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Barbiturate Overdose: Symptoms, Treatment, and More

Barbiturates, once commonly prescribed for their sedative and hypnotic properties, are central nervous system depressants that can induce relaxation and sleep. However, their potency also poses a significant risk of overdose, especially when misused or combined with other substances.

In this blog, we delve into the critical issue of barbiturate overdose, shedding light on its causes, symptoms, and the importance of seeking professional help. Additionally, we explore the role of California Prime Recovery Addiction Treatment Center, a beacon of hope for individuals struggling with addiction in Orange County, CA. Through comprehensive treatment programs and compassionate care, California Prime Recovery offers a pathway to recovery and a chance to reclaim a life free from the grips of addiction.

Clinically Reviewed by: Charee Marquez, LMFT

What Are Barbiturates?

It is a sedative medication that includes pentobarbital, secobarbital, Phenobarbital, and butalbnital. Barbiturate has historically been used as sedating anesthetics and hypnotic (sleep-inducing agents). They are commonly used to manage several conditions, ranging from headaches to seizure disorders.

You can find them in the form of liquid solutions and tablets. The long-term effects of using barbiturates are unknown. But the short-term dangers of misuse of barbiturates may include disorientation, slowed breathing, fatigue, problems with memory and concentration, and slurred speech.

Barbiturate is also largely used for non-medical purposes without a prescription by a medical expert. If you are taking barbiturates non-medically, you have a great risk of getting an overdose, especially if you are using other drugs like central nervous system depressants with it.

Barbiturate Types and Dosages

Types of Barbiturates:

  1. Phenobarbital: It has a long duration of action and is sometimes used to control seizures.
  2. Pentobarbital: This short-acting barbiturate was historically used for anesthesia and sedation but is less commonly prescribed today.
  3. Secobarbital: It’s an intermediate-acting barbiturate and was historically used as a short-term treatment for insomnia.

Dosages: Dosages of barbiturates can vary widely based on the specific drug, the intended use, and individual patient factors. The following dosages are general examples and may not be appropriate for every individual or medical condition:

  1. Phenobarbital:

    • For seizure control in adults: Initial dose of 60 to 180 mg per day, divided into 2 to 3 doses.
  2. Pentobarbital:

    • For sedation or preanesthetic use: 50 to 100 mg given intravenously.
  3. Secobarbital:

    • For insomnia: 100 mg at bedtime.

Barbiturate Uses

Historically, barbiturates were widely used for various medical purposes due to their sedative, hypnotic, and anticonvulsant properties. However, their use has decreased significantly in recent decades due to the associated risks of dependence, overdose, and the availability of safer alternatives. Some of the historical uses of barbiturates include:

  1. Sedation and Hypnosis:

    • Barbiturates were commonly used to induce sedation and sleep. Short-acting barbiturates like secobarbital were prescribed for insomnia, while longer-acting ones like phenobarbital were used for sedation.
  2. Anesthesia:

    • Barbiturates were used as anesthetic agents before the development of safer alternatives. Thiopental, a short-acting barbiturate, was commonly used for the induction of anesthesia.
  3. Anticonvulsant Therapy:

    • Phenobarbital, a long-acting barbiturate, has anticonvulsant properties and was historically used in the treatment of seizures, particularly in the control of certain types of epileptic seizures.
  4. Treatment of Anxiety:

    • Barbiturates were prescribed for anxiety disorders, but their use for this purpose has largely been replaced by benzodiazepines, which generally have a safer side effect profile.
 

Barbiturate Onset and Duration

Barbiturates are a class of drugs that act as central nervous system depressants. The onset and duration of their effects can vary depending on factors such as the specific barbiturate used, the dosage, individual metabolism, and method of administration. Here’s a general overview:

  1. Onset: The onset of effects for barbiturates can vary widely depending on whether they are taken orally or administered intravenously. When taken orally, the onset typically ranges from 15 minutes to an hour. Intravenous administration leads to a much quicker onset, usually within a few minutes.

  2. Peak Effects: The peak effects of barbiturates usually occur within 1 to 2 hours after administration. During this time, individuals may experience feelings of relaxation, drowsiness, and sedation.

