The National Attorneys General Training & Research Institute

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

Substance Abuse Newsletter August 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.

Opioids

Women are a growing demographic in the United States’ opioid epidemic. Although men continue to have higher rates of substance use than women do, the gap between the sexes is narrowing, with prescription opioid overdose deaths rising 583 percent among women between 1999 and 2016, compared to 404 percent among men, according to the National Institute on Drug Abuse. In an essay published in the most recent issue of the medical journal, The Lancet, two Yale medical researchers warn that America won’t be able to address its raging opioid epidemic if it continues to overlook women’s unique pathways to opioid misuse ― and the factors that hinder their access to treatment. “The system is evolving — but we’re at a point now where there’s a need to have it do so more rapidly, just based on the sheer volume of women who are being impacted,” said Dr. David Fiellin, who directs Yale’s addiction medicine program and co-authored The Lancet article.

The Center for Disease Control recently published a new analysis titled “The Number of Women with Opioid Use Disorder at Labor and Delivery Quadrupled from 1999-2014”. This first-ever multi-state analysis of trends reveals significant increases in the 28 states with available data. Opioid Use Disorder during pregnancy has been associated with a range of negative health outcomes for both mothers and their babies, including maternal death, preterm birth, stillbirth, and neonatal abstinence syndrome (NAS). The analysis document may be accessed here.

Tens of thousands more people have potentially died from opioid-related overdoses than previously thought, according to a new study by researchers from the University of Pittsburgh Graduate School of Public Health. Death certificates that did not specify the drugs involved in fatal overdoses may have masked more than 70,000 opioid-related deaths across the U.S. from 1999 to 2015. In Alabama, Indiana, Louisiana, Mississippi and Pennsylvania – where more than 35 percent of overdose deaths per state were tied to unspecified drugs – the potential number of opioid-related overdose deaths may be more than double in each, according to the study. For the analysis, published in the journal Public Health Reports, researchers examined death data by state from 1999 to 2015 from the National Center for Health Statistics, which gathers and codes death certificate information from coroners and medical examiners nationwide. The study also involved the chief medical examiner of Allegheny County, Pennsylvania.

Florida Attorney General Pam Bondi and the Drug Enforcement Administration’s Miami Field Division arrested a doctor and two office managers on charges related to operating a pill mill. According to a lengthy undercover investigation, Dr. Armando Falcon owned and operated Pain Center of Cutler Bay, a pain management clinic in South Florida, as a cover to illegally sell large quantities of prescription pain killers. The investigation revealed that Dr. Falcon met with patients for less than two minutes before writing prescriptions for approximately 150, 30 mg, oxycodone pills. Dr. Falcon only accepted cash payments, saw between 20 to 25 patients a day, and earned more than a million dollars a year from this illegal activity. According to bank records obtained during the investigation, Dr. Falcon used the cash proceeds from the clinic to purchase beach apartments, boats, expensive cars, and houses.

The Department of Justice and U.S. Drug Enforcement Administration have proposed a reduction for controlled substances that may be manufactured in the U.S. next year. Consistent with President Trump’s “Safe Prescribing Plan” that seeks to “cut nationwide opioid prescription fills by one-third within three years,” the proposal decreases manufacturing quotas for the six most frequently misused opioids for 2019 by an average ten percent as compared to the 2018 amount. The Notice of Proposed Rulemaking marks the third straight year of proposed reductions, which help reduce the amount of drugs potentially diverted for trafficking and used to facilitate addiction.

A product called Poppy Seed Wash is advertised as a natural alternative to opioids for relaxation and pain relief, but it’s really just an unlicensed drug, according to a statement released by the Food and Drug Administration. The FDA posted a warning letter to the makers of the product, telling them to stop making medical claims and to stop selling it online. “Your Poppy Seed Wash product is not generally recognized as safe and effective for the above referenced use and, therefore, the product is a ‘new drug,'” the FDA stated. The letter may be accessed here.

Medical/Marijuana/Synthetics

Wisconsin state agencies have won a $4.5 million judgment against an east side Milwaukee business and its owner over the sale of synthetic marijuana between 2011 and 2016, Attorney General Brad Schimel announced. Atomic Glass, at 1813 E. Locust St., was one of two businesses sued last year by the state departments of justice and agriculture, trade, and consumer protection over the sale of synthetic THC with such names as "Spice" and "Kush" in violation of a state law prohibiting fraudulent drug advertising. Milwaukee Circuit Judge Timothy Witkowiak last month found Atomic Glass and owner David Kelly of Eugene, Oregon, liable for selling 60,006 packets of synthetic cannabinoid products. General Schimel said the case was pursued as a civil forfeiture, rather than a criminal charge, because "the formula for synthetic drugs changes quicker than lawmakers can outlaw it."

The U.S. Food and Drug Administration issued a statement on July 19, 2018, warning about significant health risks of contaminated illegal synthetic cannabiniod products that are being encountered by the FDA. The FDA has become aware of reports of severe illnesses and deaths resulting from the use of synthetic cannabinoid (marijuana) products that have been contaminated with brodifacoum, a very long-acting anticoagulant commonly used in rat poison. The FDA statement may be accessed here.

