Substance Abuse Newsletter July 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

The United States Drug Enforcement Administration (DEA) released the 2016 National Heroin Threat Assessment Summary. The report outlines the expanding public health crisis afflicting America due to the use and abuse of heroin and other opioid drugs. Some key facts: The number of people reporting current heroin use nearly tripled between 2007 (161,000) and 2014 (435,000), deaths due to synthetic opioids, such as fentanyl and its analogues, increased 79 percent from 2013 to 2014 and deaths involving heroin more than tripled between 2010 (3,036) and 2014 (10,574) – a rate faster than other illicit drugs. New to this year’s summary is information on a recent phenomenon—fentanyl disguised as prescription pills—something allegedly responsible for the death of 19 people in Florida and California during the first quarter of 2016.

The Obama Administration is taking additional actions to expand access to treatment, strengthen prescription drug monitoring, enable safe disposal of unneeded drugs, and accelerate research on pain and opioid misuse and overdose. An outline of several new federal agency actions is located at The White House FACT SHEET

The Department of Health and Human Services announced on July 6, 2016, that it is raising the number of patients to which qualified health care providers can prescribe buprenorphine. Previously these providers could prescribe buprenorphine to no more than 100 patients at once. Now HHS is raising the limit to 275 patients. Buprenorphine ranks as the most common form of medication-assisted treatment for opioid addiction in the United States, according to federal officials.

A new Johns Hopkins Bloomberg School of Public Health survey suggests that more than half of patients prescribed opioids have leftover pills—and many save them for later use. The research, reported in the June 13, 2016 issue of JAMA Internal Medicine, also found that nearly half of those surveyed reported receiving no information on how to safely store their medications, either to keep them from young children who could accidentally ingest them or from adolescents or other adults looking to get high. Nor were they given information on how to safely dispose of their medications. Fewer than seven percent of people with extra pills reported taking advantage of "take back" programs that enable patients to turn in unused pain medication to pharmacies, police departments, or the Drug Enforcement Administration for disposal.

The West Virginia Attorney General’s Office and the Board of Medicine and Osteopathy teamed up to create public service announcements to promote a better understanding of the opioid epidemic and to encourage West Virginians to explore non-opioid alternatives to pain therapy. The public service announcements encourage patients to seek alternative pain therapy and ask their prescriber three questions – “Am I being prescribed opioids?” “Is there an alternative treatment?” “If not, is there a lower effective dosage?” The PSAs will appear in print, radio and social media.

The makers of Elimidrol claimed the powdered drink mix made it easier to kick opioid addiction but the Federal Trade Commission thought otherwise. Jessica Rich, Director of the FTC’s Bureau of Consumer Protection, said that “by peddling their unproven product, these defendants have prevented people from seeking legitimate treatment.” In November 2015, the FTC charged that Sunrise Nutraceuticals, LLC, made deceptive claims for Elimidrol, a powder that contains vitamins, minerals, and herbs. Sunrise has now agreed to settle the complaint and to have competent and reliable scientific evidence to back up any future claims. It has also agreed to pay $235,000.

The Office of Inspector General (OIG) has uncovered striking trends in Part D (the optional prescription drug benefit for Medicare beneficiaries) spending for opioids and compounded drugs that warrant further scrutiny. The OIG data brief describes these trends. It also provides information that can assist efforts to ensure the appropriate use of these drugs, protect the integrity of the Part D program, and promote the safety of beneficiaries and others. According to information contained in this data brief, Medicare spending for Part D drugs has continued to rise by more than $10 billion a year. Spending on commonly abused opioids exceeded $4 billion in 2015. Spending on compounded drugs has increased dramatically, in particular, compounded topical drugs rose more than 3,400 percent since 2006. These trends raise concerns about fraud, abuse, and patient safety.

A joint HHS/CDC analysis of methadone trends from 2002–14 found that overdose fatalities spiked 22.1% annually during the first 5 years of the study period, while the national distribution rate of methadone for pain jumped 25.1% and methadone diversion from legal to illegal markets rose 24.3%. Starting in 2006, though, state and federal campaigns began cracking down in earnest on the use of methadone for pain; and the impact from those efforts are reflected in the numbers after that. From 2006–14, methadone overdoses reversed direction, falling 6.5% per year, along with a 3.2% drop in distribution. Meaningful declines in diversion, though, were not observed until 2010. By the end of the study period, methadone overdose deaths were at the lowest level since 2003. Moreover, this contraction occurred despite the fact that 100,000 more people received methadone for addiction from 2002–13, indicating that restrictions on the drug as an analgesic did not hinder access of it for treatment of an opioid addiction.

