SAMHSA Prescription Drug Abuse Weekly Update
Issue 140  |  September 17, 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 Featured Article Journal Articles and Reports Professional Education and Policy Debate National Marijuana International Northeast/Mid-Atlantic News South News Midwest News West News Webinars Grant Awards Grant Announcement National Take-Back Initiative Take-Back Events and Drop Boxes Upcoming Conferences and Workshops


Center for Behavioral Health Statistics and Quality. 2015. Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health. HHS Publication No. SMA 15-4927, NSDUH Series H-50.

The 2014 National Survey on Drug Use and Health shows self-reported adult marijuana use was stable from 2002 to 2008 but then began rising and surged in 2014. Among people ages 26 and older, past-month use rose from 4.0 percent before 2009 to 5.6 percent in 2013 and 6.6 percent in 2014. Among those ages 18–25, use rose from 16.6 percent before 2009 to 19.1 percent in 2013 and 19.6 percent in 2014. In contrast, use by youth ages 12–17 was 7.4 percent, essentially unchanged since 2004.

Past-month nonmedical use of prescription drugs continued its decade-long decline among 18–25-year-olds, falling to 4.4 percent. It was essentially unchanged in other age groups at 2.5 percent overall, 2.6 percent among youth, and 2.1 percent among those ages 26 and over. The pattern was similar when nonmedical use of prescription pain relievers was analyzed separately. Past-month heroin use rose from 0.1 to 0.2 percent of the population—an increase the report noted was statistically significant. Most growth occurred among people ages 26 and older. Past-year heroin use also rose.

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B.T. Kerridge, T.D. Saha, S.P. Chou, H. Zhang, J. Jung, W.J. Ruan, S.M. Smith, B. Huang, and D.S. Hasin. 2015. "Gender and Nonmedical Prescription Opioid Use and DSM–5 Nonmedical Prescription Opioid Use Disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions—III." Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2015.08.026.

According to the National Epidemiologic Survey on Alcohol and Related Conditions—III (April 2012 through June 2013), 12-month and lifetime nonmedical prescription opioid use were greater among men (4.4 percent, 13.0 percent) than among women (3.9 percent, 9.8 percent), while corresponding rates of DSM–5 nonmedical prescription opioid use disorder did not differ between men (0.9 percent, 2.2 percent) and women (0.9 percent, 1.9 percent). Both nonmedical use and use disorder 1) decreased with age, 2) were lower among blacks, Asians/Pacific Islanders, and Hispanics, 3) were lower among people with lower socioeconomic status, and 4) were associated with other substance use disorders, posttraumatic stress, and borderline, schizotypal, and antisocial personality disorders, and only among men, were associated with major depressive disorder, persistent depression, and bipolar I disorder. Only 27 percent of men and 31 percent of women with use disorders had received treatment.

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Journal Articles and Reports

A.A. Artenie, J. Bruneau, É. Roy, G. Zang, F. Lespérance, J. Renaud, J. Tremblay, and D. Jutras–Aswad. 2015. "Licit and Illicit Substance Use Among People Who Inject Drugs and the Association with Subsequent Suicidal Attempt." Addiction, doi:10.1111/add.13030.

Multivariate analysis of biannual 2004–11 surveys of 797 people in Montreal who injected drugs in the 6 months before recruitment found odds of a nonfatal suicide act were 1.89 times higher for those who also regularly used prescription sedative–hypnotics, 2.05 for those who also drank heavily, and 1.84 for marijuana users, relative to those who were not polysubstance users. This study did not collect data on suicide deaths. The analysis excluded 443 (36 percent) of the 1,240 people recruited in the original community-based convenience sample.

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S.E. Back, D.F. Gros, M. Price, S. LaRowe, J. Flanagan, K.T. Brady, C. Davis, M. Jaconis, and J.L. McCauley. 2015. "Laboratory-Induced Stress and Craving Among Individuals with Prescription Opioid Dependence." Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2015.08.019.

This study paid 39 people with prescription opioid dependence and 36 healthy controls to stay at the hospital for 1 night and complete an experiment the following morning. Half of participants were randomly assigned to a task that reliably creates psychosocial stress (Trier Social Stress Task) or a no-stress condition. Individuals with prescription-opioid dependence had significantly larger stress increases than controls. Their opioid craving also increased significantly relative to unstressed opioid users.

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V. Baillif–Couniou, P. Kintz, C. Sastre, P–R. Pos Pok, M. Chèze, G. Pépin, G. Leonetti, and A–L. Pelissier–Alicot. 2015. "Hair Testing in Postmortem Diagnosis of Substance Abuse: An Unusual Case of Slow-Release Oral Morphine Abuse in an Adolescent." Forensic and Legal Medicine, doi:10.1016/j.jflm.2015.08.014.

A 13-year-old girl in France with no history of addiction was found dead with three empty blisters of Skenan® LP (morphine sulfate) 30 mg at her side. Opiates were detected in biological fluids and hair by chromatographic methods. Blood analyses confirmed morphine overdose, and segmental hair analysis confirmed regular exposure over several months. Suspecting the victim's mother of recreational Skenan® use, the magistrate ordered analysis of her hair, but test results were negative. From a toxicological viewpoint, this case demonstrates the value of hair testing, which documented the victim's regular exposure and exonerated the mother.

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L. Brandt, A. Unger, L. Moser, G. Fischer, and R. Jagsch. 2016. "Opioid Maintenance Treatment—A Call for a Joint European Quality Care Approach." European Addiction Research 22:36–51, doi:10.1159/000432395.

