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Are Opioid Overdose Death Rates Actually Much Worse Than We Think?

Are Opioid Overdose Death Rates Actually Much Worse Than We Think?

Author: Justin Mckibben

It hasn’t even been one week since I wrote about the Center for Disease Control and Prevention (CDC) reporting opioid overdoses increased by 30% in only one year, and already a new story from The Washington Post suggests that these numbers are actually being highly undercounted! So in reality, the increase could be skewed by the fact that the real rates of overdose deaths are tragically misrepresented.

This new study reveals that the government has actually been undercounting opioid overdose deaths by anywhere between 20% and 35%!

So how is this happening? How much worse is the overdose outbreak?

A Closer Look at Coroner Reports

The reason the study says this underreporting is happening is due to how the current numbers are actually determined. In order to estimate national trends in opioid overdose and opioid-related death, the federal Centers for Disease Control and Prevention amasses data from over 3,000 coroner’s offices across the US.

However, the issue is that coroners function independently, so their available resources vary from case to case. The same goes for their reporting practices.

Christopher Ruhm, a professor at the University of Virginia, took a closer look at tracking trends and found that a lot of coroners do not specify the drug when documenting a fatal overdose. Ruhma states that from 1999-2015, of all fatal overdoses 23.1% did not have a drug specified on the death certificate.

The CDC cannot control local coroners, so it is the states and counties responsibility to improve their overdose reporting practices. If we want a more accurate reading of how opioids are harming a community, there has to be efficient documentation.

Unfortunately, the political incentives are not very supportive of accurate reporting. Officials may be concerned that by spending money on better overdose recording, they will have paid for the chance to look like their opioid problem is actually getting worse. The incentive just isn’t there from a political stance. However, that isn’t a good enough reason to botch the records. Communities still deserve to have a comprehensive idea of the issues they are facing.

Tracking Overdose Death Trends

The inference of coroners not including the drug in the report is that there are a lot more overdoses that do not get included in the official figures released at the federal level. There could be thousands of more deaths from opioids that go unaccounted for. To take a shot at tracking trends, Ruhm studied the records of coroners who did record specific drugs for overdose deaths. Based on this tracking, he was able to attribute a “corrected count” of opioid overdoses. In his report, Ruhm states:

“Corrected rates were obtained by using information from death certificate reports where at least one drug category was specified to impute involvement for cases where none was specified.”

There are many elements to how Ruhm came up with her corrections, and I encourage everyone to read the full analysis, which is published by the Society for the Study of Addiction (SSA). The report makes some pretty intense claims about what overdose deaths opioids should account for. For example in 1999 the CDC figures show:

Yet, Ruhm’s corrected count shows 1999 saw:

  • 10,232 overall opioid deaths
  • 3,421 synthetic opioid deaths

In 2015, the CDC figures say:

  • 33,091 overall opioid deaths
  • 19,884 synthetic opioid deaths

But Ruhms count pushes that up to:

  • 39,999 overall opioid deaths
  • 23,857 synthetic opioid deaths

Finally, when we look at the 2016 CDC figure, it said 42,249 opioid overdose deaths nationwide. But the corrected count figure puts 2016 at 49,562 opioid overdose deaths nationwide

What we can take away from Ruhm’s research is simply that the severity of the opioid crisis is being underestimated. From 1999-2015, Ruhm’s corrected counts for overdose deaths were 21% to 35% higher for all opioids. With corrected counts involving heroin and synthetic opioids were 20% to 30% higher.

So when we look at these stats, even if we leave some room for calculation errors, it is still a troubling thought. Since 2009, the leading cause of injury-related death in America has been drug overdoses. For years now, opioids have been public enemy number one concerning drug policy. Everything from prescription painkillers to synthetics being shipped halfway across the world has contributed to this crisis. If all we know about the true devastation of this epidemic is merely our best guess that still doesn’t take it all in, now is truly the time to urge officials and community leaders to take significant steps toward real, lifesaving solutions.

