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September 25, 2013

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    SAMHSA Prescription Drug Abuse Weekly Update

    ISSUE 38  |  SEPTEMBER 2013

The Prevention of Prescription Drug Abuse in the Workplace (PAW) TA Center addresses prescription drug abuse--a growing public health problem with increasing burdens on workers, workplaces, and our economy. To subscribe colleagues, family members, or friends to this listserv sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), please click here or send their e-mail addresses to paw@dsgonline.com.

Featured Article


Employee Fired for Leaving Drug Rehab Too Soon: Legal?
Business and Legal Resources
September 10, 2013

An employee became addicted to Vicodin prescribed to combat pain from work-related injuries. He took leave to seek inpatient treatment but after detoxifying, left treatment early against medical advice. The company's drug-free workplace policy stated that an employee "who rejects treatment or who leaves a treatment program prior to being properly discharged will be terminated." The company gave the employee a second chance to enter rehabilitation, saying he could return to his job if he successfully completed the program. At readmission to treatment, he tested positive for hydrocodone. After 1 day of detoxification, he once again checked out of the center. He was fired. He sued the company under the Americans with Disabilities Act (ADA) and the Family and Medical Leave Act, arguing that he was not abusing pain medication at the time of his termination. Both a District Court and the 5th Circuit Court of Appeals agreed that the firing was justified. The Appeals Court affirmed that employees who are "currently engaging in the illegal use of drugs" are excluded from ADA's protections. Citing the 5th Circuit's prior ruling in Zenor v. El Paso Healthcare Systems, Ltd., the court held that "the term 'currently' includes drug use 'sufficiently recent to justify the employer's reasonable belief that the drug abuse remain[s] an ongoing problem.'" The court affirmed that "the mere fact that an employee has entered a rehabilitation program does not automatically bring that employee within the safe harbor's protection." On the contrary, "a 'significant period of recovery' is required for an employee to qualify for the safe harbor." Shirley v. Precision Castparts Corp. et al., 5th Cir., No. 12-20544 (8/12/2013).

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Journal Articles


E.G. Benotsch, A.J. Jeffers, D.J. Snipes, A.M. Martin, and S. Koester. (2013). "The Five Factor Model of Personality and the Non-Medical Use of Prescription Drugs: Associations in a Young Adult Sample." Personality and Individual Differences 55(7):852-855

Personality traits are associated with illicit drug use and substance use disorders. Nonmedical use of prescription drugs (NMUPD) is increasingly prevalent among young adults. Research suggests that dimensions of the five factor model of personality are predictive of NMUPD, but this has yet to be explored in young adults. The current study examined these relations and found that neuroticism and openness to experience were predictors of NMUPD, while conscientiousness acted as a protective factor. These relations were seen to varying degrees across different drug classes and suggest that personality traits are important to consider in college-aged samples when identifying those most at risk for negative consequences associated with NMUPD.

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L. Degenhardt, S. Larney, D. Randall, L. Burns, and W. Hall. "Causes of Death in a Cohort Treated for Opioid Dependence Between 1985-2005." Addiction. doi: 10.1111/add.12337.

Researchers linked people in New South Wales who registered for opioid substitution therapy from 1985-2005 to a register of all deaths in Australia. Crude mortality rates, age-sex-standardized mortality rates, and standardized mortality ratios across time, sex, and age were calculated. Years of potential life lost (YPLL) were calculated with reference to Australian life tables and by calculating years lost before the age of 65. There were 43,789 people in the cohort, with 412,216 person-years of follow-up. The proportion of the cohort aged 40-plus years increased from 1 percent in 1985 to 39 percent in 2005. Accidental opioid overdoses, suicides, transport accidents, and violent deaths declined with age; deaths from cardiovascular disease, liver disease, and cancer increased. Among men, 89 percent of deaths were potentially avoidable; among women, 86 percent of deaths were avoidable. There were an estimated 160,847 YPLL in the cohort, an average of 44 YPLL per decedent, and an average of 29 YPLL before age 65. Among a cohort of opioid dependent people in New South Wales from 1985 to 2005, almost nine in 10 deaths were avoidable.

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C. Forlini, S. Gauthier, and E. Racine. 2013. "Should Physicians Prescribe Cognitive Enhancers to Healthy Individuals?" Canadian Medical Association Journal 185(12). doi: 10.1503/cmaj.121508.

The authors state that the clinical and social benefits of medications for healthy individuals using certain prescription drugs for cognitive enhancement are not well supported by scientific and professional literature. Physicians have a responsibility to distribute finite and shared resources equitably and prudently which should lead to prioritizing beneficial treatments for patients. Diverging perspectives on how cognitive enhancement aligns with medical professional integrity indicate that cognitive enhancement is not yet a general or an accepted medical practice. Physicians should seriously consider refusing to prescribe medications for cognitive enhancements to healthy individuals.

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T. McJunkin, P. Lynch, L. Micklos, and E. Swing. 2013. "Patient Opioid Disengagement." Pain Medicine News Vol. 11.

Lynch and McJunkin, owners of Arizona Pain Specialists, share their answer to the question: "How should I deal with patients who are not able to take their opioid medications responsibly?" They suggest beginning with a plan that is intended to improve the quality of life for the patient by meeting his or her pain management needs and meeting the regulatory requirements of the practice. It is best to develop a protocol designed to optimize patient selection and set the foundation for prescription opioid therapy compliance.

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K. Ruiz-Colón, M.A. Martínez, L.A. Silva-Torres, C. Chavez-Arias, M. Meléndez-Negrón, M.S. Conte-Miller, and J. Bloom-Oquendo. 2012. "Simultaneous Determination of Xylazine, Free Morphine, Codeine, 6-Acetylmorphine, Cocaine and Benzoylecgonine in Postmortem Blood by UPLC-MS-MS." Journal of Analytical Toxicology 36(5):319-326. doi: 10.1093/jat/bks024.

