In Search of the Holy Grail

In popular culture, the term “the holy grail” is often used to describe the ultimate object of desire. You might consider the idea of a non-addictive pain-killer that could be used after surgery or to quell arthritis pain as one ‘holy grail’ of medicine. The drug companies have been more than willing to take part in this particular quest—oxycontin was one example of a failed quest for the holy grail of medicine. Now marijuana is being touted as the new solution to chronic pain and a number of other medical conditions. However, some doctors and researchers are not yet convinced.

The May Issue of the AARP Bulletin includes an article on medical marijuana. The article notes that medical marijuana is legal in 38 states. The market for marijuana gummies has exploded. The article cites one example of an 89-year-old woman in Maryland who started a cannabis club at Leisure World, her retirement community. She sells edibles and gummies. In the article she notes that gummies can be dangerous in older adults.

The article notes that last year the percentage of people purchasing chewable marijuana surpassed the percentage of people buying smokable marijuana. Since smoking tobacco has become socially unacceptable, it makes sense that marijuana gummies would become more popular than smoking marijuana.

The article mentions that marijuana can help with chronic pain and sleep and anxiety problems. However, the article also notes that marijuana does not seem to help with short-term pain.

There is also the danger of the delayed effect of eating gummies—it takes two or three hours to feel the full effect, so it is easy to take too many. In 2023 a study found that emergency room visits for marijuana-related problems increased 1,808 percent among people 65 and over in California from 2005 to 2019. It has also been discovered that mental problems and heart problems were more common among those who used marijuana edibles than those who smoked or vaped marijuana.

The article in the AARP Bulletin concludes, “…at Leisure World Cannabis 101 Club, Carminetta Verner is very cautious about spreading the gummy gospel. She recommends that new users keep a detailed journal of what they take, as well as the results, to see whether a gummy, or anything else, helps or has side effects. “Each person’s metabolism is different, and you have to learn how your body reacts,” she says. “The cannabis mantra is ‘start low and go slow.’””

The May 2024 issue of Newsmax Magazine also included an article about marijuana. The article cited a Danish study published in the Journal of the American Medical Association: Psychiatry (JAMA) last year.

The article in Newsmax states that between 1995 and 2010 the percentage of Danish schizophrenia diagnoses associated with marijuana usage had nearly quadrupled, and the combination of greater usage with stronger pot is bringing down the age of first onset of mental illness. Someone who might have gotten into their late 20’s without a psychotic episode could now be faced with their first break with reality while still in their teens. The article at Newsmax concludes by stating that marijuana can make treating mental illness more difficult and can throw a person’s life off course before it has a chance to get on course. It also mentions that the marijuana of today is stronger and more addictive than the marijuana than the marijuana of the 1960’s. Neither article referenced above is willing to describe marijuana as a harmless drug.

 

Medical Marijuana: Benefit or Slippery Slope?

Author:  R. Alan Harrop, Ph.D

Well, here we go again. The N.C. General Assembly may be considering making marijuana legal for medical use, which they declined to approve in the last session. Apparently enough people in North Carolina (or at least in the General Assembly) are pushing this idea so that it keeps coming up. Let’s take a look at the pros and cons of medical marijuana. It should be noted that medical marijuana is legal in 38 states and the District of Columbia.

There is surprisingly little valid scientific research on the health benefits of marijuana. Most of what is claimed is based on anecdotal reports or small studies on short term benefits. Some of the claims are that it relieves nausea caused by some cancer treatments, relief of chronic pain, although not severe pain such as from surgery or broken bones, epilepsy and seizures, Alzheimer disease symptoms, HIV/Aids, and Crohn’s disease. Marijuana has over 100 different chemicals, so it is difficult to isolate the beneficial elements for each disorder. CBD is alleged to have positive effects on health while THC produces the euphoria or high that people experience. It should also be noted that marijuana is used to treat the symptoms of a medical condition, not the cause of that condition. Another important issue is whether there already exist legal drugs or treatments that patients can readily access that address these symptoms.

