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Book Summary: This outstanding resource guide for students and young adults provides an introduction to the history of prescription drug abuse that explains how this problem has arisen and examines the social, political, economic, and health issues associated with prescription drug abuse in modern society. • Explains the dangers associated with the use of prescription drugs for nonmedical purposes • Provides a detailed introduction for readers seeking to learn about the topic of prescription drug abuse and serves as an research tool for school projects • Includes thought-provoking perspective essays from individuals involved in the discussion of how to address prescription drug abuse • Supplies primary source documents in the form of excerpts from laws, administrative rulings, and court cases regarding prescription drug abuse as well as a glossary of key terms used in discussing the topic of prescription drug abuse

Objectives: To examine the extent to which pharmacy students’ attitudes, subjective norm beliefs, and perceived behavioral control beliefs explain gray dispensing decisions, using the theory of planned behavior (TPB) as a framework. Method: Third professional year pharmacy students (n=159) from two academic cohorts were provided three written case scenarios: (1) a dentist prescribing outside of his scope of practice; (2) a physician prescribing for a family member; and (3) a patient who was out of refills on insulin. A brief questionnaire assessed TPB constructs, whether or not the student would dispense the medication, and the number of times the student would dispense in 10 similar situations. Composite scores were calculated for TPB constructs after analyzing internal consistency reliability. Linear regression techniques were used to analyze the influence of the constructs on mean intent to dispense in similar scenarios. Results: The percent of students who indicated they would dispense in each scenario was 68% in scenario 1, 74% in scenario 2, and 81% in scenario 3. For all case scenarios, mean intent to dispense in similar scenarios was explained by attitude scores (p≤0.006). For the insulin refill and family prescribing cases, mean intent to dispense was also explained by subjective norm beliefs (pImplications: Student attitudes consistently predicted intention to dispense across the gray scenarios. These findings can be used to develop and target upstream TPB construct interventions in pharmacy education that influence students’ downstream dispensing decisions. Additional research is warranted to determine if TBP constructs similarly explain the dispensing behaviors of practicing pharmacists.

Drug poisoning due to overdose is a major health problem in Tennessee. In TN there has been an increase of 210% in accidental overdose deaths since 1999 to 2010. About 80% of drug poisonings in Tennessee were either accidental or self-inflicted. Also as indicated by the CDC in 2010 enough drugs were prescribed to medicate every American adult around-the-clock for one month and the vast amount of drugs increases the risk of misuse. Drug Take Back Events are a useful measure for reducing the number of prescription medications kept in the households. However, the extent to which these events have affected in the reduction of drug poisoning is not well known. The objective of this study was to investigate the relation between the total number of drugs collected at Take Back Events and emergency department admissions due to overdose in three Counties in Northeast TN. In partnership with Drug Enforcement Administration and local law enforcement, drop box donations for controlled substances (CS) were analyzed for Washington, Carter and Sullivan County, Tennessee, from 2009 to 2012. Data were obtained from Tennessee Department of Health on number of emergency department (ED) admissions due to overdose based on International Classification of Diseases (ICD)-9 codes occurred between 2009 and 2012 in the above-mentioned counties. Linear forecast trend-line method was used to evaluate associations between the amount of controlled substances collected via donation boxes and number of ED visits occurred during 2009-12. Furthermore Pearson’s correlation analyses were conducted to investigate relationship between drop box donations and ED admissions due to overdose. From 2009 – 2012 the ED visits shows a significant decrease as the amount of drugs collected increases for Washington and Carter County. Also a negative correlation is seen between the ED visit and drugs collection for Washington and Carter County with R2 values of -0.96 and -0.90 respectively. However the same is not true for Sullivan County as the trend was not inversely proportional and also the correlation between ED visits and gathered drugs is low with R2 value of -0.562. These results quantify the potential impact of drug take back events on reduction in drug poisoning due to overdose in Northeast Tennessee. Further study is required to examine the effect of the events on the epidemic of prescription drug abuse and misuse.

