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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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S. Ramirez, V.S. Bebarta, S.M. Varney, V. Ganem, L.A. Zarzabal, and J.S. Potter. 2016. “Misuse of Prescribed Pain Medication in a Military Population—A Self-Reported Survey to Assess a Correlation with Age, Deployment, Combat Illnesses, or Injury?” American Journal of Therapeutics [Epub ahead of Print]
Thirty-one percent of patients in an emergency department waiting room at a military tertiary care hospital in San Antonio admitted to misusing opioids, according to an anonymous survey that drew 500 responses over three weeks. The most common form of misuse was using a previously prescribed medication for a new pain. Respondents with a traumatic brain injury (TBI) were less likely to misuse opioids. Among those diagnosed with a TBI or posttraumatic stress disorder, younger respondents who had been deployed in the past 5 years were more likely to report misusing opioids.
Read more:
http://www.ncbi.nlm.nih.gov/pubmed/26963723
FDA Announces Enhanced Warnings for Immediate-Release Opioids
FDA
March 22, 2016
The FDA is requiring a new boxed warning on all prescription opioid products about the serious risks of misuse, abuse, addiction, overdose, and death. The FDA also is requiring other safety labeling changes that add information on risk, including a statement that immediate-release opioids should be reserved for pain that is severe enough to require opioid treatment and for which alternative treatment options are inadequate or not tolerated. Dosing information also will provide clearer instructions regarding patient monitoring and drug administration, including initial dosage, dosage changes during therapy, and a warning not to abruptly stop treatment in a physically dependent patient. A warning will state that chronic maternal use of opioids during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated using protocols developed by neonatology experts. Updated labeling on all opioids also will include safety information about potentially harmful interactions with other medicines that can result in a serious central nervous system condition called serotonin syndrome.
Read more:
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm491739.htm?source=govdelivery&utm_medium=email&utm_source=govdelivery
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Journal Articles and Reports
S. Darke, C. Marel, K.L. Mills, J. Ross, T. Slade, and M. Tessson. 2016. “Years of Potential Life Lost Amongst Heroin Users In The Australian Treatment Outcome Study Cohort, 2001–2015.” Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2016.03.010.
Among a cohort of 615 heroin users in Australia observed between 2001 and 2015, 72 (11.7 percent) had died by 2015, with a crude mortality rate of 9.2 per 1,000 person-years. The most common cause of death was opioid overdose (52.8 percent). Neither age nor sex was associated with mortality. The standardized mortality ratio (mortality rate for this group divided by the population mortality rate matched by age and sex) was 10.2 (males = 7.3 and females = 17.2). Before age 65, 1,988 years of potential life were lost to these deaths, with a mean of 27.6 (males = 27.6 and females = 27.7). Through actuarial lifespan, 3,135 years of potential life were lost, with a mean of 43.5 (males = 41.9 and females = 46.3). Based on lifespan, accidental overdose (63.7 percent) and suicide (13.3 percent) accounted for most of the potential life years lost, where cause of death was known.
Read more:
http://www.drugandalcoholdependence.com/article/S0376-8716(16)00152-6/abstract
A.M.D. Cruz, T. Carmody, T.L. Greer, C.D. Rethorst, D. Warden, R. Walker, and M.H. Trivedi. 2016. “Baseline Medical Comorbidities in Adults Randomized in the STRIDE Trial for Psychostimulant Use Disorders.” American Journal on Addictions, doi: 10.1111/ajad.12363.
For this study, researchers analyzed baseline data on 299 treatment-seeking adults with stimulant use disorder who participated in the multisite Stimulant Reduction Intervention using Dose Exercise randomized controlled trial. The majority (59 percent) of participants did not report any history of other medical problems. The 19 percent with two or more conditions reported more pain, worse physical functioning, and more psychiatric disorders. Hypertension was more common among the 59 percent of participants with cocaine use disorders only, and liver disease was more common in the 11 percent with cocaine and other stimulant use disorders than in the 30 percent with only other stimulant disorders.
Read more:
http://onlinelibrary.wiley.com/doi/10.1111/ajad.12363/abstract
K.A. Hirchak and S.M. Murphy. 2016. “Assessing Differences in the Availability of Opioid Addiction Therapy Options: Rural Versus Urban and American Indian Reservation Versus Nonreservation.” Journal of Rural Health, doi:10.1111/jrh.12178.
The number of opioid agonist therapy clinics in Washington per 10,000 ZIP code residents was significantly lower in rural areas compared to urban areas but did not differ significantly between American Indian reservation/trust land and other areas, according to Drug Addiction Treatment Act waiver data. Waivered physicians per 10,000 ZIP code residents did not differ significantly in either comparison.
Read more:
http://www.ncbi.nlm.nih.gov/pubmed/26987797
R.N. Jamison, M.O. Martel, C.C. Huang, D. Jurcik, and R.R. Edwards. 2016. “Efficacy of the Opioid Compliance Checklist to Monitor Chronic Pain Patients Receiving Opioid Therapy in Primary Care.” Journal of Pain, 17:4, 414–23.
This study validated the eight-item Opioid Compliance Checklist for use in primary care. As part of a larger study, 177 chronic pain patients recruited from eight primary care centers in Massachusetts completed the checklist. Patients treated at these centers reported fewer incidences of misuse than patients from pain specialty centers in the larger study. Among the primary care patients, three items from the checklist were most predictive of opioid misuse, but the eight-item checklist provided equally adequate identification The best cutoff for risk of misuse was one or more positive responses, but its predictive value was not stellar (sensitivity = .60, specificity = .65, positive predictive value = .38, negative predictive power = .82).
Read more:
http://www.jpain.org/article/S1526-5900(15)00980-3/abstract
E.A. Karanges, B. Blanch, N.A. Buckley, and S.A. Pearson. 2016. “Twenty-Five Years of Prescription Opioid Use in Australia: A Whole-Of-Population Analysis Using Pharmaceutical Claims.” British Journal of Clinical Pharmacology, doi:10.1111/bcp.12937.
