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SAMHSA Prescription Drug Abuse Weekly Update
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Issue 170  |  April 21, 2016
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.
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Featured
Journal Articles and Reports
Professional Opinion and Policy
Professional Development
National
Marijuana
International
Northeast/Mid-Atlantic News
South News
Midwest News
West News
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Featured

J.L. McCauley, J.M. Hyer, V.R. Ramakrishnan. R. Leite, C.L. Melvin, R.B. Fillingim, C. Frick, and K.T. Brady. 2016. “Dental Opioid Prescribing and Multiple Opioid Prescriptions Among Dental Patients: Administrative Data from the South Carolina Prescription Drug Monitoring Program.” Journal of the American Dental Association, doi:10.1016/j.adaj.2016.02.017.

A review of South Carolina prescription drug monitoring program data on all patients prescribed at least one opioid by a dentist during 2012–13 included 653,650 opioid prescriptions. Virtually all were initial dental prescriptions for immediate-release opioids. Hydrocodone (76.1 percent) and oxycodone (12.2 percent) combination products were most frequently dispensed. People under age 21 received 11.2 percent of the opioids. Of the patients, 31 percent had a history of multiple concurrent opioid prescriptions within 180 days, including 25 percent within 90 days and 17 percent within 30 days.

Read more:
http://www.sciencedirect.com/science/article/pii/S000281771630201X

Pennsylvania OKs Medical Marijuana
Pittsburgh’s Action News 4
April 13, 2016

Pennsylvania’s governor has signed legislation making the state the 24th to legalize medical marijuana. The law sets standards for tracking plants, certifying physicians and licensing growers, dispensaries and physicians. Patients could take marijuana in pill, oil, vapor or liquid form but would not be able to legally obtain marijuana to smoke or to grow their own. The law’s list of 17 qualifying conditions includes cancer, epilepsy, autism, Parkinson’s disease, posttraumatic stress disorder, sickle cell anemia, multiple sclerosis, AIDS, and glaucoma.

Read More:
http://www.wtae.com/news/final-votes-may-be-close-on-medical-marijuana-bill/38972378

Journal Articles and Reports

D. Ciccarone, G.J. Unick, J. Cohen, S.G. Mars, and D. Rosenblum. 2016. “Nationwide Increase in Hospitalizations for Heroin-Related Soft Tissue Infections: Associations with Structural Market Conditions” Drug & Alcohol Dependence, doi:http://dx.doi.org/10.1016/j.drugalcdep.2016.04.009.

U.S. hospital admissions rates for heroin-injection-related skin and soft tissue infections rose from 4 per 100,000 in 1993 to 9 per 100,000 in 2010, according to Healthcare Cost and Utilization Project nationwide inpatient sample data. Regressions that added heroin price and purity data from the U.S. Drug Enforcement Administration found that each $100 increase in yearly heroin price per gram-pure was associated with a 3 percent decrease in the rate of admissions. Western cities, where Mexican-sourced “black tar” heroin predominates, had twice the infection rate of eastern cities where Colombian-sourced powder heroin predominates. The author suggest clinical and harm reduction efforts should promote vein health strategies, especially for black-tar heroin users.

Read more:
http://www.drugandalcoholdependence.com/article/S0376-8716(16)30036-9/abstract

S.J. Cousins, S.R. Radfar, D. Crèvecoeur-MacPhail, A. Ang, K. Darfler, and R.A. Rawson. 2016. “Predictors of Continued Use of Extended-Released Naltrexone (XR-NTX) for Opioid-Dependence: An Analysis of Heroin and Non-Heroin Opioid Users in Los Angeles County.” Journal of Substance Abuse Treatment, doi:10.1016/j.jsat.2015.12.004.

This sub-analysis of data on community provider use of extended-release (28-day) naltrexone to treat opioid addiction combined data from 60 patients followed for 30–60 days after their last dose and 111 patients from an earlier phase that did not track beyond the last dose. Those addicted to prescription opioids had virtually the same dropout pattern as those addicted to heroin, with roughly 40 percent dropping out after only one dose, another 20 percent after taking two, another 20 percent after taking three. At 30-day follow-up, urge-to-use scores were also similar.

Read more:
http://www.sciencedirect.com/science/article/pii/S0740547215003141

M.J. Fleury, M. Perreault, G. Grenier, A. Imboua, S. Brochu. 2016. “Implementing Key Strategies for Successful Network Integration in the Quebec Substance-Use Disorders Programme.” International Journal of Integrated Care, doi:10.5334/ijic.2457.

Focus groups and interviews with 105 stakeholders representing two regions and four local substance use disorder networks in Quebec, Canada, revealed that six types of service integration strategies have been implemented in use disorder networks: 1) coordination/ governance, 2) primary-care consolidation, 3) information and monitoring management, 4) service coordination, 5) clinical evaluation, and 6) training. Important investments have been made in Quebec for training on assessing individuals with substance use disorders, particularly in terms of support for emergency room liaison teams and introduction of standardized clinical evaluation tools. However, development of integration strategies was insufficient to ensure implementation of successful networks.

Read more:
http://www.ijic.org/articles/10.5334/ijic.2457

K.M. Hoffman, S. Trawalter, J.R. Axta, and M.N. Oliver. 2016. Racial Bias in Pain Assessment and Treatment Recommendations, and False Beliefs About Biological Differences Between Blacks and Whites.” Proceedings of the National Academy of Sciences, doi:10.1073/pnas.1516047113.

