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September 10, 2014


SAMHSA Prescription Drug Abuse Weekly Update
Issue 88  |  September 10, 2014
The Prevention of Prescription Drug Abuse in the Workplace (PAW) TA Center addresses prescription drug abuse—a growing public health problem with increasing burdens on workers, workplaces, and our economy. To subscribe colleagues, family members, or friends to this listserv sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), please click here or send their e-mail addresses to paw@dsgonline.com.
Table of Content Featured Article Journal Articles and Reports Professional Education News Other State and Local News Other Resources Video Audio Request for Proposal National Take-Back Event Take-Back Events and Drop Boxes Save the Date Upcoming Conferences and Workshops


B.J. Morris, J.W. Zumsteg, K.R. Archer, B. Cash, and H.R. Mir. 2014. "Narcotic Use and Postoperative Doctor Shopping in the Orthopaedic Trauma Population." The Journal of Bone and Joint Surgery 96(15):1257–62, doi:10.2106/JBJS.M.01114.

Prescription monitoring program (PMP) data from a mandatory reporting system showed 8.5 percent of 131 orthopaedic trauma patients operated on at Vanderbilt University Medical Center filled three or more narcotic prescriptions within 3 months before admission. Postoperatively, 20.8 percent of patients filled opioid prescriptions from multiple providers. Those with a single opioid provider filled an average of two prescriptions in 6 months post-discharge, compared with seven in the multiple provider group, with morphine equivalent dose of 26 mg versus 43 mg per day. Patients with a high school education or less were 3.2 times more likely to have multiple providers. Those with a history of preoperative narcotic use were 4.5 times more likely to have multiple providers.

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Journal Articles and Reports

R.J. Clough. 2014. "Gender and Prescription Painkiller Misuse: Findings from the 2011 National Survey on Drug Use and Health." Dissertations and Theses, Portland State University.

Multivariate logistic regression analyses of 2011 National Survey on Drug Use and Health data showed being male, white, unmarried, and employed, and having less than a high school diploma were all significant predictors of increased prescription pain reliever misuse. Characteristics associated with a marked decrease in the odds of misusing these drugs included being older, having a college degree, and placing importance on religious/spiritual beliefs. Social bond variables did not affect the odds, and increased income and religiousness were more protective for women than for men.

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Human Rights Watch. 2014. "No Time to Waste: Evidence-Based Treatment for Drug Dependence at the United States Veterans Administration."

Based on stakeholder interviews in early 2014, this briefing paper assesses the Department of Veterans Affairs response to veterans struggling with drug and alcohol dependence, emphasizing three programs that use evidence-based models to prevent overdose, treat opioid dependence, and end chronic homelessness. The paper recommends expanding and improving these programs.

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J.R. Maahs, R.R. Weidner, and R. Smith. 2014. "Prescribing Some Criminological Theory: An Examination of the Illicit Use of Prescription Stimulants Among College Students." International Journal of Offender Therapy and Comparative Criminology. Epub ahead of print.

Analyzed data from 484 college students at a Midwestern university found measures from social learning and social control theories were significant predictors of illicit prescription stimulant use, but academic strain was not. The strongest predictor was general deviance.

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Substance Abuse and Mental Health Services Administration (SAMHSA). 2014. The NSDUH Report: Substance Use and Mental Health Estimates from the 2013 National Survey on Drug Use and Health: Overview of Findings. Rockville, Md.: SAMHSA, Center for Behavioral Health Statistics and Quality.

This first release of 2013 National Survey on Drug Use and Health (NSDUH) estimates focuses on the percentage of individuals with behavioral health problems in the United States, as well as the percentage receiving treatment or counseling for such problems. The report found among people 12 and older, there were 6.5 million nonmedical users of prescription drugs (2.5 percent), including 4.5 million nonmedical users of prescription pain relievers. Among youth, 2.2 percent used prescription drugs, and 0.1 percent used heroin.

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Substance Abuse and Mental Health Services Administration (SAMHSA). 2014. The NSDUH Report: Workplace Policies and Programs Concerning Alcohol and Drug Use. Rockville, Md.: SAMHSA, Center for Behavioral Health Statistics and Quality.

