Author: Justin Mckibben
Suboxone is a medication meant to treat opiate and opioid withdrawal. It is one of two forms of the medication buprenorphine, which is an opiate agonist originally developed to treat pain problems. Suboxone works by binding to opiate receptors in the brain, which are the same receptors that morphine, heroin and other opiates bind to.
Is Suboxone Safe: How Suboxone Works
In order to better understand the risks of Suboxone use, it is important to understand how this medication works. Let us be clear, Suboxone is a narcotic. It is a semi-synthetic opioid made from a combination of two drugs:
This compound is intended for the treatment of pain, as well as for combating opioid addiction. However, what many people don’t realize it that buprenorphine is itself an opioid.
DEA reports show that the substance can be 20-30 times more potent than morphine as an analgesic; like morphine buprenorphine can create a dose-related euphoria. Like other opioids commonly abuse, buprenorphine is capable of producing a significant “high” and thus has been abused in various ways.
Now, all products containing buprenorphine are controlled substances. Given the nature of this powerful opioid, the other primary compound of Suboxone is added.
Naloxone is a pure opioid antagonist medication used to block the effects of opioids. It works by reversing the depression of the central nervous system and respiratory system. Narcan is a brand name for the medication that is commonly utilized as an overdose antidote.
But beyond being used to reverse overdoses, the addition of naloxone to products like Suboxone is with the intention of blocking the euphoric high resulting from the abuse of opioids by injection, like buprenorphine.
So when a drug like Suboxone is taken orally, just the opioid has affect. Naloxone blocks the impact of the opioid when it is injected. The primary purpose of naloxone in Suboxone is to deter intravenous abuse.
Is Suboxone Safe: How is it used?
Suboxone acts as a partial opioid agonist and diminishes cravings as well as prevents other opioids from reacting to the brain’s receptors. The drug has become a frequently utilized substance for trying to combat opioid addiction. Suboxone can come in tablet form, or in the form of a film taken sublingually, meaning dissolved under the tongue.
When taken orally or sublingually as directed, the naloxone is not absorbed and the buprenorphine acts uninhibited. However, the formulation still has potential for abuse. Published data has shown that the opioid receptor’s binding affinity to buprenorphine is higher, so the opioid typically overrides the antagonist, causing many reports to argue that naloxone is an insufficient deterrent for the injection of Suboxone for recreational abuse.
Serious dangers of Suboxone
While Suboxone may have become a mainstream tactic for combating opioid addiction, the question has become if it is as safe and effective as producers would have us believe. So when presented with the question of ‘is Suboxone safe?’ must look at a few factors.
Is Suboxone Safe: Adverse side-effects
The fact remains that Suboxone is an opioid narcotic. Therefore, the side-effects of Suboxone are essentially the same as other opioids.
Most common minor side-effects include:
- Mild dizziness
- Stomach pain
- Redness, pain or numbness in the mouth
- Trouble concentrating
Most common major side-effects include:
- Cough or hoarseness
- Feeling faint or lightheaded
- Feeling of warmth or heat
- Fever or chills
- Lower back or side pain
- Painful or difficult urination
Major side-effects suggest the individual should check with their doctor immediately.
Is Suboxone Safe: Withdrawal symptoms
The irony is that Suboxone is typically used because people are trying to stop abusing other illicit or prescription opioids but want to have something to curb the withdrawal symptoms. Yet, Suboxone is known to have its own withdrawals, and for some they are even worse.
Symptoms of Suboxone withdrawal can include:
- Body and muscle aches
- Difficulty concentrating
- Drug cravings
- Digestive distress
The physical withdrawals can peak in the first 72 hours after the last dose, and some of the more psychological symptoms can last much longer.
Is Suboxone Safe: Interactions with other drugs
Taking other drugs while on Suboxone, especially other opioids or sedatives, can actually be fatal. Combining Suboxone with other drugs can cause a very dangerous reactions that many also ignore. Drugs that are particularly dangerous with Suboxone are:
- Benzodiazepines (Benzos) such as Xanax
- Older Antihistamines
- Antipsychotics such as Zyprexa
Cocaine is also an extremely hazardous drug to combine with Suboxone because they are opposites on the spectrum of stimulant vs depressant. When you combine cocaine with Suboxone, it actually reduces the amount of buprenorphine that is in your bloodstream. With less buprenorphine in the body the effects of opioid withdrawal symptoms can be felt.
