This essay was also published by Scientific American on August 31, 2021.

The provisional drug overdose death statistics for 2020 confirmed the addiction field’s worst fears. More people died of overdoses in the United States last year than in any other one-year period in our history. More than 93,000 people died. The increase from the previous year was also more than we’ve ever seen—up 30 percent.

These data are telling us that something is wrong. In fact, they are shouting for change.

It is no longer a question of “doing more” to combat our nation’s drug problems. What we as a society are doing—putting people with drug addiction behind bars, underinvesting in prevention and compassionate medical care—is not working. Even as we work to create better scientific solutions to this crisis, it is beyond frustrating—it is tragic—to see the effective prevention and treatment tools we already have just not being used.

The benefits of providing effective substance use disorder treatments—especially medication for opioid use disorder—are well-known. Yet decades of prejudice against treating substance use disorders with medication has greatly limited their reach, partly accounting for why only 18% of people with opioid use disorder receive medications. Historical reluctance to provide these treatments and of insurers to cover them reflects the stigma that has long made people with addiction a low priority.

We must eliminate the attitudes and infrastructure barring treating people with substance use disorders. This means making it easier for clinicians to provide life-saving medications, expanding models of care like digital health technologies and mobile clinics that can reach people where they are, and ensuring that payers cover treatments that work.

The science of the matter is unequivocal: Addiction is a chronic and treatable medical condition, not a weakness of will or character or a form of social deviance. But stigma and longstanding prejudices—even within healthcare—lead decision-makers across healthcare, criminal justice, and other systems to punish people who use drugs rather than treat them. That approach may be simpler than asking us as a society to have compassion or care for people with a devastating, debilitating, often fatal disorder. But the risk of incarceration does not deter drug use, let alone address addiction; it perpetuates stigma, and disproportionately harms the most vulnerable communities.

Evidence-based harm reduction, such as syringe services programs, also need to be a part of any solution to our drug crisis, as these have been shown to reduce HIV and hepatitis C transmission, and help link people to treatment for addiction and other conditions. While the federal government has embraced evidence-based harm-reduction programs, many communities continue to resist them, erroneously thinking they sanction or encourage drug use. Multiple independent studies have shown that they don’t. Researchers are also evaluating innovative but historically controversial strategies operating abroad like overdose prevention centers, where people can use substances under medical supervision and access other health services, to evaluate cost-effectiveness and ability to reduce deaths and improve health.

Part of the failure of the current approach to the drug crisis arises from the unrealistic expectation that people should—and can—just stop using drugs. Little concern is shown for people with addiction unless and until they are drug-free, but the reality is that difficulties and resumed use typically mark the recovery journey. Compassion, care, and support need to extend to those still using drugs and those who return to drug use, not just to those who can satisfy the stringent standards of abstinence. Everyone with a substance use disorder, regardless of whether they are currently using drugs, needs good healthcare and may also need help with housing, employment, and childcare needs.

To prevent young people from misusing drugs and to keep people from all ages from developing substance use disorders, our nation must address the social and economic stressors that increase the risk of drug use, such as poverty and housing instability, unsafe neighborhoods and schools, and other effects of a changing economy including social isolation and despair. Drug overdose deaths are one component of the “deaths of despair” that, along with suicide and alcohol-related illness, have caused life expectancy to decline in the U.S., even before the 1.5-year drop in 2020 caused largely by the COVID-19 pandemic.

On the ground, evidence-based interventions can make a big difference: Universal prevention programs as well as interventions targeted to the most at-risk families and youth not only reduce the risk of later drug taking and addiction but have radiating benefits on other aspects of mental and physical health.

This poses a question of collective willingness to invest in these measures. The long-term savings in healthcare and justice costs relative to the costs of prevention interventions can be substantial. But they are long-term investments with benefits that will take time to accrue, and the nature of our society is to look at short-term bottom lines and expect immediate results.

Radical change to save lives is long overdue. It is crucial that scientists help policymakers and other leaders rethink how we collectively address drugs and drug use, looking to the evidence base of what improves health and reduces harms across communities, and funding research to develop new prevention and treatment tools.

This essay was originally published by STAT on August 3, 2021.

Our understanding of substance use disorders as chronic but treatable health conditions has come a long way since the dark days when they were thought of as character flaws — or worse. Yet our societal norms surrounding drug use and addiction continue to be informed by unfounded myths and misconceptions.