This report combined 2008–12 National Survey on Drug Use and Health (NSDUH) data, showing 81.4 percent of full-time employees aged 18 to 64 worked for an employer with a written policy on alcohol and drug use; 59.5 percent had access to an employee assistance program at work; and 44.7 percent had received educational materials on alcohol and illicit drug use from their employer. Full-time workers who used illicit drugs in the past month were generally less likely than those who did not to work for an employer with a written policy on employee alcohol and drug use. There were small but statistically significant increases in the percentage of full-time employees aged 18 to 64 who reported working for an employer that provided workplace policies and programs from 2003 to 2007 and 2008 to 2012. NSDUH's illicit drug definition includes nonmedical use of prescription drugs.

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Professional Education

D.J. Cobaugh, C. Gainor, C.L. Gaston, T.C. Kwong, B. Magnani, M.L. McPherson, J.T. Painter, and E.P. Krenzelok. 2014. "The Opioid Abuse and Misuse Epidemic: Implications for Pharmacists in Hospitals and Health Systems." American Journal of Health-System Pharmacy 71(18):1539–54, doi:10.2146/ajhp140157.

The authors discuss the prescription opioid abuse and misuse epidemic in the United States, emphasizing the pharmacist's role in ensuring safe and effective opioid use.

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R. Duarte and J. Raphael. 2014. "The Pros and Cons of Long-Term Opioid Therapy." Journal of Pain and Palliative Care Pharmacotherapy 28(3):308–10, doi:10.3109/15360288.2014.943383.

Evidence supporting the efficacy of long-term opioid therapy for chronic noncancer pain is scarce. However, weak evidence suggests those who are able to continue opioids long term experience clinically significant pain relief. The authors believe fear of opioid abuse or addiction should not impede opioid prescribing, but patients must be carefully selected and monitored. Among those taking opioids who experience intolerable side effects or unsatisfactory pain relief, alternatives should be sought as soon as possible.

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R.K. McHugh, S. Nielsen, and R.D. Weiss. 2014. "Prescription Drug Abuse: From Epidemiology to Public Policy." Journal of Substance Abuse Treatment, doi:10.1016/j.jsat.2014.08.004.

The papers in this special issue of the Journal of Substance Abuse Treatment include a sampling of the latest research on the epidemiology, clinical correlates, treatment, and public policy considerations of prescription drug abuse. Although much has been learned about this subject in recent years, research is still in the early stages, particularly with respect to understanding effective treatments for the population. Future research priorities include studies on the interaction of prescription drugs with other licit and illicit substances, the impact of prescription drug abuse across the lifespan, optimal treatment for prescription drug abuse and co-occurring conditions, and effective public policy initiatives for reducing abuse.

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A.E. Schweighardt and K.M. Juba. 2014. "Extended-Release Hydrocodone: The Devil in Disguise or Just Misunderstood?" Annals of Pharmacotherapy 48(10):1362–65, doi:10.1177/1060028014543174.

Approval of Zohydro ER, a product that lacks an abuse-deterrent formulation, has provoked media controversy and aggressive legislative action from multiple stakeholders. Only the industry-funded American Academy of Pain Management has released a position statement on Zohydro ER, and individual opinions vary. Additional single-entity extended-release hydrocodone formulations are in the pipeline, and Zohydro ER's limited clinical use may make the controversy associated with its approval a moot point. As with other opioids, providers will need to assess individual patient risk versus benefit when prescribing the drug.

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Study Comparing Buprenorphine Implants to Suboxone Gets Underway
Celia Vimont, Partnership for Drug-Free Kids
September 3, 2014

To address issues raised by the Food and Drug Administration when it rejected implantable buprenorphine (Probuphine), a randomized trial will compare the drug to buprenorphine/naloxone. Approximately 190 patients are being enrolled at about 20 sites around the country. They will receive a 6-month implant of Probuphine in the upper arm, along with placebo tablets under the tongue, or a placebo arm implant, with buprenorphine/naloxone tablets. Study participants will include people treated for opioid dependence who have been stable while taking buprenorphine/naloxone for several months without using illicit opioids. Participants will be checked 10 times over the study's 6 months to determine if they are using illicit drugs. At the end of the study, researchers will test for a greater than 10 percent difference in response between the two groups. The treatment will be considered successful if there are no more than 2 months in which a participant has a positive urine opioid test.

