What is CBD?
What’s the difference between CBD and Marijuana?
Is CBD really what people say it is?
CBD is everywhere. It can be hard to know exactly what CBD is and isn’t. You can search on the internet and it seems the loudest voices are promising huge returns if you only try this miracle cure. You can buy CBD from nearly anywhere in any kind of formulation. In fact the availability of it makes it seem even less likely to be a real cure for anything. I wanted to bring you the facts about CBD. In this 2-part topic we’ll talk about what CBD is, how its made, how it works and how to find real CBD. In the second part we’ll talk about the research surrounding CBD and what conditions seem to be most impacted by CBD.
You’re listening to the All Things Substance podcast, the place for therapists to hear about substance abuse from a mental health perspective. I’m your host, Betsy Byler and I’m a licensed therapist, clinical supervisor, and a substance abuse counselor. It is my mission to help my fellow therapists gain the skills and competence needed to add substance use to their scope of practice. So join me each week as we talk about All Things Substance.
Welcome back to the All Things Substance podcast. This is episode 65.
We’ve been covering substances for close to a year and we’re coming to the end of them. This doesn’t mean that we won’t do an episode in the future if a new substance comes out, but we’ve covered pretty much everything. If you haven’t had a chance to check them out, you can head over to betsybyler.com/podcast and find all of the episodes.
Today it’s not a substance of abuse because this isn’t one that’s being abused or getting you high. Instead, it’s a substance of interest. We’re going to be studying CBD or cannabidiol. CBD, as it’s abbreviated, is everywhere. You can buy CBD pretty much everything: gummies, drinks, foods, supplements, oil, vape cartridges and just about any other kind of thing you can imagine.
There are a few questions I think that a lot of people have. This is going to be a two episode topic. First, we’re going to talk about what CBD is and how it’s made. In the second part, we’re going to talk about the research and what claims are being made that are accurate, and which ones really don’t have a lot of research behind them.
As always this is meant to be as unbiased as possible. I’ll start by saying that initially the CBD craze was kind of annoying. As someone who works with a lot of people that smoke marijuana, the constant defense of marijuana, and it being harmless and even a cure for everything that ails us is frustratingly common for those of us who work in the field. So CBD being everywhere was sort of an eye-rolling experience for me.
As time has moved on and the CBD craze has broadened a bit. There have been a couple of things emerging. That there is legit CBD that has some real potential and some real uses and junk CBD that is just a bunch of trash chemicals put together and labeled CBD. So I no longer have the eye-rolling thing when I see CBD, in most places anyway. When I see them making these crazy claims about what it can cure, that’s frustrating. For me, the reason it’s frustrating is that generally people just want to feel better. They want to have something that works for them. There is no shame in that and if CBD is the thing, then they’re willing to try it. The misinformation is the hard part.
As therapists. I think that CBD is uniquely something that we need to know about. I recall working with one of my clients and wanting her to get on an anxiety medication because her anxiety is incredibly severe. The frustrating part was that she was under age at the time and needed parental permission. Her parent was struggling with the idea of using a pharmaceutical and kept pushing CBDs and was adamant that she tried CBD and essential oils. The struggle here is that those things aren’t meant to do what pharmaceutical grade anti-anxiety medications can do. That was frustrating for me and for my client.
I can hear someone thinking, “well, how do you know it wouldn’t work?” I don’t know and it’s certainly something that my client could have tried. However, my client wasn’t open to that. She was a really self-directed and bright teenager who wanted to do medication. She felt like there was solid research as she had done research online, looking at different medications.
The fear that people have about certain pharmaceuticals is understandable. The idea though, that because something is “natural” it is somehow better, that gets frustrating and potentially can keep people from getting better.
If my client had been all about trying CBD. Absolutely, I would have been on board. I usually ask clients to keep some kind of a log of daily anxiety or depression, depending on what we’re looking at so that we can tell whether things are better over time, rather than relying on subjective experience. I find that if I talk to someone on a day that they’re feeling really good, that their view of the last few weeks is more sunny. And if I talk to them on a day when they’re feeling really terrible, that their view of the past two weeks is pretty low. So I like to have something a little more objective. All of that, to say that in our practices CBD comes up. If it hasn’t come up for you yet, I’m sure it will.
