Substance Abuse Newsletter July 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 Jeff Sessions of the Justice Department and Acting Administrator Chuck Rosenberg of the Drug Enforcement Administration announced Mallinckrodt LLC, a pharmaceutical manufacturer and one of the largest manufacturers of generic oxycodone, agreed to pay $35 million to settle allegations that it violated certain provisions of the Controlled Substances Act (CSA) that are subject to civil penalties. This is the first settlement of its magnitude with a manufacturer of pharmaceuticals resolving nationwide claims that the company did not meet its obligations to detect and notify DEA of suspicious orders of controlled substances such as oxycodone, the abuse of which is part of the current opioid epidemic. These suspicious order monitoring requirements exist to prevent excessive sales of controlled substances, like oxycodone in Florida and elsewhere. The settlement also addressed violations in the company’s manufacturing batch records at its plant in Hobart, New York. Both sets of alleged violations impact accountability for controlled substances, and the compliance terms going forward are designed to help protect against diversion of these substances at critical links in the controlled substance supply chain.

Attorney General Jeff Sessions and Department of Health and Human Services (HHS) Secretary Tom Price, M.D., announced the largest ever health care fraud enforcement action by the Medicare Fraud Strike Force, involving 412 charged defendants across 41 federal districts, including 115 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $1.3 billion in false billings. Of those charged, over 120 defendants, including doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics. Thirty state Medicaid Fraud Control Units also participated in today’s arrests. In addition, HHS has initiated suspension actions against 295 providers, including doctors, nurses and pharmacists.

New Centers for Disease Control and Prevention data from North Carolina hospitals show the rise in <href="#stream/0">intravenous drug use is also causing a sharp increase in the rate of heart infections. CDC epidemiologist Aaron Fleischauer discussed the new study, the impact of the rising number of heart infections on the state’s hospitals and taxpayers, and possible strategies to address these trends. When asked how intravenous drug use causes heart infections, he responded: “It’s a well-established link. In fact, it’s been described since the 1950s, and it’s a relatively simple mechanism. Essentially injection drug users are pushing bacteria from their skin into their bloodstream. It finds its way to the heart or heart valve where it grows and damages heart valves and causes a whole mess of problems. There are probably three common ways endocarditis can be an outcome of injection drug use. One could be unsterile equipment like an unsterile syringe. The other could be a contaminated product – the drug is contaminated. Or poor cleaning of the injection site. Any of those mechanisms can introduce bacteria into the bloodstream.”

As part of a continued effort to go after suspected dealers behind deadly overdoses, the U.S. Attorney's office is prosecuting a suspected dealer, Agustin Cirino, for selling counterfeit pills — one of the first cases of its kind in Connecticut, officials said. Though cases like these aren't yet common in Connecticut, the U.S. Drug Enforcement Administration released a report that counterfeit pills disguising fentanyl, more powerful and cheaper to produce, has become another growing threat in the deadly opioid epidemic. Special Agent Timothy Desmond with the DEA's New England Division said word of this trend picking up started on the West Coast about a year ago. After Hamden police were called to an untimely death the morning of March 9, they soon found three blue pills marked "M 30," along with a cut orange straw in the home, a criminal complaint charging Cirino said. Using the victim's cellphone, investigators with a DEA task force traced the purchase of the pills.

Dr. Yasmin Hurd (left), Director of the Center for Addictive Disorders within the Mount Sinai Behavioral Health System, and Dr. Edwin Salsitz of Mount Sinai Beth Israel, have created a useful question and answer document concerning opioids. Topics include: what are opioids, signs of addiction, and how quickly someone can become addicted. The document may be accessed here.

<href="#stream/0">The state of Missouri filed suit against three major drug companies, alleging they fueled the nation’s opioid epidemic with a campaign of false advertising and fake claims. On the steps of St. Louis Circuit Court, Missouri Attorney General Josh Hawley said he would seek “hundreds of millions of dollars” in damages against Purdue Pharma L.P., Endo Pharmaceuticals Inc., and Janssen Pharmaceuticals Inc., a subsidiary of Johnson & Johnson. “These companies knew that the drugs they sell and market are highly addictive, even life threatening if misused. And yet they have engaged in a deliberate campaign of fraud to convince Missouri doctors and Missouri consumers otherwise,” Hawley said.

Medical/Marijuana/Synthetics

A marijuana trafficking ring that pretended to be growing for sick people was instead illegally shipping the drug to a half-dozen other states and bilking investors, including former NFL players, Colorado officials announced. A Denver grand jury indicted 62 people and 12 businesses in the case that involved federal and state agents executing nearly 150 search warrants at 33 homes and 18 warehouses and storage units in the Denver area. “The black market for marijuana has not gone away since recreational marijuana was legalized in our state, and in fact continues to flourish,” state Attorney General Cynthia Coffman said in a statement. The indictment targets the largest illegal marijuana operation discovered since Colorado legalized recreational pot in 2012, Coffman said. It says the enterprise produced more than 100 pounds of illegal pot each month for shipment to Kansas, Texas, Nebraska, Ohio, Oklahoma and other states.

