Substance Abuse Newsletter April 2017

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

Attorney General Patrick Morrisey has partnered with the West Virginia University School of Nursing to raise awareness about opioid abuse prevention in the Mountain State. The collaboration will focus on sharing drug abuse prevention information with eighth grade students in several counties. The initiative kicks off Thursday, March 16, at Mountaineer Middle School in Morgantown. The Attorney General’s Office will coordinate events and travel to each school with the nursing students, who will share the detailed presentation. The curriculum covers the opioid epidemic, prevention, and the long-term impact of drug use.

Heroin use in the United States has risen five-fold in the past decade and dependence on the drug has more than tripled, with the biggest jumps among whites and men with low incomes and little education, according to researchers. Whites aged 18 to 44 accounted for the biggest rise in heroin addiction, which has been fueled in part by the misuse of opioid prescription drugs. The findings are troubling because the people most affected have few resources to deal with the problem, said Dr. Silvia Martins, an associate professor of epidemiology at Columbia University Mailman School of Public Health, and her colleagues.

Florida Attorney General Pam Bondi has become a member of the White House’s Opioid and Drug Abuse Commission. Gen. Bondi joins former New Jersey Gov. Chris Christie, who will lead the commission to search for solutions to opioid abuse nationwide. “Thousands of Americans die each year from drug overdoses,” Bondi said in a statement. "I want to thank the President of the United States, Governor Christie and many others for caring about this deadly epidemic.” “I’m thrilled to work with the Attorney General on the issues of prevention and addiction to drugs so we don’t get people hooked on drugs in the first place,” Christie said.

In a paper published in the Annals of Internal Medicine, the American College of Physicians (ACP) calls substance use disorders involving prescription and illegal drugs a “serious public health issue” and says they should be considered “treatable chronic medical conditions.” “Drug overdose deaths, particularly from opioids such as prescription pain relievers and heroin, is a rising epidemic,” Dr. Nitin S. Damle, president of ACP, said in a statement. “Substance use disorders are treatable chronic medical conditions, like diabetes and hypertension, that should be addressed through expansion of evidence-based public and individual health initiatives to prevent, treat, and promote recovery.”

A top Senate Democrat is investigating the role drug companies may have played in fueling the nation’s opioid addiction epidemic— demanding internal documents from five leading drug makers on the marketing tactics for opioid painkillers and what, if anything, the companies knew about the dangers of those drugs. Sen. Claire McCaskill, D-Mo., requested information from the nation’s top five opioid manufacturers, including: any internal studies that may have detailed the possible risks of addiction and abuse associated with painkillers such as OxyContin and other powerful opioid medications, marketing and business plans — including quotas for sales representatives — to increase sales of opioids, and contributions made to third-party advocacy groups that may have worked to block efforts to increase regulation of opioids. The companies are: Purdue Pharma, Janssen Pharmaceuticals Inc., Insys, Depomed, and Mylan.

Massachusetts Attorney General Maura Healey announced a Ludlow, Massachusetts, physician has pleaded guilty to illegally prescribing opioids to patients for no legitimate medical purpose, some of whom had documented substance use disorder, and for defrauding the state’s Medicaid program (MassHealth). Dr. Fernando Jayma, age 74, a solo practitioner of general medicine in Ludlow, pleaded guilty in Hampden Superior Court before Judge Edward J. McDonough, Jr. to charges of Illegal Prescribing of Controlled Substances (22 counts), Medicaid False Claims (18 counts), and Larceny over $250 (1 count). He will be sentenced on May 16, 2017. The investigation revealed that, in multiple instances, Dr. Jayma prescribed opioids, including oxycodone, morphine, methadone, and fentanyl, to patients for no legitimate medical purpose. Dr. Jayma prescribed the drugs, which have a high potential for abuse, to some patients despite their documented substance abuse. The illegal prescriptions Dr. Jayma wrote caused pharmacies to unwittingly falsely bill MassHealth for the medication.

Medical/Marijuana/Synthetics

The Drug Enforcement Administration has recently added the temporary placement of six synthetic cannabinoids (5F-ADB, 5F-AMB, 5F-APINACA, ADB-FUBINACA, MDMB-CHMICA and MDMB-FUBINACA) into Schedule I pursuant to the temporary scheduling provisions of the Controlled Substances Act. This action is based on a finding by the Administrator that the placement of these synthetic cannabinoids into schedule I of the Controlled Substances Act is necessary to avoid an imminent hazard to the public safety.

