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Does Cannabis Use Really Cause Opioid Use Disorder?

 Does Cannabis Use Really Cause Opioid Use Disorder?

This may seem like a big leap, but some people still manage to make it. So we thought maybe we should take a look at both sides of this argument to understand the issue.

The Attorney General for the Trump Administration, Jeff Sessions, consistently comes into conflict with advocates for cannabis in America. His stance has been about the same for as far back as his career in politics, and recent actions by Jeff Sessions have caused a stir with those in support of legalization, whether medical or recreational.

Now, it seems Sessions believes that cannabis use is actually why we have an opioid crisis.

Looking at Opioid Stats

Recently, Jeff Sessions was speaking at the Heritage Foundation to the Reagan Alumni Association this week. As part of the conversation, Sessions did put a lot of focus on cutting prescriptions for opioid painkillers as a critical element to fighting the crisis. So many people who use illicit opioids like heroin or fentanyl start with prescription drug abuse. This much has been shown in several studies, such as one from 2017 published in Addictive Behaviors which found:

  • 9% of people getting opioid use disorder treatment in 2015 started with prescription drugs
  • This is an improvement from 84.7% in 2005

Some would argue that better regulations put into practice over the last several years have helped to curb that trend.

However, Sessions went on to say,

“The DEA said that a huge percentage of the heroin addiction starts with prescriptions. That may be an exaggerated number; they had it as high as 80 percent. We think a lot of this is starting with marijuana and other drugs too.”

It was that last comment that caught a lot of attention. It wasn’t all that shocking, considering Sessions never been a supporter of cannabis use. Still, some people found this commitment to the gateway drug mentality to be a little out of touch.

So, we should look into the argument from both sides.

Can You Connect Cannabis and Opioids?

A recent paper in the American Journal of Psychiatry shows Mark Olfson and a research team delves into data concerning the gateway drug concept.

The team uses data from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) to examine the association between:

  • Cannabis use reported in the 2001-2002 survey
  • Non-medical use of prescription opioids 3 years later

In relation to the survey the term ‘non-medical use of a prescription opioid’ is defined as using the drug “without a prescription, in greater amounts, more often, or longer than prescribed, or for a reason other than a doctor said you should use them” during the previous 12 months.

Olfson and his group claim that according to the data:

  1. Cannabis users more often ended up using opioids

People who used cannabis in the 12-month period prior to the initial interview were at increased risk of non-medical use of prescription opiates 3 years later.

They even checked the variables, and found this was true even when the data were adjusted to control for:

  • Age
  • Sex
  • Race/ethnicity
  • Family history variables
  • Antisocial personality disorder
  • Other substance use disorders
  • Mood or anxiety disorders

Those studied who used marijuana were still at higher risk of opioid use.

  1. Increased cannabis use correlated with increased opioid use disorder

According to the researchers, the percentage of people with Incident Prescription Opioid Use Disorder at the second interview increased as the level of cannabis use reported at the first interview increased.

To clarify, Incident Prescription Opioid Use Disorder was defined as use that occurred after the first interview that qualified to be considered opioid use disorder, restricted to people who had no prior lifetime history of opioid use disorder.

So essentially, the people who reported to using more cannabis at the beginning of the study were more likely to show signs of opioid use disorder 3 years later.

But Does Connection Equal Causality?

One thing the authors do acknowledge outright is that the majority of adults who use cannabis do NOT start using or increase use of prescription opioids.

Another thing the researchers acknowledge is that their study isn’t proof that cannabis use causes opioid use. The association of marijuana use with non-medical prescription opioids after 3 years in no way means that marijuana use is proven to actually cause opioid use.

The researchers do have a few ideas though.

  1. Brain Changes

Some animal studies seem to have shown that it is possible for cannabis to lead to changes in the brain that make individuals more susceptible to opioid misuse.

  1. Environment

Another argument is that there are several non-biological factors that can elevate the risk of opioid use. Those who regularly use marijuana may be more likely to interact with people who have access to opioids.

Correlating Drug Use

Many researchers have actually cautioned that there’s no solid evidence that marijuana use causes harder drug use.

In fact, a lot of experts and advocates argue that while marijuana use can easily correlate with harder drug use, so can alcohol and tobacco.

