SAMHSA Prescription Drug Abuse Weekly Update
Issue 131  |  July 16, 2015
The Prevention of Prescription Drug Abuse in the Workplace (PAW) TA Center addresses prescription drug abuse—a growing public health problem with increasing burdens on workers, workplaces, and our economy. To subscribe colleagues, family members, or friends to this listserv sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), please click here or send their e-mail addresses to
Table of Content Webinar Featured Article Journal Articles and Reports Professional Education and Policy Debate National Marijuana International Northeast/Mid-Atlantic News Southern News Midwest News West News Other Resources Grants Awarded Grant Announcement Take-Back Events and Drop Boxes Upcoming Conferences and Workshops


Prescription Drug Misuse: A Training for Corporate Medical Staff and MROs
Substance Abuse and Mental Health Administration Preventing Prescription Abuse in the Workplace Technical Assistance Center
August 3, 2015, 3–4:00 p.m. (EST)

The Substance Abuse and Mental Health Services Administration (SAMHSA) Preventing Prescription Abuse in the Workplace (PAW) Technical Assistance Center is hosting a Webinar designed for corporate medical officers and MROs as they address the prescription drug misuse epidemic. This Webinar will provide information on the most commonly misused prescription drugs, their mechanisms of action, the individuals most susceptible to misusing prescription drugs, ways to identify and treat those afflicted, and how to find related educational and technical assistance resources from SAMHSA. Following the Webinar, the panel will be available for a 30-minute discussion.



E.J. D'Amico, J.N. Miles, and J.S. Tucker. 2015. "Gateway to Curiosity: Medical Marijuana Ads and Intention and Use During Middle School." Psychology of Addictive Behaviors, doi.10.1037/adb0000094.

Regression analysis of 2010–11 survey data from 8,214 sixth to eighth graders in Southern California showed greater exposure to medical marijuana advertising was significantly associated with a higher probability of marijuana use in middle school and stronger intentions to use 1 year later.

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Illinois Legislature Passes First-in-Nation Bill for Locking Caps on Painkillers
Business Wire
July 9, 2015

Illinois passed House Bill 3219, which requires pharmacies that opt in to place a non-reusable numerical locking device on prescription hydrocodone containers starting in 2016. This is the first bill of its kind in the United States. If signed by the governor, the mandate would be tested for 1 year.

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Journal Articles and Reports

L. Berends, A. Larner, and D. Lubman. 2015. "Delivering Opioid Maintenance Treatment in Rural and Remote Settings." Australian Journal of Rural Health, doi:10.1111/ajr.12217.

This study describes the opioid maintenance treatment system in 2009 in a large, sparsely populated section of New South Wales, Australia. Three service hubs co-located with hospitals and a fourth in community health all provided assessment, prescribing, dispensing, and limited case management. Most staff were nurses, while prescribers were visiting specialists or sessional general practitioners. There was minimal opioid maintenance treatment provision by community prescribers and dispensers. The system served 638 clients across Australia who were younger (on average) than those in opioid maintenance treatment. The principal drug of concern was heroin (four fifths of clients); about one fifth identified prescription opioids as the problem. Opioid maintenance treatment demand rose substantially from 2006 to 2009.

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L. Gjersing and A.L. Bretteville–Jensen. 2015. "Are Overdoses Treated by Ambulance Services an Opportunity for Additional Interventions? A Prospective Cohort Study." Addiction, doi:10.1111/add.13026.

In Oslo, Norway, researchers street-recruited 172 people who injected drugs in 1997 and followed them through 2004. Ambulance services treated 54 percent of participants for an overdose during follow-up. The mortality rate was 2.8 per 100 person-years for those with an overdose, and 3.3 for those without; the adjusted hazard ratio was 1.3. The mortality hazard ratio for individuals who overdosed ranged from 9.4 in the month following the overdose to 13.9 in the 5-year period.

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H. Guarino, L.A. Marsch, S. Deren, S.L.A. Straussner, and A. Teper. 2015. "Opioid Use Trajectories, Injection Drug Use and HCV Risk Among Young Adult Immigrants from the Former Soviet Union Living in New York City." Journal of Addictive Diseases, doi:10.1080/10550887.2015.1059711.