One of the most important resources that we need to take advantage of is providing safe and effective treatment to those who are struggling. Palm Partners Recovery Center has offered innovative and holistic treatment options for over two decades. If you or someone you love is struggling, please call toll-free now. We want to help.

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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

Prince Sought Pill Addiction Rehab before Death

Prince Sought Pill Addiction Rehab before Death

Author: Justin Mckibben

April 21, 2016 we lost an amazing artist and musical visionary, and the whole world wept in the wake of this tragedy. The day after the news had hit I wrote a story to acknowledge the passing of this celebrated icon, and also to point out some of the despairing speculation surrounding the circumstances of his death. For Prince, a seemingly healthy 57-year-old rock and roll superstar, to suddenly die in an elevator there was sure to be a great deal of suspicion as to how this could have happened. While most were engaged in commemorating his inspiring legacy, some were taking a closer look to see if there was more to this story.

While some rejected the notion of drugs having any part in the death of Prince, others were concerned about the story of his plane’s emergency landing in Moline, Illinois on the way home to Minnesota, where Prince had to be checked into the hospital. This was just 6 days before this incredibly talented icon died, and the story said that he had received a “save shot” which is suspected to be Narcan to save him from a near-fatal overdose.

When tabloid reports first surfaced that this sudden halt in air-traffic was to treat Prince for a drug overdose, some people were still not convinced- but now it seems there may be more truth to the connection between a painkiller habit and his untimely death.

Prince Tried to get Treatment

According to new reports, the musical legend Prince (Prince Rogers Nelson) had actually signed up for rehab prior to his sudden and heartbreaking passing in order to battle his pain pill addiction. These sources from the Minneapolis news station KSTP 5 Eyewitness News reported that the “Purple Rain” originator knew he was addicted to the prescription painkiller Percocet before his death, so he entered an outpatient treatment program.

In a desperate attempt to try and free himself from the debilitating bondage of his addiction this actual American idol attended an unnamed rehab center to try and separate himself from using the medication, which had initially been prescribed to Prince for his severe hip pain. The publication TMZ was one of the first to report on the possibility of drug-related illness having anything to do with this terrible tragedy. According to their recent reports Prince regularly obtained the opioid pills from multiple doctors, including “a personal friend.” This side of the story again reflects similar celebrity deaths where the stars either have “personal friends” who are dealing dangerous narcotics or they receive excessive amounts of medications from doctors, turning doctors into dealers and maybe ultimately links to the chain of events that cause these deaths.

Current Investigation

The week before April 21, Prince had reportedly went to a local Walgreens pharmacy in Minneapolis to fill prescriptions four times! If that isn’t an excessive amount of opioids I don’t know what is. TMZ reported that law enforcement raided the pharmacy the following Friday, searching for evidence that could shed light on Prince’s passing, although at this point officials have yet to release a cause of death.

An official autopsy was conducted last week, but the medical examiner said it will take weeks for the cause of death to be confirmed. So far officials have not confirmed or denied what real role prescription painkillers played in Prince’s collapse, but the county sheriff investigating the death has asked for help from the Drug Enforcement Administration (DEA), as painkillers were found in Prince’s possession when he died.

According to NBC News, the DEA’s role-“will be to determine such things as where the medications came from, and what prescriptions Prince had obtained. DEA agents often check those records in death investigations.”

While the painkillers might make this investigation a little more difficult, in the end we can at least hope for the truth to come out and that if these painkillers do have anything to do with the death of Prince, it will undoubtedly raise even more concern about prescription drug abuse and addiction. If doctor shopping and drug abuse has a real connection to this catastrophe it is sure to inspire advocates of monitoring medications and restricting opioid use to be more aggressive with their protestations, and maybe more doctors will be held accountable.