Xylazine, a veterinary sedative, has been found as an adulterant of heroin in street drugs in Puerto Rico. It was found in combination with free morphine and 6-acetylmorphine, codeine, cocaine, and benzoylecgonine in postmortem cases at the Puerto Rico Institute of Forensic Sciences (PRIFS). Xylazine is not approved for human use because it is harmful. Currently, three separate analyses are required to determine all the aforementioned drugs at the PRIFS's toxicology laboratory. To reduce analysis time consumption, sample volume, run time, sample preparation, and cost, a high-throughput ultra-high-pressure liquid chromatography-tandem mass spectrometry method was developed and validated for the simultaneous quantification of xylazine, free morphine, 6-acetylmorphine, codeine, cocaine, and benzoylecgonine in postmortem blood. The developed method was successfully applied to casework.

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Related Article

Xylazine a New Potentially Fatal Addition to Other Drugs of Abuse
April 9, 2013

In a poster on March 16 at the American College of Medical Toxicology Annual Scientific Meeting, researchers reported on the prevalence of xylazine in postmortem cases related to heroin and cocaine intoxication. They studied 75 cases submitted to their laboratory from 2008 to 2010, re-analyzing them for xylazine. Cases were selected based on positive immunoassay results for cocaine and opiates and the circumstances of death, and blood samples were analyzed for xylazine. In 36 out of 75 postmortem cases (48 percent), xylazine was found in combination with heroin metabolites and/or cocaine metabolites. The 36 subjects ranged in age from 22 to 67; 32 (89 percent) were male. Xylazine concentration in postmortem blood ranged from 0.01 mg/L to 0.97 mg/L. A literature search indicates that Xylazine dosages known to produce human toxicity and fatality vary from 40 to 2,400 mg, with postmortem xylazine blood concentrations ranging from trace to 16 mg/L and non-fatal blood or plasma concentrations ranging from 0.54 to 4.6 mg/L. This overlap of postmortem concentrations between fatal cases and the non-fatal cases means there is no defined safe, toxic,s or fatal concentration. Of the 37 previously known cases of xylazine toxicity in humans, consumption was accidental, suicidal, homicidal, or intentional, and over 50 percent of uses resulted in death.

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K. Silva, A. Kecojevic, and S.E. Lankenau. 2013. "Perceived Drug Use Functions and Risk Reduction Practices among High-Risk Nonmedical Users of Prescription Drugs." Journal of Drug Issues 43(4). doi: 10.1177/0022042613491099.

This study examines the reasons young polydrug users misuse prescription drugs, and explores how young users employ risk-reduction strategies to minimize adverse consequences. The sample was recruited between 2008 and 2009 in Los Angeles and New York, and comprised 45 nonmedical users of prescription drugs, aged 16 to 25. Data from a semistructured interview were analyzed quantitatively and qualitatively. Participants reported nonmedical use of prescription drugs to change mood, to facilitate activity, and to monitor the intake of other substances. Commonly employed risk-reduction strategies included calculating pill timing, dosage, and access, and monitoring frequency of use, particularly when combining different substances. Most study participants often planned drug use to occur within socially acceptable parameters, such that prescription drug misuse was a normalized feature of their everyday lives.

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P. Veliz, C. Boyd, and S.E. McCabe. 2013. "Adolescent Athletic Participation and Nonmedical Adderall Use: An Exploratory Analysis of a Performance-Enhancing Drug." Journal of Studies on Alcohol and Drugs 74(5):714-9.

The purpose of this exploratory study was to examine the nonmedical use of Adderall among adolescents who participate in competitive sports using the Monitoring the Future survey for 2010 and 2011, a representative sample of 8th- and 10th-grade students, surveyed involvement in competitive sports, and nonmedical Adderall use among 21,137 adolescents. Past-year nonmedical use of Adderall served as the main outcome measure. Logistic regression analyses were run to examine whether sports participation in general and involvement in different types of competitive sports participation were associated with past-year nonmedical use of Adderall among males and females. The odds of past-year nonmedical use of Adderall among males were higher for male respondents who participated in lacrosse (adjusted odds ratio [AOR]=2.52, 95 percent CI [1.20, 5.29]) and wrestling (AOR = 1.74, 95 percent CI [1.01, 2.98]). However, no particular sport among females was found to be associated with past-year nonmedical use of Adderall.

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I.R. Wiechers, D.L. Leslie, and R.A. Rosenheck. 2013. "Prescribing of Psychotropic Medications to Patients without a Psychiatric Diagnosis." Psychiatric Services. doi: 10.1176/appi.ps.201200557.

Researchers used MarketScan claims data for 2009 to identify privately insured individuals who filled a prescription for at least one psychotropic medication (5.1 million patients). Bivariate and multivariate analyses were used to compare the proportion of patients with and without a psychiatric diagnosis who received a prescription for six different classes of psychotropic medications. The analyses were adjusted for potential medical indications and severity of comorbid general medical illness. Altogether, 58 percent of individuals who were prescribed a psychotropic medication in 2009 had no psychiatric diagnosis during the year. The proportion of patients who were prescribed a psychotropic medication without a psychiatric diagnosis was highest among individuals aged 50 to 64 (69 percent) and among individuals who did not receive any mental health specialty care (67 percent). The odds of being prescribed psychotropic medication without a psychiatric diagnosis were 2.9 times higher among patients aged 50 to 64 than among younger patients. Diagnoses signifying potential medical indications for use and severity of comorbid medical conditions were only weakly related to absence of a psychiatric diagnosis and did not alter these age trends. In a large private claims database, a majority of recipients of psychotropic medication, especially older patients and those not utilizing mental health specialty care, lacked a clear indication for such use.

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M.M. Yazdy, A.A. Mitchell, S.C. Tinker, S.E. Parker, E. Samantha, and M.M. Werler. 2013. "Periconceptional Use of Opioids and the Risk of Neural Tube Defects." Obstetrics & Gynecology. doi: 10.1097/AOG.0b013e3182a6643c.

