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Massive smooth muscle cell apoptosis occurs and is replaced by collagen fibers, whereas myofibroblast activation and proliferation enter an exhausted phase, leading to a significant decline in -SMA synthesis capacity

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Another piece of this is that when opioids are more affordable, less people using them come up short of their habit, resulting in oscillating between getting dopesick and getting well, which is another example of something that lowers tolerance, just like treatment or jail, therein raising OD risk