Opioid dispensing in Australia between 1990 and 2014 increased from 4.6 to 17.4 defined daily doses/1,000 population/day. Weak, short-acting, or orally administered opioids in 1990 accounted for over 90 percent of utilization. Use of long-acting opioids increased over 17-fold between 1990 and 2000, due primarily to the subsidy of long-acting morphine and increased use of methadone for pain management. Oxycodone, fentanyl, buprenorphine, tramadol, and hydromorphone use increased markedly between 2000 and 2011. Use of strong opioids, long-acting and transdermal preparations also increased, largely following the subsidy of various opioids for non-cancer pain. In 2011, the most dispensed opioids were codeine (41 percent of total opioid use), oxycodone (20 percent) and tramadol (16 percent); long-acting formulations comprised approximately half, and strong opioids 40 percent, of opioid dispensing.
Read more:
http://www.ncbi.nlm.nih.gov/pubmed/26991673
D.C. Lott and J. Rhodes. 2016. “Opioid Overdose and Naloxone Education in a Substance Use Disorder Treatment Program.” American Journal on Addictions, doi:10.1111/ajad.12364.
A community-based treatment center in the Midwest delivered naloxone and overdose education to 43 opioid users using small group lecture, a slideshow, and a handout based on published content. Total score and scores for the naloxone and action subdomains on the Opioid Overdose Knowledge Scale increased significantly from pre- to post-education, with knowledge gains maintained at 3-month follow-up. Four users had naloxone before the program. One more had obtained it at follow-up.
Read more:
http://onlinelibrary.wiley.com/doi/10.1111/ajad.12364/abstract
A.C. Pomerleau, L.S. Nelson, J.A. Hoppe, M. Salzman, P.S. Weiss, and J. Perrone. 2016. “The Impact of Prescription Drug Monitoring Programs and Prescribing Guidelines on Emergency Department Opioid Prescribing: A Multi-Center Survey.” Pain Medicine, doi:10.1093/pm/pnw032.
A multi-center cross-sectional Web-based survey of geographically spread emergency department providers who prescribe opioid analgesics obtained a 54 percent response rate (515 of 957), but many respondents left some questions unanswered. Fifty-nine percent (219/369) were registered to access a prescription drug monitoring program (PDMP), with 5 percent (18/369) unsure whether their state had a PDMP. Forty percent (172/426) followed opioid analgesics prescribing guidelines, 24 percent (103/426) did not, and 35 percent (151/426) were unaware of prescribing guidelines. Sixteen percent (68/439) had prescribed opioid analgesics to expedite patient discharge, and 12 percent (54/439) had prescribed them to improve patient satisfaction. Opioid analgesic prescribing decisions did not differ significantly between groups either by use of PDMP or by guideline adherence.
Read more:
http://painmedicine.oxfordjournals.org/content/early/2016/03/19/pm.pnw032.abstract
D.M. Qato, J. Wilder, L.P. Schumm, V. Gillet, and G.C. Alexander. 2016. “Changes in Prescription and Over-the-Counter Medication and Dietary Supplement Use Among Older Adults in the United States, 2005 vs 2011.” JAMA Internal Medicine, doi:10.1001/jamainternmed.2015.8581.
Use of at least one prescription medication among community-dwelling adults ages 62–85 increased from 84 percent in 2005–2006 to 88 percent in 2010–2011, according to in-home interviews with direct medication inspection with a nationally representative sample in 2005–2006 (n = 2,351) and re-interviewed in 2010–2011 (n = 2,206). Concurrent use of at least five prescription medications increased from 31 percent to 36 percent. Including over-the-counter drug and dietary supplement use, users of five or more substances increased from 53 percent to 67 percent. Use of over-the-counter medications declined from 44 percent to 38 percent, but use of dietary supplements increased from 52 percent to 64 percent. Those at risk for a potential major drug-drug interaction increased from 8 percent to 15 percent. Most interaction risks involved prescription medications and dietary supplements.
Read more:
http://archinte.jamanetwork.com/article.aspx?articleid=2500064
E.D. Riley, J.L. Evans, J.A. Hahn, A. Briceno, P.J. Davidson, P.J. Lum, and K. Page. 2016. “A Longitudinal Study of Multiple Drug Use and Overdose among Young People Who Inject Drugs.” American Journal of Public Health, doi: 10.2105/AJPH.2016.303084.
Among a street-based convenience sample in San Francisco of 173 injection-drug users under age 30 tracked from April 2012 to February 2014, the odds of nonfatal overdose increased significantly as heroin and benzodiazepine pill-taking days increased and when alcohol consumption exceeded 10 drinks per day compared with 0 drinks per day.
Read more:
http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2016.303084
C.D. Saucier, N. Zaller, A. Macmadu, and T.C. Green. 2016. “An Initial Evaluation of Law Enforcement Overdose Training in Rhode Island.” Drug and Alcohol Dependence, doi:/10.1016/j.drugalcdep.2016.03.011.
Rhode Island law enforcement officers (n = 316) completed a pre/post evaluation of overdose prevention and response training. They gained in self-efficacy (identifying signs of opioid overdose, naloxone indication, counseling witnesses in overdose prevention, and referring witnesses for more information), overdose identification knowledge, naloxone administration knowledge, and anticipated behaviors in response to future observed overdose.
Read more:
http://www.drugandalcoholdependence.com/article/S0376-8716(16)00154-X/abstract
J. Strang and R. Mcdonald. 2016. “New Approved Nasal Naloxone Welcome, but Unlicensed Improvised Naloxone Spray Kits Remain a Concern: Proper Scientific Study Must Accompany Innovation.” Addiction 111(4):590–2, doi:10.1111/add.13319.
The authors believe non-injectable routes of naloxone administration still need testing. They call for study of how adequately and quickly nasal naloxone is absorbed, and how quickly it exerts its life-saving effect. The new intranasal concentrated naloxone formulations appear to have relative bioavailability of 30–40 percent, with speed of onset comparable to intramuscular administration, but this information has not reached the peer-reviewed literature. The authors argue for studies with volunteer heroin/opiate users of adequacy and reliability of naloxone administered by different modes and doses. They suggest collaborating with users to identify acceptable, achievable study designs.