There are also negative effects. Because marijuana is a mind altering substance, changed perception and reaction times can negatively affect things like driving, leading to more injuries and deaths. Children can be especially harmed if they access marijuana, particularly ingestible forms such as gummy bears, cookies, brownies, etc. Although the long term impacts are not clearly understood, cognitive thinking ability and memory declines are documented for all ages. Confusion, poor muscle coordination, and dizziness are common. Motivation to lead a rewarding traditional life of work, family, and associated rewards often deteriorates, leading to nonproductive citizens. No society can flourish with large numbers of citizens addicted to drugs. Of course, the euphoria induced by marijuana is strongly related to its addictive potential and especially to its role as a gateway drug that leads the user to more potent drugs such as meth or heroin. Having worked in the N.C. Department of Correction as the Mental Health Services Director, I can testify to the numerous cases of criminal behavior in pursuit of illegal drugs that started with smoking marijuana. Interestingly, the FDA has not approved marijuana for general medical use except lab produced Epidiolex, Marinol and Cesamet to treat nausea and vomiting from chemotherapy, and low appetite for HIV patients.

Recent reports of the dramatic increase of China’s role in the marijuana trade adds another risk that should concern us all. There is increasing evidence that Chinese invaders are controlling the production and distribution of marijuana from California to Maine. They grow it and distribute it throughout the country, relying on the increased flow of illegal Chinese over our southern border for laborers. The Chinese are also the originators of the fentanyl crisis that is killing somewhere near 100,000 Americans each year. Now what could possibly go wrong with our biggest adversary, China, controlling marijuana and fentanyl production which can produce a deadly combination? Are we on a path of self-destruction? It makes one wonder. Twenty four states that started with medical marijuana have now legalized its recreational use. Result: 20% of the US population now report using marijuana. So if you think using marijuana is a good thing, then support medical marijuana since that is what is most likely to occur. Personally, I do not.

Does North Carolina Need Medical Marijuana

In the past, my objection to medical marijuana has been based on the abuses I have seen in other states. Before California legalized recreational use of marijuana and after California legalized medical marijuana, the last four or five pages on the newspapers in California were filled with advertisements from doctors who were willing to prescribe marijuana for pretty much anything from dandruff to a hangnail. The medical marijuana clinics were simply supporting the recreational uses by placing a very thin veneer over the recreational use of the drug. Now, some other problems with marijuana are coming to light. Even as we learn that marijuana has some valid medical uses, we need to look at the downside of legalizing medical marijuana.

On Wednesday, The Carolina Journal posted an article that contained some warnings about legalizing medical marijuana.

The article reports:

Dr. Christian Thurstone, director of behavioral health at Denver Health and professor of psychiatry at University of Colorado, held a media event in October warning North Carolinians not to repeat Colorado’s mistakes surrounding medical marijuana. He was invited to speak by the Triangle Christian Medical and Dental Associations in reaction to N.C. Senate Bill 711, the N.C. Compassionate Care Act.

The bill passed the state Senate 36-7 on third reading in June but did not move in the state House before session ended. A similar bill is likely to be introduced next session and could be considered in 2023.

Thurstone spoke for about 45 minutes and then gave those attending a chance to ask questions.

Thurstone’s main criticisms were that SB 711 allows marijuana in any form for patients, including powerful food products; allows marijuana as a treatment for too many conditions; allows for more than one caregiver to handle the drug; spreads distribution throughout the state, so counties don’t have the option of opting out like they do in Colorado; permits distributors to own more than one center, which led to commercialization of the marijuana business elsewhere; and allows those under 18 to receive marijuana if they have a signature from guardian without specifying safeguards to prevent forgery of signatures.

He said, “This bill is about creating an industry,” and is less about creating a compassionate new form of treatment available.

…Thurstone went through a number of slides showing data about the immediate but temporary bump in those under 18 using marijuana after their bill passed and the more sustained increase of those 18-25 using marijuana (which is now at 32% compared to 23% in the U.S. overall).

Later he spoke about the boom in new powerful products like gummies and drinks that were legally available and advertised. Many of these products and strains have 20-30% THC, which is 10 times stronger than traditional marijuana which had 2% or 3% THC.

The “concerns” section of the speech was subtitled “cars and kids,” as those were the two main areas he said N.C. should keep in mind. For cars, he mentioned a spike in traffic accidents where the driver tested positive for marijuana, rising from 9% in 2009 to 21% in 2019 in Colorado. And despite jokes that high drivers are better because they drive slower, he said the evidence shows they have twice the risk of car accidents, due to difficulty staying in lane, slower reaction times, more weaving, and worse attention and distractibility scores.

