Substance Abuse Newsletter May 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

In an effort to combat the growing epidemic of prescription drug and heroin abuse, the FBI and DEA have released Chasing the Dragon: The Life of an Opiate Addict, a documentary aimed at educating students and young adults about the dangers of addiction. The 45 minute video is available online, and the FBI and DEA are trying to get schools to incorporate it into their lesson plans.

As part of its comprehensive national plan to combat drug abuse, Walgreens announced it has made naloxone available without a prescription in all of its Alabama pharmacies in accordance with state pharmacy regulations. In February, Walgreens announced plans to make naloxone available without a prescription in 35 states and Washington D.C. in accordance with each state’s pharmacy regulations. Since its announcement, naloxone has been made available without a prescription in more than 1,300 Walgreens pharmacies throughout the states of Alabama, Indiana, Massachusetts, New York, Ohio, Pennsylvania and Rhode Island.

Adapt Pharma, maker of the Narcan nasal spray, announced it will give a free carton of the antidote to any U.S. high school. The Association of School Nurses adopted a position last year that school nurses should "review local and state policy on how to access naloxone and implement its use as part of their school emergency response protocol." The group pointed out that nurses are the first responders during a school emergency and should be ready for drug overdoses.

Addicts who cannot lay hands on painkillers are instead turning to Imodium and other anti-diarrhea medications. The active ingredient, loperamide, offers a cheap high if it is consumed in extraordinary amounts. But in addition to being uncomfortably constipating, it can be toxic, even deadly, to the heart. A report published online in Annals of Emergency Medicine recently described two deaths in New York after loperamide abuse. Overdoses have also been linked to deaths or life-threatening irregular heartbeats in at least a dozen other cases in five states in the last 18 months.

The American Association of Nurse Practitioners (AANP) and other leading nursing organizations announced today a new educational series to combat opioid abuse, encourage safe prescribing practices, and ensure patients with pain still maintain access to necessary pain relief. The educational commitment brings together the leading nursing organizations serving the profession, including AANP, the American Association of Colleges of Nursing (AACN), the American Association of Nurse Anesthetists, the American College of Nurse-Midwives, the American Nurses Association, the National Association of Clinical Nurse Specialists, and the National Organization of Nurse Practitioner Faculties. Participating organizations will educate nursing faculty, students, and clinicians across the continuum of APRN education and training about the Centers for Disease Control and Prevention's Guideline for Prescribing Opioids for Chronic Pain.

Medical/Marijuana

A new study to be presented at the Pediatric Academic Societies 2016 Meeting found that one in six infants and toddlers admitted to a Colorado hospital with coughing, wheezing and other symptoms of bronchiolitis tested positive for marijuana exposure. Of the children who were identified as having been exposed to marijuana smokers, urine samples showed traces of a metabolite of tetrahydrocannabinol (THC), the psychoactive component of marijuana, in 16 percent of them. The results also showed that more of the children were THC positive after legalization (21 percent, compared with 10 percent before), and non-white children were more likely to be exposed than white children. The findings suggest that secondhand marijuana smoke, which contains carcinogenic and psychoactive chemicals, may be a rising child health concern as marijuana increasingly becomes legal for medical and recreational use in the United States, said lead researcher Karen M. Wilson, MD, MPH, FAAP, an associate professor of pediatrics at the University of Colorado School of Medicine. Most states with legal marijuana do not restrict its combustion around children, she said.

A study from a White House-funded program says teen drug use in Colorado, since the marijuana laws in that state were loosened, has increased. Kevin Wong with the Rocky Mountain High Intensity Trafficking Area says a new study suggests past-month pot use for teens 12-17, has increased significantly. "We're seeing increases, across all age groups in the state of Colorado, for past month uses especially in 12 to 17-years-old," said Wong. According to the study, teen past month marijuana use increased by 24 percent after Colorado allowed medical marijuana in 2010, then increased another 8 percent after recreational drug use was approved in 2013.

A Maine state official validated a petition by pro-marijuana activists that would allow the state's voters to determine whether to make recreational use of the drug legal in the northeasternmost U.S. state. Maine Secretary of State Matthew Dunlap found that activists had collected enough verified signatures to be presented to state lawmakers for consideration, his office said in a statement. The state legislature has the option of approving the proposal as written or placing it on the ballot in November.

Military veterans across the country will learn whether marijuana can treat post-traumatic stress disorder effectively after a Colorado-funded study received groundbreaking approval from the federal government this week. The go-ahead from the Drug Enforcement Administration is the first time that the agency has given permission to use raw marijuana in a placebo-controlled clinical trial on PTSD, according to the study’s supporters. Researchers in three states worked for the better part of a decade to win the approval.

The Alabama legislature on Wednesday voted to decriminalize medicinal marijuana oil possession. In a 95-4 vote in the House of Representatives and a 29-3 vote in the Senate, legislators supported a bill supporters say is a bid to help families struggling with debilitating medical conditions. Though derived from cannabis, cannabidiol doesn’t cause a high like marijuana due to reduced amounts of the psychoactive property tetrahydrocannabinol, or THC. Proponents say it can help alleviate severe seizures, among other conditions.

Two years ago, the Washington state began an unprecedented policy experiment by allowing large-scale production and sale of recreational marijuana to the public. One impact of this is legalized marijuana is getting cheap very quickly. After a transitory rise in the first few months, both retail prices and wholesale prices have plummeted. The Washington Liquor and Cannabis Board noted that prices have dropped steadily at about 2 percent per month since July 2014.