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Case of Large-Scale Opioid Diversion Puts Hospitals on Alert
K. Blum, Pain Medicine News
September 2014

A former New York hospital pharmacy director was recently arrested for stealing nearly 200,000 oxycodone pills with a street value of approximately $5.6 million. Experts share their views about the case and offer tips to prevent diversion at hospitals.

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Sherrod Brown Announces New Legislation to Combat Ohio Drug Overdose Deaths
Angela Reighard, WOUB
September 3, 2014

Senator Sherrod Brown announced his support for The Recovery Enhancement for Addiction Treatment (TREAT) Act to help address drug deaths in Ohio. The Act would change U.S. law to increase the number of opioid abuse patients providers are allowed to treat in an outpatient setting. In addition, qualified nurse practitioners and physician assistants would be allowed to treat addicted patients for the first time.

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Governors to HHS: Rescind FDA Approval of the Zohydro Painkiller
Ed Silverman, The Wall Street Journal
September 4, 2014

Governors from Massachusetts, Vermont, New Hampshire, Rhode Island, and Connecticut have asked the United States Department of Health and Human Services (HHS) to rescind approval of Zohydro ER. The request was conveyed in an August 28 letter to HHS Secretary Sylvia Mathews Burwell, reflecting ongoing concern that abuse and misuse of opioid pain relievers is fueling addiction and crime. Zohydro ER lacks abuse-deterrent features.

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UPDATE: Irsay Pleads Guilty to Misdemeanor in Drug Case
Indiana Business Journal
September 2, 2014

Indianapolis Colts owner Jim Irsay pleaded guilty to a misdemeanor for driving while intoxicated at a traffic stop in March. Irsay admitted to a Hamilton County judge he was under the influence of oxycodone and hydrocodone at the time of his arrest. He said he had become dependent on pain relievers after several years of orthopedic operations. Irsay will be on probation for a year and is prohibited from drinking or possessing alcohol during that time. His driver's license was also suspended for 1 year.

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Egalet to Present Data from Abuse-Deterrence Studies at PAINWeek 2014 in Las Vegas
September 4, 2014

According to its manufacturer, Egalet-001, an as-yet unapproved abuse-deterrent, extended-release, oral morphine product candidate, demonstrated greater resistance to common forms of physical and chemical manipulation than MS Contin. The drug showed extreme resistance to crushing and grinding with all household tools tried, while the comparator was easily converted to a fine powder. Egalet-001 tablets resisted all extraction attempts and maintained extended-release characteristics throughout the studies. Extreme gelling occurred after exposure to all aqueous solvents, which means it will not be injectable.

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A Deadly Trend: Prescription Drugs to Heroin
Summer 2014

Ameritox, which conducts medically ordered testing of urine samples for opiates, assembled five pages of graphical information for the PainWeek 2014 trade show, then drew conclusions unsupported by the data. Bob Twillman, deputy executive director of the American Academy of Pain Management, said the report was "challenging to respond to, because it's a bunch of thrown-together facts without any discussion to hold them together and get them to a meaningful conclusion." Previously unpublished information in the report includes the following: a) among 171,061 urine samples from chronic pain patients with opioid prescriptions that Ameritox tested for opiates in 2012–13, less than 1.5 percent (2,206) tested positive for heroin, b) 66 percent of the heroin-positive samples also tested positive for prescription opiate use in the past month (although one third of those did not contain the prescribed opiate), and c) 20 percent of the heroin-positive samples tested positive for a non-prescribed sedative such as Xanax or Valium.

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Unintended Consequences: Why Painkiller Addicts Turn to Heroin
Dr. Sanjay Gupta, CNN
August 30, 2014

Dr. Sanjay Gupta says opiate pill and heroin abuse are taking a tremendous toll. Users are turning to heroin after becoming addicted to pain relievers, as they are similar in many ways. A typical heroin addict starts using at 23 and is likely to live in an affluent suburb. (Video included: 1:51 minutes)

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Other State and Local News

D. Paone, E. Tuazon, D.B. O'Brien, and M. Nolan. 2014. "Unintentional Drug Poisoning (Overdose) Deaths Involving Opioids in New York City, 2000–2013." New York City Department of Health and Mental Hygiene, Epi Data Brief, August, 2014 No. 50.