Medical marijuana is not compassionate. It creates more problems than it solves. The explosion of vape shops in the state in recent years has as much to do with the increase in vaping as it does the idea that when marijuana becomes legal for medical use (and then for recreational use, which will follow), the shops will already be in place.

Make no mistake–medical marijuana will follow a path very similar to Oxycontin–it may begin well, but it will not end well.

Those Who Fail To Learn The Lessons Of History…

The North Carolina legislature is currently debating the legalization of medical marijuana. There are some medical benefits to marijuana, but we also need to consider the downside. There are some medical benefits to Oxycontin, but we know how that worked out. Remember, we were told that Oxycontin was the answer to pain that was non-addictive and safe. We are being told the same thing about marijuana. One problem with medical marijuana is the regulation (or lack of regulation). During a visit to California many years ago, when medical marijuana was legal and recreational marijuana was not, the last five pages of the Sunday paper were ads by doctors who would prescribe medical marijuana for anything from ingrown toenails to broken bones. We should also be aware that laws permitting recreational marijuana use are a small step from laws permitting medical use.

A member of the Craven County Sheriff’s office informed me that a recent event in the County brought the perils of legal marijuana to the attention of our Sheriff’s Office. A package was intercepted in the Craven County mail that contained marijuana. The package came from Josephine County, Oregon, where recreational marijuana is legal. Josephine County in 2021 had a population of approximately 88,000 people.

A website called crimegrade.org reported the following about Josephine County:

Another site comments that the crime rate in Josephine County is steadily rising. So, what has been the impact of legalized marijuana on this county? The cartels have come in to buy the land to grow more marijuana. Sixty-six percent of the land is forest, and that land is being viewed as a potential source of revenue as marijuana fields. People are being forced to sell their land to the cartels or face dire consequences. There has also been an increase in arrests for driving while impaired and an increase in automobile accidents. I have heard from various law and order sources that marijuana is indeed a gateway drug. Addicts begin experimenting with other drugs in order to find a ‘higher high.’

A member of the K-9 Unit in Craven County shared some information about the impact of legalizing marijuana on the unit’s drug dogs. If marijuana becomes legal, the dogs have to be retrained not to sniff it out and/or be retired. That is expensive, time-consuming, and a difficult process. It could also have legal ramifications–a defense attorney could claim that the dog smelled marijuana, not an opiate, and the search of the vehicle or person that followed was not legal. The result of this is that police departments and sheriff’s offices that have dogs trained to sniff out marijuana are generally retiring the dogs. Since the cost of replacing a dog is between $9,000 and $15,000 per dog, they are rarely replaced. That alone will increase the amount of drug traffic in an area. It is also highly unlikely that the increased tax money from marijuana will be used to replace the dogs (as we have learned from the other states with the same issues that legalizing marijuana has caused).

When we talk about legalizing marijuana, we also need to think about the people we are ‘competing’ with for the money involved–the cartels. In California and Colorado, the state taxes on marijuana increased so rapidly that the cartels moved back into the picture. In June 2020 I posted an article at rightwinggranny about the cartels moving back into California because the state taxes on marijuana had increased so dramatically (article here:  https://www.rightwinggranny.com/?p=39161). The cartels are not nice people. They bring more crime into an area. We also need to think about the risks to police when cartels are active in an area. Consider the fact that a small amount of drugs may be worth thousands of dollars. The mule carrying those drugs knows that if he does not give the money for those drugs to his boss, he may lose his life. The stakes are high, and police and others lose their lives in the process. This is one of the more serious results of legal marijuana and the tax policies that follow.

Medical marijuana sounds like a reasonable solution, but it is actually the beginning of many more problems.

It’s About The Money–Health Concerns Are Being Ignored

Many of our more liberal states are looking for additional sources of revenue. Unfunded liabilities and expanded welfare programs and medical programs have been very expensive to the states that have embraced them. One thing that many states are looking at to increase tax revenue is the legalization of marijuana. On Saturday, Yahoo Finance posted an article about how much income legal marijuana is actually generating in California.

The article reports:

California’s legal cannabis revenue isn’t growing as fast as many state officials anticipated, recent data suggests. And one industry expert believes that taxes and a still thriving black market for marijuana, are partly to blame.