While it is very distressing to hear that drug addiction might have stolen yet another awesome and moving idol from us, it is important to take note that he was trying to get help. How many people lose their lives every day because they want help but don’t get it in time? There is help out there, so no one should wait until its too late. If you or someone you love is struggling with substance abuse or addiction, please call toll-free 1-800-851-6135

No More Paper Trail: Prescription Drugs Going Digital

No More Paper Trail: Prescription Drugs Going Digital

Author: Justin Mckibben

Prescription drugs have held an integral role in the opiate epidemic laying siege to the nation, sending a swelling portion of the masses headfirst into a downward spiral that more often than not leads to heroin addiction and devastating overdose death. Faculties of reform advocates, law enforcement and healthcare advocates have teamed together with community leaders in recent years trying to find ways to fight back, and now New York State has a plan that might change the game entirely.

Effective as of Sunday, March 27 2016 a new law dictates that doctors in New York State will be throwing the old methodology of doling out medications out the window, specifically with the pen and prescription pad. Physicians will be required to write all prescriptions electronically and transmit them directly to the pharmacy.

According to Governor Andrew Cuomo this new legislation is intended to cut down on some of the key factors that make it possible for abusers to obtain prescription drugs, including:

  • Reducing the number of fraudulent prescriptions
  • Reducing the number of stolen prescriptions

By cutting off some of these major sources of prescription drugs to the street-market New York State hopes to make some serious headway in the battle against prescription drug abuse. Last week in a press release Governor Andrew Cuomo stated:

“Addiction can affect anyone from any walk of life and this administration will continue to use every tool it can to combat this epidemic and provide help to those in need,”

So officially starting next week, doctors in the area will ONLY be allowed to write any prescriptions by hand under very limited circumstances, such as exceptional situations like natural disasters or electrical failures.

I-STOP Initiatives

The jump to prescription drugs going digital is the latest big innovation in a series of prescription reforms from the New York State’s I-STOP initiative, which are all parts of legislation aimed to curtail the pattern of over-prescribing and abuse of painkiller medications and other controlled substances.

Now this move isn’t anything too drastic, since electronic prescriptions have been required for controlled substances since 2014. Except now electronic prescriptions will be required for ALL prescriptions. For one, this gets the pad of paper for prescription drugs out of the office, and then cuts out the middle-man by eliminating the patient from the equation of sending information by transmitting the doctor’s orders directly to the pharmacy.

One of I-STOP’s first initiatives was enacted back in August of 2013, which created an online monitoring program that requires doctors to consult a patient’s controlled substance prescription history before they can prescribe additional controlled substances, which can be useful for obvious reasons.

Efforts against Epidemic

Across New York State overdoses and overdose death rates have continued to increase at alarming rates. Like many other states in America, these local lawmakers have been clamoring to find ways to fight the opiate epidemic.

Heroin has made a majority of headlines and has a longer history for its bad reputation, but in recent years it has become brutally obvious that many heroin users were first addicted to prescription pain medications before they began using heroin. According to the National Institute on Drug Abuse, about half of young heroin users reported abusing prescription drugs before making their way to heroin itself.

These new efforts are being put into place as lawmakers hope by reducing the number of people who have access to prescription drugs they can subsequently inspire a decrease in people becoming addicted to heroin. Felicia Scocozza, director of Riverhead CAP, a local drug prevention group said that getting paper prescription pads out of the office will likely cut down on fraudulent scripts and prescription theft, adding:

“Instances of people changing the prescription on the pad – changing the name of the medication, or the amount being prescribed – would basically be eliminated. It seems like it would really reduce the amount of prescription drugs out there that are not being taken as they were prescribed to be.”

Bobby Gunjupali, owner of Barth’s Drug Store in Riverhead, said that for years many local doctors have already been writing their prescriptions electronically. Southold Pharmacy owner Paulette Ofrias added that while he does fear the new requirement would probably have a “learning curve” for some local residents, especially their elderly population, it really is a more efficient process and an effective effort to try and make a difference.