The first drugs many people ever use are alcohol or tobacco, which are both legal for adults and fairly easy to get. Yet, no one automatically assumes drinking or smoking cigarettes will lead to heroin use. However, if the same data and logic used by Olfson and his group were applied to alcohol and tobacco, we would probably see a huge correlation. So many advocates argue why should cannabis use be treated any different?

A 2002 report by RAND’s Drug Policy Research Center (DPRC) suggests that it is not marijuana use, but individuals’ opportunities and unique propensities to use drugs that determine their risk of initiating hard drugs. The Institute of Medicine came to a similar conclusion to the ‘gateway drug’ concept back in 1999.

So, no evidence thus far has been conclusive, only correlational.

The Anti-Gateway Affect?

There are also those out there that believe marijuana legalization would actually have the anti-gateway affect, meaning studies have suggested there is evidence that access to marijuana actually reduces some opioid use.

This growing body of investigation indicates that medical marijuana legalization, in particular, can lower the number of people misusing opioids. Some insist it is because cannabis can help to treat chronic pain instead of opioids. Others even think access to marijuana would cause people to substitute their alcohol use. However, research in this area is still finite. Now it’s far too early to tell if this would actually be an effective strategy.

There is even a new study from David Powell and Rosalie Pacula of the RAND Corporation and Mireille Jacobson of the University of California Irvine that examines how medical marijuana legalization- particularly in states with the most access- impacts opioid-related deaths. These researchers concluded,

“These findings suggest that broader access to medical marijuana facilitates substitution of marijuana for powerful and addictive opioids.”

So while there are those who would put the data behind marijuana being a big part of the problem, there are those who avidly believe it is actually a huge part of a different strategy to overcome the opioid crisis.

What Can We Do?

Whichever side of this argument you’re on, there needs to be more time and energy put into exploring both perspectives. If the correlation between cannabis and opioids were ever proven to be more than meets the eye, then more needs to be done to make sure that legalization or decriminalization efforts co-exist with addiction treatment and support options.

If medical cannabis is found to be useful to help treat some who otherwise would be at elevated risk of chronic pain issues, opioid use disorder or even opioid-related death, then more should be done to make sure this method of treatment is safely studied and developed.

Either way, we must continue to work toward helping every individual suffering from substance use disorder of any kind. Whether it is marijuana use disorder or opioid use disorder, there should be safe and effective treatment options available.

There should always be resources available to help people who suffer from abuse. Supporting addiction recovery means breaking the stigma and offering holistic and effective solutions. Palm Healthcare Company is here to help. If you or someone you love is struggling, please call toll-free now.

CALL NOW 1-800-951-6135

MMJ or Molon Labe: Medical Marijuana Users Losing Gun Rights in States

MMJ or Molon Labe: Medical Marijuana Users Losing Gun Rights in States

Author: Justin Mckibben

It seems politicians are telling people- take your pick; guns or marijuana… you can’t have both.

Back in 2016, you may recall that we did an article covering the story of S. Rowan Wilson, a Nevada resident who in 2011 was denied when attempting to purchase a handgun when the gun store owner recognized her as a medical marijuana cardholder. In court, Wilson maintained that she does not herself use marijuana, but in August of 2016, the 9th U.S. Circuit Court of Appeals decided in a 3-0 vote that if you have a medical marijuana card, you can’t buy a gun.

Recently the ideas behind this case have sparked renewed outrage and discussion over whether or not medical marijuana users should be permitted to own a firearm. The gun control debate is one that is already being consistently argued in the shadow of recent mass shootings and pushing from politicians to address the issue. But drug policy impacting gun policy adds a new perspective to the conversation.

Now there are several states cracking down on marijuana users, and it has some people up in arms about how even though states are legalizing medical marijuana use, federal law and many state governments are cutting them off from their right to gun ownership.

Under Federal Influence

According to federal law, gun purchases are already prohibited to people who are described as:

“-unlawful user and/or addict of any controlled substance.”

Back in 2011, the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) insisted that the law applies to marijuana users-

“regardless of whether [their] State has passed legislation authorizing marijuana use for medicinal purposes.”

So it seems the ATF and the federal government are pulling out all the stops when it comes to making sure marijuana users aren’t allowed to own guns.