“The legal market is struggling with the set of regulatory rules and tax rates that are pretty onerous and make it fairly uncompetitive versus a thriving black market that’s had the whole industry for 60 years now,” Tom Adams, BDS Analytics managing director, told Yahoo Finance’s YFi PM in an interview this week.

California’s marijuana excise tax produced $74.2 million in revenue for the second quarter of this year, according to the California Department of Tax and Fee Administration.

Yet back in January, Governor Gavin Newsom’s proposed budget predicted the state would generate $355 million in excise tax revenues for the fiscal year. That projection was later revised down again to $288 million back in May.

The shortfall is reminiscent of Michigan, where a nascent medical marijuana market has resulted in lower than expected revenue.

Adams contended the legal market faces additional expenses like the cost of testing, that the illegal market does not.

Meanwhile, there is evidence that marijuana is harmful to the developing brains of young adults. There also may be a link between marijuana and mental illness.

In January 2019 I posted an article which stated:

After an exhaustive review, the National Academy of Medicine found in 2017 that “cannabis use is likely to increase the risk of developing schizophrenia and other psychoses; the higher the use, the greater the risk.” Also that “regular cannabis use is likely to increase the risk for developing social anxiety disorder.”

…These new patterns of use have caused problems with the drug to soar. In 2014, people who had diagnosable cannabis use disorder, the medical term for marijuana abuse or addiction, made up about 1.5 percent of Americans. But they accounted for eleven percent of all the psychosis cases in emergency rooms—90,000 cases, 250 a day, triple the number in 2006. In states like Colorado, emergency room physicians have become experts on dealing with cannabis-induced psychosis.

Cannabis advocates often argue that the drug can’t be as neurotoxic as studies suggest, because otherwise Western countries would have seen population-wide increases in psychosis alongside rising use. In reality, accurately tracking psychosis cases is impossible in the United States. The government carefully tracks diseases like cancer with central registries, but no such registry exists for schizophrenia or other severe mental illnesses.

On the other hand, research from Finland and Denmark, two countries that track mental illness more comprehensively, shows a significant increase in psychosis since 2000, following an increase in cannabis use. And in September of last year, a large federal survey found a rise in serious mental illness in the United States as well, especially among young adults, the heaviest users of cannabis.

Is the extra tax revenue worth it?

When The Federal Government Gets Involved In Medicine

Townhall posted an article today about the lack of logic in the current move to put more restrictions on opioids but decrease restrictions on marijuana use.

The article reminds us that marijuana is very loosely regulated in some states:

For example, in Arizona, where medical marijuana is legal, users can purchase up to 2.5 ounces every two weeks. This is enough to be stoned every day. Once you have a prescription, you can refill it for an entire year without going back to renew the prescription. It’s easy to get a prescription in most states that have legalized medical marijuana, just inform a doctor you have pain. And if you live in a state like California that has legalized recreational marijuana, there aren’t even any limits on how much you can buy (just how much you can have on hand).

Opioids are another story:

By October of this year, 33 states had passed laws limiting opioid prescriptions. They limit the supply a doctor may prescribe to seven days or less. This exponentially increases problems with timely refilling prescriptions. One chronic pain sufferer complained, “The insurance companies are lying to their own subscribers in the Prior Auth Dept, ignoring, transferring to dead lines, long appeals that go nowhere, on & on….” It also means more co-pays. Some states are now requiring doctors and pharmacists to take a course on opioids. 

Many states have limited the maximum dose as well. Federal opioid prescribing guidelines recommend doctors use caution in prescribing above 50 MME/day. But many patients need 90 MME/day or higher. In Arizona, patients are limited to 90 MME/day. There are exceptions for some types of illnesses — but not chronic pain. For those sufferers, they can only receive a higher dose if their doctor consults with a board-certified pain specialist. 

The article concludes:

The reality, according to the National Pain Report, is “America’s so-called ‘opioid epidemic’ is caused by street drugs (some of them diverted prescription drugs)  rather than by prescriptions made by doctors to chronic pain patients.” More people die from illegal opioids than prescription opioids. Opioid prescriptions were already decreasing before the crackdown started. In Arizona, prescriptions decreased every year since 2013, a 10 percent decrease total.  

And just because a few doctors overprescribed opioids does not mean everyone should be treated like a dangerous addict at risk of overdosing. One size does not fit all. Someone who has been taking a higher dosage of prescription opioids for years without incident should be allowed to continue.  