This analysis of European Quality Audit of Opioid Treatment data from eight countries compared 746 people who were on at least their second attempt at medication-assisted treatment (MAT), 573 starting a first attempt, 377 who relapsed after MAT, and 360 active opioid users who had never entered MAT. Motives for starting opioid maintenance treatment varied between countries. Transnationally, active opioid users who had previously tried MAT reported concerns about their ability to follow treatment rules and negative treatment experiences as decisive reasons for declining opioid maintenance treatment. Compared with opioid users who had not tried the treatment, MAT patients thought it provided greater flexibility, less pressure to reduce their treatment dose, and greater treatment structure.

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M. Conrardy, P. Lank, K.A. Cameron, R. McConnell, A. Chevrier, J. Sears, E. Ahlstrom, M.S. Wolf, D.M. Courtney, and D.M. McCarthy. 2015. "Emergency Department Patient Perspectives on the Risk of Addiction to Prescription Opioids." Pain Medicine, doi:10.1111/pme.12862.

Four to seven days post-discharge from October 2012 to March 2013, 174 Chicago emergency department patients completed a survey (a 59 percent response rate). All patients were discharged during daytime hours with hydrocodone–acetaminophen prescriptions for acute pain. Mean respondent age was 45; 59 percent were female, and 50 percent were white. One fourth did not know opioids could be addictive.

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N. Dasgupta, M. Jonsson Funk, S. Proescholdbell, A. Hirsch, K.M. Ribisl, and S. Marshall. 2015. "Cohort Study of the Impact of High-Dose Opioid Analgesics on Overdose Mortality." Pain Medicine, doi:10.1111/pme.12907.

Analysis of 2010 data from North Carolina's mandatory prescription monitoring program showed 22.8 percent of state residents were prescribed opioids in 2010. Among licensed clinicians, 90 percent prescribed opioid analgesics, and 40 percent prescribed extended-release formulations. Of 629 overdose deaths, 478 had an active opioid analgesic prescription on the day of their death. Mortality rates increased gradually with prescribed daily milligrams of morphine equivalents. Eighty percent of opioid analgesic patients also received benzodiazepines. Overdose death rates among those co-dispensed benzodiazepines and opioid analgesics were 10 times higher (7.0 per 10,000 person-years) than among those dispensed only opioid analgesics.

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D. Jaber, N. Bulatova, M. Suyagh, A. Yousef, and M. Wazaify. 2015. "Knowledge, Attitude and Opinion of Drug Misuse and Abuse by Pharmacy Students: A Cross-Sectional Study in Jordan." Tropical Journal of Pharmaceutical Research 14(8):1501–08, doi:10.4314/tjpr.v14i8.25.

In a Jordanian survey of 198 pharmacy students (131 undergraduate and 67 graduate students), 92 percent agreed all pharmacy staff must be trained to recognize drug misusers, informed about the kinds of drugs misused in the pharmacy's local area, and trained on how to deal with drug misusers.

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C. Lopez–Quintero, K.B. Roth, W.W. Eaton, L–T. Wu, L.B. Cottler, M. Bruce, and J.C. Anthony. 2015. "Mortality Among Heroin Users and Users of Other Internationally Regulated Drugs: A 27-Year Follow-Up of Users in the Epidemiologic Catchment Area Program Household Samples." Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2015.08.030.

In the U.S. Epidemiologic Catchment Area Program, U.S. National Death Index records through 2007 identified 723 deaths among 7,207 adults tracked since 1980–84, when they were ages 18–48. Estimated cumulative mortality was 12.4 deaths per 1,000 person-years for heroin users, compared with 3.9 deaths per 1,000 person-years for all respondents. Heroin use—even when nonsustained—predicted a 3–4-fold excess risk of premature death, largely from overdose, trauma, and infections (e.g., HIV/AIDS).

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M.C. Lovegrove, N.J. Weidle, and D.S. Budnitz. 2015. "Trends in Emergency Department Visits for Unsupervised Pediatric Medication Exposures, 2004–2013." Pediatrics, doi:10.1542/peds.2015-2092.

According to 2010–13 National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance project data on emergency department visits for unsupervised medication exposures among children under 6, 91 percent involved one medication—most commonly an oral prescription solid (46 percent) or oral over-the-counter medication (35 percent). Among prescription solids, opioids (14 percent) and benzodiazepines (13 percent) were the most common classes.

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A.G. Lydecker, M.K. Griswold, and P.R. Chai. 2015. "Opioid Analgesics and Narcotic Antagonists." Side Effects of Drugs Annual, doi:10.1016/bs.seda.2015.07.012.

This annual review summarizes data from December 2014 to July 2015 publications on adverse reactions to opioid analgesics and narcotic antagonists.

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K. Marchand, H. Palis, D. Peng, J. Fikowski, S. Harrison, P. Spittal, M.T. Schechter, and E. Oviedo–Joekes. 2015. "The Role of Gender in Factors Associated with Addiction Treatment Satisfaction Among Long-Term Opioid Users." Journal of Addiction Medicine, doi:10.1097/ADM.0000000000000145.

Surveying 160 long-term opioid-dependent individuals in Vancouver, Canada, multivariate analysis showed participants who were older, of Aboriginal ancestry, and currently receiving medication-assisted therapy (MAT) had higher MAT satisfaction scores. Participants who had methadone dose preferences of 30 mg or less expressed less satisfaction.

