GHB, or gamma-hydroxybutyrate, is a normal component of
metabolism. It is found naturally in every cell in the human body and is
most properly considered a nutrient. In the brain, the highest amounts
are found in the hypothalamus and basal ganglia [Gallimberti, 1989]. GHB
is found in greater concentrations in kidney, heart, skeletal muscles,
and brown fat tissues [Chin and Kreutzer, 1992]. It is believed to be a
neurotransmitter, although the jury is still out as to whether it
exhibits all of the properties required for fulfillment of this
function [Chin and Kreutzer, 1992]. It is both a metabolite and
precursor of the inhibitory neurotransmitter GABA (gamma-aminobutyric
acid, or gamma-aminobutyrate), another nutrient to which it bears a
close structural relationship. GHB, however, does not act directly
on GABA receptor sites [Chin and Kreutzer, 1992].
GHB was first synthesized about thirty years ago by Dr. H.
Laborit, a French researcher interested in exploring the effects
of GABA in the brain. Because little or no GABA crosses the
blood-brain barrier, Laborit synthesized GHB, which substitutes
a hydroxy group for an amino group. This difference allows GHB
to cross the blood brain barrier where some of it is metabolized
into GABA [Vickers, 1969].
As it turned out, Laborit found that GHB exhibited a range
of effects beyond those expected from GABA. Over the intervening
years, numerous researchers have extensively studied GHB's effects.
It is has come to be used in Europe as a general anesthetic, a
treatment for insomnia and narcolepsy (a daytime sleeping disorder),
an aid to childbirth (increasing strength of contractions,
decreasing pain, and increasing dilation of the cervix), a
treatment for alcoholism and alcohol withdrawal syndrome, and for
many other uses.
During the 1980s, GHB was widely available over-the-counter in
health-food stores, purchased largely by body-builders for its
ability to stimulate growth hormone release which aids in fat
reduction and muscle building. In the last few years it has
been gaining popularity as a "recreational" drug offering a
pleasant, alcohol-like, hangover-free "high" with potent
--- Scientific Reports on GHB ---
For the thirty years prior to 1990, the scientific papers on GHB were
unanimous in reporting numerous beneficial physiological effects
and the absence of long-term negative effects. In 1964, Laborit
listed "very low toxicity" as one of the "principle elements"
of the compound's pharmacology. In a 1969 report on GHB's
anesthetic uses, Vickers referred to GHB as "a truly nontoxic
hypnotic" and repeatedly emphasized its "lack of toxicity."
Vickers cited evidence that GHB demonstrates "no toxic effects
on the liver and kidney." In 1972, Laborit described the body's
metabolism of GHB and stressed "the absence of any need of
detoxification by the organism." As recently as 1989, this
scientific consensus on GHB's benign nature remained unchanged.
Gallimberti's study from that year on its uses in treating
alcohol withdrawal in humans notes that "GHB's action ...seems
to be without serious side effects." His almost off-hand reference
to the "safety of GHB" shows how well-established this property of the
nutrient had become. Then, on November 8th, 1990, the FDA banned
the over-the-counter sale of GHB in the United States. In 1991, two
scientists from the California Department of Health Services wrote a
report on ten "poisonings" associated with GHB. The authors, Chin
and Kreutzer, warned of GHB's "tremendous potential for abuse."
They observed that "all interviewed patients reported a
pleasurable sensation or a `high.' Several of them...continued
taking [GHB] because it made them `feel good'." Apparently, the
authors construed feeling good in and of itself as a potential
threat to public health. Despite such dire language, the report
acknowledged that "there are no documented reports of long-term
[detrimental] effects. Nor is there any evidence for physiologic
Of the ten "poisonings" reported, four involved "unknown doses,"
four featured the "coingestion" of other drugs, (usually alcohol),
one involved unmedicated epilepsy, and another a history of grand
mal seizures. Since alcohol and other central nervous system (CNS)
depressants are not recommended with GHB, and because GHB is
contraindicated for epileptics, such cases are not unexpected.