Over 11 percent of the population suffers from chronic pain. It is cruel and bad medical science to prevent this segment from the population from getting the only relief that works for many of them. The laws need to be changed to allow those legitimately suffering to access adequate amounts of prescription opioids, without risk to their doctor or pharmacist. It makes no sense as we’re relaxing the laws prohibiting marijuana.    

Marijuana has somehow achieved something of a protected status. At the same time we have all but eliminated any positive image of tobacco smoking from our culture, we are promoting the idea of legalizing marijuana all over the country. It truly defies logic.

A Story That Needs To Be Told

On October 6, Neal Pollack posted an opinion piece in The New York Times. The title of the opinion piece is, “I’m Just a Middle-Aged House Dad Addicted to Pot.”

The opinion piece details the author’s journey from using marijuana regularly in his 20’s to the realization that he was hooked on the drug.

Some observations from the author:

I started smoking regularly in the ’90s, when I was in my mid-20s. Pot made everything better — food, music, sex, cleaning — and it made nothing worse. I got depressed less often. I laughed all the time.

But I also lost my temper for no reason. Did I yell at strangers in public? Probably. I barely remember, because I was stoned. But I do remember that once, high as a promotional blimp, I got into a bar fight with a former friend and broke his tooth with a beer bottle.

Back when my writing career was booming, I got invited a couple of times to do readings in Amsterdam, a bad gig for a pot addict. Once, after ingesting a couple of THC pills, I dumped a pitcher of water over my head and insulted the Iraqi representative to National Poetry Day Amsterdam. Another time, I pulled down my pants and flashed a crowd of several hundred. If I had any boundaries, weed erased them thoroughly. The boom ended fast.

…In early November (2017), I had the chance to fulfill my lifelong dream of attending a Dodgers World Series game. I spent way too much money on a ticket that turned out to be fake. So high that I couldn’t remember where I’d parked, I started screaming outside the stadium. If I’d been sober, I would have just called the vendor and gotten a refund. That’s what I ended up doing, eventually. But not before security guards surrounded me.

I looked into a car mirror and saw an old man, sobbing over a baseball game. That was the moment I accepted that I had a problem. Three weeks later, I quit.

Mr. Pollack has a few thoughts on how to handle the legalization of marijuana:

There’s a reason that Alcoholics Anonymous started in 1935, two years after the end of Prohibition. Alcohol abuse became rampant, and the country almost drank itself off the rails. Will the same thing happen with marijuana?

Marijuana isn’t alcohol or an opioid. You can’t die from an overdose. It doesn’t really evince physical cravings. So is it better to call my problem marijuana “dependence”? Does it matter?

Cannabis should be legal, just as alcohol should be legal. But marijuana addiction exists, and it almost wrecked my life. If you have a problem, you are not alone.

I personally think marijuana should be limited to medicinal purposes and be a controlled substance. In places where it is legal, children have gotten into mom and dad’s stash and had severe medical issues. There is also an increase in auto accidents due to driving while under the influence of marijuana. I understand that the concept of medical marijuana has been abused in the past, and I have no solution for that. I just think most people function better when they are not under the influence of drugs (or alcohol).

An Interesting Question

CNS News posted a very interesting article today. The article asks the question, “Why No Warning Label on Marijuana?” That is a fascinating question. The government puts warning labels on everything–my hairdryer reminds me not to use it in the shower, my iron reminds me that it can get hot, the coffee I buy at Dunkin’ Donuts (I did live in Massachusetts for a very long time) tells me on the cup that the contents may be hot. So why is marijuana exempt from big daddy government?

The article reports:

The best known warning label, of course, is the one that the United States Surgeon General has required on cigarette packs since 1966. Also well-known is the warning label on alcoholic beverage containers, which states that drinking alcohol during pregnancy may cause birth defects, that people should not drink and drive, and that alcohol may cause other health problems.

That marijuana is a drug there is no doubt. The FDA states that “marijuana and marijuana-derived products” are “drugs.”

According to the National Institute of Drug Abuse, marijuana is “the most commonly used illicit drug in the United States.” According to the Drug Enforcement Administration (DEA), “marijuana is a mind-altering (psychoactive) drug.”

