A recent Biden administration proposal to crack down on opioids is causing quite a stir among criminal and civil justice reform groups.

The administration’s new drug policy proposal aims to reduce the supply and availability of illicitly manufactured fentanyl and related substances. However, civil rights groups warn this could have a significant impact on people of color and widen racial disparities in the U.S. 

What is Fentanyl and Why Does it Matter?

Fentanyl is a synthetic opioid similar to morphine, but it is 50-100 times more potent. It’s a prescription pain medication that’s typically used among patients who are unresponsive to other opioids. Those patients may be experiencing chronic pain from certain forms of cancer or pain from surgery. Medically prescribed fentanyl is available as a shot, lozenge, or skin patch. 

Fentanyl is also available on the black market. The illegal version of fentanyl is commonly sold in powder form and often “cut” (combined) with another substance, including methamphetamines, heroin, cocaine and other prescription pills. In fact, the United States Drug Enforcement Administration (DEA) recently reported an alarming increase in the amount of fake prescription pills containing fentanyl. 

According to the DEA, drug networks are now mass-producing fake pills and selling them as legitimate prescription pills. In 2021, the DEA seized 9.5 million counterfeit pills containing fentanyl, a number that jumped by 430 percent since 2019. As a result, unsuspecting Americans are overdosing in record numbers.

The DEA reports two out of every five fake pills sold on the black market now contain a potentially lethal dose of fentanyl.

Drug overdose deaths involving fentanyl are now the most common type of overdose in the United States, accounting for 59 percent of all fatal overdoses. This figure has risen drastically since 2010, when fentanyl was responsible for 14.3 percent of the drug overdose deaths.

While the COVID-19 pandemic has contributed to record high overdose deaths, the government also sees the importance of expanding the nation’s public health approach to substance use disorders in hopes of reducing overdose deaths. The new drug policy seeks to do that.

Key Points From Biden’s New Drug Policy

In September 2021, various government departments (Office National Drug Control Policy, Department of Health and Human Services, Department of Justice) presented recommendations to Congress in an effort by the Biden-Harris Administration to reduce the supply of fentanyl-related substances. This proposal also sought to protect civil rights and reduce barriers to scientific research for all schedule I substances.

Dr. Rachel Levine, Assistant Secretary for Health at the Department of Health and Human Services explained that expanding the nation’s public health approach to substance use disorders is essential. According to Levine, the proposal prioritizes comprehensive public health approaches that include expanding access to evidence-based treatment. The Biden administration’s recommendations “can help address the increasing rates of drug overdose deaths, primarily those related to synthetic opioids like fentanyl.”

The 2022 budget would provide a $41 billion investment in advancing a public-health approach to the overdose epidemic. The money would be invested in national drug program agencies, expansion of prevention, addiction treatment, harm reduction, and recovery support services. 

The key points of the proposal are:

• Permanently place all fentanyl and fentanyl-related substances (FRS) into schedule I of the Controlled Substances Act, giving law enforcement more tools to respond to illicit fentanyl manufacture and distribution
• Exclude FRS from all quantity-related mandatory minimum penalties
• Ensure courts can reduce the sentence of an individual involved in an offence related to FRS
• Expand research of scheduled substances to advance public policy
• Monitor the changes and their impact on research, civil rights, and illicit supply, and manufacturing of FRS

The Drug Policy and Racial Disparities

While this sounds like a noble undertaking on paper, the reality is that it is typically people of color who are treated unfairly when it comes to drugs.

Sakira Cook, who closely follows issues for the Leadership Conference on Civil and Human Rights, told NPR that this won’t bode well for people of color. “Since the inception of the war on drugs, African Americans and Latino people have borne the brunt of enforcement-first approaches,” said Cook. 

A staggering 70 percent of defendants charged with fentanyl-related crimes have been people of color, according to Cook. What’s even more troubling is that people of color have disproportionately been affected by overdose deaths, with non-Hispanic Blacks facing the highest increase in opioid-related deaths. Between 2014 and 2017 death rates among non-Hispanic Black people involving opioids increased  818 percent.

Leading this opposition is the Drug Policy Alliance (DPA), who stated in a letter to congress that they were deeply distressed by the Biden-Harris Administration proposal to combat the overdose crisis. They asked that Congress reject the proposal because it leans heavily on law enforcement and not on evidence-based public health solutions to solve the overdose epidemic.

They reminded Congress of the fact that FRS were classified back in 2018, yet overdoses continued to skyrocket. Despite the administration’s stated desire to use evidence-based public health interventions, the DPA pointed out that scheduling is not science-based and endorses criminalization of drug use instead of treatment.

According to the DPA, the administration’s proposal minimizes potential harms caused by scheduling. They say a public health approach grounded in expanding access to harm reduction instead of arrest and incarceration would be a more effective solution. The DPA’s letter urged the administration to let the scheduling expire and embrace public health solutions instead.

The DPA suggests a number of public health solutions to effectively combat the opioid overdose crisis, including:

• Provide individuals with access to life-saving tools (like naloxone) and related education
• Provide evidence-based treatment 
• Use medication assisted treatment
• Utilize syringe service programs
• Promote overdose prevention programs
• Provide drug checking tools so substances can be tested for fentanyl before use

Overall, opponents to Biden’s proposed opioid drug policy suggest the administration should turn to science instead of fear when combating this public health crisis.

If you or someone you love is experiencing a substance use disorder, help is available. Call 800-934-1582(Sponsored) today.

Picture it: There are 100 people standing in front of you. All of them have a substance abuse disorder. You ask them to raise their hand if they started using drugs before the age of 18.

90 hands go up.

What does the show of hands prove? Age matters. In fact, it’s a staggering statistic. Nine out of ten people – a whopping 90 percent – who have a substance use disorder first used drugs before they were 18 years old. We already know that drug use impacts your brain, but using for the first time at a young age places you at higher risk for addiction later in life.

The conclusion: A good way to prevent addiction is to delay first use.

Why Does Your Age Matter?

In short, it matters because of gray matter. The brain. Let’s take a sneak peek inside the brain of Josh, a 14-year-old boy, for some insight.

Wow – there’s a lot going on in here! The walls are constantly shifting. Neurons are firing everywhere. New information is being downloaded and processed quickly and efficiently.

In the time we’ve been in here, Josh has learned how to say “I love video games” in three different languages. And take a look at that section over there – it’s in overdrive. That’s the emotional part of the brain. It’s way more active than this region over here, which is the rational part.

