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September 24, 2015

PAW Weekly Update

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SAMHSA Prescription Drug Abuse Weekly Update
WEEKLY
UPDATE
Issue 141  |  September 24, 2015
The Prevention of Prescription Drug Abuse in the Workplace (PAW) TA Center addresses prescription drug abuse—a growing public health problem with increasing burdens on workers, workplaces, and our economy. To subscribe colleagues, family members, or friends to this listserv sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), please click here or send their e-mail addresses to paw@dsgonline.com.
Table of Content Featured Article Journal Articles and Reports Professional Education and Policy Debate National Marijuana International Northeast/Mid-Atlantic News South News Midwest News West News Other Resources Webinars Grant Awards Grant Announcements National Take-Back Initiative Take-Back Events and Drop Boxes Upcoming Conferences and Workshops

Featured

R. Lev, O. Lee, S. Petro, J. Lucas, E.M. Castillo, G.M. Vilke, and C. Coyne. 2015. "Who Is Prescribing Controlled Medications to Patients Who Die from Prescription Drug Abuse?" The American Journal of Emergency Medicine, doi:10.1016/j.ajem.2015.09.003.

In 2013, 4.5 percent of San Diego County providers licensed to prescribe controlled substances wrote a prescription for a patient whose death was prescription related. Among 254 deaths, 186 (73 percent) had prescription drug monitoring program (PDMP) records of Schedule II or III prescriptions in the 12 months before they died. Those 186 individuals had been prescribed 4,366 controlled drugs, totaling 328,928 pills by 713 providers. All had been prescribed opioids, with half also prescribed benzodiazepines. Chronic users received 96 percent of those prescriptions. Doctor shoppers accounted for 20.5 percent of all deaths, and chronic users accounted for 69 percent of deaths among those with prescriptions (with some overlap). Most providers prescribed to only one patient who overdosed, but three prescribed to four overdose patients each. Data for this analysis, which is readily replicable by government staff in some states, was collected by retrieving mandatory-reporting PDMP records for each prescription drug–related death identified by the county medical examiner system.

Read more:
http://www.ajemjournal.com/article/S0735-6757(15)00749-4/abstract

CDC: Opioids Not 'Preferred' Treatment for Chronic Pain
Pat Anson, Pain News Network
September 16, 2015

The Centers for Disease Control and Prevention (CDC) released draft guidelines recommending "non-pharmacological therapy" as the "preferred" treatment for chronic non-cancer pain. The CDC recommends prescribing opioids if the benefits of pain reduction outweigh the risks of addiction and overdose. The agency also recommends urine drug testing patients before and during opioid use and limiting prescribed doses and quantities. Only a "three or fewer days' " supply of opioids is suggested for treating most types of acute pain. The guidelines suggest benzodiazepines (antidepressants) not be prescribed concurrently with opioids. The CDC plans to finalize the guidelines in November and submit them for Health and Human Services review, with the goal to publish them in January 2016. (Editor's note: It appears public comment on the guidelines will be accepted during an interactive Webinar, but the CDC press release did not provide the date.)

Read more:
http://www.cdc.gov/drugoverdose/prescribing/guideline.html
http://www.painnewsnetwork.org/stories/2015/9/16/cdc-opioids-not-preferred-treatment-for-chronic-pain

Journal Articles and Reports

F. Boland, R. Galvin, U. Reulbach, N. Motterlini, D. Kelly, K. Bennett, and T. Fahey. 2015. "Psychostimulant Prescribing Trends in a Paediatric Population in Ireland: A National Cohort Study." BMC Pediatrics 15:118, doi:10.1186/s12887-015-0435-3.

According to data from the Irish General Medical Services scheme pharmacy claims database, in 2011, 8.63 of every 1,000 covered children under 18 received at least one psychostimulant prescription—more than double the rate of 3.77 per 1,000 in 2002. Total spending rose from €89,254 in 2002 to €1,532,016 in 2011. For both male and female children, psychostimulant prescriptions were highest among 12–15-year-olds. Methylphenidate was the most frequently prescribed psychostimulant. A psycholeptic medication was prescribed to 8 percent of all psychostimulant users; an antidepressant was concomitantly prescribed to 2 percent.

Read more:
http://www.biomedcentral.com/1471-2431/15/118

J.W. Busse, H. Mahmood, B. Maqbool, A. Maqbool, A. Zahran, A. Alwosaibai, E. Alshaqaq, N. Persaud, L. Cooper, A. Carol, J. Sumpton, E. McGinnis, D. Rosenbaum, N. Lidster, and D. Norman Buckley. 2015. "Characteristics of Patients Receiving Long-Term Opioid Therapy for Chronic Noncancer Pain: A Cross-Sectional Survey of Patients Attending the Pain Management Centre at Hamilton General Hospital, Hamilton, Ontario." CMAJ Open.

Survey responses from 170 patients presenting to the Pain Management Centre at Hamilton General Hospital in Ontario with chronic noncancer pain (a 65 percent response rate) showed 88 percent were receiving long-term opioid therapy, with a median morphine equivalent dose of 180 mg (interquartile range 60−501). Three fourths of respondents reported at least 40 percent opioid-specific pain relief; two thirds reported functional improvement; and 46.5 percent reported troublesome adverse effects. Most were receiving disability benefits (68 percent). Only 8 percent of respondents under 65 were working full time; 11 percent were working part time. In multivariate analysis, higher morphine equivalent dose was associated with greater self-reported functional improvement (odds ratio [OR] 1.45) and possibly pain relief (OR 1.38) but not troublesome adverse effects (OR 0.92) or employment (OR 0.80).

Read more:
http://www.cmajopen.ca/content/3/3/E324.short

P. Dayal, Y.P.S. Balhara, and A.K. Mishra. 2015. "An Open Label Naturalistic Study of Predictors of Retention and Compliance to Naltrexone Maintenance Treatment Among Patients with Opioid Dependence." Journal of Substance Use, doi:10.3109/14659891.2015.1021867.

