by Scarlet Palmer on 12/03/2018 | Medicinal

What Is Cannabis Hyperemesis Syndrome?

CHS disease Cannabis hyperemesis syndrome, or cannabinoid hyperemesis syndrome, is not well understood and seems to be a new illness that mostly affects heavy cannabis users. Since the first recorded case in 2004, much has been speculated about this mysterious and literally sickening syndrome. Is it cannabis intolerance? Is it neem oil poisoning? And what’s with the hot baths?


Canabis hyperemesis syndrome sounds like William Randolph Hearst rose from the dead and cursed cannabis lovers with the worst thing his undead brain could conjure.

“You will vomit uncontrollably! You will assume cannabis will help because it is a proven anti-emetic, but it will make it worse! Vomiting episodes will last up to a week! Conventional anti-emetics will not work! Your doctor will not know what is causing it! BWAHAHAHAAAA!”

Joking aside, this is a gruesome condition and there’s no denying the correlation between cannabis use and the onset of cannabis hyperemesis symptoms, and the corresponding cessation of those symptoms within an average of three months of stopping cannabis use.

Correlation, however, is not causation. Despite what the tabloid press (who have dubbed the phenomenon “scromiting” because the sufferers both scream and vomit) claim, there is currently not enough scientific evidence to state that cannabis alone is the cause.

symptoms of cannabis hyperemesis syndrome

The literal translation of ‘hyperemesis’ is ‘hyper-vomiting’. This is the primary symptom. It manifests as prolonged periods of violent nausea and vomiting which last, on average, three to four days. Severe abdominal pain accompanies the sickness.

These three to four day episodes of hyperemesis happen to the majority of sufferers about every two months, which causes weight loss, dehydration, and understandably  a lot of stress! Many are hospitalised, and need to be given intravenous hydration and medical treatment.

This stage is preceded by what is termed the prodomal phase, where sufferers feel nauseous and as though they may vomit at any moment. This symptom is also accompanied by abdominal pain, despite which people usually manage to maintain regular eating.

Because these symptoms are quite vague and could have many different causes, this phase can go on for years and only be seen as part of cannabis hyperemesis syndrome once the hyperemesis stage has begun.

Hot baths, cannabis hyperemesis syndrome, and cyclical vomiting syndrome

A photograph. A woman leans over a toilet bowl, with one hand behind her head, and another covering her mouth. Her eyes are shut. She either just has, or just will, vomit.

All these symptoms are also seen in an equally rare and literally nauseating affliction, cyclical vomiting syndrome (CVS). The two conditions share one more symptom, and it’s very unusual. In both cases, people have reported finding relief by taking hot baths or showers. As neither condition responds to conventional anti-emetics, what is known as ‘compulsive bathing as learned behaviour’ is extremely common because it is one of the very few things that seem to help.

There is even an anecdotal report of a young man having plates of food next to his shower because hot showers were the only thing that made him feel well enough to eat. Approximately 60% of patients diagnosed with cannabis hyperemesis syndrome or cyclical vomiting syndrome reported using hot baths or showers to alleviate their symptoms.

Cannabis hyperemesis syndrome and cyclical vomiting syndrome actually have all of the following symptoms in common:

  • Repeating cycles of stomach pain, extreme nausea, and vomiting
  • Periods of feeling relatively well, or only having nausea, between the vomiting episodes
  • Conventional anti-emetics don’t work
  • Hot showers or baths do work
  • Weight loss (unsurprisingly)
  • Extreme thirst, sometimes linked to vomiting up water being less painful than trying to vomit with an empty stomach
  • Sufferers are under 50 years old

What’s the difference between cyclical vomiting syndrome and cannabis hyperemesis syndrome?

When it comes to making a diagnosis, physicians are beset by problems. Firstly, little is known about either syndrome. It’s common for patients to go through years of painful and invasive tests before a diagnosis is reached, because many other diseases and health problems are initially suspected and then have to be ruled out.

Often, physicians may not have even heard of these afflictions, making it even harder to diagnose  them! According to a 2017 German medical study, it takes about ten years for a definitive diagnosis to be made.

The same study also points out the many symptoms that cyclical vomiting syndrome and cannabis hyperemesis syndrome have in common:

“…both [are] characterised by recurrent episodes of heavy nausea, vomiting … and comparative well-being between the episodes… Literature is inconsistent concerning clinical features which allow to differentiate CVS from CHS”.