Chin and Kreutzer acknowledge that the "more severe
reactions...generally occurred when patients took an unmeasured
dose, a particularly large dose, or several doses within a short
period of time." Such problems are easily avoided by following
the directions for GHB's use. Although the specific clinical
details of these ten cases are too lengthy to go into here, one
point needs addressing--the use of the terms "coma" and "seizures"
in descriptions of these cases. At a sufficiently high dose,
GHB can cause CLONUS, a rapid, rhythmic contraction and relaxation of
muscles which would be better described as muscle spasm or uncontrollable
twitching than a seizure. GHB can also cause intense drowsiness, abrupt
sedation, and deep sleep which is probably better described as
unarrousability or deep sedation than coma. Vickers 
described it as a "nontoxic coma," which blunts some of
the inflammatory connotations of the term coma. Regardless
of their alarmist tone, the authors confirm that "there
have not been any reported deaths" and that "if product use is
discontinued, full recovery with no long-term side effects is universal."
They concluded that "the prognosis for people who experience GHB poisoning
is quite good." The degree to which the pleasant state of GHB
euphoria may be psychologically addicting may not be fully
appreciated. Anybody with known attraction or addiction to
tranquilizers or alcohol should pay special heed to this
possibility. In the few cases of GHB abuse that we have
investigated, there were pre-existing use/abuse patterns with alcohol
and/or tranquilizers. Ironically, it was GHB's lack of toxicity that
led to increased frequency of use (numerous times per day) that
characterized what can only be called classic cases of psychological
addiction. Without the dehydration and CNS irritation of alcohol,
or the side effects of tranquilizers, there was no incentive to
moderate or curtail GHB use. Fortunately, few people seem to have
such overwhelming attraction to the GHB state. Even Chin and
Kreutzer minimize GHB's abuse potential by stating, "No
investigator [has] reported any long-term adverse effects,
addictive or dependent qualities associated with discontinued
usage of the drug."
--- Why Was GHB Banned? ---
It seems likely, then, that at least some of the motives behind the
1990 FDA ban of GHB were other than those of public safety. Such a ban
constitutes the only means of Federal control of a substance neither
scheduled by the DEA nor approved by the FDA as a drug. In the absence
of a genuine public-health concern, such control might have been
motivated by a desire to protect the pharmaceutical industry
(with which the FDA is closely intertwined) from competition
from a safer, more effective and less expensive alternative
to sleeping pills. Is it a coincidence that the FDA has also
banned L-tryptophan, another nutrient that functions as a safe and
effective sleep aid?
--- What Are the Real Concerns? ---
As with most substances, unpleasant and possibly dangerous side
effects can be associated with excessive doses of GHB. A dose usually
only about twice the amount required for relaxation or a prosexual
effect can, as one user put it, "knock you out but fast." In this
respect, GHB is probably comparable to alcohol: if you drink twice
as much as you normally would, you probably wouldn't function very
well. Despite its general safety and lack of toxicity, the safe
use of GHB requires information, preparation, caution, and
good judgment. In other words, follow the usage guidelines!
--- How Does It Feel? ---
Most users find that GHB induces a pleasant state of relaxation and
tranquility. Frequent effects are placidity, sensuality, mild
euphoria, and a tendency to verbalize. Anxieties and inhibitions
tend to dissolve into a feeling of emotional warmth, wellbeing,
and pleasant drowsiness. The "morning after" effects of GHB
lack the unpleasant or debilitating characteristics associated
with alcohol and other relaxation-oriented drugs. In fact, many
users report feeling particularly refreshed, even energized, the
next day. The effects of GHB can generally be felt within five
to twenty minutes after ingestion. They usually last no more than
one and a half to three hours, although they can be indefinitely
prolonged through repeated dosing. The effects of GHB are very
dose-dependent. SMALL INCREASES IN THE AMOUNT INGESTED LEAD TO
SIGNIFICANT INTENSIFICATION OF THE EFFECT. Higher levels feature
greater giddiness, silliness, and interference with mobility and
verbal coherence, and maybe even dizziness. Even higher doses usually
--- The Actions of GHB in the Body ---
GHB temporarily inhibits the release of dopamine in the brain. This
may cause increased dopamine storage, and later increased dopamine
release when the GHB influence wears off [Chin and Kreutzer, 1992].
This effect could account for the middle-of-the-night wakings
common with use of higher GHB doses, and the general feelings
of increased well-being, alertness and arousal the next day.