Among the most harmful of these is the scientifically unfounded belief that compulsive drug-taking by individuals with addiction reflects ongoing deliberate antisocial or deviant choices. This belief contributes to the continued criminalization of drug use and addiction.

While attitudes around drug use, particularly use of substances like cannabis, have significantly changed in recent decades, the use and possession of most drugs continue to be penalized. Punitive policies around drugs mark people who use them as criminals, and so contribute to the overwhelming stigma against people contending with an often-debilitating and sometimes fatal disorder — and even against the medical treatments that can effectively address it.

Stigma has major negative impacts on health and well-being, which helps explain why only 18% of people with drug use disorders receive treatment for their addiction. Stigma impedes access to care and reduces the quality of care individuals receive. People with addiction, especially those who inject drugs, are often distrusted when presenting for care in emergency departments or when visiting other providers. They are often treated in a demeaning and dehumanizing way. And physicians holding stigmatizing attitudes may not provide adequate evidence-based care for patients with addiction.

A recent national survey of primary care physicians found that although most believe that opioid use disorder is a treatable medical condition, most also expressed similar stigmatizing views toward people with opioid use disorder that are held by the wider population. More stigmatizing attitudes among primary care physicians were correlated with lower use of medication in treatment of opioid use disorder and lower support for policies designed to increase access to those medications.

The perception of stigma by people with substance use disorders may cause them to avoid or delay engaging with health care or to conceal their drug use when interacting with health care professionals. Even when care is confidential, residential treatment or daily visits to receive treatment, particularly in close-knit communities, can be noticed and trigger judgment. According to the National Survey of Drug Use and Health, fear of negative opinions by neighbors or people in their community is one of the reasons people who know they need treatment for a substance use disorder avoid seeking it.

Fear of possible criminal consequences for drug use can shape people's health decision-making in many potentially deleterious ways. Substance use may be an important fact to consider in a routine medical visit, so its concealment can lead a physician to overlook major factors in a patient's health. In some states, pregnant people with substance use disorders risk being charged with child abuse or otherwise losing their parental rights if their child shows evidence of prenatal drug exposure or is born with neonatal abstinence syndrome. Fear of such consequences of substance use may cause individuals to avoid much-needed prenatal care, treatment, and other services.

The stigma against addiction extends to those who provide care for the condition and to the medications and harm-reduction measures that are used to address it. For example, methadone and buprenorphine are highly effective at helping people recover from opioid use disorders, but lingering prejudice that conflates taking medication with the use of harmful substances is one factor that prevents people from being treated with these medications.

Although treatment for addiction is becoming more integrated into medicine, it has faced major challenges on many fronts and requires overcoming health care providers’ attitudinal barriers as well as hurdles arising in part from confidentiality protection laws that may limit gathering and sharing data on patients' use of illicit substances. When doctors don’t ask about patients' drug use, they may miss information that is important to their care. Stigma also contributes to insurers setting restrictive limits on what they will cover for medications to treat substance use disorders.

Many people intersect with the criminal justice system as a direct or indirect result of their substance use disorders, and the experience may worsen their addiction and their physical and mental health. Although roughly half of people in prison have a substance use disorder, few receive treatment for it. People with untreated opioid use disorder are highly likely to return to drug use upon release, all too often with fatal consequences because of lost tolerance to the drug while in prison. Imprisonment itself not only increases the likelihood of dying prematurely but also negatively impacts mental health and social adjustment via the stigma of having been incarcerated. And it has radiating effects: Incarceration of a parent increases their children's risk of drug use, for example.

Research has consistently shown that when people interact with members of a stigmatized group and hear their stories directly, it has a powerful destigmatizing effect, more than simply educating the public about the science underlying a condition. But while a growing number of people in recovery are speaking openly about their past use and their current struggles to keep sober, people who use drugs actively — either because of an untreated addiction or during a period of relapse or even simply as a matter of personal choice outside the context of a use disorder — are not free to do so without fear of legal consequences.

The silence of people living with active drug use disorders due to the stigma associated with their condition means the wider public has no opportunity to hear from them and no opportunity to revise their prejudices, such as the belief that addiction is a moral failing or a form of deviance.

