Meperidine Withdrawal Help - California

Never Stop Quitting
Our medical professionals get on a goal to serve, support, and raise the lives of individuals we offer through Medication- Assisted Therapy (MAT). Floor covering is considered the most effective therapy for opioid use problem by the CDC, SAMHSA, FDA as well as various other government companies. We more than happy to report 95% of our people state they have no withdrawal signs at 5 days.


OPIOID WITHDRAWAL California
What is Opioid withdrawal?To understandopioid withdrawal, it is important to first recognize what taking opioids over a long period of time does to ones body. Taking an opioid day-to-day for 3 weeks or longer brings about a change in brain chemistry which can be defined as medicine tolerance. This indicates that with time, even more of the medication is needed to accomplish the same result (bliss, discomfort control, or control or anxiety/depression). Dependancy does not necessarily mean dependency however, which is identified by regularly food craving as well as constantly busying oneself with the need to get more of the medicine. If somebody that depends on opioids quits unexpectedly, they will likely have both physical as well as emotional symptoms of withdrawal as the body is no more obtaining a medication that it hinges on. One of the most common withdrawal signs are flu- like in nature and also include:
1. Drippy nose

2. Muscle mass pains

3. Indigestion, queasiness, vomiting, diarrhea

4. Chills/sweats.

5. Quick heartbeat.

6. Goosebumps on the skin.

7. Anxiousness.

8. Failure to sleep.

9. Fatigue.


There are two primary means of entering into withdrawal:.

1) Unexpectedly stopping all opioid usage without tapering down initially (spontaneous withdrawal).

2) Taking an opioid antagonist like naloxone (had in suboxone) or naltrexone prematurely (precipitated withdrawal).





How Long Does Opioid Withdrawal Last?
If you ask any person who has experienced opioid withdrawal, the response is that it is fairly uncomfortable and in some scenarios, life- threatening. Withdrawals can start as early as a couple of hrs and also typically last 3-5 days. Nevertheless, depending upon the extent of dependency and the sort of substance abuse, signs and symptoms might last as much as 3-6 weeks (methadone). A rough rule of thumb is an onset of signs and symptoms take place after two to three times the half-life of the withdrawn opioid.
Is There Anything to Make Withdrawals Easier?
While the pillar oftreatment for opioid withdrawal, Buprenorphine/Naloxone (Suboxone), concentrates on pleasing your bodys physical reliance to opioids as well as decreasing desires, we also have extra therapy to assist minimize the various other undesirable symptoms of withdrawal. Below is a list of symptoms with equivalent therapy medications:.
1) Muscular tissue pains, headache- acetaminophen, advil, and naproxen.

2) Muscular tissue spasm- cyclobenzaprine, baclofen, and also methocarbamol.

3) Queasiness, vomiting- tigan, and also ondansetron.

4) Diarrhea- loperamide, bismuth subsalicylate.

5) Stomach cramping- dicyclomine.

6) Lack of ability to sleep (insomnia) - diphenhydramine, hydroxyzine, melatonin, trazodone, as well as doxepin.

7) Anxiousness, irritability, restlessness- diphenhydramine, hydroxyzine, and clonidine.


The Family Members MD Specializes in Opioid Addiction and also Withdrawal Treatment.
We offerMedication- helped treatmentwith Buprenorphine/Naloxone (Suboxone) to aid patientsovercome opioid addictionand withdrawal. Get started today by setting up an online visit with among our board- certified physicians. Whether youre in your home, at work, or on lunch break, weve obtained you covered and also are below to make recuperation simple. Click on this link to arrange now!

MEDICATION- ASSISTED TREATMENT California

 
At the Family MD, our team believe there are several roads that lead from addiction to healing
What is Drug Assisted Treatment (FLOOR COVERING)?

Prior to we begin speaking about therapy for opioid dependency, it is necessary to know what is specified as opioid dependency. Opioid dependency is characterized by a solid, uncontrollable urge to consume opioid medications, also when they are no more clinically called for. Opioid dependency continues to be at epidemic levels in the U.S as well as the numbers are just anticipated to climb. Right here are some fast facts:

-More than 263,000 people passed away from opioid overdose from 1999 to 2020 (21 years).
-More than 75,000 individuals died from opioid overdose in just this previous year ending in April 2021.
-10.1 million individuals misused prescription opioids this past year.
-Overdose fatalities involving opioid have increased at the very least 6 times given that 1999.