The New York City Department of Health and Mental Hygiene reported that from 2010 to 2013, the rate of unintentional drug overdose deaths increased by 41 percent, and in 2013, 77 percent of overdose deaths involved an opioid. From 2000 to 2013, the rate of overdose deaths involving opioid analgesics increased by 256 percent. Benzodiazepines were involved in 60 percent of 2013 deaths involving opioid analgesics.

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Drug Overdoses Have Killed 142 in RI This Year
Zachary Malinowski, Providence Journal
September 4, 2014

This year, Rhode Island's fatal overdoses from heroin and prescription drugs have increased to 142. Dr. Michael Fine with the state's Health Department said 1,047 opioid users have been saved with naloxone, and an additional 250 have been revived at hospital emergency rooms. Dr. Traci C. Green, a professor of emergency medicine and epidemiology at Brown University, said 15.6 percent of Rhode Island's slightly more than 1 million people are on the powerful drugs. In Vermont, 14.1 percent were using. In Massachusetts, 10.9 percent were using, and 10 percent were using in Maine. The national average is 9 percent.

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Drug Overdose Deaths Down in NM
Headlight Deming News
September 3, 2014

The New Mexico Department of Health's Bureau of Vital Records and Health Statistics reported the drug overdose death rate among New Mexico residents decreased 16 percent from 2011 to 2013. The 2013 rate of 21.8 per 100,000 is the lowest since 2009. New Mexico's efforts to combat this problem included reducing excessive prescribing of opioid pain relievers and expanded naloxone use.

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Iowa's Death Toll from Heroin More than Doubles in '13
Tony Leys, The Des Moines Register
September 5, 2014

Iowa officials reported that heroin overdoses killed more than twice as many residents last year as in any year of the previous decade. The state had 20 deaths resulting from heroin overdoses in 2013—up from eight in 2012. Kevin Hill, an addiction specialist who teaches at Harvard University, said the heroin epidemic is related to prescription pain reliever abuse. He stressed the importance of more access to effective treatment. Overall drug overdose deaths rose from 213 in 2012 to 227 in 2013. An initial review of the figures by the Iowa Office of Drug Control Policy estimated deaths from prescription pain relievers rose from 64 in 2012 to 77 in 2013.

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Prescription Drug Abuse in Perry County on the Rise, Survey Says
Sean Sauro, Perry County Times
August 30, 2014

Pennsylvania Youth Survey results for 2013 indicate that more Perry County kids are misusing prescription drugs. The biennial survey is administered in Pennsylvania middle and high schools to 6th, 8th, 10th, and 12th graders. Prescription opioid use increased from 7.1 percent in 2011 to 9.1 percent in 2013. Among students as young as 11, 8.7 percent indicated a willingness to experiment with prescription drugs.

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Police: More Drugged Drivers Hitting Streets
Mark Schlachtenhaufen, The Edmond Sun
August 29, 2014

Over the past few years, Edmond police have seen more motorists driving under the influence of drugs, including prescription medication, and more of these drivers are on the streets around midday.

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Ohio State University Opens New Alcohol and Drug Resource Center
August 29, 2014

This article and video (2:11 minutes) announced that Ohio State University will open a Higher Education Center for the Prevention of Alcohol and Drug Misuse and Recovery. The university received a $2 million grant from the Hilton Foundation in an effort to curb drug and alcohol abuse on college campuses. The center will develop prevention programs that universities across the country can use. Each year, 1,800 students overdose on prescription drugs, recreational drugs, or alcohol.

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Smuggling Suboxone: Why Inmates Are Desperate to Get the Drug
Casey Roman, WECT
September 1, 2014

This article and video (5:26 minutes) discuss how Suboxone is being smuggled into North Carolina's Brunswick County Detention Center. Jail officials said people are putting the drug underneath postage stamps. Now postage is being removed from all mail delivered to inmates at the facility, forcing them to be creative in hiding the small, dissolvable strips. Suboxone helps reduce physical symptoms of opioid withdrawal. The jail's policy is not to administer the drug, even when prescribed by a doctor.