A drug treatment center in India enrolled 153 patients in maintenance treatment with short-acting naltrexone following an initial detoxification phase. After 15 months of follow-up, retention was greater among those who did not report concurrent use of cannabis (hazard ratio [HR] 2.06) or benzodiazepines (HR 2.04) at initial presentation. Odds of 90-day retention were higher when individuals were married (OR 3.6), employed (OR 8.2), of older age at opioid initiation (OR 13.2), had a shorter duration of opioid use (OR 11.6), or had more abstinence attempts in the past (OR 7.5) as predictors. The same factors predicted retention at 180 days.

Read more:
http://www.tandfonline.com/doi/abs/10.3109/14659891.2015.1021867

A.N. Garcia and I.M. Salloum. 2015. "Polysomnographic Sleep Disturbances in Nicotine, Caffeine, Alcohol, Cocaine, Opioid, and Cannabis Use: A Focused Review." The American Journal on Addictions, doi:10.1111/ajad.12291.

A "focused" literature review concluded that opioids, like other addictive substances (nicotine, caffeine, alcohol, and cocaine) and cannabis, have a significant impact on sleep, and effects differ during intoxication, withdrawal, and chronic use. Many substance-induced sleep disturbances overlap with those encountered in sleep disorders, medical, and psychiatric conditions. Sleep difficulties increase the likelihood of substance use disorder relapse.

Read more:
http://onlinelibrary.wiley.com/doi/10.1111/ajad.12291/abstract

S.G. Kershaw, C.B. Della Vedova, I. Majumder, M.B. Ward, A.L. Farquharson, P.A. Williamson, and J.M. White. 2015. "Acute Opioid Administration Induces Hypothalamic-Pituitary-Adrenal Activation and Is Mediated by Genetic Variation in Interleukin (il)1b." Pharmacology Biochemistry and Behavior.

Randomly, 30 healthy young Caucasian adults were administered a single dose of immediate-release oxycodone (20 mg, n = 30), and 19 were assigned to a control group that was not given the drug. At 0, 1, 2, 4, and 6 hours post-administration, blood and saliva samples were collected along with an assessment of pupil diameter. No difference in cortisol production was observed between the two groups. Stratifying the database on genotype for two single nucleotide polymorphisms in the promoter of the IL1B gene that occur at a higher frequency in opioid-dependent populations, individuals carrying the − 511 T and − 31 C alleles had significantly higher cortisol levels compared with individuals homozygous for the − 511 C and − 31 T alleles. These results suggest people who carry the − 511 T and − 31 C alleles experience Hypothalamic-Pituitary-Adrenal activation in response to opioid administration and therefore may be at lower risk of misusing the drugs. (Editor's note: Subgroup analysis is questionable with such a small sample. Thus, these results are merely suggestive and need validation in a larger sample and empirical testing to determine predictive power.)

Read more:
http://www.sciencedirect.com/science/article/pii/S0091305715300563

D. Krnic, A. Anic–Matic, S. Dosenovic, P. Draganic, S. Zezelic, and L. Puljak. 2015. "National Consumption of Opioid and Nonopioid Analgesics in Croatia: 2007–2013." Therapeutics and Clinical Risk Management 11:1305–14. doi:10.2147/TCRM.S86226.

National data from Croatia showed total consumption and cost of analgesics rose annually from 2007 to 2013. The "adequacy of consumption" value was 0.19, indicating Croatia is a country with low opioid consumption. Tramadol was by far the most consumed opioid, and paracetamol had the highest use in the other analgesics and antipyretics group. In the anti-inflammatory and antirheumatic nonsteroid product group, ibuprofen use rose exponentially, overtaking diclofenac consumption in 2011. Ibuprofen and diclofenac had the highest consumption among topical products for joint and muscular pain.

Read more:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4559243

A. Krupski, I.I. West, M.C. Graves, D.C. Atkins, C. Maynard, K. Bumgardner, D. Donovan, R. Ries, and P. Roy–Byrne. 2015. "Clinical Needs of Patients with Problem Drug Use." Journal of the American Board of Family Medicine.

A survey polled 868 adults in Seattle, Wash., who admitted using illegal drugs or misusing prescription drugs in the past 3 months. Respondents were recruited between April 2009 and September 2012 from waiting rooms of primary care clinics in a safety net medical system. Patients who regularly misused opiates, stimulants, sedatives, or intravenous drugs had high levels of homelessness (50 percent), psychiatric comorbidity (69 percent), arrests for serious crimes (24 percent), and use of emergency department and inpatient care. Marijuana users with little reported use of other drugs had less psychiatric comorbidity and more stable lifestyles.

Read more:
http://www.jabfm.org/content/28/5/605.short

S.M. Monnat and K.K. Rigg. 2015. "Examining Rural/Urban Differences in Prescription Opioid Misuse Among US Adolescents." The Journal of Rural Health, doi:10.1111/jrh.12141.

Analysis of 2011 and 2012 National Survey on Drug Use and Health data from youths ages 12–17 showed 6.8 percent of rural, 6.0 percent of small urban, and 5.3 percent of large urban youth engaged in past-year prescription opioid misuse. In multivariate analysis, relative to rural areas, odds of misuse were lower in large urban areas (odds ratio .74) but not significantly different in small urban areas. Among rural adolescents, criminal activity, lower perceived substance use risk, and greater use of emergency medical treatment were associated with higher misuse, while less peer substance use, less illicit drug access, and stronger religious beliefs were associated with less misuse.

Read more:
http://onlinelibrary.wiley.com/doi/10.1111/jrh.12141/abstract

B.N. Patra, S. Sarkar, D. Basu, and S.K. Mattoo. 2015. "Quality of Life of Opioid- and Alcohol-Dependent Treatment Seeking Men in North India." Journal of Substance Use, doi:10.3109/14659891.2015.1021868.

In India, the World Health Organization Quality of Life (WHOQOL)–BREF measured QOL in 50 alcohol-dependent and 50 opioid-dependent men at treatment entry compared with 30 of their male relatives who did not have substance use disorders. Among the substance-dependent men, QOL was significantly poorer in the domains of physical health, psychological health, and social relationships. Scores out of 20 averaged 13.9, 14.2, and 15.4, respectively. Adjusted for demographic and other differences, declines in QOL score were 1.5 for alcohol use disorder and 1.25 for opioid use disorder. Psychological and social relationship losses increased with severity of opioid problems.