Read more:
http://onlinelibrary.wiley.com/doi/10.1111/add.13319/full
T.J. Wiegand, M.C. Le Lait, B.B. Bartelson, R.C. Dart, and J.L. Green. 2016. “Analysis of the Abuse and Diversion of Buprenorphine Transdermal Delivery System.” Journal of Pain, doi:10.1016/j.jpain.2016.02.015.
According to data from the Researched Abuse, Diversion, and Addiction-Related Surveillance (RADARS) System, abuse rates were lower for the buprenorphine transdermal pain control delivery system than any of 1) other buprenorphine products, 2) fentanyl patches, 3) extended-release opioid tablets/capsules, and 4) extended-release tramadol. This finding held for both population-based rates and prescription-dispensed rates.
Read more:
http://www.jpain.org/article/S1526-5900(16)00568-X/abstract
H. Wunsch, D.N. Wijeysundera, M.A. Passarella, and M.D. Neuman. 2016. “Opioids Prescribed After Low-Risk Surgical Procedures in the United States, 2004–2012.” Research Letter, JAMA, doi:10.1001/jama.2016.0130.
Among 155,297 U.S. patients who underwent one or more of four low-risk surgical procedures (carpal tunnel release, laparoscopic cholecystectomy, inguinal hernia repair, or knee arthroscopy) in 2004, 2008, or 2012, 80 percent filled an opioid prescription for any opioid within 7 days. The proportion that filled an opioid prescription and mean daily morphine equivalents prescribed increased over time for all four procedures.
Read more:
http://jama.jamanetwork.com/article.aspx?articleid=2503506
A. Yazdanbakhsh, A.M. Kazemifar, K. Nazari, B. Sadeghi, and H. Solhi. 2016. “Comparison of Effects and Side Effects of Two Naloxone-Based Regimens in Treatment of Methadone Overdose.” Iranian Journal of Toxicology 10(1): 49–52.
In an emergency department in Iran, after an initial revival with naloxone, 40 patients with methadone overdose were infused with naloxone at decreasing concentrations for 3 hours while 40 control patients received additional naloxone only if needed clinically. Withdrawal symptom severity was significantly lower in the control group.
Read more:
http://ijt.arakmu.ac.ir/browse.php?a_id=443&sid=1&slc_lang=en
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Professional Development
W. Häuser, F. Petzke, L. Radbruch, and T.R. Tölle. 2016. “The Opioid Epidemic and the Long-Term Opioid Therapy for Chronic Noncancer Pain Revisited: A Transatlantic Perspective.” Pain Management, doi:10.2217/pmt.16.5.
Read more:
http://www.futuremedicine.com/doi/abs/10.2217/pmt.16.5
K. Kaltenbach, and H. Jones. 2016. “Neonatal Abstinence Syndrome: Presentation and Treatment Considerations.” Journal of Addiction Medicine, doi:10.1097/ADM.0000000000000207.
Read more:
http://journals.lww.com/journaladdictionmedicine/Abstract/publishahead/
Neonatal_Abstinence_Syndrome___Presentation_and.99635.aspx
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National
Poll: Most Doctors Prescribe Addictive Opioids Longer than New Recommendations Suggest
National Safety Council
March 24, 2016
A recent National Safety Council survey found 99 percent of doctors who prescribe opioid pain relievers had been providing first prescriptions that last longer than the shortened 3-day period that last week's Centers for Disease Control and Prevention guidelines recommended. Twenty-three percent said they had been prescribing at least a month's worth of opioids. Additionally, 74 percent of doctors, possibly incorrectly, believe opioids are the most effective way to treat pain. Although 99 percent of doctors have seen a pill-seeking patient or evidence of opioid misuse, only 38 percent usually refer those patients for treatment, with another 5 percent themselves treating misusers.
Read more:
http://www.nsc.org/Connect/NSCNewsReleases/Lists/Posts/Post.aspx?ID=108
Legislator Criticizes Drug Company for Price Gouging on Heroin Overdose Drug
Jason Cherkis, Huffington Post
March 23, 2016
During a recent House Committee on Oversight and Government Reform hearing, Rep. Elijah Cummings (D–Md.) criticized Amphastar Pharmaceuticals, the maker of naloxone, for price gouging. The price increased with demand. In May 2014, a 10-dose pack cost the Baltimore City Health Department roughly $190. Now, it costs more than $400. In the last quarter of 2015, Amphastar had net revenues of nearly $77 million, up from $57 million from the fourth quarter of 2014. The company agreed to rebates with Ohio and New York following complaints of price increases.
Read more:
http://www.huffingtonpost.com/entry/pharmaceutical-companies-profit-heroin-
epidemic_us_56f1eafae4b02c402f65b30d
M.C. Malone, W.C. Landa, and M.K. Dhillon. 2016. “The Rise of Drug-Seeking Behavior in the ED.” ED Legal Letter 27(1):1–12.
This article discusses issues in implementing the approaches recommended for addressing drug-seeking behavior in hospital emergency departments (ED). The article highlights Ohio, Arkansas, Massachusetts, and New York City guidelines that restrict ED prescription of opioids to less than 7 days or require screening patients for substance use. After briefly outlining findings about the effectiveness of selected strategies, including prescription drug monitoring program implementation, the authors point to challenges ED personnel face in adhering to these restrictions while maintaining high-quality care. In particular, they say one Centers for Medicare and Medicaid Services regional office thinks state guidelines may be noncompliant with the Emergency Medical Treatment and Labor Act and could discourage patients from receiving treatment.
Read more:
http://www.ahcmedia.com/articles/136847-the-rise-of-drug-seeking-behavior-in-the-ed-and-strategies-to-manage-such-behavior
Senators Call for Additional Funding to Combat Drug Abuse
WRIC
March 23, 2016
A bipartisan group of 22 senators in a letter have asked the Senate Appropriations Committee to fully fund the Substance Abuse Prevention and Treatment Block Grant to increase funding to address prescription misuse. The Committee is in the midst of hearings on fiscal year 2017 budget requests from government agencies.