A University of Virginia survey of 222 white medical students and residents who were native English speakers born in the United States asked participants to read two mock medical cases (a kidney stone and an ankle fracture and make pain ratings (scale: 0 = no pain to 10 = worst possible pain) and medication recommendations (dummy coded for accuracy: 1 = accurate, 0 = inaccurate) for each. Each student’s cases randomly assigned one patient as white and the other as black, as well as randomizing the order of the two cases. Neither mean pain ratings nor medication recommendation accuracy varied significantly or sizably race. The students also rated the accuracy of 15 statements about biological differences between blacks and whites, 11 of them false. Students who answered those questions inaccurately had a higher probability of answering the pain questions inaccurately, underestimating pain levels of blacks and under-prescribing in accordance with that underestimate. [Editor’s note: Some media coverage has exaggerated the findings of this study, mischaracterizing the nature of the incorrect responses about biological differences.]

Read more:
http://www.pnas.org/content/early/2016/03/30/1516047113.abstract
http://www.medscape.com/viewarticle/861435

D. Madah-Amiri, T. Clausen, and P. Lobmaier. 2016. “Utilizing a Train-the-Trainer Model for Multi-Site Naloxone Distribution Programs.” Drug & Alcohol Dependence, doi:http://dx.doi.org/10.1016/j.drugalcdep.2016.04.007.

In Norway, during 41 workshops, 511 staff at medical facilities were shown how to train recipients of naloxone kits. Surveys of 54 workshop participants found knowledge scores improved significantly, attitude scores improved, and most staff found the training useful and intended to distribute naloxone to their clients.

Read more:
http://www.drugandalcoholdependence.com/article/S0376-8716(16)30034-5/abstract

R.K. McHugh, R.D. Weiss, M. Cornelius, M.O. Martel, R.N. Jamison, and R.R. Edwards. 2016. “Distress Intolerance and Prescription Opioid Misuse Among Patients with Chronic Pain.” Journal of Pain, doi:10.1016/j.jpain.2016.03.004.

Among a convenience sample of 51 chronic back or neck pain patients prescribed long-term opioid analgesics, 60 percent misused their opioids. Distress intolerance—the perceived or actual inability to manage negative emotional and somatic states—was associated with a slightly elevated risk of opioid misuse (odds ratio = 1.1). This association remained after controlling for pain severity and negative affect. Distress intolerance can be modified with treatment.

Read more:
http://www.jpain.org/article/S1526-5900(16)30001-3/abstract

J. Mennis and D.J. Stahler. 2016. “Racial and Ethnic Disparities in Outpatient Substance Use Disorder Treatment Episode Completion for Different Substances. Journal of Substance Abuse Treatment, doi:10.1016/j.jsat.2015.12.007.

Racial disparities in outpatient treatment episode completion vary by substance, according to an urban sample of 416,224 outpatient treatment discharges from the 2011 U.S. Treatment Episode Dataset-Discharge (TEDS-D) data set. African-American patients are less likely to complete episode treatment than Caucasian patients for all substances; the largest disparities are for alcohol and methamphetamines. Caucasian patients are more likely to complete treatment than Hispanic patients for heroin and marijuana. This could highlight the need for culturally appropriate treatment programs.

Read more:
http://www.sciencedirect.com/science/article/pii/S0740547215003177

H.J. Mosher, K.K. Richardson, and B.C. Lund. 2016. “The 1-Year Treatment Course of New Opioid Recipients in Veterans Health Administration.” Pain Medicine, doi:10.1093/pm/pnw058.

Veterans Health Administration pharmacy users who received a new prescription for an opioid preceded by a year with no opioid prescribed totaled 373,900 in 2004 and 525,500 in 2011. Among those users, 20.4 percent started long-term opioid therapy in 2004 as did 18.3 percent in 2011. Hydrocodone and tramadol increased as a proportion of initial opioids prescribed. Median days initially supplied decreased from 30 to 20 days. The percentage of new opioid prescriptions that were for 7 days or fewer rose from 20.9 percent to 27.9 percent. The proportion of new recipients who started long-term opioid therapy varied widely by medical center in 2004, but the proportions tended to equalize over time.

Read more:
http://painmedicine.oxfordjournals.org/content/early/2016/04/05/pm.pnw058

Z. Samaan, L. Naji, B. Dennis, M. Bawor, C. Plater, G. Pare, A. Worster, M. Varenbut, J. Daiter, D. Marsh, L. Thabane, and D. Desai. 2016. “A Prospective Study to Investigate Predictors of Relapse Among Patients with Opioid Use Disorder Treated with Methadone.” Substance Abuse: Research and Treatment, doi:10.4137/SART.S37030.

Among 233 methadone-maintenance treatment patients in southern Ontario, Canada, who had been on maintenance for at least 3 months and an average of 52 months, participants remained abstinent for an average of 99 days during 6 months of follow-up (including urine testing). Multivariate analysis showed relapse risk was higher for patients with a history of injecting drug use behavior (hazard ratio [HR] = 2.26), illicit benzodiazepine consumption (HR = 1.07), older age at onset of opioid abuse (HR = 1.10). Relapse risk declined with patient age (HR = 0.93).

Read more:
http://www.la-press.com/a-prospective-study-to-investigate-predictors-of-relapse-among-patient-article-a5525

Professional Opinion and Policy

T.C. Green and M. Doe-Simkins. 2016. “Opioid Overdose and Naloxone: The Antidote to an Epidemic?” Drug & Alcohol Dependence, doi:http://dx.doi.org/10.1016/j.drugalcdep.2016.03.024.

Naloxone is effective at reversing an opioid overdose when administered by professionals and laypeople. The biases and barriers to allowing laypeople to administer naloxone are decreasing as policies locally and federally are changing. The authors point out that guidelines differ about delivering naloxone before or after resuscitative measures, with little research informing the decision. Also needed is research about how well the drug works when fentanyl and other drugs are mixed with opioids, as well as treatment protocols for extended-release formulations that can remain in the body well beyond naloxone’s relatively short half-life.

