NOTES FOR IBOGAINE TREATMENT PROVIDERS
The eye altering alters all – William Blake
The following pages contain ideas, notes and reflections gathered over a period of a year during which I offered my services as both an ibogaine treatment provider and supplier of ibogaine hydrochloride.
I am not a medical practitioner and have no formal training in allopathic medicine. I am trained (through experience) in assisting people in altered states of consciousness. I have participated in a number of rituals using psychoactive substances throughout the world both as an active participant and a sitter. I have worked with people with schizophrenia and bi-polar disorder. I am currently training in holotropic breathwork and transpersonal psychology and had started my training whilst providing ibogaine treatments. I am proficient in CPR having been instructed by the British Red Cross. I have direct experience with drug habituation have been caught in cycles of addiction with cocaine, alcohol and anorexia. I consider all these details relevant when examining the procedure and protocol I used during the years 2001 and 2002.
THE IBOGAINE TREATMENT PROCEDURE
This begun with an initial introduction and consultation usually lasting at least two hours. During this period I would introduce myself and explain my reasons and motivations for doing this work and then explore exactly what the subject knew about ibogaine and why they wanted to experience it. We would discuss thoroughly the risks and benefits of the treatment and I made sure that the subject was aware of the possible dangers involved. We would discuss the subjects drug habit (if present) and the reasons for wanting to quit and the previous attempts made (if any). If previous attempts had been made we would explore the possible reasons as to why they hadn't produced the desired results. The idea of this visit was really to inform the subject fully of the pros and cons of ibogaine and to get to know each other, establish a relationship and decide whether this was the best course of action for both the subject and myself. For example there was one man with whom both of us knew we would never really hit it off. As a result he didn't want to work with me, nor me with him. I tried to listen to my gut instincts about working with certain people.
If the outcome of the initial meeting resulted in the subject wanting to proceed I would ask for a full blood work up and liver function test as well as an ECG. This I strongly recommend to any other treatment provider and in future would not treat anyone who couldn't provide reports from both these tests. For the ECG often people need to elaborate a story as to why they need one. The tests are expensive and if on the National health in the UK you have to provide a reason for the test. I suggested telling the doctor or ER that you were having pains in your heart, had tingling sensations in your hands and arms and were generally feeling tired, short of breath and scared. This always resulted in a test. Obviously if subjects had doctors who were aware of their habits these tests were relatively easy to achieve. In cases where there was a high level of secrecy surrounding the habit the tests required some elaboration of details. Generally this was not a problem except that on a few occasions especially in the early days people would arrive without the reports. They had often driven hours and I didn't have the heart to turn them away. I would now insist on seeing the reports before the day the experience was scheduled to take place.
Once I felt that an informed decision had been made and the reports of the liver function and ECG were OK we would schedule a session.
· Subject participation must be voluntary and informed.
· Subject must sign an informed consent indicating the risks and benefits of ibogaine.
· Subject must have done some research and investigation into ibogaine and thought about it for some time.
· A comprehensive medical history of the subject submitted either by their GP (if possible) or taken by the treatment provider.
· Subject must obtain an EKG and report.
· Subject must have a liver function test and blood work up and provide the report.
· Subject must sign a form stating that they have not taken any narcotics, cocaine, amphetamines or alcohol for the last 12 hours before arriving and that they have nothing on them.
· Subject must provide a next of kin in case of emergency.
· Significantly impaired liver function
· Any signs of abnormalities on the ECG or any previous heart problems.
· Severe mental health problems such as schizophrenia or bipolar disorder. I don't necessarily think that it would cause adverse reactions with a bipolar disorder but I personally didn't want to bear the responsibility.
· Anyone who was HIV or HEP C symptomatic.
· Anyone on medication for their mental health e.g. antipsychotic medication (except antidepressants).
· Anyone on any long term medication for which there was no data about the interaction with ibogaine or psychoactive compounds.