At an unstated date, the authors interviewed a snowball sample of 40 immigrants ages 18–29 from the former Soviet Union who were living in New York City and using opioids, and 40 more being treated for opioid use disorders. Eighty-five percent started by misusing prescription opioids, but half were primarily taking heroin. Progression to daily use typically took a year after initiation. Half those in treatment were still using.

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S.E. Heins, D.R. Feldman, D. Bodycombe, S.T. Wegener, and R.C. Castillo. 2015. "Early Opioid Prescription and Risk of Long-Term Opioid Use Among US Workers with Back and Shoulder Injuries: A Retrospective Cohort Study." Injury Prevention, doi:10.1136/injuryprev-2015-041630.

Among 27,519 American International Group workers' compensation claimants treated with opioids for back injuries between 1999 and 2010, those prescribed the drugs within 1 month after injury had 33 percent lower odds of using opioids for at least 3 months. Conversely, of 10,655 treated with opioids for shoulder injuries, those who received early prescriptions had 29 percent higher odds of longer-term use. Odds of longer-term use were greater for patients with non-specific diagnoses.

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W.M. Hooten, J.L. St. Sauver, M.E. McGree, D.J. Jacobson, and D.O. Warner. 2015. "Incidence and Risk Factors for Progression from Short-Term to Episodic or Long-Term Opioid Prescribing." Mayo Clinic Proceedings 90(7):850–56, doi:10.1016/j.mayocp.2015.04.012.

Among 142,377 adults in the Mayo Clinic's Rochester Epidemiology Project medical records linkage system, 1 year of follow-up data on 293 patients with a first prescription for an opioid analgesic in 2009 found patients received 515 opioid prescriptions total. One fifth progressed to a periodic prescribing pattern, and 6 percent progressed to a long-term prescribing pattern. In multivariable logistic regression analyses, past or current nicotine use and a history of substance use disorder were significantly associated with a periodic or long-term prescribing pattern as opposed to a short-term pattern.

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C.M. Jones, J. Logan, R.M. Gladden, and M.K. Bohm. 2015. "Vital Signs: Demographic and Substance Use Trends Among Heroin Users—United States, 2002–2013." Morbidity and Mortality Weekly Report 64:1–7.

Multivariate analysis of 2002–13 National Survey on Drug Use and Health and National Vital Statistics System data showed rates of heroin misuse or use disorder and heroin-related overdose deaths predictably were strongly positively correlated. During 2011–13, odds of past-year heroin misuse or use disorder were highest among those with past-year cocaine or opioid pain reliever misuse. Annual average rates of self-reported past-year heroin use increased from 1.6 per 1,000 persons older than 12 during 2002–04 to 2.6 per 1,000 during 2011–13.

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C.M. Jones and J.K. McAninch. 2015. "Emergency Department Visits and Overdose Deaths from Combined Use of Opioids and Benzodiazepines." American Journal of Preventive Medicine, doi:10.1016/j.amepre.2015.03.040.

Drug Abuse Warning Network data indicate that from 2004 to 2011, the rate of nonmedical use–related emergency department visits involving both opioid analgesics and benzodiazepines increased from 11.0 to 34.2 per 100,000 people. During the same period, Vital Statistics show that overdose deaths involving both drugs increased from 0.6 to 1.7 per 100,000. Benzodiazepine involvement increased from 18 percent of opioid analgesic overdose deaths in 2004 to 31 percent in 2011.

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L.A. Lin, A.S.B. Bohnert, M.A. Ilgen, P.N. Pfeiffer, D. Ganoczy, and F.C. Blow. 2015. "Outpatient Provider Contact Prior to Unintentional Opioid Overdose Among VHA Service Users." Psychiatric Services, doi:10.1176/

Of the 1,813 Veterans Health Administration (VHA) patients nationwide who died from unintentional prescription opioid overdoses in fiscal years 2004–07 and who used VHA services anytime within 2 years before their deaths, 1,457 were last seen in outpatient settings. Of the outpatients, 33 percent were seen within 1 week before their overdose, and 62 percent were seen within 1 month prior, with 30 percent receiving mental health or substance use disorder treatment. Only 14 percent filled an opioid prescription at their last outpatient visit.

