Below the Radar Transcript

Episode 41: Advocating for Drug Policy Reform — with Scott Bernstein

Speakers: Paige Smith, Am Johal, Scott Bernstein, Barbara Adler

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Paige Smith  0:06 
Hello, listeners. I'm Paige Smith with Below the Radar. A knowledge mobilization podcast. Below the Radar is created by SFU's Vancity Office of Community Engagement and is recorded on the territory of the Musqueam. Squamish and Tsleil-Waututh peoples. On this episode of Below the Radar our host Am Johal is joined by Scott Bernstein, the Director of Policy at the Canadian Drug Policy Coalition, leading the organization's work on the legal regulation of drugs, decriminalization and international drug policy. Through his legal practice, Scott has done work locally with Pivot Legal Society in Vancouver, and internationally with Open Society Foundations in New York. Scott and Am sit down to chat about harm reduction policies and regulation models.

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Am Johal  0:58 
Welcome to Below the Radar. We're lucky to have Scott Bernstein here with us from the Canadian Drug Policy Coalition. Welcome, Scott. 

Scott Bernstein  1:05 

Am Johal  1:06 
Scott, you've been doing a lot of work around drug policy, from working at Pivot Legal Society, at the Open Society Foundation in uh New York, and before we get talking about the Drug Policy Coalition, and the work that you're doing there. Maybe we can just start with the work that you started doing with Pivot over, I think I met you maybe a decade ago, something like that. 

Scott Bernstein  1:27 
Yeah, time flies. Absolutely. So I, let me back up even before that, and so I came to UBC Law School in 2006 with the idea. I came from the States and I was following up on my Master's in Environmental Studies and I came to be an environmental lawyer. And very soon after UBC, I became involved in the Insite legal case and so I started that was my introduction into drug policy and so I ended up working with that case for several years as a student, and then as a lawyer, and then an opportunity came up to work with Pivot Legal Society and I was really excited about that. So, I headed up The Health and Drug Policy Campaign of Pivot for three years while I was there. 

Am Johal  2:12 
And that must have been a fascinating case to work on just because uh it did go to the court of appeal, it did go to the Supreme Court and took a lot of twists and turns and politicization as well, that kind of drove it in a way. 

Scott Bernstein  2:24 
Yeah, absolutely. And I think, you know, my introduction into drug policy was sort of through the words and, you know, basically through the affidavits of some of these important people who were pioneers in moving drug policy and Vancouver forward, and in Canada. And so it was sort of a real introduction into how communities can organize to affect change the important role of science and evidence in, in fighting these battles. And also just in the persistence of people who are really trying to save lives and do good things in the face of governments that were opposing to it. Because, you know, the federal government was trying very hard to shut down Insite and the people in this community and the people that we're serving, were just not willing to let that happen. So, it was really an honor to be part of that and for me, that really formed my view and opinion about the importance of harm reduction and the importance of drug policy reform in Canada. 

Am Johal  3:20 
It's really memorable for me as well, in terms of the time period of that case, because the first public event we did as an office at SFU, when we moved out Woodward's, was with pivot around the time that it was at the Supreme Court. So it was around May of 2011 I think with Darcy Bennett. We organized a public event with a number of people and showing some of the cases being heard at the court at the time. And when I first started working in the neighborhood in the late 90s, with the UBC's Humanities 101 program, that was when there was a lot of overdoses happening, it had already been declared as a public health crisis, people like Ann Livingston, and Bud Osborne that were doing work, and I went on to work with the provincial government on the Vancouver Agreement. So just seeing that sort of debate at that time seeing neighborhood groups, some of whom were supportive, but some of whom were against harm reduction policies, and even like seeing the turn of the kind of center right Mayor at the time, Philip Owen, or even the police coming out, then in support of harm reduction measures, when it originally polled at the time, it might have been at 20% or something like that, but it wasn't that this got pushed away, the conversation was more about how do we take this 20% support and turn it to 60-70%? And what needed to happen. So it was a really interesting time to see the change in governments really being driven out of the Health Authority, but mostly out of the community, you know, Portland Hotel Society, many others. 