Josh’s brain is typical of any healthy teenager’s brain. It is rapidly developing. It is constantly learning and changing, and will continue to do so until Josh is in his early to mid-20s. His brain is far more capable of learning new things than an adult’s brain. But it’s also far more susceptible to damage.

Now let’s take a peek inside the brain of an adult who started using substances in his teen years.

Hmm…there is less gray matter in here than there should be, especially in certain areas. There are fewer neurons, which means those areas have reduced ability. And this brain has learned to seek and crave drugs.

How Does Drug Use Impact Your Brain?

Researchers have been peeking into brains for decades to learn more about teen brain development and the effects of substance use on adolescents. And they’ve made some eye-opening discoveries.

• They’re irrational: The rational part of a teen’s brain (that controls impulses and decision making) is not fully developed. In fact, it’s one of the last areas to fully develop. This won’t happen until age 25.
• They’re emotional: Teen brains work differently than adult brains. Adults rely on their prefrontal cortex (the rational part). Since teen’s haven’t developed this part yet, they use their amygdala, the emotional part of the brain, to process information and make decisions. (Ah, so that’s why they’re so dramatic!)
• They’re fast: Teen brains are fast. Every region is more active now than it will be when they are older. Their brains build connections quickly, allowing them to learn things more easily than adults.
• They learn (addiction) quickly: Since addiction is a form of learning, it’s easier for teens to learn addiction, too. Like memorizing state capitals or new vocabulary words, the repeated stimulus of drugs teaches the brain. Only instead of learning useful information, the brain is learning to seek those substances.

The substances stimulate the brain in the reward-seeking center, so the teen’s brain learns to seek this same reward in the future. And because teens are so efficient at learning, this process happens quickly, so they can become addicted faster than adults. It’s clear: drug use impacts your brain.

• They suffer: When teens introduce drugs to their fragile, developing brains, there are long-term effects. Research suggests that early drug use may alter brain maturation, cause lasting impairments, and increase the likelihood of developing a substance use disorder.

The Bottom Line for Your Brain

Judging from the evidence, we know age matters when it comes to drug use. And people who start using substances at a younger age put themselves at higher risk for long-term issues, including addiction.

So what’s the takeaway? It’s important to delay first use as long as possible. Protect that growing, delicate brain. Give it time to mature and develop without interference from damaging substances. This could be one of the best ways to prevent addiction later in life.

If you or someone you love is experiencing a substance use disorder, help is available. Call 800-934-1582(Sponsored) today.

“I just need a way out of my head. I’ll do anything for a way out of my head.”

These are the lyrics from Mac Miller’s platinum track “Come Back To Earth.” The song’s album, Swimming, achieved platinum status in February of 2021 – two and a half years after the rapper’s death.

It was Miller’s first album to go platinum.

Why didn’t Miller live to see his own success? Because on September 4, 2018, he was given counterfeit oxycodone pills. The drugs contained fentanyl, which is deadly in even the smallest doses.

Apparently unaware of the fentanyl laced into of the pills, Miller overdosed three days later. He died on September 7 from what the coroner labeled “mixed drug toxicity” – a combination of fentanyl, alcohol, and cocaine.

He was just 26 years old.

Dealer Knowingly Provided Pills Laced With Fentanyl 

Fast forward to October 2021. Miller’s songs are going double platinum, and the dealer who supplied the fentanyl-laced drugs has pled guilty of the crime. The dealer, Stephen Andrew Walter, now faces up to 20 years in prison and a fine of up to $1 million.

What happened, exactly?

According to the plea, Walter told a drug runner to give counterfeit oxycodone pills containing fentanyl to Miller’s dealer, who then provided them to Miller.

Walter admits he knew the pills “contained fentanyl or some other federally controlled substance.”

The plea also notes that, if it weren’t for the fentanyl in the pills, Miller would not have died from an overdose. But, because Walter supplied the laced drugs, Miller suffered a fatal overdose three days after receiving them.

Walter’s plea is guilty to one count of distributing fentanyl. The dealer and runner have also been charged.

Mac Miller’s Struggle With Opioid Addiction

Mac Miller, born Malcolm James McCormick, released five rap albums before his death. He was open about his struggle with sobriety, and his lyrics frequently referenced substance abuse.

Just four months before his fatal overdose, Miller crashed into a light pole while driving under the influence. Miller reported that the experience changed his perspective on life. But it clearly didn’t push him to total sobriety.

Miller was preparing to take his newest album, Swimming, on tour when the fentanyl-laced drugs landed in his hands. In one of his last interviews before the overdose, the rapper noted, “There’s pressure. A lot of times in my life I’ve put this pressure to hold myself to the standard of being whatever I thought I was supposed to be, or how I was supposed to be perceived. And that creates pressure.”

When asked what he would tell his younger self, Miller replied, “I would just tell myself to worry a little less and…don’t create all of this weight for things. Everything has so much weight, but it’s all just chapters. It’s all just pieces of the story. There’s gonna be a next part.”

Too Many Americans Never Made It to the Next Chapter

Miller was just one of nearly 30,000 people who died of opioid-related overdoses in 2018. The next year, the total jumped to 50,000.

This year, drug enforcement agencies are reporting unprecedented amounts of fentanyl in the drugs they confiscate. And stress from the ongoing pandemic seems to be escalating the crisis.

Between May 2019 and May 2020, there were over 81,000 drug overdose deaths in the U.S. That’s a record-breaker for any 12-month period, according to the CDC.

What’s next? Will we see the numbers continue to rise? Will we find new solutions to reach people and prevent future deaths like Mac Miller’s?

We’ll let his words speak for themselves:

“Somehow we gotta find a way

No matter how many miles it takes

I know it feels so good right now

But it all come fallin’ down.”

~“Ladders” by Mac Miller

Get help today at 800-934-1582(Sponsored) to learn about treatment programs for drug and alcohol addiction.

Darknet fentanyl. A 10-month investigation across three continents. Dozens of law enforcement agencies. This was no small operation.

And it paid off.

After careful coordination among nine countries, operation “Dark HunTor” took 500 pounds of illicit drugs off the market – along with $32 million in cash and 45 firearms.

The far-reaching drug enforcement operation was designed to send a message to people peddling illegal drugs: “There is no dark internet.”

