Substance Abuse Newsletter October 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

DEA has issued a warning to the public and law enforcement nationwide about the health and safety risks of carfentanil. Carfentanil is a synthetic opioid that is 10,000 times more potent than morphine and 100 times more potent than fentanyl, which itself is 50 times more potent than heroin and has been linked to a significant number of overdose deaths in various parts of the country. Improper handling of carfentanil, as well as fentanyl and other fentanyl-related compounds, has deadly consequences. It is often disguised as heroin. Carfentanil is a Schedule II substance under the Controlled Substances Act and is used as a tranquilizing agent for elephants and other large mammals. The lethal dose range for carfentanil in humans is unknown.

United States Agriculture Secretary Tom Vilsack announced an initiative that will use USDA's rural development resources to help fill the need for transitional housing for people recovering from opioid and other substance use disorders. In January, President Obama tasked Vilsack, who is chair of the White House Rural Council, with leading a federal interagency effort focused on rural opioid use. The initiative is the result of a conversation Secretary Vilsack had in May in New Hampshire at the Hillsborough County Superior Court, where individuals involved with the state's drug court program told him that a lack of access to affordable housing made it challenging for participants to successfully complete their recovery from addiction. The initiative includes: encouraging the use of USDA Community Facilities financing for transitional housing projects; making vacant USDA housing properties available for lease or sale to qualified non-profits to transform the properties into transitional housing; launching a pilot project to make vacant USDA multifamily rental units available to tenants participating in treatment programs; and releasing a suite of data that will better link existing USDA facilities with treatment service providers across the country.

Pediatricians should utilize medication-assisted therapies, such as buprenorphine, for adolescent patients with opioid abuse disorders—and refer those patients elsewhere if they haven’t taken the steps to prescribe such medications, according to a new policy statement from the American Academy of Pediatricians (AAP). Sharon Levy, MD, MP​H, director of the Adolescent Substance Abuse Program at Boston Children's Hospital and associate professor of pediatrics at Harvard Medical School in Massachusetts, helped craft the new policy statement, which she says addresses not only recommended treatment methods, but also issues with access and support. The policy statement can be accessed here.

U-47700, a synthetic drug that has been involved in multiple deaths, is now banned in Florida pursuant to an emergency scheduling by Florida Attorney General Pam Bondi. U-4700 is usually in powder or granular form, but also can be in pill form, liquid form or as a nasal spray. Some side effects of U-4770 include vomiting, intestinal bleeding, loss of consciousness, decreased blood pressure, and more.

The United States Department of Justice Drug Enforcement Administration’s Division Control Division has announced that October 22, 2016 from 10:00am – 2:00pm will be a National Prescription Drug Take Back Day. This initiative aims to provide a safe, convenient, and responsible means of disposing of prescription drugs, while also educating the general public about the potential for abuse of medications. Local collection sites and other helpful information pertaining to this event can be accessed here.

Medical/Marijuana Issues

In "Cannabinoid Hyperemesis Syndrome: Literature Review and Proposed Diagnosis and Treatment Algorithm,'' the authors reviewed recent findings regarding the role of excessive cannabinoid usage and the resulting hyperemesis syndrome. Symptoms of CHS including cyclic vomiting, abdominal pain, nausea, gastric pain, and compulsive bathing to ease pain. This topic seems to be very recent as the authors propose that cannabinoid hyperemesis syndrome (CHS) was first described only 7 years ago and the diagnostic symptoms are largely unknown throughout the medical profession and among cannabis users.

Colorado is changing packaging requirements for marijuana products. By Dec. 1, 2016, all stores and medical centers selling marijuana are required to identify their products with symbols. The symbol for retail marijuana contains an exclamation point and the letters "THC." Medical marijuana products will have a similar symbol together with the letter "M.” The packaging will also contain statements about serving size, potency, and contaminant testing. The words "candy" or "candies" cannot appear on the packaging unless they're part of the product's name.

Scientific evidence of the effectiveness of medical marijuana for most indications is still slim or nonexistent, but one of the few that is actually well supported is nausea (emesis) from cancer chemotherapy. There are FDA-approved THC-based drugs for this purpose. Pregnant women are using marijuana to control the nausea that often accompanies pregnancy (including the common “morning sickness” and the less common severe nausea called hyperemesis gravidarum). For example, according to a recent analysis, 2.6 percent of women who gave birth in Hawaii between 2009 and 2011 reported using marijuana during their pregnancy, and women who reported severe nausea during pregnancy were significantly more likely to use marijuana. Prenatal exposure to marijuana has long been implicated in possible adverse health outcomes and behavioral abnormalities in childhood and later in life. A recent review and meta-analysis found that babies of women who used marijuana during their pregnancy were more likely to be anemic, to have lower birth weight, and to require placement in neonatal intensive care than babies of mothers who did not use marijuana. Past studies have also shown links—albeit not consistently—to altered neurodevelopment and to later problems with memory, attention, and problem solving during the school years.

