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September 17, 2014


SAMHSA Prescription Drug Abuse Weekly Update
Issue 89  |  September 17, 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 Webinar Webinar Archive Grant Awarded Audio Request for Proposal National Take-Back Event Take-Back Events and Drop Boxes Upcoming Conferences and Workshops


Attorney General Holder Announces New Drug Take-Back Effort to Help Tackle Rising Threat of Prescription Drug Addiction and Opioid Abuse
United States Department of Justice
September 8, 2014

Effective October 9, 2014, a regulation from the Drug Enforcement Administration will authorize pharmacies, including those in hospitals and clinics, as well as narcotic treatment programs, to serve as authorized drop-off sites for unused medications. Long-term care facilities will be able to collect controlled substances from their residents. Finally, all U.S. residents will be permitted to directly mail in unused prescription medications to authorized collectors.

Read more:

S. Slavova, T.L. Bunn, and J. Talbert. 2014. "Drug Overdose Surveillance Using Hospital Discharge Data." Public Health Reports 129(5):437–445.

Researchers used Kentucky hospital discharge data for 2000–11 to compare three methods for identifying drug overdose cases and classifying their intent. The methods were 1) exclusive reliance on the primary external cause of injury, 2) the 2012 SafeStates Injury Surveillance Workgroup on Poisoning (ISW7) recommended diagnosis or external cause code as principal diagnosis code or first E-code, and 3) the ISW7 codes in any diagnosis or E-code field. Definition 3 identified almost 50 percent more drug overdose cases than Definition 1. Regardless of the definition, more than 53 percent of hospitalizations were self-inflicted drug overdoses, with benzodiazepines involved in about 30 percent. The 2011 age-adjusted drug overdose hospitalization rate in Kentucky was 146 per 100,000 population using Definition 3, and was understated as 107 per 100,000 population using Definition 1. The abstract provides no information on the undercount with Definition 2.

Read more:

Journal Articles and Reports

S. Baggio, S. Deline, J. Studera, A. N'Goran, M. Mohler–Kuo, J-B. Daeppen, and G. Gmel. 2014. "Concurrent Versus Simultaneous Use of Alcohol and Non-Medical Use of Prescription Drugs: Is Simultaneous Use Worse for Mental, Social, and Health Issues?" Journal of Psychoactive Drugs 46(4):334–39, doi:10.1080/02791072.2014.921747.

Editor's note: The authors of this paper define the word "concurrent" incorrectly. (The dictionary defines it as "simultaneous.") Your editor has redefined those who used both prescription drugs nonmedically and alcohol in the past 12 months—but "hardly ever" or "never" used them simultaneously—as "sequential users."

Among 544 Swiss males around age 20 who responded in 2010–11 that they used both substances, 11.8 percent were simultaneous users. Simultaneous use was correlated with greater risks of social, psychosocial, and health-related consequences.

Read more:

A. Baldacchino, D.J. Balfour, and K. Matthews K. 2014. "Impulsivity and Opioid Drugs: Differential Effects of Heroin, Methadone, and Prescribed Analgesic Medication." Psychological Medicine 1–13. Epub ahead of print.

In Dundee, Scotland, the authors compared the impulsivity of 24 people with histories of illicit heroin use, 29 former heroin users stabilized on prescribed methadone, 28 people with licit opioid prescriptions for chronic pain (without a history of abuse or dependence), and 28 healthy controls. Illicit heroin users showed increased motor impulsivity and impaired strategic planning. On a gambling task, they placed higher bets earlier and risked more. The cohort on methadone deliberated longer and placed higher bets earlier, but did not risk more. Chronic opioid exposed pain participants did not differ from healthy controls on any measures.

Read more:

A.M. Beckwith and S.A. Burke. 2014. "Identification of Early Developmental Deficits in Infants with Prenatal Heroin, Methadone, and Other Opioid Exposure." Clinical Pediatrics, doi:10.1177/0009922814549545.

Researchers examined development in infants following prenatal heroin, methadone, and opioid exposure. Abrupt discontinuation resulted in neurologic and behavioral problems (neonatal abstinence syndrome [NAS]). Following NAS treatment, 28 infants (mean age 55 days [range 21–98 days]) assessed using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley–III) had significantly lower mean language and cognition scores than historical controls.

