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October 9, 2013

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SAMHSA Prescription Drug Abuse Weekly Update
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ISSUE 40 - OCTOBER 2013
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 Webinar Grants Received Take-Back Events and Drop Boxes Upcoming Conferences and Workshops

Featured

Prescription Drugs Now the No. 2 Addiction Problem Handled by Lawyer Assistance Programs
American Bar Association Journal
October 3, 2013

The American Bar Association (ABA) Commission on Lawyer Assistance Programs Survey reported prescription drugs are the second most commonly abused substances by lawyers seeking help through state support programs. Prescription drugs accounted for as many matters handled by state programs as cocaine, methamphetamines, and heroin combined. Lawyer assistance programs received an online link to the 2012 survey in January 2013; 48 states and the District of Columbia responded. Substance abuse and addiction were the most common issues handled by the programs—slightly more than 50 percent of issues typically falling into these categories. On average, 75 percent of substance abuse/addiction issues concerned alcohol, 10 percent concerned prescription drugs, 5 percent concerned cocaine, 3 percent concerned marijuana, 2 percent concerned methamphetamine, 2 percent concerned hallucinogenic drugs, and 1 percent concerned heroin. The most common prescription drug issue involved pain medication—a problem, on average, in 74 percent of cases. The ABA Commission on Lawyer Assistance Programs supports state bar–sponsored and other lawyer assistance programs and develops policies to keep lawyers and judges who suffer from stress, addiction, and related problems from harming clients and the public while enabling them to get the help they need.

Read more:
http://www.abajournal.com/news/article/prescription_drugs_now_the_no._2_addiction_
problem_handled_by_lawyer_assist

Seminar Stacks Body Bags to Show Toll of Substance Abuse in Westmoreland County
Pittsburgh Post-Gazette
October 3, 2013

Editor's note: This article is a great illustration of what one can do with local data.
Coroner Kenneth Bacha illustrated accidental overdoses by piling up 100 body bags in front of the lectern while she was speaking. That represented the death toll for a recent 15-month period in Westmoreland County, Pennsylvania. Bacha warned that Westmoreland is on its way to another record year in deaths related to accidental overdoses. In 2002 that number was 22, but by 2012 it had increased to 78. The total for 2013 is already 72. Along with her subcommittee, Betty Gaul, a Special Projects Director for Southwest Behavioral Health Management Incorporated, took a closer look at the 100 deaths recorded in the county between January 1, 2012, and March 31, 2013. Two thirds of victims were male; 97 percent were white; 71 percent overdosed at home; and more than half were between ages 41 and 60. Illegal drugs were the main causes of death among younger victims (between 15 and 30), while prescription drugs were the major cause in older people. Sixty-five of the 100 faced legal charges in the county and 58 had been jailed at least once. Two thirds of victims had received medical assistance benefits at some point. Of that group, 61 (90 percent) had used their public health coverage for mental health, substance abuse, or prescription services.

Read more:
http://www.post-gazette.com/stories/local/neighborhoods-east/seminar-stacks-body-bags-to-
show-toll-of-substance-abuse-in-westmoreland-county-706011

Journal Articles and Reports

M. Häkkinen, P. Heikman, and I. Ojanperä. 2013. "Parenteral Buprenorphine–Naloxone Abuse Is a Major Cause of Fatal Buprenorphine-Related Poisoning." Forensic Science International 232(1):11-15.

This study estimated the proportion of buprenorphine–naloxone (BNX) to all buprenorphine (BPN)–related fatalities. The sample consisted of all 225 deceased drug abusers in Finland from January 2010 to June 2011 with a positive BPN and/or norbuprenorphine and/or naloxone (NX) finding in urine. No exposure data were available, so the sample cannot be used to study risk levels. Data were divided into three groups based on the urine NX and BPN concentrations. The "Parenteral BNX" group (> 100μg/l NX) was presumed to consist of injecting or snorting BNX abusers and the "Parenteral BPN" group (> 50μg/l BPN, 0μg/l NX) of injecting or snorting BPN abusers, while the "Other BNX or BPN" group (≤ 100μg/l NX, or ≤ 50μg/l BPN combined with 0μg/l NX) was presumed to consist of mainly sublingual BNX or BPN users. In 12.4 percent of cases, the NX urine concentration was higher than the threshold 100μg/l. In fatal BPN poisonings, the proportion of parenteral BNX was 28.4 percent. In the "Parenteral BNX," "Parenteral BPN," and "Other BNX or BPN" groups, the proportion of fatal BPN poisonings was 67.9, 31.0, and 22.6 percent, respectively. Among the 225 BPN–related fatalities, parenteral abuse of BNX was shown to be common (12.4 percent) and BNX poisoning was the underlying cause of death in 8.4 percent. Parenteral BNX caused fatal BPN poisoning proportionally more often than parenteral BPN.

Read more:
http://www.fsijournal.org/article/S0379-0738(13)00340-X/abstract

D. Kennedy, M. Eamus, M. Hill, and J.L. Oei. 2013. "Review of Calls to an Australian Teratogen Information Service Regarding Psychotropic Medications over a 12-Year Period." Australian and New Zealand Journal of Obstetrics and Gynaecology. doi:10.1111/ajo.12129.

This study determined the frequency and types of calls to a New South Wales (NSW)–based telephone counseling service regarding perinatal psychotropic agent exposure between 2000 and 2011. Researchers used retrospective analyses of MotherSafe call data between two epochs: I (2000–2005, n = 46,277) and II (2006–2011, n = 118,587). Individuals made 25,698 (15.6 percent) calls about psychotropic agents: 16,218 (9.8 percent) about antidepressants, 3,145 (1.9 percent) about mood stabilizers/antiepileptic agents, 2,878 (1.7 percent) about benzodiazepines and 3,457 (2.1 percent) about antipsychotic drugs. Calls about psychotropic agents decreased in epoch II as a proportion of total calls (16.1 percent versus 15.4 percent, P < 0.001). Selective serotonin inhibitors were the most common drugs of concern (>44 percent of total psychotropic calls). The proportion of calls regarding particular agents changed significantly between epochs, for example paroxetine (epoch I: 14.8 percent versus epoch II: 6.7 percent of all antidepressant calls, P < 0.001) and quetiapine (epoch I: 10.6 percent versus epoch II: 34.7 percent of all antipsychotic calls, P < 0.001). Calls from rural NSW areas increased from 22.6 to 24.7 percent (P < 0.001).
 