Marijuana sales in Nevada's new legal recreational market began on July 1. Adults age 21 and older will be able to buy up to an ounce of marijuana, or one-eighth of an ounce in marijuana-infused edibles and concentrates. Retail sales will be subject to a 10% sales tax, which Nevada officials expect to generate more than $60 million in the first two years. Legalizing marijuana was approved by about 55% of Nevada voters back in November. Nevada joins Alaska, Colorado, Oregon and Washington in regulating legal marijuana sales, and California, Maine and Massachusetts are expected to join next year.

Florida Gov. Rick Scott signed legislation to implement the medical marijuana amendment voters approved last year. Amendment 2, approved by 71 percent of the voters in November, took effect on January 3, 2017, and required that laws had to be in place by July 3 for how patients can qualify and receive the drug. Scott has noted that the constitutional amendment “was passed overwhelmingly” and said the law “make sense for our state.” Patients who suffered from epilepsy, chronic muscle spasms, cancer, and terminal conditions were allowed under laws Scott signed in 2014 and 2016 to receive either low-THC cannabis or full strength medical marijuana. This law adds people with HIV and AIDS, glaucoma, post-traumatic stress disorder, ALS, Crohn’s disease, Parkinson’s disease, multiple sclerosis, and similar conditions.

The West Virginia Medical Cannabis Act is officially in effect, but it could be years before citizens are able to use marijuana as a medical treatment option in the Mountain State. New changes include the appointment of an advisory board, which is headed up by the Department of Health and Human Resources (DHHR) and is made up of different professionals from throughout the state. The advisory board will be responsible for creating the framework around how medical cannabis will be prescribed and distributed. According to State Delegate Shawn Fluharty, patients will not receive prescriptions until 2019.

Mexican President Enrique Peña Nieto signed a decree legalizing medical marijuana. The measure also classified the psychoactive ingredient in the drug as “therapeutic.” Instead it calls on the Ministry of Health to draft and implement regulations and public policies regulating “the medicinal use of pharmacological derivatives of cannabis sativa, indica and Americana or marijuana, including tetrahydrocannabinol.” It also tasks the ministry with developing a research program to study the drug's impact before creating broader policies. The measure had broad support from Mexico's Senate and Lower House of Congress, where it passed 347-7 in April.

Methamphetamine

Methamphetamine use and trafficking has increased in the Oregon-Idaho HIDTA and represents the area’s greatest drug threat, followed by heroin, controlled prescription drugs, illicit marijuana, cocaine and other dangerous substances, including synthetic drugs. Methamphetamine continues to be widely used and trafficked throughout the region. Reported seizures of methamphetamine labs in Oregon remain low due to state legislation eliminating the ability to obtain pseudoephedrine without a physician’s prescription. However, crystal methamphetamine, or “ice,” continues to be highly available as Mexican drug traffickers import methamphetamine powder, liquid, and finished product from laboratories outside the state and from Mexico. Production of heroin in Mexico has expanded leading to greater availability of low-cost product in Oregon and Idaho. Reporting from law enforcement indicates that heroin is a serious threat in the region due to the substantial rise in the volume of heroin seized and the number of new users and associated overdoses.

PDMP

Veterinarians in Maine are being tasked with policing pet owners for opioid abuse, requiring them to review the prescription record of individuals picking up controlled substances for pets and alerting the state when there is cause for suspicion. The new law won’t prevent veterinarians from prescribing opioids or benzodiazepines, even when abuse is suspected. The new law went into effect in March 2017 and expands Maine’s Prescription Drug Monitoring Program (PDMP) to include veterinarians. The new law has two requirements—that veterinarians check the state’s PDMP when prescribing opioids or benzodiazepines, and that veterinarians earn three hours of continuing education on prescribing practices for opiates every two years beginning in December 2017. In order to check the PDMP, veterinarians first have to register with the state. From there, they will be required to check the records of anyone seeking an opioid or benzodiazepine for an animal.

Other

SAMHSA's Center for Behavioral Health Statistics and Quality is pleased to announce the release of a new short report, Trends in Substance Use Disorders Among Adults Aged 18 or Older. The report, based on data from the annual National Survey on Drug Use and Health, highlights the number of American adults with substance use disorders in the past year and trends in substance use disorders between 2002 and 2014. Reducing substance use disorders and related problems among adults is critical for mental and physical health, safety, and quality of life.

The National Cooperative Research and Evaluation Program (NCREP) convened a group of national experts, representing states that legalized and decriminalized marijuana, to discuss the consequences and identify issues for consideration by other states that may be considering the adoption of these laws. Key takeaways from the meeting include recommendations for states on legislation, training, public outreach, and collaboration. A report of this meeting may be accessed here.

A recent insurance study links increased car crash claims to legalized recreational marijuana. The Highway Loss Data Institute said in study result that collision claims in Colorado, Washington, and Oregon went up 2.7 percent in the years since legal recreational marijuana sales began when compared with surrounding states. Legal recreational pot sales in Colorado began in January 2014, followed six months later in Washington, and in October 2015 in Oregon. "We believe that the data is saying that crash risk has increased in these states and those crash risks are associated with the legalization of marijuana," said Matt Moore, senior vice president with the institute, which analyzes insurance data to observe emerging auto-safety trends. Researchers accounted for factors such as the number of vehicles on the road in the study and control states, age and gender of drivers, weather and even whether the driver making a claim was employed. Neighboring states with similar fluctuations in claims were used for comparison.


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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