  3. Duration: The duration of effects for barbiturates can also vary based on factors such as the specific drug and dosage. Generally, the effects of short-acting barbiturates may last for 3 to 6 hours, while those of longer-acting barbiturates can persist for up to 6 to 12 hours or longer.

How Long Do Barbiturates Stay in Your System?

The half-life of barbiturates can vary depending on the specific compound and individual factors such as metabolism and dosage. Generally, barbiturates have relatively short to intermediate half-lives compared to some other drugs. Here are approximate half-lives for some common barbiturates:

  1. Short-acting Barbiturates: Short-acting barbiturates, such as secobarbital and pentobarbital, typically have half-lives ranging from 4 to 12 hours. These drugs are commonly used for anesthesia induction and the treatment of acute conditions like seizures.

  2. Intermediate-acting Barbiturates: Intermediate-acting barbiturates, such as amobarbital, have half-lives ranging from 10 to 20 hours. These drugs are sometimes used for the management of chronic conditions like epilepsy and as sedatives or hypnotics.

  3. Long-acting Barbiturates: Long-acting barbiturates, such as phenobarbital, have half-lives ranging from 50 to 140 hours. These drugs are often used for the management of chronic conditions like epilepsy and as sedatives or hypnotics.

It’s important to note that while these are general ranges, individual variations can occur. Factors such as liver function, kidney function, age, and concurrent use of other medications can influence the metabolism and elimination of barbiturates from the body.

 

Barbiturates Controlled Substance Classification

  1. Phenobarbital:

    • Phenobarbital is classified as a Schedule IV controlled substance. Schedule IV substances have a lower potential for abuse relative to drugs in Schedule III and include accepted medical uses.
  2. Secobarbital:

    • Secobarbital is classified as a Schedule II controlled substance. Schedule II substances have a higher potential for abuse than Schedule IV and are subject to more stringent controls. Secobarbital is classified as such due to its abuse potential and the risk of physical and psychological dependence.

Barbiturates Storage and Disposal

here are some general guidelines for storing medications, including barbiturates:

  1. Cool and Dry Place:

    • Store barbiturates in a cool, dry place. Avoid exposure to excessive heat, moisture, or direct sunlight, as these factors can affect the stability of the medication.
  2. Secure Location:

    • Keep barbiturates in a secure location to prevent unauthorized access, especially if the medication poses a risk of misuse or abuse.
  3. Childproof Containers:

    • Use childproof containers to store medications, reducing the risk of accidental ingestion by children.
  4. Original Packaging:

    • Keep medications in their original packaging with the label intact. This helps ensure that you can easily identify the medication and follow proper dosage instructions.
  5. Avoid Bathroom Storage:

    • Avoid storing medications in the bathroom, as the humidity and temperature changes in this environment can impact the stability of the medication.
  6. Follow Expiration Dates:

    • Check the expiration date on the medication packaging, and do not use the medication if it has passed its expiration date. Expired medications may be less effective or may pose safety risks.
  7. Keep Out of Reach of Pets:

    • Like with children, ensure that medications are kept out of reach of pets to prevent accidental ingestion.
  8. Disposal of Unused Medication:

    • Dispose of any unused or expired medications properly. Follow local guidelines or take them to a designated medication disposal site to prevent environmental contamination or accidental ingestion.

Always consult with your healthcare provider or pharmacist for specific storage recommendations for the particular barbiturate medication you have been prescribed.

How Do Barbiturates Work in the Brain and Body?

Barbiturates work by enhancing the activity of gamma-aminobutyric acid (GABA), which is the primary inhibitory neurotransmitter in the central nervous system (CNS). Here’s a more detailed explanation of how barbiturates affect the brain and body:

  1. GABA Enhancement: Barbiturates bind to specific sites on the GABA-A receptors, which are ion channels located on neurons in the brain. When GABA binds to these receptors, it opens the ion channels, allowing chloride ions to flow into the neuron. This influx of chloride ions hyperpolarizes the neuron, making it less likely to generate an action potential and thus inhibiting neuronal activity. Barbiturates enhance the effect of GABA by increasing the duration of the ion channel opening, leading to further inhibition of neuronal activity.

  2. Central Nervous System Depression: By enhancing GABAergic transmission, barbiturates produce a generalized suppression of neuronal activity in the CNS. This leads to a range of effects, including sedation, relaxation of muscles, reduction of anxiety, and induction of sleep. At higher doses, barbiturates can cause more profound CNS depression, leading to effects such as respiratory depression, coma, and even death in cases of overdose.