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The Council on Alcohol and Drugs Takes Education on Prescription Drug Storage and Disposal to Georgia Communities and Families
Digital Journal
September 3, 2014

The Council on Alcohol and Drugs runs the multi-year family and community-focused Georgia Prescription Drug Abuse Prevention Initiative. This initiative aims to prevent prescription drug abuse by educating residents about the consequences of improper use and the need for safe storage and secure disposal of prescription and over-the-counter medications.

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Other Resources

University of Washington's Interactive Online Training Arms Physicians with Knowledge to Curb Prescription Drug Abuse
Clare LaFond, University of Washington
September 4, 2014

This article discusses the launch of a new course, COPE-REMS (Collaborative Opioid Prescribing Education for Risk Evaluation and Mitigation Strategy), by the University of Washington. COPE-REMS is sponsored by the Food and Drug Administration to better inform healthcare practitioners who prescribe opioid pain relievers to patients with chronic noncancer pain. The course features patient–prescriber video vignettes on handling tough situations, behavioral tools and tips for safe prescribing, interactive exercises, and audiovisual content. Providers learn practical tips for treating chronic pain, such as how to recognize when it's safe to prescribe opioids to patients; how to start, stop, or switch opioid therapies; and how to manage patients to minimize opioid misuse, abuse, and accidental death from overdose.

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Prevention Works: Tips for Parents
Midland Daily News
August 31, 2014

This article offers three strategies for reducing prescription pill misuse at home.

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Traveling with Prescription Medications
U.S. Food and Drug Administration
August 29, 2014

The Food and Drug Administration's Drug Info Rounds provides key points pharmacists should counsel their patients on prior to travel. (Duration: 4:02)



Youth Radio Podcast: Prescription Drug Abuse in College
Youth Radio
September 3, 2014

Youth Radio's Cyrus Abusaba explores a lethal trend of recreational prescription pill use among college students. (Duration: 6:29)


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.

National Take-Back Event

National Take-Back Initiative
Drug Enforcement Administration
September 27, 2014

Take-Back Events and Drop Boxes

Mountain Brook Residents Encouraged to Take Part in National Prescription Drug Take-Back Day
Ana Rodriquez, Alabama Media Group
August 28, 2014

Safe Drug Disposal Highlighted in Marple
Leslie Krowchenko, Delaware County News Network (Pennsylvania)
September 2, 2014

VMH Donates Prescription Drug Drop-Off Box
Tim Hundt, Great Rivers News (Wisconsin)
August 29, 2014

Speedway Police to Open Prescription Drug Drop-Off
John Tuohy, Indy Star
August 30, 2014

Roswell Unveils Drug Take Back Box
Jonathan Copsey, North Fulton.com (Georgia)
September 3, 2014

Oklahoma Bureau of Narcotics Continues to Collect Old Medications
Mark Woodward, The Oklahoman
August 30, 2014

Medication Drop-Off Box Is Now Available 24/7 in Magnolia Area
Karen Mundy, The Press-News (Ohio)
September 3, 2014

Drug Take Back Event Set for DGF Health Fair Nov. 8
Space Coast Daily (Florida)
August 31, 2014

City of Buffalo Unveils Drug Drop-Off Locations
Emily Lenihan, WIVB (New York)
August 28, 2014

Save the Date

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

Upcoming Conferences and Workshops

2014 Arkansas Prescription Drug Abuse Summit
University of Arkansas, Criminal Justice Institute
September 10, 2014
Little Rock, Arkansas

27th Annual NPN Prevention Research Conference
National Prevention Network
September 15–18, 2014
Hartford, Connecticut

2014 Harold Rogers PDMP National Meeting
Brandeis University, Prescription Drug Monitoring Program Training and Technical Assistance Center
September 22–24, 2014
Washington, D.C.

5th Annual Prescription Drug Abuse Symposium: Reversing the Tide of Opioid Abuse
Office of the Indiana Attorney General
October 16–17, 2014
Indianapolis, Indiana

Empowered Health Consciousness and Prescription Drugs: Facilitator Certification Training with Special Focus on Workplace and Parents
Organizational Wellness
November 4, 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.