Researchers used data from 1998 to 2010 from the Slone Epidemiology Center Birth Defects Study, an ongoing case-control study that interviews mothers by telephone within 6 months of delivery about sociodemographic factors and exposures during pregnancy including detailed questions on type and timing of medication use. In this case-control study, mothers of 305 offspring with neural tube defects were compared with mothers of 7,125 offspring in the non-malformed control group and 13,405 offspring in the malformed control group. Periconceptional opioid use was defined as any reported use in the 2 months after the last menstrual period. Logistic regression models were used to estimate odds ratios (ORs) and 95 percent confidence intervals (CIs) adjusted for study center. A higher percentage of mothers of offspring with neural tube defects (3.9 percent) reported using an opioid medication than mothers of offspring in the non-malformed control group (1.6 percent) and offspring in the malformed control group (2.0 percent), with adjusted ORs of 2.2 (95 percent CI 1.2-4.2) and 1.9 (95 percent CI 1.0-3.4), respectively. When offspring were restricted to those with spina bifida, the adjusted ORs were 2.5 (95 percent CI 1.3-5.0) and 2.2 (95 percent CI 1.1-4.1), respectively. A 2.2-fold increase in risk would translate to a neural tube defect prevalence of 5.9 per 10,000 live births among women who use opioids. Overall, opioid use in the periconceptional period appeared to be associated with a modest increased risk of neural tube defects.

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News and Reports


Back-to-College: Educate Your Child to Call 911
The Huffington Post
September 5, 2013

Fourteen states and the District of Columbia have Good Samaritan Laws that protect people who call 911 during an overdose. In this article, a mother urges parents to talk to their youth about calling 911 when someone overdoses and explains the 911 Good Samaritan Law. Studies show that fear of criminal prosecution is the number one reason people hesitate to call 911 for a drug or alcohol overdose.

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A Nation of Prescription Drug Addicts: More Britons Die from Abusing Painkillers and Tranquillisers Than Heroin and Cocaine
Daily Mail
September 8, 2013

More Britons die from taking pain relievers and tranquilizers than heroin and cocaine combined, according to the United Kingdom's Office for National Statistics. There were 807 fatal overdoses involving prescription drugs last year, a rise of 16 percent in 5 years. By comparison, 718 deaths resulted from taking heroin and cocaine, and numbers have been falling since 2005. The figures also show that deaths from abuse of strong painkillers and tranquillizers have been rising steadily, while those from opiates used for recreational purposes have declined. Experts have warned that general practitioners overprescribe drugs and that support for addicts is inadequate.

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NFL, Other Leagues Deal with Players' Use of Amphetamine Adderall
The Denver Post
September 10, 2013

Some consider Adderall a performance enhancement drug, so it is banned under the National Football League's (NFL's) drug policy for those who do not obtain a therapeutic-use exemption. The number of exemptions granted by the NFL is confidential, but Major League Baseball (MLB) granted 116 exemptions in the 2012 season, meaning about 9 percent of baseball players were exempt. In 2012, the NFL suspended 19 players for a violation of the league's substance-abuse policy; in eight of those cases, the player was linked to Adderall or publicly blamed it for a failed test. In 2011, seven players had drug-related suspensions, one of which was linked to Adderall. In 2013 thus far, one suspended player has been linked to Adderall. Several players have noticed an increased effort to make sure all players are aware of the policy. Adderall also is banned by MLB, the National Basketball Association, Major League Soccer, the National Collegiate Athletic Association, and the U.S. Anti-Doping Agency.

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National Drug Abuse Survey: Workplace Abuse Persists; Marijuana, Heroin Use Gain
September 11, 2013

This article discusses the 2012 National Survey on Drug Use and Health findings (see report in Listserv Archive September 11, 2012). Because an overwhelming percentage of drug abusers are employed, the survey suggests the need for continued vigilance against workplace substance abuse. The article suggests the only sure way of detecting abuse and addressing it is by drug and alcohol testing using a lawful, common-sense policy.

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Urine Drug Testing: A Patient-Centered Approach.
Monthly Prescribing Reference
September 6, 2013

Howard A. Heit, a clinical pain and addiction specialist and Assistant Clinical Professor at Georgetown University, discusses urine drug testing (UDT) as a tool in risk evaluation and mitigation strategies. UDT is a consensual diagnostic test that provides objective documentation of adherence to mutually agreed upon treatment plans; aid in the diagnosis and treatment of the disease of addiction or drug misuse, if present; and information to advocate for compliant patients in family and third-party issues. It can demonstrate recent use of prescription medications and illegal substances. Also, it has an increased window of detection compared with blood testing. It is less expensive and less invasive than blood tests. UDT provides only a snapshot of drug use at a specific moment in time, and results do not provide sufficient information to determine exposure time, dose, and frequency of use. Nor can it diagnose impairment, physical dependence, drug addiction, or diversion.

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'Just Saying No' to Opioids: Not Necessarily Good Medicine
Monthly Prescribing Reference
September 6, 2013

In this article, Michael E. Schatman, a clinical psychologist and Executive Director of the Foundation for Ethics in Pain Care, shares his views about "the war" on opioids, which has resulted in progressively increasing under-treatment of chronic pain. He admits that chronic opioid therapy has many problems including abuse, diversion, and overdose. He suggests that when determining the best patient candidates for chronic opioid therapy, clinicians should review common risk factors for aberrant opioid-related behavior: history of drug abuse, tobacco use, history of driving under the influence, male gender, and age.

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National Drug Facts Week 2014 begins January 27
National Institute on Drug Abuse
September 9, 2013

This media release announces the National Drug Facts Week 2014, beginning January 27 and ending February 2, 2014. The National Institute on Drug Abuse (NIDA) is encouraging educators, community groups, and parents to start planning their events. National Drug Facts Week stimulates community-based events where teens ask questions of addiction scientists or health experts. Topics for discussion include the science behind illicit drug use, prescription drug abuse, and use of alcohol and tobacco. NIDA provides an online toolkit that advises teens and their adult advisors how to create an event, publicize it, find an expert, and obtain scientific information on drugs.