Combining cocaine with Suboxone also increases the risk of overdosing on cocaine.
If you would like more information on Suboxone, download our free E-book: 5 Things No One Tells You about Suboxone.
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Is Suboxone safe?
Suboxone may be a legal and popular alternative to some other opioids, but that doesn’t necessarily make it all that ‘safe’ to rely on. It is of course possible to overdose on Suboxone. As we said before, Suboxone combined with other drugs can also be incredibly dangerous. And at the end of the day, you can still become psychically and psychologically dependent on the drug.
In truth, Suboxone has been useful to some who have tried to get off of drugs like heroin and other dangerous opioids by providing a buffer and some method of harm reduction. But the often overlooked aspect is that Suboxone is only intended for short-term use and not long-term maintenance. When individuals use the substance for long periods of time, they become dependent on it just like any other potent narcotic. Experts insist that Suboxone and similar drugs are only effective in combination with comprehensive treatment or cognitive behavioral therapy.
For more information, read our
A safer and far more healthy and sustainable approach to recovery from opioid addiction is with holistic treatment that offers much more than an opioid substitute with its own adverse effects. If you or someone you love is struggling, please call toll-free now. We want to help.
CALL NOW 1-800-951-6135
Photo of artists Cane in the studio
Author: Justin Mckibben
Recently one of our Palm Partners Alumni who has been pursuing his passion for music posted a powerful music video with a strong message that caught our attention. After hearing how the track he had recorded was speaking intensely and poetically about the issues concerning the opiate epidemic and the shady side of Big Pharma in the prescription drug outbreak across the country, we wanted to know more about the project.
The name behind the deep reaching lyrics is Cane, and he’s a hip-hop artist ‘straight outta Indiana’. The video is titled “Detox” and is a powerful look into the world of prescription drug abuse from someone who has personally had to fight for their life. The video itself does have some mature content, but nothing extremely graphic. It begins with news broadcasters and headlines talking about the epidemic, and the beat itself is something a lot of people might recognize as the “Run This Town” instrumental by Jay Z, but Cane does a good job of making the music his own.
He credits the recording and video production to RJ Write @FlatlineMedia with a post that has been shared by multiple sources. Hopefully it’ll trend and catch even more momentum. We wanted to celebrate this level of heartfelt dedication, so we reached out to Cane to get a glimpse at some of the thoughts behind the music.
Q & A with Cane
Q: So, what is your sobriety date and how long have you been making music?
A: “My clean date is 8-8-14. I’ve been making music for 5 years. My father is a musician also so it’s always been in my life.”
Q: What has life been like since leaving treatment?
A: “Life after leaving treatment has been truly a blessing. When you’re caught up in the grip of addiction you tend to get caught up in the rat race and you feel like you’re going to be stuck in that forever you lose hope of having any normal life. Now that I’m home I’ve went back to school and getting my GED then went and got my CDL and in my semi-truck driver. I have a daughter and I also have another child on the way, all these things seemed impossible when all I could think about was getting one more… and as I grow in this recovery process I’m learning more about myself and learning to love myself and ways that I never have… and it all started when I took that first step and entered the doors of Palm Partners.”
Q: What was the most valuable experience you took from treatment at Palm Partners Recovery Center?
A: “The most value experience I took from Palm partners is that people do truly care and you’re not alone. I was reminded that Humanity is real and it still exists, there are still people out there that genuinely care because when you’re caught up in that street life you tend to lose that reality… and they also gave me a firm foundation to build on as I got out into the world and started to recover.”
Q: In your own words, what has inspired you to write about this in your music?
A: “What had inspired me to write this in my music was looking around at myself and those around me caught in the struggle, and realizing that we all share the same pain and can relate it was at that point that I knew I had to bring a clear message through my music and be a voice for those who feel they aren’t heard and also create awareness to situations that most turn a blind eye to.”
Q: What is the main message you want to send with a song like this?
A: “The main message that I want to get through with this song is that I believe the system (Big Pharma) is more of a business built on creating revenue instead of cures, it seems they are creating momentarily relief of symptoms instead of actually trying to heal their patients. A cured patient is a lost customer, not caring about the side effects their drugs have on the consumer they over medicate to the point that we feel we can’t go through life without these medications. It’s almost as if they’re telling the public, this is your only hope… don’t worry about what’s it’s doing to your health, don’t worry about what is doing to your life because we’ll just prescribe you something to handle that stress as well.