In fact, the only initial prerequisite for a potential diagnosis of CHS disease as oppose to CVS is chronic cannabis use. Comorbidities listed as indicating cyclical vomiting syndrome instead of cannabis hyperemesis syndrome are migraines, psychiatric illnesses, and rapid gastric emptying, also called “dumping syndrome”. Those that indicate cannabis hyperemesis syndrome are delayed gastric emptying, or gastroparesis, and the cessation of cannabis use leading to the end of the hyperemesis.

In other words, if you use cannabis and have hyperemesis problems, and then you stop using cannabis and the problems stop too, this is basically what confirms the diagnosis!

What is the connection between cHS disease, cyclical vomiting syndrome, hot baths, and chili peppers?

Despite some reports that cannabis hyperemesis is unique as a syndrome in causing its sufferers to only find relief from crippling nausea by taking hot baths, cyclical vomiting syndrome shares this feature. Because conventional anti-emetics don’t work on either affliction, this is a strong indication that one of the two is present. Research published in January 2018 points to the reason why bathing becomes ‘learned behaviour’ in people suffering from CHS, and a possible cause for CHS itself.

Although far more research is needed, there is a strong hypothesis that long-term exposure to cannabinoids desensitises certain receptors, rendering them inactive. The transient receptor potential vanilloid subtype 1 (TRPV1) receptors are activated by high temperatures, cannabinoids, and capsaicin – the chemical in peppers that makes them ‘hot’ and causes a burning sensation when they are eaten.

The TRVP1 receptors are present throughout the digestive system. When activated, they exercise a strong anti-emetic effect. Exogenous phytocannabinoids can trigger this, which is why cannabis works as an anti-emetic. However, when over-stimulated by (in this case) continual exposure to cannabinoids caused by cannabis use, they can temporarily ‘burn out’ and become inactive.

The theory is that this throws the digestive system so far off balance that the symptoms of CHS result – first the (potentially years-long) prodomal phase of nausea and discomfort, eventually the excessive vomiting. In a ‘fight fire with fire’ manner, applying the other factors that stimulate TRPV1 receptors – heat and capsaicin –  cause them to start working again.

Not only is this theory borne out by the common reports of hot baths taken by sufferers of both syndromes (60% of them according to research) but when capsaicin cream was applied to the abdomens of cannabis hyperemesis syndrome patients, they reported a lessening of symptoms within a matter of hours.

So far only 15 patients have been treated like this and the results recorded, but this is already very promising for a problem that has so far proved resistant to solving by any other means than “give up cannabis”.

Cannabis hyperemesis syndrome – the new reefer madness

Despite the lack of hard evidence that cannabis hyperemesis is caused by cannabis (as opposed to being linked to cannabis use), the mainstream media have leapt on it as proof that cannabis is indeed the devil’s lettuce. The free UK Metro paper attempted to claim the word ‘scromiting’ was coined in US emergency rooms as they flooded with affected cannabis consumers, although this claim was effectively debunked.

In 2015 the tabloid Daily Mail, which seems to swing between being rabidly for and rabidly against cannabis depending on which stance will generate the most outraged headline, warned that cannabis hyperemesis is likely to “drain hospital resources”, despite only two cases having been reported in the UK at the time.

Several studies and quite a few news reports have said that CHS is on the rise, and linked this to the increasing number of places where cannabis is legal for recreational and medicinal use. However, this is as yet unproven (as is the exact cause of CHS).

The first case of cannabis hyperemesis in the Netherlands was reported in 2005 despite cannabis having been decriminalised there since the early 70s, and it certainly isn’t an epidemic. There are no reported cases in Portugal (decriminalised 2001), nor Uruguay (legalised in 2017) that this writer has been able to find.

It could be simply that there are more reported cases, specifically in the US, because more people now feel able to tell doctors about their cannabis use without fear of repercussions. However, there is one more factor that correlates to cannabis hyperemesis which should be examined.

Could neem oil cause cannabis hyperemesis?

A photograph of a large Neem tree. Its branches are wide and spreading with a large cluster of dark green leaflets. It grows in a field near a farm and is slightly slanted.