Scott Bernstein  4:44 
And absolutely, I think, you know, we look back and so the 90s and early 2000s was, you know, a horrible time in the history where overdoses spiked to numbers in the hundreds. You know, and the cause of that was attributed to a stronger heroin that was on the market and you know, people were up in arms because what had been sort of the baseline or the status quo was now blown out of the water. And you know, hundreds of people dying. And now, the overdose crisis we have now it dwarfs that it's it's many times worse. And now we have the introduction of fentanyl and other things like carfentanil even stronger doing it. And so I think we look at Insite as an example of a community response and activism pushing politicians, like I think, a lot of times politicians don't necessarily want to go there. They're not brave, they're a bit risk averse. But when the community is putting pressure and saying this is what we have to do, and this is what the evidence supports, and this will save lives, you know, ultimately, you're right, we can win people over and we can change minds. And, and that's so important. 

Am Johal  5:51 
Yeah, and people certainly were pushing for something like safe supply and public regulation, the kinds of things you guys are working on in the Canadian Drug Policy Coalition. Insite ended up being the piece they could move on, but there was regulatory issues around nurses and health care professionals, this type of thing, there was also academic studies being done that were quite slow in terms of dealing with things from a population health point of view, and there have been further studies like NAOMI and SALOME that are currently underway, but there hasn't really been traction on the ground in terms of a wider intervention, even in the context of the contamination of the drug supply, where we have tripled the number of overdose deaths, but certainly, I think, from the Health Authority, I have a feeling that there needs to be a movement. After you worked at pivot, you spent some time working internationally on this at the Open Society. Just wondering if you can talk a little bit about that period of working on this at a more global scale. 

Scott Bernstein  6:44 
Yeah, absolutely, and so I you know, working in Pivot really opened my eyes to like, definitely issues local to the Downtown Eastside, local to Vancouver, local to BC and even within Canada to degree and, you know, I started to become very curious and interested in the dynamics of international drug policy and other actors who are working in different places. And so this opportunity came up to work with Open Society Foundations, which is a large private foundation with George Soros's money that advocates and funds a lot of like, very progressive issues from equality, democracy, free speech, all these things. It had a relatively small program in global drug policy, which was, you know, it was actually the largest funder in the world of global drug policy, which says something about the amount of money that actually goes towards that. But it was a wonderful opportunity, I had a chance to work with organizations all across the world, Europe, South America, Latin America, Africa, and I had two things I was working on there. One was working with international organizations getting them ready for the UN General Assembly special session on drugs, which happened in 2016. It had been 20 years before this had happened and so this was a big deal for it to take place And so we were trying to get organizations coordinated on advocacy and on different things that we're doing. And then the other piece of my portfolio was helping nascent drug policy organizations in Africa. And so I worked in West Africa, East Africa and South Africa, a bit with some new and small organizations that are just trying to move the conversations in their own context. 

Am Johal  8:31 
And since you've landed back in Vancouver at the Canadian Drug Policy Coalition, can you give us maybe a little bit of an introduction about what you guys do? And what you're uh working on? I'm gonna ask you about, of course, the regulation project and a few others, but it would be great to get an introduction for our listeners as well. 

Scott Bernstein  8:48 
Absolutely, So the Canadian Drug Policy Coalition, we're about 10 years old. Next year, we'll have our 10 year anniversary. And we are a project based within the Faculty of Health Sciences at Simon Fraser University and we're located in downtown Vancouver in The Harbor Center. And we were formed out of a desire to coordinate some of the advocacy within Canada. So there were a lot of organizations that were working to promote harm reduction. There are some legal organizations like Pivot and the Canadian HIV AIDS Legal Network, there were other organizations doing different types of things. And it was felt that we needed a national voice and national advocacy to move that forward. So uh my boss, Don MacPherson who had who had been the city of Vancouver's drug policy person for many years and developed the four pillars approach

Am Johal  9:41 
When I was working in the provincial governments of Vancouver we're dealing with Donald and Nathan Nelson, people like that. 

