Substance Abuse Newsletter August 2016

The following is a compendium of news reports over the past month that may be of interest to our AG offices who are dealing with substance abuse issues. Neither the National Association of Attorneys General nor the National Attorneys General Training & Research Institute expresses a view as to the accuracy of news accounts, nor as to the position expounded by the authors of the hyperlinked articles.

Opioids

President Obama signed the Comprehensive Addiction and Recovery Act (CARA) into law July 22, 2016. The $181 million bill authorizes funding to help fight the heroin and prescription opioid crisis across the country. The funding will be used to create programs for prevention, treatment, and recovery. The Bipartisan Task Force to Combat the Heroin Epidemic, which was co-chaired and co-founded by Congressman Frank Guinta (R-NH) and Congresswoman Annie Kuster (D-NH) was a major force behind the passage of the bill. Senator Kelly Ayotte (R-NH) co-authored the bill and Senator Jeanne Shaheen (D-NH) co-sponsored the bill.

Federal officials are investing in telemedicine to fight the nation’s growing opioid abuse epidemic in three states. The Agency for Healthcare Research and Quality (AHRQ) is launching a three-year, $9 million effort to train rural healthcare providers in medication-assistant treatment (MAT) therapy. The project will make use of mHealth apps, online training, and specialist consults to help primary care physicians treat an estimated 20,000 residents fighting opioid addiction. A key component of the program is Project ECHO, a telemedicine training model launched in 2011 in New Mexico that pushes education and peer support through a hub-and-spoke model to rural healthcare providers. The platform has been adopted in several states and is now being proposed as a national network in the Expanding Capacity for Health Outcomes (ECHO) Act, unveiled in April by Sens. Brian Schatz (D-Hawaii) and Orrin Hatch (R-Utah). The Act has been referred to the Committee on Health, Education, Labor, and Pensions. The AHRQ effort targets Oklahoma, Colorado, and Pennsylvania, where officials say the opioid abuse epidemic is particularly hard-hitting.

The Rhode Island Medical Society has joined state health officials and the American Medical Association in signing an agreement to develop a web-based prescriber “toolbox” for treating pain and preventing opioid addiction. The toolbox is designed to centralize information and guidance for doctors and other prescribers about the appropriate treatment of acute pain, opioid use disorders, and educating patients in overdose prevention, state health officials said. Rhode Island is one of two states — the other is Alabama — selected by the federal Substance Abuse and Mental Health Services Administration (SAMHSA) to pilot the project.

CVS Health says it is teaming with Adapt Pharma to offer the opioid overdose antidote naloxone nasal spray at a special discount for people without prescription drug coverage. The company said patients without insurance will get a $35 discount, reducing the out-of-pocket expense of the drug by nearly 25%. The brand name of the drug is NARCAN, which CVS says is the only FDA-approved, ready-to-use nasal formulation of naloxone for the emergency treatment of opioid overdose. The drug has been in demand as the rise in opioid addiction has led to an increasing number of overdose deaths and injuries.

SAMHSA has a new publication available that gives an overview of data on the use of sublingual and transmucosal buprenorphine for the medication-assisted treatment of opioid use disorder. It also discusses the implications of utilizing medication-assisted treatment in recovery support.

West Virginia Attorney General Patrick Morrisey, in coordination with the state’s Board of Pharmacy, launched cutting-edge technology to help prescribers and pharmacists reduce opioid over-prescription in the Mountain State. The tool, a morphine equivalency calculator, analyzes opioid drugs prescribed to a patient and converts dosage amounts to a standard, comparable measurement. It provides quick access to the combined potency of the patient’s existing prescriptions and the impact of any new medication. The calculator will use conversion factors and formulas published by the Centers for Disease Control and Prevention to aggregate that data and convert it to a morphine milligram equivalent known as a patient score. The information will be valuable in detecting prescription abuse and overuse and potentially preventing countless life-threatening drug overdoses.

Medical/Marijuana

DEA has denied two petitions to reschedule marijuana under the Controlled Substances Act (CSA). In response to the petitions, DEA requested a scientific and medical evaluation and scheduling recommendation from the Department of Health and Human Services (HHS), which was conducted by the U.S. Food and Drug Administration (FDA) in consultation with the National Institute on Drug Abuse (NIDA). Based on the legal standards in the CSA, marijuana remains a schedule I controlled substance because it does not meet the criteria for currently accepted medical use in treatment in the United States, there is a lack of accepted safety for its use under medical supervision, and it has a high potential for abuse. In his letter to the petitioners, DEA Acting Administrator Chuck Rosenberg offered a detailed response outlining the factual and legal basis for the denial of the petitions. The full response to the petitions can be found in the Federal Register here.

The Washington Poison Center unveiled a new warning label that could be used to prevent children from consuming marijuana edibles. The symbol, chosen by the WPC, features a bright red hand held up in a "stop" gesture, accompanied by the words "Not For Kids" with an emergency confidential helpline number to call. In its draft rules, set to be filed Aug. 10, the Washington State Liquor and Cannabis Board will require the inclusion of the symbol on all edible marijuana products. If the new rule is adopted, the symbol will be required starting Jan. 17, 2017. The board would allow 90 days after adoption for the industry to comply. The Board says the new symbol was developed with their input as well as suggestions from prevention specialists.

