Tag Archives: addiction

Prescription Addiction: Made in the USA

addictionThere is a lot of information, and unfortunately, deadly misinformation about prescription opioids circulating the internet and other major media outlets. Simply put, there is a lot that the average American adult is unaware of, and what they think they know isn’t always rooted in science. In the United States, we use the vast majority of the world’s supply of prescription opioids—despite the fact that we make only 5 percent of the world’s population.

While prescription opioids are abused across the globe, America has the market share of the problem. In an attempt to shed some light on both the opioid addiction crisis and potential solutions—Dr. Sanjay Gupta joins Anderson Cooper of CNN’s “Anderson Cooper 360” for a town hall special—to discuss the prescription drug abuse epidemic in the U.S. The presentation, “Prescription Addiction: Made in the USA” airs tonight, May 11, 2016, at 9 P.M. EDT. It is likely to be more than informative and eye opening for many Americans.

Dr. Sanjay Gupta has a remarkable understanding about pain narcotics, addiction and how opioid addiction became a pervasive problem in the United States. The Chief Medical Correspondent wrote an op-ed published today by CNN, which covers many aspects of the epidemic. But, perhaps most intriguing is his belief that doctors were responsible for creating the scourge we face, and it will fall on doctors to spearhead efforts for ending the epidemic. Gupta writes:

The fact is, we have accepted the tall tales and Pollyannaish promises of what these medications could do for too long. As a community, we weren’t skeptical enough. We didn’t ask enough questions. We accepted flimsy scientific data as gospel and preached it to our patients in a chamber that echoed loudly for decades.”

He points out that while the epidemic is the result of the medical community acting on opioid prescribing recommendations they were not based on fact, doctors continue to recklessly prescribe these deadly narcotics despite knowing that the drugs should be doled out as sparsely as possible. He cites a recent study published in the Annals of Internal Medicine which showed that 91% of opioid overdose survivors managed to obtain another prescription—usually from the physician who prescribed the narcotics the patient overdosed on in the first place.

Gupta calls on prescribing physicians to:

  • Engage with patients and discuss treatment with them.
  • Set realistic expectations for patients.
  • Conduct follow-up conversations with patients to gauge treatment efficacy.

“It is not too late. In order for this American-made epidemic to finally end, however, it is the American doctors who must lead the way,” writes Gupta.

Remember to tune in tonight, or catch it on DEMAND, to see CNN’s “Prescription Addiction: Made in the USA” May 11, 2016, at 9 P.M. EDT. Join in the conversation and share this family and friends. If you’d like, you can view a short trailer about the town hall meeting by clicking here.

Opioid Withdrawal and Loperamide is Dangerous

opioid withdrawalAnyone who has abused and/or been addicted to opioid narcotics has experienced withdrawal symptoms at one time or another. They can tell you first hand, with the utmost clarity, the hell that is opioid withdrawal and that they would have done just about anything to ease their pain. For those who detoxification was not intentional, their withdrawal is usually the result of running out of drugs or money to purchase more of their drug of choice. People undergoing opioid withdrawal are most commonly outside of a medical setting, which means that they lack access to the drug typically prescribed to mitigate their symptoms, such as Suboxone (buprenorphine) or Ativan (lorazepam).

The U.S. National Library of Medicine reports that early symptoms of opioid withdrawal include: agitation, anxiety, muscle aches, increased tearing, insomnia, runny nose, sweating and yawning. Late symptoms of withdrawal include: abdominal cramping, diarrhea, dilated pupils, goose bumps, nausea and vomiting.

Clearly, the majority of the symptoms listed above make for an unpleasant time, especially when you consider that some of the symptoms can continue for several weeks. While the behavior is not new, in the wake of the American opioid epidemic a number of opioid addicts have turned to the over the counter (OTC) antidiarrheal drug loperamide (Imodium) to ease their withdrawal symptoms, NPR reports. While it may seem like a harmless practice, in very high doses loperamide fatally disrupts the heart’s rhythm. At 10 times the box recommended dose the drug can ease withdrawal discomfort, but in larger doses loperamide can actually create euphoric effects similar to opioid narcotics.