Scott Bernstein  9:46 
Yeah and so Donald was put in the head of this new organization and so we've been working on that. And over the years, our policy priorities haven't really changed much. It's just sort of where our focus is at a particular moment may adjust but we, we have three things we are advocating one is expansion of harm reduction services in Canada. So I think we're still, we're still at a point now it's a lot better than just having Insite to show for it but there's still room for improvement  and we still have to worry about provinces like Alberta and Ontario, where the provincial government changes and puts services at risk. And so that's something we want to make sure that harm reduction is widely available, and it's treated just like basic health care, that it is. And then we also are still advocating for decriminalization of all drugs and so we want to remove legal consequences and penalties from activities around drugs and that includes people possessing drugs, but it also includes certain distribution of drugs or trafficking, as people call it, because a lot of times people are caught up in selling drugs for different circumstances, and they're part of a broken system, and are not criminals and shouldn't necessarily be treated like criminals. And so decriminalization is the second issue we're advocating. And then the third is, ultimately, we see the end of the war on drugs and the end of prohibition being a system where we have legal regulation of all drugs. And so decriminalization is great. It removes stigma, it removes penalties against people, it helps people access health care. One thing it doesn't do, though, is take control of the supply of drugs. And so the problem we have now with fentanyl and carfentanil and other things contaminating the drug supply, are that nobody's watching the producers, nobody's regulating. And so we, we've ultimately ceded control of the drug supply to unaccountable factors who are mostly interested in profit. And so legal regulation would allow us to take back control of that, and regulate drugs, like we regulate all kinds of risky activities and things in Canada, including, you know, skydiving, and driving and pharmaceutical drugs, and foods and drink and all these things. And so it's sort of where we see the endgame of the war on drugs and prohibition when it ends.

Am Johal  12:08 
You know, what was really interesting around the late 90s, when those conversations were hitting into public view it was interesting as the coalition building was happening, people who emerged from within the police force who were supportive of harm reduction, people within the legal system, or even people within the business community, which historically had been quite critical of harm reduction, that you had people emerged who were very supportive from just a practical level in terms of the day to day activities that they're working on whether through the court system, frontline enforcement or running their businesses, they felt if people had a place to go, it was actually going to be more beneficial broadly for the community. So I think that's been interesting. And I think that's shown to be the case in Australia and other places where people have tried to do it. I'm wondering if you can talk a little bit about the regulation project that you're working on through the Canadian Drug Policy Coalition?

Scott Bernstein  12:55  
Sure, absolutely. So the regulation project was an idea that came about in 2017. It was on the sidelines of a drug policy conference in Ottawa where a lot of people were attending who were advocates for drug policy reforms, but also brought together government, it was called The Ottawa Drug Futures Forum. And a bunch of us decided to hold a meeting on the side to say, “let's talk about legal regulation, what, how do we move this forward?” And so there were six organizations at the time that were part of that and out of that came some ideas of how we could advocate and how we might just better coordinate. And so that initiative has sort of been cooking along at a slow boil for a number of years while we were working on other things, but one of the key objectives was to start thinking about regulatory models and what regulation would look like. And so we very quickly identified one of the problems with legal regulation and talking about legally regulating drugs is that people don't really know what that system is going to be like. And so when we don't have answers, or things to imagine, we start filling in the blanks with all kinds of scary ideas or fears or other kinds of misinformation. And so we felt that that was a problem, that when people heard "Oh, you want to legalize heroin." You know, their minds immediately run to like, okay, it's the bulk bin in the Safeway or somewhere where you're selling it. And the reality is like, no, it's actually a much more controlled and safer model. And so we decided to start thinking and looking at the evidence behind different models, like what were the experts suggesting, and sort of saying, like, how would you regulate heroin? Or how would you regulate cocaine or methamphetamine or psychedelics and there actually was a lot of literature people, academics who were writing about, this is the best way to do it, or this is one way to do it. So there wasn't a shortage of different ideas or models. Soon after that we were like, Well, okay, that's great academics are talking about it. You know, we as well can come and say like, "Here are some models or recommendations." But the real hurdle we felt was the public. And so people again, like it's sort of this issue of knowledge translation. There's a lot of academic research and things out there. But how do we talk to normal people about regulating heroin? And so, the regulation project, one piece of it, that we're leading, has evolved to developing a board game. And so this came about as I was in Porto, Portugal in May, at the International Harm Reduction Conference, talking about these models, and how we're trying to workshop them with different stakeholders and we were invited to attend and do a workshop at The Public Health Conference that is held every year in Montreal. And so the problem is, it was world cafe style, which means that you only have a few minutes at each table and so it was a bit of a head scratcher, like, how do we, how do we distill this complex policy issue into something simpler, and someone came up with the idea, like do it as a board game. And so we ran with that. And we developed this board game that's meant to be negotiation based and collaborative, to give people a chance to sort of discuss and talk about different models of things. And it's based on five questions: Who should get access to drugs? What do you have to do to get access to drugs? Where can you get them? How much can you get? And where can you consume them? And so those are just a very small set of the things we have to decide in legal regulation. But it's stuff people are really concerned about. And it's stuff that's directly related to minimizing the harms of the drugs.