My personal experience has showed me that when my tolerance grew they upped the dose, always having a pharmaceutical answer for everything…when in the end everything they gave me to better my life was actually killing me, physically, mentally and spiritually.”
Q: Who has been most influential in your recovery?
A: “Ronald “Choke” Nelson has been one person who has helped me grow the most in my process of recovery, and my family.”
Q: How has recovery made you more successful in your music or other passions?
A: “Recovery is help me in my music by helping me learn who I truly am as a person, which helps me open up more and be able to express myself freely, opening up a new platform of consciousness and truly seeing life for what it is in all its beauty and Glory which makes me see reality instead of my self-made prison which kept my close minded, judgmental and delusional.
Now I see the beauty that life truly is, I can write and create with a sense of Peace and clarity, and with other passions like Family, relationships and life in general is just gave me a sense of gratitude and appreciation which helps generate a loving atmosphere, and in a loving atmosphere all things grow.”
Q: When can we expect more projects like “Detox” from you?
A: “I’m in the process of writing a new track called “It’s Okay” which will be somewhat of a motivational song letting the people know, it’s okay to have flaws, nobody’s perfect… just learn to accept yourself regardless of your past you can have a bright future.
I also already release a song called “My Story” which also gives hope and gives you a glimpse into my world.”
Q: If you could give a message to anyone who might be hurting, what would it be?
A: “Anybody that’s out there listening still caught up in the grip of addiction just know that there is hope. Find that last piece of strength; that last piece of love that you have for yourself and find a way to get somewhere to get some help. You do not have to settle for the limitations of your past, there is a brighter future ahead just step forth and make an effort and slowly but surely things will fall into place, you just have to believe. There is a better life for you out there, you don’t have to stay stuck in the never ending cycle, so please from me to you reach out to someone who cares make that call, Reach Out and save your life”
With gratitude and humility Cane happily touched on a lot of important ideas in his song and during our conversation. It is clear this artist believes in his recovery, and believes in raising awareness and spreading the message to others. We are always proud of the amazing accomplishments and uplifting stories our Palm Partners Alumni share with us about life in recovery. We always encourage our Alumni to reach out and share their own perspectives. Part of proving recovery and life after treatment is possible is living by example and making the most out of our message. Cane is taking that to heart and putting his talents to use to try and make a difference.
You can check out the music video for ‘Detox’ here and you can check out more of Cane’s music here.
We know there are so many more Palm Partners alumni out there with talents, stories and experiences to share, and we encourage you to contact us and be part of the message that may help countless others. You never know how many lives you can touch, and how many people could make the choice that saves their life because of something that you choose to share. If you or someone you love is struggling with substance abuse or addiction, please call toll-free now.
CALL NOW 1-800-951-6135
Author: Justin Mckibben
The new Trumpcare plan, formally known as the American Health Care Act or AHCA was announced this Monday March 6th. This Trumpcare bill is the Republican Party’s long awaited plan to repeal and replace the Affordable Care Act, also known as Obamacare.
Since day one of the announcement we have seen quite a few varying opinions as to what this means for the people who were previously covered, and what it means for how healthcare altogether might change. Needless to say, not that much of the talk has been optimistic. As details emerge about Trumpcare some have become increasingly worried about the impact it will have on access to treatment for substance use disorder, especially for low-income Americans.
So what some are officials and experts saying about Trumpcare, and what it might mean for Americans struggling with addiction?
Early Predictions on Trumpcare
According to some early reports, 6-10 million Americans will lose health insurance. Not only that, millions of people in desperate need of help could be cut off from access to addiction treatment as a result of the bill.
In fact, according to one analysis, approximately 2.8 million people living with substance use disorder will lose some or all of their health insurance coverage if Obamacare is repealed. This conclusion comes from:
- Harvard health economist Richard Frank
- Sherry Glied, Dean of the Wagner School of Public Service at NYU
The publication The Hill reported in January that Frank and Glied predict that the federal government’s 21st Century Cures Act creates a recent investment of $1 billion to tackle opioid abuse. However, they state this provision would be- “squandered if the new Congress rolls back recent gains in the quality and level of substance use and mental health insurance coverage generated by the Affordable Care Act (ACA) of 2010.”