Read more:
http://www.drugandalcoholdependence.com/article/S0376-8716(16)30011-4/abstract

Professional Development

M.E. Hale, D. Moe, M. Bond, M. Gasior, and R. Malamut. 2016. “Abuse-Deterrent Formulations of Prescription Opioid Analgesics in the Management of Chronic Noncancer Pain.” Pain Management, doi:10.2217/pmt-2015-0005.

Read more:
http://www.futuremedicine.com/doi/full/10.2217/pmt-2015-0005

L. Manchikanti, A.M. Kaye, and A.D. Kaye. 2016. “Current State of Opioid Therapy and Abuse.” Current Pain and Headache Reports.

Read more:
http://link.springer.com/article/10.1007/s11916-016-0564-x

National

State Attorneys General Call for Federal Action to Aid in Battle Against Opiate, Heroin Abuse
Sara J. Ketchum, Daily Press
April 15, 2016

Thirty-three state attorneys general are calling on the federal government to close a loophole that keeps methadone clinics from reporting their dispensing data to state prescription drug monitoring programs. Closing the loophole would allow prescribers to avoid dispensing opioids to people also receiving treatment for opioid addiction.

Read More:
http://www.dailypress.com/health/dp-nws-herring-methodone-prescription-monitoring-20160414-story.html

House Republicans Playing Politics with Pain Relievers—Say Some Senate Republicans
Karoun Demirjian, Washington Post
April 13, 2016

House Majority Leader Kevin McCarthy (R-Calif.) has said that the House would not consider a Senate bill to combat heroin and opioid abuse. The Senate bill overwhelmingly survived a test vote last month. Some Senate Republicans fear the House leadership may be stalling to let members take a turn in the spotlight on a widely popular issue. And, they fear the House’s decision to start from scratch instead of picking up the Senate bill may upset a near-perfect opportunity to get something done. Only a few months remain to pass meaningful legislation before Congress effectively disbands for the election season.

Read More:
https://www.washingtonpost.com/news/powerpost/wp/2016/04/13/some-fear-house-playing-politics-with-painkiller-bills

How Obamacare Is Fueling America’s Opioid Epidemic
Sean Gregory, Time
April 13, 2016

To reward quality care, the Centers for Medicare and Medicaid Services (CMS) annually allocates $1.5 billion in Medicare payments to hospitals based on criteria that include patient ¬satisfaction surveys. Among the questions: “During this hospital stay, how often did the hospital staff do everything they could to help you with your pain?” And: “How often was your pain well controlled?” The advocacy group Physicians for Responsible Opioid Prescribing wrote CMS, asking them to stop using these surveys questions. They believe the questions unintentionally encourage the over-prescription of opioids. They also wrote the Joint Commission, urging changes in their accreditation standards around pain management. Others are concerned that new prescribing guidelines and emergency department protocols, which can deny opioids to individuals displaying drug seeking behavior, will lower CMS survey scores and hurt hospitals financially. In October, the Department of Health and Human Services announced it would review how the survey influences pain treatment and opioid prescribing.

Read More:
http://time.com/4292290/how-obamacare-is-fueling-americas-opioid-epidemic

Related: Health Officials Call for Less Aggressive Treatment of Pain
Jeanne Whalen, Wall Street Journal
April 13, 2016
http://www.wsj.com/articles/health-officials-call-for-less-aggressive-treatment-of-pain-1460576556

The Fed’s New ‘War on Drugs’: Obama Proposes $1.1 Billion to Expand Care for Opioid Addicts
Melinda Carstensen, Fox News Health
April 14, 2016

This article reviews selected studies and legislative proposals about opioid overdose, then reports on an interview with Melinda Campopiano, M.D., medical officer at SAMHSA who prescribes opioids and treats patients who have become addicted to them. Dr. Campopiano said when she was in medical school in the 1990s, professors taught students using the sickest patients. That approach may have skewed the risk–benefit factor for stronger drugs like opioids versus over-the-counter pain medications. An assumption at the time that pain was undertreated in America overall led many doctors to readily prescribe opioids. Campopiano added overprescribing of opioids also emerged from a well-intentioned effort to standardize care in response to evidence that pain in minorities was being undertreated—a bias that data suggest still affects minority and less wealthy patients today. That systematic approach persisted through the 1990s and 2000s and was accompanied by a push from the federal government for doctors to better address their patients’ pain. Big Pharma’s campaign in those decades downplayed the risks of long-term opioid misuse and encouraged use.

Read More:
http://www.foxnews.com/health/2016/04/14/feds-new-war-on-drugs-obama-proposes-1-1-billion-to-expand-care-for-opioid-addicts.html

New Federal Bill to Allow Partial-Fill of Opioid Rx
Practical Pain Management
April 13, 2016

Legislation, the Reducing Unused Medications Act, recently introduced in Congress would allow pharmacists to partially fill prescriptions for opioids at the request of patients or doctors. The legislation is intended to reduce leftover opioids stored in homes.

Read More:
http://www.practicalpainmanagement.com/resources/news-and-research/new-federal-bill-allow-partial-fill-opioid-rx

FDA to Review Remoxy New Drug Application for Pain Management
Lea Eslava-Kim, MPR
April 13, 2016

The FDA has accepted for review a new drug application for Remoxy, an extended-release form of oxycodone that uses Oradur abuse-deterrent technology.

Read More:
http://www.empr.com/drugs-in-the-pipeline/fda-to-review-remoxy-nda-for-pain-management/article/489587

The Stunning Spread of the Opioid and Heroin Epidemic, in One Map
German Lopez, Vox
April 9, 2016

Socrata, a provider of data software solutions, has published maps that contextualize how far and wide the opioid epidemic has spread, showing the rate of drug overdose deaths by county in 2004 and 2014. As the maps show, it is not just that overdose deaths increased as a result of the opioid crisis; these deaths spread to all parts of the country.