Am Johal  16:39 
And it's interesting, because I think we have all these historic examples of drugs that were previously illegal, or there was aspects of prohibition and then we're legalized and brought under order everything from alcohol, and now marijuana as well. And I'm wondering if there's some lessons that can be learned in terms of the process of legalization and regulation of marijuana, like how that might apply to the work that you're doing? And how this might be a little bit different as well?

Scott Bernstein  17:07 
Yeah, absolutely. So I think looking at the rollout of cannabis legalization or marijuana legalization in Canada, you know, it's based on largely the principles of like, let's reduce the illegal market, let's keep cannabis out of the hands of youth and have a system based on public health. And so I think, you know, my own thought is like, one of the things they really missed were, well, two things, two major things. One was, if we legally regulate drugs, we have to look at a broader set of principles of social justice of why we're doing this. And so the system we're replacing, prohibition, has been terrible, and particularly terrible for people of color, Indigenous people, youth, women, it's not a equal effect of the fact that we've prohibited and made activities around drug taking illegal. So a lot of people of color, and minorities are bearing the brunt of the policies. And so a system of regulation has to repair that. And so in cannabis, we are still wrestling with whether, you know whether or not we should be giving expungements of criminal records, or we're giving pardons, or what we're doing that should have been thought out in the system, it should have been in place before we did it. But we also need to think about things like environmental justice, we need to think about social justice issues around economics, and who has a role in the new legal system, we have to think about equity and all sorts of aspects of that. And so I think that was one thing that was not really thought out and now we're trying to pick up and catch up from that. And I think the second major thing we missed out was this idea of public in public health. And so I think, you know, we had this system of cannabis that was like a multi-billion dollar, unregulated illegal industry and the idea was that we were going to create a legal system that would displace that. And we did not adequately talk to people who consume cannabis, or people in the market who are producing it, you know, the majority of people growing and selling cannabis are not organized criminals, they're mom and pop growers, you know, in the Kootenays or in the Gulf Islands doing it, it's not Hells Angels entirely. And so I think, you know, finding a place for them in the new market finding systems that people who consume cannabis would be willing to use. And so I think that's one thing we're trying to do better when we talk about legalizing all drugs is we're first of all coming out first and foremost with those principles of equity and justice that have to form the basis of a new system. And we're also really trying to incorporate consumer preference alongside the choices and the decisions of health officials and government officials. And so I think really looking at the customers, is this a model you are okay with? Will you purchase your heroin from this? And what we're finding is like a lot of a lot of people are like, well, I don't, I don't see myself as a medical patient. So I'm not going to go to a doctor to get a prescription for heroin, or I'm not going to go to a supervised consumption site, if it feels like a medical clinic. And so I think when we ultimately end up deciding and designing a system, it has to meet the needs of the people who are using the product. Because ultimately, what we want to do is we want to create more safety and reduce the risks. We want a regulated supply. So, we not only control who gets to make it, but we also control who distributes it, and where it shows up and ultimately create spaces that people, consumers, will prefer to come to, rather than just buying it on the street.

Am Johal  20:49 
When Insite opened, it was obviously the result of many years of activism by people working on the ground, responding to a historical health crisis, and it was able to open relatively quickly in comparison to a heroin prescription program, those types of things that Health Canada required all the research around, now that NAOMI happened in SALOME happened, it hasn't really been scaled up at the level of what would be a kind of publicly regulated project that's open to the general public, although the results seem to have been positive. I'm wondering if you can give a perspective on the SALOME project and what the possibilities might be in terms of what the studies have shown and, and I realized there's a particular group of people who are able to access and use it, but it's not to the general public, and hasn't been able to respond in a kind of crisis oriented way in terms of what's been going on in the inner city neighborhoods here.

