The National Attorneys General Training & Research Institute

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

Substance Abuse Newsletter February 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.

New Developments in Combatting Opioid Abuse

Wisconsin Attorney General Brad Schimel has developed a statewide marketing campaign designed to raise awareness of prescription painkiller abuse in Wisconsin. The goals of the campaign include warning about the dangers of inadequate storage and disposal of prescription painkillers. The campaign is titled Dose of Reality.

New York Attorney General Eric Schneiderman supports the proposed 2016 Guideline for Prescribing Opioids for Chronic Pain as drafted by the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention. In a separate Sign-On letter, 36 additional Attorneys General also supported that document.

Massachusetts Attorney General Maura Healey said a task force led by her office, called the Interagency Group on Illegal Prescribing, will pair Drug Enforcement Administration and FBI agents with state and local police, public health officials, and analysts from the state auditor’s office. The goal is to identify doctors who have a questionable pattern of writing too many opioid prescriptions, or prescribe to too many people who are not from their area. The analysts would also look at pharmacists who routinely bill Medicare and Medicaid for those prescriptions, searching for fraudulent claims.

Michigan Attorney General Bill Schuette today announced felony charges against former police officer Christopher Parmelee, 37, of Lansing, Lyndsey Bennett, 33, of Dewitt, and Pamela Wolf, 50, of Eaton Rapids, for their roles in a prescription drug ring that involved impersonating doctors, submitting fake prescriptions and allegedly defrauding the Michigan Medicaid Program. “Prescription drug abuse is an epidemic in Michigan and across the country. Addressing this problem requires a multi-faceted approach—including aggressive law enforcement focused on trafficking,” said Schuette. “Addiction destroys lives. The people who supply these strong, and potentially lethal drugs need to be stopped.”

Ohio Attorney General Mike DeWine, together with White House National Drug Control Policy Director Michael Botticelli, and Lucas County Sheriff John Tharp joined CVS Health (NYSE: CVS) when it announced it would make the opioid overdose reversal medicine naloxone available without a prescription at all CVS Pharmacy locations across Ohio beginning in late March 2016

In an effort to help educate students and young adults about the dangers of opioid addiction, the FBI and DEA unveiled a documentary called Chasing the Dragon: The Life of an Opiate Addict at the Newseum in Washington, D.C., before an audience of educational leaders from the region. The 45-minute film, whose title refers to the never-ending pursuit of the original or ultimate high, features stark first-person accounts told by individuals who have abused opioids or whose children have abused opioids, with tragic consequences. “This film may be difficult to watch,” explains FBI Director James Comey, “but we hope it educates our students and young adults about the tragic consequences that come with abusing these drugs and that it will cause people to think twice before becoming its next victim.”

Focusing on its mission to advance science on the causes and consequences of drug use and addiction and to apply that knowledge to improve individual and public health, the National Institute on Drug Abuse (NIDA) has released its latest Strategic Plan. The Plan is titled: 2016 – 2020 NIDA Strategic Plan Advancing Addiction Science.

The opioid overdose antidote naloxone is being offered free to high schools around the country by the drug maker Adapt Pharma, according to U.S. News & World Report. Naloxone will be offered in nasal spray form. The Clinton Foundation’s Health Matters Initiative is collaborating on the project. Many states do not have rules that would permit high school staff to administer naloxone in an emergency without facing liability from parents or guardians, the article notes.

More than 47,000 Americans died from drug overdoses in 2014, setting a new record, according to the Centers for Disease Control and Prevention (CDC). Drug overdoses increased 6.5 percent from 2013.The states with the highest overdose death rates were West Virginia, New Mexico, New Hampshire, Kentucky, and Ohio, Reuters reports. Deaths from opioids, including painkillers and heroin, accounted for 61 percent of overdose deaths in 2014. Opioid deaths increased 14 percent from the previous year. Deaths involving illicitly made fentanyl, a potent opioid often added to or sold as heroin, also are increasing, the CDC noted.

Drug overdoses are driving up the death rate of young white adults in the United States to levels not seen since the end of the AIDS epidemic more than two decades ago — a turn of fortune that stands in sharp contrast to falling death rates for young blacks, a New York Times analysis of death certificates has found. The rising death rates for those young white adults, ages 25 to 34, make them the first generation since the Vietnam War years of the mid-1960s to experience higher death rates in early adulthood than the generation that preceded it.