Read more:
http://www.tandfonline.com/doi/abs/10.3109/14659891.2015.1021868

A.J. Photiou and D. Stevens. 2015. "Smartphone Applications for Use in Drug Overdose: A Review." Journal of Clinical Toxicology 5:262, doi:10.4172/2161-0495.1000262.

A November 2014 search of Apple's App Store, Blackberry's AppWorld, and Google Play identified 11 smartphone apps related to drug overdose, with 2 apps available in two stores. (Editor's note: A quick search of the Apple store using two of the four keywords in this article revealed many more apps were added after the reported search.) Four apps were free; five cost $0.96–$1.12; and none cost more than $3.24. (Editor's note: Poisoning and Drug Overdose from McGraw–Hill, now available on the Apple App Store, cost $69.99.) Five of the apps reviewed were designed for patients; six were designed for clinicians. Some were very narrow in focus—for example, providing an algorithm for toxicity caused by lipid soluble drugs such as local anesthetic agents. Others were broad, providing information from package inserts about the therapeutic effects and side effects of a wide range of prescription drugs, including their overdose potential.

Read more:
http://www.omicsonline.org/open-access/smartphone-applications-for-use-in-drug-overdose-a-review-2161-0495-1000262.php?aid=59582

L. Shutler, L.S. Nelson, I. Portelli, C. Blachford, and J. Perrone. 2015. "Drug Use in the Twittersphere: A Qualitative Contextual Analysis of Tweets About Prescription Drugs." Journal of Addictive Diseases, doi:10.1080/10550887.2015.1074505.

Researchers reviewed 2,100 tweets (50 daily for each of six prescription opioid keywords over 7 days, excluding retweets) using the Twitter Archiving Google Spreadsheet. Twenty percent of tweets were assessed by three investigators and analyzed for agreement. Misuse was commonly described with each keyword, ranging from 37.5 to 65 percent of tweets. The majority of terms (> 66 percent) were "tweeted" with a positive connotation. Common themes included receiving prescription opioids for dental procedures, from a doctor or emergency department, or from friends and getting high while taking prescription opioids for pain.

Read more:
http://www.tandfonline.com/doi/abs/10.1080/10550887.2015.1074505

B.D. Stein, R. Liccardo Pacula, A.J. Gordon, R.M. Burns, D.L. Leslie, M.J. Sorbero, S. Bauhoff, T.W. Mandell, and A.W. Dick. 2015. "Where Is Buprenorphine Dispensed to Treat Opioid Use Disorders? The Role of Private Offices, Opioid Treatment Programs, and Substance Abuse Treatment Facilities in Urban and Rural Counties." Milbank Quarterly 93(3):561–83, doi:10.1111/1468-0009.12137.

Multivariate analysis of 2004–11 state-level data on buprenorphine dispensed and county-level data on the number of buprenorphine-waivered physicians and substance abuse treatment facilities that use the drug show the amount of buprenorphine dispensed is increasing faster than the number of waivered providers. The number of physicians waivered to treat 100 patients with buprenorphine in both rural and urban settings was significantly associated with increased amounts of the drug dispensed per capita. No significant association was found between growth of buprenorphine dispensed and the number of physicians with 30-patient waivers.

Read more:
http://onlinelibrary.wiley.com/doi/10.1111/1468-0009.12137/abstract

F.J. Vocci, R.P. Schwartz, M.E. Wilson, M.S. Gordon, T.W. Kinlock, T.T. Fitzgerald, K.E. O'Grady, and J.H. Jaffe. 2015. "Buprenorphine Dose Induction in Non-Opioid-Tolerant Pre-Release Prisoners." Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2015.09.001.

This paper examines the dose induction procedure for 104 adults who were randomized to receive buprenorphine treatment in prison. More than 60 percent (37 of 72 males and 27 of 34 females) remained on buprenorphine at their release. Nine participants discontinued the drug because of unpleasant opioid side effects, and 69 percent complained of constipation. The trial suggests starting buprenorphine for non-opioid–tolerant former users before prison release at a lower, individualized dose than customarily used for adults actively using opioids.

Read more:
http://www.sciencedirect.com/science/article/pii/S037687161501621X

Professional Education and Policy Debate

J. Bratberg, B. McLaughlin, and S. Brewster. 2015. "Opioid Overdose Prevention." Journal of the American Pharmacists Association 55:470–76, doi:10.1331/JAPhA.2015.15535.

Pharmacists have an essential role in preventing opioid overdoses. They dispense most prescription opioids and can review prescription monitoring program reports, counsel patients on opioid safety, provide medication lockboxes, educate patients on abuse-deterrent formulations and proper drug disposal, and in some cases, offer drug disposal services. They are also increasingly able to integrate overdose education and naloxone distribution services into their practices.

Read more:
http://nmhv.japha.org/article.aspx?articleid=2442556

Effective Management of Opioid Addiction in Pregnancy
Christy L. Brocato, Clinical Advisor
September 14, 2015

To prevent withdrawal symptoms from harming a fetus, sometimes fatally, opioid maintenance therapy is the standard of care for pregnant women who present with heroin or opioid addiction. Providers are often uneasy about treating these patients and prefer to refer them to specialty care. But they have an ethical obligation to screen, assess, and provide concise interventions, and when necessary, refer them to specialized therapy. Providers should remain open and nonjudgmental, as opioid-dependent patients often fear shame or disgrace and delay seeking prenatal care.

Read more:
http://www.clinicaladvisor.com/features/effective-management-of-opioid-addiction-in-pregnancy/article/437768

M.D. Cheatle. 2015. "Prescription Opioid Misuse, Abuse, Morbidity, and Mortality: Balancing Effective Pain Management and Safety." Pain Medicine, doi:10.1111/pme.12904.

A literature review on long-term prescription opioid therapy for chronic noncancer pain found inconclusive results on efficacy among patients with chronic pain and moderate-level evidence of dose-dependent risk of harm. The estimated prevalence of prescription opioid abuse and use disorders ranges from < 1 percent to 40 percent, due to the paucity of uniform definitions of what constitutes misuse, "abuse," and "addiction." Several recent studies have developed unique methodology to more accurately assess these states in the pain population. The rate of opioid-related overdose deaths is not inconsequential. A number of patient-related and medication-specific risk factors may provide a basis for risk mitigation strategies.