The decision in the care of Wilson and the 9th U.S. Circuit Court of Appeals includes the areas:

  • District of Alaska
  • District of Arizona
  • Central District of California
  • Eastern District of California
  • Northern District of California
  • Southern District of California
  • District of Hawaii

The Supreme Court ruled that it is NOT a violation of 2nd Amendment Rights to deny guns to marijuana patients. The impact of that ruling has now begun to spread. It would seem the federal government thus far is standing by this. Special Agent Joshua E. Jackson of the U.S. Bureau of Alcohol, Tobacco, Firearms and Explosives in Washington D.C. states:

“There are no exceptions in federal law for marijuana used for medicinal or recreational purposes.”

And as far as things look now, there will be no change anytime soon to the federal government’s stance on marijuana. Especially with the current administration emphasizing so heavily a law and order approach to drug policy.

More States Against Marijuana and Guns

Even though there are 29 states and Washington D.C. that have voted to allow patients to have access to medical marijuana, several of these states are choosing to trade that opportunity for a shot at gun ownership. In fact, just this week a few state officials announced their own stance against allowing gun owners to be medical marijuana patients.


In a move that spurred a backlash of viral videos and other reports, Hawaii took a bold step in this effort. Last week the Honolulu Police Department sent letters to medical marijuana users saying that they will need to turn in their weapons within 30 days of receipt. According to Leafly, a copy of one of these letters states:

“Your medical marijuana use disqualifies you from ownership of firearms and ammunition.”

However, the letter also apparently says that the medical marijuana patients can get their firearms back. The stipulation being they would need a doctor’s clearance to do so.


A similar situation happened in Pennsylvania. The state police director of the Bureau of Records and Identification, Major Scott C. Price, made an announcement on Tuesday stating:

“So, in fact, an individual who is issued a medical marijuana card in Pennsylvania who is a user of medical marijuana, that individual would be prohibited from purchasing or technically possession of a firearm under federal law.”

So Pennsylvania won’t allow people to even be in possession of a firearm at any time with a medical marijuana card.


Ohio’s medical marijuana program becomes operation in September of 2018. Information from industry analysts estimate that 24% of the state’s population have qualifying conditions; that’s 2.8 million Ohioans. But just this week it was announced that people in the Buckeye State who register to legally use marijuana for medicinal purposes will also be prohibited from possessing firearms.

According to the ATF letter from back in 2011, marijuana users are also prohibited from:

  • Shipping
  • Transporting
  • Receiving
  • Possessing firearms or ammunition

So anyone in Ohio who is applying to purchase a gun from a licensed dealer must sign a form attesting her or she is not “an unlawful user of, or addicted to, marijuana or any depressant, stimulant, narcotic drug, or any other controlled substance.”

Under federal law, lying on the form is a felony punishable by up to 10 years in prison. Even Joe Eaton, southwest spokesman for the Buckeye Firearms Association says they are confused at this point,

““There is definitely a conflict between the state laws and the federal laws,”

Some Ohio law enforcement officials are also unsure at this point how to enforce these situations as of the moment, and are depending on their prosecutors to provide more clarification through the conflict with state and federal law.

Will Marijuana Users Go Molon Labe?

For those unfamiliar with the term, molon labe is Greek for “come and take [them]”. This declaration has been repeated by many generals and politicians to express an army’s or nation’s determination not to surrender. The motto ΜΟΛΩΝ ΛΑΒΕ is on the emblem of the I Army Corps of Greece and the Second Infantry Division of Cyprus, and is also the motto of United States Special Operations Command Central (SOCCENT). The expression “Come and take it” was a slogan in the Texas Revolution.

It is also a popular choice of words for many 2nd Amendment advocates.

The question becomes, how will the hardcore 2nd Amendment supporters react to this ruling against medical marijuana and guns? Some actually believe this may actually inspire the National Rifle Association (NRA) to become pro-medical marijuana at the federal level. Will this kind of shift in support turn the tide?

Will avid gun owners come out in strong opposition to taking away guns from medical marijuana patients, or will they agree that drug use should disqualify them from owning or possessing weapons and ammunition?

How should authorities proceed? Is this a safe political sit rep or another war of opinions waiting to happen?

Treating Marijuana Abuse

Whether or not you support gun ownership of medical marijuana patients, we should all be able to get behind having treatment resources for anyone who struggles with substance abuse.

