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Cannabis and Anxiety


Who doesn’t get nervous or anxious from time to time? Speaking in front of an audience, going for a job interview, paying bills. It happens to all of us. Fear, nervousness, anxiety — these evolutionary mechanisms represent normal, essential, and adaptive responses to help us cope with threats to our survival. Without them, we’d be totally blasé to anything that came our way. During our prairie days, we’d be so oblivious to threats, we’d get eaten by bears or mountain lions!

Present day, without a bit of “healthy” anxiety, we’d be totally oblivious to threats, we’d likely forget to pay our bills, lock our doors, or try to excel at work.  However, some people suffer from too much anxiety. And, excessive or persistent anxiety can be maladaptive. In fact, in can become so frequent, or forceful, it can take over our lives, sometimes even leading to serious disability.

As the country forges ahead by legalizing medical and recreational marijuana, there has been renewed discussion around cannabis and psychiatric disorders. How does cannabis affect the brain? Is cannabis useful as a treatment for anxiety? Or, does it create more problems? These are complicated, but important questions, with no simple black and white answers. In fact, as you’ll learn in this article, evidence suggests cannabis can be a dual-edged sword: it it can help or it can hurt. Ultimately, it comes down to a number of factors that are within most people’s control. But, first, let’s start by understanding some fundamental concepts, such as the different types of anxiety, the causes, prevalence, treatments, and how cannabis fits into the equation.

What is Anxiety?

Fear and anxiety are adaptive responses essential to coping with threats to survival. Excessive or persistent anxiety can be maladaptive, leading to serious disability.

There are several different types of anxiety disorders, including:

  • Generalized Anxiety Disorder (GAD)
  • Panic Disorder
  • Social Anxiety Disorder (SAD)
  • Post Traumatic Stress Disorder (PTSD) or Post Traumatic Stress Injury (PTSI)
  • Obsessive-Compulsive Disorder (OCD)

Those who suffer from anxiety-related disorders may experience a variety of symptoms, including:

  • Irritability
  • Feelings of dread
  • Fatigue
  • Insomnia
  • Nausea
  • Chest pain and heart palpitations
  • Shortness of breath
  • Panic attacks

How prevalent is anxiety?

According to the Department of Health & Human Services (HHS), anxiety disorders are the most common form of psychiatric disorders. One in four people will experience an anxiety disorder in their lifetime. Take any 12-month period, and we’ll find that one in 10 people (10%) have a diagnosable anxiety disorder.

Anxiety disorders are the most common mental health disorder with the 12-month prevalence among Americans estimated to be 18.1% (Harvard Medical School). According to estimates, fewer than half of people affected by a mental health disorder seek treatment. Women suffer from anxiety orders at a higher rate than men.

What Causes Anxiety?

The causes of anxiety may be a mental condition, a physical condition, the effects of drugs, or a combination of these. Typically, doctors will first attempt to determine if a medical condition is to blame for the anxiety. Other issues that contribute to anxiety may include:

  • Relationship issues (e.g. marital strife)
  • Financial pressures
  • Work-related stress
  • Academic pressures
  • Grief over an emotionally traumatic event (e.g. divorce or death of a loved one)
  • Medication side effects
  • Stress from a serious medical illness
  • Illicit drug or alcohol use
  • Symptom arising from medical illness (e.g. heart attack or heat stroke)

Are We Over Prescribed Drugs?

According to a report published by the American Psychological Association, from 2001 to 2010, spending on anti-anxiety and antidepressants increased by 22 percent. Remarkably, one in five adults takes at least one psychotropic medication. Many of these individuals were prescribed psychotropic medication without having ever visited a mental health professional.

Physicians, heavily marketed to by drug companies, rarely think twice before prescribing popular drugs. And, while getting a prescription may be easy, it’s not always the most appropriate therapeutic pathway, or for that matter, safe.

The problem with this strategy is that many patients get their script, without knowing their options. Pharmaceuticals are clearly not the only alternative. Other treatments like cognitive behavioral therapy (CBT) are safe, effective, and carry no risk of side effects.

What Treatments Are Available For Anxiety?

