Substance Abuse Newsletter March 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.

New Developments in Combatting Opioid Abuse

Attorney General Eric T. Schneiderman announced an agreement with Endo Health Solutions Inc. and Endo Pharmaceuticals Inc. (Endo), which make and sell the long-acting opioid, Opana ER. The agreement requires Endo to cease all misrepresentations regarding the properties of Opana ER, to describe accurately the risk of addiction to Opana ER, and to summarize studies regarding Opana ER on its website. Endo must also create a program that will prevent its sales staff from promoting this powerful narcotic painkiller to health care providers who may be involved in the abuse and illegal diversion of opioids. “The public health crisis created by improper opioid prescribing in New York remains pervasive and extremely dangerous,” said Attorney General Schneiderman. “My office is committed to ensuring that prescription drugs are marketed and prescribed responsibly – and that consumers get the information they need about the serious risks associated with painkillers, such as addiction.” nyag.pressoffice@ag.ny.gov

Members of the Maine Legislature’s Criminal Justice and Public Safety Committee voted 8-4 to support a bill that would allow prosecutors to pursue felony charges against anyone for possession of heroin, methamphetamine, fentanyl, or more than 14 grams of cocaine. The bill, L.D. 1554, would downgrade, however, possession of small amounts of oxycodone pills to a misdemeanor. Attorney General Janet Mills sought the changes because she said prosecutors need the threat of a Class C felony conviction – punishable by up to five years in prison – in order to force some drug users to enter treatment. Prosecutors do that by sending a case to the state’s drug court system or by using “deferred disposition,” in which accused persons are charged with a felony up front but only end up with a misdemeanor conviction or no conviction if they complete drug treatment and probation.

Much of the focus of the opioid crisis has been on heroin, but another opioid is killing users at a much higher rate: fentanyl. A new Fusion documentary called “Death By Fentanyl” explores the rise of the drug, which has two main sources: pharmaceutical companies and Mexican drug cartels.

Health and Human Services (HHS) Secretary Sylvia M. Burwell announced $94 million in Affordable Care Act funding to 271 health centers in 45 states, the District of Columbia, and Puerto Rico to improve and expand the delivery of substance abuse services, with a specific focus on treatment of opioid use disorders in underserved populations. “The opioid epidemic is one of the most pressing public health issues in the United States today,” said Secretary Burwell. “Expanding access to medication-assisted treatment and integrating these services in health centers bolsters nationwide efforts to curb opioid misuse and abuse, supports approximately 124,000 new patients accessing substance use treatment for recovery and helps save lives.”

With no end to the nation’s opioid crisis in sight, the federal government on Tuesday issued final recommendations that urge doctors to use more caution and consider alternatives before they prescribe highly addictive narcotic painkillers. This first national guidance on the subject is nonbinding, and doctors cannot be punished for failing to comply. But the head of the Centers for Disease Control and Prevention, which issued the guidelines, said the effort was critical to bringing about “a culture shift for patients and doctors.” “We are waking up as a society to the fact that these are dangerous drugs,” Director Tom Frieden said in an interview. “Starting a patient on opiates is a momentous decision, and it should only be done if the patient and the doctor have a full understanding of the substantial risks involved.”

In the next few weeks, the FDA is expected to approve a cutting edge way to deliver the drug Buprenorphine, a common treatment that helps in recovery. Doctors have been studying a long-acting Buprenorphine implant. "It's implanted into the body, with a very, very simple incision. It's basically placed underneath the skin and it's effective for six months," said Dr. Andy Mendenhall, regional medical director for CleanSlate. "Ninety-five percent of the people who suffer from an opioid addiction are not going to be successful unless they're provided access to opioid replacement therapy like Buprenorphine or Methadone," said Dr. Mendenhall. Typically, those therapies need to be taken daily, and those struggling to recover said it makes them feel like they are using again. This implant can help solve that problem and will require fewer visits to doctors or clinics

In an effort to address the opioid overdose crisis in Massachusetts, Governor Charlie Baker reached out this past fall to the deans of the commonwealth’s four medical schools (BU School of Medicine, Harvard Medical School, Tufts University School of Medicine, and University of Massachusetts Medical School) and asked for their help in designing a list of core competencies needing to be covered during medical school to help combat prescription drug misuse, addiction, and overdose fatalities. Working with the Massachusetts Medical Society and Monica Bharel, the commonwealth’s public health commissioner, the schools developed a list of 10 competencies that will be introduced into their curricula beginning this year. The new curriculum will be woven throughout the students’ education. The curricula will be integrated much like an existing curriculum around nutrition and evidence-based medicine throughout the departments. Similarly, Massachusetts' three dental schools have reached an agreement to teach their students how to prevent the misuse of prescription drugs. Dental schools at Boston, Tufts and Harvard universities have all agreed to the standards, which are supported by the Massachusetts Dental Society and the Massachusetts Department of Public Health.