GHB also stimulates pituitary growth hormone (GH) release. One
methodologically rigorous Japanese study reported nine-fold and
sixteen-fold increases in growth hormone 30 and 60 minutes
respectively after intravenous administration of 2.5 grams of
GHB in six healthy men between the ages of twenty-five and
forty [Takahara, 1977]. GH levels were still seven-fold higher
at 120 minutes. The mechanism by which GHB stimulates
growth-hormone release is not known. Dopamine activity in
the hypothalamus is known to stimulate pituitary release
of growth hormone, but GHB inhibits dopamine release at the
same time that it stimulates GH release. This suggests that GHB's
GH-releasing effect takes place through an entirely different
mechanism [Takahara, 1977]. At the same time GH is being
released, prolactin levels also rise. Serum prolactin levels
increase in a similar time-dependent manner as GH, peaking at
five-fold above baseline at 60 minutes [Takahara, 1977]. This
effect, unlike the release of GH, is entirely consistent with
GHB's inhibition of dopamine. Other compounds which lessen
dopamine activity in the brain (such as the neuroleptic Thorazine)
have been shown to result in prolactin release. Although
prolactin tends to counteract many of the beneficial effects of GH,
the sixteen-fold increases in GH probably overwhelm the five-fold
increases in prolactin.
GHB induces "remarkable hypotonia" (muscle relaxation) [Vickers,
1969]. It is now gaining popularity in France and Italy as an aid to
childbirth. GHB causes "spectacular action on the dilation of the
cervix," decreased anxiety, greater intensity and frequency of
uterine contractions, increased sensitivity to oxytocic drugs
(used to induce contractions), preservation of reflexes, a lack
of respiratory depression in the fetus, and protection against
fetal cardiac anoxia (especially in cases where the umbilical
cord wraps around the fetus' neck) [Vickers, 1969; Laborit, 1964].
GHB is completely metabolized into carbon dioxide and water, leaving
absolutely no residue of toxic metabolites [Vickers, 1969; Laborit,
1972]. Metabolism is so efficient that GHB can no longer be detected
in urine four to five hours after it is taken by injection [Laborit, 1964].
GHB activates a metabolic process known as the "pentose pathway" which
plays an important role in the synthesis of protein within the body
[Laborit, 1972]. It also causes a "protein sparing" effect [Laborit, 1964]
which reduces the rate at which the body breaks down its own
proteins. These properties, along with GHB's effect on growth hormone,
underlie its common use as an aid to muscle-building and fat loss.
Anesthetic (large) doses of GHB are accompanied by a small increase in
blood sugar levels, and a significant decrease in cholesterol. Respiration
becomes slower and deeper. Blood pressure may rise or fall slightly,
or remain stable, but a moderate bradycardia (slowing of the heart)
is consistent [Vickers, 1969; Laborit, 1964]. A slight drop in body
temperature also occurs [Laborit, 1964].
GHB also stimulates the release of acetylcholine in the brain
--- GHB and Sleep ---
GHB has been called "almost an ideal sleep inducing substance" [SMART
DRUGS II, p245]. Small doses produce relaxation, tranquility and
drowsiness which make it extremely easy to fall asleep naturally.
Higher doses increase the drowsiness effect and decrease the time
it takes to fall asleep. A sufficiently large dose of GHB will
induce sudden sleep within five to ten minutes [Laborit, 1964].
Many other hypnotics interfere with various stages of the sleep cycle
thus preventing the body from achieving a complete and balanced
session of rest and recuperation. The most remarkable facet of
GHB-induced sleep is its physiological resemblance to normal
sleep. For instance, GHB sleep is characterized by increased
levels of carbon dioxide in the arteries, as in normal sleep
[Vickers, 1969]. During normal and GHB sleep, the CNS continues
to be responsive to "noxious stimuli" (pain and other irritations),
a factor which sets limits on GHB's uses in anesthesia [Vickers, 1969].
GHB facilitates both REM (rapid eye movement) sleep, and "slow-wave"
(non-REM) sleep, the stage of sleep featuring increased release of
growth hormone [Laborit, 1972]. And unlike the unconsciousness
induced by other anesthetics, that triggered by GHB does not
feature a systemic decrease in oxygen consumption [Laborit, 1964].