Read more:
http://wric.com/2016/03/23/senators-warner-and-kaine-call-for-additional-funding-to-combat-drug-abuse
Campaign Seeks to Encourage Parents to Talk to Doctors About Children’s Pain Prescriptions
Partnership for a Drug-Free New Jersey
March 25, 2016
The Partnership for a Drug-Free New Jersey has launched a public service announcement campaign, “You Decide Before They Prescribe,” geared toward educating parents on the link between prescription pain medicine and later heroin abuse. It encourages individuals to speak to their doctor regarding the addictive qualities of opioids and possible alternatives. The campaign will appear in transit locations throughout New York and New Jersey and also be offered to community coalitions and substance use prevention alliances nationwide.
Read more:
http://www.prnewswire.com/news-releases/national-campaign-launched-in-times-square-to-empower-parents-to-challenge-doctors-before-their-child-is-prescribed-pain-medicine-300241540.html#continue-jump
Opioid Taper Program Helps Patients Take Less Medication Without More Pain
C. Vimont, Partnership for Drug-Free Kids
March 23, 2016
Patients are willing to taper off high-dose opioid medication if they receive guidance on how to cope with pain without drugs, according to results of a 34-patient pilot study discussed at the American Academy of Pain Medicine’s recent annual meeting. The patients had been on high daily opioid doses for an average of 7 years. The level of opioids a patient was taking and the duration of time they were taking them did not predict whether a patient engaged in voluntary taper. More than half cut their daily opioid dose by more than 50 percent. Thirty percent of the sample cut their average dose between 75 percent and 100 percent. Overall, three-quarters of patients reduced their dose by at least 25 percent. On average, the pain intensity of patients did not increase, and some had decreases in pain. Their reduction in pain was directly related to the decrease in their opioid dose. The researchers also found anxiety decreased significantly for those who moved through the taper program.
Read more:
http://www.drugfree.org/join-together/opioid-taper-program-helps-patients-take-less-medication-without-pain
Drug Company Makes Tablets to Deter Opioid Abuse
Linda Stein, Mainline Media News
March 21, 2016
Drug Company Egalet Corp. is developing immediate-release opioids that it claims are abuse-resistant because they are hard to pound into powders, cannot be chewed, and turn into a gummy, gooey substance when diluted. One of its tablet products, a form of oxycodone, is on the market and another, a form of extended-release morphine, is awaiting FDA approval.
Read more:
http://www.mainlinemedianews.com/articles/2016/03/25/main_line_
suburban_life/news/doc56f04b658e591970367638.txt
Safety Concerns Raised Over Centers for Disease Control and Prevention Opioid Guidelines
Glenn Counts, WCNC News
March 18, 2016
New Centers for Disease Control and Prevention (CDC) guidelines for physicians who prescribe pain medications add restrictions to reduce overprescribing. North Carolina pharmacist Jeff Lemelin speculates that this policy in the short term could increase robberies of local pharmacies by dependent drug-seekers. (Includes video: 2:23 minutes)
Read more:
http://www.wcnc.com/news/health/safety-concerns-raised-over-cdc-opiod-guidelines/89164151
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K.F. Boehnke, E. Litinas, and D.J. Clauw. 2016. “Medical Cannabis Associated With Decreased Opiate Medication Use in Retrospective Cross-Sectional Survey of Chronic Pain Patients.“ Journal of Pain, doi:10.1016/j.jpain.2016.03.002.
Invitations of customers by a medical cannabis dispensary in Ann Arbor, Mich., resulted in online survey responses by 244 medical cannabis patients with chronic pain between November 2013 and February 2015. The authors analyzed 185 complete responses. Of 119 respondents who used opioids (prescription or illicit) before receiving medical cannabis, only 33 (28 percent) still were using them. Patients also reported decreased use of other medications, less side effects of medications, and a 45-percent gain in quality of life. [Editor’s note: Those who found medical marijuana ineffective and never regularly visited the dispensary may not have been invited to respond. The lack of a comparison or control group is important; studies of chronic opioid users who stop use without starting medical marijuana also often find that quality of life rises and side effects drop. Also, this study was exempted from Institutional Review Board review.]
Read more:
http://www.jpain.org/article/S1526-5900(16)00567-8/abstract
S.R. Savage, A. Romero-Sandoval, M. Schatman, M. Wallace, G. Fanciullo, B. McCarberg, and M. Ware. 2016. “Cannabis in Pain Treatment: Clinical & Research Considerations.” Journal of Pain, doi:10.1016/j.jpain.2016.02.007.
This professional education article reviews clinical, research and policy issues related to herbal cannabis in order to support clinicians in thoughtfully advising and caring for patients who use cannabis. It examines obstacles and opportunities to expand research on the health effects of herbal cannabis and cannabinoids.
Read more:
http://www.jpain.org/article/S1526-5900(16)00543-5/abstract
Veterans Using Pot to Ease Posttraumatic Stress Disorder, Despite Scant Research
Ben Finley, Associated Press
March 22, 2016
Veterans are increasingly using marijuana to help manage their anxiety, insomnia, and nightmares even though studies have yet to show it is effective in the treatment of posttraumatic stress disorder (PTSD). Federal law requires randomized controlled trials to prove that a drug is effective before Veterans Health Administration doctors can recommend it. Nevertheless, the percentage of PTSD-afflicted veterans who have been diagnosed with a marijuana use disorder, which some experts say can hamper recovery from trauma, has increased from 13 percent in 2002 to nearly 23 percent in 2014.
Read more:
http://www.military.com/daily-news/2016/03/22/veterans-are-using-pot-ease-ptsd-scant-research.html?ESRC=marine_160322.nl
Employer Liability/Employee Rights Under Illinois Medical Cannabis Pilot Program
Nathan Bach, Heyl, Royster, Voelker & Allen, P.C.
March 22, 2016
Illinois courts have not yet addressed the issue of whether an employer may forbid medicinal use of cannabis. Courts in other states have generally sided with employers. Illinois employers may continue to maintain zero-tolerance policies prohibiting the use of all illegal drugs, including medicinal cannabis, regardless of whether the employee uses the drugs at work or during nonworking hours. Employers can protect themselves by updating their drug policies, properly disseminating them to employees, and enforcing them equally throughout the workforce.