Naloxone, a heroin overdose antidote drug, will now be within reach from different pharmacies in 35 states, said Walgreens on Tuesday, Feb. 9. It will be covered by most insurance plans. For those without insurance, it will cost them $78 per dose via the Walgreens Prescription Savings Club, according to the Daily Herald. In order to ensure proper and safe disposal of the used drug, Walgreens will also be putting up kiosks in pharmacies in 39 states. "Now if you have a parent, for example, that has a child that is struggling with addiction or an adult child living at home, they can have it on hand," said Mike Nerheim, attorney for Lake County State. "Those minutes count and I think the more Naloxone out there, the more accessible it is, the more lives are going to be saved."

In New Hampshire, as part of Farnum Center North, the Ray House will be the first residential drug treatment center specifically for veterans in the Granite State. "We don't want to stick them with a bunch of people who have no idea what they've been through," Dr. Cheryl Wilkie, Senior Vice President of Easter Seals Treatment. "When they have been brothers and sisters to each other, we want to give them that space to get well." The Ray House will add 22 beds to the 60 available at the Farnum Center in Manchester.

Updates in Marijuana Legalization

Arkansas Attorney General Leslie Rutledge has rejected a proposed constitutional amendment to legalize marijuana in Arkansas. The proposal sought to legalize the cultivation, production, sale, possession, and use of the cannabis plant and all products produced by the cannabis plant, including marijuana. General Rutledge indicated there were ambiguities in the text of the proposal and that a number of additions or changes are necessary to the proposal as written.

Attorney General Mike DeWine rejected a medical marijuana ballot proposal aiming for the November election. After examining the wording of the proposal, DeWine rejected it because of three errors, including a confusion about the number of medical marijuana cultivation facilities. He also found fault with a provision that would prevent marijuana users from being penalized for "operating a motor vehicle, aircraft, train, or motorboat while impaired by marijuana." There was also a mistake about the date for obtaining a valid medical marijuana registration card. DeWine's rejection letter and the text of the proposed amendment is online at http://www.ohioattorneygeneral.gov/Legal/Ballot-Initiatives/Petitions-Submitted-to-the-Attorney-General-s-Offi

Nearly six million Americans - or 2.5 percent of adults in the U.S. - suffer from “marijuana use disorder”, according to a new study by NIAAA. The study was released as a record number of ballot proposals to either legalize or decriminalize marijuana have been proposed in 16 states this year, according to BallotPedia. “Marijuana use disorder is common in the United States, is often associated with other substance use disorders, behavioral problems, and disability, and goes largely untreated,” according to NIAAA, which is part of the National Institutes of Health (NIH).The findings from NIAAA’s National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) study were published in The American Journal of Psychiatry.

The company that will provide a seed-to-sale tracking system for every single cannabis plant in Alaska’s commercial industry is the same company that tracks commercial cannabis in Colorado and Oregon, the state announced this week. Franwell, which calls itself a technology company focusing on supply chain tracking, has contracted with the state for more than five years, according to Alcoholic and Marijuana Control Office director Cynthia Franklin. Under Alaska’s marijuana regulations, all commercial grows, retailers, testing facilities and manufacturers must use the tracking system. Every plant and package of marijuana will be tagged. Each tag has a RFID (radio frequency identification) chip, a barcode and human-readable identification. The plants will be tracked through the stages of growth, as well as the drying and curing process.

The Oregon House overwhelmingly passed House Bill 4094 that protects Oregon banks who provide financial services to state-regulated marijuana businesses. Governor Kate Brown is expected to sign the bill. This will make Oregon the first state to remove all criminal penalties for banks and credit unions that work with cannabis businesses operating within state law.