Alaska-based soldiers have been barred from attending any events involving promotion of the use of marijuana or hemp, including all fairs, festivals, and conventions, to clarify the military’s position as the state prepares to allow legal pot sales. The policy, issued by Maj. Gen. Bryan Owens, commander of U.S. Army Alaska, was announced Thursday and took effect immediately. It is punitive — so a violation could mean punishment under the Uniform Code of Military Justice. Alaskan voters approved legalized marijuana in November 2015

Kratom

The Drug Enforcement Administration has withdrawn its notice of intent to temporarily place Schedule I controls on kratom (mitragynine and 7-hydroxymitragynine, two substances of the plant Mitragyna speciosa) and is soliciting public comments until December 1, 2016. DEA’s withdrawal notice and solicitation of comments may be found here.

Synthetics

Texas Attorney General Ken Paxton announced Sept.8 that the Office of the Attorney General (OAG) and the Harris County Attorney’s Office (HCAO) reached a settlement of $1.175 million with the Katz Boutique stores and their owner, Bao Quoc Nguyen, also known as Tony Nguyen. The settlement stems from a lawsuit filed in 2015 against Nguyen and his nine Katz Boutiques for violating the Texas Deceptive Trade Practices Act and the Texas nuisance law numerous times by selling synthetic marijuana. The Katz Boutique lawsuit was the first synthetic cannabinoid lawsuit filed jointly by the OAG and HCAO. According to the OAG, evidence collected during the lawsuit revealed the stores sold more than 90,000 packets of synthetic drugs to Texas consumers since 2013 and made millions of dollars from the sale of illegal drugs.

PDMP

The United States Department of Justice Drug Enforcement Administration’s Diversion Control Division has recently updated its website regarding state prescription drug monitoring programs and commonly asked questions and answers. The site also contains lists of scheduling actions, controlled substances, and regulated chemicals updated as of August 2016.

The Office of Justice Programs’ Bureau of Justice Assistance (BJA) today announced funding of more than $8.8 million in 20 separate awards to 19 state health and pharmacy boards and departments to better track and share prescription drug information to help reduce drug abuse, misuse, and diversion. The awards, funded under the BJA’s Harold Rogers Prescription Drug Monitoring Program FY 2016 Competitive Grant Program, enable awardees to create, implement, and enhance Prescription Drug Monitoring Programs (PDMPs). The awardees include among others: Alabama Dept. of Public Health, Arkansas Dept. of Health, Arizona State Board of Pharmacy, Connecticut Dept. of Consumer Protection, Kentucky Cabinet for Health and Human Services, Illinois Dept. of Human Services, and City of Lowell, Massachusetts.

Other

The Justice Department and the U.S. Securities and Exchange Commission filed criminal and civil charges against two Colorado men who allegedly reaped more than $12 million from selling bogus stock linked to a hydroponic marijuana firm. The SEC reported that the men, William Sears and Scott Dittman, used false financial filings and bogus letters from a lawyer to prop up FusionPharm Inc., inflating sales of refurbished shipping containers called PharmPods that are designed for growing pot indoors, the SEC said in a statement on Friday.

On October 21, 2016, The Substance Abuse and Mental Health Services Administration will launch MATx, a free mobile app that will give health care practitioners immediate access to vital information about medication-assisted treatment (MAT) for opioid use disorder. Key features of the app include: information on medications approved by the U.S. Food and Drug Administration for use in the treatment of opioid use disorders and treatment approaches for practitioners, a buprenorphine prescribing guide, which includes information on the Drug Addiction Treatment Act of 2000 waiver process and patient limits, clinical support tools such as treatment guidelines, continuing education opportunities, and recommendations for working with special populations and access to critical helplines and SAMHSA's treatment locators. Information about the free app and how to download it to a mobile device is available here.

Following years of declines, the percentage of employees in the combined U.S. workforce testing positive for drugs has steadily increased over the last three years to a 10-year high, according to an analysis of nearly 11 million workforce drug test results released today by Quest Diagnostics (NYSE: DGX), the world's leading provider of diagnostic information services. The Quest Diagnostics Drug Testing Index™ examines illicit drug use by America's workforce based on an analysis of de-identified results of more than 9.5 million urine, 900,000 oral fluid, and 200,000 hair laboratory-based tests performed nationally by the company for employers in 2015.

The National Institute on Drug Abuse (NIDA) has recently begun posting some of NIDA Director Dr. Nora Volkow’s presentations online. In particular, three times a year she presents to the National Advisory Council on Drug Abuse. The slide presentations (starting in February of this year) are available here.


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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