In recognition of the need to continuously examine the effects of cannabis production, distribution, and consumption in Oregon, the Oregon-Idaho HIDTA established a research project based upon a framework of shared concerns – areas of common interest to both the federal and state government – and then impartially gathered and examined readily available data, which is relevant to those concerns. The project establishes an empirical foundation on which ongoing strategic analyses can be conducted. The project findings have been published as “An Initial Assessment of Cannabis Production, Distribution, and Consumption in Oregon 2018 - An Insight Report.” This research effort does not purport to be a policy evaluation or policy performance review; rather, this assessment provides a verifiable analysis of assorted information and data, which has been centralized as part of this effort. The report may be accessed here.

A federal court judge has ruled that a New Jersey business doesn’t have to waive its mandatory drug testing requirement for a worker who uses medical marijuana. Daniel Cotto had filed a discrimination lawsuit against Bridgeton-based Ardagh Glass last year. He was a forklift operator there for six years before he was let go in August 2017. Cotto said he had told company officials when he was hired that he used medical marijuana for pain from a 2007 injury. After being hurt on the job in November 2016, he claimed the company wouldn’t let him return to work unless he submitted to breathalyzer and urine screenings. The company argued that the state’s medical marijuana law doesn’t require employers to waive drug tests for substances that are illegal under federal law.

Over the course of 24 hours in New Haven, Conn., on Wednesday, August 15, 2018, more than 70 people overdosed on what authorities believe to be synthetic marijuana, also known as K2 or spice. Dozens of those overdoses took place on the New Haven Green, a historic downtown park bordering the Yale University campus. Most were treated at local hospitals, but at least five refused to be transported. By late that night there had been no deaths reported. Kathryn Hawk, an emergency department physician at Yale New Haven Hospital, told the New Haven Register that the Drug Enforcement Administration confirmed the drugs contained K2 mixed with fentanyl. Some patients treated at the Green did not initially respond to naloxone and needed a higher concentration of the overdose reversal drug once they arrived at hospitals.

Methamphetamine

Wisconsin Attorney General Brad Schimel, Marshfield Clinic Health System, Northwoods Coalition and the Alliance for Wisconsin Youth continued their efforts to educate the public on the dangers of using meth by releasing KNOW METH campaign ads showing an ‘Altered State’ of Wisconsin. “Methamphetamine is hitting many Wisconsin communities hard and it is seeping into our way of life,” said Attorney General Brad Schimel. “Law enforcement is working hard to go after the criminals harming our communities with this highly addictive drug but prevention campaigns like this are critical to making sure the problem doesn’t get worse.” The campaign spots show beloved Wisconsin symbols being left in an “Altered State,” similar to what happens to a meth user’s body and life when he or she becomes addicted. Attorney General Schimel utilized $225,000 from settlement funds in consultation with the he Wisconsin State Legislature’s Joint Committee on Finance (JFC).

Ohio Attorney General Mike DeWine, Montgomery County Sheriff Phil Plummer, and U.S. Department of Homeland Security Investigations Special Agent in Charge Steve Francis announced the seizure of approximately 38 pounds of suspected methamphetamine with an estimated street value of more than a million dollars. Authorities with the Miami Valley Bulk Smuggling Task Force seized the drugs, which field-tested positive for methamphetamine, while serving a search warrant at a home on Lexington Avenue in Dayton. Members of the task force arrested Donald Garrett, 52, of Dayton, on drug charges. Authorities believe the suspected methamphetamine was manufactured in Mexico, transported to California, and then shipped to Ohio.


Other

The top Massachusetts court unanimously ruled on Monday that a judge can require defendants with substance use disorders to remain drug-free as a condition of probation and send them to jail if they relapse. The case, which challenged a requirement routinely imposed by judges across the country, had been closely watched by prosecutors, drug courts and addiction medicine specialists. The defense argued that addiction is a chronic, relapsing brain disease that compromises an individual’s ability to abstain. The prosecution maintained that addiction varies in intensity and that many individuals have the ability to overcome it and can be influenced by institutional penalties and rewards, like incarceration or a cleared criminal record. While acknowledging the numerous experts who weighed in on each side, the seven justices of the Massachusetts Supreme Judicial Court declined to take a stance in the debate. Instead, they said, the defendant in the case should have raised the issue when her probation condition was first imposed, when it could have been fully argued before a trial judge. Justice David A. Lowy wrote that a judge has the power and discretion to determine probation requirements tailored to an individual and that further probation’s twin goals: rehabilitation and public safety. Judges, he said, “stand on the front lines of the opioid epidemic” and are “faced with difficult decisions that are especially unpalatable.” The opinion may be accessed here.

Alabama Attorney General Steve Marshall joined with CVS Health Chief Policy and External Affairs Officer Thomas Moriarty, Jefferson County Sheriff Mike Hale, Homewood Mayor Scott McBrayer and Homewood Police Chief Tim Ross today to announce a safe medication disposal program in Alabama. CVS Health has provided in-store drug disposal units at five of its stores in Alabama and also has equipped 36 law enforcement agencies with on-site disposal units to provide a regularly available means for people to properly discard unused medications.


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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