One or more of the following therapies and medications may be used to treat the various types of anxiety disorders including:

Non-Drug Treatments:

  • Therapy such Cognitive Behavioral Therapy (CBT), Interpersonal Therapy (IPT), and Dialectical Behavioral Therapy (DBT)
  • Meditation
  • Lifestyle changes

Prescription Drugs:

  • Benzodiazepines such as Xanax (alprazolam), Ativan (lorazepam), and Valium (diazepam)
  • Selective Serotonin Reuptake Inhibitors (SSRIs) antidepressants such as Prozac (fluoxetine), Zoloft (sertraline), and Wellbutrin (bupropion)
  • Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) antidepressants such as Pristiq (desvenlafaxine), Cymbalta (duloxetine), and Effexor (venlafaxine)
  • Tricyclic antidepressants such as amitriptyline, imipramine, and nortriptyline

Despite their popularity as first-line treatments, many of these drugs deliver agonizing side-effects that are often worse than the conditions they are prescribed to treat. Insomnia, constipation, depression, hallucinations, and even suicidal thoughts (especially in teens) are all-too-common with these drugs. Likewise, long-term use of benzodiazepines often leads to addiction, and benzodiazepines are involved in nearly one out of three fatal overdoses.

Can Cannabis Treat Anxiety?

With so many negative side effects associated with pharmaceutical treatments, predictably, many Americans have opted to self-medicate with other substances.

As the U.S. marches forward with an increasing number of states legalizing medical marijuana, recreational adult-use, or both, there has been renewed interest in the relationship between cannabis and anxiety. Clearly, a significant percentage of canna-consumers use cannabis to self-medicate for anxiety. Likewise, many people have had a bad experience with cannabis and found that it induced anxiety, or perhaps even a panic attack.

So, what do scientists (and the science) say about cannabis and anxiety? Dr. Ethan Russo, the neurologist who identified and coined the term, “the entourage effect,” wrote about the potential antianxiety effects of cannabis in the book, Cannabinoids as Therapeutics (edited by Dr. Raphael Mechoulam). Russo noted that in India — as far back as 1500 B.C. — cannabis was credited for helping alleviate anxiety and depression. More recently, in 1860, the Ohio State Medical Committee on Cannabis stated: "As a calmative and hypnotic, in all forms of nervous inquietude and cerebral excitement, it will be found an invaluable agent, as it produces none of those functional derangement or sequences that render many of the more customary remedies objectionable.”

No doubt, many people consume cannabis to relax, unwind, and alleviate stress, and there’s nothing wrong with that. Studies of THC (the primary psychoactive constituent and a CB1 receptor agonist) — and, CBD (the primary non-psychoactive constituent and CB1 antagonist) suggest that in acute administration, both can produce antianxiety effects. But, as mentioned, high doses of THC can induce anxiety, even panic attacks.

While consuming a THC-rich cannabis strain to occasionally reduce anxiety may be relatively benign, and possibly beneficial, given the psychotropic properties of THC, few medical practitioners would support the use of high-THC cannabis to treat chronic anxiety. (Of course, no responsible physician should recommend most anti-anxiety drugs for long-term use, given the potential of developing a use disorder.) Irrespective of what substance someone takes to treat anxiety, use should be short-term or occasional so as to avoid potential dependency issues. Likewise, just because cannabis is more benign and less addictive than alcohol, nicotine or other drugs, doesn’t mean it’s completely devoid of risk. Are there any substances that are totally risk free?

How Do Different Cannabis Strains or Consumption Methods Affect Anxiety?

How you react to cannabis can depend on a number of variables including method of consumption, cannabinoid concentrations and ratios, and even environment. Inhaling cannabis (smoking or vaping) produces immediate effects. Some people prefer this mode, because it allows them to self-titrate (i.e. gradually increase dosage until desired effect is reached). While the onset of effects are fairly quick, the duration of effects is relatively short, generally a couple of hours. Oral ingestion — like edibles — takes longer to produce effects, but the effects are more steady and much longer in duration.

Further, levels and ratios of THC to CBD can have a profound effect on outcomes:

High CBD, Very Low THC: “High” effect is low to nonexistent. Consumers report a general uplifting of mood without adverse side-effects. Research suggests high therapeutic potential: antipsychotic, antianxiety, could be used in epilepsy treatments.