The primary disadvantage to GHB's use as a sleep aid is it's
short-term influence--about three hours. During GHB's influence, sleep is
deeper and more restful, but after the GHB has worn off, people have a
tendency to wake up. The higher the dose, the greater is this
tendency. Some have called this pattern the "dawn effect" and
have speculated that it is related to the release of stored-up
dopamine. Some people minimize this effect by taking minimal
doses of GHB. Others take advantage of this effect by getting
a couple of hours of work done in the middle of the night. Still
others choose to take a second dose of GHB to sleep for another three
hours. It should be noted that not everyone can be put to sleep by GHB. We
have spoken to three men who have never achieved sleep even with the doses
normally used for such purposes. In addition, Takahara 
reported that one of the six men in the growth hormone study cited
above remained conscious even though he had received two and a
half grams of GHB intravenously, a dosage which rendered the
rest of the participants unconscious.
--- GHB, Alcohol and Alcoholism ---
GHB shows great promise in the treatment of alcoholism. In Europe,
one of its primary uses is to relieve withdrawal symptoms, cravings, and
anxiety among alcoholics.
In laboratory rats addicted to alcohol, withdrawal symptoms closely
resemble those exhibited by humans, including tremors, convulsions, and
hypersensitivity to sound. All of these symptoms were blocked by
sufficiently high doses of GHB [Fadda, 1989]. Administration of GHB
has also been found to prevent alcohol consumption among rats that
voluntarily ingest alcohol [Fadda, 1989; Gallimberti, 1989].
In a rigorous, double-blind, placebo-controlled study conducted of
human alcoholics, "nearly all withdrawal symptoms disappeared within
two to seven hours" after administration of GHB. On a
severe-moderate-mild-or-none scale, withdrawal symptoms remained
below moderate during the entire period. The only side effect
observed was slight, occasional, and transient dizziness. The
researchers concluded, "the results clearly indicated that GHB
is effective for the suppression of withdrawal symptoms in
alcoholics" [Gallimberti, 1989].
--- Other Uses of GHB ---
GHB has a decades long track record of use as a general anesthetic.
Administered intravenously, an anesthetic dose of GHB is in the range
of 4-5 grams for a 150-pound person [Vickers, 1969]. Its advantages
as an anesthetic include low toxicity, relatively few
contraindications, slowing of the heart rate without loss of blood
pressure, the absence of irritation to the veins with intravenous
administration, muscle relaxation, absence of respiratory depression
(usually), reduction of body temperature (hypothermia), and various
protective and anti-shock actions [Laborit, 1964]. However, GHB
can almost never be used in anesthesia without the additional
administration of other drugs [Vickers, 1969] because it does not
produce complete surgical anesthesia except in children
[Laborit, 1964]. The autonomic nervous system remains active
during GHB-induced anesthetic coma, and thus the body continues
to respond to surgical stimuli through increases in heart rate, blood
pressure, and cardiac output, as well as through sweating,
peripheral vasoconstriction, vocalization, and reflex muscle
action [Vickers, 1969]. Local anesthetics or other drugs which
suppress these responses must therefore also be used, like the
way a dentist or orthodontic surgeon might use Novocaine to kill
pain along with nitrous oxide to render a patient unconscious.
It is suspected that part of GHB's protective function involves
a slowing of the metabolism of brain cells, thus reducing their
requirements for oxygen and glucose [Chin and Kreutzer, 1992;
Artru, 1980]. Another factor in GHB's anti-shock capability may
be the marked vasodilation induced in the liver and kidney, thus
increasing blood flow to those vital organs. GHB's efficacy
for treating anxiety has been positively demonstrated in tests
involving schizophrenic subjects [Laborit, 1964]. Its sedative
properties have earned it a role as a psychotherapeutic adjunct
[Vickers, 1969]. It has also been used to assist the process of
"abreaction," or the release (usually through verbalization) of
repressed emotion [Vickers, 1969]. Unlike other "anxiolytic"
(or anti-anxiety) drugs, GHB's effect is non-toxic. Furthermore,
GHB's reduction of inhibitions, its tendency to encourage
verbalization, and the typical lack of fear during the GHB
experience would seem to provide an ideal context for the verbal
exploration of difficult emotional territory during therapy.