Read more:
http://www.natlawreview.com/article/zero-tolerance-employer-liabilityemployee-rights-under-illinois-compassionate-use
Ohio Attorney General Issues Fourth Rejection to Medical Marijuana Group
Associated Press
March 18, 2016
For the fourth time, Ohio Attorney General Mike DeWine has rejected Ohio Medical Cannabis Care’s effort to get a medical marijuana question on the ballot, citing at least 11 defects in the latest proposed constitutional amendment.
Read more:
http://fox8.com/2016/03/18/ohio-attorney-general-issues-4th-rejection-to-medical-marijuana-group
Vireo Health of New York Protests Google Medical Cannabis Advertising Rejections
New Cannabis Ventures
March 18, 2016
Vireo Health of New York, which produces and sells medical cannabis, has urged Google to accept advertisements using the words “medical cannabis” and “medical marijuana.” Google AdWords has rejected seven advertisements from Vireo, citing Google’s advertising policy that prohibits “the promotion of substances that alter mental state for the purpose of recreation.” Under New York’s Compassionate Care Act, Vireo’s products cannot be sold or used for recreational purposes. Therefore, Vireo believes that Google’s rejection is a misapplication of the company’s own policy and a potential violation of First Amendment and antitrust laws. Google has not responded to Vireo’s requests to meet with them. Vireo’s press release did not address whether Google legally can carry advertising for a product that it is illegal to sell under federal law.
Read more:
https://www.newcannabisventures.com/vireo-health-of-new-york-protests-google-medical-cannabis-advertising-rejections
New Mexico Marijuana Dispensary Fined After Butane Hash Oil Explosion
Noelle Crombie, The Oregonian
March 16, 2016
The U.S. Occupational Safety and Health Administration has fined New MexiCann, a medical marijuana dispensary, for a dozen violations after two men were badly hurt in a butane hash oil explosion. A butane leak from one of the lines met with an ignition source to cause the blast, separating the roof from the wall. Fire inspectors could not pinpoint what caused the ignition. (Includes video: 0:21 minutes)
Read more:
http://www.oregonlive.com/marijuana/index.ssf/2016/03/new_mexico_marijuana_dispensar.html
The Medical Marijuana Mess: A Prescription for Fixing a Broken Policy
John Hudak, Brookings Institution
March 22, 2016
In December 2013, Beth Collins and her 13-year-old daughter Jennifer moved from Virginia to Colorado to seek treatment for Jennifer’s medical condition. The family hoped that Colorado cannabis would help treat Jennifer’s epilepsy because prescription drugs had failed. This blogpost details their difficult journey to access medical marijuana. The author concludes that medical marijuana access is problematic because federal law does not allow a doctor to prescribe marijuana, a pharmacy to dispense it, or a patient to buy or use it.
Read more:
http://www.brookings.edu/research/essays/2016/the-medical-marijuana-mess
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International
Health Canada: Naloxone No Longer Requires a Prescription
Maryse Zeidler, CBC News
March 22, 2016
Health Canada has announced that naloxone is now available without a prescription in Canada.
Read more:
http://www.cbc.ca/news/canada/british-columbia/naloxone-canada-no-prescription-1.3503316
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Northeast/Mid-Atlantic News
Insurance Company Gives $750,000 to Maryland Opioid Abuse Efforts
Sarah Gantz, Baltimore Business Journal
March 22, 2016
Chesapeake Employers’ Insurance Company, a workers’ compensation provider, has given $750,000 to the Maryland Department of Health to expand and improve the state’s prescription drug monitoring program. The company decided to support this effort because patients are often prescribed pain relievers during their recovery from on-the-job injuries and sometimes become addicted.
Read more:
http://www.bizjournals.com/baltimore/news/2016/03/21/chesapeake-employers-insurance-co-gives-750k-to.html
New York City Subway Workers Fail Drug, Alcohol Tests
Jim Hoffer, WABC-TV
March 24, 2016
Eyewitness News Investigators received a tip that construction workers at a 2nd Avenue subway construction site in New York City were using pills, cocaine, liquor, and marijuana. During the last 2 weeks, workers have been randomly tested for alcohol and drugs. The Metropolitan Transportation Authority (MTA) confirmed that 82 workers were tested; 9 failed and were fired immediately. The whistleblower said that the random testing was not so random. The foreman asked if employees could pass before sending them to the mobile testing truck. If not, he sends them home. Officials are now testing more often and at different times. The MTA’s inspector general is also investigating. More than 600 workers had been tested for drugs or alcohol in the past 3 years, with 16 failing.
Read more:
http://abc7ny.com/news/investigators-exclusive-2nd-avenue-subway-workers-fail-drug-alcohol-tests/1261052
Dealing with Opioid Addiction in the Workplace
Briana Vannozzi, NJTV News
March 24, 2016
Larry Redmon, an engineer, had an opioid and alcohol addiction 29 years ago and still attends weekly support group meetings. He has many friends who were Wall Street executives and worked for big corporations but became homeless as a result of addiction. People in high-pressure professional careers are more likely to use drugs and less likely to get help because of the stigma. More than 128,000 New Jersey residents are addicted to heroin or prescription opioids and many are barely hanging on to a job. There has been talk about testing workers and federal employees for opioids, but advocates prefer to see a greater emphasis on expanding treatment and offering a second chance. (Includes video: 3:11 minutes)
Read more:
http://www.njtvonline.org/news/video/dealing-with-opioid-addiction-in-the-workplace
Report: New Hampshire Has Third-Highest Drug Deaths Per Capita in Nation
Ella Nilsen, Concord Monitor
March 20, 2016
In 2015, 428 people died from drug overdoses in New Hampshire, with eight cases still pending. New Hampshire now ranks third-highest for per-capita drug deaths nationwide. The medical examiner attributes the problem to a widespread prescription opioid use problem that has shifted into a heroin and fentanyl epidemic. Law enforcement reported that the drugs are manufactured by Mexico’s Sinaloa cartel, crudely mixed in Massachusetts, and then distributed in New Hampshire. The opioid epidemic has become a bipartisan issue dominating the conversation in the Legislature as they work to pass Medicaid expansion, expand insurance benefits of substance abuse treatment, and increase access to naloxone. Still health and law enforcement officials warn that they do not have the manpower to address the issue.