The Surgeon General’s 1996 report entitled “Facing Addiction in America” describes marijuana as one of the “addictive drugs.”

Likewise, marijuana is not safe.

Despite all the recent changes in many state laws over the last five years and the massive public advocacy and lobbying of the emerging multi-billion-dollar marijuana industry, the FDA has not changed its position on marijuana but continues to hold that it “has not approved marijuana as a safe and effective drug for any indication.” Now, within the last nine months, two new reports on the dangers of marijuana have been issued.

So why are reports of the dangers not resulting in warning labels?

The article contains on example of the warning that would be appropriate for marijuana:

WARNING. Using cannabis can lead to the development of schizophrenia, other psychoses and other mental-health problems. Cannabis can cause hallucinations, delusions, and panic attacks. Cannabis can cause an increase in suicide ideation and suicide attempts. Smoking cannabis can worsen respiratory infections and bronchitis episodes. Using cannabis can lead to an increased risk of motor vehicle crashes. Maternal cannabis smoking is associated with the lower birth weight of babies.

The crusade against cigarettes included both warning labels and an extensive public-education campaign. Today, public education about marijuana consists in emphasizing that legalized marijuana will supply both “jobs and taxes.”

The usual answer to the type of question the article asks is ‘follow the money.’ In this case, it seems that many states are more interested in the tax money they will receive from the legalization of marijuana than the damage it will cause to the people using it. I don’t object to the legitimate use of marijuana for medical purposes, but if you look at the ads in the back of the newspaper in states where medical marijuana is legal, you quickly realize that an unethical doctor can write a prescription for marijuana to cure an ingrown toenail. There are so many areas where the government interferes to ‘protect’ Americans, it is interesting that the government chooses to remain silent about a danger that is rapidly becoming socially acceptable.

Common Sense From Patrick Kennedy

Yes, you read that right. Patrick Kennedy, former Congressman from Rhode Island, has started Smart Approaches to Marijuana (SAM), a group to fight the increasing legalization of marijuana.

Accuracy in Media posted an article yesterday showing some of the reporting on the new group::

The paper (The Washington Post) said Kennedy wants “to shift the debate from legalization to prevention and treatment—despite what appears to be a growing social acceptance of the drug.”

That “growing social acceptance” is being driven by the drug-friendly media, the pro-drug entertainment industry, and a dope lobby led by the Drug Policy Alliance that is mostly funded by billionaires such as George Soros.

I don’t know a lot about marijuana–I am so old that there were no drugs in the schools when I was in high school. The general concept of a drug addict in the early 1960’s was someone with a needle injecting drugs, and there was no way that was socially acceptable. However, I have been exposed to teenagers and adults who have used marijuana, and I can honestly say that I have never seen anyone whose life improved due to drug use. I am not convinced that we truly understand the effect of marijuana on the human body–long term or short term.

The article further reports:

Kennedy’s involvement follows other experts who have been discussing marijuana’s threat. Mental health expert Clayton Cramer tells Accuracy in Media, “The studies that have been done on the subject clearly demonstrate not just a correlation between mental illness and marijuana use, but a causal connection.”

However, the pro-marijuana movement is on the move, with the state of Oregon sinking so low as to authorize the use of “medical marijuana” for a 7-year-old child with leukemia. The child’s father, who is divorced from the girl’s mother, reported the marijuana use to child welfare officials and said that he found the little girl “stoned out of her mind.”

The prospect of Patrick Kennedy’s involvement gives hope to those who believe the U.S. has been surrendering the war on drugs.

It is good news that Patrick Kennedy has taken up this cause. Hopefully we can stop the legalization train before we become a nation of narcissists smoking pot to avoid facing reality.

I would like to mention something that I noticed on a visit to California, where medical marijuana is legal. The last two pages of the Sunday newspaper were filled with advertisements from doctors stating that they prescribed marijuana for headaches, digestive problems, etc. It was obvious from the ads that all you had to do if you wanted to smoke marijuana legally was go to one of these doctors and complain that you had a headache. In states where marijuana has actually been legalized, it is not even necessary to visit a doctor, but in California, a doctor’s visit is necessary before you can legally smoke pot.

I rather doubt that increasing drug use is an indicator of a healthy society. The obvious questions here is, “Who profits by making marijuana legal?” I don’t have the answer to that questions, but I suspect it would explain a lot.

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