Read more:
http://onlinelibrary.wiley.com/doi/10.1111/ajo.12129/abstract?systemMessage=Wiley+Online+
Library+will+be+unavailable+for+approximately+4+hours+between+09%3A00+EDT
+and+14%3A00+EDT+on+Saturday%2C+28+September+2013+as+we+make+upgrades+
to+improve+our+services+

Related Article
More Women Prescribed Psychiatric Drugs and Left at Risk of Birth Defects
The Sydney Morning Herald
September 28, 2013

Doctors fear some women of child-bearing age are being prescribed psychiatric medications that can cause pregnancy complication and birth defects. A study of calls to the Royal Hospital for Women's MotherSafe pregnancy and breastfeeding information line found inquiries about psychiatric medications doubled over the past decade. The number of calls increased from 850 between 2000 to 2005 and to 2,400 between 2006 and 2011. Calls about quetiapine, commonly sold as Seroquel, increased tenfold. Debra Kennedy, MotherSafe Director and the study's author, said calls about psychiatric medications seemed to be increasing in rural and regional areas. She feared women in those areas might be more likely to be medicated because few psychologists and psychiatrists were available who could treat their problems without medication. A rise in diagnosis of bipolar disorder has prompted doctors to prescribe women mood-stabilizing medication that carries a high risk of birth defects and lowered IQ for their babies if taken after getting pregnant. Research linked Epilim with rates of fetal abnormality of up to 17 percent and significant decreases in IQ. Epilim prescriptions have increased by nearly one third over the past 10 years.

Read more:
http://www.smh.com.au/national/health/more-women-prescribed-psychiatric-drugs-and-
left-at-risk-of-birth-defects-20130927-2ujoj.html

G. Li, J.E. Brady, and Q. Chenc. 2013. "Drug Use and Fatal Motor Vehicle Crashes: A Case-Control Study." Accident Analysis and Prevention 60:205–10.

Researchers used a case-control design to assess the association between drug use and fatal crash risk. Cases (n = 737) consisted of drivers who were involved in fatal motor vehicle crashes in the continental United States during specific periods in 2007, and controls (n = 7,719) were participants of the 2007 National Roadside Survey of Alcohol and Drug Use by Drivers. Overall, 31.9 percent of the cases and 13.7 percent of the controls tested positive for at least one non-alcohol drug. The estimated odds ratios of fatal crash involvement associated with specific drug categories were 1.83 [95 percent confidence interval (CI): 1.39, 2.39] for marijuana, 3.03 (95 percent CI: 2.00, 4.48) for narcotics, 3.57 (95 percent CI: 2.63, 4.76) for stimulants, and 4.83 (95 percent CI: 3.18, 7.21) for antidepressants. Drivers who tested positive for both alcohol and drugs were at substantially heightened risk relative to those using neither alcohol nor drugs (Odds Ratio = 23.24; 95 percent CI: 17.79, 30.28).

Read more:
http://www.sciencedirect.com/science/article/pii/S0001457513003527

L.J. Merlo, S. Singhakant, S. Cummings, and L.B. Cottler. 2013. "Reasons for Misuse of Prescription Medication Among Physicians Undergoing Monitoring by a Physician Health Program." Journal of Addiction Medicine 7(5):349-53. doi:10.1097/ADM.0b013e31829da074.

This study, which aimed to develop better mechanisms for prevention and intervention, identified reasons for prescription drug misuse among physicians referred to a physician health program for monitoring because of substance-related impairment. It relied on guided focus group discussions with 55 physicians (94.5 percent male) who were being monitored by state physician health programs for substance-related impairment. Participation was anonymous. All participants had been diagnosed with substance dependence; 69.1 percent had a history of misusing prescription drugs. Participants documented the following five primary reasons for prescription drug misuse: 1) to manage physical pain, 2) to manage emotional/psychiatric distress, 3) to manage stressful situations, 4) to serve recreational purposes, and 5) to avoid withdrawal symptoms.

Read more:
http://journals.lww.com/journaladdictionmedicine/Abstract/2013/09000/Reasons_for_Misuse_
of_Prescription_Medication.7.aspx

M.A. Raebel, S.R. Newcomer, L.M. Reifler, D. Boudreau, T.E. Elliott, L. DeBar, A. Ahmed,  P.A. Pawloski, D. Fisher, W.T. Donahoo, and E.A. Bayliss. 2013. "Chronic Use of Opioid Medications Before and After Bariatric Surgery." The Journal of the American Medical Association 310(13):1369-76. doi:10.1001/jama.2013.278344.

Researchers conducted a retrospective cohort study in a distributed health network (10 demographically and geographically varied U.S. healthcare systems) of 11,719 individuals 21 and older who had undergone bariatric surgery between 2005 and 2009 and were assessed 1 year before and after surgery, with the latest follow-up by December 31, 2010. They measured opioid use as morphine equivalents 1 year before and 1 year after surgery, excluding the first 30 postoperative days. Chronic opioid use is defined as 10 or more opioid dispensings over 90 days or more as dispensings of at least a 120-day supply of opioids during the year prior to surgery. Before surgery, 8 percent (95 percent CI, 7–8 percent; n = 933) of bariatric patients were chronic opioid users. Of these individuals, 77 percent (95 percent CI, 75–80 percent; n = 723) continued chronic opioid use in the year following surgery. Mean daily morphine equivalents for the 933 bariatric patients who were chronic opioid users before surgery were 45.0 mg (95 percent CI, 40.0–50.1) preoperatively and 51.9 mg (95 percent CI, 46.0–57.8) postoperatively (P < .001). For this group, change in morphine equivalents before surgery versus after surgery did not differ between individuals with loss of more than 50 percent excess body mass index versus those with 50 percent or less. Changes in morphine equivalents before versus after surgery did not differ between those with or without preoperative diagnosis of depression or chronic pain. In this cohort of patients who underwent bariatric surgery, 77 percent who were chronic opioid users before surgery continued chronic opioid use in the year following surgery, and the amount of chronic opioid use was greater postoperatively than preoperatively.