The correlation between cannabis and cannabis hyperemesis is not in doubt. The causation is still unproven. What if, rather than the cannabis itself, something that is ingested along with it is the problem?

Neem oil is a natural pesticide which is certified for organic use in the US. The growth of the legal cannabis industry in the US, together with the eagerness of many licensed cultivators to produce an organic product, has led to an increase in the use of products containing azadirachtin, the substance derived from the neem tree which kills pests.

Symptoms of neem oil poisoning are virtually identical to symptoms of CHS – and abate in the same way when the exposure to neem oil and its derivatives ceases.

This hypothesis has mainly been raised by cannabis aficionados rather than doctors, and it is possible that conventional science just doesn’t know enough about how cannabis is grown to make the connection. There are currently 139 products containing neem oil that are registered with the Organic Materials Review Institute and available in the US.

However, it is not authorised for use in Canada (it’s actually illegal to use it as a pesticide there), nor in the UK, where rates of cannabis use among the population are closely comparable to the US but reported cases of cannabis hyperemesis syndrome are far fewer.

The Albanian connection

In 2013, a slew of poisonings were reported in Albania. Over 700 people “sought treatment… for the effects of planting, harvesting, pressing and packing the cannabis in the village of Lazarat”. Notorious at the time for its lawlessness and industrial-scale cannabis production, Lazarat hosted about 2000 people working in the cannabis fields.

The people needing treatment were almost all women and children, who were more likely to be handling and processing the cannabis than simply cutting the plants down, and far less likely to be deliberately ingesting any of it – especially when their employers only paid €8 per 10 processed kg .

Their symptoms were “bouts of vomiting, stomach pain, irregular heart beats and high blood pressure”. At the time, this was blamed on the cannabis alone. It’s extremely unlikely that this is the case. These are also the symptoms of neem oil poisoning.

It’s not possible to prove that neem oil was being used as a pesticide on the fields of cannabis in question. It is certain though that neem oil has been encouraged as an organic fertilizer throughout Albania, with 400 neem trees introduced there in 2005 as part of a ‘Raincoat Package’, along with training of local farmers in how to use it. This is circumstantial evidence, but it is evidence nonetheless.

So what next?

There are no definite answers to the questions of what causes cannabis hyperemesis syndrome, why it has only emerged in the last two decades of thousands of years of cannabis use, and whether or not it should even be called cannabis hyperemesis syndrome instead of ‘mystery emesis syndrome’ or ‘possible neem poisoning emesis syndrome’. What we can conclude, however, are the following points:

  • Cyclical vomiting syndrome and cannabis emesis syndrome only differ in two respects – the sufferer’s (self-confessed) use of cannabis, and the gastric emptying speeds. There is no indication that people diagnosed with CVS have been tested for cannabis use so it seems to be down to the individual to inform the doctors about it. Based on this, is it possible that some cases of CVS are actually CHS?
  • Neem oil poisoning is virtually identical to CHS. Neem oil is used on cannabis as an organic pesticide in both legal and illegal farming. If the neem oil remains on the cannabis flowers, it can be easily ingested by people who are unaware of its presence. Circumstantial evidence points to some cases of cannabis hyperemesis syndrome potential being neem oil poisoning.
  • The efficacy of hot baths and capsaicin cream in treating CHS suggests that the hypothesis of the TRPV1 receptors becoming over-stimulated by cannabinoids points to not all cases of cannabinoid hyperemesis syndrome being caused by neem oil, as these treatments would have no effect on neem oil poisoning.

What to do if you think you have cannabis hyperemesis syndrome

Firstly, stop ingesting cannabis. Whether it’s neem oil or not, you need to give your system a rest; cannabis hyperemesis syndrome symptoms usually take about three months to abate.

If you keep having symptoms after this time, it could be that something else is wrong, but the only way to rule out cannabis hyperemesis syndrome is to stop using cannabis.

Secondly, see your doctor and explain what you think is happening. You might need extra fluids and in extreme cases, an IV drip to replace lost liquids.

Have you had CHS, or do you know someone who has? What do you think could be the cause? Please let us know your thoughts in the comments below.