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J. Neale and J. Strang. 2015. "Naloxone—Does Over-Antagonism Matter? Evidence of Iatrogenic Harm After Emergency Treatment of Heroin/Opioid Overdose." Addiction, doi:10.1111/add.13027.

This article reanalyzed 70 face-to-face interviews conducted in two Scottish cities during 1997–99 within a few hours of hospital-treated heroin/opioid overdose, and 130 additional interviews with illicit opiate users at drug services or pharmacies. Data were generated from emergency departments, drug services, and pharmacies. Respondents had limited knowledge of naloxone and its pharmacology, yet routinely described it in negative terms and were critical of its medical administration. In particular, they complained naloxone induced acute withdrawal symptoms, causing patients to refuse treatment, become aggressive, discharge themselves from the hospital, and take additional street drugs to counter its effects. Participants believed hospital staff should administer naloxone selectively and cautiously and prescribe counter-naloxone medication if dosing precipitated withdrawals. In contrast, observational data indicated participants did not always know they had received naloxone and hospital doctors did not administer it incautiously.

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S.W. Patrick, M.M. Davis, C.U. Lehman, and W.O. Cooper. 2015. "Increasing Incidence and Geographic Distribution of Neonatal Abstinence Syndrome: United States 2009 to 2012." Journal of Perinatology, doi:10.1038/jp.2015.36.

Analysis of Healthcare Utilization Program Kids' Inpatient Database and Nationwide Inpatient Sample data showed neonatal abstinence syndrome incidence increased nationally from 3.4 per 1,000 hospital births in 2009 to 5.8 in 2012. Related aggregate hospital charges ranged from $732 million to $1.5 billion, with 81 percent charged to state Medicaid programs. The highest incidence rate was 16.2 per 1,000 in the East South Central Division (Kentucky, Tennessee, Mississippi, and Alabama); the lowest was 2.6 in the West South Central Division (Oklahoma, Texas, Arkansas, and Louisiana).

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C. Ringwalt, S. Schiro, M. Shanahan, S. Proescholdbell, H. Meder, A. Austin, and N. Sachdeva. 2015. "The Use of a Prescription Drug Monitoring Program to Develop Algorithms to Identify Providers with Unusual Prescribing Practices for Controlled Substances." The Journal of Primary Prevention, doi:10.1007/s10935-015-0397-0.

The most valid prescription drug monitoring program (PDMP) metrics to identify providers manifesting unusual and uncustomary prescribing practices are co-prescribing opioids and benzodiazepines (e.g., valium), prescribing high levels of opioid analgesics, and writing temporally overlapping prescriptions, according to an analysis of North Carolina PDMP and Vital Statistics data. These metrics pinpointed prescribers whose patients were at high risk of death.

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Professional Education and Policy Debate

R.N. Jamison and J. Mao. 2015. "Opioid Analgesics." Mayo Clinic Proceedings 90(7):957–68, doi:10.1016/j.mayocp.2015.04.010.

This article discusses the role of psychiatric comorbidity and validated assessment tools to identify individuals at greatest risk for opioid misuse. It also describes interventional treatment and clinical management strategies for patients with chronic pain who are at risk for misusing opioids.

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S.E. Nadeau. 2015. "Opioids for Chronic Noncancer Pain." Neurology, doi:10.1212/WNL.0000000000001766.

The recent American Academy of Neurology position paper by Franklin, "Opioids for Chronic Noncancer Pain," suggests the benefits of opioid treatment are likely to be substantially outweighed by the risks, and it recommends avoiding doses above 80–120 mg/day morphine equivalent. The author of this review disagrees.

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Top 20 States for Pharmacy Robberies
Mark Lowery, Drug Topics
June 30, 2015

During the first 5 months of 2015, Indiana had 68 of the nation's 382 armed pharmacy robberies—the most of any state, followed by Wisconsin, with 32.