A recent study shows that the use of the prescribed opioids among pregnant women has increased the rate of the neonatal abstinence syndrome. "The steep increase in the number of opioids prescriptions dispensed in the U.S. has been associated with a parallel rise in their misuse, fatal overdose and heroin use," said Nora Volkow, the director at the National Institutes on Drug Abuse at the National Institutes of Health. "More recently, attention has been focused on the large increase in the number of infants born with neonatal abstinence syndrome," she continued.

The FDA Advisory Committee recommends approval of Buprenorphine implant for opioid addiction. The implant, probuphine, provides a steady dose of medication called buprenorphine, which is used to treat withdrawal symptoms and decrease cravings for opioids like heroin and prescription painkillers in addicts. Currently, buprenorphine is available in pill form or in dissolvable strips, which the implant's manufacturer, Braeburn Pharmaceuticals, argues come with many shortcomings, including the fact that patients have to remember to take the daily doses themselves.

As directed by Congress, the Department of Justice (DOJ) and the White House Office of National Drug Control Policy (ONDCP) convened the National Heroin Task Force in March 2015 to develop strategies to confront the heroin problem and curtail the escalating overdose epidemic and death rates. The Task Force developed this report outlining the steps the Administration is taking to address the opioid problem through a multifaceted approach of robust criminal enforcement, prevention efforts, and increased access to substance use disorder treatment and recovery services.

Updates in the Field of Marijuana Legalization

With the opening of eight dispensaries statewide, New York joined the ranks of nearly half the states on Thursday in allowing the use of medical marijuana. The dispensaries are serving a variety of tinctures, concentrates, vapors and other forms of the drug.

The Vermont Department of Health and key stakeholders conducted a Health Impact Assessment of the possible effects on the health of Vermonters that could result from regulating and taxing adult marijuana use.

In Alaska, the five-member Marijuana Control Board has finalized its rules which outline Alaska’s commercial marijuana industry. The 127 page document outlines everything from grower operations to testing and processing requirements. The regulations go into effect on February 21. On February 24, the state must begin accepting license applications.

Floridians will decide this November whether to allow medical marijuana in the state. On Wednesday, a constitutional amendment to legalize the drug gained enough signed petitions to qualify for the ballot next November. If passed, the amendment would allow doctors to prescribe marijuana for people with “debilitating conditions” such as cancer, HIV/AIDS, epilepsy or multiple sclerosis.

In a split decision, a state appeals panel in Grand Rapids, Michigan said that harvested marijuana being kept in canisters to dry does constitute usable marijuana. The state Legislature says "usable" marijuana includes "the dried leaves and flowers of the plant" but not seeds, stalks and roots.

Medical marijuana has been legal in some states for two decades but school districts and lawmakers are only now starting to grapple with thorny issues about student use of a drug still illegal under federal law. "School districts are trying to find their way and navigate this landscape as laws develop and social norms change," said Francisco Negron, general counsel of the National School Boards Association. "This is a situation in which the changing social norms are ahead of the existing operational structure.” The possibility of medical marijuana in schools raises a number of questions for school officials, such as who will administer it, how to prevent it from being redistributed by students, and even the legality of having it on campus. Only three of the 23 states where medical marijuana is legal have seen schools or state officials set up rules, according to the pro-reform Marijuana Policy Project.

U.S. District Court Judge R. Brooke Jackson dismissed a lawsuit in Denver, Colorado which sought federal approval for the first credit union for marijuana in Colorado, saying that allowing it "would facilitate criminal activity." Judge Jackson said in a nine-page opinion that he was compelled to reject The Fourth Corner Credit Union's suit because marijuana remains illegal under federal law.

Arizona’s nearly 88,000 medical marijuana patients smoke, ate or otherwise consumed more than 19 tons of the drug last year. Looking at it another way, it translates to more than 40 million joints, assuming the High Times estimate that a typical one weighs about four-tenths of a gram. And if the average price for marijuana from state-regulated dispensaries is $300 an ounce, it means medical users spent more than $184 million last year acquiring the drug legally.

Synthetic Drug News

District of Columbia Attorney General Karl Racine is partnering with the U.S. Drug Enforcement Administration (DEA) to offer an educational webinar about the dangers of synthetic drugs and how convenience store owners and operators can help combat the spread of these deadly substances. “Synthetic Drugs: Ensuring Your Entire Product Line is Legal,” will be hosted by NACS, the Association for Convenience and Fuel Retailing (formerly known as the National Association of Convenience Stores).