An effective public health response to substance use and substance use disorders must consider the policy landscape of criminalizing substance use, which constitutes a major socially sanctioned form of stigma. In addition to research already underway on stigma and stigma reduction at the National Institutes of Health, research on the positive and possible negative outcomes associated with alternative policy models that move to prioritize treatment over punishment are also urgently needed, as such models could remove a major linchpin of the stigma around drug use and addiction and improve the health of millions of Americans.

Nora D. Volkow is a psychiatrist, scientist, and director of the National Institute on Drug Abuse, which is part of the National Institutes of Health.

Substance use disorders (SUDs) are among several health conditions that have been identified by the CDC as increasing a person’s risk for becoming severely ill from COVID-19. For this reason, it is especially important that people who use or are addicted to drugs become vaccinated. Because people with a history of experiencing stigma from the healthcare system due to an addiction may be hesitant, community leaders, healthcare providers, and others in the community must play a role in encouraging and facilitating vaccination for people with drug problems.

The increased risks of COVID-19 infection to people with SUD have been established by a growing amount of data: In an analysis of electronic health records of 73 million patients at U.S. hospitals, my colleagues and I found that people with SUDs, especially recent diagnoses, were at much higher risk than other people of having COVID-19 or suffering its worst outcomes; this was especially true for Black people. Studies in Korea and New York City found similar associations between SUDs and vulnerability to COVID-19, as did an analysis of data from 54,529 patients by researchers at the University of Texas Medical Branch, Galveston. Those researchers also suggested that chronic cardiovascular or respiratory conditions related to substance use may mediate this higher vulnerability.

Anyone over 12 years of age in the U.S. is now eligible to become vaccinated. Critically, people cannot be denied vaccination because of underlying health conditions, including substance use or a substance use disorder. Communities and health systems everywhere in the country are providing the vaccines free of charge, regardless of one’s immigration status or whether one has health insurance. Recipients cannot even be charged for the office visit, or any other fee. All three of the FDA-approved vaccines are considered equally effective and safe.

However, fears around vaccines, distrust of the government and the pharmaceutical industry, and misinformation are preventing many people from taking the potentially life-saving measure of getting vaccinated. Vaccine hesitancy could be especially a problem for people who may have experienced a history of mistreatment by healthcare for their drug use.

A survey conducted last year by the Addiction Policy Forum (APF) found that almost half of their sample of people affected by substance use disorders (actively using drugs, in treatment, or in recovery) expressed unwillingness to get a COVID-19 vaccine. Reasons cited by respondents included distrust of the government, wariness about the rapidity with which vaccines were being developed, and skepticism that they were at higher risk.

Respondents in the APF survey also said, however, that they trust their own doctor more than any other individual when it comes to making healthcare decisions, which is consistent with other surveys showing that people trust the most their healthcare providers for information on COVID-19 and vaccinations. It means that, as trusted messengers, health professionals are in the best position to help persuade patients of the safety of the vaccines and of the many important benefits of becoming vaccinated.

There is no evidence that COVID-19 vaccines are less safe or effective for people who use substances, people who have SUDs, or people who are receiving medications to treat addiction. And for these individuals, the benefits go well beyond reducing the risk of contracting or experiencing the worst effects from COVID-19. Importantly, vaccination enables safely gathering with others again. Isolation is a risk factor for relapse to drug use, and recovery groups have had to suspend in-person meetings this past year.  For some, virtual meetings have been a lifeline; for others, they are not an adequate substitute for face-to-face interactions and may not even possible. Thus, for people with addiction and perhaps other mental health conditions like depression or anxiety that have been exacerbated by the stress of isolation, vaccination will bring a return to normalcy, including greater access to social supports.

People who use drugs also need not have privacy concerns when obtaining a vaccine for fear of having to disclose past or present drug use. Providers administering COVID-19 vaccine will not ask about your substance use. Recipients will not need to disclose information about medical history, other than known allergies to vaccines or immune- or blood-related conditions potentially relevant to receiving a vaccine. The pre-vaccination screening form issued by the CDC can be downloaded.

Healthcare providers, pharmacies, treatment centers, and others who are part of the vaccine-dispensing effort should prioritize trying to reach people in their community who use drugs. Opioid treatment programs and syringe-services programs, for example, should also make vaccines available at their facilities. Walk-in vaccination clinics are now available in some locations to serve people with complicated schedules and housing situations.