People are curious about things that can help them. CBD feels accessible because you don’t need a doctor to do it and it’s going to be cheaper if you don’t have insurance. In the United States, a lot of our decisions are based on what insurance will pay for or not.
So in order to do a full discussion of CBD, we’re going to start at the beginning. We need to first talk about the plant where this comes from. It is the cannabis plant and you’re right. Cannabis is another name for marijuana. Cannabis Sativa, and Cannabis Indica are the two main categories of strains coming from the cannabis plant.
For our purposes today, we’re going to be focusing on Cannabis Sativa. The cannabis plant is indigenous to Central Asia, and particularly in the Indian sub-continent. Though it’s usage has been shown much further than that. Archeological records suggest its cultivation dates back to the birth of agriculture.
As a strong fibrous material hemp was used as textile fiber. The cannabis plants can produce both what we know as marijuana and what we know as hemp. They look pretty different from a typical marijuana plant, which is shorter. Hemp plants tend to be stockier with more fibrous stalks and thinner leaves. Hemp that’s selectively bred for consumer use can also have resin rich flowers that contain high concentrations of CBD.
Cannabis seeds essentially contain no cannabinoids. Cannabinoids are found in higher concentration in the flowers, leaves and stalks. Hemp is often used to create paper, clothing, textiles, animal feed, plastic, and some food products like hemp seed, hemp milk, hemp, protein powder, or hemp. Because hemp grows faster than trees and other crops it’s considered to be more sustainable.
Interesting fact, as you’ve probably seen hemp hearts in the store or hemp seeds, these do not contain CBD or THC, but instead are rich in omega-3 and omega six fatty acids. Hemp tends to be a tall cane-like variety. While female plans have a shorter branchier variety are the ones typically with a higher THC content and known as marijuana. There are some classifications that see it only as Cannabis Sativa, whereas other classifications see it as sativa and then subspecies of Indica and Ruderalis.
The main component that we’re looking at here are cannabinoids. Cannabinoids are more than 80 known chemical compounds found in all parts of the cannabis plant. It’s especially concentrated in the female flower heads and they’re responsible for the physical and psychological effects when the dried leaves and flowers of the plant are consumed.
The main psychoactive ingredient or chemical is tetrahydrocannabinol or THC. THC is the part of the plant that gives someone a high. The rest of the plant isn’t psychoactive, meaning it does not give the user a high. These plants are grown in large quantities.
You can take the marijuana plant, dry it and smoke it. It doesn’t require a refinement. However, for our purposes with CBD, it requires a decent amount of processing in order to get the chemical that we’re looking for. Remember that THC is the only psychoactive component in the plant. The rest of the plant has a ton of different compounds and chemicals, and we’re not looking for all of them.
We’re looking for the other compound in the plant that has the highest concentration. There’s THC. But if we remove THC, what we’re looking for now is cannabidiol. In a freshly harvested cannabis plant, THC and CBD are present in their acidic forms.
It’s primarily when they’re heated that they move into their more commonly known “free” and pharmacologically active forms. Heating could occur during smoking or vaping. Or it could occur during the extraction from the plant.
When we’re talking about someone making THC oil, they’re going to be doing it using a solvent, typically, using compressed gases, like butane or other liquids, like ethanol. We talked about this back in our marijuana episodes when we talked about creating wax or THC oil.
The point of the extraction is to purify and concentrate the cannabinoids present in the plant material that results in higher cannabinoid amounts per unit volume. It removes other undesired substances. Not necessarily undesired because they’re bad but just because they’re not part of the CBD that’s being identified.
What’s happened in the cultivation is just like any other type of plant they’ve been bred for specific purposes. So plants that are going to be used for THC have been bred to create a higher THC per unit volume in the plant, whereas plants that are being used for the creation of CBD are labeled as hemp. One of the key points here is knowing that CBD and THC exist in both types of the plant.
CBD is present in the marijuana plant and THC is present in the hemp plant. The question here is about how much THC. Prior to 2018, that hadn’t been defined and hemps legal status. was undetermined.
It’s a common misconception that hemp and marijuana are two different species of the plant. When in fact they are the same plant and part of the same species science may not differentiate between hemp and marijuana, but the law does. Legally the key difference between the two is the THC content.
Remember that THC is the part that gets users high and that CBD is not psychoactive, meaning it doesn’t give you a high. The term hemp is used to mean cannabis that contains 0.3% or less THC content by dry weight. The question then is why 0.3%?