Regarding the exclusion criteria noted above, I tried to stick to this but was on occasion flexible and took people on who I knew had HEP C and whose livers were not functioning optimally. Most people that I treated were not in good health. Most had been heroin users for 5 year plus and had heavy habits. Several had HEP C and I wouldn't exclude people on this basis. However if they had Hep C and any other health problems such as a stomach ulcer or mental health problems I would probably exclude. Anyone with any heart problems was excluded. Depression and diagnosed mental health problems didn't pose a problem with me unless it was schizophrenia or severe bi-polar. Nearly everyone I treated had depression and several had manic depression alongside agoraphobia or other compulsive disorders. I don't personally agree with modern mental health diagnoses or treatment and think sedation is almost criminal in many cases. Generally mental health disturbances provide an opportunity from which to grow and heal from. They are more of a spiritual or emotional crisis, where experiences no longer fit comfortably into the daily mindset. In these case I believe ibogaine can actually be extremely helpful.
I think it warrants discussion that of the five people treated who had Hep C though not symptomatic no problems were encountered. If anything they perhaps suffered a little more physically from nausea than others but nothing else. The most extreme problem I encountered with anyone was a 35 year old heroin addict who had both Hep C and a stomach ulcer. He vomited blood for several hours (see discussion below).
The treatment program took place in the tranquil surroundings of The Farm, West Sussex where I lived. There I had a soundproofed studio (previously a recording studio) separate from the main house, surrounded by beautiful countryside. The studio was undisturbed at all times and completely private. Prior consultations took place either in a separate office (again privacy guaranteed) or in the subjects home. I treated two people in their own homes. I definitely think that the results achieved were enhanced when done outside of their own homes. The opportunity to have 3 days divorced from ones normal daily life was much appreciated by most people treated. They knew they wouldn't be disturbed and could relinquish control over the situation and any responsibilities that may bother people in their own homes.
I provided ibogaine hydrochloride because I personally felt that dosages could be that much more accurate with the hydrochloride. I had seen the results of lab tests of the indra extract and wasn't satisfied that there was a uniform substance. Both lab results I saw showed different levels of ibogaine contained in the extract. I wanted to know exactly what I was giving people so chose the hydrochloride. From witnessing people take both it also seems the HCL is somewhat gentler physically.
Dosages ranged from 15-20mg/kg of body weight for people wishing to detox and interrupt an addiction. 10-12mg/kg was given to people using ibogaine for self-exploratory or spiritual reasons. In the latter case this dose always achieved the desired results. The only time it didn't seem to really provide the desired experience was in the case of a female who was given 12mg/kg for self-exploratory purposes. She had an intense experience for about 3 hours and then literally got up within 7 hours and claimed to have felt nothing after the 3 hours. She slept that night normally having ingested at about noon. I gave her a booster raising the total dose to 15mg/kg after approximately 3 hours and she didn't feel the booster at all. However what she had experienced in the first 3 hours I believe led her to shut down the experience. She relived the trauma of being raped by her father as a baby. After that perhaps she didn't want to see anything else. It is after experiences like this that people really have to be supported emotionally and for there to be someone to talk things through with.
In the dose range for addiction interruption I found that 17mg/kg - 19mg/kg worked most effectively. The higher the dose generally the most effective. However as many subjects had a poor liver I didn't want to exceed that range and even stuck to the 17mg/kg as there was no medical support at hand.
Subjects were given ginger tea with honey 30 minutes before ingesting the capsules of HCL to help with the nausea. They hadn't consumed any drugs for 12 hours prior to the ibogaine and had been advised not to eat anything other than fruit on the day of the experience. However many people said they couldn't hold off and had eaten eggs/full breakfast etc in the morning. They were generally sicker although I am not entirely sure how much food affects the experience. So long as they had had nothing for four hours I would proceed. I suggested that upon taking the ibogaine people said out loud or to themselves their intent for the experience and to focus on this (5-15 minute meditation)
Whilst waiting for the effects to come on (anywhere from 20 minutes to 3 hours) we would talk and then as soon as the effects started to be felt silence would proceed unless they wanted to engage. The room was quiet and lit by candlelight only. I remained in the room for the duration of the experience leaving only to eat (quickly) and go to the bathroom. If I needed a significant break I would ask someone I lived with to sit in the room for a while. I stayed in the room for the first 16 hours vigilantly. After that depending on the progress I would leave for longer periods at a time. I would however recommend that someone is present at all times for the first 36 hours and would work in shifts if I started treatments again. The subject in my opinion should be monitored and cared for constantly. I worked alone to keep the costs down for people but wouldn't do this again. I had the support of the community where I was living and there were people at hand to help and support but this was not sufficient to actually be working in regular shifts. The work as a result exhausted me after some months.