The names of licensed nonprofit medical marijuana producers and those seeking licenses from the state will become public under new rules which took effect on February 29, 2016, according to the New Mexico Department of Health. The changes in confidentiality apply only to producers and producer applicants, not the more than 21,000 patients certified in the state Medical Cannabis Program.

Colorado’s Department of Revenue reported that cannabis sales reached $996 million in the 2015 fiscal year; up from $699 million during 2014’s fiscal year. That represents an increase of 42 percent. The fiscal year runs from June 1 to May 31. Recreational sales were only allowed for last five months of the 2014 fiscal year because the law went into effect on Jan. 1, 2014. The DOR released the information on Tuesday in its annual report, which tracks funds collected from taxes and licensing fees.

The Maine Board of Education approved a new policy that affects students who are certified by a medical professional to use medical marijuana. The policy was added in light of state law which allows its use, board members said, not out of concern about the issue locally. Superintendent James Anastasio said the policy is based on a model policy from the Maine School Management Association. It is meant to give guidance to staff members in dealing with students who use medical marijuana to manage a medical condition and have written certification from a medical provider for the use of medical marijuana. The policy states students would not be allowed to possess medical marijuana in school and requires medical marijuana to be administered, in nonsmokable form, by a primary caregiver, such as a parent.

The Washington D.C. City Council unanimously voted to prohibit employers from testing potential employees for cannabis use, until after they have made them a conditional job offer. The bill, “Prohibition of Pre-Employment Marijuana Testing Emergency Act of 2014,” was sponsored by Councilmember Vincent Orange (D-At Large). Orange presented the bill last March, which states, “An employer may only test a prospective employee for marijuana use after a conditional offer of employment has been extended, unless otherwise required by law.”

As the legal marijuana economy has grown, insurance coverage for this emerging industry has become a hot topic. The U.S. District Court for the District of Colorado in The Green Earth Wellness Center, LLC v. Atain Specialty Insurance Company, No. 13-cv-03452-MSK-NYW, 2016 WL 632357 (D. Colorado Feb. 17, 2016) was recently faced with determining the extent of coverage under a commercial property policy for damage sustained to marijuana plants at a growing facility and addressing whether legal marijuana was even insurable. The Court declined to follow Tracy v. USAA Casualty Ins. Co., 2012 WL 928186 (D. Hawaii March 16, 2012) and declare the policy unenforceable as against public policy citing, in particular, the “several additional years evidencing a continued erosion of any clear and consistent federal public policy in this area.” The Court ordered that Green Earth’s breach of contract claim for the $40,000 in damage to its harvested marijuana buds and flowers must be tried.

Virginia's lawmakers passed a bill which will allow for the eventual production and distribution of marijuana oils in the Commonwealth. After lengthy discussions and negotiations, SB701 passed both the House and the Senate unanimously. This legislation seeks to create a way to process and provide THCa and CBD Oils for patients with intractable epilepsy. The bill only applies to intractable epilepsy patients. Families who need the medical marijuana will have to wait at least a year to see the benefits as the Board of Pharmacy creates regulations for the product.

Residency restrictions on investments in Oregon cannabis businesses were impacted by Oregon HB4014 (2016) which was signed into law late last week by Oregon Governor Kate Brown. The prior residency restriction mandated that cannabis licensees be majority owned by Oregon residents, thereby making it more difficult for Oregon cannabis businesses, especially small businesses, to attract needed investment from nonresident investors. The residency restriction would have also required nonresident shareholders of Oregon cannabis businesses to be listed on the recreational license applications, which would have been a cumbersome and unworkable obligation for publically traded companies. The new law removes this requirement and streamlines the recreational licensing process.

Synthetic/Designer Drug News

Attorney General Pam Bondi thanked members of the Florida House for voting unanimously in favor of HB 1347, sponsored by Representative Clay Ingram. “Instead of individually identifying dangerous chemical compounds found in synthetic drugs, and then outlawing them, this legislation will allow us to categorically outlaw synthetic drugs as a whole,” said Attorney General Bondi. “I want to thank Representative Clay Ingram and all members of the Florida House for passing this legislation that will certainly save lives.”