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A. Reisner, L.L. Hayes, C.M. Holland, D.M. Wrubel, M.A. Kebriaei, R.J. Geller, G.R. Baum, and J.J. Chern. 2015. "Opioid Overdose in a Child: Case Report and Discussion with Emphasis on Neurosurgical Implications." Journal of Neurosurgery: Pediatrics, doi:10.3171/2015.4.PEDS14667.

This case study describes a 2-year-old girl who suffered an accidental opioid overdose, presenting with altered mental status that required cardiorespiratory support. Treatment included emergency posterior fossa decompression, partial cerebellectomy, and CSF drainage due to cerebellar edema compressing the fourth ventricle.

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P. Miller, A. Curtis, R. Jenkinson, N. Droste, S.J. Bowe, and A. Pennay. 2015. "Drug Use in Australian Nightlife Settings: Estimation of Prevalence and Validity of Self-Report. Addiction, doi:10.1111/Add.13060.

Researchers conducted 7,028 street intercept surveys in nighttime entertainment districts in Australia between 10 p.m. and 5 a.m. over a 7-month period during 2011–12. They covered three metropolitan Australian cities (Sydney, Melbourne, and Perth) and two regional cities (Wollongong and Geelong). The response rate was 93 percent, with oral drug swabs (the available brand was known to be insensitive to low doses) collected from a subsample of 401 (an 80 percent response rate). Nine percent of participants said they consumed illicit or nonprescribed pharmaceutical drugs prior to the interview, including 7 percent who used psychostimulants. Only 34 percent (n = 63) who reported consuming methamphetamine, cocaine, opiates, cannabis, and/or benzodiazepines earlier in the night returned a positive drug swab result for any of these substances. Of participants who reported no substance use prior to the interview but were swabbed, an additional 16 individuals (6 percent) returned a positive drug swab result. Thus, self-report and the drug swabs used were in substantial disagreement.

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D. Paone, E. Tuazon, M. Stajic, B. Sampson, B. Allen, S. Mantha, and H. Kunins. 2015. "Buprenorphine Infrequently Found in Fatal Overdose in New York City." Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2015.08.007.

Blood from all 98 unintentional drug overdose cases in New York City from June to October 2013 showed all involved multiple substances. Only two tested positive for buprenorphine metabolites.

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C. Vignali, C. Stramesi, L. Morini, F. Pozzi, and A. Groppi. 2015. "Methadone-Related Deaths. An Overview of Ten Years." Forensic Science International, doi:10.1016/j.forsciint.2015.08.017.

Researchers registered 36 fatal methadone poisonings and 111 heroin overdoses among 500,000 residents in Pavia, Italy, over the past 10 years. Two thirds of methadone deaths occurred among individuals in methadone maintenance programs for heroin detoxification; the rest were taking the drug without a medical prescription.

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N. White, R. Ali, B. Larance, D. Zador, R.P. Mattick, and L. Degenhardt. 2015. "The Extramedical Use and Diversion of Opioid Substitution Medications and Other Medications in Prison Settings in Australia Following the Introduction of Buprenorphine–Naloxone Film." Drug and Alcohol Review, doi:10.1111/dar.12317.

Discussions with 21 Australian prison staff and structured interviews with a convenience sample of 60 Medication Assisted Therapy (MAT) clients who reported being incarcerated in the 12 months prior to the interview found the majority of clients were prescribed MAT in prison, with 25 percent diverting all or part of their supervised dose on at least one occasion, 44 percent reporting use of nonprescribed medications, and 14 percent injecting the drug. One third of MAT recipients reported selling/sharing methadone with others in prison—sometimes because they were pressured to share. Introduction of buprenorphine–naloxone film into the prison system changed diversion methods but did not stop diversion.

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Professional Education and Policy Debate

K.T. Brady, J.L. McCauley, and S.E. Back. 2015. "Prescription Opioid Misuse, Abuse, and Treatment in the United States: An Update." The American Journal of Psychiatry, doi:10.1176/appi.ajp.2015.15020262.

This review of 2006–14 literature concludes that numerous federal and state policy and educational initiatives have promoted more responsible opioid prescribing and use. Initial reports suggest diversion and abuse levels have begun to plateau—likely a result of these efforts. Although a large body of research suggests opioid substitution coupled with psychosocial interventions is the best treatment option for heroin dependence, limited research focuses specifically on treatment for prescription opioid dependence. The authors think chronic pain treatment for people with prescription opioid use disorders is underexplored.

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C.S. Davis, T.C. Green, and N.D. Zaller. 2015. "Addressing the Overdose Epidemic Requires Timely Access to Data to Guide Interventions." Drug and Alcohol Review, doi:10.1111/dar.12321.

The U.S. response to its overdose crisis has not used public health tools that have proven effective in combating epidemics. In particular, prescription drug monitoring program data are incomplete, fragmented, and often unavailable to public health analysts. The authors urge a shift in emphasis and resources toward an evidence-based public health approach to overdose prevention.

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J.M. Tetrault and J.L. Butner. 2015. "Non-Medical Prescription Opioid Use and Prescription Opioid Use Disorder: A Review." Yale Journal of Biology and Medicine 88(3):227–33.

This article discusses the epidemiology of nonmedical use of prescription opioids, potential progression to prescription opioid use disorder, state and national efforts addressing addiction and diversion, treatment options, and the impact of "stigma" surrounding opioid use disorder.