THOUGHTS ABOUT SET AND SETTING
In my opinion a quiet, tranquil and private environment is optimal for any experience in which one enters into an altered state. Many people state how much they appreciated coming out of the experience into the countryside, being able to sit on the grass surrounded by trees in privacy with no cars, traffic or general public around. The soundproofed room was also optimal although I don't think entirely necessary. Some people claim not to hear anything except the noise in their head so it wouldn't have mattered had there been more noise.
Comfort however is essential as the subject will be lying down for a number of hours and so will experience muscle aches and cramps at various points in the procedure. This can be ameliorated by a comfortable bed and bedding. Ideally I would suggest a TEMPUR mattress.
The question of music is an interesting one. I always told people that if they felt like it all they had to do was ask. No-one asked. When offered only one person accepted. However when I had one subject who didn't come down from the trip for 6 days I used music to help bring her back as I am aware that this is what occurs in the Bwiti (see Giorgio Samorini's work). The music certainly helped ease the tension of the situation. I asked her opinion when she returned and she could not remember the music or indeed that there had been any! So to conclude comfort is essential but anything else, music, smells etc are a personal choice and in my experience most chose not to have them.
DURATION AND TYPICAL STAGES OF THE IBOGAINE EXPERIENCE
Duration lasted anything from 12hrs to 6 days although the latter was extremely unusual. Generally people would hallucinate for up to 12 hours and then enter stage 2, which was characterised by introspective reflection. Not much communication would take place but restlessness would begin to be apparent after the 12th hour (except for those who were hit really hard). Stage 2 could last up to 24 hours plus and then would move into a desire for sleep and discomfort in the body. At this point I would offer valiums to help the subject sleep if they were distressed by the discomfort and inability to sleep. After waking from the sleep (however short that may have been) they usually moved into stage 3 characterised by optimism and an experience of reset. They were aware they were clean and were happy about it at this point. With some people physical discomfort lasted some days in which case they would stay longer at the farm. I would say 5 out of the 18 people treated suffered extremely physically. Getting sick at the 12 hour point and then retching for the next 12 hours or so. Followed by a weakness and nausea that could continue for another 12 hours (24 in total). Any longer than that and I would assume that withdrawal was taking place. This happened more frequently with women than men (see discussion on women). This is something I have never been entirely clear on and may warrant discussion in the manual. If someone is very sick 12 hours into the experience what can one do and does it indicate withdrawal symptoms (the nausea was usually accompanied by sweats and cramps and leg twitching). Can we administer anti nauseates at this stage and will they help? This is not something I experimented with. The problem with the vomiting was that it was often dry retching as there was obviously nothing to bring up. This can tear the oesophageal lining, which I believe can be dangerous. I would definitely want some information on how to alleviate this or prevent it from happening. I treated one woman who had an experience for about 8 hours, 4 of which included hallucinating. She then however went into severe withdrawal for the next five days (during which I stayed with her). I concluded from this and from my other experiences with women that women needed as much if not more ibogaine than men, something contrary to what I had read. I had always been led to believe that women should have a slightly lower dose (DR Mash advised this) but as a result I found that ibogaine didn't work as efficiently for women as for men, (SEE DISCUSSION BELOW).
In the final stage of the treatment counselling occurred. I would sit and talk with the subject about their experience and about any issues that had arisen. I found people to be much more open post ibogaine and much more willing to engage especially if the experience had been strong for them. Occasionally people would be in a very negative space and want to leave possibly to score. If this was the case I would encourage them to stay another night and take advantage of the facilities at hand - fresh organic food, walks, massage, floatation tank, ozone tank. This was definitely beneficial as each time this happened people really thanked me for encouraging them to stay as they had just needed more time. Most people stayed with me for 3 days. Some 4 days and only one 7 days.