Read more:
http://onlinelibrary.wiley.com/doi/10.1111/pme.12904/abstract

A. Sollami, L. Marino, S. Fontechiari, M. Fornari, P. Tirelli, and E. Zenunaj. 2015. "Strategies for Pain Management: A Review." Acta Biomedica 86(2 Supp.).

A literature search identified 49 articles published since 2000 in English and Italian using the keywords "pain management" and "nurse." Prevalence of pain symptoms ranged from 40 to 63 percent among hospitalized patients, with pain peaking among 82 percent of cancer patients who were in advanced disease or terminally ill. Several studies concluded that pain should be recognized as the fifth vital sign—hence the need for validated scales, whether single or multidimensional, quantitative or qualitative. Pain management requires a multiprofessional approach that uses pharmacology following the World Health Organization's three-step approach. Training operators who can communicate accurate information to patients is helpful.

Read more:
http://www.mattioli1885.com/onlinejournals/index.php/actabiomedica/article/view/4798

M. Tai, M.I. Casher, and J.R. Bostwick. 2015. "How to Prevent Misuse of Psychotropics Among College Students." Current Psychiatry 14(8):29–31, 43–46.

This article examines common issues associated with drug misuse among college students and reviews prevention strategies.

Read more:
http://www.currentpsychiatry.com/home/article/how-to-prevent-misuse-of-psychotropics-among-college-students/57b8862aab5d8cf579aa2294827ffdeb.html?ooct=CP-slideout

National

50-State Convening to Prevent Opioid Overdose and Addiction
Sylvia Mathews Burwell, U.S. Department of Health and Human Services
September 17, 2015

U.S. Department of Health and Human Services (HHS) Secretary Sylvia Burwell convened a 2-day national invitational meeting on the development of regional approaches to safer prescribing practices and better access to medication-assisted treatment (MAT) and naloxone. Secretary Burwell announced HHS will expand MAT access by revising regulations for prescribing buprenorphine to treat opioid dependence. (Editor's note: Burwell did not further detail that revision, which presumably will increase the number of patients a provider can supervise without a waiver.) She also announced $1.8 million in grant awards to rural communities in 13 states to expand naloxone access.

Read more:
http://www.hhs.gov/about/leadership/secretary/speeches/2015/50-state-convening-prevent-opioid-overdose-and-addiction.html

Katherine Clark's Opioid Abuse Progress; Clam Chowder and Obama; The Iran Deal
Davis S. Bernstein, WGBH
September 14, 2015

On voice votes, the House of Representatives passed U.S. Rep. Katherine Clark's Protecting Our Infants Act of 2015, which seeks to address neonatal abstinence syndrome (NAS), and a bill steered through committee by Joe Kennedy III to reauthorize and expand a law on funding for prescription drug monitoring programs. The Clark bill would require the federal government to collect data on babies born addicted to drugs and direct the Department of Health and Human Services to develop a best practices handbook for handling babies with NAS.

Read more:
http://wgbhnews.org/post/katherine-clarks-opioid-abuse-progress-clam-chowder-and-obama-iran-deal

FDA Gets New Authority to Stop Fake Drugs
Robert King, Washington Examiner
September 14, 2015

A new Food and Drug Administration rule allows the agency to destroy a drug valued at $2,500 or less that was refused admission into the United States. If customs officials find a larger shipment of counterfeit drugs, that shipment would be detained and sent back to the country of origin.

Read more:
http://www.washingtonexaminer.com/fda-gets-new-authority-to-stop-fake-drugs/article/2571979
http://www.gpo.gov/fdsys/pkg/FR-2015-09-15/html/2015-23124.htm

MARIJUANA

B. Jensen, J. Chen, T. Furnish, and M. Wallace. 2015. "Medical Marijuana and Chronic Pain: A Review of Basic Science and Clinical Evidence." Current Pain and Headache Reports: Anesthetic Techniques in Pain Management.

Cannabinoid compounds include phytocannabinoids, endocannabinoids, and synthetics. The two primary phytocannabinoids are delta-9-tetrahydrocannabinol (THC) and cannabidiol, with CB1 receptors in the brain and peripheral tissue and CB2 receptors in the immune and hematopoietic systems. The route of cannabis delivery is important, as bioavailability and metabolism are very different for smoking and oral/sublingual routes. Although gold standard clinical trials are limited, some evidence supports cannabinoid use for cancer pain and neuropathic, acute, and chronic pain conditions.

Read more:
http://link.springer.com/article/10.1007/s11916-015-0524-x

P. Kleczkowska, I. Smaga, M. Filip, and M. Bujalska–Zadrozny. 2015. "Cannabinoid Ligands and Alcohol Addiction: A Promising Therapeutic Tool or a Humbug?" Neurotoxicity Research, doi:10.1007/s12640-015-9555-7.

Some suspect cannabinoid receptor antagonists are useful for treating alcohol dependence and addiction. Researchers present an overview of studies focused on the effects of cannabinoid ligands (agonists and antagonists) during acute or chronic consumption of ethanol.

Read more:
http://link.springer.com/article/10.1007/s12640-015-9555-7

P. Roy–Byrne, C. Maynard, K. Bumgardner, A. Krupski, C. Dunn, I.I. West, D. Donovan, D.C. Atkins, and R. Ries. 2015. "Are Medical Marijuana Users Different from Recreational Users? The View from Primary Care." The American Journal on Addictions, doi:10.1111/ajad.12270.

This longitudinal survey of adult primary care patients in Washington who reported use of medical marijuana (131), recreational marijuana (525), or other drugs (212) retained 87 percent through 3-, 6-, 9-, and 12-month assessments. A "no drug" comparison group was not included. Not surprisingly, medical marijuana users had more health problems than other groups, a larger proportion reporting more than 15 days of medical problems in the past month, and smaller proportions reporting no pain and no mobility limitations. They also had lower drug and alcohol problem severity and a larger proportion of using marijuana alone or concomitant with opioids only. The differences observed mostly had small effect sizes (< .2).

