prevention Resource Center.

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Another Tool in Their Arsenal: Muskego Police Now Using Narcan in Opiate Overdose Cases
Katie Delong, Fox 6
September 30, 2014

Wisconsin's Muskego Police Department has equipped all marked squad cars with Narcan. Police officers have been trained by the Tess Corners Fire Department to administer the nasal spray to anyone exhibiting signs of an opioid overdose.

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Adams County: Overdose Deaths Up 25 Percent from 2009
Jennifer Wentz, The Evening News
September 30, 2014

In Adams County, Pennsylvania, prescription drug overdose deaths have increased by about 25 percent over the past 5 years. There were 43 overdose deaths in 2013, compared with 33 in 2009. Virtually all involved prescription drugs.

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Inside Utah's Struggle with Drug Abuse
Lisa Ling, CNN
October 3, 2014

Utah has seen a dramatic increase in pill-related deaths. Lisa Ling explores the issue in this week's episode of her new CNN show, This is Life with Lisa Ling. Ling talks to Mormon Church leaders and those recovering from addiction. (Includes video: 2:06 minutes)

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Statewide Effort Against Drug Abuse Arrives in Middlesex County
Sue Epstein, New Jersey Advance
October 2, 2014

During the "Do No Harm Symposium," speakers said physicians must be the first line of defense in stemming the heroin and prescription drug abuse epidemic. Iqbal Jafri, who helps direct the pain program at John F. Kennedy Johnson Rehabilitation Institute, said healthcare providers have to know various treatment options and stop relying on pills as an answer for every type of pain.

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Some Nebraska College Students Turn to 'Study Drug' Adderall
Ryan Robertson, NET News
October 2, 2014

A reporter talks to students about using and selling Adderall on the University of Nebraska–Lincoln campus. Although Guy didn't have a prescription, he could get a pill for about $5. He used the drug mainly during finals. Stef became addicted to Adderall while she was studying for her master's and doctoral degrees. She used the drug to keep up with coursework, and it was easy to find on campus. Nebraska law enforcement said sentences for distribution of Adderall range from 1 to 20 years in prison, a $25,000 fine, or both. (Includes audio: 5:35 minutes)

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Other Resources

5 Signs Your Doctor Might Be an Overprescriber
Orly Avitzur, Consumer Report
September 28, 2014

Consumer Report lists five warning signs a doctor might be an overprescriber: he or she prescribes multiple drugs for no apparent reason, writes a prescription for every symptom, prescribes antibiotics for the common cold, has an office full of pharmaceutical logos, and does not ask about nonprescription drugs and supplements.

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Twitter Chat

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

In observance of National Medicine Abuse Awareness Month, CADCA and ONDCP will host a Twitter chat exploring the nation's medicine misuse and abuse epidemic, discussing solutions to the problem, and sharing tools and resources for parents, educators, and community leaders.

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Grant Awarded

CHC Gets Federal Grant for Prevention or Reduction of Underage Drinking and Prescription Drug Misuse and Abuse
Marianas Variety
September 29, 2014

The Commonwealth Healthcare Corporation's Community Guidance Center received a 5-year, $1.3 million grant from the Substance Abuse and Mental Health Services Administration. The Partnership for Success grant focuses on preventing or reducing the consequences of underage drinking, adult problem drinking and driving, and prescription drug misuse and abuse throughout the Commonwealth of the Northern Mariana Islands.

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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

Ohioans Dispose of 10.5 Tons of Prescription Drugs
Akron Beacon Journal (Ohio)
October 2, 2014

Roanoke Valley Officials Collect Over a Ton of Medication at Drug Take-Back
Jordan Fifer, The Roanoke Times (Virginia)
September 27, 2014

Palm Beach County Program Collects 5,500 Pounds of Prescription Pills
Marisa Gottesman, Sun Sentinel (Florida)
October 2, 2014

Police Collect Almost 1,200 Pounds of Drugs for Safe Disposal
The Frederick News-Post (Maryland)
September 28, 2014

State Police Collect More Than 1K lbs. of Prescription Drugs
Bethel's HamletHub (Connecticut)
October 1, 2014

Prescription Drug Takeback Day Yields More Than 970 Pounds of Prescription Drugs
The Daily Press (California)
September 29, 2014

Howard Co. Police Collect 821 lbs. of Prescription Drugs
Katie Lang, WBAL TV (Maryland)
September 30, 2014

Over 800 Pounds of Unwanted Prescription Drugs off Area Streets
Joe Carlson, New Jersey Herald
September 30, 2014

'Drug Take Back' Reclaims Over 700 Pounds of Unused Prescription Drugs
KOLR 10 News (Missouri)
September 28, 2014

State Police Collect More Than 500 Pounds of Prescription Drugs on National Prescription Drug Take-Back Day
Michigan State Police
Accessed October 3, 2014

Geneva Drug Dropoff Site Getting Regular Use
Mike Hibbard, Finger Lake Times (New York)
October 1, 2014

Community/Senior Center Drug Take Back Box
KCSG (Nevada)
October 1, 2014

Police in Howell Adding Drug-Disposal Barrel
Livingston Daily (Michigan)
October 2, 2014

Pampa PD Now Offering Prescription Drug Take Back Program
The Pampa News (Texas)
September 30, 2014

New Drop Box Set Up for Unused Drugs
George Levine, The Salem News (Massachusetts)
October 2, 2014

Santa Monica Public Safety Facility Installs Prescription Drug Drop-Box
Santa Monica Mirror (California)
September 27, 2014

Prescription Drug Receptacle Available at Leland Police Department
StarNews Media (North Carolina)
September 30, 2014

Kane Drug Drop-Off Program Expands North, South
Dan Campana, Sun-Times Media (Illinois)
September 28, 2014

New Incinerator Helps Fight Prescription Drug Abuse in WV
Christina Fan, WOWK TV (West Virginia)
October 1, 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
New York, New York

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.