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M.F. Weaver. 2015. "Prescription Sedative Misuse and Abuse." Yale Journal of Biology and Medicine 88(3):247–56.

Sedatives are abused for their euphoric effects, which may have dangerous consequences. Some sedative overdoses can be treated with flumazenil, a reversal agent, along with supportive care. Long-term treatment of sedative addiction requires counseling, often with the help of an addiction professional.

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FDA Fears over Possible Mistakes While Administering Long-Term Opioid Painkiller
Guneet Bhatia, International Business Times
September 10, 2015

FDA Staff Flag Likely Dosing Errors with Purdue's Opioid Painkiller
Fox News
September 8, 2015

Food and Drug Administration (FDA) staff expressed concerns about two oxycodone products that recently completed clinical trials. To date, opioids have been taken without regard to food intake. Long-acting Xtampza (from Collegium Pharmaceuticals Inc., using its DeterX technology) is designed to be consumed after eating and provides insufficient pain relief if that instruction is not followed, increasing risks of overuse leading to overdose and addiction. Conversely, fast-acting "abuse deterrent" Avridi (Purdue Pharma) is designed to be taken every 4 to 6 hours on an empty stomach, with insufficient pain relief when taken after eating tending to prompt misuse. Both manufacturers proposed to address the issue through clear labeling. Two FDA advisory panels unanimously recommended approving Xtampza. In contrast, by a 23–1 margin, the panels voted against approving Avridi, stating labeling cannot adequately reduce confusion and associated overdose risk. The FDA is not required to follow the panel's recommendations.

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Opioid Switch to Buccal Buprenorphine May Limit Withdrawal
Pauline Anderson, Medscape
September 11, 2015

Buprenorphine HCl buccal film is a small patch placed on the mucosa of the inner cheek. An as-yet unpublished and very small randomized trial suggests patients taking morphine or oxycodone can be safely switched to buccal buprenorphine without the need for tapering and without significant withdrawal or undertreatment of pain. The delivery system technology is called BEMA (BioErodible MucoAdhesive, Biodelivery Sciences). Thirty-nine adult opioid-dependent patients who received long-term opioid therapy for more than 28 days were randomly assigned to receive BEMA or 50 percent of their normal opioid dose. One patient receiving buccal buprenorphine and two receiving the full agonist experienced significant withdrawal.

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Whitfield–Kennedy Bill to Battle Prescription Drug Abuse Passes House
September 8, 2015

A bipartisan U.S. House of Representatives voted to reauthorize the National All Schedules Prescription Electronic Reporting Reauthorization Act (Whitfield–Kennedy), which provides states grant funding to foster use of prescription drug monitoring programs. The bill heads to the Senate.

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One in Two Adolescents Misuse Their Prescription Drugs, Study Shows
Quest Diagnostics
September 10, 2015

Quest Diagnostics medication compliance testing shows a significant decrease in prescription drug misuse among minors, with 52 percent not using their medications appropriately in 2014 (down from 70 percent in 2011). The greatest decrease occurred in New York and New Jersey.

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As Overdose Deaths Climb, so Does Demand for Their Antidote
Anna Edney, Bloomberg News
September 9, 2015

Naloxone's price has increased tenfold in recent years, leading police, emergency responders, and schools to seek government subsidies to obtain the medication. At least two companies are awaiting approval to enter the market this year with nasal spray versions, competing with four that already make an injectable drug. A kit to turn one of the most popular versions of the antidote into a nasal spray costs about $45 a dose, including $30 for the medicine. The White House has proposed $12 million in the 2016 budget for state grants to fight opioid overdose–related deaths, including money to buy naloxone and train emergency responders to use it.

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Physicians Leading Fight Against Opioid Crisis
September 9, 2015

Prescription-opioid and heroin-related deaths have led to a public health crisis in America. Over the past few years there has been some progress on the national front to begin turning the tide on this crisis, but with 44 people still dying every day from prescription opioid overdose and many more becoming addicted, the epidemic demands increased attention from the entire medical community and all levels of government. New Hampshire is experiencing some of the country's highest numbers of heroin-related deaths, and policymakers have taken bold steps to help enact and support policies to stem the epidemic and save lives. Combating the problem will require comprehensive efforts with specific approaches that must be implemented in all emergency departments, physician practices, outpatient surgical settings, and community health centers. This includes a focused national push to increase availability and access to comprehensive pain treatment options as well as a comprehensive approach to ensure more consistency among state prescription drug monitoring programs.

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You'll Never Guess What's Killing America's Teens
September 10, 2015

A report issued by the Centers for Disease Control and Prevention in July cited a major rise in heroin deaths and overdoses in the United States. More disturbingly, the increases were seen across the board among men and women in most age groups, including teens, and at all income levels. What used to be an almost exclusively inner-city problem is now plaguing small towns and suburbs. Forty-five percent of people who used heroin are also addicted to prescription opioids. That connection presents an even bigger threat to the country's health and economic well-being.

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Couple Calls Out Heroin Overdose in Daughter's Obituary
USA Today
September 8, 2015

Confronted with the sudden death of their 18-year-old daughter, Fred and Dorothy McIntosh Shuemake made a defiant decision: They would not worry about any finger-pointing, whispers, or family stigma. Alison Shuemake's obituary began with the reason for her death—a heroin overdose. The Shuemakes aren't the first grieving American parents to cite heroin in an obituary, as such deaths nearly quadrupled nationally over a decade. In Butler County, Ohio, their home town, the coroner's statistics show heroin-related deaths jumped from 30 in 2012 to 103 in 2014, with 86 recorded already through the first 6 months of 2015.