Read More:
http://www.vox.com/2016/4/9/11392856/opioid-heroin-epidemic-map

Older Adults’ Health Often at Risk from Too Many Medications, Including Opioids
Celia Vimont, Partnership for Drug-Free Kids
April 13, 2016

An estimated 10,000 people per day turn 65 in the United States. The growing population of older adults who are taking many medications prescribed by different doctors, combined with the growing opioid epidemic, is contributing to the increasing problem of drug misuse among the elderly. Harry Haroutunian, M.D., suggests how children and caregivers of older adults can recognize drug misuse, how they can differentiate it from signs of normal aging, and what they can do about it.

Read More:
http://www.drugfree.org/join-together/older-adults-health-often-risk-many-medications-including-opioids/?utm_source=Stay+Informed+-+latest+tips%2C+resources+and+news&utm
_campaign=72de240f1b-JT_Daily_News_Older_Adults_Health_Often_4_13_2016
&utm_medium=email&utm_term=0_34168a2307-72de240f1b-224293653


Can a Smart Pill Dispenser Curb Prescription Drug Overdoses?
John Bonazzo, Observer
April 8, 2016

MedicaSafe has patented a smart tamper-resistant pill dispenser that requires patients to enter a passcode to access medication. When a doctor prescribes a medication under the MedicaSafe system, it is packaged in a dispenser with a unique ID. Patients must enter a code to get pills, and over each 24-hour period, the MedicaSafe will provide only the daily dose of medication set out in the prescription. The device locks if the patient tries to take extra pills.

Read more:
http://observer.com/2016/04/can-a-smart-pill-dispenser-curb-prescription-drug-overdoses

Of Pills and Planes: Flight Grounded After Students Found with Drugs
Ken Chang, The Review
April 12, 2016

A chartered airplane full of Delaware college students bound for the Bahamas on spring break was diverted to Orlando, Fla., after students were caught snorting Adderall in the airplane bathroom. FBI agents detained for questioning those passengers allegedly involved, according to a witness.

Read More:
http://udreview.com/of-pills-and-planes-flight-grounded-after-students-found-snorting-adderall-on-board/

Marijuana

California Town to Appeal Medical Marijuana Debate to State’s Supreme Court
Liset Marquez, Inland Valley Daily Bulletin
April 13, 2016

An appeals court in California has sided with the California Cannabis Coalition, finding that the city of Upland, Calif., is obligated to hold a special election that could allow three medical marijuana dispensaries because the necessary signatures were gathered to get the initiative on the ballot. City officials will appeal the decision to the state supreme court. They also made the rare request of asking the supreme court to unpublish the appeals court’s opinion due to its possible consequences.

Read More:
http://www.dailybulletin.com/government-and-politics/20160413/upland-to-appeal-medical-marijuana-debate-to-the-supreme-court

Native American Church Can’t Use Pot, Judges Say
Cathy Bussewitz, Associated Press
April 6, 2016

A federal court has ruled that a church for Native Americans in Hawaii should not be excused from federal marijuana laws despite the group’s claim that ingesting cannabis is part of their sacred sacrament. The court said the church did not present enough evidence about the details of its religion. While the federal government will allow the church to use the hallucinogenic drug peyote in religious ceremonies, marijuana will remain illegal.

Read more:
http://www.usnews.com/news/us/articles/2016-04-06/court-native-american-church-not-excused-from-cannabis-laws

Ex-NFL Players Rally Behind Medical Marijuana
Abby Haglag, Daily Beast
April 14, 2016

Thirty former NFL players have teamed up with a cannabis company in California to test medical marijuana as a treatment for chronic pain and depression. The move comes in the wake of increasing reports on the physical and mental anguish retired football players face, including the potentially debilitating brain disease chronic traumatic encephalopathy. A 2007 study published by the American College of Sports Medicine found half of retired professional football players struggle with chronic pain. A 2013 study found that 40 percent suffer from some level of depression.

Read More:
http://www.thedailybeast.com/articles/2016/04/14/ex-nfl-players-rally-behind-medical-marijuana.html

Menstrual Cramps Considered for Medical Marijuana Treatment in New Jersey
Associated Press
April 8, 2016

Lawmakers in New Jersey are considering legislation that would loosen the state’s strict medical marijuana law to allow women to get marijuana-based products to ease menstrual cramps. Other states have not formally extended their laws to include menstrual cramps as an eligible ailment.

Read more:
http://www.courierpostonline.com/story/news/2016/04/08/menstrual-cramps-medical-marijuana-treatment/82798570

Pharmacists Should Be on Front Lines of Medical Marijuana, say Canadian Pharmacists
David Salazar, Drug Store News
April 8, 2016

The Canadian Pharmacists Association is calling for pharmacists to be on the front lines of patient management and dispensing of medical marijuana. Its director, Phil Emberley, said the medication expertise brought forward by pharmacists should play a critical role in the management and monitoring of marijuana, just for other medications. This position marks a reversal for the organization, which had opposed involving pharmacists due to the unproven efficacy of medical marijuana and increased risk for pharmacy thefts.

Read more:
http://www.drugstorenews.com/article/cpha-pharmacists-should-be-front-lines-medical-marijuana

Three Military Veterans Explain What Weed Does for Their Posttraumatic Stress
Tobias Coughlin-Bogue
April 13, 2016

In Santa Cruz, Calif., an organization distributes free marijuana to veterans. Many claim it is useful in treating the symptoms of posttraumatic stress disorder.

Read More:
http://www.thestranger.com/weed/2016/04/13/23950860/three-military-veterans-explain-what-weed-does-for-their-ptsd

Bill Would Broaden Medical Marijuana Access, Expand Production
Kevin Litten, NOLA.com
April 8, 2016

A Louisiana state representative has introduced a bill that would significantly expand the scope of medical marijuana in Louisiana and speed efforts to begin growing and dispensing the drug.