No More Hiding in the Dark for Darknet Fentanyl

The dark web has become a playground for online peddling of pills laced with fentanyl.

Dealers have found new ways to push drugs, post their offerings, and package them like any other online purchase.

“Today, we face new and increasingly dangerous threats as drug traffickers expand into the digital world and use the Darknet to sell dangerous drugs like fentanyl,” noted Administrator Ann Milgram of the Drug Enforcement Administration (DEA).

When researchers interviewed dealers on the dark web, they discovered that it has (seemingly) offered a “safe” space for illegal sales, attracting new criminals and illegal “entrepreneurs.”

One respondent admitted, “I hadn’t ever thought about selling drugs in any capacity because I dislike violence… I was always too scared and slightly nerdy to do that and never really contemplated it seriously until the dark web.”

Another boasted, “Selling offline is borderline stupid. You can make so much more money online, the risks [in selling outside cryptomarkets] aren’t even remotely worth it.”

Finally Holding Internet Criminals Accountable

This recent operation led to a staggering 150 arrests – so far. Jean-Philippe Lecouffe, deputy director of operations for Europol, reports that the investigation is ongoing, and will likely lead to even more arrests. He noted, “Each time we arrest people, each time we search a house, we find new leads.”

Lecouffe explained, “The point of operations such as the one today is to put criminals operating on the dark web on notice: the law enforcement community has the means and global partnerships to unmask them and hold them accountable for their illegal activities, even in areas of the dark web.”

Assistant Attorney General Kenneth A. Polite Jr. of the Justice Department’s Criminal Division also noted, “The men and women of the department’s Criminal Division, in close collaboration with our team of interagency and international partners, stand ready to leverage all our resources to protect our communities through the pursuit of those who profit from opioid addiction, under the false belief that they are anonymous on the Darknet.”

IRS Criminal Investigation Chief Jim Lee added, “The Darknet no longer provides a concealing cloak for criminals to operate.”

Darknet Fentanyl Dealers Busted Around the World

Operation Dark HunTor included coordinated efforts among agencies in the United States, the United Kingdom, Australia, Bulgaria, France, Germany, Switzerland, the Netherlands, and Italy. The investigation and resulting arrests exposed key players in the illicit online drug market. The 150 arrests included 65 in the U.S., 47 in Germany, and 24 in the United Kingdom.

What kinds of dealings did the operation discover? In Monaco, officials exposed home-bound drug makers who produced deadly-disguised pills. Using special presses, they could create pills that resemble legitimate medication. Another piece of the investigation uncovered operations based in Florida and Rhode Island that “advertised and sold pressed fentanyl pills throughout the United States.” Lecouffe reports that the long list of suspects arrested includes some “long-sought, high-value targets.”

Deputy Attorney General Monaco noted, “Operation Dark HunTor prevented countless lives from being lost to this dangerous trade in illicit and counterfeit drugs, because one pill can kill.” And that’s no exaggeration. Just two milligrams of fentanyl can be fatal. And dealers often lace their drugs with far more than the lethal amount.

“These drug traffickers are flooding the United States with deadly, fake pills, driving the U.S. overdose crisis, spurring violence, and threatening the safety and health of American communities,” said Milgram. “DEA’s message today is clear: criminal drug networks operating on the Darknet, trying to hide from law enforcement, can no longer hide. DEA, the U.S. interagency, and our valued international partners are committed to dismantling drug networks wherever they are, including the Darknet.”

If you or someone you love is experiencing a substance use disorder, help is available. Call 800-934-1582(Sponsored) today.

When does drug use become drug abuse?

What does it look like to cross the line from medication to dependency?

How can you tell if you or a loved one needs help with opioid addiction?

How about we take the guesswork out of it?

Mental health professionals look to the DSM-5 for guidance, and we can too. The Diagnostic and Statistical Manual of Mental Disorders (5^th edition) is the ultimate guide for professionals to diagnose mental health disorders. This tool, published by the American Psychological Association (APA), includes over 150 mental disorders, and explains the symptoms, risk factors, and criteria for each.

One of these disorders is opioid use disorder (OUD).

Based on the following 11 symptoms, OUD is diagnosed as mild (2-3 symptoms), moderate (4-5 symptoms) or severe (6 or more symptoms). Watch for two or more of these red flags to know if it’s time for you or a loved one to seek help with opioid addiction.

Recognize These Red Flags for Opioid Addiction?

• Warning sign: Opioids are taken in larger amounts or over a longer period of time than intended.

Steve injured his knee playing football last year. His injury has healed, but he continues to take painkillers “just in case.”

• Warning sign: Multiple attempts have been made to stop taking opioids but with no success in reducing, controlling, or stopping use.

Rachel swore she was done with the painkillers. She threw the rest of them away, and resolved to get through the rest of the week without taking another one.

That was last month. Since then, she’s gotten more and has continued to take them every day. She just can’t seem to make it through the day without “a little help.”

• Warning sign: An excessive amount of time is spent obtaining, using, and recovering from the effects of opioids.

Jimmy doesn’t seem to have time for much anymore. He takes fewer shifts at work because he’s often too high or dope sick to work. He spends most of his nights searching online for opioids and arranging his next purchase. It’s like he’s devoting more time to the drugs than the people in his life.

• Warning sign: Cravings to use opioids are persistent.

It’s like hunger or thirst. From the moment I wake up, my body is aching for another hit. And once I use, it doesn’t stop. I start craving more right away.

• Warning sign: Opioid use makes it difficult or impossible to fulfill obligations at home, school, or work.

Natalie used to be the one everyone could count on. But now, she shows up late to work, and she often takes long breaks. She forgets appointments. Her house is a wreck. And she gave up entirely on the class she was taking. All because she’s hooked on prescription pain medication.

• Warning sign: Continued use even though the behavior causes clear social or interpersonal problems.

Bob’s boss threatened to fire him if he ever showed up to work high on drugs again. His girlfriend broke up with him because his drug use ruined their relationship. And his ex-wife threated to take away visitations with their son. But none of that changed Bob’s habits – he had no plans to stop using heroin.

• Warning sign: Participation in social, occupational, or recreational activities stops.

Sue used to be involved in a lot of things, but she didn’t seem interested anymore. She volunteered each month at the food pantry. She went out to dinner with friends on the weekends. She went to classes at the gym. Now, all of that has stopped. She just wants to stay home.