District of Columbia Attorney General Karl Racine has introduced proposed legislation that would constitute one of the nation’s most comprehensive synthetic drug statutes. In an effort to be at the forefront in the ongoing struggle between law enforcement and manufacturers of synthetic cannabinoids and synthetic cathinones, the Synthetics Abatement and Full Enforcement Drug Control Act of 2015 (SAFE DC) incorporates best practices in enforcement from multiple jurisdictions around the nation.

Florida Attorney General Pam Bondi has introduced the 2016 Florida Designer Drug Enforcement Act in an effort to crack down on the synthetic drug known as “Flakka”.

Texas Attorney General Ken Paxton obtained a temporary restraining order stopping two Houston businesses and their owners, from selling highly addictive and dangerous synthetic drugs, known as K2. The office also filed lawsuits as part of the joint operation with the Harris County Attorney’s Office, the City of Houston, the Houston Police Department (HPD) and the Houston Forensic Science Center. Several undercover investigations by the HPD Narcotics Division uncovered and ultimately led to the seizure of dangerous synthetic drugs at both places of business. “Today’s joint operation shows the commitment of state, county and city authorities to form a united front to fight this growing threat to our youth,” said Attorney General Ken Paxton. “The illegal marketing and sale of powerful and deadly drugs, to children and adults alike, must be put to a stop. My office will continue working with local authorities across Texas to clearly send the message that businesses who choose to sell these substances will pay the price.”

Kratom

In January 2016, United States Marshals, acting with investigators from the U.S. Food and Drug Administration, seized nearly 90,000 bottles of a beverage containing the herbal ingredient kratom. The beverages were manufactured for and held by Dordoniz Natural Products LLC, of South Beloit, Illinois and marketed under the brand name RelaKzpro. The product is estimated to be worth more than $400,000.The bottles were seized after the U.S. Attorney’s Office in Chicago filed a civil forfeiture complaint on behalf of the FDA. The complaint alleges that kratom is a new dietary ingredient for which there is inadequate information to provide reasonable assurance that it does not present a significant or unreasonable risk of illness or injury.

Some users embrace kratom as a natural painkiller and benign substitute for more dangerous substances. But its growing popularity and easy availability are raising concerns among substance abuse experts and government officials who say it is being furtively marketed as a way out of addiction, even though it is itself addictive. Worse, some of those experts say, kratom can lead some addicts back to heroin, which is cheaper and stronger.

Other News of Interest

West Virginia Attorney General Patrick Morrisey’s Office reached a $2.5 million settlement with Miami-Luken. It resolves allegations that the regional pharmaceutical distributor failed to detect, report and stop the flood of suspicious drug orders into West Virginia.

Researchers have identified more than 400 diseases that can co-occur in people with Fetal Alcohol Spectrum Disorder (FASD). The findings reinforce that alcohol can affect any organ or system in the developing fetus, the researchers note. “We’ve systematically identified numerous disease conditions co-occurring with FASD, which underscores the fact that it isn’t safe to drink any amount or type of alcohol at any stage of pregnancy, despite the conflicting messages the public may hear,” lead researcher Dr. Lana Popova of the Center for Addiction and Mental Health in Toronto noted in a news release

Medicaid would cover 15 days of inpatient addiction treatment per month under a new proposed plan by the Centers for Medicare and Medicaid Services, which runs the program. Inpatient rehab would be covered for anyone enrolled in a Medicaid managed care plan. Until now, people on Medicaid generally have had to rely on funds from state and local sources for drug or alcohol treatment, NPR reports. Some treatment providers say the plan doesn’t go far enough.

After the Police Chief of Gloucester, Massachusetts announced the town will connect people with treatment when they come to the police station with illegal drugs and paraphernalia, instead of arresting them, 56 police departments in 17 states have started similar programs .An additional 110 police departments are preparing to start programs that emphasize treatment over incarceration, according to The New York Times report. Two hundred treatment centers nationwide have agreed to be partners in these programs. In May 2015, Gloucester Police Chief Leonard Campanello posted on Facebook, “We will walk them through the system toward detox and recovery. We will assign them an ‘angel’ who will be their guide through the process. Not in hours or days, but on the spot.” Since then, Gloucester has developed a national network of centers that are willing to provide treatment beds and take referrals by police, whether or not a person has insurance.


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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