Attorney General Jeff Sessions issued a memo to 94 U.S. Attorney’s Offices and Department of Justice component heads providing an update on the Department’s Task Force on Crime Reduction and Public Safety. As part of that update, the Attorney General announced the creation of Task Force subcommittees that will focus on a variety of issues including developing violent crime reduction strategies, supporting prevention and re-entry efforts, updating charging and sentencing policies, reviewing asset forfeiture guidance, reducing illegal immigration and human trafficking, combatting hate crimes, and evaluating marijuana enforcement policy. The press release may be accessed here.

The Court of Appeals in Arizona ruled colleges and universities can prohibit medical marijuana on campuses, but lawmakers can't make it a crime. The medical marijuana law approved by Arizona voters in 2010 allowed cardholders to possess small amounts of marijuana but it prohibited possession in prisons, schools, and on school buses. The ruling struck down a 2012 decision by the Legislature to expand the off-limits list by adding college and university campuses. However, the Court of Appeals ruling said colleges and universities can still forbid possession of medical pot under their own rules. Expanding the list of places where medical marijuana is prohibited doesn't "further the purpose" of the voter-approved medical marijuana law and even "eliminates some of its protections," Judge Peter Swann wrote in the ruling. The decision overturned a medical marijuana cardholder's 2015 conviction for possession of a small quantity of pot in his Arizona State University dorm room. The decision may be accessed here.

The Marijuana International Corporation, a holding company, has added five new companies to the U.S. Marijuana Index as a result of its quarterly rebalancing. In order for a company to be in the index, they have to have a weighted average minimum market capitalization of $30 million, daily trading volume of $600,000 and a share price that is at least 10 cents. Companies with over $5 million in revenue per year are exempt from these requirements. The United States Marijuana Index has jumped from a level of 48.39 a year ago to the current level of 70.83, an increase of 46%. Here are the five companies added to the index in alphabetical order: AmeriCann Inc., Cannabics Pharmaceuticals, Marapharm Ventures, Inc., mCig, Inc., and Solis Tek, Inc.

PDMP

To better track prescription drug abuse, Kroger pharmacies in Michigan have integrated Michigan Automated Prescription System (MAPS) data and advanced analytics into their workflow. Appriss Health, a technology partner for Michigan's prescription drug monitoring program (PDMP), helped facilitate Kroger's integration into MAPS. Kroger can now directly access MAPS and other information through its pharmacy management system for patients with histories for Schedule II-V controlled substances prescribed and dispensed.

Other

Harvard Medical School has created a new online course called “The Opioid Crisis in America” (OpioidX), on the HarvardX elearning platform. The course is free to the public and provides authoritative information about opioid addiction as well as practical, scalable solutions and abundant evidence-based resources for treatment. Experts in addiction medicine, pain management, and health policy from the Harvard Medical School faculty have guided development of the course, which also includes the perspectives of law enforcement, harm reduction specialists, pharmacists, and others working on the front lines of the opioid epidemic. Topics include: causation of the epidemic of opioid misuse ,are there appropriate ways to use opioids, misuse versus addiction, can opioid misuse and addiction be treated, can opioid overdose be prevented and treated, and what does the evidence say about effective long-term recovery. This online, mobile-responsive course can be viewed on any device, anywhere. It is entirely self-paced and will take about 7 hours to complete and the learner can come back to where he/she left off anytime. The course is largely video-based, featuring first-person testimonials as well as supplemental readings and forum discussions moderated by Harvard medical students specializing in addiction medicine. Learners can purchase identity-verified certificates if they need the credential to advance their careers or simply prove they completed the course. The course may be accessed here.

New Research shows emotional abuse during childhood may lead to opioid addiction and substance-related problems (SRP) in adults who suffer from impulsivity and posttraumatic stress disorder (PTSD).

A team of investigators headed by Matthew Price, PhD, assistant professor, Department of Psychological Science, University of Vermont, in Burlington, found that emotional abuse and negative urgency were related to PTSD symptoms, which in turn were related to SRP, suggesting that PTSD plays a key role in SRP. “People in our sample reported all types of abuse history, but emotional abuse was more relevant to future opioid misuse than the other forms of abuse,” Dr. Price told Medscape Medical News.

“Emotional abuse was associated with strong negative urgency, which contributed to the severity of PTSD. Severe PTSD can lead to greater agitation and, in turn, to self-medication with opioids,” he said.

The study was published in the June issue of Addictive Behaviors.

HBO Documentary Films has created a new film which addresses the devastating effects of opioid addiction in America. Titled “WARNING: THIS DRUG MAY KILL YOU,” the film profiles four families whose lives have been decimated by addictions that all began with legitimate prescriptions to dangerous painkillers. Included in the film are home videos and photos that humanize this public health crisis. The film will be screened at the Tribeca Film Festival April 27 – 30, 2017 and will debut on HBO on May 1, 2017.


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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