Substance Abuse Newsletter September 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 U.S. Department of Health and Human Services announced $53 million in funding to 44 States, four tribes, and the District of Columbia to improve access to treatment for opioid use disorders, reduce opioid related deaths, and strengthen drug misuse prevention efforts. In addition, funding will also support improved data collection and analysis around opioid misuse and overdose as well as better tracking of fatal and nonfatal opioid-involved overdoses. Administered by SAMHSA and the Centers for Disease Control and Prevention (CDC), the funding supports six programs: Medication-Assisted Treatment Prescription Drug Opioid Addiction Grants, Prescription Drug Opioid Overdose Prevention Grants, Strategic Prevention Framework Partnerships for Prescription Drugs Grants, Prescription Drug Overdose Prevention for States Program, Prescription Drug Overdose Data-Driven Prevention Initiative and the Enhanced State Surveillance of Opioid –Involved Morbidity and Mortality Program.

A new study shows that even short-term use of opioids after surgery is leading to high rates of addiction and dependence. In the survey, it showed that even prescribing opioids for short-term postsurgical pain could have a serious risk for the patients. The national survey was conducted by Wakefield Research on behalf of Pacira Pharmaceuticals, Incorporation. It involved 500 adults in the U.S., who had an orthopedic or soft tissue surgery in the previous 12 months. There were about 200 U.S. surgeons who perform these procedures. The survey indicated that one in ten of the patients admitted they became addicted to or dependent on opioids after exposure to these medications following an operation. There are about 70 million surgical patients in the U.S. that are receiving opioids yearly. The findings indicate that as many as 7 million patients could have an opioid addiction or dependency this year following a surgical procedure. The rate among younger people with ages 18 to 29 is about 15 percent. Meanwhile, the rate for those living in the western region of the U.S. is as high as 18 percent.

Every doctor in the United States will be receiving this letter (PDF) from the US surgeon general. It's the first time that America's top doctor has reached out to all physicians. But Dr. Vivek Murthy has an urgent reason: Americans are dying each year by the tens of thousands from overdoses of prescription painkillers such as Oxycontin and Vicodin. Dr. Vivek Murthy told physicians he understood their desire to keep their patients out of pain. "It is important to recognize that we arrived at this place on a path paved with good intentions," he wrote. But those good intentions have gone horribly wrong.

In a first-in-the-nation settlement with the largest pharmacy chain in the country, Massachusetts Attorney General Maura Healey announced today that CVS Pharmacy, Inc. (CVS) will strengthen its policies and procedures around the dispensing of opioids and will require its Massachusetts pharmacy staff to check the state’s Prescription Monitoring Program before filling prescriptions for commonly misused opioids. The assurance of discontinuance, filed in Suffolk Superior Court, along with a separate settlement agreement between CVS and AG Healey’s Office, resolves allegations that CVS failed to provide its Massachusetts pharmacists with a way to access the Massachusetts Online Prescription Monitoring Program (PMP) prior to March 2013. The assurance and settlement agreement also resolve allegations that certain CVS pharmacies in Massachusetts failed to monitor drug use patterns or use sound professional judgment when dispensing controlled substances, particularly opioids. For more information, contact Emalie Gainey of the Massachusetts Office of the Attorney General at (617) 727-2543.

The U.S. Drug Enforcement Agency has warned communities across the country about a deadly opioid called carfentanil. Officials in Ohio have already declared a public health emergency. The drug is normally used to tranquilize elephants. It is 100 times more potent than fentanyl, the prescription painkiller that led to the death of pop star Prince earlier this year. Carfentanil is also 50 times more deadly than heroin. When sold on the streets, heroin is sometimes laced with the opioid. Addiction experts say antidotes like naloxone are rendered useless against this drug.

Medical/Marijuana

The Ninth US Circuit Court of Appeals’ three-judge panel has ruled that the Department of Justice (DOJ) cannot spend budget money to prosecute people who grow, sell, or use medical marijuana, if they comply with state law. “If the federal government prosecutes such individuals, it has prevented the state from giving practical effect to its law,”Circuit Judge Diarmuid O’Scannlain wrote for the court. Under a 2014 congressional budget rule, the DOJ cannot use funds to prevent U.S. states “from implementing their own state laws that authorize the use, distribution, possession, or cultivation of medical marijuana.” This recent appeals ruling affects nine western states in the Ninth Circuit’s jurisdiction, eight of which currently have some type of medical marijuana law. However, Judge O’Scannlain specifically stressed that the court’s unanimous ruling should not be seen as immunity by medical marijuana purveyors. "Congress could restore funding tomorrow, a year from now, or four years from now," he wrote, "and the government could then prosecute individuals who committed offenses while the government lacked funding." The panel has also warned that “individuals who do not strictly comply with all state-law conditions” can be prosecuted.

A federal government ban on the sale of guns to medical marijuana card holders does not violate the 2nd Amendment, a federal appeals court ruled. The ruling by the 9th U.S. Circuit Court of Appeals applies to the nine Western states that fall under the court's jurisdiction, including California, Washington, and Oregon. It came following a lawsuit filed by a Nevada woman who tried to buy a firearm in 2011 after obtaining a medical marijuana card. The 9th Circuit in its 3-0 decision agreed that it's reasonable for federal regulators to assume a medical marijuana card holder is more likely to use the drug. In addition, a ban on the sale of guns to marijuana and other drug users is reasonable because the use of such drugs "raises the risk of irrational or unpredictable behavior with which gun use should not be associated," Senior District Judge Jed Rakoff said. The decision can be accessed here.