GENERAL COMMENTS AND OBSERVATIONS
As I have mentioned previously, from my experience of treating women with ibogaine it seems that women are generally not affected as strongly by ibogaine as men. There was definitely a difference in reaction to the substance by the genders. Gender response to psychoactive substances has been something I have been interested in for years so I paid special attention to this. I began noticing a pattern. Generally ibogaine did not hit women as hard, they tripped less and generally were up and walking and talking much quicker than men. In fact in the majority of female subjects I treated they also claimed to be experiencing withdrawal symptoms and thereby complaining that the ibogaine wasn't working. These results indicate perhaps a faster metabolism and a quick conversion of ibogaine into noribogaine thereby reducing the oneiric phase. I treated six women and twelve men so unfortunately do not have even numbers of both genders to compare. However out of the six women only one had a strong experience and she was unusual anyway as she didn't emerge from the treatment room for six days and was incoherent and clearly hallucinating for 5 days. I gave her the strongest dose I had given a female - 19mg/kg. Prior to that I hadn't exceeded 17mg/kg with women. She had just stepped off a long haul flight, had slept for a few hours and then took the ibogaine so jet lag may have had something to do with the duration. Unfortunately I have lost touch with this woman and am unable to get more information on how she is now and what she has experienced since. The other women treated were definitely not as affected as men were by ibogaine. The dose differentiation between the genders was never more than about 2mg/kg which I wouldn't have imagined to have such a dramatic impact thereby leading me to conclude that it is something to do with the way women metabolise the substance.
I strongly think that this limited data warrants more research. I do not think this data is unusual as someone else has informed me that this is common and that in the clinic in which they have worked this is the case for about 70% of women -"that they trip less and act up more". I have been told by someone working with ibogaine that women almost always appear to respond to ibogaine doses of 600-800mg very poorly. That they are not quiet or mellow or "in" the experience but rather that they run around, often yell and shout and require a number of people to calm them down .One theory posited is that most women are somewhere between medium and fast metabolisers and so convert almost everything to nor-ibogaine. This is mediated by oestrogen and liver function; not directly by body fat levels. Another possibility is perhaps the dynamic of a female treatment provider treating females. It would be interesting to see if male treatment providers had experienced this or if they possibly had better effects with women suggesting something in the gender dynamic of therapist/client. I don't think this idea is as solid but it would certainly warrant further investigation.
SAFETY - MY EXCLUSION/INCLUSION REQUIREMENTS
I think that all treatment providers should discuss in considerable detail the possible dangers and risks involved with ingesting ibogaine. I do know of a treatment provider who does not do this as he considers it the subjects responsibility to investigate the substance. In my opinion however, the treatment provider must take responsibility for informing the subject as they are probably in a position to know more about ibogaine and the risks involved. By focusing on the risks you are also more likely to obtain the truth from the subject about their health if they know that it could be a matter of life or death.
I think that an ECG, a liver function test and blood work up are essential pre-requisites. When I started treatments I was more relaxed about this and administered ibogaine to people whom had not obtained the ECG. It wasn't until I had a couple of worrying situations that I made this essential inclusion criterion. If something were to go wrong and I hadn't obtained these reports I would personally never forgive myself. After all, people coming to do a treatment trust the provider and are paying the money because it is safer than doing it at home on their own or so they believe. As a treatment provider you have credibility and experience in the eyes of the clients. Therefore the position bears responsibility and should attempt to minimise the risks as much as possible. Eliminating the possibility of prior health complications will certainly decrease the risks.
I would also now consider a comprehensive medical history a pre-requisite. Even if a subject gets a clear ECG they may have had previous heart problems. This can be a danger and so a present medical work up is not necessarily enough. The case of the woman in Amsterdam dying recently shows this. She had apparently been given the all clear by her doctor on the condition of her heart and had even done ibogaine once before. However she had had open-heart surgery years previously. This in itself could have led to her death. One can never be sure but at least if you know the medical history of somebody you can make an informed decision as to whether you want to treat them.
The problem with this is obtaining the medical history as many people will lie about their health in a state of desperation. For this reason alone I would in future want to be working with a doctor who could request the medical history of the client from their GP. Failing that he could probably obtain an adequate history himself and could do a full physical work up. Obviously this is not always practical and the majority of ibogaine providers are doing it without medical assistance and providing a great service. However, potential sitters for ibogaine sessions should be aware of the responsibility and dangers involved and try to obtain as much information about the health of the client as possible. If anything happens and you haven't obtained this information how would you feel? At least if you have obtained all the information you can be satisfied that you tried your best.
I also think it is important that the provider can perform CPR as there have been several cases where this has been needed (although not in my personal experience).