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A.J. Budney, J.D. Sargent, and D.C. Lee. 2015. "Vaping Cannabis (Marijuana): Parallel Concerns to E-Cigs?" Addiction, doi:10.1111/add.13036.

Vaporization ("vaping") of cannabis makes unsupported claims to offer health benefits by reducing harm from ingesting toxic smoke. Although vaping is being sold as a safer way to use cannabis, no data exist on the health effects of chronic vaping. Users say vaping offers a better taste, has more efficient and intense effects, and allows discreet use in more places. These aspects of vaping could increase the likelihood of trying cannabis, reduce the age of onset, make initial experiences more pleasant, and prompt more frequent use, thereby increasing the likelihood of problematic use or addiction. Sales and marketing of vaping devices with no regulatory guidelines—especially related to advertising or product development targeting youth—parallel concerns under debate related to e-cigarettes and youth. Thus, the quandary of whether or not to promote vaping as a safer method of cannabis administration and how to regulate vaping and vaping devices necessitates substantial investigation and discussion. Addressing these issues in concert with efforts directed toward e-cigarettes may save time and energy and result in a more comprehensive and effective public health policy on vaping.

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K.G. Creswell, T. Chung, D.B. Clark, and C.S. Martin. 2015. "Solitary Cannabis Use in Adolescence as a Correlate and Predictor of Cannabis Problems." Drug and Alcohol Abuse, doi:10.1016/j.drugalcdep.2015.08.027.

Cannabis-using adolescents ages 12–18 were recruited from Pittsburgh-area clinical programs (n = 354) and community sources (n = 93). Participants reported on cannabis use patterns and diagnostic symptoms at baseline and multiple follow-ups into young adulthood. Compared with social-only users, adolescent solitary cannabis users were more likely to be male and report more frequent cannabis use and DSM–IV cannabis use disorder symptoms. Multivariate analysis showed solitary cannabis use in adolescence predicted use disorder symptom counts at age 25, but that relationship was explained by differential use-disorder symptom counts in adolescence.

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A–K. Danielsson, D. Falkstedt, T. Hemmingsson, P. Allebeck, and E. Agardh. 2015. "Cannabis Use Among Swedish Men in Adolescence and the Risk of Adverse Life Course Outcomes: Results from a 20 Year-Follow-Up Study." Addiction, doi:10.1111/add.13042.

In a longitudinal cohort study of 49,321 Swedish men born in 1949–51 who were conscripted into military service at ages 18–20, those who used cannabis at high levels before serving were more likely to be unemployed in the future and receive social welfare assistance. Adjusted for social background, psychological functioning, health behaviors, educational level, and psychiatric diagnoses, the group that had used cannabis at least 50 times had a 1.26 risk of unemployment and a 1.38 risk of social welfare assistance relative to other conscripts. Those using cannabis 1–10 times had a 1.15 risk of social welfare use relative to those who never used marijuana.

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R. Daniulaityte, R.W. Nahhas, S. Wijeratne, R.G. Carlson, F.R. Lamy, S.S. Martins, E.W. Boyer, G.A. Smith, and A. Sheth. 2015. "Time for Dabs": Analyzing Twitter Data on Marijuana Concentrates Across the U.S." Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2015.07.1199.

Dabs are a dose of THC concentrate that is heated on a hot surface, usually a nail, then inhaled, producing an intense high. eDrugTrends collected 125,255 dabs-related tweets between October 20 and December 20, 2014, using Twitter's streaming API. Almost 22 percent contained identifiable state-level geolocation information. Dabs-related tweet volume for each state was adjusted using a general sample of tweets to account for different levels of overall tweeting activity for each state. Adjusted percentages of dabs-related tweets were higher in states that allowed recreational and/or medicinal cannabis use than in states that had not passed such laws.

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D. Feingold, J. Fox, J. Rehm, and S. Lev–Ran. 2015. "Natural Outcome of Cannabis Use Disorder: A 3-Year Longitudinal Follow-Up." Addiction, doi:10.1111/add.13071.

This longitudinal study analyzed wave 1 (2001) and wave 2 (2004) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Of 444 respondents ages 18 and older diagnosed with DSM–IV cannabis misuse or use disorder during the 12 months prior to wave 1, two thirds remitted at follow-up. Of those who remitted, 63 percent were abstinent. Remission was associated with Hispanic ethnicity (odds ratio [OR] 2.6), baseline daily or near-daily use of cannabis (OR 1.9), baseline use of other drugs (OR 1.63), and two or more medical conditions at baseline (OR 8.4). Nonabstinent remission was associated with baseline daily or near-daily use of cannabis (OR 1.9).

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W. Hall. 2015. "U.S. Policy Responses to Calls for the Medical Use of Cannabis." Yale Journal of Biology and Medicine 88(3):257–64.

This paper discusses the evolution of U.S. policy responses to calls for medical cannabis use. It summarizes evidence on the safety and efficacy of cannabinoids for various medical uses and outlines challenges in developing pharmaceutical cannabinoids that are safe, effective, and acceptable to patients. It compares strengths and limitations of different state approaches to medical use, such as allowing access for research trials only, permitting medical necessity as a defense against prosecution, and permitting commercial medical dispensaries to provide cannabis to approved patients. The author argues that liberal definitions of indications for medical cannabis use and commercialization of the medical cannabis supply in California have produced the de facto legalization of recreational cannabis use.