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Doctors on Alert for 'Drug Seekers'
National Pain Report
September 6, 2013

When a new patient asks for a particular type of pain reliever, doctors may get suspicious that the patient is a potential drug abuser or dealer, according to Charlie Cichon, Executive Director of the National Association of Drug Diversion Investigators. Doctors are worried about getting a visit from law enforcement or the regulatory board, so they are on alert. Drug seekers use a range of techniques to scam physicians into prescribing pain medicine. John Burke, President of the National Association of Drug Diversion Investigators, advises doctors to get new patients to complete detailed history forms listing the drugs they have taken and the physicians they have seen. Doctors should also run the patient's name through a prescription drug monitoring system. If one is not available, he recommends that the patient's old doctors or emergency room physicians be contacted to verify the information.

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Alternatives to Long-Term Opioid Use for Chronic Pain
The Partnership at Drugfree.org
September 13, 2013

Join Together speaks with Barry Meier, New York Times reporter and author of the new e-book, A World of Hurt: Fixing Pain Medicine's Biggest Mistake, about the alternatives to long-term opioid use for treating pain.

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Number of People Seeking Addiction Treatment Could Double Under New Health Law
The Partnership at Drugfree.org
September 6, 2013

The number of people seeking addiction treatment could double under the Affordable Care Act, the Associated Press reports. Under the new law, 4 million people with drug and alcohol problems will become eligible for insurance coverage. The new law designates addiction treatment as an "essential health benefit" for most commercial insurance plans, meaning the plans must cover it.

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The Partnership at Drugfree.org and the Center for Motivation and Change Join Forces to Pioneer Unique Support Network for Parents of Young People Struggling with Drug and Alcohol
The Partnership at Drugfree.org
September 6, 2013

The Partnership at Drugfree.org announced a new pilot program for parents whose children are struggling with drug and alcohol problems. The Parent Support Network is designed to provide direct peer-to-peer support and assistance to parents who are dealing with their teen or young adult's substance abuse issues. The Partnership at Drugfree.org has trained an initial group of parents from around the country in parent-to-parent phone coaching based extensively on two evidence-based approaches: Community Reinforcement and Family Training, an evidence-based family model focused on positive reinforcement and positive communication, and Motivational Interviewing. These parents have also been trained in integrating their own personal and family experiences with addiction into one-on-one telephone and online coaching of parents who have called the Partnership's Parents Toll-Free Helpline looking for assistance.

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Highly Medicated Young Adults at Significant Risk for Misuse, Potential Diversion of Prescription Amphetamines
September 6, 2023

This press release reports Ameritox's new research that shows a correlation between misuse of prescription amphetamines and positive tests for cocaine, marijuana, and non-prescribed medications among chronic pain medication users. It studied nearly 1.5 million urine samples from a nationwide pool of chronic pain patients on prescription opioid therapy. Of those, more than 30,000 samples were from people also prescribed. Patients who were not misusers of amphetamines had marijuana present 10 percent of the time. The rate of marijuana use nearly doubled among misusers to 18.5 percent. The most at-risk age group for misuse of amphetamines were those of "college age": more than 50 percent of samples collected from patients between the ages of 18 and 25 did not contain the amphetamine that the doctor prescribed, based on urine drug monitoring results. Among all patients prescribed an amphetamine, the prescribed stimulant was not found 35.4 percent of the time.

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WellPoint Provides Tips for Playing It Safe with Medicine
Scoop San Diego
September 12, 2013

Matthew Gibbs, Chief Pharmacy Executive for pharmacy services at WellPoint, offers four tips when using prescription drugs: (1) know your drugs, (2) beware of interactions, (3) follow instructions, and (4) get help if you need it.

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Treating Pain Without Creating an Addiction
September 8, 2013

People struggling with pain every day need a plan formulated to manage their pain and avoid addiction from overuse of opioid medications. Sometimes alternatives to narcotics are more suitable for patients. Cynthia Tolbert, a family practitioner for CORE Physicians in Hampton, said there is a class of drugs that act as "pain modulators" by changing the way a patient feels pain without causing addiction. She said pain modulators are safer and can be used on a regular basis for those suffering from chronic or ongoing pain. In an April 2013 press release, Lynn R. Webster, President of the American Academy of Pain Medicine, stressed the need for better management of pain therapies and offered three initiatives. She recommended more education for physicians and patients in the safe prescribing and use of pain medication. She called for a better health care delivery system, so comprehensive treatment would be available to all patients suffering chronic pain. Finally, she proposed investing in new treatments that are more effective and safer than current options. Finding a good pain specialist and creating a plan based on an individual patient's needs can result in a safe and comfortable life without the fear of addiction.

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New Safety Measures Announced for Extended-release and Long-acting Opioids
United States Food and Drug Administration
September 10, 2013

The Food and Drug Administration (FDA) announced a set of significant measures to enhance the safe and appropriate use of extended-release and long-acting (ER/LA) opioids. These actions include proposed class-wide safety labeling changes and new post-market requirements for all ER/LA opioid analgesics. The FDA also responded to two citizen petitions.

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Related Article

FDA Requires Bolder Warning Labels on Oxycontin and Other Long-Acting Opioid Pain Pills
The Washington Post
September 10, 2013

The Food and Drug Administration (FDA) announced that prescription pain relievers will now require stronger warning labels. The changes are designed to remind doctors and patients about the fatal risks of misusing and abusing long-acting opioid pain relievers. The new label will say the drugs should only be used for "pain severe enough to require daily, around-the-clock" treatment that cannot be managed with alternatives. The new label will also include a boxed warning about the risks of opioid withdrawal syndrome in infants who are exposed to the drugs during pregnancy, labor, and nursing. The FDA is also requiring manufacturers of the targeted products to conduct long-term studies tracking rates of misuse, abuse, addiction, and death among patients. This will affect about 20 prescription products.