At this point you may be wondering how a commonly used OTC medication can cause an opioid-like high and still be purchased without a prescription. Keeping the conversation as “clean’ as possible, a common side effect of opioid narcotics is constipation, a side effect that people experiencing diarrhea would appreciate. It just so happens that loperamide is a opioid-receptor agonist and acts on μ-opioid receptors, but unlike other opioid drugs, loperamide is mostly prevented from entering the blood stream and crossing the blood brain barrier essentially preventing euphoria from occurring, according to a study titled “Poor Man’s Methadone: A Case Report of Loperamide Toxicity” published in the American Journal of Forensic Medicine & Pathology.

The research showed that in very high doses, loperamide is able to cross the blood-brain barrier gaining access to the central opioid receptors in the brain, causing euphoria and respiratory depression. Until recently, it was fairly uncommon for people to abuse the drug, but with more people than ever abusing opioids in our country, there has been a spike in hospital cases involving loperamide, which at one time was classified as Schedule II of the Controlled Substances Act 1970, transferred to Schedule V in 1977 and then decontrolled in 1982.

Because of its low cost, ease of accessibility and legal status, it’s a drug that is very, very ripe for abuse,” says William Eggleston, a doctor of pharmacy and fellow in clinical toxicology at the Upstate New York Poison Center, which is affiliated with SUNY Upstate Medical University. “At the Upstate New York Poison Center, we have had a sevenfold increase in calls related to loperamide use and misuse over the last four years.”

Eggleston and his co-authors, whose new study was published the Annals of Emergency Medicine, believe that loperamide should be restricted; much like pseudoephedrine was in the wake of the American methamphetamine crisis. If taken in recommended doses, such drugs are relatively harmless, but they carry a high potential for abuse.

If you, or a loved one, struggles with opioid addiction, stay clear of OTC medications that people claim will help with withdrawal symptoms. The safest course one can take is contacting a licensed addiction rehabilitation center, such as PACE Recovery Center. We can get you the help you need, and aid you in getting on the road to recovery.

Cannabis Use: Mental Health Consequences

cannabisIn November, a number of states are likely to vote on legalizing adult cannabis use or medical marijuana programs. California is one of the states that many believe will vote in favor of legalization, two decades after it became the first state to pass medical marijuana legislation.

With each year that passes, Americans seem to be more in favor of ending the 80 year prohibition that has resulted in hundreds of thousands of nonviolent drug offenders being sent to jail or prison. While it can be difficult to compare marijuana to the other illegal drugs, it is important that we have all the facts before decisions are made.

Last week, Michael Botticelli, director of the White House Office of National Drug Control Policy (ONDCP), came out against legalization. The “drug czar’s” stance comes from concerns over heightened marijuana use rates among teenagers and young adults, and that cannabis can serve as a “gateway” to harder drugs. His views are in line with the President, who has arguably had the lightest stance on the drug, compared to former commander-in-chiefs. While Botticelli, who is in recovery for addiction himself, has a valid point, there are a number of people in the field of medicine who are in favor of ending the prohibition.

This week, the formation of the organization Doctors for Cannabis Regulation (DFCR) was announced, the group of physicians is calling on states and the federal government to legalize and regulate the use of cannabis in the interest of public health. The group includes a former surgeon general and faculty members from some of the nation’s most prestigious medical schools. The DFCR argues that legalizing and regulating marijuana is most effective way to:

  • Ensure Public Safety
  • Combat the Illicit Drug Trade
  • Mitigate the Negative Consequences Affecting Disadvantaged Communities

Both the ONDCP and DFCR make good arguments that may impact how people vote this November. However, we can also look to science for guidance on the subject. Decades of prohibition prevented scientists and health experts from conducting cannabis research. There is a lot that is unknown about the drug, such as its effect on the brain. In recent years, medical marijuana and legalization efforts have given researchers the ability to conduct long overdue research. These findings can be an invaluable resource for those considering how they will vote in the 11th hour of 2016.

A group of scientists from the United States, United Kingdom, Europe and Australia raise awareness about the potential consequences of cannabis use, primarily with regard to mental health, The Guardian reports. They say that the evidence is clear, that marijuana can cause psychosis in the vulnerable. To be clear the scientists are not claiming that those who use the drug are at risk of psychosis, rather that those who are vulnerable to psychosis could jump start the illness by using marijuana. “Cannabis alone is neither necessary nor sufficient to cause psychosis.” Research published in Biological Psychiatry indicates that deterring heavy use could prevent 8-24% of psychosis cases.