I would also monitor breathing during the session as respiratory depression has been an issue according to the literature and if someone had severe asthma along with general poor health I would probably exclude him or her. I know of people with asthma who have done ibogaine for self exploratory purposes and been perfectly fine, however in the case of asthma with a severe addiction and heavy crack/smack (smoking) use I would not want to risk it.
This brings me onto the discussion of risks. There will always be risks as a treatment provider as we are performing this service outside of medical institutions and without medical training. Each treatment provides new material from which to carry out research into the drugs action. We are mapping new territory. For example if you stick rigidly to the exclusion criteria we may never learn about the interaction of ibogaine with certain medications and certain health conditions. But it’s a risk as a provider I was only able to do for a certain amount of time.
Examples of note are the treatment of an individual with insulin dependant diabetes. I didn't want to treat the individual and he requested for almost a year before I finally agreed. I didn't want to do the treatment because there was no information on ibogaine and diabetes available to me. However the treatment was a success. I monitored his blood sugar levels every half-hour to begin with for the first 2 hours and then every hour following that. His blood sugar remained high throughout the experience but not dangerously high and as he came down he was able to bring the sugar levels down to a more comfortable level. He said afterwards that perhaps he would have tried to get his levels down lower before starting again, as when he ingested they were higher than normal.
On the other hand I treated someone who I hadn't been aware had a stomach ulcer. I hadn't been thorough enough in my medical questioning of the individual. I don't know if I had known previously whether this would have stopped me carrying out the treatment. However his experience was one of the worst I encountered. He vomited blood for 5 hours between 1am and 6am. Initially negligible amounts however the content increased and I became worried that something was going wrong internally. This is obviously the first sign of haemorrhaging. I wanted to take him to hospital but he really didn't want to go and seemed to think that everything was fine. Our communication led me to believe that he probably was OK as he was showing no signs of distress and all his vital signs were normal - temp. blood pressure, pulse and breathing. I began to ask him at this stage if he had a stomach ulcer or anything similar and he said that he had. It was then that I realised that I hadn't been thorough with my questioning. This man had Hep C and had been dry retching for hours so it was most likely a small tear in the oesophageal lining.
Here we have two examples where risks were clearly taken, the case of the man with diabetes knowingly and the case of the man with the stomach ulcer unknowingly. One result was desirable and one not. On the whole I would say I would not knowingly take risks and hence the added requirement of the full medical history of the client. However sometimes in certain circumstances one will take risks and I think as long as the client knows himself that it is a risk and he is willing then it is a decision the treatment provider makes and has to live with. As a provider the majority of our knowledge comes from experience and sometimes we may be willing to cross into the unknown.
Taking a psychoactive substance such as ibogaine can lead into relatively unexplored areas of the mind. Generally this is not a problem with ibogaine as you maintain your rational state of mind throughout and your ego. This prevents fear of losing oneself or losing ones mind, a familiar fear on other psychoactives. However it is worth noting that on one occasion I was with someone who had a deep dislike of tripping. This can often be the case with addicts particularly with heavy crack/cocaine users. As the experience started to unfold for him he became visibly distressed. He kept asking me when it was going to end, that he couldn't stand all the things flying around the room and that the noises in his head were just too much to bear. This then progressed into feeling that he was dying. This is the only time someone experienced this kind of fear but it is a possibility that treatment providers should be aware of. If this should arise obviously it is of paramount importance that the sitter remain calm and reassure the subject that they are OK, that physically they are not dying. Perhaps ask them exactly why they think they are and then rationalise that these physical symptoms can be the effects of ibogaine. The body will feel strange but the experience will subside and get easier and gentler with time. Hold their hand, give them physical touch and stay close to them. One would also make sure that they are not in any physical danger by checking al the vital signs. The most important thing to stress is that the experience will pass and encourage them to relax into it rather than fight it. It is the fighting that intensifies such emotions.