Arkansas Attorney General Leslie Rutledge has approved the wording of a proposal to legalize recreational and medical marijuana, allowing supporters to begin gathering signatures to put the measure on the November ballot. Rutledge on Monday certified the proposed constitutional amendment by Mary Berry that would legalize the cultivation, production, distribution, sale and possession of marijuana. Berry must now gather nearly 85,000 signatures from registered voters to put the proposal on the ballot.

Fatal crashes involving drivers who recently used marijuana doubled in Washington after the state legalized the drug, according to the latest research by the AAA Foundation for Traffic Safety. New research also shows that legal limits for marijuana and driving are arbitrary and unsupported by science, which could result in unsafe motorists going free and others being wrongfully convicted for impaired driving. Washington was one of the first two states to legalize the recreational use of marijuana, and these findings raise serious concerns about drug-impaired driving with at least 20 states considering marijuana legalization this year.

The Arizona Supreme Court unanimously ruled the AMMA does not immunize a physician against prosecution for falsely attesting that he or she reviewed a patient’s medical records from the previous twelve months before providing a written certification authorizing medical marijuana use. In 2012, a Navajo County Grand Jury indicted Dr. Robert Gear on one count of Forgery and one count of Fraudulent Schemes and Artifices. Dr. Gear allegedly signed a medical marijuana certification for a police informant before receiving a year's worth of the patient's records. The trial court dismissed the indictment, ruling ARS 36–2811(C) immunized Dr. Gear against prosecution on those charges. The Court of Appeals affirmed. The ruling, written by Justice Clint Bolick, the Arizona Supreme Court vacated the opinion of the Court of Appeals, reversed the trial court’s order of dismissal, and returned the criminal case against Dr. Gear back to the trial court in Navajo County.

Counterfeit

It was first developed in a Canadian lab more than three decades ago, promising and potent — and intended to relieve pain in a less addictive way. Labeled W-18, the synthetic opioid was the most powerful in a series of about 30 compounds concocted at the University of Alberta and patented in the U.S. and Canada in 1984.But no pharmaceutical company would pick it up, so on a shelf the recipe sat, the research chronicled in medical journals but never put to use. The compound was largely forgotten. Then a Chinese chemist found it, and in labs halfway around the world started developing the drug for consumers in search of a cheap and legal high — one experts say is 100 times more potent than fentanyl and 10,000 stronger than morphine. And now it has come to North America. More than 2.5 pounds of W-18 was discovered in the home of a Florida man, who was sentenced to 10 years in federal prison after he pleaded guilty to smuggling fentanyl from China. He faced no charges for possessing the W-18, however, because it’s not yet illegal in the U.S. There are currently no tests to detect the drug in a person’s blood or urine, according to reports, making it difficult for doctors to help someone who might be overdosing, a risk outlined in the drug’s 1984 patent.

One of the ways health officials are able to track emerging trends in illicit drug use is through the National Drug Early Warning System, a network of monitoring sentinel sites across the country that is currently coordinated and operated by the Center for Substance Abuse Research, or CESAR, at the University of Maryland, College Park.

Prescription Drug Monitoring

New York is the latest state to partner with New Jersey’s Prescription Monitoring Program (NJPMP) to share records on the sale of prescriptions for Controlled Dangerous Substances (CDS). Delaware, Connecticut, Rhode Island, Virginia, Minnesota, and South Carolina also share their prescription monitoring data with New Jersey, which allows prescribers and pharmacists to identify “doctor shoppers” who cross state lines to obtain their drugs fraudulently.

Maryland Governor Larry Hogan signed into law HB 437 – Department of Health and Mental Hygiene – Prescription Drug Monitoring Program (PDMP) – Modifications. This requires mandatory registration with the Prescription Drug Monitoring Program to all providers that have a license to prescribe or dispense controlled dangerous substances before obtaining a new or renewal controlled dangerous substance registration. It also requires certain providers to check the PDMP before prescribing an opioid or benzodiazepine.

Georgia Governor Nathan Deal signed into law HB 900 relating to electronic data base of prescription information. The law authorizes numerous actions including but not limited to: the retention of data base information for two years; to provide for delegates of prescribers and dispensers to access data base information under certain conditions; to revise language relating to subpoenas and search warrants; to provide for accessing data base information for purposes of investigation of potential abuse; and to provide for the release of nonpatient specific data to the agency for instructional, drug abuse prevention, and research purposes.

Other

Americans turned in more unused prescription drugs at the most recent DEA National Prescription Drug Take-Back Day than on any of the previous ten events since it began in 2010, demonstrating their understanding of the value of this service. The DEA and over 4,200 of its state, local, and tribal law enforcement partners collected 893,498 pounds of unwanted medicines—about 447 tons—at almost 5,400 sites spread through all 50 states, beating its previous high of 390 tons in the spring of 2014 by 57 tons, or more than 114,000 pounds. The top five states with the largest collections, in order, were Texas (almost 40 tons); California (32 tons); Wisconsin (31 tons); Illinois (24 tons); and Massachusetts (24 tons).

California Governor Jerry Brown signed legislation that has raised the minimum age for smoking cigarettes from 18 to 21 that health advocates say will save lives and pave the way for states across the US to adopt stricter tobacco laws.


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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