Read more:
http://www.nola.com/politics/index.ssf/2016/04/medical_marijuana_expansion_le.html

What’s Allowed in Ohio’s Medical Marijuana Plan?
Jessie Balmert, Cincinnati.com
April 13, 2016

A group of Ohio lawmakers have announced a plan to provide patients with medical marijuana by 2018. The proposal would allow Ohioans age 18 and older to buy edible marijuana, patches, plant material, and oils with their doctor’s recommendation. A commission would create rules regarding marijuana production within a year after the law passed.

Read More:
http://www.cincinnati.com/story/news/politics/2016/04/13/lawmakers-plan-tackle-medical-marijuana/82938422

Colorado Schools Slow to Allow Medical Marijuana, Lawmakers Want a Change
Bente Birkeland, KUNC
April 13, 2016

Colorado schools may soon be forced to allow students to use medical marijuana in a non-smokeable form while on school grounds. It is already allowed under state law, but no districts have created access policies, leaving many families frustrated. A bill under consideration would require all school districts to allow parents or caregivers to administer medical marijuana on school grounds.

Read More:
http://www.kunc.org/post/colorado-schools-have-been-slow-allow-medical-marijuana-lawmakers-want-change#stream/0

Medical Marijuana Creates Different Challenges for Employers
Brad Allis, Tucson Local Media
April 13, 2016

Arizona legalized medical marijuana a few years ago, but employers are still adjusting to how the law affects their workplace policies. Marijuana, even for medical use, is still illegal under federal law. There are more than 77,000 qualified patients with medical marijuana cards in the state. The average age of cardholders is 44 for men and 48 for women. The top reason for use is severe and chronic pain.

Read more:
http://www.tucsonlocalmedia.com/news/article_a28cd6e2-00d4-11e6-bf4a-23fb24c76279.html

Massachusetts Politicians Form Bipartisan Anti-Marijuana Legalization Coalition
CBS Boston
April 14, 2016

Massachusetts’s governor, Boston’s mayor, state legislators, and healthcare professionals have formed a coalition to oppose a ballot question that would legalize marijuana in the commonwealth. The coalition warns of the harm legalization would cause to young people, citing a 20 percent rise in teen marijuana use in Colorado after the drug was legalized.

Read More:
http://boston.cbslocal.com/2016/04/14/anti-marijuana-legalization-committee-massachusetts-charlie-baker-marty-walsh-robert-deleo

What to Do if Your Employee Asks to Use Medicinal Marijuana at Work
Howard Levitt, Financial Post
April 13, 2016

Although employers are not permitted to ask invasive health questions when an employee requests permission to use medical marijuana in the workplace, employers have several options if they are interested in keeping a drug-free workplace. The author suggests five actions to consider: accommodation, investigation, disclosure, request for information from a physician, and protection of the company’s reputation.

Read More:
http://business.financialpost.com/executive/careers/what-to-do-if-your-employee-asks-to-use-medicinal-marijuana-at-work

Medical Marijuana Advocates Fight New York Roadblocks
Jon Campbell, Democrat and Chronicle
April 12, 2016

Advocates for medical marijuana recently traveled to New York’s capital to push lawmakers to loosen the state’s new law concerning medical use. New York's medical marijuana program only allows physicians—no other healthcare professional with prescribing privileges—to prescribe non-smokeable marijuana and for a limited list of conditions.

Read more:
http://www.democratandchronicle.com/story/news/politics/blogs/vote-up/2016/04/12/medical-marijuana-advocates-fight-ny-roadblocks/82954278/

International

Canada: Abuse Deterrent Opioids Too Expensive
Pat Anson, Pain News Network
April 12, 2016

While the FDA is promoting the development of more opioid pain medication with abuse-deterrent formulas, Canadian health officials are saying the drugs are too expensive and will have little to no effect in the fight against opioid abuse and addiction. Health Canada last week rejected a proposed regulation that would require all medications containing oxycodone to have tamper-resistant properties. According to the Healthcare Bluebook, a Web site that estimates the market price of medications, the fair price for a 60-day supply of OxyContin 20mg in southern California is $352. A 60-day generic version of oxycodone—without abuse deterrence—retails for $138.

Read more:
http://www.painnewsnetwork.org/stories/2016/4/12/canada-abuse-deterrent-opioids-too-expensive

Healthcare System Flaws Hindering Ontario’s (Canada) Response to Fentanyl Crisis
Karen Howlett and Andrea Woo, Globe and Mail
April 10, 2016

A surge in overdose deaths in Ontario, Canada, linked to illicit fentanyl is exposing gaps at every level of the healthcare system, leaving frontline workers who are responsible for monitoring drug use ill-equipped to respond to the crisis. Fentanyl was developed as a prescription pain reliever but gained popularity as a street drug after OxyContin was removed from the market in Canada in 2012. Fentanyl is up to 100 times more toxic than morphine—the equivalent of two grains of salt can kill a healthy adult.

Read more:
http://www.theglobeandmail.com/news/investigations/health-care-system-flaws-indering-ontarios-response-to-fentanyl-crisis/article29582102

Doctor Flagged Six Years Before Drug Charges
The Chronicle Herald
April 13, 2016

A Canadian doctor charged with trafficking opioids was flagged four times between 2010 and 2016 for questionable prescribing practices, according to search warrants filed in the case. She was charged in late February with trafficking 50,000 opioids.