Its clear that opioids have a high capacity for triggering addiction in people, even when they are taken as recommended. Although there are multiple roads torecovery, only one is referred to as the most effective by the CDC as well as authorized by numerous government agencies (FDA, SAMHSA, and various other companies), and that is Medication- assisted treatment.Medication- assisted treatment( FLOOR COVERING) entails the use of medication, along with cognitive or behavioral therapy, to give an alternative strategy to treatingopioid addiction.

Here at The Family members MD, we integrate reducing edge technology with MAT treatment inWoodland HillsCalifornia.
Although MAT has actually conserved millions of clients from opioid related issues as well as fatality, less than 20% of those struggling with opioid addiction have access to it.In addition to geographic restraints, there is a scarcity of physicians that are learnt its application. According to SAMHSA, much less than 7 percent of physicians are efficiently waivered to treat opioid addiction. Tele- floor covering solutions, like we offer atThe Family members MD, is one means to enhance accessibility to look after those who might not otherwise be able to do so as a result of cost, absence of accessibility to or absence of accessibility of prescribing physicians.

The M inMATstands for certain FDA accepted medicine that is utilized to decrease food cravings as well as physiologic dependence on opioids. While there are several formulations as well as makers, every one of them can be summarized in three medications:.
1) Buprenorphine.
2) Methadone.
3) Naltrexone.
The first two, buprenorphine and also methadone, are both partial as well as full opioid agonists specifically, whereas naltrexone is an opioid villain. While all 3 are authorized for therapy of opioid addiction, maybe the very best one for many clients is buprenorphine/naloxone (Suboxone) as a result of its positive profile. Since it is just a partial agonist, it stops the sensations of bliss when taken, lowers cravings at the very same time, as well as inhibits IV shot. Because of this, buprenorphine/naloxone (Suboxone) is the only FDA accepted treatment that is prescribed at The Family MD. With greater than 95% of clients withdrawal totally free at 5 days, our outcomes are a testimony to our know-how when handling opioid addiction. Set up a visit now to discuss further how we can best aid you achieve long-term soberness.


TRANSITION FROM METHADONE California.


What is Methadone?

Methadone is one of 3 drugs that is FDA approved for the treatment of opioid usage.
condition, as aMedication- assisted therapy( MAT). It is the first of the MAT drugs (authorized in the 1960s) and also is one of the most greatly researched.Unlike the other two medications that are used in MAT, methadoneis a full opioid agonist, which indicates it carries all the risks that any type of other opioid off the road would certainly have.These include bliss, danger of respiratory system clinical depression, possibility of overdose, and also hallucinations among other points. Due to this, other MAT drugs such asSuboxonehave now become a lot more chosen due to its minimal negative effects profile. Woodland Hills California.



How Long Does Methadone Withdrawal Last?

If changing fromMethadoneto one more MAT drug, such asSuboxone, it is initially essential to.
reduce the quantity of methadone one is on to 30 mg daily for at the very least one week. When stable on this dosage, methadone is ceased totally and also suboxone started as soon as mild- modest withdrawal signs and symptoms begin to set in, which is normally after 36 hrs however might vary depending upon dependency extent. After 3 to five days, withdrawal is normally complete as well as client is currently effectively on Suboxone.

The Household MD Specializes in Methadone Dependency and also Withdrawal Therapy.

We provide Medication- assisted therapy with Buprenorphine/Naloxone (Suboxone) to help people.
conquered methadone addictionand withdrawal.Get began today by scheduling a virtual check out with one of our board- licensed doctors.Whether youre at home, at the workplace, or on lunch break, weve obtained you covered and are right here to make recovery easy.Click right here to set up now.

 

  

Exactly how it works
It is important to very first quit all methadone usage. You should wait up until you have moderate to modest withdrawal signs and symptoms (typically 12- 72 hours) before taking your initial dosage of Suboxone. If it is taken too early, it can force you into precipitated withdrawal, which is both extremely uncomfortable as well as may threaten. Proceed as directed by your physician and thats it. Normally 95% of our patients do not have any kind of withdrawal signs and symptoms after the very first 5-7 days of beginning Suboxone. You might additionally request additional medication to aid relieve withdrawal signs so that you can proceed with your everyday tasks (work, institution, and so on) without missing a beat.