It is important to educate the public about this now,” said Nora Volkow, director of National Institute on Drug Abuse (NIDA). “Kids who start using drugs in their teen years may never know their full potential. This is also true in relation to the risk for psychosis. The risk is significantly higher for people who begin using marijuana during adolescence. And unfortunately at this point, most people don’t know their genetic risk for psychosis or addiction.”

The use of marijuana can become an addiction, negatively impacting one’s life. If you are addicted to marijuana, please contact PACE Recovery Center for help. Our drug abuse treatment program specializes in developing individualized treatment plans to meet the unique needs of all our clients.

Some Sober Living Homes Lack Oversight

sober living homesRecovering from addiction is a process, the success of which often rests on the length of treatment – the longer the treatment stay the better chance of success. Most reputable treatment facilities recommend a 90 day stay; centers with 30 day lengths of stay will strongly encourage that clients check into an extended care facility afterwards. A number of treatment centers will recommend to clients with a long history of substance abuse, especially chronic relapsers, move into a “sober living” home after the completion of their treatment stay.

Sober living homes can be an opportunity for people who are new to recovery to transition back into the swing of everyday life in the company of others working towards the same goal. Sober homes vary in size and cost, some simply require weekly drug testing with 12-Step meeting attendance, while others will add to that by holding weekly house processing groups. The houses are usually managed by someone in recovery, charged with overseeing the day-to-day routines of the clients. Early recovery can be a difficult time, chock full of triggers and cravings; staying at a sober living home after treatment can serve as an extra level of protection.

With staggering opioid addiction rates across the United States, more people than ever are in need of addiction treatment services. Providing access to treatment has proved challenging in a number of areas of the country, which has resulted in a push from government officials to increase funding for addiction treatment. The opioid epidemic has also led to an increased demand for sober living homes, which has led to some questionable practices among people trying to exploit those in recovery.

Unlike treatment centers, sober living homes are hardly ever managed by credentialed professionals and are subject to little regulation, the Associated Press reports. The lack of oversight has led to cases of insurance fraud. Some transitional living homes will even allow clients to use drugs or alcohol, as long as rent is still being paid. Allowing clients to “use” could have a fatal outcome; many sober living homes are housing opioid addicts, whose choice of drugs can lead to overdose.

“In most states, there is not a regulatory body because recovery residences aren’t considered treatment,” said Amy Mericle, a scientist at Alcohol Research Group, a California nonprofit that studies alcohol and drug addiction.

Growing concerns about lack of oversight has prompted some states to pass or consider passing legislation, according to the article. Such laws would require the inspection and certification of sober living homes, and subjecting them to consumer protections and ethical codes.

It is important to point out that the sober homes guilty of exploiting addiction for profit are not the rule, there are a number of transitional living spaces that provide a healthy, structured environment – giving tenants a real shot at long-term recovery. “The ones that are good are fantastic,” said Pam Rodriguez, CEO of Treatment Alternatives for Safe Communities.

At PACE Recovery Center’s Transitional Living Program we offer an exclusive gender-specific (all male), transitional living, alcohol addiction and drug rehab for men struggling with chemical dependency and behavioral health issues. Our transitional program focuses on assisting our clients in learning how to manage both vocational/school goals and addiction recovery commitments.

Recovery Support for the Parents of Addicts

recoveryWhen we talk about addiction recovery, we speak on what it takes for people living with a substance use disorder to change their life for the better. Everyday people turn to addiction treatment programs and/or 12-Step recovery meetings to learn how to live life clean and sober. It is often said that the easiest part of recovery is putting down mind altering substances, the hard part is not picking them up again. This is a fact that can be clearly supported by the rate of relapse in early recovery. That aside, if newcomers are willing to take certain steps and follow the guidance of those who have managed to maintain long term continuous sobriety, recovery is possible.

Recovering alcoholics and addicts rely on one another to stay the course, without one’s peers life can quickly fall apart. The same can be said for the families of people living with addiction. Addiction affects entire families, watching a loved one slowly self-destruct takes its toll on others. Mothers and fathers find themselves brought to the brink of despair, a byproduct of the realization that their children’s addiction is out of their control. There is a reason why many primary care addiction treatment facilities have family programs. Families often lack the tools to cope with their loved one’s addiction, they often do not understand how this could happen and why there are changes they need to make in their own lives.