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Documentary Film on Prescription Drug Abuse Premiers at Flynn Sept 27
The University of Vermont
September 5, 2013

The Hungry Heart, a documentary film, will premiere September 27, 2013, at the Flynn Theater in Burlington, Vt. The film explores prescription drug addiction through the intimate world of Vermont pediatrician Fred Holmes, who works with patients struggling with this disease. The film provides a close look at addiction and recovery, and reveals the many challenges that Holmes and his patients face in confronting a relentless and difficult disease.

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Other State and Local News


Fight vs. Rx Abuse Sees Progress
The Arizona Republic
September 7, 2013

Yavapai County, Ariz., has a comprehensive prevention program centered on a wide-range of community members who help reduce prescription drug abuse. Since the program began, narcotics detectives have reported a decrease in the number of prescription drugs they encounter, residents have disposed of thousands of pounds of unwanted prescriptions at secure drop boxes, and pamphlets alerting patients of the dangers of addiction can be found in pharmacies and doctor's offices. The campaign will evaluate if emergency room visits and overdoses decline. When the state's prescription drug management program started, 11 percent of doctors in Yavapai County used the database. In the past year, usage has tripled because of outreach efforts of the Prescott-based coalition. Also, physicians receive report cards every quarter that show how frequently other physicians with similar practices are writing the same prescriptions. The prevention program's goal is to replicate its success in Arizona's Yavapai, Pinal, Graham, and Greenlee counties.

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Official: Prescription Drug Abuse a Problem; Not Enough Doctors Tracking
September 12, 2013

In Arizona, only 23 percent of doctors are signed up for the prescription monitoring program and only 43 percent of pharmacists use it to check on patient prescription history. In Yavapai County, coalition members went door-to-door to every practitioner in the county to encourage them to sign up for the prescription drug monitoring program. Maricopa County is far behind because there are too many practitioners for them to go door-to-door. The pharmacy board plans to focus their efforts on Mohave County next. It eventually hopes to push a bill that would make it mandatory for doctors to use the database.

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Industry Fights Maine's Prescription Drug Law
Courthouse News Service
September 13, 2013

Maine enacted a law to make it easier for residents to buy prescription drugs from neighboring Canada. This article discusses the pharmacy and pharmaceutical industry claims that Maine's "Importation Law" poses "serious health risks to consumers" and violates the Foreign Commerce Clause and the Supremacy Clause.

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As Prescription Drug Abuse Soars, Doctors Take Action
Dallas/Fort Worth Healthcare Daily
September 10, 2013

Village Health Partners (VHP) in Texas instituted a new controlled substance program to educate and protect patients from misuse of prescription pain and anxiety medications. It hired an in-house controlled substance coordinator to manage this program. The drug screening and compliance program allows physicians to monitor whether patients are mixing other harmful drugs with their prescription. In addition, if patients are receiving a prescription for a controlled substance, VHP wants to ensure that they have the appropriate levels of the medication in their systems. It is also partnering with others within the healthcare community to ensure patients are not misusing their controlled substance prescriptions or obtaining prescriptions from multiple physicians. VHP works with other physicians who specialize in chronic pain and addictionology to offer specialist care to patients who need additional help.

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Task Force Releases Recommendations to Reduce Opiate Usage
The Daily Targum
September 13, 2013

Heroin addiction and prescription drug abuse continue to increase throughout New Jersey. The New Jersey Task Force on Heroin and Other Opiates released its recommendations to control opiate usage in New Jersey during the 22nd annual summit for the Governor's Council on Alcoholism and Drug Abuse. It recommends making the state's prescription-monitoring program mandatory for all prescribers and pharmacists; launching a "recovery high school" for addicted youth; and making curriculum changes starting at the middle school level.

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Prescription Medication Abuse is Colorado's Fast-Growing Drug Problem
The Denver Post
September 10, 2013

Bill Holen, the Arapahoe County Commissioner in Colorado, and Grayson Robinson, Sheriff of Arapahoe County, share their views about prescription overdoses and deaths in this blog post. The Center for Behavioral Health Statistics reported that since 2004, emergency room visits for overdoses of pain relievers increased 164 percent. In 2010, 89 individuals died of drug-related deaths and drug-related suicides. During the last 10 years, Arapahoe County has seen an 86 percent increase in drug-related deaths, according to the county coroner. Commissioner Holen and Sheriff Robinson give their recommendations for addressing this problem.

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St. Louis County Drug Drop-Off Collects 210 Pounds of Pills
Duluth News Tribune
September 12, 2012

In 3 months, Saint Louis County, Minn., gathered 210 pounds of prescription drugs. It has seven "Take It to the Box" medication drop-off sites. The drugs are transported by deputies to a facility where they are incinerated. The medication drop-off sites were funded by a Minnesota Pollution Control Agency grant.

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Indiana Legislators Urged to Act on Painkiller Addiction
The Indianapolis Star
September 9, 2013

Mental health experts told a legislative study committee that Indiana must do something to reduce prescription drug abuse among hardcore addicts, people suffering from chronic pain, and well-intentioned doctors who are out of their depth. They say it is hard distinguishing addicts from patients who legitimately require powerful pain relievers to function day-by-day. The state needs more doctors trained to recognize signs of drug dependence, according to Dr. Andy Chambers, Chief of Indiana University School of Medicine's psychiatry department. Indiana has only a few psychiatrists who are also trained to treat addiction and more than 200 certified community health providers. The right mix of mental health treatment and medical care can help wean addicts off their dependency.

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Event Ensures Drugs Disposed of Properly
Lansing State Journal
September 10, 2013

Recently, the Michigan Pharmacists Association (MPA) hosted its annual medication disposal event as part of the MPA's annual Pharmacy Day. In 2012, it collected 579 pounds of unwanted prescription drugs, an increase from 400 pounds in 2011.