Surely this is all “fake news” and “alternative facts” right?
Not so much. According to reports from the Washington Post Thursday, House Republicans admitted, after questioning by Massachusetts Democratic Representative Joe Kennedy III, that their the Trumpcare plan to repeal-and-replace would- “remove a requirement to offer substance abuse and mental-health coverage that’s now used by at least 1.3 million Americans.”
How does this happen? By attacking the expansion of Medicaid and the ‘essential benefits’ states are required to provide for.
Trumpcare Impact on Medicaid
Trumpcare’s plan to roll back Medicaid and health insurance tax credits are pretty distressing aspect of this reform. For all the Americans who rely on government assistance for addiction treatment this is a pretty huge deal.
Addiction treatment in the past is notably impacted by Medicaid. According to Truven Health Analytics, Medicaid was the second largest payer for addiction treatment, after state and local programs, in 2014.
Starting in 2020, Trumpcare is set to:
- Freeze Medicaid enrollment
- No longer require Medicaid to cover essential health benefits like addiction treatment
What is the point? To make it so the federal government pays less for Medicaid over time by shrinking coverage.
So if this is all the case, it is a terrifying reality. In a time when more Americans than ever desperately need addiction treatment, in the midst of an opioid epidemic that is tearing families and communities apart, the government’s Trumpcare plan stands to save money by stripping addiction resources from those relying on Medicaid?
Representative Kelly and Peter Welch, Democratic Representative from Vermont, attempted to amend the bill to restore the federal mandate for those ‘essential benefits’ but were voted down. Kenny is popularly quoted in the news recently for his statement,
“There is no mercy in a country that turns their back on those most in need of protection: the elderly, the poor, the sick, and the suffering. There is no mercy in a cold shoulder to the mentally ill… This is not an act of mercy — it is an act of malice.”
While Trump’s comments say he wants to give states “flexibility” with Medicaid to make sure no one is left out, many believe this is just adding the idea of paying more for less.
Senate Minority Leader Chuck Schumer vows to lead efforts to defeat Trumpcare, stating he believes it will “Make America Sick Again” and believes that it will create more drug addicts. In a report from The Hill Schumer attacks the bill saying,
“To make matters worse, this sham of a replacement would rip treatment away from hundreds of thousands of Americans dealing with opioid addiction, breaking the President’s word that he would expand treatment, not cut it.”
This is continuously troubling. When it comes to the fight against addiction, President Trump’s administration seems to be more focused on borders and “law and order” than providing resources. Trump did promise to work on creating more coverage options, but all the action taking place almost points the opposite direction.
Trumpcare Impact on Treatment Providers
This chain reaction wouldn’t just hurt those who need insurance by denying them coverage. Experts say Trumpcare also has the capacity to do damage to the treatment providers themselves.
Keith Humphreys, a drug policy expert at Stanford University, points out this issue directly. Humphreys notes that treatment providers, which tend to be small businesses in many parts of the country, may find it difficult to stay in business if clients lose coverage for addiction treatment. If less people are able to get coverage, less people will be able to get treatment. At the same time even bigger treatment providers could have trouble because it still has the capacity to reduce reimbursement rates for treatment services.
Thus, Trumpcare could affect both the supply and quality of treatment. In one interview Humphreys states,
“Most providers are small, mono-business entities that can’t absorb costs elsewhere in their care systems,”
“While hospitals will not go broke if poor people get less oncology care coverage, many [substance use disorder] treatment agencies will.”
But it isn’t just Democrats or University Professors or addiction experts speaking out. The AARP, the American Hospital Association, and the American Medical Association voice opinions against the overhaul of the ACA and the potential harm Trumpcare could do.
Even Republicans are speaking out against the danger that Trumpcare poses to addiction. Ohio Governor John Kasich is vocal with his own opposition to the bill saying,
“[Trumpcare] unnecessarily puts at risk our ability to treat the drug-addicted mentally ill and working poor who now have access to a stable source of care.”
Not to say that healthcare was ever perfect. It is noted by many doctors in the addiction field, as well as politicians and other experts, that there is already a treatment deficit. Approximately 10% of America’s population has what could be considered a substance use disorder, and only 13% of those people ever get treatment.