Well, the definition was first proposed in 1979 in a book called The Species Problem in Cannabis Science and Semantics. In the book, the author, Ernest Small addresses the fact that it’s difficult to distinguish between hemp and cannabis because there’s no actual taxonomical difference between the two. He proposed the 0.3% rule as a possible solution, but he acknowledges that it’s an arbitrary number.
This number was used in the legal definition of hemp in the Agricultural Act of 2018 or what’s called the Farm Bill in the United States. The idea is that the THC level of 0.3% is so low it’s unlikely to get you high at 0.3%.
The Farm Bill made hemp legal as long as there is a THC content of less than 0.3% by dry weight. This cleared the way for hemp to be grown at a much larger scale than it had previously. Marijuana was of course illegal to grow in the United States on a federal level, state level is a different issue, but federally it’s been illegal to grow it and this left hemp growers in kind of a bind with the legality of their crop being undetermined.
After 2018, if you noticed an increase in CBD products, this is why. Once the decision came down that hemp was legal we started seeing the growth and production of CBD skyrocket.
Now that we know where it comes from let’s talk about what cannabinoids are supposed to do. In order to do that we need to talk about the endocannabinoid system in the body.
So cannabinoids function by stimulating two receptors in our endocannabinoid system. The endocannabinoid system or the ECS is a complex cell signaling system that has emerged as an important neuromodulatory system over the last 25 years. Identified in the early nineties by research that was exploring THC.
What we know about the endocannabinoid system is that it’s involved in a ton of processes and scientists are still figuring out what it does. Research has linked the endocannabinoid system to a number of things.
Here is a list: appetite and digestion, metabolism, chronic pain, inflammation, and other immune system responses, learning and memory, motor control, sleep, cardiovascular system function, muscle formation, bone remodeling and growth, liver function, reproductive system functioning, stress and skin and nerve function. Experts believe that maintaining homeostasis, which is the stability of your internal environment, is the primary role of the endocannabinoid system.
The three parts of the system are the endocannabinoids that are produced in the body often called endogenous cannabinoids. Then we have the receptors which received both the endocannabinoids in the system or any that we introduced from outside the system like CBD or THC. The two main receptors are CB-1 and CB-2. The endocannabinoids bind to them in order to signal that the ECS or the endocannabinoid system needs to take action.
CB-1 receptors are mainly found in the central nervous system. CB-2 receptors are mostly found in the peripheral nervous system, especially in our immune cells. The endocannabinoids can bind to either receptor; the effects that result depend on where the receptor is located.
For example, an endocannabinoid might target a CB-1 receptor in a spinal nerve to relieve pain. Others might bind to a CB-2 receptor in the immune cell to signal that your body is experiencing inflammation. The third part of the endocannabinoid system are the enzymes responsible for breaking down endocannabinoids.
The cannabinoid receptors in the brain, those are the CB-1 receptors, outnumber many of the other receptor types in the brain. They’re described as traffic cops to control the levels and activity of most of the other neurotransmitters. This is how they regulate things.
They give immediate feedback, turning up or turning down the activity of whichever system needs to be adjusted, whether that’s hunger, temperature, or alertness. In order to stimulate these receptors that’s where the endocannabinoids come in, which are structurally similar to the molecules in the cannabis plant. The CB-2 receptor also plays an important role in modulating intestinal inflammation contraction in pain in inflammatory bowel conditions.
So let’s talk about how this breaks down. The endocannabinoid system is important in all of these different functions and I think that is partly why CBD is seen everywhere and touted as solving problems in all sorts of different systems.
The issue here is that we don’t totally know what all of this does. We know that there’s two main endogenous cannabinoids in our system. That we produce two main cannabinoids. We know that we have two main receptors that are numerous in the body. One is the primary central nervous system. The other is the peripheral nervous system. We know that there are enzymes to break it down.
Once it’s done doing its job. We know that the endocannabinoids are sort of like neuro-transmitters sending information and binding to different receptors to do different things. So our internal cannabinoids are regulating things in our body to keep us at a homeostasis level where things are just chill.
When we add endocannabinoids from outside the system, these are exogenous cannabinoids are not created within our bodies. Then they’re going to bind to the receptors and do different things. Because the receptors are numerous and because they do different things, it can be hard to know what does what, and that is part of where the difficulty lies in determining what CBD does exactly.