Families often struggle to find people they can talk to about their son or daughter’s addiction, especially since there is still a lot of stigma surrounding the disease. Many people continue to view addiction as a moral failing or that somehow addiction is the result of bad parenting. The aforementioned idea, could not be further from the truth as is evident by the millions of Americans abusing prescription opioids and heroin, or the 70 plus overdose deaths every day. The opioid epidemic has brought addiction out into the light; more and more people are accepting that addiction is a mental illness that is out of the control of both the addict and their loved ones.

There are a number of outlets that parents can turn to for support. Just as those in recovery lean on each other, parents can find support from other parents who are facing the same reality, i.e., Al-Anon. And now, even if you live in rural America, where prescription opioids and heroin have taken thousands of sons and daughters, you can find support – all one needs is an internet connection. In fact, thousands of mothers of opioid addicts connect with each other online, The Wall Street Journal reports. Online support groups have become beacons of hope across the country, ranging from as small as five individuals to tens of thousands. The Addict’s Mom (TAM), a place to “share without shame,” has more than 70,000 members on Facebook.

For probably 10 years I had no one to talk to about it. I had my head down like a guilty parent,” says Margaret Worthen, a member of a small support group called Soul Sisters, “All the sudden I had other women, other good moms all going through the same thing.”

Here at PACE Recovery Center our treatment team, many of whom are Licensed Marriage and Family Therapists, takes an active role in working with our clients and their families to define their goals and move towards these goals.

Spring: A Time to Recover from Addiction

addictionLast Sunday marked the beginning of Spring and with it comes the long thaw up to Summer. The transition from Winter into Spring is not just about the changing of seasons, it is also about changes with one’s self – or can be. People often associate Spring with a time to set new goals which they endeavor to achieve. Spring cleaning doesn’t apply only to dusting around the house; it’s about cleaning out the bad from your internal dwelling. Perhaps there are some things in your life that you would like to do away with, such as drinking and drugging?

It is quite common for people to add sobriety to their list of New Year’s resolutions. Every year, a number of people who have made an addiction recovery resolution, manage to learn how to live a life free from drugs and alcohol – maintaining a program of recovery. This is usually accomplished by entering a substance use disorder treatment center and/or attending 12-step recovery meetings. Unfortunately, some people do not succeed at bringing recovery resolutions to fruition, falling back into the cycle of addiction.

With the Spring Equinox still in the rear-view mirror, this may be a perfect time to give recovery an honest go – doing away with what doesn’t work in your life and adopt healthy practices for a successful future. If you have never been to a 12-step meeting, you may find it to be intimidating. Do not be discouraged, everyone sitting in a meeting house probably had similar feelings when they attended their first meeting.

It is often said in recovery circles that reaching out to newcomers is of the utmost importance. Those who found recovery before you were guided by those who came before them, and in turn they will not only make you feel welcome – they will help you learn how to live a life in recovery, the way they learned how. If you choose to move forward with the 12-step route of recovery, we implore you to keep an open mind – look and listen for the similarities you share with others, not the differences.

It’s possible that you may need more, initially, than just meetings. Depending on the type of substance you struggle with, and the severity of your addiction, checking into a treatment facility may be the best avenue. A number of treatment centers have detoxification units, which help clients to ease into recovery in safe way, mitigating withdrawal symptoms in closed environments – free from the distractions and triggers of the outside world. Treatment stays vary in length, but 90-day stays are generally considered to be the duration associated with the greatest chance of success. The longer the stay, the stronger you will be when you transition back into everyday life.

If you feel that treatment at an all male inpatient treatment facility would benefit you, please contact PACE Recovery Center. Our extended residential care program incorporates the principles of 12-Step recovery programs including Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). We can offer you a safe and comfortable environment to begin your journey of addiction recovery.

Major Media Covers the Opioid Epidemic

opioid epidemicA number of major media outlets have taken it upon themselves, and for good reason, to shine a light on prescription opioid and heroin abuse. For over a decade now, our nation has been severely affected by the opioid epidemic, a crisis that takes over 70 lives a day, according to the Centers for Disease Control and Prevention (CDC). While health agencies and lawmakers are working hard to increase access to both the life saving overdose reversal drug naloxone and addiction treatment, there is still a lot more that needs to be done to combat the calamity.