  3. Different Types of Barbiturates: Barbiturates can be classified based on their duration of action, ranging from short-acting to long-acting. Short-acting barbiturates, such as pentobarbital and secobarbital, are commonly used for anesthesia induction and the treatment of acute conditions like seizures. Long-acting barbiturates, such as phenobarbital, are used for the management of chronic conditions like epilepsy and as sedatives or hypnotics.

  4. Tolerance and Dependence: Prolonged use of barbiturates can lead to tolerance, meaning that higher doses are required to achieve the desired effects. Additionally, abrupt discontinuation of barbiturates after chronic use can lead to withdrawal symptoms, including anxiety, tremors, seizures, and potentially life-threatening delirium and cardiovascular collapse. Because of these risks, barbiturates are now less commonly prescribed and have been largely replaced by safer alternatives for conditions such as anxiety and insomnia.

In summary, barbiturates exert their effects by enhancing GABAergic transmission in the CNS, leading to a generalized suppression of neuronal activity. While they can be effective for certain medical conditions, their potential for abuse, tolerance, dependence, and overdose underscores the importance of cautious prescribing practices and close medical supervision.

Usage of Barbiturate

Barbiturate is usually used for psychological and neurological treatments. Some common uses of barbiturates include:

Treat Anxiety

Barbiturate medications are taken in low doses to treat anxiety. They have therapeutic effects on tension and anxiety. This is because of the barbiturate’s soothing effects on your central nervous system.

Manage Epilepsy and Seizures

Barbiturates can treat epileptic disorders and seizures. And they have lower side effects for seizures.

Work as Pre-Anesthesia

Barbiturates, such as thiamylal and thiopental, are also used as anesthesia for some patients. They can make medical surgeries and other procedures easier for doctors.

Helps With Insomnia

It is a sleep disorder characterized by staying asleep or difficulty falling asleep. Barbiturate medications can help you control your nervous system, which eventually helps you sleep better and for longer.

Supports Euthanasia

Doctors recommend large doses of barbiturates for terminally people to help them die peacefully. These drugs are also used on pets to eliminate the suffering of animals when they are at the end of their lives.

Side Effects and Risks of Barbituates

Here are some general short-term and long-term side effects:

Short-Term Side Effects:

  1. Drowsiness and Sedation:

    • Barbiturates have a strong sedative effect, leading to drowsiness and a feeling of relaxation.
  2. Impaired Coordination:

    • Motor coordination may be affected, leading to issues with balance and fine motor skills.
  3. Cognitive Impairment:

    • Barbiturates can cause cognitive impairment, including difficulties with memory, concentration, and judgment.
  4. Slurred Speech:

    • Speech may become slurred due to the depressant effects on the central nervous system.
  5. Respiratory Depression:

    • Barbiturates can suppress the respiratory system, leading to shallow breathing or respiratory depression.
  6. Dizziness:

    • Some individuals may experience dizziness or lightheadedness.
  7. Nausea and Vomiting:

    • Gastrointestinal side effects such as nausea and vomiting may occur.
  8. Hypotension:

    • Barbiturates can cause a drop in blood pressure, leading to hypotension.

Long-Term Side Effects:

  1. Tolerance:

    • With continued use, individuals may develop tolerance, requiring higher doses to achieve the same effects.
  2. Dependence:

    • Long-term use can lead to physical and psychological dependence.
  3. Withdrawal Symptoms:

    • Abrupt discontinuation of barbiturates can result in withdrawal symptoms, including anxiety, tremors, insomnia, and seizures.
  4. Cognitive Decline:

    • Chronic use may contribute to cognitive decline, affecting memory and cognitive function.
  5. Increased Fall Risk:

    • Long-term use of barbiturates can increase the risk of falls, particularly in the elderly.
  6. Overdose:

    • Barbiturate overdose can be life-threatening, leading to respiratory failure and cardiovascular collapse.

Can You Overdose on Barbiturates?

Yes, it is possible to overdose on barbiturates. Barbiturate overdose can occur when an individual takes too much of the medication, either intentionally or accidentally. An overdose of barbiturates can lead to severe central nervous system depression, which can be life-threatening. The risk of overdose is higher when barbiturates are taken in combination with other central nervous system depressants, such as alcohol, benzodiazepines, or opioids.