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Lawmakers Pass Prescription Drug Reform Bills
Los Angeles Times
September 9, 2013

The California Assembly passed a pair of bills aimed at reducing prescription drug abuse and overdose deaths. The bills would help track drug-abusing patients and doctors who recklessly prescribe pain relievers. Now, the bills head back to the State Senate. If the State Senate passes the latest versions, the bills would move on to the governor for final approval. Senate Bill 62 would require coroners to report prescription overdose deaths to the Medical Board of California for review. Senate Bill 809 would sustain California's prescription drug monitoring program. The bill would create a steady stream of funding for the program by raising fees on physicians and other prescribers. A third bill that would make it easier for the Medical Board to stop doctors from prescribing narcotics while under investigation is awaiting Assembly vote.

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Lake Michigan Drowning in Prescription Drug Waste
Mother Nature Network
September 6, 2013

In Wisconsin, prescription drugs are contaminating Lake Michigan 2 miles from Milwaukee's sewage outfalls. Milwaukee Water Works did not detect pharmaceuticals in the city's water. The scientists did, however, find 27 chemicals in the lake, the four most common being metformin, caffeine, sulfamethoxazole, and triclosan, an antibacterial and antifungal compound found in some soaps, toothpastes, and other consumer products. The Environmental Protection Agency concluded that the chemicals may pose risks to wildlife and humans. The Milwaukee Metropolitan Sewerage District has collected 21 tons of unused medicines since 2006, so people will not flush them down toilets.

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Addicts Using Open Houses to Steal Drugs from Medicine Cabinets
News 12 New Jersey
September 9, 2013

New Jersey health experts warn people with homes on the market to watch out for prescription drug abusers who could be stealing prescription drugs from their medicine cabinets. Drug addicts are posing as potential buyers and raiding medicine cabinets. The Center for Alcohol and Drug Resources is working on educating real estate agents and home sellers about the threat.

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Delaware Docs Seek Guidance on Pain Relief to Help Stem Prescription Drug Abuse
September 5, 2013

Delaware uses telemedicine, a new videoconferencing program called Project ECHO (Extension for Community Healthcare Outcomes), to connect primary care doctors with some extra expertise. They also provide support as doctors help patients deal with pain. It is part of the state's fight against prescription drug abuse. Some of the doctors at Westside Family Healthcare have a monthly face-to-face appointment with a team of pain management specialists from across the country.

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Colleges Address Abuse of ADHD Meds
The Observer-Dispatch
September 8, 2013

As students head back to college, Senator Charles Schumer has called on New York colleges to put protections in place to reduce stimulant abuse among its students. Officials said students at Utica College, Hamilton College, Mohawk Valley Community College, and Herkimer County Community College cannot receive an ADHD diagnosis or prescription through college health services. Senator Schumer recommends that colleges carefully check student history before diagnosing ADHD or filling prescriptions written elsewhere; offer education to help students cope with college workloads; teach incoming freshmen about the risks of stimulant abuse; and direct students to qualified health care providers.

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Teen Prescription Drug Abuse in OC Declining
Physicians News Network
September 9, 2013

Since 2008, the California Healthy Kids Survey (CHKS) discovered that teen prescription drug abuse has declined in Orange County. The issue of prescription drug abuse and overdose deaths in the Southern California region has led to calls for stricter monitoring of drug prescriptions by doctors, more oversight of drug-abusing patients, and better prevention. A 2-year intervention program at Kaiser Permanente Hospital in Orange County helped reduce prescriptions of oxycodone by 70 percent. In Orange County, rates of heroin abuse have remained steady among teenagers, according to the CHKS. A study published in 2012 showed that interventions, including family strengthening programs and school-based interventions, proved effective in curbing drug abuse. Study participants had lower misuse rates than the control group. Across three studies, relative reduction rates ranged from 32 percent to 65 percent for study participants.

2012 Adult Arrestee Drug Use in the San Diego Region
SANDAG Criminal Justice Bulletin
September 2013

This research bulletin includes updated information regarding self-reported drug use, the results of urinalysis trends since 2000, factors related to drug use, drug market dynamics, prior justice system contact, participation in other risky behaviors, and prior receipt of drug and/or mental health treatment. As part of this project, arrestees are approached (using a random sampling method) within 48 hours of their arrest and booking into jail. If the arrestee is available and willing to participate in a confidential survey, she or he is asked a series of questions related to her or his drug use history and to provide a urine sample for drug testing. In 2012, 586 male arrestees were interviewed at the Vista and Central Jails and 293 female arrestees at Las Colinas. Of these 879 arrestees, 854 completed the interview and also provided a valid urine sample for analysis.

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Related Article

Prescription Drug Abuse Contributing To Rise in Heroin Use in San Diego County, Study Shows
Ramona Sentinel
September 5, 2013

Over a 10-year period between 2002 and 2012, the percent of adult men booked into jail who tested positive for opiates jumped from 5 percent to 10 percent, according to a study released by the San Diego County Association of Governments Criminal Justice Research Division. The rate among women increased from 6 percent to 12 percent. Cynthia Burke, Director of Criminal Justice Research, said there is strong evidence that the recent increase in heroin use is driven in part by the growing abuse of prescription pain relievers. Heroin is used as a substitute for prescription opiates. For the first time, younger adults booked into jail--those ages 18 to 24--were more likely to test positive for opiates (14 percent) in 2012, compared to those ages 25 to 39 (12 percent) and 40 and older (8 percent). Other findings from the study showed that 27 percent of those who have tried heroin reported that they had used prescription opiates before trying heroin, and 63 percent of these individuals said they started using heroin as a substitute for the prescription opiates. Younger adults ages 18 to 24 were more likely to report having abused a prescription opiate (46 percent), compared to 32 percent of those between the ages of 25 and 39 and 28 percent of those 40 and older.

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$500M Google Money Helps Fund Rhode Island Police
September 12, 2013

Police departments in Rhode Island will receive $230 million in a settlement between Google and the federal government. Investigators from local agencies are entitled to the money because they helped a federal investigation into the search engine's distribution of ads for illegal prescription drug sales.