Indoor marijuana cultivation is one of the most energy-intensive industries in the United States, generating nearly $6 billion in energy costs annually. According to the Northwest Power and Conservation Council, which carries out energy planning for the Columbia River Basin states (Montana, Idaho, Washington and Oregon), growing marijuana indoors consumes up to 5,000 kilowatt-hours of electricity per kilogram of output. For comparison, aluminum production requires about 16 kilowatt-hours per kilogram. As marijuana businesses become more competitive and specialized, growers are moving their farms indoors to get a more controlled product. Indoor cultivation requires electricity to power high-intensity lights, to enable frequent air exchanges and ventilation, and to maintain consistent temperatures and humidity levels day and night. Experts estimate that a 5,000-square-foot indoor marijuana facility in Colorado consumes six times more electricity per square foot than an average commercial business and 49 times more than an average residence.

Every few years, SAMHSA combines data from the annual National Surveys on Drug Use and Health to derive estimates of monthly marijuana use among Americans age 12 and older. The data, encompassing the years 2012 to 2014, include responses from approximately 204,000 people. That sample makes it possible to visualize marijuana use rates with a level of detail not possible with traditional surveys. The report finds that nationally, 7.7 percent of people 12 an older — roughly 20.3 million Americans —or approximately 1 in 13 people over the age of 12 use marijuana monthly or more. Broadly speaking, marijuana use rates are highest in the Western states and lowest in the South.

In a new Gallup poll, thirteen percent of U.S. adults state they currently smoke marijuana, nearly double the percentage who reported smoking marijuana only three years ago. In addition, 43% of Americans report they have tried marijuana cannabinoids, similar to the 44% recorded last year and up slightly from 38% in 2013. The percentage of Americans who say they have tried the drug has slowly increased from 4% in 1969.

Synthetics

The Center for Disease Control and prevention has released a new study titled “Acute Poisonings from Synthetic Cannabinoids”. The study highlights that synthetic cannabinoid poisonings increased in all U.S. Census regions. The increase in acute synthetic cannabinoid poisonings underscores the importance of targeted prevention interventions and the need for education about the potentially life-threatening consequences of synthetic cannabinoid use.

Illinois has enacted a new state law banning retailers from selling synthetic drugs known as “bath salts”. Effective Jan. 1, it will be a Class 3 felony, publishable by a fine of up to $150,000, to sell or offer for sale “any synthetic or natural material containing any quantity of a cathinone chemical structure.” The law also will allow local governments to revoke the licenses of retailers who are convicted of a violation.

The Texas Office of the Attorney General (OAG) obtained a temporary restraining order (TRO) against Spice Boutique in Houston for violating the Texas Deceptive Trade Practices Act (DTPA) and the nuisance statute. The OAG also sued Spice Boutique’s owners, brothers Minh Dang and Tuan Dang. The lawsuit is based on an investigation by the Houston Police Department Narcotics Division (HPD) into 16 synthetic marijuana overdoses that happened in Hermann Park in June 2016. The OAG, Harris County Attorney’s Office, and the City of Houston filed the lawsuit in Harris County district court. This is the tenth lawsuit the OAG has filed in Harris County with the goal of stopping retail stores from selling synthetic drugs in Houston. The TRO includes an asset freeze, a first for an OAG synthetic marijuana case. To view a copy of the original petition click here.

Kratom

The CDC issued a report yesterday concerning the emerging use of a plant-based alkaloid known as kratom, a “natural” opioid substitute grown in southeast Asia. The report discusses the risks of opioid dependence, severe withdrawal syndromes, as well as risks of mixing Kratom with other drugs such as alcohol or other depressants. The CDC has labeled kratom an “emerging public health threat.”

Other

Carfentanil is the most potent commercial opioid in the world — 10,000 times stronger than morphine — and law enforcement from northwest Canada to the eastern U.S. have raised alarms about it tainting heroin batches and even being sold as the drug itself. Heroin cut with carfentanil offers a harder-hitting, longer-lasting high and allows dealers a shortcut to increase their supplies. But users often don’t know what they’re getting. In recent months, authorities have linked carfentanil to a spike in overdoses in several states, and have warned that it could spread to others. If diluted sufficiently, a dose of the same size — just the fraction of the weight of a paper clip — could also send 500 humans to the morgue.

Michelle Paranto of the town of Washington, Illinois will serve a six-year prison term for smoking marijuana before she sped through a stoplight, broadsided a young woman’s car and instantly killed her 20 months ago. Tests revealed a “high level” of THC, the active ingredient in marijuana, in Paranto’s system. She was found guilty in a short bench trial last March. Paranto was driving more than 20 miles over the 55-mph speed limit on U.S. 24 at Main Street when her westbound car slammed into Hardin’s southbound car on Oct. 26, 2014. The vehicles struck two other cars stopped at the intersection and left three others, including Paranto’s adult passenger, injured.

Health insurance claims for people hooked on prescription painkillers and heroin skyrocketed as the number of Americans who fatally overdosed on those opioids hit record highs, a new analysis reveals. The number of private health insurance claims related to opioid dependence diagnosis soared by 3,204 percent from 2007 to 2014, the analysis found. The same analysis by Fair Health also found other disturbingly sharp spikes upward in the number of private insurance claims related to opioid abuse, drug dependence by pregnant women, and heroin overdoses since 2011.


Joanne Thomka is the Editor of Substance Abuse News and may be reached at 202-326-6269. Substance Abuse News is a publication of the National Association of Attorneys General. Any use and/or copies of this newsletter in whole or part must include the customary bibliographic citation. NAAG retains copyright and all other intellectual property rights in the material presented in this publication. For content submissions or to contact the editor directly, please e-mail jthomka@naag.org.

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