Read more:

National Transportation Safety Board. "Safety Study: Drug Use Trends in Aviation: Assessing the Risk of Pilot Impairment." NTSB SS-14/01, Public Meeting of September 9, 2014.

Toxicology results for 6,677 pilots who died in aircraft incidents between 1990 and 2012 showed rising drug involvement. The proportion of pilots testing positive for drugs with impairment potential rose from 11 percent in 1990 to 23 percent in 2012. No pilots who died in large airline crashes had recently used illicit drugs, though some had been using potentially impairing medications. The most commonly used drug was a sedating antihistamine (diphenhydramine) found in many cold and allergy medications and sleep aids. Illicit drug use was relatively uncommon among the study population, increasing from 2.4 percent of pilots who died in general aviation incidents in the 1990s to about 4 percent by 2012—largely due to increasing marijuana use. Importantly, the report warns it was difficult to ascertain whether a pilot who tested positive was actually impaired at the time of the incident. Study data came from the FAA Civil Aerospace Medical Institute toxicology database and National Transportation Safety Board aviation accident database.

Read more:

M. Pugatch, J.R. Knight, P. McGuiness, L. Sherritt, and S. Levy. 2014. "A Group Therapy Program for Opioid Dependent Adolescents and Their Parents." Substance Abuse. Epub ahead of print.

This paper describes a 13-week psychoeducational group therapy program that has parallel tracks for adolescents with opioid use disorders and their parents. In addition to group therapy, adolescents received medical care at a children's hospital outpatient clinic that included medication-assisted treatment for opioid dependence, drug testing, medical follow-up, psychopharmacology, individual counseling, and parental guidance. Forty-two adolescents and 72 parents attended the group program between 2006 and 2009, with 36 adolescents (86 percent) completing three or more sessions, and 24 (57 percent) completing 10 or more sessions. Twenty-two (52 percent) adolescents reported abstinence from all substances in each of their weekly evaluations. Adolescent–parent agreement for substance use was good to very good.

Read more:

C. Songy, D. Nemeth, and T. Olivier. 2014. "Use of the Prescription Monitoring Program to Verify Patients' Reports." Archives of Clinical Neuropsychology 29(6):575, doi:10.1093/arclin/acu038.187.

This case presentation shows how a prescription monitoring program (PMP) can be a useful tool for gathering background information. The patient was a 24-year-old Caucasian male referred by a state rehabilitation agency for neuropsychological evaluation to determine vocational placement options. Relevant patient history included a severe traumatic brain injury—secondary to a motorcycle accident—and reported past substance abuse. The patient was not forthcoming about his current substance use, which was detected using the PMP. His ongoing abuse significantly affected the diagnoses rendered in the report and vocational recommendations.

Read more:

Professional Education

A.N. Mead. 2014. "Appropriate Experimental Approaches for Predicting Abuse Potential and Addictive Qualities in Preclinical Drug Discovery." Expert Opinion on Drug Discovery, doi:10.1517/17460441.2014.956077.

This review summarizes the core preclinical data that frequently contribute to building understanding of abuse potential for a new molecular entity, and highlights models that can provide increased resolution regarding risk levels. The author distinguishes between abuse potential and addiction potential and suggests ways preclinical models can inform on both.

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Updated 'Tool Kit' to Prevent Opioid Overdose
Pauline Anderson, Medscape
September 8, 2014

At the PAINWeek meeting, speakers discussed the SAMHSA tool kit that encourages doctors to prescribe naloxone when they first treat a patient with methadone or oxycodone. Twenty-five states have made it easier for medical professionals to prescribe and dispense naloxone. Physicians should also properly assess patients and use state prescription monitoring programs. In addition, providers should select the appropriate medicine and execute proper prescription orders to prevent manipulation by patients and others.

Read more:

Stop It'Sugar from Selling Products That Promote Prescription Drug Abuse
Josie Feliz, Partnership for Drug-Free Kids
September 11, 2014

The Partnership for Drug-Free Kids wants communities to ask IT'SUGAR, a national retail candy store popular with teens, to remove a drinkware line that resembles prescription drugs and pill bottles from its stores. The Partnership believes these products promote prescription drug abuse among young people and reinforce misperceptions about dangers associated with abusing medicine.