Read more:
http://onlinelibrary.wiley.com/doi/10.1111/ajad.12270/abstract

Mundelein Medical Marijuana Dispensary Gives Early Tours
Rick Kambic, Chicago Tribune
September 18, 2015

The medical marijuana dispensary in Mundelein, Ill., gave informational tours a day before getting its state license. The dispensary plans to sell its first batch of cannabis by late October. It is the second licensed facility in Illinois and the first in the Chicago area.

Read more:
http://www.chicagotribune.com/suburbs/mundelein/news/ct-mun-marijuana-dispensary-tl-0924-20150924-story.html

Mass. Woman Fired for Using Medical Marijuana
Jim Armstrong, WBZ-TV
September 17, 2015

Cristina Barbuto was fired on her very first day at Advantage Sales and Marketing after testing positive for marijuana. She suffers from Crohn's disease and uses medical marijuana when her symptoms flare up. Barbuto's attorney argued the drug would not affect her ability to perform her job and that Crohn's disease is protected under the Americans with Disabilities Act. A former Middlesex assistant district attorney thinks Advantage Sales and Marketing is legally in the right if the company chooses to enforce a zero-tolerance drug policy, regardless of Massachusetts laws that permit medical marijuana.

Read more:
http://boston.cbslocal.com/2015/09/17/mass-woman-fired-for-using-medical-marijuana

International

Gym Employee Arrested for Allegedly Selling Prescription Meds Has Unfair Dismissal Case Dismissed
Renee Thompson, SmartCompany
September 16, 2015

A recently hired Anytime Fitness employee in Adelaide, South Australia, lost his job after being arrested for allegedly possessing steroids and selling prescription drugs. The employee's unfair dismissal case was rejected by the Fair Work Commission because he had not completed the minimum work period. Attorney Ben Tallboys stresses two points in this case: 1) It is risky for an employer to dismiss an employee because of pending criminal charges that may ultimately be thrown out and 2) Employers should independently investigate charges or wait for criminal proceedings to be resolved.

Read more:
http://www.smartcompany.com.au/legal/48407-employee-arrested-at-gym-for-allegedly-selling-prescription-meds-has-unfair-dismissal-case-dismissed.html

Fentanyl Becoming Deadly in BC
Oliver Chronicle
September 17, 2015

From January through May 2015, the British Columbia Coroners Service recorded 54 drug overdose deaths involving fentanyl. Another 12 deaths involving the drug occurred between July 7 and August 7. Interior Health is working to raise awareness about fentanyl in communities across the Okanagan and has stepped up its Take Home Naloxone program.

Read more:
http://www.oliverchronicle.com/fentanyl-becoming-deadly-in-bc

Northeast/Mid-Atlantic News

Taking the Opioid Crisis to the Boardroom
Steve Annear, The Boston Globe
September 17, 2015

The Gloucester Police Department in Massachusetts encouraged residents to contact Abbott Laboratories, Pfizer, Johnson and Johnson, Eli Lilly and Company, and Merck to determine what they are doing to curb the opioid crisis. Police Chief Leonard Campanello listed names and contact information of corporate executives on Facebook and urged the department's 10,000 followers to reach out directly. Several companies responded they had already taken steps to help prevent prescription drug abuse.

Read more:
http://www.bostonglobe.com/metro/2015/09/17/gloucester-police-ask-residents-contact-pharmaceutical-ceos-about-opioid-epidemic/4xLg05rYk3ZXiXAbbeWujL/story.html

Opioid Overdose Prevention Project Expanding Statewide
Dianne DeOliveira, New Jersey 101.5
September 13, 2015

The Opioid Overdose Prevention Project will expand to North and South Jersey next month and receive an additional $1 million in funding from the Governor's Council on Alcoholism and Drug Abuse. Under the program, families are provided with free Narcan kits and training on administering the nasal spray. Those who complete training will receive identification cards.

Read more:
http://nj1015.com/opioid-overdose-prevention-project-expanding-statewide

School Nurses Stock Drug to Reverse Opioid Overdose
NPR
September 16, 2015

Dansville Central became the first school district in New York to store naloxone. Dansville hosted a training attended by nurses from 11 rural districts in the region. Nurses are protected from liability if they act in good faith. (Includes audio: 3:42 minutes)

Read more:
http://www.npr.org/sections/health-shots/2015/09/16/440770695/school-nurses-stock-drug-to-reverse-opioid-overdoses

Pa. Budget Impasse May Delay Opioid Prescription Tracker
Newsworks
September 13, 2015

The Pennsylvania Medical Society is concerned budget bickering in the state legislature will mean further delays for an opioid drug tracker to buttress the prescription drug monitoring program. The budget stalemate is the second blow to the expanded drug registry. Although authorized, the program was not funded under last year's spending plan.

Read more:
http://www.newsworks.org/index.php/local/harrisburg/86040-pa-budget-impasse-may-delay-opioid-prescription-tracker

Senators Lay Out Legislation to Address Opioid Addiction
Andy Metzger, Eagle Tribune
September 14, 2015

Some Massachusetts senators want to require schools to screen students for drug use and increase access to alternative pain management. The Special Senate Committee on Opioid Addiction Prevention, Treatment, and Recovery Options recommends requiring pharmaceutical companies to participate in drug take-back programs; requiring Medicaid, private insurance, or both to cover non-narcotic pain management; and requiring insurers to report when they reject coverage of behavioral health and addiction services, including why the treatment was denied.

Read more:
http://www.eagletribune.com/news/senators-lay-out-legislation-to-address-opioid-addiction/article_4fb0d75a-81a6-5376-887b-4d6f47502ec4.html

Massachusetts Bill Seeks to Ban Prescribing Oxycontin for Children
Michelle Williams, MassLive
September 16, 2015

State Representative Diana DiZoglio filed a bill that would prohibit Massachusetts medical professionals from prescribing OxyContin to children under 17 in hospitals or dispensing the drug from pharmacies, even if it was prescribed. The bill is a reactionary measure aimed at blocking a recent Food and Drug Administration approval, which was intended to stop off-label prescribing to children.

Read more:
http://www.masslive.com/politics/index.ssf/2015/09/massachusetts_bill_seeks_to_ba.html

South News

South Carolina Awards Contract to Appriss for New Prescription Monitoring Solution
GlobeNewswire
September 16, 2015

In the next 60 days, South Carolina will implement the Appriss prescription monitoring program (PMP) platform, AWARxE. AWARxE facilitates interstate data sharing and integrates PMP data into clinical workflows.