Read more:
http://jama.jamanetwork.com/article.aspx?articleid=1745677

News

Prescription Drugs Sold Illegally Online—ABC7 Investigation
ABC7
October 2, 103

This article and video (3:48 minutes) discuss how easy it is to purchase drugs on Craigslist without a prescription. During a 2-month period, Eyewitness News discovered that OxyContin, Norco, Xanax, anabolic steroids, Viagra, and a variety of prescription drugs were sold on Craigslist every day. Law enforcement is responding. For example, a Craigslist vendor sold 16 Viagra pills for $100 to an undercover sheriff's deputy and was arrested by HALT team agents from the Los Angeles County Sheriff's and Health Services departments. Chris Bell, an award-winning documentary filmmaker, found it easy to purchase OxyContin on Craigslist when his doctor would no longer prescribe the drug. Prescriptions are also sold illegally at storefront swap meets. HALT seized an estimated $1 million worth of prescriptions shipped from places like El Salvador and India. California State Senator Ted Lieu wants to ban Craigslist outright for allowing these postings. He will meet with representatives from the site on October 30 to discuss his request to take down illegal prescription postings.

Read more:
http://abclocal.go.com/kabc/story?section=news/consumer&id=9271923

Locking Cap Web Site and Addiction Blog Announce Partnership
Digital Journal
October 2, 2013

This press release announces a partnership between the Locking Cap Web site and Addiction Blog to reduce prescription drug abuse among teenagers and young children. Locking Cap makes a safety cap locking system for medication bottles. The bottle caps fit most prescription bottles and offer more than 10,000 locking combinations.

Read more:
http://www.digitaljournal.com/pr/1504478

NSC 2013: Prescription Drug Abuse Poses a Major Threat to Workplace Safety
EHS Today
September 30, 2013

Janet Froetscher, National Safety Council's Chief Executive Officer, said the top emerging threat to workplace safety and public health is prescription pain reliever abuse. She noted 45 people die from prescription pain medication abuse every day—more than heroin and cocaine combined. During her keynote address at the 2013 National Safety Congress and Expo, Froetscher also shared that pain reliever abuse accounts for 10 percent of workers' compensation costs. She warned this problem is showing up in the workplace and employers will continue to see more in the future, especially with changing demographics.

Read more:
http://ehstoday.com/safety/nsc-2013-prescription-drug-abuse-poses-major-threat-workplace-safety

National Medicine Abuse Awareness Month Kicks Off
Fort Mill Times
October 1, 2013

Community Anti-Drug Coalitions of America (CADCA) and the Consumer Healthcare Products Association have partnered to spread awareness about prescription drugs and over-the-counter (OTC) medication abuse. During National Medicine Abuse Awareness Month in October, the organizations encourage communities to help raise awareness about abuse of prescription medicine as well as OTC drugs that contain the cough suppressant dextromethorphan. CADCA urges its membership to plan and promote an educational event about the potential dangers associated with medicine abuse and to discuss prevention, intervention strategies, and treatment.

Read more:
http://www.fortmilltimes.com/2013/10/01/2995680/national-medicine-abuse-awareness.html

Arrest in U.S. Shuts Down a Black Market for Narcotics
The New York Times
October 2, 2013

The Federal Bureau of Investigation arrested the mastermind behind Silk Road, an underground online marketplace for drug users looking to purchase marijuana, LSD, ecstasy, and prescription pills. It became a black market version of eBay, where criminals could do business with more than 100,000 customers. Users could gain access to the network only through software meant to ensure anonymity and they made transactions using Bitcoins, a virtual currency. Ross Ulbricht, a 29-year-old known as Dread Pirate Roberts, was arrested on narcotics and money laundering charges and may be charged with murder. Silk Road was responsible for almost half of all transactions involving Bitcoins. Its sales revenue was more than 9.5 million Bitcoins, valued at about $1.2 billion. Investigators believe Mr. Ulbricht collected commissions of more than 600,000 Bitcoins—the equivalent of $80 million—which they are trying to gain access to. So far, authorities have seized 26,000 Bitcoins, worth about $3.6 million, from escrow accounts where Silk Road buyers placed funds.

Read more:
http://www.nytimes.com/2013/10/03/nyregion/operator-of-online-market-for-illegal-drugs-is-
charged-fbi-says.html?ref=us&_r=0

Related Article
Online Drug Markets Are Alive and Thriving
Time
October 4, 2013

Hours after the news of Silk Road's demise, the value of the Bitcoin dropped roughly 20 percent. However, the news is unlikely to shut down online drug trade. Atlantis, an online site, launched a marketing campaign aimed at Silk Road's market share and a YouTube video meant to train new users on how to access the site. Atlantis then announced it had been forced to shut down for "security reasons outside its control." Two other low-key sites, Black Market Reloaded and the Sheep Marketplace, claim they offer everything from marijuana to ecstasy and firearms. One reason the Silk Road owner was caught was because he purchased several fake IDs to rent servers for growing Silk Road's capacity. The IDs were shipped from Canada and discovered during a routine customs inspection.

Read more:
http://business.time.com/2013/10/04/online-drug-markets-are-alive-and-thriving/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+time%2Fbusiness+(TIME%3A+Top+Business+Stories)

Bipartisan Group of Senators Urges AG Holder to Establish Drug Take-Back Programs for DoD and VA
United States Senator for Maine Susan Collins
October 1, 2013

This press release discusses a letter that U.S. senators sent to Attorney General Eric Holder, urging the Department of Justice to address prescription drug abuse among service members and veterans by allowing the Department of Defense (DoD) and Department of Veterans Affairs (VA) to establish prescription drug take-back programs in coordination with the Drug Enforcement Administration (DEA). A rule proposed by the DEA under the Secure and Responsible Drug Disposal Act of 2010 does not allow DoD and VA to participate in the DEA's drug take-back efforts because it does not account for the unique conditions at DoD and VA facilities. Under current law, only the DEA has the authority to designate authorized collectors of controlled substances through drug take-back programs for the purpose of safe disposal. A January 2012 report, Army 2020: Generating Health and Discipline in the Force, recommended establishment of a military drug take-back program to help combat prescription drug misuse or abuse in the ranks. In June, a bipartisan group of senators introduced legislation that would direct Attorney General Holder to establish drug take-back programs in coordination with DoD and VA.