High THC, Very Low CBD: Produces euphoria, elevated mood, uncontrollable laughter. confused thought, uncontrolled laughs. High dosage can produce strong side-effects: elevated heart rate, anxiety, and tension.

Moderate-High THC, Moderate CBD (e.g. 2:1 ratio of THC to CBD): Pleasant euphoric effects, laughter, creativity. Potential side-effects are generally mild.  

Moderate THC, Moderate CBD (e.g. 1:1 ratio): Produces mild euphoric, an overall sense of calm and tranquility. Potential side-effects are rare and few.

The Research: Is CBD The “Magical Molecule?”

Cannabis has well over a hundred active constituents called cannabinoids. The two most prominent, and well studied are THC (delta-9-tetrahydrocannabinol) and CBD (cannabidiol). THC is responsible for producing the psychoactive effects (i.e. feeling “high” or “euphoric”), while CBD is largely non-psychoactive. Both THC and CBD provide therapeutic applications, but only THC produces significant psychoactive effects.

Because CBD has an excellent safety profile and potentially a wide therapeutic spectrum, scientists have turned more attention to studying how it can be used to treat anxiety disorders. In recent years, evidence continues to emerge suggesting CBD may be effective  in everything from helping opioid dependents quit, minimize withdrawal symptoms and prevent relapse — to helping treat a wide spectrum of anxiety disorders (see below).

Data from human experimental studies, some trials in a clinical setting, and epidemiological studies, has been encouraging. Accumulating preclinical evidence strongly supports a role for CBD to treat a variety of anxiety-related disorders including PTSD, obsessive-compulsive disorder (OCD), panic disorder, social anxiety disorder (SAD), and generalized anxiety disorder (GAD). While encouraging, we shouldn’t “jump the gun,” as most studies have been short in duration. No doubt, future research will be longer in duration and evaluate the long-term use and benefits of CBD.

Two noteworthy systematic reviews of cannabidiol (CBD) to treat anxiety-related disorders come from researchers at the New York University School of Medicine, Cannabidiol as a Potential Treatment for Anxiety Disorders (lead by neuroscientist, Esther Blessing, MD, Ph.D.) and a group of neuroscientists and psychiatric researchers from Brazil, Cannabidiol, a Cannabis Sativa Constituent, as an Anxiolytic Drug.

CBD is therapeutically versatile

  • Existing preclinical evidence strongly supports CBD as a treatment for generalized anxiety disorder (GAD), panic disorder, social anxiety disorder (SAD), obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD).
  • Evidence from human studies strongly support the potential for CBD as a treatment for both healthy individuals and those suffering from anxiety disorders. At oral doses ranging from 300 to 600 mg, CBD reduced anxiety in healthy subjects and patients with social-anxiety disorder (SAD) who were put in stressful situations (e.g. public speaking).
  • Evidence from human studies supports the role of CBD to treat anxiety in acute dosing and has considerable potential as a treatment for multiple anxiety disorders

CBD can temper potential adverse effects of THC

  • Evidence suggests CBD, the most prominent non-psychoactive in Cannabis, can temper the adverse effects of THC (including anxiety)
  • Higher CBD content in chronically consumed cannabis may protect against adverse effects of THC and other drugs (e.g. opioids), including psychotic symptoms (among vulnerable populations), drug cravings, and memory loss.
  • Unlike THC, even at high doses, CBD does not induce anxiety or other adverse effects. In fact, researchers point to the fact that CBD has a notable absence of anxiogenic (anxiety producing) effects.

CBD may be an effective PTSD treatment

  • Data supports the efficacy of CBD in promoting “aversive fear extinction” (e.g. extinguishing “traumatic memories”) suggesting CBD may be effective as an individual treatment, or as an adjunct to treatment (e.g. enhancing cognitive behavioral therapy (CBT) or other therapies).
  • A retrospective study of civilian patients suffering from PTSD, and a case study of an individual who suffered severe sexual abuse-related PTSD, found chronic cannabis use to significantly reduce symptoms arising from PTSD symptoms. (Unfortunately, there was no data on THC:CBD ratios.)

Consistently, CBD demonstrates that it can be a potent antianxiety agent, with mild sedative effects and an excellent safety profile. Most studies involve acute dosing, so further research studies that are longer in duration will be important to establish evidence proving chronic dosing produces similar effects.