Is getting rid of the prescription pad going to make a difference? Will adding more security to prescription drugs via direct digital transmission make enough of a difference when it comes to the abuse of prescription drugs? What kind of impact could this have on the heroin epidemic and should more states be pushing to get rid of the paper-trail and put their trust in electronic prescriptions?

One could easily argue with everything leading up to our current state of affairs across the country that there isn’t enough being done for those who have become addicted as a result of prescription drug abuse. Hopefully as more initiatives go into place we will see some real change. If you or someone you love is struggling with substance abuse or addiction please call toll-free 1-800-951-6135


Over 90% of People Who Overdose on Painkillers Continue Using


Author: Shernide Delva

It turns out a brush with death is not enough to keep addicts from continuing to use. A recent study reveals that 90% of people who overdose on painkillers continue using despite their near-death overdose experience.

The study was conducted by The American College of Physicians and involved data from 3000 patients over a 12-year period collected from a national insurance claims database known as Optum. All the patients had a previous history of having a nonfatal overdose on prescribed opioids originally given to them to treat chronic pain.

Despite nearly dying from these medications, 91% of the patients continued to use the painkillers even after the overdose. Even more surprising, 70% of the patients continued to use the same healthcare provider to refill their prescriptions. Researchers followed up with the patients two years later and discovered that individuals who continued using opioids were twice as likely to have another overdose in comparison to those who ceased after the initial overdose.

Overdoses from Opioids

The opioid and heroin epidemic has gained media attention for being the nation’s biggest challenge for the next coming years. President Obama released a memorandum to combat the opioid epidemic through training medical professionals in understanding drug addiction as an illness and not a crime.   Americans wait eager to learn what solution could possible help bring down the numbers of people dying from drug overdoses.

Similar to heroin, prescription painkillers bind to receptors in the brain to decrease the perception of pain. These powerful painkillers create a feeling of euphoria that eventually will result in physical dependence an addiction. Therefore, even with an overdose, a person will still have cravings to continue taking the drug.

As more addicts are entering treatment centers and detoxing, there needs to be increased awareness about overdoses. Research reveals there is an increase in overdoses after treatment since a person’s tolerance to drugs will have decreased. After leaving rehab, an addict may relapse and overdose.

The ability for someone to overdose depends on a wide variety of factors including tolerance, age, state of health and how the substance was consumed. Some people do not make it out of an overdose. Treatment for an overdose may be quick and easy or may include long-term treatment such as an alcohol rehab center or longer hospitalization. Pharmacies like CVS have worked to make the overdose antidote Nurcan available over the counter to reduce the amount of overdose deaths.

Statistics released in September 2014 show that prescription drug deaths have quadrupled in the US between 1999-2011, from 4,263 to over 17,000 and those number show no signs of slowing down. The pharmaceutical industry had contributed to the opioid epidemic by over prescribing painkillers.

“The amount that [opioids] are administered by well-meaning physicians is excessive,” said Dr. Robert Waldman, an addiction medicine consultant not involved with the research. “Most physicians are people-pleasers who want to help and want to meet people’s needs, and they are more inclined to give people the benefit of the doubt until you are shown otherwise.”

The medical profession began transforming the way they approached pain in the early 90s when it was decided that pain would be treated aggressively. Traditionally, opioids were only prescribed for cancer patients and recovering from surgery. However, this new change made it okay to proactively treat patients who suffered from symptoms of pain. In 1995, more powerful drugs like extended release OxyContin was approved for use.

Doctors continued to prescribe pain medications and the medical use of opioids grew by ten-folds in just 20 years. The consequences of the opioid epidemic have been far worse than anyone could have imagined just two decades ago. Opioids are now reported in 39 percent of all emergency room visits for non-medical drug use. Even worse, the direct health costs of opioid users have been estimated to be more than eight times that of nonusers.

The opioid addiction is affecting Americans in every part of the country. Now, there needs to be an increase in awareness in educating on how to prevent deaths from overdoses. 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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