Pennsylvania Governor Tom Wolf signed into law a bill that authorizes Pennsylvania’s Agriculture Department and institutions of higher education to cultivate industrial hemp for research purposes. Act 92 of 2016, allows colleges, universities, agencies, and individuals that are properly registered with the state to legally cultivate industrial hemp, either by themselves or through independent contractors. The new law also establishes a Hemp Research Board, which will be responsible for regulating and managing the program. The board will handle applications for registration, inspections, a registered persons database, registration fees, and labeling and testing guidelines.

Seven experts with experience in marijuana policy, including legal, medical, and business types, will help a group of 20 Massachusetts in the debate over the marijuana legalization ballot question in order to generate helpful information on the initiative. The experts, including two officials who work directly with Colorado’s legal marijuana industry, will be questioned by the 20-voter panel of the Citizens’ Initiative Review (CIR), a pilot program designed to produce pro and con statements about the ballot question that could be easily digested by average voters. The group of 20 Massachusetts voters, selected to closely match the demographics of the state electorate, will meet for four days inviting testimony from supporters, opponents, and the policy experts. The panel will not endorse a yes or no vote on the question, but instead strive to give voters as much unvarnished information as possible in the form of pro and con statements that will be distributed statewide immediately following the end of the deliberations.

Synthetics

New York’s Attorney General filed a lawsuit against a website accused of selling illegal hallucinogens and K2. The company, Legalherbalbud.com, went on a court-ordered hiatus from its business selling products the company calls “100% legal” on its website. An investigation from the Attorney General’s office found that Legalherbalbud.com was selling synthetic marijuana, a designer drug made of chemicals, but labeling it as legal herbal incense or potpourri. The lawsuit alleges the company’s products have almost no label information as required by law. Federal regulations state that all consumer products must be labeled with, at least, a description of the net contents and the name and place of business of the product’s manufacturer, packer, and distributor.

Flakka or "gravel" is the synthetic stimulant Alpha-PVP, a more potent form of the drug known as bath salts, and it is highly addictive. Its small clear or pink crystals can be snorted, smoked, injected, or eaten. Flakka can cause a user's core body temperature to shoot up to 104 or 105 degrees and make them tear off their clothes while also providing an adrenaline boost that can result in high pain tolerance and superhuman strength. It tends to cause euphoria and hallucinations, but taking even just a little too much of the drug — which costs about $5 a hit — can lead to aggression, paranoia, psychosis, heart problems, and death. It is sometimes called "$5 psychosis." Drug-treatment professionals say it can take days for first-time users to return to a normal state of mind and as long as two weeks for repeat users.

Kratom

The U.S. Drug Enforcement Administration has filed a notice of intent (PDF) to place the Southeast Asian plant called kratom into the most restrictive classification of the Controlled Substances Act. The Summary of the Notice of Intent reads as follow: “The Administrator of the Drug Enforcement Administration is issuing this notice of intent to temporarily schedule the opioids mitragynine and 7-hydroxymitragynine, which are the main active constituents of the plant kratom, into schedule I pursuant to the temporary scheduling provisions of the Controlled Substances Act. This action is based on a finding by the Administrator that the placement of these opioids into schedule I of the Controlled Substances Act is necessary to avoid an imminent hazard to the public safety. Any final order will impose the administrative, civil, and criminal sanctions and regulatory controls applicable to schedule I controlled substances under the Controlled Substances Act on the manufacture, distribution, possession, importation, and exportation of, and research and conduct of instructional activities of these opioids.” The full Notice of Intent can be accessed here.

PDMP

Massachusetts' new prescription drug monitoring program (PDMP) will allow data sharing among states. The program tracks when a patient is prescribed a drug that has the potential for abuse or addiction and lets a doctor view a patient's prescribing history in order to avoid over-prescribing. As of October 15, 2016, doctors will be required to check the PDMP any time they prescribe a Schedule II or III drug, rather than just the first time they prescribe a drug to a patient. The program will also allow doctors in Massachusetts to access data from Vermont, Rhode Island, Connecticut, and New York by the end of the month, with other states slated to join later.

Other

The AAA Foundation for Traffic Safety has developed Roadwise Rx, a tool to help individuals understand how their medications may affect them and their driving.

To mark the 30th anniversary year, Partnership for Drug-Free Kids is launching Fried Egg 2016 a new campaign which is a nod to their iconic TV spot from the 1980s and is re-envisioned to reflect parenting today. The TV PSA focuses on the litany of drug questions that parents face from their teens and how the Partnership can assist with answers, guidance and solutions.

The Rocky Mountain High Intensity Drug Trafficking Area (HIDTA) has released a study which indicates marijuana related traffic deaths increased 48 percent since 2013 in Colorado. Marijuana related emergency room visits and calls to poison control are also up. The report further notes that Colorado leads the nation in marijuana consumption among teens and adults.


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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