Read more:
http://globenewswire.com/news-release/2015/09/16/768719/10149571/en/South-Carolina-Awards-Contract-to-Appriss-for-New-Prescription-Monitoring-Solution.html

'Pharmacy Crawl' Causes Examination of Pill Mill Regulations
Dara Cam, WJXT
September 16, 2015

Some patients are forced to do the "pharmacy crawl" to get pain medications ordered by doctors. The dilemma has reached such proportions that the Florida Board of Pharmacy's Controlled Substances Standards Committee is holding a series of meetings in an attempt to determine what can be done. At the committee's last meeting, doctors testified that a handful of patients have committed suicide, and some patients are coming to the meetings begging for help. The Florida Medical Association opposed forcing pharmacists to use the prescription drug monitoring program database. Some pharmacies, reeling from recent federal action, may be treating 5,000 dosage units of controlled substances per month as a cap, whereas it is actually a trigger number for distributors to ensure retailers are not filling prescriptions inappropriately. A Board of Pharmacy committee agreed last month to review and consider revising the relevant 2002 "Standards of Practice for Dispensing of Controlled Substances for the Treatment of Pain."

Read more:
http://www.news4jax.com/news/pharmacy-crawl-causes-examination-of-pill-mill-regulations/35304038

Midwest News

Indiana Battles No. 1 Rank in Pharmacy Robberies
Shari Rudavsky, The Indianapolis Star
September 11, 2015

Indiana has experienced more pharmacy robberies than any other state. The Indiana Board of Pharmacy has recorded 151 robberies and robbery attempts in 2015, with more than 130 in Indianapolis.

Read more:
http://www.usatoday.com/story/news/nation/2015/09/11/indiana-battles-rank-pharmacy-robberies/72110172

KY Considering Roadside Driver Drug Tests
Mike Wynn, The Courier-Journal
September 15, 2015

The Kentucky Office of Highway Safety is partnering with authorities in Louisville, Paducah, and Madison Counties to test 100 portable kits police officers could carry to test drivers for controlled substances. Kits include a mouth swab and screening device that can analyze saliva samples for up to 10 drugs within minutes. Officials are only testing the kits for accuracy and reliability, administering them to volunteers after an arrest is complete. If they prove reliable, lawmakers say they will consider legislation next year to expand their use as a common part of police work. The results will go to a state task force on impaired driving and the Governor's Executive Committee on Highway Safety. If approved, local communities would decide whether or not to use the kits because they are too expensive for the state to provide.

Read more:
http://www.courier-journal.com/story/news/local/2015/09/15/ky-considering-roadside-driver-drug-tests/72303836

Ohio Hospitals Seek Federal Help to Fight Prescription Drug Addiction
Sabrina Eaton, Northeast Ohio Media Group
September 17, 2015

Representatives from Ohio hospitals spoke at a state Senate briefing on prescription drug misuse and the growing number of babies born addicted to drugs. Carrie Baker of the Ohio Children's Hospital Association said the number of drug-addicted babies nationwide increased 800 percent between 2004 and 2013, and a new study estimates 21,732 babies were born with neonatal abstinence syndrome in 2012. Doctors and other specialists said greater efforts are needed to monitor prescriptions so patients cannot obtain more drugs than they need.

Read more:
http://www.cleveland.com/open/index.ssf/2015/09/ohio_hospitals_seek_federal_he.html

DOJ Launches Drug Abuse Program
Shelby Le Duc, Green Bay Press-Gazette
September 17, 2015

Wisconsin's Department of Justice launched a $1.7 million public awareness campaign to prevent prescription pain reliever misuse. The Dose of Reality campaign will include radio and television ads, a website, social media, and other types of advertising. The campaign also incorporates information about the prescription drug monitoring program and drug take-back days.

Read more:
http://www.greenbaypressgazette.com/story/news/local/2015/09/17/doj-launches-drug-abuse-program/72365304

New Miami Police Wary of Prescription Thefts
The Columbus Dispatch
September 14, 2015

The New Miami Police Department has seen too many fraudulent prescription drug theft reports filed by drug abusers and dealers who take the reports to doctors or pharmacies to get more drugs. Other departments in Butler County, Ohio, agree there is more scrutiny of prescription theft reports. Officers in Middletown and Hamilton say detectives handle drug theft investigations. If the case seems suspicious, they can take steps to check drug history, including using the prescription drug monitoring program database.

Read more:
http://www.dispatch.com/content/stories/local/2015/09/14/police-wary-of-prescription-thefts.html

West News

Former Las Vegas Doctor Pleads Guilty in Prescription Drug Scheme
Jeff German, Las Vegas Review-Journal
September 14, 2015

Former Las Vegas physician Sebastian M. Paulin Jr. pleaded guilty to unlawfully distributing prescription pain pills and hiding money from the IRS. Paulin was originally indicted by a federal grand jury in October 2011 on 11 counts of drug distribution, structuring, and money laundering. A year later, his wife and office manager, Estelita Paulin, was added as a defendant in a new indictment. She is facing money laundering and structuring charges and will stand trial in December. The government is seeking forfeiture of $1.2 million from the couple. State records show Paulin surrendered his medical license in March 2012 under the weight of the federal investigation.

Read more:
http://www.reviewjournal.com/news/las-vegas/former-las-vegas-doctor-pleads-guilty-prescription-drug-scheme

How to Properly Store Prescription Drugs
Kristin Carringer, KUSA
September 14, 2015

The JP Prescription Drug Awareness Foundation, which promotes medication safety in Colorado, suggests three steps for safely handling medications: 1) Take only medications prescribed to you, 2) Lock up your medications, and 3) Do not flush unused medicine or give it away. (Includes video: 3:38 minutes)

Read more:
http://www.9news.com/story/news/health/2015/09/14/prescription-drugs-storage/72244432

Update: Free Drug Kits Passed Out in Val Verde
Austin Dave, The Santa Clarita Valley Signal
September 16, 2015

notMYkid, a nonprofit organization, donated 500 in-home drug testing kits to the Youth Activity League. The kits, which test for seven illicit drugs and five prescription drugs—including marijuana and heroin—were distributed to seven league locations. The Santa Clarita Valley Sheriff's Department offered the free kits to families in Val Verde, Calif.