The US Food and Drug Administration (FDA) is encouraging the innovation of long-acting opioid formulations that are manipulation-resistant. The purpose of this commentary is to assess the benefits and limitations of abuse-deterrent opioid formulations (ADFs) and discuss their role in mitigating the current opioid epidemic. ADFs have been created with chemical properties that make it difficult for people who non-medically use prescription drugs to crush and dissolve opioid tablets, as well as by combining opioids with antagonists such as naloxone or naltrexone, which are released only when the dosage form has been manipulated or the drug is taken by a non-intended route. Despite these and other technologies, consensus regarding the effectiveness of these formulations in preventing non-medical use is lacking given the difficulty in obtaining post-marketing data. Researchers also question if the creation of abuse-deterrent drugs will have a positive effect on those struggling with a severe opioid-use disorder, fearing that current opioid users will simply find a new – perhaps more dangerous – drug of choice. Abuse-deterrent opioids are still opioids, and although they may make manipulation more difficult than non-ADF formulations, they are not “abuse proof.” The introduction of ADFs could provide a false sense of security among prescribers and dispensers, and we fear that ADFs may have a minimal impact on non-medical use of prescription opioids. Further epidemiological studies will be required to determine the large-scale impact of abuse-deterrent opioids in preventing opioid use disorder and its downstream consequences.

The next presentation will examine common gray areas of community pharmacy practice. For example: under what circumstances do pharmacists fill early, transferred controlled substance prescriptions for out-of-town patients; when do pharmacists sell syringes to patients without proof of medical need; and how do pharmacists determine that a buprenorphine prescriber is acting in a patient's best interest? These and other ethical or legal dilemmas challenge pharmacists as they try to balance identifying and preventing potential drug abuse and diversion with providing evidence-based, quality patient care. Based on data from pharmacists and pharmacy students, as well as established theory, presenters will describe typical approaches to decision-making. Multiple pharmacy cases will be discussed. Participants will learn how to integrate best-practice patient care systematically into common practice scenarios.

The abuse of and dependence on opioids are major public health problems, and have been the focus of intense media coverage and scholarly inquiry. This research explores the problem in Iowa through the lens of infectious disease modeling. We wanted to identify the current state of the crisis, factors affecting the progression of the addiction process, and evaluate interventions as data becomes available. We introduced a novel sequential Approximate Bayesian Computation technique to address shortcomings of existing methods in this complex problem space, after surveying the literature for available Bayesian computation techniques. A spatial compartmental model was used which allowed forward and backward progression through susceptible, exposed, addicted, and removed disease states. Data for this model were compiled over the years 2006-2016 for Iowa counties, from a variety of sources. Prescription overdose deaths and treatment data were obtained from the Iowa Department of Public Health, possession and distribution arrest data were acquired from the Iowa Department of Public Safety, a measure of total available pain reliever prescriptions was derived from private health insurance claims data, and population totals were obtained from the US Census Bureau. Inference was conducted in a Bayesian framework. A measure called the empirically adjusted reproductive number which estimates the expected number of new users generated from a single user was used to examine the growth of the crisis. Results expose the trend in recruitment of new users, and peak recruitment times. While we identify an overall decrease in the rate of spread during the study period, the scope of the problem remains severe, and interesting outlying trends require further investigation. In addition, an examination of the reproductive numbers estimated for contact within and between counties indicates that medical exposure, rather than spread through social networks, may be the key driver of this crisis.