This week, the United States Senate voted overwhelmingly in favor of the Comprehensive Addiction and Recovery Act (CARA). If the bill passes in the House, the legislation will give the Attorneys General the power to award grants to address the national epidemics of prescription opioid abuse and heroin use. The funding will be used for strengthening a number of programs and initiatives, including: addiction education and prevention, prescription drug monitoring and treatment.

CARA is just one effort among a multifaceted interagency approach to addressing the opiate epidemic. The White House, the Substance Abuse and Mental Health Services Administration, the Food and Drug Administration, et al., are all committed to saving lives and providing access to substance use disorder treatment. What’s more, there is still a lot that the American public does not understand about the drug crisis and the true scope of the disease of addiction.

Last month, the Federal Bureau of Investigation (FBI) along with the Drug Enforcement Administration (DEA) released a film: “Chasing the Dragon: The Life of an Opiate Addict”. The film was created mainly for young Americans, and was essentially a call to action for the public to take part in ending the opioid epidemic. Towards the end of February, PBS aired a new “Frontline” documentary “Chasing Heroin.” The film is nearly 2 hours long, and took a year to film. The documentary covers a number of elements of the epidemic, but perhaps the most interesting aspect was the coverage of how law enforcement is addressing the problem. Police officers are acting as social workers and not jail taxis, instead of slapping on the handcuffs they are referring addicts to addiction treatment services. You can watch a short clip below or watch the full documentary by clicking here.

Tonight, ABC News will air a special edition of “20/20” at 10 p.m. ET. “Breaking Point: Heroin in America.” The report covers the ongoing heroin epidemic in New Hampshire.

“When you realize that nearly everyone you meet has been touched by the drug in some way, that’s really eye-opening,” said David Muir. “It helps begin a conversation out there, and the more we can be part of the conversation, the better.”

We hope that everyone, whether the opioid epidemic has touched you or not, will take time to watch the important documentaries. We can all have a hand in the solution to this insidious problem.

Ending The War On Drugs

war on drugsIn 1971, President Richard Nixon declared drug abuse “public enemy number one,” and thus began the United States’ “war on drugs.” While there is little doubt about the insidious nature of both drug abuse and the drug trade, it has become clear that not only was the war on drugs an unwinnable campaign – it has resulted in the jailing and imprisonment of millions of Americans whose only crime was to suffer from the disease of addiction. We know that incarceration has little effect on addiction rates, mental illness requires treatment not handcuffs.

The United States has been faced with an opioid epidemic for well over a decade, a public health crisis that has affected people and families from every demographic. As the nation’s lawmakers address the issue, politicians from both sides of the aisle agree that addiction treatment and education is the most effective weapon. Unfortunately, we cannot reverse the damage that the war on drugs has inflicted on countless Americans, but we can take more humanitarian approach for the future – doing away with many of the nation’s draconian drug laws.

This week, Der Spiegel published an essay written by Nobel Peace Prize winner and former United Nations Secretary-General Kofi Annan. With the use of powerful words, Annan declared that the global war on drugs has done more harm than good, and has given more weight to punishment than health and human rights. It has created the perfect environment for illegal drug manufacturers and distributors to foster. He writes:

“In my experience, good public policy is best shaped by the dispassionate analysis of what in practice has worked, or not. Policy based on common assumptions and popular sentiments can become a recipe for mistaken prescriptions and misguided interventions. Nowhere is this divorce between rhetoric and reality more evident than in the formulation of global drug policies, where too often emotions and ideology rather than evidence have prevailed.”

In April the United Nations General Assembly will hold a special session on drugs, a chance Annan believes for changes to be made regarding global drug policies. He wrote four critical steps that he believes should be accepted and implemented.

1) Decriminalize personal drug use.
2)Accept that a drug-free world is an illusion.
3)Look at regulation and public education rather than the total suppression of drugs.
4)Recognize that drugs must be regulated precisely because they are risky.

Some final thoughts…

At PACE Recovery Center our men’s only extended care drug and alcohol treatment program is built on the idea that by helping the client work on their underlying issues, they will be able to achieve long-term sobriety. PACE’s addiction treatment team incorporates the most effective treatment modalities, which have been proven through empirical research. We will follow with interest the special session on drugs that will be conducted at the United Nations General Assembly.