Bottom line: overwhelming evidence suggests CBD is very safe, and probably effective to treat anxiety. When considering cannabis strains, don’t ignore CBD, as it can be helpful for a number of reasons, and in particular, mediating any potential unwanted side effects from higher doses of THC.  

Final Tips & Considerations

Most users find consuming moderate doses of cannabis produces a soothing, relaxing  experience, stimulates creativity, makes them laugh (sometimes uncontrollably), and can even enhance intimacy. However, most people are unaware of how variable concentration levels of THC and CBD can profoundly influence their experience. It’s important to be mindful of your individual tolerance and sensitivity levels. Everyone reacts differently, so what may work for your friends, may affect you differently. But, as a rule of thumb, the higher the THC, the higher the risk that consuming cannabis will exacerbate anxiety — the exact opposite effect that most people desire. Higher CBD, by contrast, counteracts these effects and evidence suggests it possesses potent anti-anxiety properties.

You may find it helpful to experiment with different strains with variable concentrations and ratios until you find a strain that produces the effects you’re seeking. And, remember, always start with a lower dosage and gradually titrate up. A good rule of thumb when consuming to relieve stress is to follow the adage, “less is more.” Consume just the right amount to elicit the effect you want. 

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Wikileaf fan
23:40, February 23, 2017
I have suffered from anxiety and PTSD for almost 30 years. Pharmaceuticals have never brought me much relief without adding a combination of two or three medication. I believe in the spiritual, medicinal, and many many benefits. So many to name. A vacation before or after I have knee surgery will be exactly what I need.
Wikileaf fan
11:08, February 23, 2017
I choose to relax to free my mind from this world of stress and anxiety and insomnia. I think the reason I smoke is to be who I actually am
Wikileaf fan
7:55, February 18, 2017
I choose to be able to not have my social anxiety and depression not hinder my life or my health. I've always had major stomach problems from my anxiety to the point where I couldn't keep down water even. But the first time I smoked was the first time I ate an entire cheeseburger. ~<3
Wikileaf fan
3:47, February 14, 2017
There's a couple reasons I smoke, I smoke because it helps me eat and sleep and when I get an anxiety attack the cannabis kicks it rite away!!! I can truly say for me it is cannabis and my dog that keeps me positive and focused... I no people that drink and I'd rather be happy and chill then sloppy drunk
Wikileaf fan
5:16, February 13, 2017
It helps with my depression as well as my anxiety and also helps with the stress of my life it helps me become a better person and makes me want to be more than just who I am but what I can be
Wikileaf fan
12:35, February 09, 2017
I was constantly on pain killers and sleep aids. My anxiety would leave me awake and I did not feel like I reached my full potential as a being. Ever since I went on cannabis, I have deeper thoughts and my mind opens up to so many answers I\'ve never knew before. It is a truelly healing and loving experience and I never thought I would love myself now than I did before.
Wikileaf fan
12:42, February 06, 2017
Hi my name is Ashley I choose to eat edible eater I also dab cbd for pain in my back, but this story isn't about me it's about the love of my life my finance Ashley (yes we have the same name) she chooses to smoke to keep her anxiety under control it is really hard to travel but we love to this would be an opportunity of a life time to travel and not worry about her having her meds please let me win for me and her thank you for the opportunity
Wikileaf fan
8:08, February 06, 2017
I choose to consume because it helps with my anxiety and food aversions. Normally I can go whole days without eating and it makes me sick. And it helps with my food so that I can be home with my children more
Wikileaf fan
8:20, February 05, 2017
I choose to be able to eat throughout the day, to ease my anxiety and depression, and to break the cycle of my addiction naturally instead of pharmaceutically
Wikileaf fan
5:27, February 03, 2017