Some of the innovative strategies implemented during the pandemic to deliver addiction treatment and medications to people with substance use disorders, such as mobile vans dispensing medications for opioid use disorder, could be leveraged to provide COVID-19 vaccines as well. Telehealth modalities increasingly used for medication management can be used to inform and encourage patients to get vaccinated. Treatment centers and other providers can also contact their patients via text message. With funding from the Foundation for Opioid Response Efforts, APF has established a Vaccine Navigator to help people with drug problems navigate local vaccine scheduling complexities and to address any concerns they may have about getting vaccinated.

For more information about vaccines, how they were developed, and the importance of becoming vaccinated, see the APF video I recorded with Dr. Fauci.

This piece originally appeared on April 27, 2021 in a Health Affairs Blog. It is reposted here with permission and is available in Spanish.

The COVID-19 pandemic has highlighted the large racial health disparities in the United States. Black Americans have experienced worse outcomes during the pandemic, continue to die at a greater rate than White Americans, and also suffer disproportionately from a wide range of other acute and chronic illnesses. These disparities are particularly stark in the field of substance use and substance use disorders, where entrenched punitive approaches have exacerbated stigma and made it hard to implement appropriate medical care. Abundant data show that Black people and other communities of color have been disproportionately harmed by decades of addressing drug use as a crime rather than as a matter of public health.

We have known for decades that addiction is a medical condition—a treatable brain disorder—not a character flaw or a form of social deviance. Yet, despite the overwhelming evidence supporting that position, drug addiction continues to be criminalized. The US must take a public health approach to drug addiction now, in the interest of both population well-being and health equity.

Inequitable Enforcement

Although statistics vary by drug type, overall, White and Black people do not significantly differ in their use of drugs, yet the legal consequences they face are often very different. Even though they use cannabis at similar rates, for instance, Black people were nearly four times more likely to be arrested for cannabis possession than White people in 2018. Of the 277,000 people imprisoned nationwide for a drug offense in 2013, more than half (56 percent) were African American or Latino even though together those groups accounted for about a quarter of the US population.

During the early years of the opioid crisis in this century, arrests for heroin greatly exceeded those for diverted prescription opioids, even though the latter—which were predominantly used by White people—were more widely misused. It is well known that during the crack cocaine epidemic in the 1980s, much harsher penalties were imposed for crack (or freebase) cocaine, which had high rates of use in urban communities of color, than for powder cocaine, even though they are two forms of the same drug. These are just a few examples of the kinds of racial discrimination that have long been associated with drug laws and their policing.

Ineffective Punishment

Drug use continues to be penalized, despite the fact that punishment does not ameliorate substance use disorders or related problems. One analysis by the Pew Charitable Trusts found no statistically significant relationship between state drug imprisonment rates and three indicators of state drug problems: self-reported drug use, drug overdose deaths, and drug arrests.  

Imprisonment, whether for drug or other offenses, actually leads to much higher risk of drug overdose upon release. More than half of people in prison have an untreated substance use disorder, and illicit drug and medication use typically greatly increases following a period of imprisonment. When it involves an untreated opioid use disorder, relapse to drug use can be fatal due to loss of opioid tolerance that may have occurred while the person was incarcerated.

Inequitable Access to Treatment

While the opioid crisis has triggered some efforts to move away from punishment toward addressing addiction as a matter of public health, the application of a public health strategy to drug misuse remains unevenly distributed by race/ethnicity. Compared to White people, Black and Hispanic people are more likely to be imprisoned after drug arrests than to be diverted into treatment programs.

Also, a 2018 study in Florida found that African Americans seeking addiction treatment experienced significant delays entering treatment (four to five years) compared to Whites, leading to greater progression of substance use disorders, poorer treatment outcomes, and increased rates of overdose. These delays could not be attributed to socioeconomic status alone. Studies have shown that Black youth with opioid use disorder are significantly less likely than White peers to be prescribed medication treatment (42 percent less likely in one study, 49 percent in another) and that Black patients with opioid use disorder are 77 percent less likely than White patients to receive the opioid addiction medication buprenorphine. 

A Vicious Cycle of Punishment

The damaging impacts of punishment for drug possession that disproportionately impact Black lives are wide ranging. Imprisonment leads to isolation, an exacerbating factor for drug misuse, addiction, and relapse. It also raises the risk of early death from a wide variety of causes.