Read more:
http://www.concordmonitor.com/news/nation/world/21623482-95/report-new-hampshire-has-third-highest-drug-deaths-per-capita-in-the-nation-with-little
New Hampshire Senate Approves $5 Million More to Fight Drug Crisis
Allie Morris, Concord Monitor
March 24, 2016
New Hampshire’s senate has approved an additional $5.1 million to fight the opioid crisis. Under the proposed law, the state’s health department could allocate $4.5 million to either sober housing or the Governor’s Commission on Alcohol and Drug Abuse Prevention, Treatment, and Recovery. Funds would be used to hire a new drug prosecutor in the attorney general’s office and create a $500,000 grant program to fund peer-to-peer recovery services. The programs would be funded with money that other state agencies do not use this budget cycle.
Read more:
http://www.concordmonitor.com/news/politics/21728402-95/senate-approves-5m-more-to-fight-drug-crisis-kills-casino-proposal
Connecticut Bill Would Limit New Opioid Prescriptions to 7-Day Supplies
Arielle Levin Becker, Connecticut Mirror
March 21, 2016
A Connecticut legislative committee has approved a bill that would limit opioid prescriptions to a 7-day supply when it is first prescribed to address non-chronic pain in adults. Minors would be limited to a 7-day supply without the possibility of refills and the provider would have to discuss the risks associated with opioids with the minor’s parent or guardian. The bill includes an exception for cases in which the prescriber determines that a longer supply is needed to address a patient’s acute medical condition, chronic pain, pain associated with cancer or for palliative care. In those cases, the prescriber would be required to indicate in the patient’s medical record that an alternative to the opioid drug was not appropriate.
Read more:
http://ctmirror.org/2016/03/21/bill-would-limit-new-opioid-prescriptions-to-seven-day-supplies
New York Prisons Training Inmates to Administer Overdose ‘Cure’
Fred Mogul, WNYC News
March 24, 2016
Queensboro Prison—a short-term, pre-discharge prison in Long Island City, N.Y.—was the first facility to train its inmates to administer naloxone and give them the kits to take home. Overdose death risk is very high in the first months after release from jails or prisons. Over the past year, a handful of discharged inmates used the naloxone kits to save their lives. The program expanded to other state prisons over the past year. (Includes audio: 7 minutes)
Read more:
http://www.wnyc.org/story/state-prisons-training-inmates-administer-overdose-cure
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South News
Pinellas County (Fla.) Sheriff: Nine Overdose Deaths in 2016 Linked to Counterfeit Xanax
Claire McNeill, Tampa Bay Times
March 21, 2016
Nine people in Pinellas County, Fla., have overdosed this year on counterfeit Xanax pills laced with fentanyl. Police officials are urging individuals to stop purchasing Xanax on the street. The counterfeit pills look like Xanax but are thinner and have a stamped-on number. The sheriff’s office is also seeing an increase in fentanyl mixed with other drugs, such as heroin, in the past 2 years. In 2014, the sheriff’s office lab saw 14 such cases. In 2015 it saw 71. This year it may exceed 100.
Read more:
http://www.tampabay.com/news/publicsafety/pinellas-sheriff-nine-overdose-deaths-in-2016-linked-to-counterfeit-xanax/2270250
Fentanyl Overdoses Rival New Orleans Homicide Numbers
Meg Gatto, WVUE
March 23, 2016
The fentanyl overdose rate in New Orleans matches the city’s homicide numbers. So far this year, 72 percent of the people who died from drugs in Orleans Parish had fentanyl in their system, up from 19 percent in 2015. Fentanyl is often mixed with heroin which causes a lethal combination. The Orleans Parish coroner sees a lot of professionals addicted to opiates. (Includes video: 3:09 minutes)
Read more:
http://www.ksla.com/story/31552621/fentanyl-overdoses-rival-new-orleans-homicide-numbers
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Midwest News
Fort Wayne, Ind., Pain Doctor’s License Suspended
Sheryl Krieg, News-Sentinel
March 24, 2016
Michael Cozzi, M.D., a pain doctor who owns and operates FW Interventional Pain Management in Fort Wayne, Ind., has had his medical license suspended for at least 90 days for dangerously prescribing controlled substances. Dr. Cozzi prescribed more controlled substances than any other prescriber in Indiana from January 2014 to February 2016.This included 2 million doses of oxycodone and 1.2 million doses of hydrocodone. In one month, Cozzi allegedly prescribed controlled substances to about 1,700 patients. Three of Cozzi’s patients died due to complications of drug use. Cozzi was arrested and his property was searched. The Allen County Health Department activated its crisis response plan, developed after another doctor was suspended in 2015, to help Cozzi’s former patients who need care and treatment.
Read more:
http://www.news-sentinel.com/news/local/crime/Fort-Wayne-pain-doctor-s-license-suspended
Indiana Governor Signs Legislation to Combat Drug Abuse
WBIW
March 22, 2016
Indiana Governor Mike Pence has signed several bills, one of which ensures those convicted of repeated, drug dealing felony offenses may not receive suspended sentences if the offense involves methamphetamine or heroin and the person has a prior conviction for dealing cocaine, heroin or methamphetamine. Another bill establishes the Indiana Commission to Combat Drug Abuse which will be responsible for coordinating substance abuse prevention, treatment and enforcement throughout the state. The third bill requires the Indiana State Department of Health to issue a statewide standing order for naloxone and provides immunity from certain offenses for individuals who administer naloxone to a person who has overdosed, call 911, and cooperate with law enforcement when they arrive on the scene. And, the fourth bill requires Medicaid coverage for inpatient detoxification in accordance with American Society of Addiction Medicine patient placement criteria, including for treatment of opioid or alcohol misuse disorders.