 

TREATMENT FOR NORCO WITHDRAWAL Woodland Hills California 

 What is Norco?

Norco is a mix pain medicine, including both acetaminophen and hydrocodone. It is utilized to deal with modest to serious pain. Hydrocodone, which is the addictiveopioidcontained withinNorco, is derived from either codeine or thebaine as well as it is one of the most frequently recommended opioid in the United States. It is generally for short-term discomfort and also is often utilized as an antitussive (cough suppressant). When over used, it can additionally be crushed and snorted. It takes about 10 to half an hour for you to feel the results ofNorcowhen taken and effects can last as much as 4 to 6 hrs. Various other trade names which contain both hydrocodone and acetaminophen are Lortab, Vicodin, Lorcet- HD, Hycodan, and Vicoprofen.


How Much Time Does Norco Withdrawal Last?

The start ofwithdrawal symptomsroughly begins concerning 6 to twelve hours after last use. Signs generally come to a head around day 3 and also are usually significantly reduced by seven to 10 days. Sometimes it is possible to last longer than 10 days depending on the intensity of the addiction and it varies on a situation by case basis.


The Family MD Specializes in Norco Addiction as well as Withdrawal Treatment

We offerMedication- assisted treatmentwith Buprenorphine/Naloxone (Suboxone) to aid clients overcomeNorcoaddiction andwithdrawal. Get started today by arranging an online check out with among our board- licensed medical professionals. Whether youre in your home, at the office, or on lunch break, weve got you covered and also are right here to make healing easy. Visit this site to arrange currently.





How it works
It is necessary to initial stop all Norco usage. You need to wait up until you have light to moderate withdrawal symptoms (normally 12- 72 hrs) prior to taking your initial dosage of Suboxone. If it is taken prematurely, it can require you right into precipitated withdrawal, which is both really uncomfortable and also might be dangerous. Proceed as guided by your physician and thats it. Typically 95% of our clients do not have any withdrawal signs after the first 3-5 days of startingSuboxone. You may also ask for additional medicine to aid alleviate withdrawal symptoms to make sure that you can proceed with your day to day activities (job, school, etc) without missing a beat.

THERAPY FOR OXYCODONE WITHDRAWAL Woodland Hills California


What is Oxycodone?

Oxycodone is a prescription opioid drug that was first made in 1916 from thebaine, an ingredient of poppy plant. It is made use of for treatment of modest to severe discomfort and also is known for being extremely addicting. It generally starts to manage pain within fifteen mins and also can for as much as 6 hrs with the instant release formulation. It is likewise offered under the brand names Roxicodone and OxyContin (which is the prolonged launch type), to name a few. The prolonged release type is slowly launched right into the body and provides all the time discomfort control. Because of the slower beginning, it has less potential for misuse compared tooxycodonewhich has a quicker onset of activity.



How Long Does Oxycodone Withdrawal Last?

The onset ofwithdrawal symptomsroughly begins regarding 8 to twelve hrs after last usage. Signs and symptoms typically come to a head around day three as well as rarely last longer than 5 to 7 days. As always, there can be an extended withdrawal phase depending upon the severity of addiction and also relying on specific factors.

The Household MD Concentrates On Oxycodone Dependency as well as Withdrawal Therapy

We offerMedication- assisted treatmentwith Buprenorphine/Naloxone (Suboxone) to help patients overcomeoxycodone addictionandwithdrawal. Start today by scheduling a virtual see with one of our board- certified physicians. Whether youre at home, at the office, or on lunch break, weve obtained you covered and also are below to make recuperation easy. Click on this link to schedule currently.

 

 

Just how it works
It is very important to very first stop all oxycodone use. You have to wait up until you have light to moderatewithdrawal signs( generally 12- 72 hrs) prior to taking your very first dosage of Suboxone. If it is taken too early, it can force you into precipitated withdrawal, which is both really uneasy and may be dangerous. Continue as guided by your doctor and thats it. Typically 95% of our people do not have any withdrawal symptoms after the very first 3-5 days of beginning Suboxone. You might likewise request added medicine to help ease withdrawal signs to make sure that you can continue with your daily tasks (work, college, etc) without avoiding a beat.

THERAPY FOR FENTANYL WITHDRAWAL Woodland Hills California


What is Fentanyl?