Scott Bernstein  21:42 
So let me backup a little bit. And so I think the NAOMI study, the idea was that people had looked at prescription heroin programs, mostly in Europe, and said, this would work in Canada. And so there was a trial set up. And it was originally it was North American, it was meant to be Montreal, Vancouver, and also a site in the US and the US became nervous about it and ended up not going ahead. And so it was a small population in Montreal and a larger one in Vancouver who participated in this. And so one of the problems was that people who are the participants of these studies, both NAOMI and SALOME, were people in very marginalized, as a qualification to be in this study you had do have a long history of injection drug use, and have not responded to other treatments like methadone. And basically, this is the last stop. And people who were on there did really well. It was this idea, like once we take away the criminality, of getting the drugs, and once we have providing you with that your life can improve. You're not spending food and housing money on illegal drugs, you're not engaging in sex work or other risky activity, and you can start, you know, improving your life and focusing on it. So people did really well. The problem was that when the study ended, because it was, you know, scary heroin, the government was, nobody was willing to put this in place as an actual program.

Am Johal  23:08 
And allow for compassionate access at the end. So from an ethics point of view it was a real problem. 

Scott Bernstein  23:13 
That's right and so people were cut off, there wasn't a lot of follow up. Anecdotally, people went back to using street drugs, some people died. And people who were participants of the study were really mad. And so you know, SALOME came around as a response to nothing happening in NAOMI, because they saw well, you know, the biggest barrier here is the fact that we're dealing with heroin, you know, scary heroin that's hard to get in a lot of bureaucratic hurdles to work with it. So let's try hydromorphone, dilaudid, as another injectable, and so SALOME ran both heroin and hydromorphone, side by side. And again, wonderful results. For the large part, hydromorphone worked really well for people, regardless, like most people in this study did well and did great. But again, there was no exit strategy for when the study ended. What do you do with somebody who you've taken out of a really risky situation where their lives were not doing well? You allowed them into this study, gave them a lot of resources, their lives improved, because they're getting this drug. Is it ethically okay to just cut them off and put them back on the street? And so when I was at Pivot, we were approached by a group of VANDU members who are like, this is not great. And so we started to begin legal actions. We wrote letters. We, you know, we're trying to really push the Health Authority and the Providence Healthcare that was running the study to do it. And ultimately the doctors in the Crosstown clinic where this was run applied to the federal government for special access to heroin. And for a couple dozen patients they received it. Except this was in the Harper government, the response was the Minister of Health Rona Ambrose at the time came out and said, "You know what? We're closing this loophole." And they called it a loophole.

Am Johal  25:05 
Interesting. They asked for compassionate access, Health Canada granted it, the Minister intervened. And if I remember correctly, there was then a message sent out to Conservative Party supporters, a fundraising letter based around this.

Scott Bernstein 25:18  
They want, you know, they want to use your tax dollars to give drug addicts heroin, like that's the message that they do. 

Am Johal  25:24  
And the legal case was supported in court. 

Scott Bernstein  25:26 
Yes, ultimately, we ended up suing at the time it was five clients of SALOME, who were plaintiffs as well as Providence Healthcare joined in which we thought was a wonderful victory to have them alongside and this was brought to the BC Supreme Court. And ultimately, the court granted an injunction that said, well, you people can get access to that. And in the meantime, the government in Canada changed. And one of the first things that the Trudeau government did was to allow access to diacetylmorphine, heroin, through programs such as this and so the problem though, like getting back to your original question was more about scale up than legal access, because now, the federal government has lowered a lot of barriers to importing heroin. Hydromorphone, which is produced in Canada is even fewer barriers and that works as well, but we don't set...

Am Johal  26:19  
That could be prescribed today in a mass way. 