Read more:
http://www.collins.senate.gov/public/index.cfm/press-releases?ID=10c0b53e-6936-4f99-9ec1-
2c4b0fb6a348

Savvy Senior: How to Safely Dispose of Unused Medicines
The Western Queens Gazette
October 2, 2013

A concerned grandmother asks the Savvy Senior how to dispose of unwanted medications. The response discusses take-back events, finding collection sites, and self-disposal.

Read more:
http://www.qgazette.com/news/2013-10-02/Seniors/Savvy_Senior.html

URI Researcher: College Students Face Risks from Misuse of Prescription Stimulants
The University of Rhode Island
October 1, 2013

Little evidence exists that prescription stimulants enhance cognitive abilities of college students without attention deficit hyperactivity disorder (ADHD); however, they can pose serious health risks. In a systematic review of hundreds of research studies, University of Rhode Island Psychology Professor Lisa Weyandt found between 5 and 35 percent of college students without ADHD reported taking the stimulants. Stimulants may increase students' ability to focus, but do not make them more intelligent or superior readers. They may complete their assignments, but the quality of their work does not improve and in fact, may worsen. Misused stimulants can cause cardiac effects, decreased appetite, and difficulty sleeping. Weyandt said those at greatest risk for misusing stimulants are members of sororities and fraternities and students with lower grade point averages or greater levels of internal restlessness, stress, anxiety, or depression. She also noted that 6 percent of graduate students in a wide variety of academic programs throughout the United States reported misusing the stimulants within the past year. Seventeen percent reported misusing them at some point in their lifetime.

Read more:
http://www.uri.edu/news/releases/?id=6799

Universities Warned of 'Explosion' in Use of Smart Drugs
The Telegraph
September 28, 2013

Students at some of Britain's top universities are putting their health at risk amid an "explosion" in the availability of Modafinil, an investigation has found. They use the medicine to stay awake and alert for long periods and boost performance on exams. As many as one fourth of students may have experimented with Modafinil. Although it is not illegal to purchase the prescription-only drug, supplying it to other people is against the law. Experts warned long-term drug effects were unknown and users may be putting their future health at risk. Sky News discovered a black market around universities including Oxford and Cambridge, where students found the drug online and sold it for around £2 a pill. It also talked to a number of students at top universities who admitted using the drug. A spokesman for Universities UK, which represents vice-chancellors, said they are not aware of any new research or data to suggest such drugs are widely used and available among the UK's higher education student population of 2.5 million students.

Read more:
http://www.telegraph.co.uk/education/universityeducation/10340244/Universities-warned-of-
explosion-in-use-of-smart-drugs.html

VA's Opiate Overload Feeds Veterans' Addictions, Overdose Deaths
Center for Investigative Reporting
September 28, 2013

This investigative report discusses how the Department of Veteran Affairs (VA) may have contributed to a fatal overdose rate nearly double the national average. It also shares stories about those who lost their lives and continue to battle addiction. In 2009, new VA regulations required clinicians to follow an "integrated approach" for helping veterans in pain, with emphasis on treating root causes of pain rather than using narcotics to reduce symptoms.VA doctors, however, are prescribing more opiates than ever before, and data suggest adoption of the regulations varies. The agency has issued more than one opiate prescription per patient, on average, for the past 2 years. Prescriptions for hydrocodone, oxycodone, methadone, and morphine increased by 270 percent in the past 12 years. Jack C. Montgomery VA Medical Center in Muskogee, Okla., and its clinic in Tulsa issued 1.6 opiate prescriptions per patient over the past decade—the most opiates per patient in the VA hospital system. The VA hospital in Muskogee is 1 hour's drive from the region's main population center in Tulsa. It does not have an emergency room or urgent care ward and rarely makes same-day appointments. Veterans who need VA treatment for root causes of pain often wait months.

Read more:
http://cironline.org/reports/va%E2%80%99s-opiate-overload-feeds-veterans%E2%80%99-
addictions-overdose-deaths-5261

Gov. Brown Signs 2 of 3 Bills Fighting Prescription Drug Abuse
Los Angeles Times
September 27, 2013

California's governor signed two bills into law that address prescription drug abuse, but he vetoed a third requiring coroners to report prescription drug deaths. Consumer advocates were happy with the two bills, but felt the third one was crucial. They complained vetoing the third bill undercuts the state's ability to identify patterns of death linked to a particular doctor. The governor vetoed the bill because of the cost. One new law refunds the state's prescription drug monitoring program. The second will sanction doctors who fail to turn over deceased patients' records or repeatedly postpone interviews.

Read more:
http://www.latimes.com/local/la-me-0928-rx-reforms-20130928,0,6850019.story

Police Worry Drug Abusers Playing Them
Mohave Valley Daily News
October 1, 2013

The Bullhead City Police Department is looking at high numbers of stolen prescription pills within Mohave County, Arizona. Thus far in 2013, 35 reports have been filed regarding stolen prescription drugs—a high percentage of the reports were deemed unfounded by investigators. Police are making arrests if reports were filed under false pretenses. The Deputy Police Chief realized police were essentially placing more drugs into abusers' hands. For a patient to get ostensibly stolen medication replaced, an official report had to be filed with the police department. The patient would than receive a report number to take the doctor, where he or she would receive a replacement prescription. Doctors are not required to wait for police verification of the theft.