Fentanyl is a synthetic opioid, which means that it is created by pharmaceutical firms in the lab. It is a really effective opioid and also is about 50- 100 times extra stronger than morphine. Due to its strength, it is largely being used for discomfort administration treatment of cancer people. Of note, many customers are uninformed they are purchasingfentanyllaced products when they purchase opioids. Distributors do this since it makes medicines less costly, raises strength, increases habit forming residential or commercial properties, and as a result, makes thesefentanyllaced medicines extremely harmful also in little doses. Beginning to activity is three to five minutes if made use of intravenously. Various other usual types that it is produced in is as a transdermal patch (Duragesic), as a lozenge called lollipops (Aqtic), and in an injectable kind (Sublimaze).



For How Long Does Fentanyl Withdrawal Last?

The start ofwithdrawal symptomsroughly begins concerning six to twelve hours after last use. Signs and symptoms commonly come to a head around day three and also rarely last longer than five to seven days. Nonetheless, it might happen relying on the severity of addiction or instance by case basis.

The Family Members MD Focuses On Fentanyl Addiction and Withdrawal Treatment

We offerMedication- aided treatmentwith Buprenorphine/Naloxone (Suboxone) to aid people overcomefentanyladdiction andwithdrawal. Get started today by scheduling an online check out with among our board- accredited doctors. Whether youre in your home, at work, or on lunch break, weve got you covered and are here to make healing very easy. Click here to arrange currently.





Just how it works
It is essential to initial stop all Fentanyl use. You should wait until you have moderate to modest withdrawal signs (usually 12- 72 hrs) prior to taking your initial dose ofSuboxone. If it is taken prematurely, it can compel you into precipitated withdrawal, which is both extremely uncomfortable and also may be dangerous. Continue as guided by your medical professional which it. Typically 95% of our clients do not have any type of withdrawal symptoms after the very first 3-5 days of beginning Suboxone. You might additionally request extra medicine to help ease withdrawal signs to make sure that you can continue with your everyday activities (job, institution, and so on) without missing a beat.

TREATMENT FOR OXYMORPHONE/OPANA WITHDRAWAL Woodland Hills California

 

What is Oxymorphone?

Oxymorphoneis a highly potentopioidindicated for the therapy of extreme pain. It is a lot more commonly understood asOpanaor Numorphan. It is significantly stronger than morphine as well as is utilized to treat pain that is less competent to various other opioid medications. In 2017, the FDA asked the maker of oxymorphone to eliminate its product from the US market and also since has actually been not available in the US. Nevertheless, prolonged release oxymorphone formulas are still readily available in the US as a result of its slightly lower misuse capacity. The immediate release regulates pain 5-10 minutes if taking IV, as well as after 30 minutes if taken orally, and afterwards last 3-4 hours. If taking the extensive release, discomfort control lasts 12 hours.

 

How Long Does Oxymorphone/Opana Withdrawal Last?

The onset of withdrawal symptoms roughly starts about four to forty eight hours after last use. Symptoms typically intensify at two to five days and peak during the first week.
 

The Family MD Specializes in Oxymorphone Addiction and Withdrawal Treatment

We offer Medication- assisted treatment with Buprenorphine/Naloxone (Suboxone) to help patients overcome oxymorphone addiction and withdrawal. Get started today by scheduling a virtual visit with one of our board- certified doctors. Whether you’re at home, at work, or on lunch break, we’ve got you covered and are here to make recovery easy. Click here to schedule now.  

 

 

How it works

It is essential to first quit all oxymorphone usage. You need to wait until you have light to moderate withdrawal symptoms (normally 12- 72 hours) before taking your initial dose of Suboxone. If it is taken prematurely, it can force you into precipitated withdrawal, which is both extremely uncomfortable and also might be dangerous. Proceed as guided by your physician and thats it. Normally 95% of our patients do not have anywithdrawalsymptoms after the first 5-7 days of startingSuboxone. You may likewise ask for added medicine to aid relieve withdrawal signs and symptoms to ensure that you can proceed with your day to day tasks (job, institution, and so on) without skipping a beat.

TREATMENT FOR TRAMADOL WITHDRAWAL Woodland Hills California

 

What is Tramadol?