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Amphastar Is Criticized by Lawmaker Over Pricing for Its Heroin Antidote
Ed Silverman, The Wall Street Journal
July 8, 2015

U.S. Representative Cummings sent a letter to Maryland state officials suggesting drug maker Amphastar is overcharging for naloxone. Cummings cites reports that state agencies were paying $41 a dose—a 111 percent increase from June 2014. He urged Maryland Governor Hogan to negotiate rebates, as New York and Ohio have done.

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Resigned Toyota Exec Won't Be Charged with Drug Crimes
Laura Lorenzetti, Fortune
July 8, 2015

Julie Hamp, the recently resigned Toyota executive, was released from a Japanese jail and will not be charged with illegally importing prescription drugs. Prosecutors determined the move was "not malicious."

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Prescription Drug Addiction in Young Athletes
Deborah Huddleston, Metropolitan Drug Commission
July 7, 2015

When pain relievers mask a sports injury, not allowing the body to heal properly before returning to the field, it can lead to drug addiction among young athletes. The American Academy of Pediatrics Council on Sports Medicine and Fitness recommends young athletes limit their sports-specific activities to 5 days a week, with 1 full day of rest from all physical activity. In addition, the council recommends young student athletes take at least 2 months off from a specific sport to properly rest and rebuild their bodies.

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Lucideon Publishes White Paper on Pharmaceutical Abuse Deterrence
July 7, 2015

A white paper written by an international materials technology company discusses requirements for abuse-deterrent solutions for pharmaceutical products and the technologies in place and emerging to meet them.

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Recreational Marijuana Is Now Legal in Oregon
Lucy Perkins, NPR
July 1, 2015

On July 1, 2015, recreational marijuana became legal in Oregon. Residents 21 and older can possess up to 1 ounce of marijuana when away from home and up to 8 ounces at home. It is legal to grow up to four plants per household; however, only medical marijuana patients can legally buy the drug. This article lists seven ways people can get in trouble under the law.

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Appeals Court Again Favors Medical Pot Patient in Workers' Comp Claim
Steve Terrell, The Santa Fe New Mexican
July 8, 2015

The New Mexico Court of Appeals has ruled that a patient in the state's Medical Cannabis Program who was injured on the job must be reimbursed by an employer for the cost of marijuana used in treatment. This is the third time since May 2014 the appeals court has ruled in favor of a medical marijuana patient in a workers' compensation claim. In the most recent case, American General Media and Gallagher Bassett Services, a third-party workers' compensation administrator, argued the state's medical marijuana law created a conflict with the federal Controlled Substances Act, which prohibits all marijuana use. The judge wrote "federal public policy was ambiguous in contrast with New Mexico's clear public policy expressed in the [state] Compassionate Use Act." His ruling refers to a 2013 U.S. Department of Justice memo that says when it comes to medical marijuana, the federal government "would generally defer to state and local authorities."

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Seven Million Drug Addicts in Pakistan
The Citizen Bureau
July 7, 2015

Of Pakistan's 7 million drug users, 3 million use medicines without a prescription. According to the Director General of Anti-Narcotics Force, far more Pakistanis die from drug use than from terrorism: 700 versus 39 a day.

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Music Festival Will Test Your Drugs so You Don't Overdose
Beckie Strum, New York Post
July 7, 2015

Concertgoers at the Evolve Festival in Nova Scotia, Canada, can submit a sample of their "mind enhancers" to festival staff, who will test the drugs and provide a breakdown of their chemical makeup. The organizers hope this will reduce overdoses.

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Research to Unlock Study Doping Facts
Medical Press
July 10, 2015

University of Queensland doctoral candidate Charmaine Jensen is studying Australian university students' attitudes toward and experiences with taking prescription drugs to improve study sessions. She is seeking survey respondents.

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Northeast/Mid-Atlantic News

Lepage Signs Bill Funding Diversion Alert Drug Program
Jen Lynds, Bangor Daily News
July 8, 2015

Maine's governor signed LD 1307, An Act to Fund the Maine Diversion Alert Program, authorizing $95,000 to back 1 year of the program's operation. Every month, the Diversion Alert Program distributes a list of local individuals arrested or summoned for prescription or illegal drug–related crimes to prescribers, pharmacists, and law enforcement agencies registered to receive the alerts.