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NABP Launches .Pharmacy Generic Top-Level Domain to Help Consumers Find Safe Pharmacies Online
September 9, 2014

The National Association of Boards of Pharmacy (NABP) launched the .pharmacy generic Top-Level Domain to provide consumers a means to identify safe, legal, and ethical online pharmacies and related resources. NABP will grant use of the domain only to legitimate website operators that adhere to pharmacy laws in the jurisdictions where they are based, and where their patients and customers reside. The first registration phase for .pharmacy domain names will begin in November 2014.

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Woman's Bid to End Prescription Drug Sales on eBay
Liz Neporent, ABC News
September 11, 2014

Nancy White, a Tennessee-based IT manager, has filed hundreds of reports with eBay customer service complaining about prescription drugs sold illegally on its site. The company removes the listings, but they reappear hours later under the same profile. White has reported some prescription drugs (including Yasmin, a birth control pill, and Tegretol, an anti-seizure drug) multiple times. A company spokesperson said eBay does not allow listings of any substance that requires a prescription from a licensed medical practitioner or administration by such a practitioner. White said she hopes her crusade results in eBay cleaning up all illegal prescription drug sales.

Read more:

Ending Opioid Abuse
Tom Frieden, Medscape
September 9, 2014

Tom Frieden, director of the Centers for Disease Control and Prevention, shares his views on what clinicians and states can do to end opioid abuse. He also provides a national overview of the problem. (Includes video: 5:55 minutes)

Read more:

Nation's Leading Health Advocates Join Clinton Foundation, Johns Hopkins Bloomberg School of Public Health in Signing Consensus Statement on Prescription Drug Misuse, Abuse, and Addiction
John Hopkins Bloomberg School of Public Health
September 9, 2014

The Clinton Foundation and Johns Hopkins Bloomberg School of Public Health announced a consensus statement addressing prescription drug misuse, abuse, and addiction in the United States. The group emphasized the urgency for a coordinated intervention along the supply chain and in the clinical, community, and addiction treatment settings. They seek to apply a public health frame to scaling and widely disseminating existing evidence-based interventions to combat abuse and misuse, as well as evaluating promising and innovative solutions. At the same time, they argue for promoting appropriate and safe use of prescription opioids. In the coming months, the group will focus on development of engineering strategies to make product and packaging safer, strengthening prescribing guidelines and professional practices, expanding accessibility and use of prescription drug monitoring programs, widening naloxone distribution, and deploying greater community-based prevention initiatives. The resulting action plans and recommendations will be included in a report scheduled for release in spring 2015.

Read more:

Not All Canadian Drivers Are Aware of the Effects of Prescription Drugs on Their Driving Ability: Poll
September 8, 2014

Based on a survey, the Traffic Injury Research Foundation (TIRF) estimates that almost 780,000 drivers on Canadian roads would admit to driving under the influence of potentially impairing prescription drugs in 2013. TIRF's report, The Road Safety Monitor 2013: Drugs and Driving, looks at drivers' views, experiences, and behaviors related to use of licit and illicit drugs and driving. Before driving, 3.2 percent of respondents said they used prescription drugs; 1.6 percent used marijuana or hashish; and 0.8 percent used illegal drugs. More than 63 percent of respondents felt drug-impaired drivers posed a serious threat to traffic safety, with the youngest (71.9 percent) and oldest (78.5 percent) drivers expressing the most concern. People who chose to drive after taking prescription drugs that warn against driving had 60 percent higher odds of self-reporting injury in a motor vehicle crash than other drivers. This correlation may simply mean they are risk takers, rather than imply causation.

Read more:

Other State and Local News

Coon Rapids Firefighters Now Equipped with Heroin Antidote
Sarah Horner, Pioneer Press
September 6, 2014

Coon Rapids firefighters are the first in Minnesota to carry naloxone.

Read more:

Campaign Focuses on Prescription Drug Misuse
Ashley Sanchez, ABC Fox Montana
September 9, 2014

Missoula, Montana launched a public service campaign informing the community about the importance of properly using, storing, and disposing of prescription medications. Campaign materials include commercials, radio ads, and posters, which will be distributed over a 6-week period. (Includes video: 2:06 minutes)

Read more:

At Least One Oklahoman Will Die Today from Prescription Drug Overdose
Warren Vieth, Jaclyn Cosgrove, Andrew Knittle, and Phillip O'Connor, The Oklahoman
September 7, 2014

The Oklahoma medical examiner's office typically takes 2 to 3 months to complete death investigation reports and submit them to the state narcotics bureau for review. In 2012, unintentional prescription drug overdoses claimed the lives of 534 Oklahomans. State health authorities said about half had taken drugs prescribed by their doctors. In the past 12 years, Oklahoma has seen the overall number of overdose deaths from prescription drugs more than double, and the number of deaths due to hydrocodone and oxycodone use more than quadruple. The state's prescription monitoring program is underused by enforcement authorities and prescribers, and the narcotics bureau does not routinely mine program data to target overprescribers, relying instead on tips and complaints to initiate almost all cases.