Attorney General Eric T. Schneiderman announced on March 8, 2016, that the online designer drug company “Surrealistic Sensations,” is permanently enjoined from selling designer drugs. Consistent with the Attorney General’s allegations, Bronx Supreme Court Justice Lizbeth Gonzalez found the drugs were mislabeled, misbranded, and injurious to the public. In a March 8, 2016, Decision & Order, Justice Lizbeth Gonzalez ordered Jamail (the owner) to comply with all applicable state, local, and federal labeling requirements with respect to the sale, distribution, and promotion of his products. According to the decision, the misrepresentations Surrealistic Sensations made in regards to the side effects of its drugs were “alarming.” A hearing to determine restitution, damages, and civil penalties was also ordered. “The Court’s decision is a resounding victory in our efforts to clean the shelves of designer drugs across New York State,” said Attorney General Schneiderman. “Designer drugs are dangerous, insidious substances, and have contributed to a public health crisis across the nation. We must be vigilant and relentless in our efforts to remove these mislabeled and misbranded street drug alternatives from our neighborhoods.”

The Truth About Synthetics Drugs documentary is part of Foundation for a Drug-Free World's hard-hitting multimedia approach to drug education, including public service announcements and 14 fact-filled booklets on the most commonly abused drugs. The entire synthetic drugs curriculum is now available through the Foundation's website and incorporated into their Drug-Free World app. The Truth About Drugs materials dispel pro-drug myths and reach youth with the factual information they need to make information decisions not to use drugs.

Other News of Interest

Attorney General Roy Cooper kicked off an annual program aimed at fighting prescription drug abuse among teenagers at Asheville High School. General Cooper is sponsoring the Stop Rx Abuse contest. The competition asks teens to produce short public-service videos that raise awareness about pill abuse among kids. "Through these 30-second commercials, not only can young people learn about the problem and all of the background, but they can also convince their peers that the abuse of prescription drugs can be deadly," Cooper said. The first place winner will get an iPad and the second place wins a GoPro camera. Cooper said kids often learn best from one another. This is the fifth year of the video contest and the second year it has included middle school students.

When March 27 arrives, all New York doctors will be required to switch from paper to electronic prescriptions, making New York the first in the nation to make the move and say goodbye to the physician-scribbling tradition of providing medication. But with little less than 30 days remaining before the measure goes into effect – and with no additional extension of the deadline in the works – the big question is whether doctors and hospitals will be ready to ditch the desk pad and go digital. “We’re all moving from living our lives on small pieces of paper to a digital world,” said Paul Testa, chief medical information officer at NYU. Part of the 2012 I-STOP Act (Internet System for Tracking Over-Prescribing), the switch provides “real-time” prescription monitoring for practitioners and pharmacists, as well as improved safeguards for the distribution of specific abuse-prone prescription drugs.

Researchers led by a team from the National Institute on Drug Abuse (NIDA) have found promising results in using continuous heart rate monitoring to detect substance abuse relapse. The researchers used a suite of biosensors called AutoSense which is part of the NIH Genes, Environment, and Health Initiative. “Autosense is an unobtrusively wearable wireless sensor system for continuous assessment of personal exposures to addictive substances and psychosocial stress as experienced by human participants in their natural environments”

Tennessee and New Jersey are the latest states to enact legislation prohibiting sales of over-the-counter (OTC) cough medicines containing dextromethorphan (DXM) to minors. The laws are designed to decrease the abuse rate of these medicines by teens, while maintaining access for legitimate consumers of these products. Tennessee’s law took effect January 1, 2016, while New Jersey’s law took effect February 1. California was the first state to prohibit sales to minors in 2012. Other states that ban DXM sales to minors include New York, Arizona, Louisiana, Virginia, Kentucky and Washington.

Attorney General Kathleen G. Kane’s office announced criminal charges have been filed against 26 individuals accused of distributing or possessing illegal drugs in Blair County.

A yearlong investigation that culminated in today's charges focused on street- to mid-level dealers accused of distributing heroin, cocaine, bath salts and prescription narcotics.

Agents from the Attorney General’s Bureau of Narcotics Investigation partnered with investigators from the Blair County Drug Task Force and the Altoona Police Department on the joint investigation. Law enforcement officials used various tools, including surveillance techniques and undercover purchases, as they worked to file charges.

Over the course of the investigation, investigators made a series of controlled purchases utilizing confidential informants and undercover officers/agents. Controlled purchases were made in the City of Altoona and the surrounding municipalities. The investigation is ongoing and more arrests are expected.


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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