Read more:
http://thechronicleherald.ca/novascotia/1356720-doctor-flagged-six-years-before-drug-charges

Northeast/Mid-Atlantic News

Pennsylvania Governor: Make Life-Saving Medication Available at Schools
Marc Levy, The Daily Item
April 12, 2016

Pennsylvania’s governor recently announced his state has started the application process for 642 public high schools to obtain a free two-dose carton of the heroin antidote naloxone. Pennsylvania is the first state to implement what may serve as a model program. In partnership with Pennsylvania-based pharmaceutical company Adapt Pharma, the program will increase statewide access to naloxone.

Read more:
http://www.dailyitem.com/news/wolf-make-life-saving-medication-available-at-schools/article_4543c88e-00d3-11e6-9473-bb2a8619a969.html

Medical Offices in Princeton Abusing Drug Drop Box, New Jersey Police Say
Keith Brown, NJ.com
April 13, 2016

The prescription drug drop box at Princeton police headquarters has been a success—a bit too successful, in fact. The bin, which is the size of a U.S. Postal Service collection box, has been filled to the brim on occasion. So, the Princeton police checked the video surveillance and realized local medical offices were dumping their expired prescription drugs. These medical facilities are being advised to cease and desist with this practice immediately.

Read more:
http://www.nj.com/mercer/index.ssf/2016/04/princeton_police_to_doctors_offices_stop_it_stop_i.html

Opioid Prescription Debate: Grappling with Pain and the Law in New Hampshire
Mark Hayward, New Hampshire Union Leader
April 9, 2016

The New Hampshire Board of Medicine has preliminarily approved rules for physicians when prescribing opioids. The final proposal still must be reviewed and approved by the Joint Legislative Committee on Administrative Rules then formally adopted by the Board of Medicine.

Read more:
http://www.unionleader.com/Opioid-prescription-debate:-Grappling-with-pain-and-the-law

Maryland Officials Discuss Opioid Epidemic
Mike Davis, MyEasternShoreMD
April 13, 2016

Medical and behavioral health practitioners and law enforcement officials met at Anne Arundel Medical Center in Annapolis, Md., on April 8 to discuss the growing issue of opioid addiction throughout Maryland and how to best serve those in need.

Read more:
http://www.myeasternshoremd.com/news/queen_annes_county/article_e6cec8af-3f5e-5473-904d-86fa28d58ad5.html

South News

Guidelines for Virginia Hospital Emergency Departments Take Aim at Opioid Abuse
Amy Trent, News & Advance
April 12, 2016

Emergency departments across Virginia have received guidelines on how they can help curb the state’s growing opioid abuse epidemic. The 14-point guidelines, which encourage doctors to avoid prescribing opioids and give patients no more than a 3-day supply in extreme cases, were endorsed by the Virginia Hospital & Health Care Association along with the Virginia College of Emergency Physicians. The guidelines aim to address the more than 900 overdose deaths in Virginia in 2013, the majority—more than 500—related to prescription opioids.

Read more:
http://www.newsadvance.com/news/local/rules-take-aim-at-opioid-abuse-state-hospital-association-releases/article_56e1a9b8-3e5f-52d2-9b2f-597732fe9838.html

Fighting Prescription Drug Abuse Gets a Little Easier for Florida Providers, Pharmacists
Martin Dix and Sheryl D. Rosen, JDSupra Business Advisor
April DD, 2016

Beginning July 1, 2016, designees working on behalf of Florida pharmacists and prescribers will be authorized to check the prescription drug monitoring program database and submit reports.

Read more:
http://www.newsadvance.com/news/local/rules-take-aim-at-opioid-abuse-state-hospital-association-releases/article_56e1a9b8-3e5f-52d2-9b2f-597732fe9838.htmlhttp://www.jdsupra.com/legalnews/fighting-prescription-drug-abuse-gets-a-74929/

Commentary: Texas Needs an Open Prescription for Life-Saving Naloxone
Mark Kinzly and Charles Thibodeaux, Austin American-Statesman
April 8, 2016

Texas’s legislature las year passed a bill that allows greater access to naloxone, but the Texas Health and Human Services Commission and the Texas Medical Association have not implemented the law by getting an open prescription in place. This opinion piece calls for the organizations to act.

Read more:
http://www.mystatesman.com/news/news/opinion/commentary-texas-needs-an-open-prescription-for-li/nq2SC

West Virginia Doctor Investigated for Deaths in Opioid Epidemic
Jim Axelrod and Ashley Velie, CBS News
April 13, 2016

A West Virginia physician has written more than 40,000 prescriptions for oxycodone in the last 2 years. Nearly 100 percent of his patients get prescriptions for oxycodone. In the last 2 years, three of the doctor’s patients died after overdosing on a cocktail of pills—including oxycodone—prescribed by him along with pills prescribed by other physicians.

Read more:
http://www.cbsnews.com/news/west-virginia-doctor-michael-kostenko-investigated-for-deaths-in-opioid-painkiller-epidemic

North Carolina Campaign Warns of Danger in Medicine Cabinet
Beth De Bona, The Times-News
April 9, 2016

HopeRx, a community-based prescription drug abuse initiative funded by a SAMHSA grant, is working to spread awareness of the dangers of medication getting into the hands of teens with the “Lock Your Meds” campaign. One in six teens in North Carolina reported that they have taken a prescription medication not prescribed to them. The SAMHSA grant also funded the recent “We Are Hope” campaign that spread awareness to local middle and high school students about substance abuse and misuse.

Read more:
http://www.blueridgenow.com/article/20160409/news/160409842

Midwest News

Ohio Governor Seeks Tighter Controls on Prescription Drugs
Alan Johnson, Columbus Dispatch
April 13, 2016

Ohio will limit prescriptions of narcotic pain pills to 90 days, improving access to medication-assisted drug treatment, and tightening pharmacy licensing requirements. Its governor is proposing mandatory licensing for facilities treating at least 30 patients with buprenorphine, as well as making naloxone available to homeless shelters, halfway houses, and schools. Also proposed were required registration of 42,000 pharmacy technicians; invalidating an opiate prescription unused after 30 days; enacting oversight by the pharmacy board for sole private practitioners who dispense pain relievers; and waiving the requirement that clinics that provide methadone be certified in Ohio for at least 2 years before doing business.