I choose to consume cannabis to help calm my anxiety and depression 

Wikileaf fan
8:42, February 01, 2017
I love everything to do with marijuana. The Tricombs, aroma, different colors. It's a beautiful plant. I use pot to stay relaxed. I've been prescribed Benzo's to help my anxiety but I don't want to be restricted by a pill. The side effects are just on going and a downfall for people who are recovering addicts which I am. It helps my appetite since I lack on eating a lot. Makes my migraines go away. AND ITS NOT ONLY THE THC PART. CBDS saved me as well. I was born with my hips not aligned,they were able to fix it but once in a while the pain is unbearable. Putting some cbd cream after a shower and relaxing makes me so calm. My insomnia has been terrible since I was a child. Weed does help and so does applying CBD around my neck before bed n THC/CBD honey 1:1. I'm blessed that this plant is on earth!
Wikileaf fan
6:51, January 30, 2017
I choose to consume because I suffer from PTSD and very bad anxiety . It tends to leave me stress free and happier than ever !(:
Wikileaf fan
9:36, January 29, 2017
Me and my husband smoke together. He has ADHD and insomnia, I have anxiety and PCOS. We were both in a car accident and suffer from back pain. With cannabis, we can actually sleep, relax, and not be in pain.
Wikileaf fan
3:08, January 26, 2017
I choose to calm my anxiety and depression. I have OCD and bi-polar depression and the one thing that has helped me get through it all has been cannabis!
Wikileaf fan
2:20, January 17, 2017
I choose to treat my insomnia, Depression, anxiety with cannabis. It's a beautiful plant. So many uses, helpfulness and love.
Wikileaf fan
12:55, January 15, 2017
I choose to consume because it helps my anxiety and depression! I've been on countless medications since I was 13 and cannabis is the only thing with minimal side affects and makes me feel so much better! Drug free for 7 years!
Wikileaf fan
8:52, January 06, 2017
I have anxiety and depression
Wikileaf fan
1:52, December 24, 2016
I use cannabis to treat bouts of depression and anxiety after the loss of my 16 year old daughter to cancer. Sometimes crippling, cannabis takes it away instantly. Thankful that I live in California!
Wikileaf fan
11:46, December 21, 2016
I consume because it makes my anxiety and depression much easier to deal with; when I smoke, the part of my brain that keeps telling me to worry calms down. I am able to be much more outgoing and \"normal\" with the help of marijuana.
Wikileaf fan
5:31, December 20, 2016
I've been attacking anxiety and a host of other mental illnesses for most of my life. This year I lost my father, my job, my apartment, and a host of other things that were important to me. I choose to consume to be balanced. I choose to consume to make navigating every day life manageable. I choose to consume because I choose peace.
Wikileaf fan
10:04, December 17, 2016
As a kid I was very sickly that's how I got my exposure to high fructose , my step_dad was a politician in back home ( that's my button politically correct thinking ) twenty years later added with some stupid mistakes ; moved to L.A some how was convinced to move in with my mom and sam and anxiety disorder set in . It's been 9 phkng years ( muscle spams , cramps , depression , mood swings ) what has helped the most is actually meditating , working-out & eating right ( most often than not faded ) . It's whering me out to be living with the one responsible for 50 % of my former toxic behavior , right now finishing studies to be a personal trainer/massage therapist to help others fight big pharma . #OneBowlAtATime , Blessings
Wikileaf fan
4:01, December 09, 2016
Started smoking with my dad and his hippie friends as a teenager, now that I'm older and I have healthy problems, I have completely taken myself off of prescription antidepressants and anxiety meds and am only smoking marijuana for my pain, stress and anxiety and I feel wonderful!! The natural cannabis route is the way to go!!
Wikileaf fan
1:06, December 09, 2016
I hate taking my xanax. Marijuana has given me relief from a lot of my anxiety as well as some depressing moments in my life. I don't use regularly, only when it is very evident that I need to.
Wikileaf fan
9:20, December 08, 2016
I choose to defeat social anxiety and chronic pain
Wikileaf fan
5:59, December 08, 2016
My dad is dying of stage 4 liver cancer as we took a long tough hard journey he is left with 48 hours to live. Cemotheropy only made the matter worse. We resorted to THC and CBD! We live in lantana Florida so to obtain CBD oil was near impossible, but managed to get it mailed from sources through Colorado. I am personal user of marijuana myself. Helps me to sleep, create an appetite and for anxiety as well. This vacation would be the escape from this tough hard journey that my family is going through. Thank you for taking the time to read this!