Read more:

State Launches Initiative Against Heroin, Prescription Drug Abuse
Tiffany Holland, The Roanoke Times
September 8, 2014

Virginia Attorney General Mark Herring detailed a plan to address the growing number of heroin and prescription drug fatalities in the state. One focus is prosecuting illegal drug users and medical professionals who make prescriptions available illegally. A second is to expand approved naloxone use. Herring's office will draft legislation that gives immunity to people who call for medical help when drug users overdose.

Read more:

State Hopes Tracking Pain Pills Will Reduce Overdoses
Meredith Cohn, The Baltimore Sun
September 8, 2014

Maryland launched its prescription monitoring program in December with a goal to reduce overdose deaths 20 percent by 2015's end. About 4,500 accounts have been created. Approximately one third are from pharmacies, and the rest are from doctors, dentists, registered nurses, and other valid prescribers. The system adds about 150 doctors, pharmacists, and others each week. It was checked more than 5,000 times a week in February and more than 12,000 times a week by mid-August. Officials want more doctors to sign up and use the system and are targeting those who work in emergency departments and pain clinics.

Read more:

Pushing Drugs in the NFL Locker Room
Bucky Gleason, The Buffalo News
September 6, 2014

Former National Football League (NFL) players share their stories about taking pain pills to stay on the field. Some struggle with addiction and ailments, while others have died young. A former Buffalo Bills player recalls being offered pain medication and beer on a regular basis while on the team's chartered plane. Pills flowed regularly in the locker rooms. Some players have filed a class-action lawsuit claiming the NFL illegally issued drugs without prescriptions or warnings about their side effects.

Read more:

Doctors Say They Were Duped in Beach ADHD Suicide
Elizabeth Simpson, Virginia Pilot
September 12, 2014

Psychiatrists Waldo Ellison and Charles Parker of Virginia Beach said they were duped by Richard Fee, who sought an excessive amount of prescription stimulants leading to his suicide. Both went before a Virginia Board of Medicine committee to answer allegations that they violated their duties as doctors by failing to properly diagnose attention deficit disorder and attention deficit hyperactivity disorder and monitor patients' use of Adderall. The Board of Medicine's three-member panel issued a reprimand against Parker and ordered him to take courses on medical record keeping and proper prescribing practices. Because Ellison's violations were considered serious enough to warrant suspension or revocation of his license, allegations against him were forwarded to a formal hearing of the entire board. Ellison admitted his failure to seek out past medical histories and make good notes in his medical chart.

Read more:

Prescription Drug Abuse Among Nurses a Growing Problem
Barbara Harrington, WBAA
September 9, 2014

A WBAA reporter interviews a Certified Registered Nurse Anesthetist about his recovery from addiction to pain medication. Recently, the National Association of Drug Diversion Investigators held a training session in Indiana on healthcare drug diversion. Existing regulations require employers and employees to report drug diversion at workplaces. Some facilities choose to discipline employees themselves, or ignore the issue altogether. In Indiana, if professionals admit their addiction and successfully complete treatment, criminal charges can be removed from their records, and their licenses can remain intact. (Includes audio: 4:05 minutes)

Read more:

Opioid Crisis: Massachusetts Stepping Up Drug Courts
Nathan Lamb, Wicked Local Media
September 11, 2014

Massachusetts has 19 drug courts, and most are in the Greater Boston area. Five additional drug courts, two mental health courts, and two veterans treatment courts are slated to open in 2015—in part to address rising abuse of prescription and illicit opioids. The drug courts are administered by the Massachusetts Probation Service, which estimates more than 80 percent of people in the probation system are dealing with some form of addiction. The court's tools include mandatory treatment and regular drug testing, which is monitored by judges and probation officials. The program typically lasts 16 to 24 months.