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James Kitchener

For 13 years I suffered from this at the extreme end of the scale, it went pretty much undiagnosed for 11 yrs at which point I was diagnosed with CVS after previously being tested for hundreds of conditions. I would end up vomiting to the point where I would end up with full body muscle spasms and go into kidney failure, this would last from 5 to 14 days at a time. Nothing the doctors gave me would relieve the vomiting, the only thing that helped was sitting in a hot shower or bathtub, which I would have for pretty much 24 hrs a day. My vitals got so bad that the doctors told me 8 to 10 times that I should have been dead or in a coma. My body rejected any fluids that I put into my body, I have a lot of information from my experience with this if you would like to contact me.

13/03/2018

Mel

I don’t smoke cannabis or take neem but I have had a vomiting problem for years.i vomit if I rush,go up or down stairs,brush my teeth etc but it’s not good,it’s that I’m constantly mucousy & (I hate to be graffic-sorry) but my left ear leaks.Doctors don’t seem to know why & no suggestion has really been made.I do get sudden cramps & diarrhoea but no massive or long lasting stomach pains.Does this sound like cvs?

13/03/2018

Jennifer O

Hi! I have a question about your symptoms? After you stopped smoking, how long after did it go away? And did anything help? How does it get better?

14/03/2018

Leanne

I recently had this happen to me. Luckily the doctors working on my case figured it out. I too, took hot showers, to help with my pain and comfort. I couldn't even hold a sip of water. I was using the cannabis pens like two I a week. I was released from hospital today. I would love to find out more. I

04/08/2018

deba

did u ever get sick from second hand thc smoke? I have CHS and all of sudden i have started to get symptoms for second hand smoke

02/07/2019

Jeffery Rittenour

I have this and it was the second worse pain I've ever had... if you experience it stop smoking weed and it will go away. Life may suck for A LOT of people without weed but it's worth it. I quit and it went away. If I smoke now the pain comes back in my stomach... it's not worth it.

16/04/2018

Michael Benko

Would be very interesting to have somebody such as yourself, who experiences recurrence of symptoms with re-attempted cannabis use, try cannabis that is 100% known to be grown without any pesticides.

This would allow for some insight into whether neem oil or other residues could truly be linked with CHS.

23/05/2018

Elke320

My 20 year old son got diagnosed last week with CHS. He’s had a “sensitive” stomach for years, sometimes we suspected dairy/lactose intolerance. He managed a lot of times with probiotics, drinking 2-4 oz aloe Vera water first thing in the morning and of course ridiculously long showers. I encouraged peppermint essential oil topically during these episodes but come to find out clove oil can be beneficial. And he said he got relief from an oil blend called thieves which had clove oil in it. I read basil, clove, and chamomile may be helpful for this. I also read up that it’s similar to having a migraine in your stomach. And that possibly a keto diet( high fat-200gms or more!! moderate protein-like 60GMs, and low carb20-25 carbs can be amazingly helpful and can help heal your gut. And of course, abstain from canabis. Good luck to those who have found yourself in this situation. My son says he wants to quit but it’s his journey and very hard to be on the sidelines watching and knowing. He has had a rough past 3 years and was trying to just smoke pot for his “anxiety”. I’ve also read a great book called the mood cure by Julia Ross that had recommendations for people in recovery for simple, not expensive amino supplements. But I have to watch my codendance here and I understand I can’t change him, or his choices. I’m a bit of an over researcher but trying to keep myself in check, and go to several meetings a week myself.

05/05/2018

Chris Leary

Are the symptoms of pesticide poisoning relieved by hot showers? No. And if anything about chs has been determined by science it's that it is caused by cannabinoids! Many desperate, weed-loving sufferers have grown their own clean product with disappointing results. Despite the feelings of marijuana proponents (that would include me) chs is forcing us to rethink the way it is used medically. CHS is probably the result of increased potency of strains developed.

27/05/2018

Scarlet Palmer

Hi Chris,

Thank you for your comment. I agree that symptoms of pesticide poisoning are not relieved by hot showers, although they are similar enough to CHS that I do wonder if some cases of the former are misdiagnosed as the latter. Please could you let me know your sources for the statement "if anything about chs has been determined by science it’s that it is caused by cannabinoids!" as I was unable to find any scientific evidence of a link between cannabinoids and hyperemesis when I was researching and writing this article? I could only find circumstantial evidence, and proof of correlation but not causation. If there is more up to date evidence, I would like to be able to update this article with it as there is a lot of controversy and speculation around this topic.