What I’m explaining is a seriously paired down version of the system. Not that I have some massive knowledge of the system. I told you about as much as I know about the endocannabinoid system and how it functions.
When we’re talking about CBD, we’re talking about these cannabinoids that are made from hemp that are put into our bodies, attaching to the CB one and the CB two receptors. The formulation of CBD is going to affect where it goes and what it attaches to. That is a level of chemistry that is needed to make sure that those are going to the right places to do the right thing.
There’s research about a ton of different things about depression, anxiety, schizophrenia, and endocannabinoid systems involvement in psychosis. And I think that the endocannabinoid system is going to end up being important in the regulation of all of these things. And for us, that means something.
We know that when THC binds to the CB-1 receptor in the brain, it impacts memory. This is part of how we understand the fact that the endocannabinoid system has to do with memory to begin with. There’s a question about whether or not CBD or THC can help with PTSD because it does affect memory and could potentially lower intrusive thoughts. However, the side effect of being high or being fuzzy, that’s something they have to work out still.
There have been a number of different experiments involving chemicals extracted from the cannabis plant. There was a medication created as a weight loss drug that was designed to block the CB-1 receptors. The thinking was that since the endocannabinoid system controls hunger, and when it’s activated by THC creates what we call the munchies when you’re high, they thought that blocking that receptor would be a way to help reduce hunger signals.
The medication called Rimonabant did cause weight loss quite successfully, but since the endocannabinoid system also regulates mood, it had to be withdrawn from the market on an emergency basis because the people who were taking it were becoming suicidal.
Initially the research into the ECS was basically to try to demonize CBD and everything related to the cannabis plant. What ended up coming out of it was research that has grown mainly because of the approval of one specific medication called Epidiolex. Epidiolex is a CBD medication that was found to be useful in treating two specific types of childhood seizure disorders, Lenoxx-Gastraut and Dravet syndrome.
These are the ways that THC affects these parts of the brain: in the hippocampus impairment of short-term memory, neocortex-impairment of judgment and sensation, basal ganglia-altered reaction time and movement, hypothalamus-increased appetite, nucleus accumbens-euphoria, amygdala- panic and paranoia, cerebellar-ataxia, the brain stem- anti emesis and spinal cord-analgesia.
So we’re using what we’re finding about how THC impacts the brain and the body and we’re using it to think about how CBD would affect those systems as well. So, If THC impacts the hippocampus and impairs short-term memory, what could it do to memory if the THC part that is psychoactive wasn’t there.
We know that THC affects the neocortex and impairs judgment and sensation. If we remove the psychoactive component, what happens in the neocortex? So each part of the brain that THC affects we’re wondering what happens if you take the THC out and what CBD could do. The CBD molecules are extremely close to what is happening in our body already.
This is part of what feels exciting to researchers is because this is a plant and could we formulate it to affect certain receptors in certain parts of the body to do specific things. The research is behind consumer demand and that’s mainly because of the legality of things, holding up a lot of that research.
In 2018 when the Farm Bill got passed and hemp became legalized, things exploded, and science is still trying to catch up. One of the main things is trying to figure out how it’s metabolized. There are many things that can affect how CBD is metabolized in the body.
Understanding the potential for CBD is important. The endocannabinoid system affects a ton of what we do and the idea that a plant or a plant derived substance could impact these parts of our bodies to help improve functioning, which is the hope is exciting.
As people we’re always looking for a way to feel better and to help our bodies function better, it might seem like a solution for everybody to take CBD. There are side effects to taking CBD and there are some contraindications.
Some of the main information about CBD side effects come from the studies that they did on the medication Epidiolex. During the review and approval process CBD was found to have these potential risks such as causing liver injury, increasing the risk of sedation and drowsiness, especially when taken with alcohol or medications to treat anxiety, stress, panic, or sleep disorders, a changing level of alertness, decreasing appetite, and some gastrointestinal issues.
One study called Cannabidiol Adverse Effects and Toxicity found that in some animals the CBD adverse effects included developmental toxicity, embryo fetal mortality, central nervous system inhibition and neurotoxicity, hepatocellular injuries, spermatogenesis reduction, organ weight alterations, male reproductive system alterations and hypotension. These particular adverse effects were when the animals were given a larger dose than would be suggested. In human CBD studies for epilepsy and psychiatric disorders: reported drug interactions, hepatic abnormalities, diarrhea, fatigue, vomiting, and some sleep issues.