POST IBOGAINE TREATMENT
The question of what comes next, what happens after the ibogaine is perhaps the second most important issue in the ibogaine story. All treatment providers will stress the importance of post treatment therapy and yet how to actually achieve the follow up care is a question that certainly still looms large in my mind. Most people that came to me for ibogaine had been through all the government funded drug addiction therapy and had left complete with their habit and disillusioned by the entire concept of therapy. I would propose that this is why they chose ibogaine. Ibogaine lets you do the work on your own. No-one is telling you to do anything, the sitter is just a facilitator and a friendly ear and shoulder to lean on for a short period of time. No commitment required here other than a five day stint. This is not to denigrate the commitment that they make in consuming ibogaine. However they don't have to commit to a follow up program, there are no requirements. This appeals to a certain type of person whom I would suggest is thoroughly disillusioned with therapy! A number of people said to me that they benefited more from the ibogaine than they had from 7/8 years in therapy. Whilst discussing after care options there were often none that appealed to my clients. Yet it is essential. From the results I have seen, the people that are still clean over a year later are the people that signed up for therapy post ibogaine.
Certainly in the UK there are very few options that appeal to people I have talked to or worked with. I would suggest that NA groups offer a great support structure and have been extremely helpful to one man I treated who is currently clean 14 months later. However many people have an extremely negative reaction to NA and many have said that they are places where you meet more people with more problems and often you start a relationship in an NA group which becomes co-dependent. Then one person falls back to using and "drags the other with them". There are many stories of negative encounters in the groups. Government funded treatment or therapy is usually group based and nearly everyone I have spoken to has criticised these programs saying that the people running the programs are often extremely young, have no experience of drug addiction themselves and that often you are just not listened to in the group. People have said that they have finally released extremely painful and personal material in the group only to be ignored. This leads to re -traumatising the individual.
Private therapy is somewhat hit and miss. There are brilliant practitioners out there but not many with any ibogaine experience (if any). Of these therapies I would agree with Nick Sandberg that bodywork is extremely important. Addiction, certainly in my case was about disconnecting from the physical reality and severing the connection with my physical body/existence. Escaping in an anaesthetic world of illusions. The thing that has most helped me has been bodywork, in the form of acupuncture particularly auricular therapy, which is less invasive. This helped a lot when I gave up cocaine. Breathwork has been the most important thing for me for reconnecting with the traumas lodged in my body that had been ignored and buried by cocaine alcohol or anorexia. The anorexia was an attempt to cut myself off from my body as it stops/stunts physical development. Anorexia also becomes sexual anorexia, as does heroin for many people. So sexual therapy is often required. This can be extremely difficult for people to confront and talk about and so breathwork is an easy way of letting the body/breath throw up the traumas, bring them to the surface and in an open somewhat altered state of mind this can be a good space in which to address them. It is worth noting that about 70% of people I worked with were the victims of sexual abuse.
So for people that are disillusioned by therapists and group counsellors various forms of bodywork can be extremely effective - acupuncture, rolfing, breathwork (rebirthing or Grofs), dance and movement therapy. Anything that reconnects you with the trauma lodged deep in your body. If you have been addicted for years the ibogaine may bring the reasons for the distress to the surface but that won't necessarily release them - especially if they are lodged deep - which is why the previously mentioned practices help.
I would also suggest that a support group is extremely beneficial. Unfortunately no matter how much I tried I couldn't get the people that I had seen to form an ibogaine support group and I think this would really help. I have seen it help on the ibogaine list. People able to talk to each other about their experiences on line. Perhaps this is the only way to do it but it would be good for example to have a group in the UK that met once a month to talk about things. I was criticised by a friend of someone that died six months after doing an ibogaine treatment with me. The man had been clean for six months and got to his 30th birthday and OD'd on heroin. He had apparently always said that he didn't want to live past this age. However his friend said that the guy had been finding life difficult post treatment as he had no-one to talk to about what had been for him a momentous and spiritual/life changing experience. As a result he couldn't relate to his world anymore. I had maintained contact with him but he hadn't told me about this. At the time I was treating other people and couldn't monitor this guy closely. He then died. Whether or not he killed himself I will never know but it made me think about the importance of follow up. This experience can dramatically change peoples lives and without adequate support this can be extremely difficult for people. This is definitely something I would like to address and see other treatment providers address more as well. I would suggest that a support group following treatment would be beneficial if not essential as well as a course of at least twenty sessions of some form of bodywork or counselling (or both ideally). A 24-hour ibogaine helpline would also be a good idea.
To conclude, no three day recovery program in itself can correct years of substance abuse. It is therefore essential to arrange follow up care. The ibogaine experience itself leaves you open and enthusiastic about creating changes in your life. Post treatment bodywork/counselling is essential, as it will help maintain this positive transformation and facilitate a deeper understanding and release of years of abuse.
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