Wikileaf fan
8:36, December 07, 2016
I choose to consume to help my insomnia, anxiety and menstrual cramps
Wikileaf fan
4:50, December 06, 2016
I'm in recovery it's not easy to stop opiates and various other drugs without going batshit crazy THC makes my anxiety go away and my thought process slow down to where it should be thank God for making it
Wikileaf fan
11:16, December 03, 2016
I use cannabis because my anxiety is violent, and xannex can kill you!
Wikileaf fan
11:11, December 02, 2016
I choose to consume to control my anxiety and anger. I prefer to not freak out everytime I enter a room with a lot of people.
Wikileaf fan
4:09, December 02, 2016
I consume so I do not have to take pain killer,antideppresents or anxiety medicine..
I have been in a couple of bad wreaks and have had alot of death in my life...Consuming saved me!
Wikileaf fan
8:41, December 01, 2016
I choose to consume because anxiety is a horrible way to live unmedicated
Wikileaf fan
5:05, December 01, 2016
I choose to treat my anxiety and depression naturally and effectively with cannabis.
Wikileaf fan
11:55, November 30, 2016
I choose to consume because of the plant's ability to relieve my anxiety in a more natural way. I also run, and don't have any negative side effects from consuming.
Wikileaf fan
2:22, November 29, 2016
I choose to consume to relieve anxiety and depression.
Wikileaf fan
9:05, November 28, 2016
I was diagnosed five years ago with PTSD, depression and severe anxiety. I am also a recovering alcoholic. If it was not for medical cannabis I don't know where my life would be right now. at this very moment I am now on nothing but medical cannabis to combat all of these illnesses and I swear by it. It has saved my life and I would probably still be drinking and not even know that I had PTSD, depression and severe anxiety if I had not known that cannabis would be able to save my life like it has for the last five years, I am a living testament and proof that medical cannabis is a lifesaver .
Wikileaf fan
4:25, November 27, 2016
I choose relieve anxiety naturally instead of with pharmaceuticals.
Wikileaf fan
6:16, November 26, 2016
I choose to not let my chronic pain from siatica, spinal stenosis ,ruptured L4 & L5 discs, severe anxiety disorder , insomnia amd bipolar ruin my life. Since ,smoking medical weed I only take meds for my bipolar which the dose has been lower. I was on a opiates ,anxiety pills and sleeping pills. I am grateful to medical marijuana for helping me.
Wikileaf fan
6:23, November 22, 2016
I choose to treat my health without chemicals. I choose the possibility of happiness over unrelenting anxiety and depression. I choose positivity and creativity.
Wikileaf fan
4:15, November 19, 2016
I choose to consume because I have suffered from anxiety my whole life it helps me calm my taughts. I also is for pain relief for my back.
Wikileaf fan
6:46, November 16, 2016
I consume because it has changed my life when it comes to my anxiety & depression. Thank goodness for marijuana becoming legal
Wikileaf fan
6:42, November 16, 2016
#ICHOOSETOCONSUME because I have really bad anxiety so when it's triggered, I go outside, light the already rolled joint, and relax. Plus I have heart problems and it helps keep me calm.
Wikileaf fan
12:54, November 15, 2016
I choose to relax, I love it, and i choose to maintain my sanity over anxiety & depression.
Wikileaf fan
8:33, November 15, 2016
I choose to relax, be calm, & in control. I choose to be able to sleep at night. I choose creativity. I choose to not be anxiety ridden. I choose to not poison my body with government approved drugs. I choose to be happy!
Wikileaf fan
9:15, November 14, 2016
I choose not to let anxiety rule my life!
Wikileaf fan
1:47, November 11, 2016
I'm a service connected disabled vet. I Use canabis to help with PTSD, anxiety and chronic pain. I am a RN unable to practice anymore due to health problems. I went without a vacation for over 10 years while I cared for my mother and father in my home until the passed. Two weeks after they passed I had a massive heart attack and and needed a triple bypass. I have used up all my savings to save my house from the bank taking it. With out canabis I probably would be dead. Just would like one vacation in my life without worry and to enjoy / celebrate no longer being in fear of being arrested for using one of gods natural cures
Wikileaf fan
1:18, November 11, 2016
I choose to consume because it helps me with my anxiety which I have dealt with since I was a small child. I also like to show others that I'm still ok! As a result of consuming I have not been arrested, overdosed, died, gone on a rampage, etc. this medicine has helped me get back to ME, do things that are beneficial to me that I was afraid to do before.
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