Besides leading to incarceration, an arrest for possession of even a small amount of cannabis—a much more common outcome for Black youth than White youth—can leave the individual with a criminal record that severely limits their future opportunities such as higher education and employment. This excess burden of felony drug convictions and imprisonment has radiating impacts on Black children and families. Parents who are arrested can lose custody of their children, entering the latter into the child welfare system. According to another analysis by the Pew Charitable Trusts, one in nine African American children (11.4 percent) and 1 in 28 Hispanic children (3.5 percent) have an incarcerated parent, compared to one in 57 White children (1.8 percent).

This burden reinforces poverty by limiting upward mobility through impeded access to employment, housing, higher education, and eligibility to vote. It also harms the health of the incarcerated, their non-incarcerated family members, and their communities.

Moving Toward a Public Health Approach

Five years ago, the 193 member nations of the United Nations General Assembly Special Session on drugs unanimously voted to recognize the need to approach substance use disorders as public health issues rather than punishing them as criminal offenses. Research is urgently needed to establish the effectiveness and impact of public health–based alternatives to criminalization, ranging from drug courts and other diversion programs to policies decriminalizing drug possession.

In addition to policy research, proactive research is needed to address the racial disparities related to drug use and addiction. From the opioid crisis, we have learned that large research initiatives can be mounted that engage multiple stakeholders—including the justice system (courts, prisons, jails) and the health care system—to cooperate toward the common purpose of reducing a devastating health problem. From the COVID-19 crisis, we have learned that the research enterprise can adapt and rapidly mobilize to address critical threats. These lessons can be applied to reduce systemic inequities in how addiction is addressed and to advance access to high-quality addiction care for all people who need it, whatever their race or background.

With this in mind, the National Institute on Drug Abuse is redoubling its focus on vulnerabilities and progression of substance use and addiction in minority populations. We are exploring research partnerships with state and local agencies and private health systems to develop ways to eliminate systemic barriers to addiction care. We are also funding research on the effects of alternative models of regulating and decriminalizing drugs in parts of the world where such natural experiments are already occurring.

People with substance use disorders need treatment, not punishment, and drug use disorders should be approached with a demand for high-quality care and with compassion for those affected. With a will to achieve racial equity in delivering compassionate treatment and the ability to use science to guide us toward more equitable models of addressing addiction, I believe such a goal is achievable.

Nora Volkow, Addiction Should Be Treated, Not Penalized, Health Affairs Blog, April 27, 2021, https://www.healthaffairs.org/do/10.1377/hblog20210421.168499/full/ Copyright © 2021 Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc.

As cannabis becomes more available and socially accepted in the U.S., it is increasingly important to facilitate research on this drug’s effects. A major hindrance, however, has been the lack of a standard unit by which to measure cannabis intake and compare its effects across studies. Existing experimental data are often hard to interpret due to the wide variability in potency of cannabis plant material and extracts, the lack of standard measures of use, and the wide variety of ways people consume cannabis. To help rectify this, NIDA, along with the National Cancer Institute; the National Heart, Lung, and Blood Institute; and the National Institute of Mental Health, have published a notice in the NIH Guide directing researchers funded by these institutes to measure and report their findings from clinical research on cannabis using a standard unit of  delta-9-tetrahydrocannabinol (THC) of 5 milligrams.

A standard unit is not a limit, nor any kind of recommendation for consumption that would apply to consumers or to dispensaries; it is simply a unit of measure to help facilitate cannabis research. Similar standard measures have also been applied for other substances. Researchers use morphine milligram equivalents to compare effects of opioids having widely varying potencies. And research on alcohol and tobacco has been facilitated by defining a standard drink (.6 fl oz or 14 grams of pure alcohol) and a cigarette, respectively.

Cannabis is a complex plant with many constituents that might influence its effects; however, research has established that THC is the main chemical responsible for the high that users seek as well as for some of the medicinal effects that have been demonstrated in clinical trials. Like other drugs, THC’s effects vary based on the route of administration and the tolerance of the user, among other factors. Having a standard unit of measurement will make it easier to compare the influence of these factors on how individuals respond to the drug. 

