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Adding to doctors worries are concerns about purity and dosing, because users typically buy from websites selling unregulated Chinese product some of which comes from plants that previously produced the deadly opioid fentanyl

It should be given in a clean, clinical setting to reduce the small risk of infection or irritation at the injection site

The most common treatment is lifelong B12 intramuscular injections although small amounts of B12 can be absorbed without intrinsic factor

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