• Warning sign: Using opioids in situations that may not be safe.

No, I don’t know for sure what’s in the drugs I take at parties, but that’s ok. I’ll risk it. I bought some pills the other day from some guy online, and they turned out fine. What’s the big deal?

• Warning sign: Continued use of opioids even though it negatively affects mental or physical health.

Dave woke up in unfamiliar surroundings. He could tell he was in a hospital, but he didn’t know why?

His mom quickly came to his bedside and answered his questions. Apparently, he had overdosed last night.

“Well then,” he thought to himself, “I’ll have to be more careful next time with the number of pills I take.”

•  Warning sign: A level of tolerance is present to achieve the effects of opioids.

I remember when one pill sent me flying. Now, I have to take several to get that same feeling. It’s getting pretty expensive to keep this up.

• Warning sign: Withdrawal symptoms are experienced when opioid use stops.

Kevin seemed anxious. He was sweating, and he couldn’t sit still. When I asked him what was wrong, he quickly said he was fine. But he seemed nauseated, and his eyes didn’t look right, either. He explained that he had run out of medicine and just needed to get a refill – then he would feel better.

Recognizing It’s Time to Seek Help for Opioid Use Disorder

Opioid addiction is challenging, but remember that effective treatment options exist. If you (or a loved one) are currently using opioids, knowing how to recognize the signs can be life-saving. Don’t wait for OUD to worsen. Help is available now.

If you or someone you love is experiencing a substance use disorder, help is available. Call 800-934-1582(Sponsored) today.

I remember when he was five and his biggest concern was getting the latest dinosaur toy. Now Josh is 15, and he’s just so different lately.

I don’t expect him to be five anymore, but the changes I’m seeing…I’m concerned. He’s lost interest in soccer, started hanging out with a new crowd, and he’s just so moody. Is this normal teen trouble, or should I be worried about drug abuse?

This mom is rightfully concerned. If there’s one thing we all know is true, it’s that the teen years typically involve some moodiness and unpredictable behavior. After all, these kids are a cocktail of hormones, and they’re trying to figure out their place in the world.

But still, there are some behaviors that go beyond the norm. And these behaviors could indicate opioid abuse.

Signs Your Teenager is Abusing Opioids

Be on the lookout for the following warning signs:

• Severe Mood Swings

Teenagers whose moods and personalities change suddenly and drastically are potentially under the influence of opioid abuse. These mood swings are more severe than your typical teenage drama. If your teen is abusing opioids, he might become depressed and withdrawn or angry and hostile (or all of the above). He may even get violent or threaten other family members.

• Loss of Interest

Teens who become addicted to opioids may lose interest in the things that used to bring pleasure. School, sports, friends, work, and other interests can quickly fall by the wayside. He may lack motivation to fulfill obligations and start to withdraw from extracurricular and other social activities. Grades may drop. If your teen has become apathetic and unmotivated – and there is no other clear reason for the abrupt change – it could indicate your child is struggling with opioid abuse.

• Physical Changes

Opioid abuse takes its toll on the body. Physical symptoms can include constricted pupils, constipation, flushed cheeks, and slowed breathing. Your teen may also experience drowsiness or sudden bursts of energetic euphoria. You may also notice a lack of energy and poor eating habits.

If your teen is abusing opioids, he may experience withdrawal when unable to get his hands on a drug of choice. Opioid withdrawal symptoms include sweating, nausea, headache, diarrhea, insomnia, body aches, and anxiety.

Opioid abuse can also affect your teen’s appearance. No matter their age, people who are addicted to opioids eventually tend to neglect their appearance. They may care less about bathing and brushing their teeth; many wear the same dirty or wrinkled clothes for days on end.

• A Group of New “Friends”

Teen social circles change on a dime. But if your teen starts to hang out with a new crowd for no apparent reason, it might be due to drug use. Keep in mind that this shift in relationships can happen gradually or suddenly. He may let old friendships die off as they drift toward other teens using the same drugs. Or, he might make a drastic shift into a whole new friend circle. Either way, this could be a warning sign that he’s mixed up in the drug scene.

• Opioid Drug Paraphernalia

If you find drug-related items in your teen’s possession or in his room, this is an obvious red flag. Opioid paraphernalia may include needles, lighters, pipes, and, of course, the actual drugs. If your teen isn’t abusing the drugs, he definitely knows someone who is. It’s highly unlikely he’s just the innocent bystander holding someone else’s supplies, but isn’t doing the drugs himself. The important thing to remember is you can’t afford to dismiss opioid paraphernalia as insignificant.

What If You Notice the Warning Signs? 

At the end of the day, if you notice the warning signs your teen is abusing opioids, you have one pro-active choice: talk to your teenager.

If you’ve noticed physical symptoms, suggest taking him to the doctor for a check-up. Resistance to a routine exam may be further indication that your teenager is abusing opioids.

Interact with him after he’s been hanging out with friends. This can help you pinpoint signs of drug use (if that’s what they’ve been doing in their new social circle).

Ask about his behavior changes. Let him know your concerns. Yes, it’s a hard conversation to have, but ignoring the issue isn’t in his best interest. Take action as soon as possible, so, if he is abusing opioids, he can get the help he needs.

Get help today at 800-934-1582(Sponsored) to learn about treatment programs for drug and alcohol addiction.

Waiting on a loved one to hit “rock bottom” before getting help for an addiction is not only harmful, it is potentially lethal. While we may have been encouraged to proceed with tough love by not “enabling” a loved one, we can inadvertently push them further into their addiction. 

Instead, a more helpful approach would be to ignore the harmful rhetoric and intervene at a much earlier stage – like the grey area. It gives your loved one better chances of staying alive, and it can also prevent them from doing so much damage in the process. 

Don’t Wait for Rock Bottom 

I have been to countless AA meetings where the pervasive “rock bottom” myth is repeated over-and-over. The belief of many in the 12-step community is that you have to reach the depths of addiction before you can finally surrender to the disease and get help. 

“He needs to go out and do more research,” Malcolm explained to me in a meeting in response to a newcomer who had relapsed. I couldn’t quite believe that a member of AA, whose only requirement of membership is a desire to stop drinking, was encouraging someone to go back to drinking until they had truly had enough. 

But I experienced this more times than I wish to recall.