Read more:
http://www.signalscv.com/section/36/article/142462

Other Resources

American Chiropractic Association to Host Twitter Chat on Prescription Painkiller Epidemic
Newswire
September 15, 2015

To address opioid pain reliever overuse and misuse, the American Chiropractic Association is hosting a Twitter chat on September 29 from 2 p.m. to 3 p.m. (ET) using the hashtag #PainFreeNation. The chat will raise awareness on conservative approaches to pain and educate the public about enhancing physical strength and avoiding pain and injury in everyday life.

Read more:
http://www.newswise.com/articles/american-chiropractic-association-to-host-twitter-chat-on-prescription-painkiller-epidemic

October Is National Medicine Abuse Awareness Month: Participate in the CADCA 50 Challenge!
Community Anti-Drug Coalitions of America (CADCA)
September 19, 2015

For National Medicine Abuse Awareness Month, CADCA is asking everyone to take the 50 Challenge by hosting a town hall meeting or other educational event on prescription drug misuse and over-the-counter cough medicine.

Read more:
http://www.preventrxabuse.org/facts-tools/the-cadca-50-challenge/#.VfwPOGnJAgB
http://www.cadca.org/resources/october-national-medicine-abuse-awareness-month-participate-cadca-50-challenge

Webinars

Battling Opioid Addiction: Public Policy and Healthcare Strategies for an Epidemic
Health Management Associates
September 29, 2015, 1–2 p.m. (EDT)
http://bit.ly/1JBynnp

Addressing the Prevention Needs of College Students: Collecting Data and Fostering Buy-In
SAMHSA's Center for the Application of Prevention Technologies
October 1, 2015, 3–4:30 p.m. (EDT)
https://captus.samhsa.gov/news-and-events/addressing-prevention-needs-college-students-collecting-data-and-fostering-buy

Grant Awards

White House Drug Policy Office Announces $86 Million to Prevent Youth Substance Use in Almost 700 Communities
Office of National Drug Control Policy
September 4, 2015

The Office of National Drug Control Policy announced $86 million in funding for 188 new Drug-Free Communities (DFC) grants, 486 continuation grants for coalitions already in a 5-year cycle, 20 new DFC Mentoring (DFC-M) grants, and 3 continuation DFC-M grants. The funding provides community coalitions with needed support to prevent and reduce youth substance use.

Read more:
https://www.whitehouse.gov/the-press-office/2015/09/04/white-house-drug-policy-office-announces-86-million-prevent-youth

Wisconsin Tribes Receive Federal Grant to Tackle Alcohol and Drug Abuse
Scottie Lee Meyers, Wisconsin Public Radio
September 16, 2015

Wisconsin's Great Lakes Inter-Tribal Council received a $4 million SAMHSA grant to address substance misuse in native tribes by incorporating culturally appropriate approaches. Funding will be allocated to four Wisconsin tribes: the Bad River Band of the Lake Superior Tribe of Chippewa Indians, the Lac Courte Oreilles Band of Lake Superior Chippewa Indians of Wisconsin, the Lac du Flambeau Band of Lake Superior Chippewa Indians, and the Menominee Indian Tribe of Wisconsin. They will target underage drinking, youth binge drinking, and prescription drug misuse. (Includes audio: 20:08 minutes)

Read more:
http://www.wpr.org/wisconsin-tribes-receive-federal-grant-tackle-alcohol-and-drug-abuse

Beshear Announces Grant Awards for Heroin, Prescription Drug Abuse Treatment, and Neonatal Abstinence Syndrome
WHAS
September 16, 2015

Kentucky Governor Steve Beshear announced the state's community mental health centers and residential treatment facilities will receive more than $3.5 million to address prescription drug and heroin misuse and neonatal abstinence syndrome. The grant program is part of Senate Bill 192, which was passed by the 2015 General Assembly.

Read more:
http://www.whas11.com/story/news/local/2015/09/16/beshear-announces-grant-awards-heroin-prescription-drug-abuse-treatment-and-neonatal-abstinence-syndrome/32516015

Local Non-Profit Agency Awarded Big Grants
The Duncan Banner
September 15, 2015

The Wichita Mountains Prevention Network was awarded $3 million to address substance misuse in Southwest and South Central Oklahoma.

Read more:
http://www.duncanbanner.com/news/local-non-profit-agency-awarded-big-grants/article_e250c15c-5b3a-11e5-af1a-bfb8a0641634.html

Mt. Ascutney Prevention Partnership Receives $45,000 Holt Fund Grant
Vermont Business Magazine
September 15, 2015

The Mt. Ascutney Prevention Partnership was awarded a $45,000 grant from the Fanny Holt Ames and Edna Louise Holt Fund to help mentor the Springfield Prevention Coalition in its prevention efforts.

Read more:
http://www.vermontbiz.com/news/september/mt-ascutney-prevention-partnership-receives-45000-holt-fund-grant

Grant Announcements

Prescription Drug Monitoring Program Achieve
State of Pennsylvania
Bid deadline: October 8, 2015, 1 p.m.
http://www.pennsylvaniabids.com/bid-opportunities/2015/09/05/6556108-Prescription-Drug-Monitoring-Program-PDMP-Achieve.html

2016 Grant Funding Cycle
Community Action Coalition
Applications available: September 7, 2015
Deadline: October 16, 2015
http://www.greensburgdailynews.com/news/cac-grant-applications-available/article_4738ff77-2226-5e18-b4ff-2bcc45e15002.html

Partnership for Clean Competition
Pre-applications due November 1
Full applications due December 1
http://www.cleancompetition.org/Pages/programs-grants.aspx

NIDA Translational Avant-Garde Award for Development of Medication to Treat Substance Use Disorders
U.S. Department of Health and Human Services, National Institutes of Health
Deadline: December 3, 2015
http://www.grants.gov/web/grants/search-grants.html

National Take-Back Initiative

National Prescription Drug Take-Back Day
Drug Enforcement Administration
September 26, 2015, 10 a.m. to 2 p.m.
Various locations nationwide
http://www.deadiversion.usdoj.gov/drug_disposal/takeback