Read more:
http://www.wbiw.com/state/archive/2016/03/governor-pence-signs-legislation-to-combat-drug-abuse-in-indiana-through-increased-enforcement-treat.php
Oklahoma Doctor Charged With 29 Felonies Connected to ‘Pill Mill’
Andrew Knittle, The Oklahoman
March 24, 2016
Harvey Jenkins, M.D., owner of Aria Orthopedics in Oklahoma City, has been charged with 29 felony counts and a single misdemeanor. Prosecutors allege Dr. Jenkins did not spend adequate time with patients before writing prescriptions and failed at guarding against the diversion of narcotics which he prescribed in large volumes before January 2015. Jenkins also used another doctor’s identity to write prescriptions for narcotics. Along with Jenkins, five former employees were charged with similar offenses. One was an off-duty Oklahoma County sheriff’s deputy, who was hired as a security guard. (Includes video: 9:51 minutes)
Read more:
http://newsok.com/article/5487203
Ohio Police Warn Prescription Drug Users to Follow Drug Laws
WYTV
March 21, 2016
Police in Youngstown, Ohio, have arrested three people for having 3,000 Tramadol tablets. In November, the drug was added to a restricted drug class. One loose pill can result in criminal charges. Police officials warned the community to follow the law by making sure that they have a prescription for the drug. (Includes video: 0:42 minutes)
Read more:
http://wytv.com/2016/03/21/police-warn-prescription-drug-users-to-follow-drug-laws
Spike in Opioid Overdoses Straining Ohio Medical Facilities; Fentanyl Linked to Crisis
Casey Ross, The Plain Dealer
March 23, 2016
Hospitals and rehabilitation facilities in northeast Ohio do not have enough detox or treatment beds for people who need them because of the spike in opioid overdoses. Officials have linked the increase to fentanyl. At least 22 people have died in Cuyahoga County so far in March, including 12 in a 5-day span between March 10 and 14. Fentanyl use is contributing to a constant stream of non-fatal overdoses. On March 8 alone, Cleveland police responded to 10 overdoses, two of them fatal. St. Vincent Hospital is now getting three to four overdoses a day. The hospital’s inpatient detoxification averages about 3,200 calls for help a month and is only able to admit about eight patients a day. The hospital estimates about 90 percent of their patients are addicted to opioids. MetroHealth, university hospitals, and the Cleveland Clinic also are reporting increases in overdoses and patients seeking outpatient treatment.
Read more:
http://www.cleveland.com/healthfit/index.ssf/2016/03/spike_
in_opioid_overdoses_straining_hospitals_rehab_
facilities_fentanyl_linked_to_spiraling_crisis_photos.html
Missouri County May Set Up Opiate Drug Monitoring Program
Dan Greenwald, KMOV
March 21, 2016
St. Charles County, Mo., is researching the feasibility in setting up a prescription drug monitoring program like Saint Louis County instituted recently. (Includes video: 1:54 minutes)
Read more:
http://www.kmov.com/story/31530483/st-charles-co-may-set-up-opiate-drug-monitoring-program
Indiana County Health Department Releases Videos to Educate Citizens About Opioid Crisis
Sheryl Krieg, News-Sentinel
March 23, 2016
The Fort Wayne-Allen County (Ind.) Department of Health has placed 17 videos on its Web site to educate the general public about the opioid crisis. They include victims’ stories, first-responders and medical doctors’ viewpoints, and drug court perspectives.
Read more:
http://www.news-sentinel.com/news/local/crime/Department-of-Health-releases-videos-to-educate-citizens-about-opioid-crisis
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West News
Seattle Soon to Get ‘Drug Drop-Off’ Sites
Chris Daniels, KING
March 23, 2016
Seattle and King County, Wash., will launch a drug drop off program this year that will be paid for by pharmaceutical companies. It will include drop boxes and mail-in envelopes. (Includes video: 2 minutes)
Read more:
http://www.king5.com/news/local/seattle/seattle-soon-to-get-drug-drop-off-sites/98706836
Survey: Many in San Diego Don’t Know How to Dispose of Old Medicines
Erik Anderson, KPBS
March 23, 2016
The University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Science reported that many people do not know how to dispose of unused or expired drugs. Thirty percent of respondents throw drugs in the trash, while 15 percent flush them down the drain. A third keep the drugs around the house. More than 80 percent of those polled say their health care provider never talked to them about the issue. Nine of 10 people surveyed thought putting collection bins at pharmacies made sense. (Includes video: 1:42 seconds)
Read more:
http://www.kpbs.org/news/2016/mar/23/survey-finds-many-san-diegans-dont-know-how-dispos
Nurse Accused of Stealing Fentanyl from Summit County (Colo.) Hospital
Noelle Phillips, Denver Post
March 19, 2016
A Summit County nurse has been arrested and charged with obtaining a controlled substance, fentanyl, by fraud or deceit and theft from the St. Anthony Summit Medical Center. She is suspected of misappropriating doses of injectable hydromorphone fentanyl intended for her patients in a Breckenridge, Colorado hospital. The article also discusses a former surgical technologist at Swedish Medical Center who was charged with stealing fentanyl from an operating room.
Read more:
http://www.denverpost.com/news/ci_29661532/nurse-accused-stealing-fentanyl-from-summit-county-hospital
Santa Barbara (Calif.) Neighborhood Clinics Soon Screening for Opioids
Nick Welsh, Santa Barbara Independent
March 24, 2016
Santa Barbara Neighborhood Clinics in California will soon require patients over the age of 12 seeking treatment to be screened for opioid use. Anyone testing positive for opioids and benzodiazepines will be subjected to a brief intervention and referred to a treatment provider.