The reality is that not everyone reaches a rock bottom. Some people die before they reach rock bottom. Others find themselves facing a host of dangerous and life-threatening situations, such as: 

• Overdose
• Buying substances laced with fentanyl
• Using alone
• Experiencing homelessness because a misguided parent kicked them out 
• Not carrying naloxone because a loved one believes it enables drug use

People with substance use disorders really don’t need to be pushed to those depths. Instead, we could reach them much earlier at the gray area. 

What is Gray Area Drinking?

Alcohol use disorder exists on a spectrum: from the gray area (less severe) to the more acute stages (rock bottom). About 90 percent of people who drink problematically do not have severe AUD, according to the Centers for Disease Control and Prevention.

Gray Area Drinking expert, Jolene Park explains: 

“We’re all familiar with the rock-bottom kind of drinking that ruins too many lives. On the other end of the spectrum, there are those who rarely drink. If you fall in between those two extremes you might identify as a gray area drinker.”

Key signs of gray area drinking, as highlighted by Park, can include:

• Intending to have one glass of wine but finishing a bottle
• Stopping drinking for periods of time but returning because you think you have control
• Thinking and rationalizing your drinking
• Allowing drinking to prevent you from achieving the life you want

Intervening in the Gray Area 

Reflecting on my own drinking, I wish I’d had an intervention at an earlier stage. I drank problematically from the time I was 13 years old. 

To the outside world, I appeared to have it all: a bachelor’s degree, a place to live in the city, and a good job. On the outside, I had made it. But internally, I was progressively crumbling, over two decades. 

I went from drinking a bottle of wine after work (stopping occasionally) to losing all control. I was drinking around four bottles of wine a day toward the end of my addiction. If I’d had an earlier intervention where I knew that I didn’t have to sit in a church basement and listen to sad stories, I might have gotten help much sooner. 

I know that is easier said than done. As a family member, you may be afraid to confront the person dependent on alcohol or drugs. Or you may have trusted the familiar sayings in the rooms of Alanon where a family member reaches a magical “rock bottom” and instantly asks for help. 

Don’t Put the Intervention Off

The reality is that If loved ones wait too long, it may actually be too late. Here are some ways you can support your loved one by intervening long before that rock bottom moment manifests:

• Model alcohol free social events: suggest to your loved one that you go for a coffee date instead of hitting a bar.
• Ask if you can cook them dinner as you’d like to discuss something on your mind. Don’t confront them, but ask them if there is anything they’re struggling with and if you can better support them.
• Tell them that you are concerned about their drinking, but not in a confrontational way. Perhaps you could say that you have noticed they’re drinking more than usual and you wondered if everything is OK. Practice active listening rather than trying to solve their problems. Ask them what their options are and if there is anything you can do.
• Be prepared by educating yourself about AUD and the options available. Ensure you have these resources to hand:
  • Guidelines on normal drinking limits.
  • Look for gray area digital recovery options, like Tempest, Jolene Park’s Gray Area Coaching, This Naked Mind, Workit Health. 

At the end of the day, you have to decide if you’d rather overcome the anxiety of approaching the subject or deal with the shame and regret of a loved one losing his or her life to addiction. Don’t delay; intervene today.

If you or someone you love is experiencing a substance use disorder, help is available. Call 800-934-1582(Sponsored) today.

The U.S. continues to not only fight the COVID-19 pandemic, it is now also grappling with some major supply chain issues that are leaving the country in chaos. Caused in part by the pandemic, disruptions to the global supply chain are responsible for gridlock in ports, material scarcity, bare shelves in grocery stores and prison commissaries, increasing freight prices, and a huge shortage of workers. 

Not surprisingly, there are a lot of stressed workers, unhappy customers, and anxious companies watching their profits dwindling. But plenty of Americans are also faced with health-related consequences as alcohol and other pharmaceuticals are among many of the products delayed.

For people struggling with alcohol use disorder and health conditions like opioid addiction, this is having a visible impact. 

A Time of Uncertainty

Jake Duke, a regional manager of Spec’s Liquor told ABC News: “We had 50 people waiting in line, just to see what we had coming in this morning because it’s a guessing game for us, just as it is for the guest.”

He shares his frustration about this supply chain uncertainty, “They don’t know what’s coming. We don’t know what’s coming,” he said.

Last week, the American Medical Association called the supply chain issues an urgent healthcare crisis, as the Food and Drug Administration announced 115 drugs are in short supply nationally. Those drugs include chemotherapy, Adderall, insulin, oxycodone, and some anxiety medications.  

Heading the writing on the wall – and experiencing their own supply chain delays – pharmacists warn hundreds of medicines could be placed on backorder at any time. 

So what are the implications? Well, those with substance use disorders could face some pretty severe consequences if suddenly forced to stop certain medications. And withdrawal symptoms are one of those consequences.

The Risk of Suddenly Stopping Medication

To abruptly stop using opioids, including prescription opioids that are in short supply, can cause withdrawal symptoms, including (but not limited to) flu-like symptoms, stomach ache, vomiting, diarrhea, muscle aches, anxiety, restlessness, inability to sleep, high blood pressure, runny nose, rapid heartbeat, visual disturbances, and excessive sweating.

For those struggling with severe alcohol addiction who face a lack of supply, the results could be potentially deadly. People who are used to drinking large amounts of alcohol have likely developed a dependence. If they stop drinking (also known as “going cold turkey”) they can experience seizures and delirium tremens — a life-threatening condition that can cause tremors, shaking, confusion, hallucinations and can lead to a heart attack, stroke, or even death. 

Risk factors for those who stop drinking and develop delirium tremens include:

• Adult men
• People with a history of seizures
• Those with have experienced alcohol withdrawal previously
• Heavy and long-term drinkers: defined as men who drink more than 14 drinks per week and women who drink more than 8 alcoholic drinks per week.

Why is America Experiencing Supply Chain Issues?

According to the Economist, the main reason for the supply chain problem is the pandemic. After $10.4 trillion in global stimulus money was distributed, it resulted in people buying more goods and services than ever, putting a major strain on supply chains globally. 

However, the pandemic also caused a serious manufacturing problem; some goods can’t be made as quickly and efficiently as others. Electronics and clothing are stuck because of industrial shortages in microchips in places like Taiwan, and the Delta variant has closed down clothing factories in other parts of Asia. 

When goods are eventually sent to the U.S., we don’t have enough truck drivers to deal with the huge demand to get goods to customers. Companies are now struggling to fill these service jobs and, despite hefty signing bonuses for truck drivers, we are still in need of tens of thousands of truck drivers to make up the supply chain short fall.