--- GHB and Sex ---
Scientists and doctors have traditionally been reluctant to ascribe
aphrodisiac properties to any substance, although this tendency may have
abated somewhat in recent years. It is a testament, then, to the power the
GHB's sexual effects that they were clearly acknowledged in the scientific
literature by 1972. Dr. Laborit wrote:
"A last point should still be mentioned: the [GHB] action on Man
which could be called 'aphrodisiac.' We cannot present any animal
experiments on this subject. However, the oral form has now been
sufficiently used so that, as generally agreed, no doubt can
subsist as to its existence."
We have identified four main prosexual properties:
2) heightening of the sense of touch (tactility),
3) enhancement of male erectile capacity, and
4) increased intensity of orgasm.
Perhaps the foremost prosexual property of GHB is disinhibition. Some
users suggest that GHB's other sexual benefits are secondary effects, made
possible (or at least amplified) by this loosening of psychosomatic
constraint. A number of people have commented that this disinhibition is
particularly marked among women.
Women often report that GHB makes their orgasms longer and more
intense, as well as more difficult or time-consuming to achieve,
especially at higher doses. As with its other effects, GHB's impact on
female orgasm seems highly sensitive to small adjustments in dosage.
--- Legal Status and Availability ---
GHB is not approved in the US and has been banned from
over-the-counter sale by the FDA. GHB has not yet been "scheduled" as a
"controlled substance" by the DEA, and therefore simple possession is not
illegal. GHB continues to be sold to legitimate laboratories and
scientists for research purposes, but selling it specifically for
human consumption, especially while making claims about its health
benefits, is a violation of current FDA regulations and policy.
In some European countries, GHB is an approved drug available by
prescription. Local doctors, pharmacists and government bureaucrats
should be able to provide country-by-country specifics.
GHB is growing in popularity and seems to be widely available in the
underground "gray market." Since most of the GHB available through such
channels is of the "bootleg" variety, manufactured by nonprofessional
"kitchen" chemists, concerns about quality and purity should be
kept in mind. Caveat emptor (buyer beware)!
--- Safety Issues ---
As has been emphasized, the overall safety of GHB is well-established,
and no deaths attributable to GHB have been reported over the thirty year
period that this compound has been in use [Vickers, 1969; Chin and
Kreutzer, 1992]. In fact, as of 1990, only forty-six adverse
reactions had been reported in the United States surely constituting
only an infinitesimal fraction of actual usage, all followed by
rapid and complete recovery [Chin and Kreutzer, 1992]. Unlike a
large proportion of other drugs including alcohol and even Tylenol,
GHB has no toxic effects on the liver, kidney or other organs
[Vickers, 1969; Chin and Kreutzer, 1992]. One program of sleep therapy
using six to eight grams daily for a period of eight to ten days produced
no side effects. Vickers  even reports that doses as high as twenty
to thirty grams per twenty-four hour period have been used for several
days without negative consequences (don't do this at home kids!). In the
Canadian studies of narcolepsy mentioned earlier, the nightly use of two
to six teaspoons (one teaspoon equaling roughly 2.5 grams) for several
years resulted in no reports of long-term adverse effects, or problems
with issues of addiction or dependence. In one of these studies, one
patient inadvertently ingested fifteen teaspoons without adverse
consequence "other than deep sedation and headache the next day"
[Chin and Kreutzer, 1992]. And in France, sub-anesthetic oral
doses were used by "a large number of patients for about six
years" without untoward effect [Laborit, 1972].
--- Side Effects ---
According to Dr. Gallimberti , the action of GHB is "without
serious side effects." Some research programs have reported no side
effects at all. Nonetheless, it's clear that some minor side effects
can occur. Those most commonly experienced are drowsiness, dizziness,
nausea, and sometimes vomiting. As a sedative-hypnotic, GHB's effects
bear some similarity to those of alcohol and tranquilizers. GHB not
only "may cause drowsiness" like these other drugs, IT WILL ALMOST
INVARIABLY DO SO. Ataxia, or incoordination, can also be a side effect
of GHB. DO NOT DRIVE A VEHICLE OR OPERATE DANGEROUS MACHINERY WHILE
UNDER THE INFLUENCE OF GHB. As mentioned, clonic movements (muscle
contractions or "seizures") have been observed during the onset of
GHB-induced sleep. Headache is sometimes reported. A moderate slowing
of the heart rate is a consistent effect, and small changes in blood
pressure can take place. Likewise, orthostatic hypotension (a sudden
drop in blood pressure caused by standing up quickly) has also been
reported. Sometimes this is experienced as brief dizziness, and
rarely people can briefly lose consciousness. At very high doses,
cardiac and respiratory depression can occur. Sufficiently large
doses of GHB can cause sudden sedation and loss of consciousness.