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R.M. Johnson, B. Fairman, T. Gilreath, Z. Xuan, E.F. Rothman, T. Parnham, and C.D.M. Furr–Holden. 2015. "Past 15-Year Trends in Adolescent Marijuana Use: Differences by Race/Ethnicity and Sex." Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2015.08.025.

Data from the National Youth Risk Behavior Survey showed prevalence of lifetime marijuana use in grades 9–12 decreased modestly from 1999 to 2009 (44 percent to 37 percent), then increased slightly, reaching 41 percent in 2013. Other marijuana use variables (e.g., past 30-day use) followed a similar pattern. Male–female differences in marijuana use decreased over time.

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S.J. Kaar, C.X. Gao, B. Lloyd, K. Smith, and D.I. Lubman. 2015. "Trends in Cannabis-Related Ambulance Presentations from 2000 to 2013 in Melbourne, Australia." Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2015.08.021.

Surveillance data showed annual cannabis-related ambulance attendances involving 15–59-year-olds in metropolitan Melbourne rose from 0.6 per 100,000 population in 2000–10 to 5.5 in 2010–13. Both cannabis and cannabis with polydrug use calls jumped. Crystal methamphetamine was the most common illicit co-intoxicant among cannabis presentations in 2013.

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M.J. Krauss, S.J. Sowles, S. Mylvaganam, K. Zewdie, L.J. Bierut, and P.A. Cavazos–Rehg. 2015. "Displays of Dabbing Marijuana Extracts on YouTube." Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2015.08.020.

In January 2015, the authors searched for dabbing-related videos on YouTube. A sample of 116 dabbing videos published by 75 unique channels were viewed and coded for content. The videos had a total of 9,545,482 views. Three fourths of channels focused on marijuana, and 23 percent were located in California. Eighty-nine percent of videos showed at least one person dabbing, and 61 percent of those showed someone dabbing repeatedly. Most dabbers were male (67 percent). One third of the videos reviewed a product; 28 percent provided instructions on dabbing or other educational information; and 21 percent contained at least a brief cautionary message. More than half (54 percent) referenced medical marijuana. Only 20 percent had an age restriction.

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M.E. Morean, G. Kong, D.R. Camenga, D.A. Cavallo, and S. Krishnan–Sarin. 2015. "High School Students' Use of Electronic Cigarettes to Vaporize Cannabis." Pediatrics, doi:10.1542/peds.2015-1727.

In a spring 2014 survey of 3,847 students from five high schools in southeastern Connecticut, 28 percent reported lifetime e-cigarette use, 29 percent reported lifetime cannabis use, 19 percent reported lifetime use of both, and 5.4 percent had vaporized cannabis using e-cigarettes. Vaporizing cannabis using e-cigarettes was common among lifetime e-cigarette users (18.0 percent of that group), lifetime cannabis users (18.4 percent), and lifetime dual users (26.5 percent). Students reported using e-cigarettes to vaporize hash oil (e-cigarettes: 15.4 percent, cannabis: 15.5 percent, dual users: 22.9 percent) and wax infused with THC (e-cigarettes: 10.0 percent, cannabis: 10.2 percent, dual users: 14.8 percent) and using portable electronic vaporizers to vaporize dried cannabis leaves (e-cigarettes: 19.6 percent, lifetime cannabis: 23.1 percent, lifetime dual users: 29.1 percent). Binary logistic regression indicated that male students (odds ratio [OR] 2.05), younger students (OR 0.64), lifetime e-cigarette users (OR 5.27), and lifetime cannabis users (OR 40.89) were most likely to vaporize cannabis using e-cigarettes. These findings raise concerns about the lack of e-cigarette regulations and potential use of e-cigarettes for purposes other than vaping nicotine.

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J.M. Niesink, S. Rigter, M.W. Koeter, and T.M. Brunt. 2015. "Potency Trends of Δ9–THC, Cannabidiol and Cannabinol in Cannabis in the Netherlands: 2005–2015." Addiction, doi:10.1111/add.13082.

From 2005 to 2015, five different cannabis products were bought anonymously in an annual random sample of 50 coffee shops in the Netherlands. The samples included 664 of the most popular Nederwiet, 537 of the supposedly strongest Nederwiet varieties, 183 imported herbal samples, 140 samples of resin made from Nederwiet, and 602 samples of imported cannabis resin. All samples were chemically analyzed for their THC, cannabidiol, and cannabinol content. Mean THC content of the most popular and strongest Nederwiet and imported cannabis resin was 16.0 percent, 17.0 percent, and 16.5 percent, respectively. Imported herbal cannabis was 6.5 percent THC, and cannabis resin made from Nederwiet was 30.2 percent THC. THC content declined over time by 0.22 percent annually. Only imported cannabis resin had a relatively high cannabidiol/THC ratio (0.42).

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L.R. Stanley and R.C. Swaim. 2015. "Initiation of Alcohol, Marijuana, and Inhalant Use by American-Indian and White Youth Living on or Near Reservations." Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2015.08.009.

Student surveys at 32 schools in the Southwest, Northern Plains, and Upper Great Lakes in 2009–12 provide further evidence that American Indian youth living on or near reservations initiate substance use significantly earlier than white youth who attend the same schools. At age 8, the odds of initiating marijuana use by age 17 were 10.5 for American Indian girls (relative to white girls) and 7.0 for American Indian boys (relative to white boys). This differential was 5–6 times the differential in risk of drinking to intoxication or using inhalants.