Read more:
http://www.dispatch.com/content/stories/local/2016/04/12/kasich-seeks-tighter-controls-on-prescription-drugs.html

Michigan Representative: Coming Together to Combat the Heroin Epidemic
Rep. Tim Walberg, LenConnect.com
April 8, 2016

According to Rep. Tim Walberg (R-Mich.), the Office of National Drug Control Policy has added Michigan to its list of high-intensity drug trafficking areas, which will bring additional resources to the state.

Read more:
http://www.lenconnect.com/article/20160408/OPINION/160409119

Wisconsin Legislators Combat Addiction Epidemic
royalpurplenews.com
April 12, 2016

In 2015, 255 people died from drug overdoses in Wisconsin, a 53-percent increase from 2012. The governor recently signed a series of bills—part of the Heroin Opioid Prevention and Education (HOPE) agenda—intended to reduce heroin and opioid abuse in Wisconsin.

Read more:
http://royalpurplenews.com/state-legislators-combat-addiction-epidemic

How One Ohio Jail Treats Addicts
Terry DiMio, Cincinnati.com
April 8, 2016

Seventy inmates of the Kenton County (Ohio) Detention Center are part of an evidence-based addiction treatment program that is seeing impressive results. Of 176 inmates who completed treatment at the jail so far, only 10 have re-offended.

Read more:
http://www.cincinnati.com/story/news/2016/04/08/how-one-jail-treats-addicts/82512064

Missouri Politician Cites Privacy in Blocking Prescription Drug Monitoring Program
Join Together Staff, Drug Free
April 13, 2016

In Missouri, the only state without a prescription drug monitoring program, state senator Rob Schaaf is blocking approval of the program because he thinks it represents an invasion of privacy.

Read more:
http://www.drugfree.org/join-together/missouri-politician-cites-privacy-blocking-prescription-drug-monitoring-program

West News

Why California Doctors Shouldn’t Have Their Own Secret Programs to Fight Addiction
Michael Hiltzik, Los Angeles Times
April 8, 2016

Legislation in California, which would reestablish a separate substance abuse program for physicians and keep this information confidential from the Medical Board and a physician’s patients, was scheduled for a committee hearing on April 18. The California Medical Association supports restoring the program, which was abolished in 2008. The bill could set the stage for awarding a lucrative state contract to a treatment program co-founded by the association.

Read more:
http://www.latimes.com/business/hiltzik/la-fi-hiltzik-diversion-20160407-snap-htmlstory.html

Hawaii Drug Treatment Centers See Opiate Addictions Soar
Jim Mendoza, Hawaii News Now
April 11, 2016

Hawaii substance abuse treatment centers are seeing an alarming increase in people addicted to pain medications. Seven percent of adults treated at Hina Mauka treatment facilities on the island of O‘ahu admit to being addicted to opiates. A few years ago it was less than 1 percent. (Video included = 1:58 minutes)

Read more:
http://www.hawaiinewsnow.com/story/31697370/opiate-addiction-alarmingly-high

Four Indicted in Colorado After Patients Die from Illegal Prescription Drugs
Victoria Sanchez, KUSA Channel 9
April 12, 2016

A former Parker, Colo., doctor, office manager, and two pharmacists have been arrested and charged with conspiracy and illegal distribution of prescription drugs that resulted in patients’ deaths. (Video included = 1:40 minutes)

Read more:
http://www.9news.com/news/crime/4-indicted-after-patients-die-from-illegal-prescription-drugs/129614130

Join the Pledge to End Prescription Drug Abuse in Montana
Stefanie Ponte, ABC/Fox Montana
April 13, 2016

Montana Attorney General Tim Fox has pledged to start a conversation in communities on safe disposal and use of prescription drugs, adding that many cases of abuse start with people sharing their medications. (Video included = 0:58 minutes)

Read more:
http://www.9news.com/news/crime/4-indicted-after-patients-die-from-illegal-prescription-drugs/129614130http://www.kfbb.com/story/31716246/join-the-pledge-to-end-prescription-drug-abuse-in-montana

Other Resources

Slideshow: Medical Marijuana
WebMD

This resource has an overview of what medical marijuana is, which medical symptoms and conditions it is used to treat, how it impacts the body, and how it is ingested.

Read more:
http://www.webmd.com/brain/ss/slideshow-medical-marijuana?ecd=wnl_wmh_041316&ctr=wnl-wmh-041316_nsl-ld-stry_img&mb=hnoTiuCzFUom3DvggMSUNeHnVev1imbCHRMIDbuI8u4%3d

Heroin and Other Opioids from Understanding to Action
Partnership for Drug-Free Kids

The Partnership for Drug-Free Kids formally launched its new education initiative “Heroin and Other Opioids: From Understanding to Action” in early April. The program includes two versions of a presentation that can be given by local law enforcement and their community partners, one version to target community mobilization and the other for parent education. The centerpiece is a 1.5 minute film riven by a powerful story and supported with 3-D animation and statistics to illustrate the devastation of the epidemic to communities across America.