Do not take such doses except when reclining on a bed or sofa. It
is also a bad idea to take such doses in the presence of people who
don't know anything about GHB. You may alarm your family or friends
and wake up in an emergency room (with a large medical bill).
More unusual and extreme reactions have included diarrhea, lack of
bladder control, temporary amnesia, and sleepwalking. Whatever
side effects may be noted, they are often much more severe when
GHB is combined with other central nervous system depressants
[Chin and Kreutzer, 1992, Gallimberti, 1989; Takahara, 1977;
--- Contraindications ---
Although contraindications for GHB have been described as "remarkably
few" [Vickers, 1969], those who suffer from any of the following
conditions should not use GHB: severe illness of any kind, epilepsy,
eclampsia (convulsions), bradycardia (slowed heart-beat) due to
conduction problems [left-bundle-branch-block is an example of
conduction difficulty], Cushing's syndrome, severe cardiovascular
disease, hyperprolactinemia, and severe hypertension [Gallimberti,
1989; Vickers, 1969]. Severe alcoholism is sometimes mentioned
as a contraindication for GHB [SMART DRUGS II, p244] even though
GHB has been used quite successfully in the treatment of withdrawal
symptoms. The explanation for this seeming contradiction probably
lies in the likelihood that severe alcoholics may combine GHB with
alcohol. GHB should not be used with benzodiazepines ("minor
tranquilizers" such as Valium and Xanax), phenothiazines ("major
tranquilizers" like Thorazine and Stellazine), various painkillers
(barbiturates and opiates), alcohol, anticonvulsants (Dilantin and
phenobarbital) and even many over-the-counter allergy and sleep
remedies--without direct medical supervision.
--- Dosage ---
Determining the ideal dose is probably the trickiest aspect of working
with GHB. The amount required for a given level of effect will vary
from person to person, and the dose-response curve is fairly steep.
Overestimating the dose can have consequences ranging in seriousness
from ruining your plans for the evening to waking up in the emergency
ward as a result of panic on the part of concerned-but-uninformed
friends or relatives. Once you have found the levels that give
you the effects you desire, they will remain consistent. Tolerance
to GHB does not develop. However, recent (not current) alcohol
consumption may decrease the effect of a given dose of GHB [Fadda, 1989].
Most people find that a dose in the range of 0.75-1.5 grams is
suitable for prosexual purposes, and that a quantity in the range of
2.5 grams is sufficient to force sleep.
Some people think that GHB might lower potassium levels and should
therefore be taken with potassium supplementation. Some research papers
have identified such an effect, others have not. If you want to play
it safe, take a potassium supplement equal to 10% of the GHB dose.
--- Notes: ---
Note 1: This article is excerpted and adapted from a 40-page special
report on GHB written by the authors and available from:
Post Office Box 4667
Petaluma, California, 94955
To order send a check for $22.95 ($19.95 for the report and $3 for
shipping). We do not accept credit cards.
(*) Note 2: This article was originally published in SMART DRUG NEWS
[3(6): p1] and is copyright (c) 1994 by the Cognitive Enhancement Research
Institute and the authors. For free information about CERI and SMART DRUG
NEWS, telephone (415) 321-CERI or (415) 323-3864 FAX or e-mail to CERI's
Executive Director Steven Wm. Fowkes at firstname.lastname@example.org. A small
sidebar to this article written by Steven Wm. Fowkes and entitled "The
Demonization of GHB" is also available for downloading from this directory.
Note 3: John Morgenthaler and Steven Wm. Fowkes (along with Ward Dean,
M.D.) are coauthors of the book SMART DRUGS II: THE NEXT GENERATION (Smart
Publications, 1993). This book is available from CERI and your local
bookstores. It is a supplement to the first smart-drug book SMART DRUGS &
NUTRIENTS, authored by Dr. Ward Dean and John Morgenthaler in 1990. The
two books provide a comprehensive summary of smart drugs.
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Chin MY, Kreutzer RA and Dyer JE. Acute poisoning from
gamma-hydroxybutyrate in California.
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