Thanks in advance, and with best wishes,

Scarlet

28/05/2018

JJ

My first experience was in 1998 vomiting for 3 days doctors at hospital didn't have a clue in the following year's I would experience it at least once every 3 months few near death experiences due to dehydration and not getting to hospital for fluids after 5 or more days of almost constant vomiting bile reflux my veins had collapsed and I remember it being a struggle to get fluids into me due to veins being missed I did find the article about chs within weeks of it being published because my older brother also was having regular problems with it and someone at the hospital gave him the article on a pamphlet around 2003/2004 in the Adelaide hills of south Australia growing weed was very common and accepted so people were not afraid to tell doctors they smoke it immediately set alarm bells ringing with the hot baths and showers for relief as I would find myself trying to sleep in a hot bath at times because these hot cold chills and bouts of vomiting, nausea would last for days only getting temp relief when I was submerged in hot water and it was same for my brother we both smoked daily for at least 10 years prior there was a massive change in strain quality about 1993 it all went indoors but no sickness started till 1998/99 still a regular occurrence for us both now but glad to see it being recognized finally as this one pamphlet was not backed by any other study at the time and no info anywhere else about it, i tried to spread the word ten years ago but no one ever heard anything about it my opinion after all these years is most likely pesticide poisoning but my thoughts back in the day were people not flushing the chems and nutrients solutions in the final weeks of grow before harvest and I thought also that bacteria in bong water or the bong itself maybe responsible it is certainly worthy of further study.

06/06/2018

Gd

I just talked with my MJ dr. Re: me symptoms Of bouts of nausea, eventually diarrhea and stomach pains every day. Started when I was referred for thc/cbd for back problems. Works great for pain relief but these new symptoms caused me to stop completely a few weeks ago just to see, the nausea and stomach ills have gradually disappeared! Dr. Gave me this name to look up, I’ve never heard of it. I am not a chronic user, never used before 7 months ago so that is different. Did not experience vomiting yet, or use of hot showers. I thought I must be allergic! He suggests trying cbd alone, slowly increasing dose until pain relief is obtained, if it works and no symptoms come up. My experience was the thc worked much better for pain.
I hope this helps others!

12/07/2018

Wendell

I had my first experience with CHS several days ago. Woke up. Felt off. Starting vomiting. Swearing. More vomiting and incredible feelings of “wretching” that i have never experienced. It was like my insides were possessed and I simply could not find physical comfort. Then reading about hot showers, I jumped in and at least I quit puking so readily. But so thirsty and by now not keeping anything in. So now it’s “do I go to ER now or risk it?” I almost called 911. I didn’t, because I made it to the ER driving, albeit with 3 stops.

Gave me Haldol 2mg (antipsychotic) which actually took some edge off. Then sedative via Ativan. Fell asleep. Bliss. Forced rest. IV. Thank you God.

Home later that day. Woke up next day ok. Day after that, puking again. Not as severe. No ER. Hadn’t smoked since 1 puff morning of initial ER visit. Sick all day, by toilet 2 hrs. Oh, doctor prescribed capsaicin cream for next time (in lieu of hot showers). Worked ok, but you have to remember that in no way do you feel normal while showering. You just feel a little bit less like you want to die. And I mean that. You do want to die.

05/09/2018

dc

i have supposedly suffered from this and still am but not everything is the same.a hot shower would kill me, i need to be cold, i sweat like crazy and cannot stop vomitting with EXTREME violence.the pain is unbarable, ive contemplated suicide as the hospitals here are useless and every time have me waiting over 6 hours to be seen while i lie on the floor screaming and vomitting. also morphine seems to totally stop it for me, but im pretty sure its a dosage thats borderline overdose. and it stops for me after a few days in hospital with the vomiting ceasing after a few hours once im given cyclizine ondansatron and lots of morphine. also it only happens at most frequent once every 6 months and that was when i quit weed to see if it was because of it. so i dont know, i had a ct scan in spain that showed i had a inflammed and intusscesspted small intestine, i think might really be sick.

10/09/2018

Bob Malley

Hi guys, I want to talk seriously about Cannabinoid Hyperemesis Syndrome which is a legit medically published condition that was first described in the early 2000’s.

I have had it 3 times in exactly 10 years, and there doesn't seem to be much first hand info or widespread knowledge of this very real and very horrible sickness. I have needed medical care twice and will outline what happened leading up to the sickness coming on each of the three times.

