The National Attorneys General Training & Research Institute

The National Attorneys General Training & Research Institute The National Attorneys General Training & Research Institute

Substance Abuse Newsletter January 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

The U.S. Department of Health and Human Services Office on Women’s Health (OWH) recently published a white paper titled, "Opioid Use, Misuse, and Overdose in Women." This white paper explores what is currently known about the opioid epidemic, describes promising practices for addressing opioid use disorder prevention and treatment for women, and identifies areas that are less well understood and may warrant further study. The report was developed as part of an initiative supported by OWH to examine prevention, treatment, and recovery issues for women who misuse, have use disorders, and/or overdose on opioids.

SAMHSA announces the release of the Protecting Our Infants Act Report to Congress. Mandated by Congress, this report includes: an overview of prenatal opioid exposure and neonatal abstinence syndrome, a description of U.S. Department of Health and Human Services (HHS) surveillance, research, service delivery, education, and coordination activities for prenatal opioid exposure and NAS, as well as current gaps in HHS programs and recommendations for addressing them, and a strategy to address gaps, overlap, and duplication among federal programs, and to effectively address prenatal opioid exposure.

The Center for Disease Control has compiled multi-year data, which indicates that since 2013, law enforcement encounters (drug submitted for analysis) testing positive for fentanyl reported by laboratories participating in NFLIS has sharply increased in a growing number of states. Included in the data is a finding that the number of fentynal encounters more than doubled in the United States from 5,343 in 2014 to 13,882 in 2015. In addition, a 2015 CDC Health Alert documented states with high or increasing numbers of fentanyl encounters also reported increases in fentanyl-involved overdose deaths. Most of the increases in fentanyl deaths over the last three years do not involve prescription fentanyl but are related to illicitly-made fentanyl that is being mixed with or sold as heroin—with or without the users’ knowledge and increasing as counterfeit pills.

The National Institute on Drug Abuse Director Dr. Nora Volkow has posted her latest blog entitled “Taking Stock of NIDA’s Achievements and Looking to the Future” which highlights some of NIDA’s major accomplishments in 2016 and opportunities/challenges faced in 2017 and beyond. The full content may be accessed on the NIDA web site.

Medical/Marijuana

Marijuana can be an effective medicine in some cases for treating pain, nausea, muscle spasms and other conditions, but the drug that is wafting into the mainstream is not harmless, and more research is needed, the nation’s top scientists concluded in a recently released landmark report. The nonprofit National Academies of Sciences, Engineering and Medicine issued its report, “The Health Effects of Cannabis and Cannabinoids,” summarizing the body of research into the efficacy of medical pot. The 395-page paper is a medical review of the botanical drug, which an estimated 8 percent of American adults used in the past month.

Counterfeit/Suspicious Drugs

McKesson Corporation (McKesson), one of the nation’s largest distributors of pharmaceutical drugs, agreed to pay a record $150 million civil penalty for alleged violations of the Controlled Substances Act (CSA), the U.S. Drug Enforcement Administration (DEA) recently announced. The nationwide settlement requires McKesson to suspend sales of controlled substances from distribution centers in Colorado, Ohio, Michigan, and Florida for multiple years. The staged suspensions are among the most severe sanctions ever agreed to by a DEA-registered distributor. The settlement also imposes new and enhanced compliance obligations on McKesson’s distribution system. In 2008, McKesson agreed to a $13.25 million civil penalty and administrative agreement for similar violations. In this case, the government alleged again that McKesson failed to design and implement an effective system to detect and report “suspicious orders” for controlled substances distributed to its independent and small chain pharmacy customers– i.e., orders that are unusual in their frequency, size, or other patterns. From 2008 until 2013, McKesson supplied various U.S. pharmacies an increasing amount of oxycodone and hydrocodone pills, frequently misused products that are part of the current opioid epidemic.

PDMP Purdue Pharma, the manufacturer of prescription opioid Oxycontin, has announced that it will fund an upgrade of Virginia’s prescription drug monitoring program (PDMP) that will integrate prescribing information into patients’ electronic health records (EHRs). The collaboration with the Virginia Department of Health comes about two months after Governor Terry McAuliffe declared the state’s opioid addiction crisis a public health emergency. Virginia currently has a state-run electronic database to track the prescribing and dispensing of controlled substances, such as opioids, but clinicians must visit a separate website to access it before prescribing or dispensing a controlled substance. However, incorporating the PDMP within each patient’s EHR would alleviate burden by “integrating the PDMP query into the existing workflow,” according to the governor’s office.

Other

New technology devices are being developed and approved by the FDA to treat chronic pain. There is hope that these devices, along with over-the counter-medication and physical therapy, may help to reduce opioid use in patients suffering chronic pain. The devices are reaching the market now because the science and engineering are only recently advanced enough for this to be possible: "The technology wasn't available in the past, because the electronics weren't able to be made small enough," said Laura Perryman, the chairman and CEO of Stimwave, a company that manufactures a tiny implantable device to treat chronic pain, which was approved by the FDA in March. Many of these devices are designed to specifically treat peripheral pain — pain in nerves that flow from every part of the body up through the spinal cord and into the brain.

The Narcan Now app is now available free for download at Google Play and Apple App store.


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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