Read more:
http://www.drugfree.org/heroin

Webinars

Research into Action Series Webinar
Community Anti-Drug Coalition
Thursday, April 21, 2016
2 p.m. (ET)
http://www.cadca.org/resources/register-now-cadcas-next-research-action-webinar-series-1

Preventing Youth Marijuana Use: Changing Perceptions of Risk
Center for the Application of Prevention Technologies
Thursday, May 19, 2016
2 p.m. (ET)
https://captconnect.edc.org/event/preventing-youth-marijuana-use-changing-perception-risk

Grant Announcements

FY 2016 Harold Rogers Prescription Drug Monitoring Program
Bureau of Justice Assistance
Due: April 26, 2016
http://www.grants.gov/web/grants/search-grants.html
https://www.bja.gov/funding/PDMP16.pdf

NIDA Challenge: Addiction Research: There’s an App for that
National Institute on Drug Abuse
Submission Period begins November 3, 2015, 9 a.m. (ET)
Submission Period ends April 29, 2016, 11:59 p.m. (ET)
http://nida.ideascale.com/a/pages/addiction-research-theres-an-app-for-that

Bottle Tracking Program
National Association of Drug Diversion Investigators
Due: None Specified
http://www.naddi.org/aws/NADDI/pt/sp/programs_grants
http://naddibottletracking.org/law-enforcement

National Take-Back Initiative

National Prescription Drug Take-Back Day
Drug Enforcement Administration
Saturday, April 30, 2016
10:00 a.m. - 2:00 p.m.
http://www.deadiversion.usdoj.gov/drug_disposal/takeback

Take-Back Events & Drop Boxes

National Prescription Drug Take-Back Day set for April 30 in Maine
The Ellsworth American
April 14, 2016
http://www.ellsworthamerican.com/maine-news/cops/national-prescription-drug-take-back-day-set-april-30

Green Brook (N.J.) Police to Collect Unwanted Prescription Medications April 30
TAPinto
April 14, 2016
https://www.tapinto.net/towns/north-plainfield-slash-green-brook-slash-watchung/articles/green-brook-police-department-to-collect-unwanted

Prescription Drug Round-Up April 30th in Washoe County (Nev.)
KOLO Channel 8
April 14, 2016
http://www.kolotv.com/content/news/Prescription-drug-round-up-April-30th-375782661.html

Rockville (Md.) Drug Take-Back Day 2016: When, Where to Get Rid of Drugs
Deb Pelt, Rockville Patch
April 14, 2016
http://patch.com/maryland/rockville/drug-take-back-day-2016-when-where-get-rid-drugs-0

Options to Safely Dispose Unused Prescriptions at Airbase in Fort Lewis (Wash.)
Capt. Dara Shin, Northwest Guardian
April 14, 2016
http://www.nwguardian.com/2016/04/14/24543_options-to-safely-dispose-unused.html

Drug Take-Back Event Is April 30 in Tullahoma (Tenn.)
The Tullahoma Tennessee News
April 15, 2016
http://www.tullahomanews.com/drug-take-back-event-is-april-30/

Susquehanna (Penn.) District Attorney Takes Fight Against Pain Relievers to the Streets
Eric Deabill, PA Homepage
April 14, 2016
http://www.pahomepage.com/news/susquehanna-da-takes-fight-against-painkillers-to-the-streets

Londonderry (N.H.) Police Add 24/7 Drug Take-Back Box
Eli Okun, Union Leader
April 13, 2016
http://www.unionleader.com/article/20160414/NEWS07/160419676/-1/mobile?template=mobileart

Tipton County (Tenn.) Agencies to Participate in Drug Take-Back Effort
The Leader
April 14, 2016
http://www.covingtonleader.com/local-agencies-to-participate-in-drug-take-back-effort-cms-4389

Fort Lee (Va.) Drug Take-Back Day Set
Fort Lee Traveller
April 14, 2016
http://www.ftleetraveller.com/community_life/kenners_corner/drug-take-back-day-set/article_43eae6d6-01b7-11e6-9fe5-e787ee39a225.html

Fairfield (Conn.) Police And U.S. Drug Enforcement Agency Team Up to Take Back Drugs
Kathy Reakes, Fairfield Daily Voice
April 14, 2016
http://fairfield.dailyvoice.com/police-fire/fairfield-police-and-dea-team-up-to-take-back-drugs/651483/

Wayne (N.J.) Police Will Collect Unwanted Prescription Drugs
Debra Winters, Wayne Today
April 14, 2016
http://www.northjersey.com/news/public-safety/unwanted-prescription-drugs-will-be-collected-at-town-hall-1.1544562

Brentwood (Tenn.) to Take Part in Prescription Drug Take-Back Day
Collin Czarnecki, The Tennessean
April 14, 2016
http://www.tennessean.com/story/news/local/williamson/brentwood/2016/04/14/brentwood-take-part-prescription-drug-take-back-day/32583033

Kerrville (Texas) Police Department Offers Drug Disposal
Community Journal
April 14, 2016
http://www.hccommunityjournal.com/news/article_a3a86284-00d0-11e6-8f5e-63fbd44fbfee.html

Upcoming Conferences and Workshops

Marijuana Summit
Smart Approaches to Marijuana and New Jersey Prevention Network
April 28, 2016
Atlantic City, N.J.
http://www.njpn.org/summit2016

Medical Marijuana Seminar
Private Motor Truck Council of Canada
May 3, 2016
Alberta, Canada
http://www.todaystrucking.com/alberta-hosting-spring-talk-on-medical-marijuana-in-trucking
http://www.pmtc.ca/News.asp?a=view&id=113

24th Annual Meeting
Society for Prevention Research
May 31–June 3, 2016
San Francisco, Calif.
http://www.preventionresearch.org/2016-annual-meeting

2016 Annual Conference
International Health Facility Diversion Association
September 13–14, 2016
Duke Energy Convention Center
Cincinnati, Ohio
https://ihfda.org/2016-annual-conference/

Register:
https://www.regonline.com/Register/Checkin.aspx?EventID=1803476

29th Annual National Prevention Network Conference
National Prevention Network
September 13–15, 2016
Buffalo, N.Y.
http://www.npnconference.org

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

Call for Presentations
Online Application Deadline: April 18, 2016, 5 p.m.
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.