Read more:
http://www.mohavedailynews.com/articles/2013/10/02/news/local/doc524babe109527641554959.txt

Other State and Local News

Moves to Stop Doctor Shopping Could Have Unintended Consequences
ABC News Australia
October 1, 2013

The Western Australia State Government has introduced new laws to Parliament designed to better monitor the use of prescription drugs and prevent so-called "doctor shopping." The Medicines, Poisons, and Therapeutic Goods Bill 2013 will require doctors and pharmacists to report drug-dependent patients and "doctor shoppers" to the Health Department. The department may then place their names on a statewide drug addict register called the Drugs of Addiction Record. The real-time record can be checked by doctors before prescribing a patient certain drugs. The penalty for failing to report such a patient has also jumped from $1,000 to $15,000. In the new legislation, a reportable patient is defined as a "drug dependent" or "oversupplied person" rather than an addict. Drug dependent is defined as someone who has acquired an overwhelming desire for the continued administration of a drug or Schedule 9 poison. Critics fear the new laws will damage the relationship between doctors and patients and discourage addicts from seeking help.

Read more:
http://www.abc.net.au/news/2013-09-30/moves-to-stop-doctor-shopping-could-have-unintended-consequences/4989618?section=wa

Drug Abuse Epidemic is 'Everybody's Problem,' Sheriff Says
The Frederick News-Post
October 1, 2013

Delegate Kelly Schulz organized a meeting to share what Frederick County, Md., is doing to reduce fatal overdoses and addiction. The community has seen prescription drug abuse lead to heroin use and the entire county is affected. This is everyone's problem, according to the sheriff. Experts told parents to be more intrusive in children's lives, trust their instincts, and beware of lies addicts tell. Parents want more law enforcement and more treatment information. The president of the Parent Teacher Association would like the panel to visit several schools. Thurmont's mayor plans to have a single page listing all available resources mailed to every county resident.

Read more:
http://www.fredericknewspost.com/news/health/article_080d12c0-c75e-5760-b925-4dee
76b4a360.html?TNNoMobile

Prescription Drug Overdoses High in Frankston and Mornington Peninsula
Herald Sun
October 1, 2013

The Coroners Court of Victoria (Australia) showed the region had 71 overdose deaths from 2010–12, with 42 deaths recorded for Frankston and 29 recorded for the Mornington Peninsula. Sixty-four deaths were recorded as pharmaceutical overdose, with benzodiazepines, pharmaceutical opioids, antidepressants, and antipsychotic drugs accounting for the highest rates of overdose deaths. Frankston and the Mornington Peninsula had the highest rates of deaths involving antidepressant and antipsychotic medications.

Read more:
http://www.heraldsun.com.au/leader/bayside/prescription-drug-overdoses-high-in-frankston-
and-mornington-peninsula/story-fngnvli9-1226730184429

In Overdose Deaths, Fewer Pills, but More Street Drugs
Herald Tribune
September 28, 2013

In DeSoto, Manatee, and Sarasota counties, deaths caused by oxycodone dropped from 63 to 38, according to the Florida Department of Law Enforcement's Medical Examiners Commission Drug Report. Deaths caused by alprazolam dropped from 57 to 33 and methadone-caused deaths dropped from 46 to 36. Of the eight drugs listed by circuit, only deaths caused by morphine and heroin increased locally. Street prices for drugs like oxycodone and methadone continue to rise; as a result heroin and methamphetamine usage has increased. Nevertheless, the Sarasota County Sheriff attributed the decrease in prescription drug deaths to education and increased cooperation between law enforcement, doctors, pharmacists, and schools.

Read more:
http://www.heraldtribune.com/article/20130928/ARTICLE/130929633/2055/NEWS?Title=In-
overdose-deaths-fewer-pills-and-more-street-drugs

Opiate Addiction on the Rise in Morongo Basin
Hi-Desert Star
October 1, 2013

The Morongo Basin, Calif., Sheriff's Station has seen an increase in prescription drug and heroin-related arrests and deaths over the past 5 years. A local substance abuse counselor at Yucca Valley Center for Change said he is treating a higher number of opiate addicts than he did 10 years ago. The county lacks detox treatment and residential treatment facilities to help those struggling with addiction.

Read more:
http://www.hidesertstar.com/news/article_ef4ba8ae-27e8-11e3-96ed-001a4bcf887a.html

Ky. Teens Using Fewer Prescription Drugs Improperly, Officials Say
Kentucky.com
October 4, 2013

State officials announced prescription drug use without a doctor's direction has dropped significantly among young people over the past 4 years. In 2008, 15.2 percent of 12th graders surveyed said they had used prescription drugs without a doctor's permission, but that figure dropped to 9 percent in 2012, according to the Kentucky Incentives for Prevention School Survey. Students surveyed reported decreasing unauthorized prescription drug use since 2004; the decline accelerated after 2008. Students in grades 6, 8, 10, and 12 take the survey. Among 10th graders, reported use of prescription medication without a doctor's direction dropped from 14.1 percent in 2008 to 7.6 percent in 2012. Use among 8th graders dropped from 6.5 percent in 2008 to 2.9 percent in 2012, and declined from 2 percent to 1 percent among 6th grade students. Students reported a decline between 2008 and 2012 in the use of nearly every substance covered, including alcohol, tobacco, cocaine, and hard drugs.

Read more:
http://www.kentucky.com/2013/10/04/2859052/ky-teens-using-fewer-prescription.html

One in Five Inmates Takes Drugs in South Australian Prisons
NewsLifeMedia
September 29, 2013

In the last fiscal year, South Australian prison drug-test information shows 839 prisoners, about one in five, returned a positive drug test.  The most common drugs used were cannabis (430) and buprenorphine (305), followed by amphetamines (73 positive tests). More than 50 tested positive for methadone; benzodiazepines, including Valium and Xanax; and antidepressants. In almost 150 drug tests, a prisoner tested positive for more than one drug. Cadell Training Centre and the Adelaide Women's Prison returned the highest amount of positive drug tests in proportion to the number of prisoners. Inmates at Adelaide Women's Prison with a 148-bed capacity had 124 positive drug tests. The Adelaide Remand Centre with a 267-bed capacity had 183 positive tests.