A standard unit does not place a limit on how much THC researchers can use in experiments—they can use multiples (or fractions) of the unit. But adoption of a standard unit for measuring and reporting purposes will facilitate data interpretation and will make it possible to design experiments on drug effects that have real-world relevance, as well as make it easier to translate that research into policy and clinical practice.

Utilizing a THC standard unit in cannabis research will help us gain a better understanding of the effects of cumulative THC exposure, such as the effects of prenatal and/or adolescent exposure on brain development, cognition, and educational attainment. It will also facilitate understanding THC’s adverse medical effects seen in frequent users such as hyperemesis or cardiovascular toxicity, as well as effects like psychosis seen in individuals with certain underlying vulnerabilities. In research on treatment of cannabis use disorder, a standard unit will enable researchers to more accurately capture reduction in use as an outcome measure, the same way researchers now capture clinically meaningful reductions in alcohol consumption via heavy drinking days, defined as four or more drinks per day for women, and five or more for men. In the cancer setting, the use of a THC standard unit will aid research investigating molecular mechanisms of cannabis effects on tumor growth, invasion, metastasis, as well as clinical research to determine benefits and risks of cannabis use for a variety of cancer treatments side-effects such as nausea and vomiting, pain management, neuropathy, anxiety, insomnia, and loss of appetite.  

A few years of information-gathering and deliberation have gone into NIDA’s decision to establish a 5-milligram standard unit of THC. The Cannabis Policy Research Workgroup established in 2017 by the National Advisory Council on Drug Abuse issued a report in 2018 recommending that NIDA explore establishing a standardized THC unit to help researchers analyze cannabis use and to help those who use cannabis understand their consumption of this drug. In October 2019, researchers Tom P. Freeman (University of Bath, UK) and Valentina Lorenzetti (Australian Catholic University) proposed adopting 5 milligrams as the THC standard unit in an article in the journal Addiction. In March 2020, NIDA issued a request for information (RFI) from the research community, interested stakeholders, and the general public asking for input on the proposed establishment of a standard unit for cannabis research.

The responses reflected a diversity of opinions, but overall, there was support for the idea. Some suggested that a larger amount of 10 milligrams would be more relevant for people who use cannabis frequently or who use today’s high-potency products. But extensive discussion with experts in the field showed wider support for Freeman and Lorenzetti’s original recommendation of 5 milligrams. This dose may produce a high in both experienced and occasional users, but in most studies, has not produced adverse effects; and in some states, 5 milligrams is already the standard serving size in edible products that contain THC (others use 10 mg).

The 5-milligram standard unit will only apply to THC, not to other psychoactive constituents of the cannabis plant such as cannabidiol (CBD). Our hope is that adopting this 5-milligram standard will enable a clearer understanding of the effects of THC by researchers as well as the wider public.

Also see - FAQs Regarding Notice of Information: Establishment of a Standard THC Unit To Be Used in Research

Medications for Opioid Use Disorder Infographic
This infographic shows the different types of medications prescribed for opioid overdose, withdrawal, and addiction.

Medications for opioid overdose, withdrawal, and addiction
Medications for opioid overdose, withdrawal, and addiction are safe, effective and save lives.

The National Institute on Drug Abuse supports research to develop new medicines and delivery systems to treat opioid use disorder and other substance use disorders, as well as other complications of substance use (including withdrawal and overdose), to help people choose treatments that are right for them.

FDA-approved medications for opioid addiction, overdose, and withdrawal work in various ways.

Four cards show medications prescribed to reduce opioid use and cravings.

Medications for Opioid Use Disorder Infographic
This infographic shows the different types of medications prescribed for opioid overdose, withdrawal, and addiction.

Medications for opioid overdose, withdrawal, and addiction
Medications for opioid overdose, withdrawal, and addiction are safe, effective and save lives.

The National Institute on Drug Abuse supports research to develop new medicines and delivery systems to treat opioid use disorder and other substance use disorders, as well as other complications of substance use (including withdrawal and overdose), to help people choose treatments that are right for them.

FDA-approved medications for opioid addiction, overdose, and withdrawal work in various ways.

Four cards show medications prescribed to reduce opioid use and cravings.

This publication is available for your use and may be reproduced in its entirety without permission from NIDA. Citation of the source is appreciated, using the following language: Source: National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services.

Copyright © 2024 Recovery Alliance Initiative
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