What Causes Barbiturates Overdose?

A barbiturate overdose can occur due to various factors, including:

  1. Accidental Ingestion: In some cases, individuals may accidentally take too much of a prescribed barbiturate medication, either due to misunderstanding the dosage instructions, forgetting that they have already taken a dose, or confusing their medication with another.

  2. Intentional Overdose: Some individuals may purposefully ingest large quantities of barbiturates in an attempt to harm themselves or to achieve a desired effect, such as euphoria or sedation. This may occur as a result of underlying mental health issues, substance abuse disorders, or suicidal ideation.

  3. Combining with Other Substances: Mixing barbiturates with other central nervous system depressants, such as alcohol, benzodiazepines, or opioids, can significantly increase the risk of overdose. Combining these substances can potentiate their effects on the central nervous system, leading to severe respiratory depression, coma, and death.

  4. Tolerance: Prolonged use of barbiturates can lead to the development of tolerance, meaning that higher doses are required to achieve the desired effects. Individuals who have developed tolerance to barbiturates may inadvertently take larger doses in an attempt to overcome tolerance or to achieve the same effects they experienced initially, increasing the risk of overdose.

  5. Medical Conditions or Interactions: Certain medical conditions or interactions with other medications can affect the metabolism and elimination of barbiturates from the body, increasing the risk of overdose. For example, liver impairment can impair the metabolism of barbiturates, leading to higher blood levels and increased toxicity.

  6. Misuse or Abuse: Barbiturates have a high potential for misuse and abuse due to their sedative and euphoric effects. Individuals who misuse or abuse barbiturates may take them in higher doses or through non-prescribed routes of administration, increasing the risk of overdose.

Overall, a barbiturate overdose can occur due to a combination of factors, including accidental ingestion, intentional misuse, interactions with other substances or medications, and underlying medical conditions. It is important to use barbiturate medications only as prescribed by a healthcare professional and to seek immediate medical attention if an overdose is suspected.

 

Signs and Symptoms of Barbiturate Overdose

Signs and symptoms of a barbiturate overdose can vary depending on the severity of the overdose and individual factors such as the specific barbiturate taken, the dosage, and the person’s tolerance to the medication. Here are common signs and symptoms of a barbiturate overdose:

  1. Extreme Drowsiness or Sedation: Excessive sleepiness or difficulty staying awake is a hallmark sign of barbiturate overdose. The individual may have difficulty responding to stimuli and may appear lethargic or unresponsive.

  2. Confusion or Disorientation: Barbiturate overdose can impair cognitive function, leading to confusion, disorientation, and difficulty thinking clearly.

  3. Slurred Speech: Speech may become slurred or difficult to understand due to the central nervous system depressant effects of barbiturates.

  4. Impaired Coordination: Motor coordination may be significantly impaired, leading to unsteady gait, clumsiness, or difficulty performing tasks that require fine motor skills.

  5. Respiratory Depression: One of the most serious effects of barbiturate overdose is respiratory depression, characterized by slow, shallow, or irregular breathing. In severe cases, breathing may become dangerously slow or even stop altogether, leading to hypoxia (oxygen deprivation) and respiratory arrest.

  6. Hypotension (Low Blood Pressure): Barbiturates can cause a drop in blood pressure, leading to symptoms such as dizziness, lightheadedness, fainting, or shock.

  7. Bradycardia (Slow Heart Rate): Barbiturate overdose may cause a decrease in heart rate, leading to bradycardia. This can manifest as a slow pulse, weakness, or fainting.

  8. Hypothermia: Barbiturates can lower body temperature, leading to hypothermia. Symptoms may include shivering, cold extremities, and confusion.

  9. Coma: In severe cases of barbiturate overdose, the individual may progress to a state of unconsciousness or coma. Coma is a medical emergency and requires immediate medical intervention.

  10. Death: In extreme cases, barbiturate overdose can be fatal, especially if respiratory depression progresses to respiratory arrest or if other complications occur.

It’s important to note that the signs and symptoms of a barbiturate overdose can be life-threatening and require immediate medical attention. If you suspect that someone has overdosed on barbiturates, call emergency services or seek medical help immediately. Prompt treatment is crucial to prevent serious complications or death.