Generally the information I found suggested that CBD is possibly safe to take inappropriate doses. Doses of up to 200 milligrams daily have been used safely for up to 13 weeks. The common side effects are dry mouth, low blood pressure, lightheadedness, drowsiness, gastrointestinal issues and nausea.
Specifically, there are some drug interactions with blood thinners. Another potential interaction has to do with medications that affect the liver functioning. The liver issue isn’t just about medications that are for liver functioning. We’re talking about the fact that many medications are broken down by the liver as just part of how they naturally function. This could be a problem if we have some impaired liver functioning. The potential for liver injury was found as we talked about just a few minutes ago, during the Epidiolex review process.
So it would make sense that there might be some contraindication with liver impacting medications. Because of the issue of drowsiness it would make sense as well that anything having to do with a central nervous system depressant could also be problematic.
We, of course, remember that depressants have a cumulative effect stacking on top of each other. Consumers should always be aware of sacking medications that cause drowsiness because of potentially very serious side effects.
There are lists of medications that are impacted by this, that we know of. Some of the ones familiar to us are going to be Celexa, Topamax, lithium, Lamictal, and methadone. Some early research suggests that taking high doses of CBD might make muscle movement and tremors worse in some people with Parkinson’s disease.
I will note that there is another medication that’s been approved for use in the UK, but it’s still pending in the U S. It’s a medication for MS, multiple sclerosis, that is a nasal spray based on CBD and THC. It’s the combination of these two substances together that research suggests might help improve pain and muscle tightness associated with Ms.
Some special cautions are about pregnant and breastfeeding mothers. Not necessarily because CBD itself has a problem, but because of the issue that we’re going to talk about next: junk CBD.
The thing we need to know about the CBD industry is that it is totally unregulated by a federal or governmental oversight agency. This means that a company who’s making something and calling it CBD can literally make it anything that they want. Now, if there was a complaint, then it could be looked into and they could be fined if they’re found to be violating certain laws. However, most of the companies doing things are going to know how to avoid that. They have to avoid certain statements and suggesting that they are somehow approved by the FDA.
Remember that in 2018 in the US hemp became legal. Since then, we’ve had an incredible explosion of hemp products. Wherever there’s money to be made corruption abounds. What they have found is that there is a ton of junk CBD on the market.
The FDA lists warning letters on their website for places that they’ve warned about their claims and what they’re selling. The warning letters are listed by year and each year. Each year the number of letters just depends on how many complaints and investigations they’ve done.
For instance, a company called Hemp Oil Care. There were hemp products like hemp CBD complex drops, in different flavors, hemp honey, hemp pure vape oil drops, and they were found to be negative for cannabinoids. What does that mean then?
What is in there that people are using? There was a company called Natural Organic Solutions and they were making CBD oil extract capsules also found negative for cannabinoids.
Some of the companies warned in the last two years are: Honest Globe Ink, Elixicure, Bio CBD, plus biospectrumcbd.com., nasadol.com. Evolved Ayurvedic Discoveries, Inc. Bee Delightful, G&L Wellness, New Leaf Pharmaceuticals. Next level Services Group with a website thisstuffisgoodforyou.com, Wellness Bio-Sciences Dragontree Apothecary and a company called Nutrapure or cbdpure.com.
This is only a handful of the ones that have been warned. This hopefully is making the point that a vast amount of CBD products on the market are not real. . In July of 2020, an analytical testing laboratory called SC Laboratories did a study where they purchased 17 samples at unlicensed CBD shops or retailers in and around the Los Angeles area. In that study of the 17 different samples, more than 70% of the samples failed. Either for excessive contamination, or did not qualify as hemp. The level of contamination was several hundred times more than allowable limits in some cases. Lastly, most of the tested products contained levels of THC sufficient to cause serious psychoactive effects.
What we know is that CBD has some potential, which we’ll talk about in the next episode. And so if our clients are going to be buying CBD, how do they find the right stuff? Well, there are some suggestions.