Take-Back Events and Drop Boxes

Sheriff: Drug Take Back Day Yields 18 Boxes of Medication
Mark Gilger Jr., The Republican-Herald (Pennsylvania)
September 14, 2015
http://m.republicanherald.com/news/sheriff-drug-take-back-day-yields-18-boxes-of-medication-1.1942728

Phoenix Police Hosting Free Drug Take Back Event Sept. 26
Ahwatukee Foothills News (Arizona)
September 16, 2015
http://www.ahwatukee.com/news/article_00a1a75a-5bd8-11e5-9972-9b74545a6998.html

Siskiyou Sheriff's Office Announces Prescription Drug Take-Back Event
The Siskiyou Daily News (California)
September 15, 2015
http://www.siskiyoudaily.com/article/20150915/NEWS/150919832

Prescription Drug 'Take Back Day'
Frank Juliano, CT Post (Connecticut)
September 14, 2015
http://www.ctpost.com/news/article/Prescription-drug-take-back-day-scheduled-6503085.php

Authorities to Collect Old Medicines for Safe Disposal at Floyd County Jail
Rome News-Tribune (Georgia)
September 15, 2015
http://www.northwestgeorgianews.com/rome/news/local/authorities-to-collect-old-medicines-for-safe-disposal-at-floyd/article_fe8787ec-5b68-11e5-a427-3fab3b017409.html

Annual Prescription Drug Take Back Scheduled
BigIslandNow.com (Hawaii)
September 12, 2015
http://bigislandnow.com/2015/09/12/annual-prescription-drug-take-back-scheduled

Vernon Hills Hosts National Drug Take-Back Day
Chicago Tribune (Illinois)
September 17, 2015
http://www.chicagotribune.com/suburbs/lake-county-news-sun/news/ct-lns-vernon-hills-drug-collection-st-0918-20150917-story.html

National Prescription Drug Take-Back Day: Sept. 26
City of Derby (Kansas)
September 14, 2015
http://www.derbyweb.com/CivicAlerts.aspx?AID=479

Danville Police Set for National Prescription Drug Take Back Initiative
WTVQ (Kentucky)
September 16, 2015
http://www.wtvq.com/2015/09/16/danville-police-set-for-national-prescription-drug-take-back-initiative

Sheriff Hosting Drug Take Back
Shreveport Times (Louisiana)
September 18, 2015
http://www.shreveporttimes.com/story/news/2015/09/18/sheriff-hosting-drug-take-back/72391812

County Pharmacies Now Offer Year-Round Prescription Drug Take-Back Option
City of Lincoln (Nebraska)
September 15, 2015
http://lincoln.ne.gov/city/mayor/media/2015/091515.htm

Prescription Drug Round Up Collects Unwanted Medications
Marcella Corona, Reno Gazette-Journal (Nevada)
September 17, 2015
http://www.rgj.com/story/news/2015/09/17/prescription-drug-round-up-collect-unwanted-medications/32554501

Prescription Pill Drop-Off Slated for 6 Sites in Hudson County
Rebecca Panico, The Jersey Journal (New Jersey)
September 15, 2015
http://www.nj.com/hudson/index.ssf/2015/09/prescription_pill_drop-off_on_sept_26_could_save_l.html

Give Your Old Prescription Meds to the Cedar Grove Police
Eric Kiefer, Patch.com (New Jersey)
September 13, 2015
http://patch.com/new-jersey/verona/give-your-old-prescription-meds-cedar-grove-police

Howell Residents Have Opportunity to Turn in Prescription Medications
Jennifer Ortiz, Tri-Town News (New Jersey)
September 17, 2015
http://tri.gmnews.com/news/2015-09-17/Front_Page/Howell_residents_have_opportunity_to_turn_in_presc.html

Newberry County Sheriff's Office to Hold Ninth Annual Prescription Drug 'Take Back' Campaign
The State (South Carolina)
September 16, 2015
http://www.thestate.com/news/local/crime/article35436729.html

Harlingen PD to Host Prescription Drug Take-Back Event
KVEO (Texas)
September 16, 2015
http://www.rgvproud.com/news/local-news/harlingen-pd-to-host-prescription-drug-take-back-event

Upcoming Conferences and Workshops

SCOPE of Pain Training
Oakland County Prescription Drug Abuse Partnership
October 3, 2015
Waterford, Michigan
https://www.oakgov.com/health/partnerships/Pages/Oakland-County-Prescription-Drug-Abuse-Partnership.aspx#1

Register:
https://www.scopeofpain.com/in-person-training/index.php?event=145

Sixth Annual Prescription Drug Abuse Symposium
State of Indiana, Attorney General's Office
October 28–29, 2015
Indianapolis, Indiana
http://www.in.gov/bitterpill/symposium.html

Register:
https://www.eventbrite.com/e/6th-annual-prescription-drug-abuse-symposium-tickets-17987317551

143rd Annual Meeting and Exposition—Health in All Policies
American Public Health Association
October 31–November 4, 2015
Chicago, Illinois
https://www.apha.org/events-and-meetings/annual

Register:
https://www.apha.org/events-and-meetings/annual/registration-information

2015 Fall Research Conference: The Golden Age of Evidence-Based Policy
Association for Public Policy Analysis and Management
November 12–14, 2015
Miami, Florida
http://www.appam.org/events/fall-research-conference/2015-fall-research-conference-information

Register:
http://www.appam.org/events/fall-research-conference/2015-fall-conference-registration

28th Annual National Prevention Network Conference: Bridging Research to Practice
National Prevention Network
November 17–19, 2015
Seattle, Washington
http://www.npnconference.org

Register:
http://www.npnconference.org/registration

University of Michigan Injury Center Prescription Drug Overdose Summit
University of Michigan Injury Center
December 1, 2015
Ann Arbor, Michigan
http://www.injurycenter.umich.edu/conferences/opioid-overdose-summit

Ensuring Access to Pain Care: Engaging Pain Medicine and Primary Care Teams
American Academy of Pain Medicine
February 18–21, 2016
Palm Springs, California
http://www.painmed.org/annualmeeting

2016 National Rx Drug Summit
March 28–31, 2016
Atlanta, Georgia
http://nationalrxdrugabusesummit.org
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.