Read more:
http://www.news.com.au/national-news/south-australia/one-in-five-inmates-take-drugs-in-
south-australian-prisons/story-fnii5yv4-1226729576884

Nose Spray May Mean Life or Death for Drug ODs
New York Post
September 27, 2013

Staten Island police officers in the 120th precinct will be given Naloxone, in a nasal form, to administer to victims overdosing on opioid analgesics, the mayor's office announced. Staten Island has tripled the opioid analgesic overdose rate of any other borough, according to a study released by RxStat. The city's Department of Homeless Services has already trained more than 350 peace officers to administer Naloxone in shelters and found it was successful in reversing 25 of 29 overdoses over the last 3 years.

Read more:
http://nypost.com/2013/09/27/nose-spray-may-mean-life-or-death-for-drug-ods

The Price of Addiction: Portland Docs Prescribing Opioids More Cautiously (Series)
Portland Business Journal
September 30, 2013

Oregon hopes to decrease the high rate of overdose by using a multipronged approach. The state is a member of the National Governors' Association Task Force on Prescription Drug Misuse, which is working to reduce the number of pills in circulation and to educate patients, prescribers, and the public about the long-term effects and risks. Oregon Health & Science University (OHSU) is organizing periodic educational events for physicians and other professionals. The Public Health Authority has a prescription drug monitoring program. OHSU, Providence Health & Services, Legacy Health, and other hospitals have informally developed community standards for prescribing opiates. Kaiser Permanente Northwest also limits the number of pills a patient can get in a prescription, starting patients with a small amount of pain medication while ensuring there is no risk of substance abuse.

Read more:
http://www.bizjournals.com/portland/blog/health-care-inc/2013/09/the-price-of-addiction-
portland-docs.html

Waterville Chief Spreads Word on Drug Fight
Portland Press Herald
September 28, 2013

Waterville Police Chief Joseph Massey shared a story about how he started a prescription drug diversion program in 2007. The program provides information about people convicted in drug-related cases to pharmacies, doctors' offices, hospital emergency rooms, and other places that dispense narcotics. The monthly fact sheets include photos, bios, and information about charges. No pharmacy robberies have occurred in Waterville this year; three were reported in 2012, none were reported in 2011, and one was reported in 2010. In 2012, Maine had 58 pharmacy robberies—so far this year it has only eight. Roy McKinney, director of the Maine Drug Enforcement Agency (DEA), believes pharmacy robberies have decreased because of a high arrest rate, significant sentences, and federal prosecution of all pharmacy robbers. News media coverage has also helped raise awareness. The Maine DEA, sheriff's departments, police, medical facilities, and community prevention coalitions have organized drug take-back days and more than 70 police departments in Maine now have drug drop boxes.

Read more:
http://www.pressherald.com/news/waterville-chief-spreads-word-on-drug-fight_2013-09-28.html

Prescription Drug Abuse 'Out of Control,' Police Say
The Tennessean
October 1, 2013

A Portland Police officer described the prescription narcotic epidemic as being out of control. He recently arrested two women—a 51-year-old and a 54-year-old—for prescription fraud. The officer received training to look for common signs of prescription drug offenders. Between July 2012 and May 2013, one woman acquired 20 prescriptions from four doctors, filled them at two pharmacies, and received 745 hydrocodone and 20 oxycodone pills. She visited one doctor 12 times and filled 18 prescriptions at a single pharmacy. The other woman obtained 13 prescriptions and filled them at three pharmacy chains, receiving 627 clonazepam and 60 Xanax pills in 10 months. She frequented one pharmacy 11 times without detection.

Read more:
http://www.tennessean.com/viewart/20131001/GALLATIN01/310010116/Prescription-drug-
abuse-out-control-police-say

Coalition to Tackle Prescription Drug Abuse
The Times-News
October 1, 2013

The Partnership for Health of Henderson County in North Carolina has launched HopeRx, a coalition formed to curb prescription drug use in the county. Most crimes committed in Henderson County are directly related to prescription drugs and methamphetamines, according to the Henderson County Sheriff's Office. The coalition has planned a series of forums for citizens and stakeholders to develop solutions to address addiction and accidental overdose deaths. The first one, "Community Conversation," will be held on November 7.

Read more:
http://www.blueridgenow.com/article/20131001/ARTICLES/131009985/1042/news?Title=
Coalition-to-tackle-prescription-drug-abuse

Just What the Doctor Prescribed: A Lesson in Rx Dangers for Middle Schoolers
University of Minnesota
October 2, 2013

Since 2009, pharmacy students at the University of Minnesota have participated in AWARxE, an educational outreach program. They volunteer their time visiting individual classrooms statewide and raise awareness of prescription drug abuse among youth. The students also provide information on how to prevent prescription drug misuse. In the 2010-12 school years, about 20 College of Pharmacy students from the Duluth and Minneapolis university campuses delivered 100 presentations reaching more than 2,500 middle schoolers. This program gives future pharmacists the opportunity to practice explaining complex information to customers.

Read more:
http://www.healthtalk.umn.edu/2013/10/02/prescription-drug-abus-education-for-mn-middle-schools

Triad, Northwest NC Counties Among Top in State for Substance Abuse Deaths
Winston-Salem Journal
September 28, 2013

The Partnership for a Drug-Free North Carolina reported that nearly half of the 14 counties in the Triad and Northwest North Carolina are on the Top 20 list for deaths related to substance abuse statewide. Surry County has the region's highest risk ranking for substance abuse–related deaths and is fourth in the state, while Ashe County is eighth. Forsyth County is ranked 81st in the state. The agency said the higher the ranking, the less risk involved. Other regional counties in the Top 20 are Wilkes (11th), Alleghany (17th), Rockingham (19th), and Yadkin (20th). The ranking is based on deaths from prescription drugs, alcohol, and illegal drugs. The partnership said 90 percent of prescription medication–related deaths in Surry were accidental or unintended, as were 75 percent in Ashe and 76 percent in Forsyth.

Read more:
http://www.journalnow.com/news/local/article_2e90bbfa-289b-11e3-9058-0019bb30f31a.html

Former Teacher Accused of Stealing Drugs from Co-Workers Pleads Guilty
WPBN-WTOM TV
October 1, 2013

A former Cheboygan County, Mich., kindergarten teacher pleaded guilty to several charges after she stole prescription drugs from co-workers. She was accused of stealing pills from a fellow teacher's purse at West Elementary School in Cheboygan. Over a 3-day span, she stole 90 Vicodin pills. After the first teacher reported the incident, another came forward claiming the woman broke into her home while she was away.