 

Responding to an Overdose of Barbiturate

Responding to a barbiturate overdose requires prompt action and medical attention. If you suspect that someone has overdosed on barbiturates, follow these steps:

  1. Call Emergency Services: Dial your local emergency number immediately to summon medical assistance. Provide the dispatcher with all relevant information, including the person’s condition, any medications they may have taken, and any other substances involved.

  2. Monitor Vital Signs: While waiting for help to arrive, monitor the person’s vital signs, including their breathing, pulse, and level of consciousness. If necessary, administer first aid measures such as cardiopulmonary resuscitation (CPR) if the person stops breathing or their heart stops beating.

  3. Do Not Leave the Person Alone: Stay with the person and provide reassurance. Try to keep them calm and comfortable while waiting for medical help.

  4. Provide Information: If possible, gather any relevant information about the overdose, such as the type and amount of barbiturate taken, when it was ingested, and whether any other substances were involved. This information can be crucial for medical professionals in providing appropriate treatment.

  5. Do Not Attempt to Make the Person Vomit: While it may be tempting to induce vomiting to remove the barbiturate from the person’s system, this can be dangerous and is not recommended. Vomiting can lead to aspiration, where vomited material enters the lungs, potentially causing choking or aspiration pneumonia.

  6. Follow Medical Instructions: Once medical help arrives, follow the instructions of the emergency responders or healthcare professionals. Be prepared to provide any additional information they may request and cooperate fully with their assessment and treatment efforts.

  7. Supportive Care: Treatment for barbiturate overdose may involve supportive care to maintain vital functions, such as assisted ventilation to ensure adequate oxygenation and intravenous fluids to maintain hydration. In severe cases, antidotes or other medications may be administered to reverse the effects of the overdose.

Responding to a barbiturate overdose requires quick action and coordination with medical professionals. By following these steps and seeking prompt medical attention, you can help ensure the best possible outcome for the person experiencing the overdose.

 

Emergency Medical Treatments

Emergency medical experts will choose different types of treatments for an individual showing barbiturate overdose symptoms, such as:

  • Airway support
  • Blood tests
  • Heart monitoring
  • IV fluids
  • Activated charcoal administration

When a person is admitted due to a barbiturate overdose, during the testament, the health expert team will continuously monitor an individual’s breathing and try to maintain oxygen levels and healthy blood pressure.

Also, to help quit an addiction, avoiding opting for a detox procedure by yourself is important. You need to consult a health expert to help you withdraw barbiturates. Medically assisted detox can make the process less painful and several for people taking barbiturates for extended periods. The health experts provide you with a secure environment and help you undergo different procedures that last about a week. The entire process will focus on making you stable, sober, and prepared for life after the treatment.  

Here are the two most common treatment methods used for addiction treatment.

Alcohol Use and Barbiturates

Combining barbiturates with alcohol is extremely dangerous and can have severe consequences. Both barbiturates and alcohol are central nervous system depressants, meaning they slow down brain activity and vital functions such as breathing and heart rate. When taken together, they can potentiate each other’s effects, leading to increased risks of overdose, respiratory depression, coma, and death.

Here are some reasons why combining barbiturates and alcohol is particularly hazardous:

  1. Increased Central Nervous System Depression: Barbiturates and alcohol have additive or synergistic effects on the central nervous system, meaning that their combined use can lead to profound sedation, loss of consciousness, and impaired cognitive and motor function. This can increase the risk of accidents, falls, and other injuries.

  2. Respiratory Depression: Both barbiturates and alcohol can suppress respiratory drive, leading to shallow breathing, respiratory depression, and potentially fatal respiratory arrest. Combining these substances can exacerbate respiratory depression, significantly impairing breathing and oxygenation.

  3. Risk of Overdose: Combining barbiturates and alcohol increases the risk of overdose, as the effects of each substance can mask the symptoms of overdose from the other. This can make it difficult to recognize and respond to an overdose in a timely manner, increasing the likelihood of severe complications or death.

  4. Liver Toxicity: Both barbiturates and alcohol are metabolized in the liver, and combining them may increase the risk of liver toxicity and damage. Chronic use of barbiturates and alcohol together can lead to liver dysfunction, hepatitis, cirrhosis, and other serious liver-related conditions.