Ending Supply-Related Withdrawal Symptoms 

While shopping and nice-to-have items are one thing, life-saving medications and substances that people are dependent on are a much more serious problem.

If you go to a hospital, you don’t expect to find out they’re out of a drug that can save your life. Or if you have a prescription for a medication that keeps chronic pain at bay, that you’ll suddenly be left with excruciating pain and withdrawal symptoms. So what’s the answer?

According to the Harvard Business Review, the U.S needs to reimagine its pharma supply chain. They say we’re in this situation because of a poorly designed global supply chain, despite relying on it for our nation’s most essential medical needs. While it’s an intolerable, and potentially dangerous situation for millions of Americans, they say it need not be this way if we fulfill the production of vital medicines within the U.S. instead of abroad. 

The U.S. is too dependent on global production and supply of these medicines. When something goes wrong, like a pandemic, we’re left struggling to meet the needs of our nation. 

The answer, HBR says, is to stop relying on China and India for medicine materials — where 80 percent of active medicine ingredients come from — and start making these medicines in the U.S. 

If you or someone you love is experiencing a substance use disorder, help is available. Call 800-934-1582(Sponsored) today.

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“Two out of every five fentanyl pills that we are seizing are a lethal dose.” – Kyle Williamson, Special Agent, El Paso Drug Enforcement Agency

It’s unprecedented. Fentanyl seizures by the El Paso DEA are up over 524%, and methamphetamine seizures are up over 200%.

These numbers were reported by Kyle Williamson, a recently retired Special Agent with the El Paso Drug Enforcement Agency. Why the massive increase? Williamson says one of the main reasons is the influx of fentanyl streaming across the southern border. The demand for opioids in the U.S. is high, so the supply is coming in to meet it.

But…people aren’t getting the drugs they might expect. Often, the drugs are counterfeit fentanyl pills manufactured in Mexico. These lethal-dose pills are disguised to look like regular Oxycodone that a person might get from their doctor.

The result? Overdose deaths are on the rise. The CDC reported a staggering 96,779 drug overdose deaths across the nation in the 12-month period ending March 2021. In the 12 months prior to that, there were 74,679.

Williamson stressed the importance of educating people about the deadliness of fentanyl, especially since these pills become so easy to access. He notes, “They are distributed through social media, they’re on the streets, they’re in the schools…they’re everywhere.”

Why is Fentanyl So Deadly?

Fentanyl is 100 times more powerful than morphine. With proper medical monitoring, it is possible to use this controlled substance safely for severe pain relief. But…that’s not exactly what’s happening with smuggled drugs.

Dealers mix fentanyl with other substances to make their product more powerful and cheaper to produce.

Since just two milligrams of fentanyl can be fatal, the drug concoctions that dealers are putting in people’s hands are often far deadlier than people realize. The U.S. DEA has come across counterfeit pills stuffed with more than 5.1 milligrams of fentanyl each.

Of course, someone can take a pill without realizing it contains any fentanyl. Or, they may take a pill knowing it contains the powerful drug, but not know just how much they’re getting in that little pill. It’s not as if there’s quality control or oversight of smuggled drug production. If drugs are purchased on the black market, there’s no way to know exactly what’s in them – until it’s too late.

A Spreading Poison

Williamson and other El Paso officials have noticed the uptick in smuggling and overdoses, but the problem isn’t just at the border. DEA Acting Administrator Christopher Evans noted, “While a major entry point for fentanyl is the Southwest border, the cartels are spreading their poison into communities across the nation.”

In an effort to stop this spread, the DEA launched Project Wave Breaker. This initiative “aims to reduce the amount of fentanyl coming across the Southwest border, reduce crime and violence associated with drug trafficking, and ultimately save lives by reducing the demand for illicit fentanyl.”

Launched in April of 2021, Project Wave Breaker involves outreach and enforcement efforts to stop the flow of fentanyl. It will also target Mexican criminal organizations, who are known as the biggest suppliers and distributors of this drug in the United States.

What Else Can be Done About Fentanyl?

Well, we can apply some basic economic principles, even if the business is illegal (and deadly). It’s basic supply and demand. The demand is high, so the supply has risen. We need to reduce the demand.

As Williamson noted, education is key. That means continuing to educate people about fentanyl and how smugglers are sneaking it into illegal substances in deadly amounts. By taking even one pill, people are taking their lives into their own hands.

Would some still take the risk? Possibly. But hopefully the increased awareness will give people pause and prevent some of the overdoses we’re seeing across the country.

Meanwhile, initiatives like Project Wave Breaker will continue to attack the problem from the legal side. Last year, officials involved in the project seized a total of 2,316 kilograms of fentanyl. That’s enough lethal doses to kill more than a billion people.

For information about treatment options for you or a loved one, call 800-934-1582(Sponsored) today.

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You may have heard about the opioid crisis, and could be wondering, what are opioids, and is heroin an opioid? The dangers of heroin and opioids continue to take a toll on America. In 2020, more than 70,000 people in the U.S. died from opioid overdoses, with heroin accounting for 13,000 of those deaths.¹ Having a better understanding of heroin and opioids may help you avoid addiction or encourage you to seek help if you need it.

In This Article:

• What Are Opioids, and Is Heroin an Opioid?
• What Are the Effects of Heroin?
• What Are the Dangers of Long-term Heroin Use?
• Heroin vs. Opioid Medications
• Heroin Use and Overdose
• Help for Heroin Addiction

What Are Opioids, and Is Heroin an Opioid?

Opioids are a class of drugs that interact with the opioid receptors in your brain.² These receptors are connected to your brain’s reward system. When stimulated, the opioid receptors create a loop that links the stimulus to pleasure. It’s this system that makes opioid drugs very addictive.²

Some opioids are prescribed as medications. These include oxycodone (OxyContin), hydrocodone (Vicodin), codeine, morphine, and others. Heroin is also an opioid but it has no medicinal purpose. For this reason, it is listed as a Schedule 1 narcotic by the U.S. Drug Enforcement Administration (DEA). Schedule 1 drugs are substances that have a high potential for abuse and no accepted medical use.³

Prescription opioid medications are classified as Schedule 2 drugs because they do have an accepted medical use, but they also have a high potential for abuse that can lead to addiction. ³ Several types of Schedule 2 opioid medications account for a large proportion of overdose deaths. These include fentanyl, oxycodone, morphine, methadone, and hydrocodone.⁴

Regardless of intended purpose, opioids and heroin create a euphoric ‘reward’ experience in your brain.² Opioid medications may be safe if you used them as prescribed by your doctor for a short period. However, if using them for two weeks or longer, you may become physically dependent on them.⁵

What Are the Effects of Heroin?