Read more:
http://www.upnorthlive.com/news/story.aspx?id=953831

Other Resources

Teen Prescription Drug Misuse Fact Sheet
Rhode Island Prevention Resource Center
Accessed October 1, 2013

This fact sheet discusses common misconceptions about prescription drugs, health concerns, the most commonly misused prescription drugs, and preventing prescription drug misuse among teens.

Read more:
http://riprc.org/files/2013/09/teenrxdrugmisusefactsheet.pdf

Videos

Walgreens Turns to Time Delay Safes to Fight Crime
ABC 13
October 2, 2013

This video (:41 seconds) and transcript discuss Walgreens' installation of time-delay safes in Ohio, Kentucky, and Indiana pharmacies. After a safe is activated, it stays locked for several minutes.

Watch:
http://www.13abc.com/story/23594293/walgreens-turns-to-time-delay-safes-to-fight-crime

Prescription Drug Abuse—Regina LaBelle
East Tennessee State University
October 2, 2013

In this video (46:24 minutes) Regina LaBelle, White House Office of Drug Control Chief of Staff, speaks about prescription drug abuse.

Watch:
http://www.youtube.com/watch?v=MDyYh6ffRdM&feature=youtube_gdata

Prescription Drug Abuse Drug Disposal Yellowknife
Lessard, George
September 30, 2013

This public service announcement (1:40 minutes) encourages residents in Yellowknife Northwest Territories to dispose of prescription medications at their local pharmacies. It features Emily Larson from the University of Ohio's Generation Rx project.

Watch:
http://www.youtube.com/watch?v=cg2dMA-CwTk

For Some Veterans, Prescription Drugs May Be Causing Pain
PBS Video
October 3, 2013

Some veterans from the Iraq and Afghanistan wars have returned home to face another battle: addiction to narcotic pain relievers prescribed by their doctors. Aaron Glantz of the Center for Investigative Reporting takes a look at whether these wounded warriors are being overmedicated with prescription opiates. (Duration: 9:17 minutes)

Watch:
http://video.pbs.org/video/2365092319

Webinar

Overview of the Opioid Analgesic Epidemic: Sponsored by the Children's Safety Network
October 16, 2013
3 p.m. to 4 p.m. EST

"Overview of the Opioid Analgesic Epidemic" will be presented by Dr. Andrew Kolodny, Chief Medical Officer of Phoenix House and President of Physicians for Responsible Opioid Prescribing. Dr. Kolodny will discuss factors that led to sharp increases in opioid overdose deaths and opioid addiction. He also will discuss strategies for bringing the epidemic under control.

Read more:
http://campaign.r20.constantcontact.com/render?llr=apwefcdab&v=001NwCPkktRlazat
6brckARIXMNRbQsLbe0uLSLwi9_VNdwpTVPX_BgHaYQcGoTQva0Ob_3_dtGZ-De
TyksKt4wkXSmNnqyU3b4ca6BYHYnz10%3D

Grants Received

$2 Million Awarded by the Conrad N. Hilton Foundation to ABAM Foundation
American Board of Addiction Medicine (ABAM) Foundation
Access October 2, 2013

The Conrad N. Hilton Foundation awarded $2 million to the ABAM Foundation to establish a national center for physician training in addiction medicine with special emphasis on prevention and screening, brief intervention, and referral to treatment among adolescents and young adults. The center will be directed by Dr. Richard Blondell, Professor of Family Medicine at the University at Buffalo School of Medicine and Biomedical Sciences.

Read more:
http://www.abamfoundation.org/hilton_grant/?utm_source=Join+Together+Daily&utm_
campaign=b8522775db-JT_Daily_News_Drugged_Drivers_Three&utm_medium=email&
utm_term=0_97f4d27738-b8522775db-221990529

Take-Back Events and Drop Boxes

DEA's National Take-Back Initiative
October 26, 2013
http://www.deadiversion.usdoj.gov/drug_disposal/takeback

Balto. Co. Unveils Prescription Drug Drop-Off Boxes
The Baltimore Sun
September 27, 2013

Baltimore County police installed prescription drug drop boxes at 10 precincts. People are also allowed to place illegal drugs in the boxes. The county plans to educate the public about overdose prevention and advocate for the use of Naloxone.

Read more:
http://www.baltimoresun.com/news/maryland/baltimore-county/bs-md-co-prescription-boxes-
20130927,0,2593691.story

Prescription Drug 'Take Back' Saturday, Oct. 26
City of Independence
October 1, 2013

The Independence, Mo., Police Department will participate in the Drug Enforcement Administration's National Take-Back Initiative from 10 a.m. to 2 p.m., October 26, 2013, at City Hall. Residents can drop off their drugs without ever leaving their car by using a drive-through lane. Stadium Pharmacy is also participating by adding drop-off boxes inside their stores.

Read more:
http://www.ci.independence.mo.us/story.aspx?id=3556

Prescription Drug Take-Back Event
City of Tucson
Accessed October 3, 2013

The Tucson Police Department will participate in the Drug Enforcement Administration's National Prescription Drug Take-Back Initiative on October 26. Residents can dispose of prescription medications at two drop-off locations. The department is not collecting sharps/needles, intravenous medications, glass containers, or inhalers.

Read more:
http://cms3.tucsonaz.gov/home/announcement/prescription-drug-take-back-event

Dispose of Prescription Drugs at Drug Take-Back Day
Coloradoan.com
September 27, 2013

Fort Collins Police Department, Loveland Police Department, and other sites in Northern Colorado will participate in the Drug Enforcement Administration's National Take-Back Initiative. They will not accept intravenous solutions, injectables, syringes, mercury (thermometers), oxygen containers, chemotherapy/radioactive substances, pressurized canisters, or illicit drugs.

Read more:
http://www.coloradoan.com/article/20130927/NEWS01/309270028/Dispose-prescription-
drugs-drug-take-back-day?gcheck=1&nclick_check=1

Prescription Drug Drop-Off Box
Dayton Daily News
October 1, 2013

The Miami County Sheriff's Office in Ohio now has a prescription drug drop-off box located in its lobby. Residents can dispose of prescription medications during normal business hours. No liquids or needles will be accepted.