Read more:
http://www.independent.com/news/2016/mar/24/neighborhood-clinics-soon-screening-opioids
Four Corners (N.M.) Hospital Seeing Success in Prescription Monitoring Program
Devin Neeley, KOB Eyewitness News 4
March 24, 2016
In 2013, San Juan Regional Medical Center, N.M., reported that at least 30 percent of hospital emergency department visits were to get a prescription for opiate drugs. It now consults the prescription drug monitoring program (PDMP) before prescribing, leading to a 2,700-visit decline in emergency department visits. If doctors suspect that a patient is seeking opioids, they flag the patient in the PDMP database. Patients and their primary care providers then are notified that no narcotic prescriptions will be written from the emergency department except for one dose scripts when the drug is needed immediately. (Includes video: 1:34 minutes)
Read more:
http://www.kob.com/health-news/four-corners-hospital-seeing-success-in-opioid-prescription-monitoring-program/4084831/#.VvVaKWkUVdj
Arizona House Tentatively OKs Mandatory Prescription Drug Monitoring
Ryan Van Velzer, WBNS-TV
March 24, 2016
The Arizona House preliminarily approved a measure that would require doctors to check the state’s PDMP database before prescribing drugs that contain opioids or benzodiazepine in most circumstances. The bill requires the statewide Health Information Exchange to incorporate the database so that doctors can more easily access the information. If the House formally approves the bill on a second vote, the program will begin in October 2017.
Read more:
http://www.10tv.com/content/stories/apexchange/2016/03/24/az-xgr--prescription-monitoring-program.html
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Other Resources
Marijuana Research Report
National Institute on Drug Abuse
March 2016
This set of online fact sheets from the National Institute on Drug Abuse summarizes what science has to say about marijuana and its effects on those who use it. Among other topics, it covers: What are marijuana’s effects and how does it produce them? What risks does marijuana use pose? How does marijuana use affect school, work, and social life? And, can marijuana use during and after pregnancy harm the baby?
Read more:
https://www.drugabuse.gov/publications/research-reports/marijuana/letter-director
Educational Resources
GenerationRx
Accessed March 25, 2016
GenerationRx.org provides educational resources to help prevent the misuse of prescription medications in communities. The site’s teen materials have been recently revamped and expanded. Generation Rx also offers free educational materials targeted to elementary students, college students, adults, seniors, patients, and those in the workplace.
Read more:
http://www.generationrx.org
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Webinars
Weed in Your Workplace: What You Need to Know
National Safety Council
Wednesday, April 20, 2016
2 p.m. (ET)
http://eventcallregistration.com/reg/index.jsp?cid=59487t11
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Grant Award
Maine to Receive $1.2 Million to Help Monitor Prescription Drug Abuse
WAGM
March 18, 2016
Maine has been awarded $1.2 million from the U.S. Department of Health and Human Services to improve its prescription drug monitoring program, evaluate current policies for effectiveness, and implement new prevention and intervention strategies.
Read more:
http://www.wagmtv.com/content/news/12M-coming-to-Maine-to-help-monitor-prescription-drug-abuse-372578692.html
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Prescription Drug Overdose Prevention for States
Centers for Disease Control and Prevention
Due: April 1, 2016
http://www.grants.gov/web/grants/search-grants.html
SP-16-003: Strategic Prevention Framework - Partnerships for Success
SAMHSA
Due: April 12, 2016
http://www.grants.gov/web/grants/search-grants.html
NIJ-2016-9090: Research and Evaluation on Drugs and Crime
National Institute of Justice
Due April 20, 2016
http://www.grants.gov/web/grants/search-grants.html
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
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National Take-Back Initiative
National Prescription Drug Take-Back Day
Drug Enforcement Administration
Saturday, April 30, 2016
10 a.m. – 2 p.m.
http://www.deadiversion.usdoj.gov/drug_disposal/takeback
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Take-Back Events & Drop Boxes
Nevada County (Calif.) Prescription Medication Take-Back Day Saturday, April 30
Coalition for Drug-Free Nevada County
March 22, 2016
http://drugfreenevadacounty.org/prescription-medication-take-back-day-saturday-april-30th-2016-1000-am-to-200-pm
Shoppers Drug Mart, Loblaw in Toronto Collected 620 Tons of Expired Meds in 2015
Michael Johnsen, Drug Store News
March 24, 2016
http://www.drugstorenews.com/article/shoppers-drug-mart-loblaw-collected-0-tons-expired-meds-01
Logan County (W.Va.) Sheriff’s Office Takes in 50 lbs. of Expired Medications
WOWK
March 20, 2016
http://www.wowktv.com/story/31520368/logan-county-sheriffs-office-takes-in-50-pounds-of-expired-medications
Pennsylvania District Attorney and National Guard Help Dispose Of Drugs
Emma Ginader, The Daily Item
March 23, 2016
http://www.dailyitem.com/news/district-attorney-mike-piecuch-and-the-pa-national-guard-help/article_5039aa30-f0f5-11e5-9db4-576c2568fa0c.html
Georgetown County (S.C.) Providing Second Location for Safe Disposal of Unwanted Medications
WCBD
March 21, 2016
http://counton2.com/2016/03/21/georgetown-co-providing-2nd-location-for-safe-disposal-of-unwanted-medications
Box Continues to Collect Unwanted Drugs in Tom Bean (Texas)
Alex Maxwell, Herald Democrat
March 18, 2016
http://heralddemocrat.com/news/police-reports/box-continues-collect-unwanted-drugs-tom-bean
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Upcoming Conferences and Workshops
29th Annual National Prevention Network Conference
National Prevention Network
September 13–15, 2016
Buffalo Niagara Convention Center
153 Franklin Street
Buffalo, New York
The National Prevention Network Conference highlights the latest research in the substance abuse prevention field. It provides a forum for prevention professionals, coalition leaders, researchers, and federal partners to share research, best practices and promising evaluation results for the purpose of integrating research into prevention practice.
Read more:
http://www.npnconference.org
Register:
http://www.npnconference.org/registration
Call for Presentations
Online Application Deadline: April 18, 2016, 5 p.m. (ET)
Pharmacy Diversion Awareness Conference
U.S. Drug Enforcement Administration
April 17–18, 2016
Towson, Maryland
http://www.deadiversion.usdoj.gov/mtgs/pharm_awareness
2016 National Rx Drug & Heroin Summit
March 28–31, 2016
Atlanta, Georgia
http://nationalrxdrugabusesummit.org
Third Annual Smart Approaches to Marijuana Education Summit
March 31, 2016
Atlanta, Georgia
http://nationalrxdrugabusesummit.org/sam-summit-2
Register:
https://www.123contactform.com/form-1486587/2016-National-Rx-Drug-Abuse-Summit
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
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
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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. |
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