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ACHC Data Report: 2013 Youth Prescription Drug Use in Oakland County, Michigan
Alliance of Coalitions for Healthy Communities.
Summer 2013

In this report, the Alliance of Coalitions for Healthy Communities (ACHC) asked 8th- and 12th-grade students in Oakland County, Mich., whether or not they had used prescription drugs for nonmedical reasons within the past 30 days. They discovered 4.4 percent of Oakland County youth reported misuse of prescription drugs. The most common ways youth obtained prescription drugs were from a friend (40 percent) or a doctor (21 percent). Oakland County teens who said that their friends misused prescription drugs were 22 times more likely to say that they had also misused prescription drugs.

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W.Va.'s Substance Abuse Problem Merits Review
Spirit of Jefferson
September 11, 2013

In this article West Virginia Attorney General Patrick Morrisey discusses efforts to reduce drug abuse, particularly prescription medications, in the state. His office has created an internal task force to address this issue, employed accomplished investigators to pursue violations of the law, and retained prosecutors with experience handling substance abuse cases. Soon, the consumer outreach specialists will begin educational efforts throughout the state. Morrisey held meetings on prescription drug abuse strategies with community leaders, employers, physicians, and other pharmacies as well as with representatives of both Cardinal Health and McKesson, two of the largest drug wholesalers operating in the state. His office is seeking input from any individual or organization that can help West Virginia overcome this challenge. Over the next few months, Morrisey expects to release a number of detailed initiatives that the community can tackle collectively.

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Ocean County Prosecutor to Send Drug-Sniffing Dogs into Schools to Search for Heroin
The Star Ledger
September 9, 2013

New Jersey's Ocean County prosecutor will send drug-sniffing dogs into high schools and middle schools next month to combat the surge in heroin and prescription pain reliever abuse. There have been 87 fatal drug overdoses in Ocean County this year, compared to 53 in 2012. Most victims were in their late teens and early 20s, and died from an overdose of heroin, pain relievers, or a lethal cocktail of both. The school searches will begin in October, after assistant prosecutors host a series of drug seminars at each school.

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Safe Disposal of Old Medications Made Simpler at The Well
The State Hornet
September 11, 2013

The California Product Stewardship Council's campaign, "Don't Rush to Flush," has started. The program provides a safe and convenient place to dispose of unused pharmaceuticals. Sacramento State students will now find a green metal bin in the pharmacy section of The Well. This location for the bin is one of six planned locations within the two counties. Individuals can dispose of unwanted prescription drugs and veterinary medications. The campaign's bin is a product of Sacramento State's Office of Environmental Health and Safety, Sacramento State's Sustainability team, and the Student Health and Counseling Services Pharmacy.

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Drug Disposal Program Begins in September
Stillwater Newspress
September 8, 2013

The Oklahoma Bureau of Narcotics prescription drug disposal program will take over the Stillwater Police Department's disposal program this month. Individuals may still drop off old prescriptions while the change is being made. Stillwater police will have a disposal box site, but its officer will no longer be involved with it. Stillwater police discontinued the program after a sergeant was charged with larceny of controlled dangerous substances. He was accused of taking pain relievers intended for the department's Drug Take Back disposal program.

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State Reports Decrease in Drug Overdose Deaths
The Taos News
September 9, 2013

The New Mexico Department of Health reported that 486 New Mexicans died from drug overdoses last year, a decrease of 7 percent from 2011. In 2012, there were 24.2 deaths per 100,000 persons, a decrease from the 2011 rate of 25.9. More males than females died from overdoses in 2012. Men had more than 60.1 percent of drug overdose deaths. The 2012 female drug overdose death rate was almost five times higher than in 1990, while the male rate was almost three times higher. Prescriptions for opioid analgesics in 2012-13 rose 2.2 percent over the prior fiscal year. In 2010, New Mexico had the second highest drug overdose death rate in the nation.

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Washington County Passes Drug Take-Back Program
Waste and Recycling News
September 12, 2013

The Board of Health in King County, Wash., passed a medicine take-back law that will mandate pharmaceutical companies to pay for the safe disposal of leftover and expired medicines. King County will become the second municipality to institute this law; Alameda County, Calif., passed the first drug take-back and disposal ordinance in July 2012. King County's new law will provide residents with more drop-off points at no cost to users. County officials estimate the cost of the medicine return system will amount to a few pennies per prescription.

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Column: Program Series to Help 'Push Back Against Drugs'
Wausau Daily Herald
September 10, 2013

The Marathon County Public Library and the Marathon County Alcohol and Other Drug Partnership in Wisconsin will host an educational series as part of the Pushback Against Drug Abuse campaign. They hope to raise awareness of the scope of the problem and demonstrate how everyone plays a part in the solution. Educational sessions will be offered twice a week for four weeks in October at the Marathon County Public Library's Wausau headquarters.

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Side Effects of States' Crackdown on Painkillers
Zanesville Times Recorder
September 8, 2013

This article discusses the efforts that Ohio has made to cut down on pill mills which resulted in an increase in heroin abuse. The increase in pain pill prescriptions fueled a rise in heroin use and overdose deaths. The heroin supply increased, its price dropped, and dealers focused on the suburbs and rural users who had tried prescription pain relievers. Drug deaths increased by 276 percent between 2000 and 2010. Authorities say the crackdown on pill mills and over-prescription has intensified the heroin crisis.

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Ask Laz: Unused Prescription Drugs
September 9, 2013

In this video (1:12 minutes), Los Angeles Times columnist David Lazarus answers the question, "How should you dispose of unused prescription drugs?"


Communicating Benefit and Risk Information
United States Food and Drug Administration
August 21, 2013

Every medication approved by the FDA has benefits and risks. It is important that patients hear both, and have a clear understanding so they can make informed decisions with their health care professional. In this video (4:16 minutes), benefit and risk information in clinical trials, Medication Guides, and drug advertisements are reviewed. FDA Drug Info Rounds pharmacists talk about the benefit risk balance, and how health care professionals may approach this topic with their patients.