When it was at first authorized in 1995, tramadol was not considered an opiate even though its system of action was similar. Nevertheless, as a result of all the cases of misuse as well as dependency, the FDA at some point marked tramadol as a controlled substance in 2014. Compared to other controlled substances nevertheless, tramadol has less capacity for misuse. Due to this, tramadol is among the several usual treatments for osteo arthritis and various other excruciating conditions.


The Length Of Time Does Tramadol Withdrawal Last?

The beginning of withdrawal signs about begins regarding thirty- 6 to seventy- 2 hours after last use. Signs normally last five to eight days. As always, there can be a long term withdrawal phase relying on the seriousness of addiction as well as depending on individual aspects.


The Household MD Focuses On Tramadol Addiction and also Withdrawal Treatment

We provide Medication- assisted treatment with Buprenorphine/Naloxone (Suboxone) to assist individuals overcome tramadol dependency as well as withdrawal. Get going today by arranging a virtual check out with one of our board- certified physicians. Whether youre at home, at the workplace, or on lunch break, weve got you covered as well as are here to make recovery simple. Go here to schedule now.

 

 

How it works

It is important to first quit all tramadol use. You have to wait up until you have mild to modest withdrawal signs and symptoms (typically 12- 72 hours) prior to taking your very first dosage of Suboxone. If it is taken prematurely, it can force you right into precipitated withdrawal, which is both extremely unpleasant as well as might be dangerous. Proceed as guided by your medical professional and thats it. Typically 95% of our people do not have any kind of withdrawal signs and symptoms after the first 3-5 days of starting Suboxone. You might likewise ask for extra medication to aid reduce withdrawal symptoms so that you can proceed with your everyday tasks (work, college, and so on) without missing a beat.TRAMADOL

TREATMENT FOR CODEINE WITHDRAWAL Woodland Hills California

 

 What is Codeine?

Codeine is an opiate that is commonly found is prescription- grade cough suppressants. Tylenol 3, a popular painkiller, is codeine combined with acetaminophen. Because codeine- based cough syrups are less regulated that some other opiates considered to be more dangerous (Such as morphine and oxycodone), it is relatively easy to start getting and abusing it. Once ingested, codeine is converted into morphine in the body, thus producing similar effects but to a lesser degree.  

 

 How Long Does Codeine Withdrawal Last?

The onset of withdrawal symptoms roughly starts about four hours after last use. Symptoms typically intensify at one to three days and peak during the first week. The final phase of codeine withdrawal can last anywhere from one week after last dose and can linger for months.

The Family MD Specializes in Tramadol Addiction and Withdrawal Treatment

We offer Medication- assisted treatment with Buprenorphine/Naloxone (Suboxone) to help patients overcome tramadol addiction and withdrawal. Get started today by scheduling a virtual visit with one of our board- certified doctors. Whether you’re at home, at work, or on lunch break, we’ve got you covered and are here to make recovery easy. Click here to schedule now.  

 

 

How it works

It is important to first stop all methadone use. You must wait until you have mild to moderate withdrawal symptoms (generally 12- 72 hours) before taking your first dose of Suboxone. If it is taken too early, it can force you into precipitated withdrawal, which is both very uncomfortable and may be dangerous.  Continue as directed by your doctor and that’s it. Generally 95% of our patient’s do not have any withdrawal symptoms after the first 5-7 days of starting Suboxone. You may also request additional medication to help ease withdrawal symptoms so that you can continue with your day to day activities (work, school, etc) without skipping a beat .

TREATMENT FOR MORPHINE WITHDRAWAL Woodland Hills California

 

 What is Morphine?

Morphine is considered the classic opioid analgesic with which other painkillers are compared. It is a non- synthetic narcotic that is derived from opium and has a high potential for abuse. Traditionally morphine was almost exclusively used by injection, but the variety of pharmaceutical forms that it is marketed as today supports its use by oral and other routes of administration.  

 

How Long Does Morphine Withdrawal Last?

The onset of withdrawal symptoms roughly starts about four hours after last use. Symptoms typically intensify at one to three days and peak during the first week.

The Family MD Specializes in Morphine Addiction and Withdrawal Treatment

We offer Medication- assisted treatment with Buprenorphine/Naloxone (Suboxone) to help patients overcome morphine addiction and withdrawal. Get started today by scheduling a virtual visit with one of our board- certified doctors. Whether you’re at home, at work, or on lunch break, we’ve got you covered and are here to make recovery easy. Click here to schedule now.  