Heroin is a highly addictive, illegal drug derived from certain varieties of poppy plants. Pure heroin is a white powder that is made primarily in South America and areas of Asia and smuggled into the U.S. It is normally snorted or smoked. Black tar heroin is made mostly in Mexico. The dark color comes from crude processing methods that leave behind impurities. Black tar heroin is usually diluted and injected into the body.⁶

After heroin is snorted, smoked, or injected into the body, it is converted to morphine, binding to opioid receptors in the brain and nervous system.⁶ The effects of heroin and opioids include blocking pain, increasing feelings of pleasure, and slowing down breathing and heart function.⁶ During an overdose, a shortage of oxygen to the brain can lead to coma, permanent brain damage, or death.⁶

People who struggle with heroin use will experience two stages of addiction—the short-term highs and the long-term lows.

Initially, heroin opioid use delivers a “rush” of pleasure, also called a euphoric high. Still, even in the short term, taking heroin can trigger unwanted side effects such as:⁷

• Dry mouth
• Warm flushing of the skin
• Heavy arms and legs
• Nausea
• Vomiting
• Severe itching
• Brain fog
• Drifting between a conscious and semiconscious state

Over time, heroin use may result in more severe side effects. Long-term heroin use can lead to:⁸

• Insomnia
• Collapsed veins (if you regularly inject heroin)
• Damaged nasal tissue (for those who snort heroin)
• Valve and heart lining infections
• Abscesses (swollen, pus-filled areas of skin)
• Chronic constipation
• Stomach cramps
• Kidney and liver disease
• Lung disease and complications
• Depression
• Antisocial personality disorder
• Sexual dysfunction for men
• Irregular menstrual cycles for women

What Are the Dangers of Long-term Heroin Use?

Repeated use of heroin changes the physiology of the brain, creating imbalances in the body’s neuronal and hormonal systems.⁶ Studies have shown that prolonged heroin use results in deterioration of the brain’s white matter.⁹ This may detrimentally affect a person’s ability to control their behavior, respond to stressful situations, and make decisions. ⁹ During an overdose, a shortage of oxygen to the brain can lead to coma, permanent brain damage, or death.⁸

People who use heroin and opioids through injection are also at risk of contracting infectious diseases such as hepatitis and HIV/AIDS, if sharing non-sterile needles.⁶ Use of heroin during pregnancy can lead to a baby born with fetal effects.⁶

Since 2007, heroin use in the U.S. has steadily increased. In 2016, approximately 948,000 Americans reported using heroin in the past year, and 626,000 met the criteria for heroin use disorder.⁷ The age group driving this increase the most is 18–25 year-olds.⁷

It appears this trend is related to the widespread misuse of opioid pain killers in the U.S.⁶ After becoming dependent on opioid medications, many turn to the more readily available—and more affordable option—heroin.⁶

Heroin Dependency and Addiction

Heroin dependency can happen quickly, after just two weeks of using the drug.⁵ Dependency means you will experience withdrawal symptoms, which normally occur 24-48 hours after the last dose.⁵

Signs of heroin and opioid withdrawal include:⁵

• Restlessness
• Muscle and bone pain
• Problems sleeping
• Diarrhea
• Vomiting
• Cold flashes
• Goosebumps
• Leg movement you can’t control
• Severe cravings for heroin

Using heroin and opioids regularly can also cause you to develop tolerance.⁶ This is when you need to take larger and more frequent doses of heroin to experience the high you used to get from smaller, less frequent doses.

Once you become dependent on heroin or other opioid drugs, you may develop an addiction, which is defined clinically as an opioid use disorder (OUD). This is when having and using heroin becomes the central focus of your life. A person is diagnosed as having an OUD when some of the following signs are present within a 12-month period:¹⁰

• Taking heroin in larger amounts or for longer than prescribed
• Wanting to reduce or stop using heroin but not managing to
• Spending a lot of time getting, using, or recovering from heroin use
• Having cravings and urges to use heroin
• Experiencing withdrawal effects when stopping heroin use
• Needing to use heroin in larger amounts to attain the effects your experienced when you first started using it
• Not living up to obligations at work, home, or school because of heroin use
• Continuing to use heroin despite the problems it causes problems in relationships
• Giving up important social, occupational, or recreational activities because of heroin use
• Using heroin even in situations where it is dangerous to do so
• Continuing to use heroin when you know you have a physical or psychological problem that could have been caused or made worse by the drug

An OUD diagnosis is ranked by severity according to the number of symptoms listed above that a person has. Having 2-3 symptoms indicates a mild OUD, 4-5 symptoms indicates a moderate OUD, and 6 or more symptoms indicates a severe OUD.¹⁰

Heroin vs. Opioid Medications

Because heroin and opioid medications have the same effects on the body, more people are misusing both types of drugs.⁶ Some people may turn to heroin after their prescription for an opioid medication runs out and they are unable obtain more prescriptions. Evidence suggests that almost 80% of people who have used heroin previously misused prescription opioid medications.¹¹

On the other hand, some people may start with heroin and turn to stronger opioids, such as fentanyl, after developing a tolerance to heroin. This is indicated by studies showing that about 33% of people entering opioid addiction treatment misused heroin before misusing opioid medications.¹²

The severity of effects can change when using heroin vs. opioid substances. Turning to stronger opioid drugs such as fentanyl is even more risky than using heroin. Fentanyl, a synthetic opioid often made illegally, is 50 times more potent than heroin.⁷ This is one reason fentanyl has become the leading cause of drug overdose in the U.S. In 2020, 57,000 people in the U.S. died from overdoses involving fentanyl.¹³ Some of these deaths are likely due to dealers cutting drugs like heroin or cocaine with fentanyl, since all of these substances come in the form of white powder. In such cases, it’s impossible for a buyer to know if heroin has been mixed with more potent drugs such as fentanyl.³