Even in CBD shops or companies that are licensed to carry products, the numbers aren’t much better. The difference between what’s on the label versus what’s in the bottle tends to be pretty different. First and foremost. ACBD manufacturer should be able to produce a third party certificate of analysis called a COA.
That shows how its products performed on screenings for CBD THC and any contaminants. A COA should also have a product batch number. The CBD and THC levels and certification indicating that heavy metals, pesticides, and solvent residues fall within the range of allowable limits. The allowable limits in this case can vary from state to state.
If there’s no information about product testing, or if the product has an old and or outdated certificate of analysis, these are indicators that there may be a problem. Another tip is that the label makes too good to be true marketing claims. If a bottle of CBD oil, capsules, et cetera, claims to cure anxiety or fix your sleep problems. That’s a big red flag.
In fact, Making health claims is only legal for prescription drugs. And making these kinds of claims is strictly forbidden by the FDA and the federal trade commission. Another tip is that it needs to list the amount per serving. If it doesn’t, that’s an automatic move on to another product. Another tip is that the price is dirt cheap. We love a bargain. We want to buy things that are cheaper and. Going back to the fact that extracting CBD from the hemp plant is complicated.
They have to use processes that involve solvents and that can introduce byproducts that we don’t want in something that we’re going to be taking. That takes money and. It also costs money to have a third party go over your product and give you a certificate of analysis.
That’s going to get passed on to the consumer. Dirt. Cheap CBD is not going to be what it says it is. I think as humans, we’re always hoping that we don’t have to be cynical about these things and so maybe this one is real. All of the things that they say on their bottle, even the name of it is meant to inspire confidence.
We want our clients to look a little further and find the ones that have been approved by a third agent, that have a certificate of analysis, that are moderately to higher priced, that the ingredients are clearly listed, that then dosage is listed and the final two tips that I found were that it shouldn’t be at a gas station, convenience store, et cetera and it should not come in a clear plastic bottle.
CBD tends to come in darker colored bottles to provide more protection than clear glass. Reputable brands would only store their CBD oils in a bottle that will properly preserve the product. We know that plastic breaks down over time and can contaminate things and that’s another reason that glass is the material of choice.
There are other things like the fact that hemp seed oil is not the same thing and should be listed as a carrier oil only. It definitely should not show up as the first ingredient.
Part of the reason this matters is it’s not just that someone might be taking something that is unhelpful, neutral, like taking a placebo pill. There’s a story of 52 people over a winter being sickened and or poisoned by bad CBD products.
So it’s not just a matter of wasting money and taking something that’s just junk. There are contaminants and heavy metals and things that are showing up in some of these products. When someone is taking CBD, it should be coming from a place that has that third-party research, is not making outrageous claims about what they can cure and or fix and costs more money and comes in a dark glass bottle and has dosing instructions on the label.
The very last part I’ll talk about is the fact that CBD is supposed to come from hemp rather than marijuana. CBD can come from marijuana, but that is gonna have a higher THC percentage, which means it might get you high. There should be such a low THC quantity that it cannot, and won’t have psychoactive properties. With the explosion of CBD and hemp being made legal there is an incredible abundance of hemp.
In the Delta-8 episode that I did last month we talked about the fact that the industry needed something to do with all of this hemp and Delta-8 gets created from it. Delta-8 is the cousin to the THC that’s in marijuana, which is Delta-9. Delta-8 isn’t as potent, but it does get you high.
While the THC level in hemp is quite low. If you have a ton of it, you can still pull the THC out of it and create something that will get someone high. Enter Delta-8.
I’m not sure that we have the information yet to tell which CBD companies might potentially be supporting the Delta -8 industry. I do wonder how many clients or people wouldn’t want to support that industry if they knew that they were creating a drug that gets people high.
It’s a tricky place to be right now and it’s unfortunate because CBD does seem to have some promise. In the next episode, we’re going to be talking about specific things that CBD may be able to help with. We’ll go over what the claims are and look at the research behind it. I hope you’ll join me for that podcast. And until then have a great week.
Thank you for listening to the All Things Substance podcast. For show notes, links and downloads, please visit betsybyler.com/podcast. If you loved what you heard today, it’d be great if you would share those with your therapist friends and colleagues. If there are topics that you think would be useful and you’d like to hear me cover them, please let me know. Just send a message to firstname.lastname@example.org. I’ll see you on next week’s podcast. And until then have a great week.
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