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Byron Center Schools Encourage Parents to Talk to Students About Dangers of Adderall, Other Drugs
Monica Scott, MLive Media Group
September 9, 2014

Michigan's Byron Center Public Schools sent a letter home to parents, encouraging them to speak with their children about possessing, using, or distributing prescription medications like Adderall. The superintendent said the letter was intended to be a proactive approach to student safety and maintaining transparency about past incidents as the school year began.

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Other Resources

It's a Thin Line: Between Use, Misuse, and Abuse
United States Army
Accessed September 12, 2014

The U.S. Army's "It's a Thin Line" marketing campaign is designed to educate soldiers, their friends and families, and the provider community about the dangers of prescription drug misuse and abuse. The campaign encourages safe and responsible decisions when using prescription drugs, and offers a variety of resources on its website.

Read more:


Webinar: Addressing Opioid Misuse and Abuse: ONDCP and SAMHSA Partnership to Reduce Risk of Overdose
American Psychiatric Association
September 30, 2014
12–1 p.m. EST

This Webinar will review federal policy related to opioid misuse, abuse, and overdose, and will provide an overview of the SAMHSA Opioid Overdose Prevention Toolkit. The etiology of opioid abuse and clinician interventions that can reduce the risk of misuse will be addressed.

Read more:

Webinar Archive

Evidence-Based and Promising Workplace Programs to Prevent Prescription Drug Abuse
Substance Abuse and Mental Health Services Administration, Preventing Prescription Abuse in the Workplace Project
June 16, 2014

This Webinar described four workplace prescription abuse prevention programs and key replicable programmatic factors for successfully addressing such abuse in the workplace.
(Duration: 1:34)

Read more:

Grant Awarded

Northwestern DA's Office Gets Drug Grant
Fred Contrada, MassLive.com
September 5, 2014

The Harold Rogers Prescription Drug Monitoring Program awarded $203,770 to the Northwestern District Attorney's Office in Massachusetts to help reduce opioid abuse. The money will go toward improving prescription monitoring and forming partnerships.

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New Drug Czar Tackles Weed, Prescription Pain Pills
National Public Radio
September 8, 2014

Robert Siegel interviews Michael Botticelli, acting head of the Office of National Drug Control Policy, about battling drug abuse at a time when related laws are changing around the country. (Transcript included; duration: 7:41 minutes)


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
Various locations nationwide

Take-Back Events and Drop Boxes

Army Joins National Drug Take-Back Effort
Leslie Sweeney, Fort Leavenworth Lamp (Kansas)
September 11, 2014

Prescription Drug Drop Off Events Yield 171 Pounds
Ocean County Prosecutor's Office (New Jersey)
September 5, 2014

Drop Box Available in Danville for Prescription Drug Disposal
Pam Wright, The Advocate Messenger (Kentucky)
September 10, 2014

FCSO Receives Drug Collection Unit
Franklin County Times (Alabama)
September 9, 2014

DPD Receives Medication Drop Box
Matt Cole, Demopolis Times (Alabama)
September 5, 2014

Prairie Village Police Place New Drug Collection Bin at Station
Prairie Village Post (Kansas)
September 9, 2014

Sheriff's Department Installs Drug Take-Back Box
Troy Krause, Redwood Falls Gazette (Minnesota)
September 10, 2014

Prescription Medicine Disposal Site Now Available in Vinton
Dean Close, Vinton Today (Iowa)
September 5, 2014

Possible Year-Round Disposal Sights for Prescription Drugs Important for Safety
Sara Schaefer, WTHITV 10 (Indiana)
September 10, 2014

Prescription Drug Drop-Off Box Now Available at WPD
City of Worcester (Massachusetts)
September 4, 2014

Upcoming Conferences and Workshops

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

Prescription for Prevention Summit
Lake Forest-Based Leading Efforts Against Drugs
September 23, 2014
10:30 a.m. to 2:30 p.m.
Advocate Condell Conference Center
801 South Milwaukee Ave.
Libertyville, Illinois

The Prescription for Prevention Summit will address the growing incidence of prescription drug abuse and misuse among teens. This summit will explore multiple strategies based on research of evidence-based solutions that have been successfully implemented across the United States. It will also outline local drug issues and community-wide solutions and bring together community leaders to discuss the topic. Following the 4-hour summit, attendees will have the opportunity to participate in a naloxone training course.

Read more:

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

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.