However, the miles of red tape Trumpcare might wrap around them could cut that number drastically. So even if these are unintended consequences, they are very real consequences just the same.
Obamacare was far, far from perfect. This is absolutely true. But is Trumpcare the best answer we can come up with?
As it now stands, Trumpcare may take so much away from those struggling with addiction and mental health that some experts are calling it dangerous. Having safe, effective and comprehensive treatment resources for these issues is extremely important to the preservation of life and the future of America. This is a matter of life and death. It is not the time for an ‘anything but Obamacare’ mentality… if the government expects a better plan, they need to make it happen. How about we put a hold on spending billions on border walls and expanding the nuclear program, and instead focus on healing Americans who need it most.
If you or someone you love is struggling with substance abuse or addiction, think about who you want to be working with to find a real solution. Please call toll-free now.
CALL NOW 1-800-951-6135
Author: Shernide Delva
Drug overdoses have skyrocketed across the United States, and as a result, the popularity and accessibility of naloxone have risen as well. Most pharmacies now carry naloxone and even schools are carrying it in the event of an overdose emergency. Nationwide, naloxone is available to emergency departments and paramedics who find they are using the overdose antidote more than ever before.
While the use of naloxone is saving countless lives, one of the major battles first responders are facing is that they often administer naloxone to the same people over and over again. The repeated overdoses have many pondering; Where do we go from here? What is the next step after naloxone?
After the Overdose Reversal
First responders have acknowledged the pattern of repeated overdoses throughout the country. While an overdose often is a turning point for many, for others it is not enough to stop the active addiction. Therefore, in many areas of the country, first responders and community members have launched programs to reach out to those who recently overdosed. These programs aim to offer resources on overdose prevention, mental health counseling and substance use disorder treatment.
In July 2015, the Township of Colerain, Ohio, started a post-naloxone outreach program led by their Director of Public Safety, Daniel Meloy. Ohio has some of the highest rates of drug overdoses in the country. Under the program, representatives from the Colerain Police Department, the Colerain Fire Department, and Addiction Services Council all meet to review overdose reports from the previous week. Then, the representatives, known collectively as the Rapid Response Team, go into their community to visit the homes where the overdoses occurred.
“We knock on doors and ask to speak with either the person who overdosed or any friends or family,” says Shana Merrick, a social worker with Addiction Services Council. “We explain that we are not there to make an arrest, but to offer resources to keep the person healthy, safe and well. Most people open their doors and we talk about their situation and needs.”
In cases where a person lacks medical insurance, these programs help them find insurance. For those who are not eligible for insurance or Medicaid or simply can’t afford insurance, there are dedicated funds to help pay for treatment costs.
“About 80% of the people we see eventually seek some form of treatment,” says Shana. “It’s not always right away, but if we build a relationship over time then they may contact us later on asking for help.”
One of the biggest challenges is treatment capacity. When all beds are full, Shana enrolls people in intensive outpatient programs until a slot opens up at a traditional inpatient program. Some will enroll in medication-assistant treatment programs. Another challenge is staying in touch with people who are transient and may have changed address or phone numbers.
Shana and The Rapid Response Team are fortunate to have a variety of resources available to them to help guide people. Other places are not so fortunate. The Santa Fe Prevention Alliance in New Mexico have similar post-overdose outreach program but have fewer resources to utilize.
“There aren’t a lot of substance use or mental health treatment services in our area where we can refer people,” says Bernie, who visits people who have recently overdosed each week, along with a paramedic from the Santa Fe Fire Department.
“We do offer to help people find treatment facilities if they want, but during most of our visits we work with families to come up with an overdose response plan, offer naloxone and training on how to use it, and brainstorm about how to reduce the risk of another overdose. People are excited and respond well to us. No one has ever refused to let us visit.”
Do These Programs Work?
The purpose of these programs is helping those who have recently overdosed from overdosing again. The vast majority of people are receptive to receiving help. In some cases, they may not want help right away but often reach out in the future.
There is a critical overdose epidemic nationwide, and communities are exploring ways to help past the initial overdose reversal. Post-naloxone programs do offer hope, however they are just one solution to a very complex issue. There is not a quick-fix one-step solution–—not naloxone, not post-overdose outreach programs, not more inpatient treatment, not injected medications that block cravings for opioids—is a magic cure.