Marijuana, much like any other substance, can be abused and have an adverse impact on the overall quality of life for many people. No matter what the legal status of any drug, it can still have a negative impact on people who grapple with substance use disorder. We know this all too well, as plenty of prescription medications helped create the opioid crisis in America.

There still needs to be resources available to help people who suffer from abuse. Supporting addiction recovery means breaking the stigma and offering holistic and effective solutions. Palm Healthcare Company is here to help. If you or someone you love is struggling, please call toll-free now.

CALL NOW 1-800-951-6135

California says NO to Pot Delivering Drones

California says NO to Pot Delivering Drones

Californians expecting to get their marijuana delivered via drone should not hold their breath. A new set of regulations will make it harder for California businesses who try to deliver pot in unique ways.

The legalization of marijuana has raised a host of controversy. For one, the question of who has the right to distribute pot is already a complex issue. However, now there is the question of how these products get delivered.

Pot Drones? Should they be allowed?

California legislators are hoping to get these questions answered before issuing dispensary licenses next year. They came together this month to lay down the rules. Ultimately, it was decided that marijuana could NOT be delivered by drones.

The decision was part of the Commercial Cannabis Business Licensing Program Regulations released by the state.

“Transportation may not be done by aircraft, watercraft, rail, drones, human-powered vehicles, or unmanned vehicles,” the regulations read, according to Ars Technica.

While deliveries will be allowed, they must adhere to the following guidelines:

Deliveries may be made only in person by enclosed motor vehicle. Cannabis goods may not be visible to the public during deliveries. Cannabis goods may not be left in an unattended motor vehicle unless the vehicle has an active alarm system. Vehicles used for delivery must have a dedicated, active GPS device that enables the dispensary to identify the geographic location of the vehicle during delivery.”

The news will be a major disappointment to the handful of businesses in California who already promised future pot deliveries by drone. One company, MDelivers, said the opportunity to deliver marijuana via drone was “unmistakable.”

Nevertheless, the company CEO did not count on lawmakers forbidding drone deliveries:

After navigating the complexities of medical marijuana permitting, the state and FAA licensing process was actually pretty simple. Nobody can jump in at the 11th hour and rewrite the laws of aerodynamics,” Chris Boudreau, CEO and founder of MDelivers said in a blog post before the regulations were announced.

With the new policies in place, there is no telling how entrepreneurs will get marijuana to their customers. Even if drones are off the table, there are a variety of other new, interesting methods being considered.

We may see a vending machine attached to a self-driving car before we see a drone,” Marshall Hayner, CEO of Trees Delivery, told Mashable.

As California prepares to expand its cannabis market, there continues to be challenges among those against marijuana legalization, especially when it comes to the products crossing state lines illegally. This has already been a major concern for states where port had been legal for recreational use such as Colorado and Oregon.

Surrounding states are trying to address the marijuana diversion issue by requiring pot businesses to track their product from “seed to store.” Time will tell how these sorts of issues will be regulated.

Furthermore, there remains to be conflicting ideologies on whether or not marijuana use is beneficials. While there has been proven benefits of marijuana use, there are also negative effects of marijuana use. Like any drug, marijuana has the potential to be abused.

As more and more states legalize marijuana, logistical challenges remain such as how the products can be delivered. Marijuana remains illegal under federal law, where it’s still classified as a controlled substance. This results in a variety of challenges in states like Colorado where recreational marijuana is legal.

The federal government requires that Colorado and any state that legalizes marijuana work together to prevent:

  • Distribution of marijuana to minors.
  • Transporting marijuana from states where it’s legal to other states.
  • Growing marijuana on public lands.
  • Marijuana possession or use on federal property.
  • Other criminal activity or violence associated with the sale of marijuana.

It is important to remember that like any drug, marijuana has the potential to be abused. Do not feel shame for feeling out of control of your marijuana use. Stigma should not prevent you from seeking treatment. If you or someone you know is struggling with substance abuse, please reach out today. Do not wait. Call toll-free now.

CALL NOW 1-800-951-6135

Medical Marijuana Plan Pass in Ohio House

Medical Marijuana Plan Pass in Ohio House

Author: Justin Mckibben

In a historic turn of events for legislators in the home of the Buckeyes, Ohio lawmakers in the House have passed a medical marijuana plan after an extensive debate reaching across both sides of the aisle.