Scott Bernstein  26:22 
That's right. And so what we're not seeing though, is this massive scale up to offer people safe supply, this is one form of safe supply, people coming to a clinic and getting a syringe filled with a drug that's produced in a officially licensed laboratory, you have quality and known potency. And so you know, we really think it's a, I would say, it's like really a failing on the part of health authorities and provincial governments to not roll these out and fund them. And it's, it's really a problem across Canada, you know, anywhere where there's overdose, that is a model that could help some people, not everybody, because there are still, like I said, there's still barriers to people who think of themselves or don't think of themselves as a medical patient in using this, and so not everybody is willing to show up at a clinic three times a day to get their injection, but some people are, and largely people who are at the highest risk of overdose would fall into that category. And so I think, you know, what we've seen then are now, other small pilot projects emerging of like, how do we get past those barriers? And so one is Dr. Mark Kindle's dispensing machines. They're actually vaults where patients can store their own prescribed medicine and retrieve it on demand through a biometric sensor. And so that's one way that people can take some dilaudid pills home and use them as they want without somebody watching over them and, and it being a paternalistic system.

Am Johal  27:55 
Wondering if you can talk a little bit about the national dialogues project as well, that's happening through the Canadian Drug Policy Coalition.

Scott Bernstein  28:00 
Sure, absolutely. So I think we're stuck in a broken system. And so a lot of things like harm reduction's wonderful, it saves lives, but it's also a band aid. And it's a bandage on a system that's ultimately broken. Decriminalization also is a policy change, that's a band aid, that helps a lot, but it's a response to a broken system. And so, what we are doing now is we've been funded through some different funders, Health Canada has funded us through The Substance Use and Addiction Program, to do a set of national dialogues across Canada to talk to people about what is a public health response to drugs, and so we're proud in Vancouver we're enlightened about the necessity of harm reduction, you know, having Naloxone, all these things, a lot of parts in Canada, they're not. And we're seeing a reaction when things like supervised consumption sites open up, we're seeing a lot of the "not in my backyard" attitudes of communities who are raising concerns about, you know, those people on my street and, and, you know, needles and all kinds of things. And so part of what we're doing with these dialogue projects is to engage stakeholders and communities with an honest discussion about this is how we feel about drug policy. These are some of the things we want to do, and try to really move forward. Like we're trying to not preach to the choir, but actually bring people in all kinds of constituencies together, to really have an open and honest debate and to listen, and to listen to other perspectives and views. And so this is a project that's gonna be rolling out over the next three years across Canada in 18 cities. We also have funding through The Community Action Initiative and the Vancouver Foundation to do some specific dialogues in BC. And so those are going to be focused specifically on systems change. Like we know where we've got to get, and we've got to get to decriminalization and legal regulation of drugs, how do we get there? And so these will focus on six to eight communities in BC, where we just are hoping to see a bit of advocacy and a bit of action on those topics.

Am Johal  30:08 
Scott, thank you so much for joining us on Below the Radar. 

Scott Bernstein  30:11 
My pleasure.

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Paige Smith  30:17 
Thank you again to Scott Bernstein for joining us on Below the Radar. You can find more information about the Canadian Drug Policy Coalition in the episode description. In the next episode, we are joined by Barbara Adler, an interdisciplinary artist, curator and educator who graduated from SFU School of Contemporary Arts with an MFA. She is currently working as the professional development coordinator at the school and is the co founder of Sawdust Collector, a weekly performance series that presents new, experimental, and improvised works of artists in an interdisciplinary context.

Barbara Adler  30:52 
Initially, when we got into it, we thought we'd be programming our own work. We thought, "Oh, we need a space to put on our own shows. And it would be great to have a little experimental space." And then we realized how narcissistic that would be and not moving things forward. It's evolved to actually be a thing that is almost entirely about supporting other people's work and supporting what we hope to happen in our community of artists more than supporting our own artistic practice. But that flip of thinking, "Oh, we need to help ourselves"  to. "We actually want to be part of helping a bigger scene" was, it was a transformation, it wasn't something that we started out with.

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Paige Smith  31:32 
Stay in the loop with Below the Radar by following us on Twitter and Facebook and be sure to subscribe wherever you find your podcasts including Apple Podcasts, SoundCloud, Overcast and Player FM and please leave us a review. As always, I'd like to thank the team that puts this podcast together, including myself, Paige Smith, Rachel Wong, Fiorella Pinillos and Kathy Feng. David Steele is the composer of our theme music, and thank you for listening. Tune in next time for a brand new episode of Below the Radar.

Transcript auto-generated by and edited by the Below the Radar team.
March 17, 2020

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