Heroin Use and Overdose

While fentanyl has become the No. 1 drug to cause overdose deaths, heroin is close behind. In 2019, nearly a third of all overdose deaths in the U.S. involved heroin.¹⁴

When a person overdoses on heroin, it means the amount of heroin they have used is more than their body can manage, resulting in death or a life-threatening condition. During an overdose, a shortage of oxygen to the brain can lead to coma, permanent brain damage, or death.⁶ Mixing heroin with alcohol, other opioid drugs such as fentanyl, or other drugs including benzodiazepines can also lead to overdose more easily than many people may realize.⁶

What does a heroin overdose look like? After using too much heroin or opioid drugs, your breathing may slow or even stop. This cuts off oxygen to your brain—a condition known as hypoxia.  So, even if you survive an overdose, you may emerge with permanent damage to your brain and nervous system.⁸ Alternatively, you may remain in a coma due to the effects of hypoxia.⁸

An overdose from heroin and opioids can be treated, if done immediately, with a medication called naloxone. It is available as an injectable medication, used by emergency medical personnel, or as a nasal spray, available to consumers. In either form, this medication binds to opioid receptors, which blocks the effects of heroin or other opioids, reversing overdose symptoms.¹⁵

Naloxone in the nasal spray form is available in some states without a prescription. If the state you live in requires a prescription, ask your primary doctor for a naloxone prescription if you are concerned that you or a loved one may be at risk for opioid overdose. Be sure you know in advance how to properly use naloxone. Keep in mind that naloxone only works on overdoses caused by heroin or other opioids.¹⁵

More than one dose of naloxone may be necessary to help you breathe after an overdose, and other medical care may be required. For these reasons, always seek immediate emergency medical care for an overdose.

Help for Heroin Addiction

If you struggle with heroin and opioid use, help is available. Today, a range of effective treatment options, including medication and different forms of therapy, are used to help people stop using heroin.⁸ Because of the variety of opioid and heroin treatment options available, you can find treatment that meets your specific needs and preferences.

Medications for Heroin Addiction

To help you through the withdrawal process, when detoxing from heroin and opioids, your treatment specialist may prescribe lofexidine.⁸ This is an FDA-approved, non-opioid medicine that reduces opioid withdrawal symptoms.⁸                 

There are also opioid agonist medicines, such as buprenorphine and methadone, that can help you stop using heroin.⁸ These medications also bind to your brain’s opioid receptors, but they do so in a weaker way than heroin, so they may reduce your heroin cravings and lessen your withdrawal symptoms.⁸

Alternatively, your doctor may recommend naltrexone, a medication that blocks opioid receptors.⁸ When you take naltrexone, opioid drugs will not affect your body.

Studies show that buprenorphine/naloxone combinations are similarly effective to solo use of extended-release naltrexone.^8,15

Behavioral Therapy During Opioid Addiction Treatment

In addition to medications, your treatment program may involve behavioral therapies for heroin addiction. Two popular methods often used in addiction treatment are cognitive behavioral therapy (CBT) and contingency management.⁸

With CBT, you learn to change your thoughts about drug use and your behaviors surrounding heroin misuse. In this way, you can learn to effectively manage your drug-use triggers so that you don’t relapse in times of stress.⁸

With contingency management, you can earn motivational incentives, such as vouchers or small cash rewards, when you engage in positive behaviors by avoiding heroin and opioid use to maintain sobriety.⁸

A variety of other types of therapy for opioid addiction, including holistic approaches, are available in many treatment centers today. The methods of therapy that work best for you will depend on your individual situation and personality. What is most important to know is that behavioral treatment is highly effective when combined with medication for heroin addiction.⁸

For more information about treatment for heroin dependency, or to find a treatment center that meets your needs, call 800-934-1582(Sponsored) today.

References

1. Centers for Disease Control and Prevention. (2021, August 1). Provisional Drug Overdose Death Counts. National Center for Health Statistics.
2. Merrer, J. L., Becker, J. A. J., Befort, K., & Kieffer, B. L. (2009). Reward Processing by the Opioid System in the Brain. Physiological Reviews, 89(4), 1379–1412.
3. Drug Enforcement Administration. (2020). Drugs of Abuse: A DEA Resource Guide/2020 Edition. U.S. Department of Justice.
4. Centers for Disease Control and Prevention. (2019, October 25). Regional Differences in the Drugs Most Frequently Involved in Overdose Deaths: United States, 2017. National Vital Statistics Reports, 68(12).
5. Johns Hopkins Medicine. Opioid Addiction. The Science of Addiction.
6. Volkow, N.D. (2014). Heroin. Research Report Series. National Institute on Drug Abuse.
7. National Institute on Drug Abuse. Heroin Research Report: What is the scope of heroin use in the United States? National Institutes of Health.
8. National Institute on Drug Abuse. (2020, July 24). Heroin DrugFacts. National Institutes of Health.
9. Qiu, Y., Jiang, G., Su, H., Lv, X., Zhang, X., Tian, J., & Zhuo, F. (2013). Progressive white matter microstructure damage in male chronic heroin dependent individuals: a DTI and TBSS study. PloS One. 8(5).
10. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
11. Cicero, T. J., Ellis, M. S., & Kasper, Z. A. (2017). Increased use of heroin as an initiating opioid of abuse. Addictive Behaviors, 74:63-66.
12. Carlson, R. G., Nahhas, R. W., Martins, S., & Daniulaityte, R. (2016). Predictors of transition to heroin use among initially non-opioid dependent illicit pharmaceutical opioid users: A natural history study. Drug and Alcohol Dependence, 60:127-134.
13. Centers for Disease Control and Prevention. (2021, August 8). Provisional Drug Overdose Death Counts. National Center for Health Statistics.
14. Centers for Disease Control and Prevention. (2021, March 5). Drug Overdose: Heroin Overdose Data.
15. National Institute on Drug Abuse. (2021). Opioid overdose reversal with naloxone (Narcan, Evzio).
16. Lee, J. D., Nunes, E. V., Mpa, P. N., Bailey, G. L., Brigham, G. S., Cohen, A. J., Fishman, M., Ling, W., Lindblad, R., Shmueli-Blumberg, D., Stablein, D., May, J., Salazar, D., Liu, D., & Rotrosen, J. (2016). NIDA clinical trials network CTN-0051, extended-release naltrexone vs. buprenorphine for opioid treatment (X:BOT): Study design and rationale. Contemporary Clinical Trials, 50:253-64.