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Parents Should Know Dangers of Prescription Drugs
Accessed September 13, 2013

This video (1:28 minutes) discusses the dangers of prescription drug abuse among youth in general and in Omaha, Neb. Every day, 2,500 young Americans start abusing prescription drugs for the first time. Many of them are getting high by simply opening up the family medicine cabinet.


Attendee Comments from Tribal Prescription Drug Abuse Conference
Lamar Associates
September 11, 2013

In this video (1:10 minutes), hear from past attendees about the Tribal Prescription Drug Abuse and Drug Endangered Children Conference. The training is supported by the Department of Justice's Office of Community Oriented Policing Services.


Prescription Drug Abuse--How It Is Affecting Our Community and What We Can Do To Prevent It
Waldo County General Hospital
September 11, 2013

This video (27:38 minutes) discusses how prescription drug abuse affects Maine and what Waldo County General Hospital is doing to prevent it.

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Overview of the Opioid Analgesic Epidemic
Wednesday, October 16, 2013
3:00 p.m.-4:00 p.m. (EDT)

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Drug Facts Chat Day
January 28, 2014
8:00 a.m.-6 p.m. (EST)

This web chat is sponsored by the National Institute on Drug Abuse during National Drug Facts Week. The purpose is to provide an opportunity for students and teachers to ask questions of the nation's top experts in the field of drug abuse and addiction.

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Bid Solicitation

Peer Support and Education of Prescription Misuse
Federal Business Opportunity
Response Date: September 24, 2013
The Department of Health and Human Service (DHHS), Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment (CSAT) intends to award a contract to support SAMHSA's efforts to: (1) engage college communities in dialogues to identify additional strategies and policies within academia about the misuse of prescription drugs among youth that can further provision of behavioral health services and intervention for youth and young adults in need; (2) record and report on the findings and proposed solutions, and; (3) educate participants about the breadth of materials that have been created and specifically target the youth and young adults to combat prescription misuse and mental and/or substance use disorders. The initiative will reinforce the educational information and resources provided from all previous iterations of Talking About Prescription Medicine Abuse: A National Multi-Media Outreach Campaign Addressing Prescription Medicine Misuse by Youth Ages 12-17 and Young Adults Ages 18-25, with a specific emphasis on the college-aged population.

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Grants Awarded


Drug Free Communities Support Program: FY 2013 DFC Grant Announcement
The White House Office of National Drug Control Policy
Accessed September 12, 2013

The Office of National Drug Control Policy announced $19.8 million in new Drug-Free Communities (DFC) Support Program grants to 147 communities and 19 new DFC Mentoring grants across the country. It also announced an additional $59.4 million in DFC continuation grants to 473 currently funded DFC coalitions and four DFC Mentoring continuation coalitions. These grants provide community coalitions needed support to prevent and reduce youth substance use. Grant awards typically are $125,000 per year for 5 years (including options). Most new grantees will target underage drinking, marijuana use, and prescription drug abuse.

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New Hampshire Receives $400,000 Grant to Support a Prescription Drug Monitoring Program
New Hampshire Office of Attorney General
September 5, 2013

The New Hampshire Department of Justice was awarded a $400,000 Department of Justice grant to support implementation of a prescription drug monitoring program. The New Hampshire Board of Pharmacy will oversee the program.

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Call for Public Comment: National Action Plan for Adverse Drug Event Prevention


Public Comment Opens September 4--Provide feedback on the National Action Plan for Adverse Drug Event Prevention
Public comment open period: September 4 to October 3, 2013 until 5:00 p.m.

Adverse drug events are the largest contributor to hospital-related complications and account for more than 3.5 million physician office visits each year. As a result of increased attention to reduce and prevent the dangers associated with adverse drug events, the Department of Health and Human Services (DHHS), in partnership with the Department of Defense, Department of Veterans Affairs, and the Bureau of Prisons, has developed the National Action Plan for Adverse Drug Event Prevention. DHHS currently seeks feedback from a wide array of stakeholders including organizations and professional groups on the draft version of the National Action Plan for Adverse Drug Event Prevention.

To participate, visit: http://1.usa.gov/15fSxvQ

National Take-Back Event


DEA's National Take-Back Initiative
October 26, 2013
Local Take-Back Events

Don't Flush Old Medicine
The Garden Island
September 10, 2013

The Kauai Police Department in Hawaii will be participating in the National Take-Back Initiative on Saturday, October 26, 2013. Residents can dispose of unwanted prescription medication. The Drug Enforcement Administration Honolulu District Office collected 1,300 pounds of prescription medications from the April 27, 2013, Take-Back event.

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Drop Box Program Started for Drug Disposal
Lansing State Journal
September 6, 2013

Eaton County Resource Recovery in Michigan announced the launch of the Controlled Substance Prescription Drop Box Program at two locations. Residents can drop off their prescription medications from 8:00 a.m. to 5:00 p.m., Monday thru Friday. On September 21, residents can participate in the "Recycle-Palooza" by discarding controlled and uncontrolled substances as well as over-the-counter drugs.

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Upcoming Conferences and Workshops


Pharmacy Diversion Awareness Conference
September 21-22, 2013
Boston, Massachusetts

National Conference on Addiction Disorders 2013
September 21-25, 2013
Anaheim, California

Harold Rogers Prescription Drug Monitoring Program National Meeting
September 25-27, 2013
Washington, D.C.

2013 National Safety Council Congress and Expo
Congress: September 28-October 4, 2013
Expo: September 30-October 2, 2013
Chicago, Illinois

4th Annual Executive Forum on Creating a Culture of Health and Wellness
October 9-10, 2013
Chicago, Illinois

2013 American Association for Treatment of Opioid Dependence Conference
November 9-13, 2013
Philadelphia, Pennsylvania

11th Annual World Health Care Congress
April 7-9, 2014
National Harbor, Maryland
News and Research on Prescription Drug Abuse 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. News and Research on Prescription Drug Abuse 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 News and Research on Prescription Drug Abuse.

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