Medical/Marijuana

Marijuana gummy bears won’t be legal in Colorado starting next month. Neither will marijuana products in the shape of any other animal. Or fruits. Or people. A bill signed into law June 10, 2016, by Gov. John Hickenlooper (HB 16-1436) makes it a crime to sell pot-infused candies in certain shapes. Sponsors say that gummy bears, gummy worms and chewy candies shaped like fruits are too attractive to children. Colorado will require edible marijuana to come with a stamp that says the item includes THC, marijuana’s intoxicating ingredient. That requirement takes effect later this year. The gummy bear ban takes effect July 1.

The Louisiana State University Board of Supervisors approved a resolution that will allow the LSU Agricultural Center to begin taking the necessary steps to produce medical marijuana as part of a state initiative. LSU and Southern University’s agricultural centers were given the first right of refusal to be licensed as the production facility for medical marijuana. No additional state funding will be provided to the University for this project. The growth and production of medical marijuana will be done according to stringent rules set forth by the State Department of Agriculture and Forestry. Rules for doctor recommendations will be set by the Louisiana State Board of Medical Examiners, and guidelines for distribution will be set by the State Board of Pharmacy.

Parents and guardians of children with epilepsy and other medical conditions will be able to obtain a "safe harbor" letter next month allowing them to obtain medical marijuana from outside Pennsylvania. Temporary regulations for child patients are the first to be rolled out by the state Department of Health. Caregivers are required to complete a background check, provide a picture ID, and obtain a physician form from a doctor licensed by the state in order to be approved for out-of-state purchases. The state Department of Health has warned, however, that marijuana is still listed as a Schedule I controlled substance under federal law. That means that the letter may not be a shield against prosecution for individuals traveling with marijuana outside Pennsylvania, even for those intending to bring it back for the use of a state-approved child patient.

Tech giant Microsoft announced it is partnering with a cannabis industry-focused software company called Kind Financial. The company provides “seed to sale” services for cannabis growers, allowing them to track inventory, navigate laws, and handle transactions all through Kind’s software systems. The partnership marks the first major tech company to attach its name to the burgeoning industry of legal marijuana.

Synthetics

Researchers from the University of Arkansas for Medical Sciences have received a federal grant to study the dangers posed by synthetic marijuana products. The $2.7 million grant is from the National Institutes of Health National Institute on Drug Abuse. Over five years, the seven-member UAMS team will study why synthetic compounds - such as K2 and Spice - are more toxic than marijuana. Researchers will study the compounds’ effects on human cells in the lab, in mice, and in those who take the synthetic drugs and are admitted to the emergency room at UAMS and at ERs in New York.

Methamphetamine

The National Association of State Controlled Substance Authorities has completed a white paper titled “Impact of State Laws Regulating Pseudoephedrine on Methamphetamine Production and Abuse”. Locate the link to this paper here.

Drug Take Back

The Indiana Attorney General’s Prescription Drug Abuse Prevention Task Force is teaming up with the Indianapolis Colts for a prescription drug take back event at Training Camp. Fans who bring unused or expired prescription medications for safe disposal on August 1st will be given a complimentary copy of the 2015 Colts highlight DVD.

Prescription Drug Monitoring

All California health practitioners licensed to prescribe or dispense scheduled medications are required by law to sign up for CURES by July 1, 2016 (Controlled Substance Utilization Review and Evaluation System ). The fully upgraded CURES 2.0 database was launched in January 2016 through a joint partnership between the California Departments of Justice and Consumer Affairs. CURES enables healthcare providers to review their patients’ medication histories before prescribing new controlled substances. In addition to providing users with faster and more reliable access to patient activity reports, the upgraded 2.0 system features cutting-edge analytics for flagging at-risk patients, allowing medical professionals to prescribe wisely and helping to prevent abuse or diversion of controlled medications such as opioids.

Other

Data on the 10 states with the most drug overdoses in the United States can be found here.

The Oregon Marine Board, law enforcement from 32 counties, and the Oregon State Police will be participating in Operation Dry Water as part of a nationally coordinated effort to reduce the number of accidents and fatalities related to boating under the influence of intoxicants. “Because there is clear evidence from Washington State that recreational marijuana increases fatal car crashes, we can only assume that some people will take their impairment to the water," says Randy Henry, Boating Safety Manager for the Marine Board. "To help marine officers prepare, we are training them to recognize drug impairment along with alcohol impairment and arrest those operators --including those with paddles," Henry adds. The effects of drugs and alcohol are also amplified on the water with the combination of sun, glare, wind, waves, and other motion.

The American Academy of Pediatrics (AAP) has updated its policy statement and clinical guidelines on teens and substance use, calling for pediatricians to expand efforts to screen and treat adolescents. The policy statement: Substance Use Screening, Brief Intervention, and Referral to Treatment.


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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