For the years leading up to now the House has opposed plans to legalize marijuana, medicinal or otherwise, despite all efforts put forth by advocates in the area. Now in a surprising turn of events they have approved a plan 71-26 just this Tuesday. The bigger

For the first time members of Ohio’s GOP-controlled House had a serious discussion about medical marijuana after they found themselves feeling the pressure with two medical marijuana efforts working toward the November ballot.

What Changed?

Probably the biggest influence on this shift was that recent polls determined the majority of Ohioans are much more interested in legalizing medical marijuana rather than marijuana for recreational use. The change may have come when they realized with so many issues being taken with Big Pharma and the abuse of prescription drugs, a more progressive push towards alternative medicine might not be as terrible as they once considered.

For House Democratic Representative Dan Ramos from Lorain, this was the focal point of his opinion. Ramos expressed that he believes medical marijuana is a needed alternative to opiates for some chronic pain patients, and cited the opiate epidemic for his reasoning with a dramatic demonstration.

Ramos held up a sheet of paper saying it represented the total number of people who have died of marijuana overdoses…

The paper was blank.

By comparison, he exclaimed that 2,020 deaths were linked to opiates in 2014 – nearly 80% of all overdose deaths. This probably had a profound impact on the lawmakers, seeing as how Ohio has seen a lot of devastation from the opiate epidemic and overdose outbreak in the past few years.

Setting the Boundaries

House Representative Stephen Huffman is actually the bill’s GOP sponsor. Huffman is an emergency room physician from Tipp City, and in talks about medical marijuana he stated this new proposal is what’s best for patients after the U.S. Food and Drug Administration failed to act. After reciting a heavy helping of the Hippocratic Oath that physicians take to care for patients, Huffman passionately argued,

“I am absolutely convinced that there is therapeutic value in medical marijuana. There is absolutely no doubt in my mind.”

Still, Ohio’s GOP-controlled legislature isn’t quite as open to accepting ALL forms of medical marijuana… so don’t get ahead of yourself just yet. The bill sets up stern restrictions, including:

  • It would not allow patients to grow marijuana at home
  • Patients are not permitted to smoke it
  • Employers can still fire employees for having marijuana in their systems, even if it is recommended by a physician
  • Tetrahydrocannabinol (THC- the chemical that gives users their “high”) would be limited to 35% of plants and 70% of extracts

However, one of the loopholes for the smokers is that patients could use a vaporizer, which heats marijuana into a gas or stream rather than burning it to smoke. The bill has changed in some noteworthy ways since it was introduced last month. One way is that it specifies about 20 conditions that would benefit from medical marijuana, including:

  • AIDS
  • Cancer
  • Epilepsy or another seizure disorders
  • Chronic pain
  • Traumatic brain injuries

The commission could add other diseases as needed. Other changes include:

  • Allowing parents and caregivers to possess marijuana to administer it to someone else
  • Requiring identification cards for patients AND caregivers
  • Creating a program to help veterans and others afford medical marijuana

Even with the changes, medical marijuana advocates fear strict restrictions on doctors will deter physicians from recommending medical marijuana to those who could possibly benefit.

Various Concerns

The spokesman for Ohioans for Medical Marijuana is Aaron Marshall, and one thing that troubles him about this bill is that while the House seems to be taking at least some action toward alternative medicine, the law should be tailored to benefit patients and not hinder their treatment. Marshall commented,

“If they are going to use the threat of our ballot issue to pass a bill through the House, it should be a patient-focused plan that will actually provide medical marijuana to those in need,”

It is worth mentioning that several of those who opposed the bill did so for reasons concerning the patients, not so much out of an outright opposition to the idea. For example, Democratic Representative Alicia Reece from Bond Hill, along with five other Democrats, voted against the proposal because it fails to protect workers who use medical marijuana recommended by a physician. Reece said she was “torn” on which way to vote. While she believes in the value of the treatment, Reece says she feared more people, especially African Americans, would be sent to jail for small amounts of medical marijuana or fired from their jobs for a testing positive and that they would not be protected by law. Her opinion was simply,

“Should it be a bill or should it be taken to the people and be in the constitution?” I’m always a believer in the people. I always think the people know best.”