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H.R. White, J. Bechtold, R. Loeber, and D. Pardini. 2015. "Divergent Marijuana Trajectories Among Men: Socioeconomic, Relationship, and Life Satisfaction Outcomes in the Mid-30s." Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2015.08.031.

In a longitudinal sample of 506 Pittsburgh boys recruited in seventh grade in 1987–88, 408 were re-interviewed in 2009–10 at roughly age 36. The initial sample included an oversample of 255 problem youth (25 later died). Earlier analysis of twice-annual and then annual data from ages 14–26 identified four patterns of marijuana use. A youth's trajectory group had minimal ability to predict frequent and persistent marijuana use in adulthood, with the exception that black youth of lower socioeconomic status who were chronic users in adolescence typically continued chronic use as adults.

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NZ Law Firms Drug Test New Lawyers
Kurt Bayer, New Zealand Herald
September 9, 2015

Top New Zealand law firms are drug testing incoming employees, with testing increasing in the past 18 months. The North Shore–based Drug Detection Agency has 18 law firms signed up for its services; five use its pre-employment drug testing. Hair samples are tested for amphetamines or methamphetamine, prescription medication, cocaine, or THC. A lawyer caught taking drugs breaches Law Society rules and faces being struck off the roll.

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French Club Toulon Denies Involvement in Prescription Drug Probe
September 8, 2015

Rugby players at European Cup holder Toulon reportedly received performance-enhancing drugs, including anabolic steroids and pain medications from local pharmacies in a suspected fraud against France's public health insurance system. Marseilles prosecutor Brice Robin said a formal investigation into the pharmacies was opened last May after France's anti-doping agency sounded the alarm. Toulon's president said none of its team members were implicated.

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Northeast/Mid-Atlantic News

Amid Heroin Scourge, Schools Stock Up on Overdose Antidote
Michelle Smith, The Seattle Times
September 11, 2015

Many schools now keep naloxone on hand, and some states allow or encourage schools to stock it. Rhode Island requires the drug at all middle, junior high, and high schools. Naloxone may never be needed in an individual school, say nurses, officials, and health workers, but it can save a life if a child, parent, or school employee overdoses on heroin or prescription pain pills. Kathleen Gage, a nurse at Pilgrim High School in Warwick, R.I., bought Narcan on her own after attending a lecture and receiving training on the drug. She pushed for the law to require it and even brought it into her 11th grade health classroom, teaching students how to use it and get it at a pharmacy. The National Association of School Nurses is pushing all schools to keep the antidote on hand.

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Opioid Antidote Can Now Be Prescribed by Pharmacists
Ed Stannard, New Haven Register
September 8, 2015

For the first time, Connecticut pharmacists will be able to prescribe naloxone to reverse an opioid overdose. Legislation passed in the last session of the General Assembly enabled pharmacists to become trained and certified to prescribe naloxone and give the treatment kit to patients, caregivers, and family members. Pharmacists could previously dispense the drug but were not permitted to prescribe it.

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Baltimore Fights Heroin Overdoses with Antidote Outreach
September 9, 2015

Heroin is among Baltimore physician Leana Wen's gravest concerns. There were 104 overdose deaths in the city during the first quarter of 2015—a 49 percent increase over the 70 reported during the same period in the previous year. Dr. Wen chairs a committee with a state mandate to review every fatal drug and alcohol overdose. Committee members come from the health department, police department, and other agencies. Many victims repeatedly sought care (or opioid prescriptions) in hospital emergency rooms—some as many as 50 times, and many were repeat drug offenders who were frequently at central booking or the local jail. Dr. Wen sees those points of contact as places to educate people about naloxone. She wants to blanket Baltimore with the drug.

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Tatamy Police Receive Life-Saving Atomizers for Overdose Victims
Pamela Sroka–Holzman, The Express-Times
September 6, 2015

The Tatamy Police Department became the first in Northhampton County, Pa., to carry naloxone atomizers.

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South News

Second Man Charged in Connection with Overdose Death
Spenser Hickey, The Marion Star
September 9, 2015

The federal trial of alleged drug kingpin Eric Creagh continues. A new charge has been filed against a second individual, Rashawn D. Thomas, an alleged associate of Creagh. The indictment charges that Thomas "did aid and abet Eric Lee Creagh in the knowing and intentional distribution of approximately .5 gram of a mixture or substance containing a detectable amount of heroin, a Schedule I controlled substance, and fentanyl, a Schedule II controlled substance, the use of which by Christopher Wolford resulted in the death of Wolford." Wolford, 31, died May 22 during a spike in overdoses in Marion County. Law enforcement linked the overdose spike to the new, stronger heroin and fentanyl mixture, distinguished by a bluish tint that Marion Police Chief Bill Collins said was Creagh's signature.

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Littlest Victims of America's Heroin Epidemic 10News
September 10, 2015

As America's heroin epidemic continues to grow, more hospital rooms are scrambling into action to help babies born into addiction. One of those babies is 2-month-old Azaryah Jackson. A healthy infant now, her life began in rehab where her heroin-addicted mother admitted using the drug while pregnant. Crystal Vanover started using prescription pain pills recreationally 10 years ago. She then moved on to heroin—a more powerful and often cheaper drug—to get the same high. Vanover has been in and out of rehab programs and eventually lost custody of her first three children. She was pregnant with her fourth, Azaryah, when she relapsed again. She finally got help from Freedom House, a women's addiction recovery program in Louisville, Ky.