FBI Film About Opioid Addiction

addictionThere is no question, the opioid epidemic in the United States is both unprecedented and insidious; however, if there is a silver lining to be found it is that the crisis has forced an evolution to occur regarding how we, as a nation, both view and talk about addiction. For years, addiction experts have said that addiction does not discriminate – an assertion that was hard for many lawmakers to accept; however, in the wake of the scourge of opioid addiction affecting practically every demographic throughout the nation for well over a decade – we are now seeing a paradigm shift with how lawmakers believe we should handle this calamity.

It has become clear that we cannot arrest this epidemic away, as we tried to do during the 1980’s through the ‘90s with the cocaine problem in America. The use of draconian drug laws to combat addiction focused more on the symptoms of addiction and did little to address the disease of addiction. Addiction cannot be treated with steel bars, solutions can only be found with evidence-based, scientifically accepted methods of substance use disorder treatment. With 44 people dying from overdoses every day, there is a great need for expanded access to both the life saving opioid overdose reversal drug naloxone and to substance use disorder treatment services.

In recent months, there has been an inter-agency push to get those struggling with addiction the help they need without fear of prosecution. Overdose survivors do not need to fear be arrested, and are actually being directed to rehabilitation services. In fact, the President is asking Congress for $1.1 billion to expand access to addiction treatment services; in some places, addicts who would like help have to wait up to a month to get a bed at treatment centers.

While making treatment more available is huge and has the potential to save thousands of lives, there is also a need for more in the way of prevention through education. Recently, both the Drug Enforcement Administration (DEA) and the Federal Bureau of Investigation (FBI) joined forces to make a film about the opioid epidemic – aimed at youth, The Washington Post reports. The goal is to prevent adolescents from abusing prescription opioids, which is strongly believed to be the link to beginning heroin use. The film: “Chasing the Dragon: The Life of an Opiate Addict” was produced at the insistence of James Comey, the current Director of the FBI.

“You will see in ‘Chasing the Dragon’ opioid abusers that have traveled a remarkably dangerous and self-destructive path,” said Acting DEA Administrator Chuck Rosenberg. “I hope this will be a wakeup call for folks. Please pay close attention to this horrific epidemic. Help reverse it. Save a life. Save a friend. Save a loved one.”

We hope that you will watch Chasing the Dragon below:

If you are having trouble watching the film, please click here.

Addiction Recovery: No Mind Altering Substance is Safe

addiction recoveryEarly addiction recovery is arguably the most difficult, addicts and alcoholics are still developing the skills necessary to maintain a program of abstinence. On top of being newly sober, and a bit shaky, people in early recovery are often bombarded with a lot of information which can become a bit overwhelming for some. What’s more, it is common to hear conflicting opinions from those with significant time regarding the “do’s and the don’ts.”

While it is important to listen to what those in recovery have to say, if you find yourself unsure about something regarding the program it is always best to run one’s uncertainties by your sponsor or therapist. Such people could be compared to a ship’s anchor, keeping you from drifting into unsafe waters. People in early recovery using the 12-steps should look to their sponsor as a model for how to work a program and maintain their sobriety.

A common misconception that many alcoholics and addicts have when starting an addiction recovery program is that they still can use certain mind altering substances, and that they only need to stay away from the drug or drink with which they struggled. Sadly, that line of thinking is in error, many alcoholics who are new to recovery will smoke marijuana, and a number of drug addicts will continue to consume alcohol. More often than not, such actions will lead people back to their substance of choice. It may not happen overnight, but in time the idea will creep back in one’s mind that they can moderately use the drug that brought them to the point of needing recovery in the first place.

The aforementioned misunderstanding may be in part the result of recovery nomenclature, and the multitude of 12-step modeled programs. The idea that somehow an alcoholic is different than an addict, and vice versa; alcoholics attend Alcoholics Anonymous meetings and drug addicts will often choose to attend Narcotics Anonymous. The reality is that Addiction is Addiction, if a person has ever used a mind altering substance to the point of despair, the likelihood that that same person could develop an unhealthy relationship with another potentially addictive substance or behavior is exponentially increased.

If you are new to recovery, working a program to break the cycle of addiction, regardless of which 12-step program you attend please remember that no mind altering substance is safe. Hopefully, it is a warning you hear early on upon entering the rooms of recovery, and one that is heeded with vigilance.

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