A combination of efforts that explore a diverse range of treatment options is key. While saving lives using naloxone is extremely important, the post-naloxone addict needs just as much assistance. What are your thoughts? If you or someone you know is struggling with addiction, please call now. Do not wait.
CALL NOW 1-800-951-6135
(This content is being used for illustrative purposes only; any person depicted in the content is a model)
Author: Shernide Delva
The narrative of the orphan child has never been a positive one. We’ve all seen movies about it. Abandoned children struggle with mental illness, emotional distress and sadly, many fall into addiction. The nation’s drug-addiction epidemic is excelling the number of children enter foster care. Many states must take urgent steps to care for neglected children. Unfortunately, there are too many and the numbers only continue to rise.
The problem is addicts often neglect, abandon or mistreat their children. Several states such as New Hampshire and Vermont made laws to make it possible to pull children out of homes with addicted parents, or states increased budgets to hire more social workers to deal with the emerging crisis.
Other states like Alaska, Kansas and Ohio have issued emergency pleas for more people to foster neglected children, many of them infants, into their homes.
“We’re definitely in a crisis, and we don’t see an end in sight any time soon,” said Angela Sausser, executive director of the Public Children Services Association of Ohio, a coalition of public child safety agencies in the state.
Life as a Child in Foster Care
Sadly, these children grow up and have a high risk of having a drug addiction. According to a 2016 study funded by the National Institute of Mental Health (NIMH), 35% of older youth in foster care have a substance use disorder.
While there is no universally accepted cause of drug addiction, one theory commonly accepted is a relief from physical, mental, and emotional pain. There are emotions foster youth feel on a regular basis. Foster youth are ripped from their families and put into state care due to neglect or abuse. Those two words—neglect, abuse—result in an array of emotional and physical realities. These realities must be addressed.
Lisa Marie Basile was a foster youth from age 14 to 19. She is a successful edited and writer in New York who wrote the poetry book Apocryphal. She discussed her thoughts in an interview in The Fix:
“The narrative of the foster youth has been hijacked by this idea that foster youth are just losers. Like it’s inherent, expected. The thing is, something has been done to them. I wish more people understood the loneliness,” she explained.
The Numbers Are Now Increasing
For a while, the number of children in foster care was decreasing. The enormous increase in parental drug abuse is driving the number of foster care youth up at an incredible pace. As of 2014, the number was at 3.5%. In San Diego, more and more babies are in need of foster care placement, and many infants are born addicted to drug. Not only are these babies born experiencing withdrawals, they also have a long-term risk for medical, developmental, emotional and behavioral hardship. Furthermore, they are an extremely high risk for addiction.
There are programs out there to help these children, but they have to reach out for it. The first step is admitting the addiction. This is the exact reason why many addicts are stuck. Lisa Basile says she made her way through foster care without using, however once she reached college, she began to overindulge in drinking.
“I drank a lot more than most college students. And that behavior—day drunk, wine for lunch—stayed with me for a while after college. It became less about partying and way more about numbing everything out so I could get through college without facing my tragedies.”
The Emotional Aftermath
The issue lies in the emotional toll the foster care process can have on these children. The National Institute of Mental Health states that that foster youth have a high risk conduct disorder and post-traumatic stress disorder (PTSD). Youth with PTSD or conduct disorder are found to have the “the “highest risk for substance use and disorder.”
What is PTSD? PTSD is defined by the National Alliance on Mental Illness (NAMI) as “requir[ing] that children have experienced, witnessed, or learned of a traumatic event, defined as one that is terrifying, shocking, and potentially threatening to life, safety, or physical integrity of self or others.”
It is clear by this definition why foster children are likely PTSD sufferers and why they are more at risk for addiction rather than just drug experimentation. Foster children are often born in situations where their basis needs are ignored and where their emotional wounds remained unhealed.
There is Hope
With the right resources, children in these situations can be granted the opportunity to change their future. Everyone involved plays a role. From teachers, therapists, volunteers and neighbor, the right person providing the right connection can turn things around.
Foster children and addiction may go hand in hand, but that does not mean anyone’s situation is hopeless. There is not an excuse for changing your future. If you were brought up in an unfortunate situation, there is still time to shift the direction of your life. If you or anyone you know is struggling with substance abuse or addiction, please call now.
CALL NOW 1-800-951-6135