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Disruptions in the intrinsic factor (IF) pathway, including impaired IF production due to autoimmune conditions (pernicious anemia), damage to the ileum from diseases like Crohns or celiac disease, or surgical resection of the ileum, can severely impair B12 absorption

The FDA referred the case to the DOJ

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Recreational use significantly increases the risk of addiction, as the drug is being taken in ways not intended by a doctor, often in higher doses or alongside other substances to enhance its effects