Please note** anti-emetic drugs like Stemetil etc. don't always work there is a tablet called Nexium (Esomeprazol) that stops too much stomach acid and this has helped a little. The only other things that help all are very, very hot water and absolutely no smoking for at least 24 hours.

These common denominators were present over the past 10 years just prior to getting CHS symptoms:

Weight Loss - 3/3 times CHS came on I was in the middle of a diet/losing weight, this is I think the main cause - THC can stay in your fat cells for months and when you lose weight it is released and comes flooding back into your system along with the new cannabinoids you smoke and you are essentially overdosing. This is very important because all three times this has happened I was losing weight and on a diet (symptoms were not caused by change in diet or lack of food, water etc.)

Bongs - 3/3 times CHS happened I was smoking between 30-50 cones of very strong hydro cannabis daily (i'm embarrassed to admit this) never happened with joints

Kush Strains/Purple Strains 3/3 times CHS came on I was smoking Kush and or Purple strains (1st time Purple Kush, 2nd time Purple Chemdawg, 3rd time Violator Kush)

Tobacco - 2/3 times I was smoking tobacco and the syndrome happened but I never mixed it with cannabis in a bong to consume only having a cigarette afterwards.

Angostura Bitters - 2/3 times the night before CHS came on I had consumed angostura bitters in water (no alcohol) and angostura bark is know to treath stomach disorders. I know it’s unlikely a cause but it was present and worth noting.

I'd bet my life it is to do with the THC in your fat cells flooding your system that causes this overdose, but these are just the common denominators present before all three episodes of CHS over 10 years.

FIRST CHS EPISODE 2008, I was smoking close to 40 cones of cannabis a day and 15 roll your own tobacco cigarettes. I got some Purple Kush and it was extremely strong, I loved it but after a week I would get these gassy burps and feel a sickly pressure was building in my stomach all the time not long after smoking. One morning I woke up and smoked a bong straight away and then I was anxious, ill, throwing up bile, shaking and I thought I was poisoned and the only relief I got was when I had a very hot bath, then when I would get out of it I would instantly feel ill again. I thought I was going crazy.

My mother took me to the Dr's who had no idea what was going on, I was throwing up every minute and was in a bad state, the Dr. gave me an anti-emetic injection and some Nexium tablets and I got better and quit bongs from that day forwards and resumed smoking joints a few weeks later with no ill effects. I thought the whole thing was from contaminated cannabis I had consumed and nothing bad happened until September 2016.

SECOND CHS EPISODE I learned about CHS sometime in 2011 and couldn't believe other people had experienced the same symptoms and relief from very hot water. At this time I stupidly bought a bong and got up to smoking close to 30 cones a day of Purple Chemdawg until the exact same symptoms occurred, I felt them coming on though early and only had a brief bought of vomiting and I immediately quit smoking and threw out my bong and didn't need medical intervention this time, but it scared me because weeks afterwards, out of the blue despite not smoking cannabis this nausea would hit me.

THIRD CHS EPISODE November 2018 I stupidly bought a bong again and some Violator Kush and was up close to consuming 40 cones a day and the same thing happened again, I know I must be insane to keep pushing myself to this. I awoke last Sunday morning with nausea, that feeling of anxiety and the sick pressure in my stomach, I smoked a pipe and made a coffee and then began throwing up, lots of bile and I couldn't keep any liquids down. I booked in to see my GP and had a very hot shower and then felt amazing and cancelled the appointment. After an hour the symptoms came back and I showered again but the relief only lasted 10 minutes. I took an anti-nausea tablet and but threw it up, then I booked into the GP again.

I explained to the GP that I was ill with CHS and they thought I was bonkers and questioned me thoroughly about other drug use. I explained my history and the situation when I was last at the clinic for CHS and she gave me an injection of Stemetil and some Nexium and I slept in the observation room for 20 mins and felt better and went home.

So that is my history. I'm on a long cannabis break now and I truly hope this info can be used or at the very least considered by serious medical researchers, as I've had this three times I personally feel very alone and on the cutting edge of understanding and dealing with this very real 'thing' and I really want to get the word out there. Thank you very much guys for reading and I would really like to hear what you think.

08/11/2018

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