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Midwest News

Lake County Opioid Initiative: Heroin Law Will 'Save So Many Lives'
Chicago Tribune
September 10, 2015

With a 44–11 vote by the Illinois Senate, the General Assembly completed an override of a veto by Gov. Bruce Rauner to enact a sweeping set of measures for reducing heroin and opiate addiction. House members had already voted 105–5 to override Rauner's veto. Although the governor had supported many sections of the legislation, he based his actions on costs associated with treatment services. Rauner said those provisions would be too expensive considering the state's current financial situation. A section of the legislation dealing with expanded access to naloxone is referred to as "Lali's Law" in honor of Alex Laliberte, who died from a 2008 overdose in Buffalo Grove.

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West News

California Doctor on Trial After 3 of Her Patients Overdose on Painkillers
ABC News
September 3, 2015

California doctor Lisa Tseng is on trial for murder, accused of killing three patients who overdosed on powerful pain medicine she prescribed. Dr. Tseng was aware her patients were misusing those prescriptions—one even overdosed in her office. In opening statements, prosecutors said although Dr. Tseng was informed more than a dozen times that her patients were overdosing, she kept prescribing potent medicines like OxyContin to the point of recklessness. The defense said Dr. Tseng is not guilty—that she's a hard-working mother who never meant to hurt anyone, and that the victims are ultimately responsible for taking more than the prescribed dose and mixing pills with alcohol. (Video: 2:33)



ROSC and MAT Part II: Opioid Treatment Services
Great Lakes Addiction Technology Transfer Center Network
September 23, 2015, 1–2:30 p.m. (EDT)


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

Addressing the Prevention Needs of College Students: Collecting Data and Fostering Buy-In
SAMHSA's Center for the Application of Prevention Technologies
October 1, 2015, 3–4:30 p.m. (EDT)

Grant Awards

State Gets Grant to Curb Opioid Misuse
California Healthline
September 8, 2015

Federal officials awarded a $3.7 million grant to the California Department of Public Health to help prevent prescription opioid misuse. The grant will fund efforts to educate consumers, pharmacists, and prescribing providers about opioid dangers.

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Oklahoma Receives Grant to Fight Prescription Drug Overdose Deaths
September 8, 2015

Oklahoma will get $820,000 as one of 16 states receiving a federal grant. The money will help the state educate providers about overprescribing and patients about abusing prescription drugs, support the Oklahoma Bureau of Narcotics' effort to improve the prescription drug monitoring program, and equip more emergency medical services personnel with naloxone.

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Arizona Gets $3.5M Grant to Address Prescription Drug Addiction
September 8, 2015

The Arizona Department of Health Services is getting a $3.5 million grant from the Centers for Disease Control and Prevention to fight prescription drug addiction. Health Director Cara Christ said her department is equipping providers with the tools they need to prevent and treat addiction.

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Grant Announcement

Prescription Drug Monitoring Program Achieve
State of Pennsylvania
Pre-bid: September 21, 2015
Bid date and time: October 8, 2015, 1 p.m.

This contract seeks an existing Software-as-a-Service (SaaS) solution to host and support a prescription drug monitoring program.

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2016 Grant Funding Cycle
Community Action Coalition
Applications available: September 7, 2015
Deadline: October 16, 2015

Partnership for Clean Competition
Pre-applications due November 1
Full applications due December 1

NIDA Translational Avant-Garde Award for Development of Medication to Treat Substance Use Disorders
U.S. Department of Health and Human Services, National Institutes of Health
Deadline: December 3, 2015

National Take-Back Initiative

National Prescription Drug Take-Back Day
Drug Enforcement Administration
September 26, 2015, 10 a.m. to 2 p.m.
Various locations nationwide

Take-Back Events and Drop Boxes

Division of Public Health Coordinates Prescription Drug Take-Back Day for September 12
September 8, 2015

Worcester Schedules Prescription Drug Take Back, Other Events to Fight Opiate Abuse
Michael D. Kane, MassLive (Massachusetts)
September 7, 2015

Local Police Offering Prescription Drug Collection Kiosks
Brian Benson, The Milford Daily News (Massachusetts)
September 5, 2015

Several Downriver Police Departments Accepting Unused Prescriptions for Disposal
Anne Runkle, The News-Herald (Michigan)
September 4, 2015

Taylor PD Taking Back Unwanted Prescription Drugs
Taylor Press (Texas)
September 5, 2015

Upcoming Conferences and Workshops

SCOPE of Pain Training
Oakland County Prescription Drug Abuse Partnership
October 3, 2015
Waterford, Michigan


Sixth Annual Prescription Drug Abuse Symposium
State of Indiana, Attorney General's Office
October 28–29, 2015
Indianapolis, Indiana


143rd Annual Meeting and Exposition—Health in All Policies
American Public Health Association
October 31–November 4, 2015
Chicago, Illinois


2015 Fall Research Conference: The Golden Age of Evidence-Based Policy
Association for Public Policy Analysis and Management
November 12–14, 2015
Miami, Florida


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


University of Michigan Injury Center Prescription Drug Overdose Summit
University of Michigan Injury Center
December 1, 2015
Ann Arbor, Michigan

Ensuring Access to Pain Care: Engaging Pain Medicine and Primary Care Teams
American Academy of Pain Medicine
February 18–21, 2016
Palm Springs, California

2016 National Rx Drug Summit
March 28–31, 2016
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.