Read more:
http://www.daytondailynews.com/news/news/local/prescription-drug-drop-off-box/nbCjx

'Take Back' Effort to Collect Old Medications
Journal-Courier
October 4, 2013

Jacksonville Police Department will participate in the Drug Enforcement Administration's National Take-Back Initiative on October 26 at several locations throughout West Central Illinois.

Read more:
http://www.myjournalcourier.com/news/local/take-back-effort-to-collect-old-medications/
article_169a160c-2cb2-11e3-87bd-001a4bcf6878.html

Perkasie Sees Success with Prescription Drug Collection Box
Montgomery Media
October 3, 2013

Since January, Pennsylvania's Perkasie Police Department has collected more than 188 pounds of prescription drugs and other items, according to the police chief. Their drop-off box is located inside the police station. Drugs are given to the District Attorney's Office where they are incinerated. Perkasie will also participate in the Drug Enforcement Administration's National Take-Back Initiative on October 26.

Read more:
http://www.montgomerynews.com/articles/2013/10/03/perkasie_news_herald/news/doc
524b950c1ea77983834186.txt?viewmode=fullstory

Utica Police Offer Prescription Drug Disposal Box
Observer-Dispatch
September 29, 2013

In New York, Utica Police Department installed a prescription drug drop box at its police station on Oriskany Street West.

Read more:
http://www.uticaod.com/archive/x452544864/Utica-police-offer-prescription-drug-disposal-box

Safe Way to Dispose of Unwanted Prescription Drugs
Peterson Air Force Base
September 30, 2013

Peterson Air Force Base will participate in the Drug Enforcement Administration's National Take-Back Initiative on October 26. Base access is not required; individuals can drop off prescription medications at the west gate visitors' center parking lot. Volunteers will recycle empty prescription bottles when all personal information has been removed.

Read more:
http://www.peterson.af.mil/news/story.asp?id=123365148

PPD Offers New Service to Collect Unwanted Prescription Medications
The Portland Daily Sun
September 30, 2013

The Portland, Maine, Police Department installed a MedReturn Drug Collection Unit at its Middle Street headquarters. Now residents can drop off prescription medications in their original containers. The department does not accept liquid medications, medical waste, or over-the-counter medications. The drop box is emptied once a day by the department's evidence technician, logged, and stored for transfer to the Drug Enforcement Administration on its take-back days.

Read more:
http://www.portlanddailysun.me/index.php/newsx/local-news/10369-ppd-offers-new-
service-to-collect-unwanted-prescription-medications

El Dorado Sheriff Participating in Prescription Drug Take Back Day
Sacramento Bee
October 1, 2013

The El Dorado County Sheriff's Office in California will participate in the Drug Enforcement Administration's National Take-Back Initiative on October 26, 2013. Individuals can dispose of prescription medications at three locations.

Read more:
http://blogs.sacbee.com/crime/archives/2013/10/el-dorado-sheriff-participating-in-prescription-
drug-take-back-day.html

Bolingbrook Police to Host Prescription Drug Disposal Program in October
Suburban Life Media
October 1, 2013

Illinois' Bolingbrook Police Department will participate in the Drug Enforcement Administration's October 26 National Take-Back Initiative. Officers will be available to discuss the dangers of prescription medication abuse.

Read more:
http://www.mysuburbanlife.com/2013/10/01/bolingbrook-police-to-host-prescription-
drug-disposal-program-in-october/aoll93x

New Prescription Drug Drop-Boxes Go Out Statewide
THZ11
October 1, 2013

The "MONITOR SECURE and DISPOSE" Drop Box Project has awarded 60 MedReturn Drug Collection Units to law enforcement agencies throughout Arkansas. The boxes serve as safe and convenient disposal sites for unused prescription drugs.

Read more:
http://www.thv11.com/news/article/281709/2/New-prescription-drug-drop-boxes-go-out-statewide

Police Take Back 669 Pounds of Unused Medication
Village News
October 2, 2013

Chesterfield County Police collected 669 pounds of prescription drugs during a Medication Take-Back event on September 14. The next event will be held from 10 a.m. to 2 p.m. on October 26, 2013, at the Chesterfield County Fairground in Virginia.

Read more:
http://www.villagenewsonline.com/node/13314

Pinetop-Lakeside Police Taking Back Unwanted Prescription Drugs Oct. 26
The White Mountain Independent
October 1, 2013

The Pinetop–Lakeside, Ariz., Police Department will participate in the Drug Enforcement Administration's National Take-Back Initiative on October 26. Individuals can dispose of prescription medication at the police station on North Niels Hansen Lane.

Read more:
http://www.wmicentral.com/news/latest_news/pinetop-lakeside-police-taking-back-unwanted-
prescription-drugs-oct/article_66d80cf6-2a18-11e3-8e87-0019bb2963f4.html

Upcoming Conferences and Workshops

4th Annual Executive Forum on Creating a Culture of Health and Wellness
October 7-8, 2013
Chicago, Illinois
http://www.worldcongress.com/events/HH13077

California Department of Health Care Services
Audits and Investigations: Prescription Drug Diversion Symposium
October 10, 2013 
Sacramento, California
http://www.dhcs.ca.gov/individuals/Pages/AI_PDDS.aspx

Heroin in Kentucky Headlines
October 24, 2013
Richmond, Kentucky
http://richmondregister.com/localnews/x134964301/County-group-hosting-conference-on-
rise-of-heroin-use

CFPC's Annual Substance Abuse Conference: Our Drug Epidemic
November 1, 2013
Andover, New Jersey
http://www.centerforprevention.org/conference.html

2013 American Association for Treatment of Opioid Dependence Conference
November 9-13, 2013
Philadelphia, Pennsylvania
http://www.aatod.org/national-conference/2013-aatod-conference-philadelphia

11th Annual World Health Care Congress
April 7-9, 2014
National Harbor, Maryland
http://www.globalmedicalmeetings.com/events/hr14000

The Weekly Updateis 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.