Prescription ADHD medication has been shown to be on the rise as a drug of abuse among young people. Unlike other drugs that serve only the purpose of achieving a high, this particular substance can also be perceived as useful and beneficial by those who abuse it. It is these positive attributes given to the illicit use of these drugs that make them so dangerous, especially in the hands of youths. To date extant research has made little effort to contextualize this type of drug use within theories of deviance. This study looks to fill that void as well as bridge the gap between current epidemiological studies on this topic and future etiological studies looking to assess causation within a theoretical context. Examining a national sample of 12th grade students (N=2,384), this study looks at what risk factors and predictors exist for the illicit use of ADHD medication. By testing aspects of social bonding and social learning theories, the goal is to assess which theory can best predict this type of drug use. Due to the low proportion of users, a rare events logistic regression is utilized in the analysis. While social learning items were able to account for the greatest level of variance in use, many of the findings contradict the theory, and therefore no theoretically based conclusions can be made at this time. Overall, more research needed on this topic using better fitting data tailored for theoretical interpretation. Considerations for future studies are also discussed.

Numerous consequences of sexual assault have been identified, including psychological consequences such as posttraumatic stress disorder (PTSD) and health-risk behaviors such as substance misuse. Previous research has indicated that survivors of sexual assault may engage in substance misuse (i.e. alcohol and other illicit and prescription drug use) in attempt to suppress negative thoughts, memories, and flashbacks of the assault. The present study seeks to expand on and examine health-risk behaviors among undergraduate college women after the experience of sexual assault. Although many researchers have focused on the use of alcohol following sexual assault, less have studied non-medical use of prescription drugs (NMUPD) as an alternative method of maladaptive coping. NMUPD has recently been identified as the fastest rising recreational substance among college populations. With NMUPD becoming a norm among college students in recreational settings, exploring NMUPD for alternative uses seems like the next logical step in research. This study views sexual assault on a continuum starting from unwanted sexual contact and ending in completed rape. This study aims to bridge the gap in research by attempting to connect the risky behavior of NMUPD to coping with any experience on the sexual assault continuum among college undergraduate women. Participants with and without a history of sexual assault were recruited for the present study. Participants completed a measure of sexual assault history and severity, along with questionnaires assessing current alcohol, marijuana, and NMUPD use

Introduction: Prescription drug monitoring programs (PDMPs) are one strategy established to curb the prescription opioid abuse epidemic. Prescriber use mandates has emerged as a promising practice to increase PDMPs impact on prescription opioid abuse; however, evidence of its effectiveness has not yet been established. Kentucky was the first state to implement comprehensive prescriber use mandates in July 2012. Objective: To assess the relationship between prescriber use mandates policy and emergency department (ED) visits related to prescription opioid poisoning among adults in Kentucky and North Carolina. Secondary aim: to evaluate the economic impact of prescriber use mandates in Kentucky. Methods: A controlled, pre-post study design. Data from the State Emergency Department Databases (SEDD) and the State Inpatient databases (SID) were used to identify prescription opioid poisoning ED visits among those ≥ 12 years old. Prevalence rate were estimated. Prescription opioid poisoning ED visits were characterized based on sociodemographic and clinical characteristics. Logistic regression was applied to compare occurrences of prescription opioid poisoning ED visits pre and post prescriber use mandates in Kentucky, and between Kentucky and North Carolina for the period 2011 to 2014. A cost of illness framework was applied to estimate direct medical costs associated with prescription opioid poisoning ED visits. The economic impact of prescriber use mandates was quantified based on logistic regression coefficient for the interaction term (state*time to implementation). Results: There were 7,419 and 12,598 prescription opioid poisoning -related ED visits in Kentucky and North Carolina, respectively. Young and Middle age, male gender, white, having one or more chronic conditions, and psychiatric conditions (such as depression and drug abuse) were significantly associated with prescription opioid poisoning ED visits (p-value<0.05). The odds of having a prescription opioid poisoning ED visit in Kentucky were significantly lower compared to North Carolina in 2012, 2013, and 2014 compared to 2011 (OR = 0.9, 0.7, and 0.7 respectively). The total estimated direct medical costs were $13.77 and $24.37 million in Kentucky and North Carolina, respectively. In Kentucky, the economic impact of prescriber use mandates was estimated at - $2.3 million. Conclusion: Prescriber use mandates is effective in reducing prescription opioid poisoning ED visits, and its economic impact is considerable.