  5. Impaired Judgment and Decision-Making: Barbiturates and alcohol can impair judgment, decision-making, and impulse control. Combining these substances can lead to risky behaviors, such as driving under the influence, engaging in unsafe sexual practices, or making poor decisions that can result in harm to oneself or others.

Overall, combining barbiturates and alcohol is highly dangerous and can have life-threatening consequences. If you or someone you know is struggling with substance abuse involving barbiturates, alcohol, or both, it’s essential to seek help from healthcare professionals or addiction treatment specialists. They can provide support, guidance, and resources for overcoming addiction and promoting recovery.

Pregnancy and Barbiturates

Barbiturates are not recommended for use during pregnancy due to their potential risks to both the pregnant person and the developing fetus. Here are some reasons why barbiturate use during pregnancy is concerning:

  1. Teratogenic Effects: Barbiturates have been associated with an increased risk of birth defects when used during pregnancy, particularly during the first trimester when fetal organogenesis occurs. These birth defects may include congenital malformations of the heart, central nervous system, limbs, and other organs.

  2. Neonatal Withdrawal Syndrome: Prolonged use of barbiturates during pregnancy can lead to physical dependence in the fetus, resulting in neonatal withdrawal syndrome after birth. Neonatal withdrawal syndrome can cause symptoms such as irritability, tremors, feeding difficulties, respiratory distress, and seizures in newborns.

  3. Risk of Miscarriage and Stillbirth: Barbiturate use during pregnancy has been associated with an increased risk of miscarriage, stillbirth, and premature labor. The use of barbiturates, especially in high doses or for an extended period, can disrupt normal uterine function and increase the likelihood of adverse pregnancy outcomes.

  4. Neurodevelopmental Effects: Exposure to barbiturates during pregnancy may have long-term effects on the neurodevelopment of the child. Studies have suggested an association between prenatal barbiturate exposure and cognitive impairments, behavioral problems, and learning disabilities in children.

  5. Maternal Health Risks: Barbiturate use during pregnancy can also pose risks to maternal health, including respiratory depression, hypotension, and impaired liver function. These health risks can indirectly impact fetal development and pregnancy outcomes.

Due to these potential risks, healthcare professionals typically advise against the use of barbiturates during pregnancy, especially for nonessential purposes. If a pregnant individual requires treatment for a medical condition that may traditionally be managed with barbiturates (such as epilepsy or certain psychiatric disorders), alternative medications with a better safety profile during pregnancy may be recommended.

Are Barbiturates Addictive?

Yes, barbiturates are addictive substances. They have a high potential for abuse and dependence, both physical and psychological. Barbiturates produce feelings of relaxation, euphoria, and sedation, which can lead to their misuse for recreational purposes. When taken regularly or in high doses, tolerance can develop, meaning that individuals require higher doses to achieve the desired effects. Additionally, dependence can develop, leading to withdrawal symptoms when the drug is discontinued.

Withdrawal from barbiturates can be severe and potentially life-threatening, characterized by symptoms such as anxiety, tremors, insomnia, hallucinations, seizures, and even delirium or cardiovascular collapse in extreme cases. Due to the risks associated with tolerance, dependence, and withdrawal, barbiturates are now less commonly prescribed and have been largely replaced by safer alternatives for conditions such as anxiety, insomnia, and seizures.

 

Treatment Options for Barbiturates Addiction

Inpatient Rehab

It is one of the most severe types of addiction treatment. In the case of inpatient rehab, patients need to live in the rehabilitation center and undergo treatment for several days. Some treatment methods used are:

  • Individual therapy
  • Medicated-assisted therapy
  • Group therapy
  • Dual-diagnoses treatment
  • Family therapy

Patients who participate in inpatient treatment live with other struggling people like them. This offers support and hopes to recover patients.

Outpatient Rehab

Outpatient Rehab provides the same inpatient treatments but with less intensity. Patients attending outpatient rehab live at home and undergo treatment procedures for a few hours for few times a week.

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If you or a loved one are struggling with mental health challenges or substance abuse, reach out to California Prime Recovery today. Our team of compassionate professionals is here to support your journey towards lasting well-being. Give us a call at 866-208-2390

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