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New Jersey Cranks Up Its Efforts to Fight Opioid Addiction, Deaths
Andrew Kitchenman, New Jersey Spotlight
July 9, 2015

Three bills that await New Jersey governor Christie's signature would require doctors to check the prescription drug monitoring program database when writing new scripts, allow people in drug court to receive medications like methadone (to assist in their treatment), and compel state colleges to provide housing for students recovering from addiction.

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Deaths from Fentanyl-Laced Heroin Surge
Meredith Cohn, The Baltimore Sun
July 6, 2015

Baltimore health officials announced a campaign to educate heroin users about the danger of fentanyl in street-sold drugs. The city linked 39 deaths to fentanyl in the first quarter of 2015—nearly three times the number recorded over the same period last year. (Includes video: 54 seconds)

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Southern News

Heroin Deaths Still Rising in Capital Region
Mark Armstrong, WBRZ
July 7, 2015

The East Baton Rouge Coroner's Office is concerned heroin overdose deaths could reach record highs this year. They think the increase is caused by reduced mandatory sentencing for possession and tighter controls on prescription pain medicine. The Livingston Parish Coroner's Office also reported an increase in heroin-related deaths.

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Midwest News

Governor Establishes Michigan Prescription Drug and Opioid Abuse Task Force
The Herald-News
July 2, 2015

Governor Snyder announced the initiation of the Michigan Prescription Drug and Opioid Abuse Task Force to address related deaths. The task force will examine trends, evaluate strategic options, and develop a statewide action plan by fall 2015. The fiscal year 2016 budget includes $1.5 million to support this effort.

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More 'Drugged' Drivers Hitting Iowa Roads, Officials Say
Shaina Humphries, KCCI
July 2, 2015

Iowa Department of Public Safety officials said more people are driving under the influence of opiate pain relievers. (Includes video: 2:04 minutes)

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Addicted: Young Adults in Wisconsin Battle Heroin Rise
Robin Opsahl, Wausau Daily Herald
July 2, 2015

Heroin use is rising among young adults in Wisconsin. The Division of Public Health reported that use typically starts at age 21, and 80 percent of young heroin users started within 3 years of abusing opiate drugs such as oxycodone. Several initiatives are teaching youths about heroin's dangers. Rise Together, for example, sends recovering addicts to schools to talk about their experiences. And the University of Wisconsin Marathon County's Student Government Association hosted a heroin summit last spring.

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High Schoolers' Heroin Use Prompts Survey
Jonathon Anderson, Marshfield News Herald
July 2, 2015

The Marshfield Area Coalition for Youth and Marshfield Clinic Center for Community Outreach launched an online survey to assess public knowledge of illicit prescription drugs and heroin. The survey results will be used to craft a more focused public awareness campaign.

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Union County Begins Deployment of Heroin Overdose Prevention Kits
Joe Clark, WCMH
July 2, 2015

With overdose calls rising, Union County, Ohio, has equipped its law enforcement officers with naloxone.

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West News

Drugged Driving Cases on Rise in San Diego
Dana Littlefield, San Diego Union-Tribune
July 4, 2015

San Diego's deputy city attorney is handling a growing number of driving under the influence (DUI) cases that involve drugs or a combination of drugs and alcohol—about four to five per week. Roughly 65 percent of cases involve some type of prescription drug, and 5 to 10 percent involve illegal drugs. The rest are marijuana cases. In the 6 months after California law changed in January 2014 to codify drug-related DUI, San Diego filed charges in 57 cases—54 of which resulted in convictions.

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Other Resources

The Partnership for Drug-Free Kids Unveils New Multimedia Youth Campaign Using Emojis to Let Teens Know #WeGotYou
Jose Feliz, Partnership for Drug-Free Kids
July 7, 2015

The Partnership for Drug-Free Kids launched a multimedia campaign for teenagers called "#WeGotYou." Written in emojis and anchored in a mobile experience, the campaign directs teens to a mobile website through digital out-of-home, cinema, mobile, social, pre-roll, and print advertising. Individual emoji sentences act as cryptic messages, encouraging teens to "crack the code" via a unique URL at the end of each ad. Teens are provided with thought-provoking facts and empowering messages and have the ability to submit their own emoji sentences to the site.