Many of the other House lawmakers remain hopeful that the voters will embrace their measured approach over the two ballot initiatives working toward the November ballot. These measures are currently being pushed by Ohioans for Medical Marijuana and Athens-based Grassroots Ohio. They two movements have been working on collecting the 305,591 signatures needed by July 6 to get their own plans on the ballot.

The bill will be going before the Ohio State Senate before long, and minor changes are expected there. Ohio Governor John Kasich could find himself sitting down to sign-off on it by the end of the month, and Kasich himself has said he would support a medical marijuana proposal if it were property written and there was evidence that the need was there.

So, the question becomes will Ohioans prefer this new House approved option over the other two plans outlined by community advocate organizations. Does this plan stand to help provide alternative treatment while effectively preventing drug abuse and other issues associated with drug abuse and addiction? If you or someone you love is struggling with substance abuse or addiction, please call toll-free 1-800-951-6135


Marijuana Legalization Could Help California’s Water Crisis

Marijuana Legalization Could Help California's Water Crisis

Author: Shernide Delva

California is in the middle of their worst drought in 1200 years. Recently, I wrote an article about how marijuana farms are draining the state of its water supply. The growing season for marijuana plants comes during California typically dry summer months. An article in The Rolling Stone pushed for regulating the drug stating their needs to be a crackdown on water usage.

As a side effect, Marijuana Reform is now being viewed as a possible solution for California water drought problem. The legalization of marijuana is now heavily promoted as a way to save California’s water crisis.

Marijuana plants require six gallons of water a day per plant to grow. Often, this large water supply is diverted from rivers, lakes, and streams or even stolen from farmers whose water use is already strictly regulated. The majority of marijuana is produced in an area known as the Emerald Triangle consisting of Humbold, Mendocino, and Trinity counties.

Unfortunately, much of the Emerald Triangle is currently classified as ecologically vulnerable. Writer S.E Smith argues in one article that the solution is to legalize pot so that large marijuana growers would go away from ecologically vulnerable areas.

The legalization of marijuana would result in environmental benefits, the article mentions.  Marijuana growers would be required to grow their crops next to other farms and thereby have to follow the same water regulations. It would allow regulators to monitor the growth of the plants and offer guidelines for reducing water usage such as establishing a rainwater collection for the summer months.

The full legalization of marijuana in California is seen as inevitable for many corporations. In efforts to prepare, The North Coast Regional Water Control Board is in the process of setting up permits associated with marijuana cultivation. Other pilots programs across the states have implemented new guidelines to cultivate marijuana in an environmentally conscious manner.

What this means for Marijuana Reform:

So what does this all mean? Essentially the drought in California is making the fight for legalization easier. In addition to all the health benefits and revenue that marijuana has the potential to bring; the environment is another reason for reform.

California has one of the largest running medical marijuana programs, but in the past, recreational marijuana has been voted down.  Since the drought has gotten to be so horrible, most people will lean towards supporting any legislation that will improve the water shortage. California’s significant loss in agricultural yield, income and employment will likely influence the decision to legalize recreational marijuana.

Furthermore, the higher tax revenues generated from marijuana will result in other states to want to cash in on marijuana as well.  Legalization in California is predicted to generate a rippling effect influencing legislation in states nationwide. As more states legalize marijuana, there will be less of a need to grow only in one area and farms will spread in other areas of the country.

Until recently, farmers sought out hidden nooks and crannies of the state to cultivate their crops. They were not conscientious about water usage or environmental regulations. Marijuana still remains largely in the shadows because its illegality makes it impossible to regulate. How do you regulate a crop that people can’t legally produce?

For now, as long as farmers offer documentation that they are growing plants on behalf of those with medical marijuana prescriptions, they can continue to grow. Unless marijuana legalization occurs, this will be an uncertain situation with minimal solutions.

Marijuana is an easily abused drug, and legalization poses other consequences. However,  medical marijuana regulations are not beneficial to the environment. The next step for California may be to protect the environment by legalizing the drug and enforcing proper regulations.

Marijuana is a mind-altering substance that can be abused just like any other drug. Research is suggesting there could be health implications from heavy use. Although marijuana reform is getting significant amounts of attention, it is important to recognize if your drug use is becoming an addiction.

Remember, legal or not, drugs can be abused and drug addiction can occur. If you or someone you love is struggling with substance abuse or addiction, please call toll-free 1-800-951-6135.

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