The National Attorneys General Training & Research Institute

The National Attorneys General Training & Research Institute The National Attorneys General Training & Research Institute

Substance Abuse Newsletter April 2018

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.


The U.S. Food and Drug Administration announced the latest action to encourage and support the development of treatment options for people with opioid use disorder (OUD). The agency has released the first of two new draft guidance documents intended to aid industry in developing new medications for use in medication-assisted treatment (MAT) for opioid dependence. The first document explains the FDA’s current thinking about drug development and clinical trial design issues relevant to the study of sustained-release “depot” buprenorphine products (i.e., modified-release products for injection or implantation).

The National Institute of Health has launched the HEAL (Helping to End Addiction Long-term) Initiative to speed scientific solutions to address the national opioid crisis. NIH will significantly increase funding to bolster research on opioid misuse and addiction as well as pain with an investment of $1.1 billion in FY2018, made possible by the FY 2018 Consolidated Appropriations Act, which provides $500 million for opioid addiction research. HEAL will bolster research to inform better addiction prevention strategies through enhanced pain management and improve treatments for opioid misuse disorder and addiction. The NIH announcement may be accessed here.

Attorney General Mark Brnovich announced a grand jury indicted Dr. David Alan Ruben, a medical doctor and board-certified psychiatrist, on 26 felony charges, including Fraudulent Schemes and Artifices and Administration of Narcotic Drugs. The Tucson District Office of the Drug Enforcement Administration and Special Agents from the Arizona Attorney General’s Office investigated this case. Dr. Ruben, 70, is the owner of Healthcare Southwest, a pain management medical clinic in Tucson. Pursuant to an Arizona Medical Board Order in February 2016, Dr. Ruben was prohibited from prescribing, administering, or dispensing any Schedule II controlled substance for two years. Despite the order, Dr. Ruben allegedly prescribed hydrocodone and oxycodone to 11 different patients on 25 separate occasions between September 2016 and March 2017.

Attorney General Mike Hunter issued a statement commending the members of both the Oklahoma House and Senate after approving a bill that criminalizes the trafficking of fentanyl and its equivalents. Senate Bill 1078 is the first piece of legislation recommended by the Oklahoma Commission on Opioid Abuse to pass both chambers and make it to the governor’s desk. The full statement may be accessed here.

The American Dental Association announced it would implement a seven-day time limit on how long opioids could be used, along with education requirements for those who prescribe medication to patients and the suggested use of Prescription Drug Monitoring Programs (PDMPs). The association says that its goal is to help encourage a responsible approach that others throughout the medical world can follow.

U.S. Surgeon General Jerome M. Adams, M.D., M.P.H., urged more Americans to carry the lifesaving medication, naloxone, that can reverse the effects of an opioid overdose. The Surgeon General is now recommending that more individuals, including family, friends and those who are personally at risk for an opioid overdose, keep the drug on hand.

Among the 1.9 million nonelderly adults with opioid addiction, those with Medicaid were twice as likely as those with private insurance or no insurance to have received treatment in 2016, according to a new analysis by the Kaiser Family Foundation. Forty-three percent of nonelderly adults with opioid addiction who were covered by Medicaid received inpatient and/or outpatient opioid addiction treatment services in 2016, compared with 21 percent of those with private insurance and 23 percent of those who were uninsured, based on analysis of data from the National Survey on Drug Use and Health. Of the 1.9 million nonelderly adults with an opioid addiction in 2016, Medicaid covered nearly 4 in 10 (38%), in part through Medicaid expansion in 33 states. It provides access to a range of treatment services, including medication-assisted treatment, which combines medication with counseling and other support services.


Health officials in Illinois are warning people about mock marijuana that is spreading across Chicago and the central part of the state, causing severe bleeding among users and, in some cases, death. Synthetic cannabinoids, also known as K2 or Spice, has been linked to 56 cases in which people in the state experienced severe bleeding after using the substance, officials with the Illinois Department of Public Health said in a statement. The users were hospitalized — and two of them died — after coughing up blood, finding blood in their urine or bleeding from their noses or gums, officials said.

U.S. law enforcement agencies seized over 100 homes in the Sacramento, California-area this week in what the U.S. Justice Department said was part of a sweeping crackdown on a criminal marijuana growing operation funded by China-based criminal groups. In the two-day sweep, the Justice Department said hundreds of federal agents and local police executed search warrants at about 74 homes and two business offices believed to be used for marijuana-growing operations. At the same time, the Justice Department filed civil forfeiture actions against 100 homes, a legal action allowing the government to confiscate assets if there is probable cause to believe a crime was committed.


The U.S. Food and Drug Administration announced it has issued a mandatory recall order for all food products containing powdered kratom manufactured, processed, packed, or held by Triangle Pharmanaturals LLC, after several were found to contain salmonella. The agency took this action after the company failed to cooperate with the FDA’s request to conduct a voluntary recall. This is the first time the agency has issued a mandatory recall order to protect Americans from contaminated food products. The FDA is advising consumers to discard the products that are part of the mandatory recall, which include, but are not limited to: Raw Form Organics Maeng Da Kratom Emerald Green, Raw Form Organics Maeng Da Kratom Ivory White, and Raw Form Organics Maeng Da Kratom Ruby Red. The FDA understands that Triangle Pharmanaturals may manufacture, process, pack and/or hold additional brands of food products containing powdered kratom, including powder and encapsulated powder forms.


Attorney General Pam Bondi’s Office of Statewide Prosecution, the U.S. Drug Enforcement Administration and the Orange County Sheriff’s Office announced the conviction of Hasan Nguyen, 25, for trafficking thousands of dollars’ worth of heroin. The investigation into Nguyen began in 2015 and covered crimes in Orange and Seminole counties. Investigators captured audio and video recordings of Nguyen selling trafficking amounts of heroin on three separate occasions to undercover officers. Investigators paid Nguyen more than $2,000 in undercover drug deals through the course of the investigation. In total, authorities seized more than 45 grams of heroin with a street value of approximately $10,000. An Orange County jury found Nguyen guilty of four counts, including trafficking in heroin 20 grams or more, conspiracy to traffic heroin 28 grams or more, trafficking in heroin 14 grams or more and unlawful use of a two-way communication device. The Honorable Leticia Marques sentenced Nguyen to a mandatory minimum sentence of 25 years in the Florida Department of Corrections.

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

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