Read more:

Return on Investment (ROI) Calculator for EAPs
Chestnut Global Partners
Accessed July 8, 2015

This return on investment tool works with or without the Workplace Outcome Suite© and allows the user to enter his or her specific employee assistance program and customer data, which combines with economic data by industry and region. The flexible input fields let people create customized calculations for each employer group.

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Grants Awarded

Vermont Gets $12.4M Grant for Substance Abuse Prevention
The Oklahoman
July 6, 2015

Vermont was awarded a $12.4 million federal grant to expand a program aimed at reducing underage drinking, marijuana use, and prescription drug misuse among 12- to 25-year-olds. The program will expand to Addison, Bennington, Caledonia, Essex/Orleans, Franklin, and Windsor counties.

Read more:

Grant Announcement

Partnership for Clean Competition
Pre-applications due March 1, July 1, and November 1
Full applications due April 1, August 1, and December 1

2015 Healthy Living Grant Program
American Medical Association
Deadline: September 11, 5 p.m. Central

Take-Back Events and Drop Boxes

Somers Take-Back Campaign Yields 150 Pounds of Prescription Drugs
Carol Reif, The Daily Voice (New York)
July 6, 2015

Alabaster Residents Can Dispose of Prescription Drugs Any Time at Police Department
Brianne Britzius, WBRC (Alabama)
July 7, 2015

JPD Installs Box for Unwanted Pills
Emily Russo Miller, Juneau Empire (Alaska)
July 10, 2015

Prescription Drug Drop Boxes
Town of Florence (Arizona)
Accessed July 8, 2015

Prescription Drugs Can Be Safely Dropped Off at Local Police Stations
Victoria Berkow, Pioneer Press (Illinois)
July 2, 2015

Drug Take-Back Program Gains Momentum
Erica Gibson, WBAA (Indiana)
July 9, 2015

Aberdeen Police Department Sets Up Prescription Drug Return Kiosk
The Baltimore Sun (Maryland)
July 9, 2015

Police Department Installs 24-Hour Drug Drop Off Kiosk in Lawrence
North of Boston Magazine (Massachusetts)
July 2015

Maple Grove Has New Prescription Drug Drop-Off Site
Northwest Community Television (Minnesota)
July 9, 2015

Secure Drop Box at MSC Seen as Anti-Abuse Tool
Nate Ellis, Upper Arlington News (Ohio)
July 8, 2015

Grand Opening Held for New Palacios PD Prescription Drug Drop Box
KKHA (Texas)
July 9, 2015

Upcoming Conferences and Workshops

Mid-Year Training Institute
Community Anti-Drug Coalitions of America
August 2–6, 2015
Indianapolis, Indiana


Fourth Annual Generation Rx University Conference for Collegiate Prevention and Recovery
The Ohio State University College of Pharmacy
August 4–6, 2015
Columbus, Ohio

Prescription Drug and Heroin Conference
Berrien Community Foundation
August 28, 2015, 8 a.m. to 4 p.m.
St. Joseph High School Auditorium
2521 Stadium Drive
St. Joseph, Michigan 49085

This conference will cover various topics related to prescription drug and heroin use, including medically assisted recovery and the role of drug courts in the heroin epidemic.

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28th Annual National Prevention Network Conference: Bridging Research to Practice
National Prevention Network
November 17–19, 2015
Seattle, Washington


2016 National Rx Drug Summit
March 28–31, 2016
The Westin Peachtree Plaza
Atlanta, Georgia
The Weekly Update is a service provided by the SAMHSA Preventing Prescription Abuse in the Workplace Technical Assistance Center (PAW) to keep the field abreast of recent news and journal articles to assist in forming policy, research, and programs to reduce prescription drug misuse or abuse. Please note, the materials listed are not reflective of SAMHSA's or PAW's viewpoint or opinion and are not assessed for validity, reliability or quality. The Weekly Update should not be considered an endorsement of the findings. Readers are cautioned not to act on the results of single studies, but rather to seek bodies of evidence. Copyright considerations prevent PAW from providing full text of journal articles listed in the Weekly Update.