 

 

 

How it works

It is important to first stop all morphine use. You must wait until you have mild to moderate withdrawal symptoms (generally 12- 72 hours) before taking your first dose of Suboxone. If it is taken too early, it can force you into precipitated withdrawal, which is both very uncomfortable and may be dangerous. Continue as directed by your doctor and that’s it. Generally 95% of our patient’s do not have any withdrawal symptoms after the first 5-7 days of starting Suboxone. You may also request additional medication to help ease withdrawal symptoms so that you can continue with your day to day activities (work, school, etc) without skipping a beat .

TREATMENT FOR HYDROMORPHONE WITHDRAWAL Woodland Hills California

 
What is Hydromorphone?

Hydromorphone, also commonly known as dilaudid, is an opioid medication used to treat severe pain. It is a semi- synthetic opioid that is derived from morphine, however it is 2-8x more potent than morphine. It has higher addictive potential because of its shorter duration to onset and causes greater sedation. It is used to treat pain that is not controlled by other opiate medications.  

 

 How Long Does Hydromorphone Withdrawal Last?

The onset of withdrawal symptoms roughly starts about four to eight hours after last use. Symptoms typically intensify and peak at one to two days. After three days the symptoms should start to subside and are generally resolved after the first week.

The Family MD Specializes in Hydromorphone Addiction and Withdrawal Treatment

We offer Medication- assisted treatment with Buprenorphine/Naloxone (Suboxone) to help patients overcome hydromorphone addiction and withdrawal. Get started today by scheduling a virtual visit with one of our board- certified doctors. Whether you’re at home, at work, or on lunch break, we’ve got you covered and are here to make recovery easy. Click here to schedule now.  

 

  

How it works

It is important to first stop all hydromorphone use. You must wait until you have mild to moderate withdrawal symptoms (generally 12- 72 hours) before taking your first dose of Suboxone. If it is taken too early, it can force you into precipitated withdrawal, which is both very uncomfortable and may be dangerous. Continue as directed by your doctor and that’s it. Generally 95% of our patient’s do not have any withdrawal symptoms after the first 5-7 days of starting Suboxone. You may also request additional medication to help ease withdrawal symptoms so that you can continue with your day to day activities (work, school, etc) without skipping a beat .
 

TREATMENT FOR MEPERIDINE WITHDRAWAL Woodland Hills California

What is Meperidine?

The brand variation of Meperidine is called Demerol. It has a misuse prospective similar to that of morphine, yet it ought to not be utilized for therapy of chronic discomfort. Meperidine ought to only be used in the therapy of severe episodes of extreme pain due to the risk of seizures from the accumulation of meperidine metabolites, namely normeperidine, if it is made use of long term. In addition to seizures, it can additionally cause serotonin syndrome if made use of in combination with certain medications. It is available in intramuscular, subcutaneous, intravenous, syrup, and tablet kinds.



How Much Time Does Meperidine Withdrawal Last?

The start of withdrawal symptoms about starts concerning three- twenty 4 hours after last use. Signs and symptoms usually peak around three days as well as begin to reduce in strength after the very first week. Some signs and symptoms might be presented for a long term amount of time relying on the extent of the dependency.

The Household MD Concentrates On Meperidine Dependency and Withdrawal Treatment

We offer Medication- assisted treatment with Buprenorphine/Naloxone (Suboxone) to assist individuals conquer Meperidine dependency and withdrawal. Start today by scheduling a virtual see with among our board- accredited doctors. Whether youre in the house, at the office, or on lunch break, weve obtained you covered as well as are here to make recovery simple. Click on this link to schedule now.







Just how it functions

It is important to very first quit all Meperidine usage. You need to wait till you have light to modest withdrawal signs and symptoms (usually 12- 72 hours) prior to taking your very first dose of Suboxone. If it is taken too early, it can require you into precipitated withdrawal, which is both extremely uncomfortable and might threaten. Proceed as guided by your physician and thats it. Usually 95% of our individuals do not have any withdrawal symptoms after the very first 5-7 days of starting Suboxone. You may additionally ask for additional drug to aid alleviate withdrawal signs to ensure that you can continue with your everyday activities (job, college, and so on) without skipping a beat.