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Microdosing Ozempic? Why some people are playing doctor with weight-loss drugs

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Microdosing Ozempic? Why some people are playing doctor with weight-loss drugs

Shauna Bookless never imagined she’d become her own pharmacist. But after gaining more than 20 pounds during undergraduate and graduate school and feeling unhappy with her weight, the Hollywood resident found herself mixing vials in her kitchen to create her own doses of a popular weight-loss drug.

“I’m playing doctor,” Bookless said, describing her foray into the world of do-it-yourself GLP-1 medication, injections developed to control diabetes and now also used for weight loss.

Her journey began conventionally enough. She’d first heard of Wegovy, a GLP-1 made by Novo Nordisk, from a friend’s success story. Bookless then talked to her own doctor, who told her it wasn’t medically necessary and insurance wouldn’t pay for it because her body mass index wasn’t high enough to qualify her for coverage (without insurance, the cost can be $1,300 a month). So Bookless took matters into her own hands. And it led her to the fringes of a booming weight-loss drug market.

First, she considered her alternatives. She could go to a med-spa, but that would cost about $1,000 a month, still too much for the new therapist. Then, another friend at work told her about getting it directly from a laboratory that produces the product. Bookless wasn’t sure about this method — it meant having no doctor to turn to if she had questions — but a friend of hers assured her it was a legitimate, and a much cheaper route. She put her order in, paid $130, and two days later, in August, a package with a vial of white powder, sterile water, and needles arrived in the mail. It was semaglutide, a drug sold under the brand names Ozempic (for diabetes) and Wegovy (for weight loss).

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Following instructions provided in the packaging, she mixed the powder and water and put it in the fridge, taking out one-fourth to one-half a milligram to inject herself in the stomach once a week.

Instead of consistently stepping up the dose to a target dose of 2.4 mg as the manufacturer’s instructions and FDA’s guidance recommend, she’s been sticking close to the amount she started with. Even at these lower-than-recommended levels, her appetite soon winnowed and she began to shed weight. Bookless has used two months’ worth of the semaglutide over three months of jabbing herself weekly.

Twenty-three pounds of weight loss later, she’s figuring out how low of a dose she can use.

“I don’t want to lose any more weight,” she said. “But I also don’t want to gain the weight back. It’s going to be an experiment to go off of it.”

As demand for popular weight-loss drugs like Wegovy and Zepbound skyrockets, Bookless’ DIY approach highlights the lengths some are willing to go to slim down while saving money. Some patients, with or without the help of doctors, are experimenting with “microdosing” weight loss drugs — using smaller-than-recommended amounts — in order to stretch limited supplies, reduce costs and even potentially curb side effects.

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Meanwhile, medical experts are raising concerns, saying that there are not enough data about the effects of such weight loss drugs on those with lower BMIs and that the consequences of such off-label use remain largely unknown.

“We don’t have any clearly identified risks of people using it if they don’t meet criteria,” said Dr. Alyssa Dominguez, a specialist in endocrinology, diabetes and metabolism at the USC Keck School of Medicine. “But we don’t know because we haven’t been looking at those people in the scientific way.”

When the semaglutide medication Wegovy first hit the market in 2021, it became the first weight-loss drug to get FDA approval since 2014 and immediately became the go-to weight-loss treatment. At the heart of these medications are two key hormones, depending on the drug: GLP-1 (glucagon-like peptide-1) and GIP (glucose-dependent insulinotropic polypeptide). These naturally occurring hormones play crucial roles in regulating insulin, appetite and metabolism.

At first, these medications were used to treat diabetes. But when the FDA finally gave pharmaceutical companies approval to use these same drugs for weight loss, demand for them skyrocketed.

The enthusiasm wasn’t just about dropping pounds. A landmark study in 2023 found that semaglutide reduced major cardiovascular events by 20%, even in patients without diabetes. Perhaps most striking was a 19% lower death rate from any cause. With more than 70% of American adults affected by obesity or overweight — conditions that increase risk for heart attack, stroke and premature death — these findings suggested that injecting oneself with Ozempic, or any number of the other brands semaglutide are sold under, could offer significant long-term health benefits.

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The popularity led to sky-high prices, supply shortages and, in some cases, desperate measures by those seeking to lose weight.

“No one size fits all.”

— Dr. Vijaya Surampudi, associate director of the UCLA Medical Weight Management Clinic, on microdosing weight-loss drugs.

No matter the drug, microdosing is an inexact art. The weight-loss drug users and doctors whom The Times spoke to for this story all had slightly different takes: staying closer to the starting dose of 0.25 milligrams, cutting down to as low as 0.1 milligrams or simply refraining from injecting the medication every seven days as recommended. While “microdosing Ozempic” joins the lexicon on gentler-sounding beauty terms like “baby Botox” and “mini face lift” that make procedures seem more approachable, the reality is that some people do see benefits from lower doses.

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Even as this approach gains popularity, pharmaceutical companies advise patients against adjusting dosages.

“We do not condone these practices and it’s important to understand that for Ozempic, only the marked doses on the pens (0.25, 0.5, 1.0 and 2.0 mg) are approved for use (with 0.25 mg only approved for initiation and not maintenance),” a Novo Nordisk spokesperson said in an email. “The approved doses are the only dose strengths that have been studied as maintenance doses in our phase 3 clinical development program.”

“The products are not interchangeable and should not be used outside of their approved indications,” the spokesperson added.

Dr. Vijaya Surampudi, associate director of the UCLA Medical Weight Management Clinic, works with patients who want to stay at lower doses. She emphasizes that patient responses to these medications vary widely and the need for higher doses doesn’t necessarily correlate with how much weight someone needs to lose. Instead, she carefully monitors each person’s reaction to the medication, tailoring the approach based on their body’s unique response.

“No one size fits all,” she said.

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But there are practical limitations in microdosing weight-loss medications, she said. Brand-name GLP-1 medications come in fixed-dose pen injectors, making personalized dose adjustments impossible.

Bookless found a way around this roadblock by acquiring a compounded version of the medication, a copy of brand-name medicines. Federal law normally bans pharmacies from making copycat versions of commercially available drugs. But when medications are in short supply, regulators don’t consider them “commercially available” — opening the door for pharmacies to create and sell similar products.

Dr. Tasneen Bhatia, better known as Dr. Taz, an integrative medicine physician and wellness expert, offers compounded GLP-1 to clients at her Los Angeles office, where she estimates about 10% to 20% of clients are microdosing the medication.

Bhatia sees microdosing as an option for clients who come to her office with the goal of losing 20 pounds or less or patients who have proved to be sensitive to the side effects of GLP-1, which include nausea, constipation, lack of energy and diarrhea.

Because early research shows many patients regain weight once they cease use of GLP-1, Bhatia says many doctors expect patients to use these medications for the rest of their lives. Bhatia, however, sees a future where people microdose the drug on and off as needed, something she acknowledges is not yet conventional wisdom.

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“I think by switching it up, you’re challenging the metabolism a little bit, and so using it more, maybe once a quarter, to get back on track,” she said. “The goal should never be that someone has to be on something forever.”

Dr. Suzanne Trott, a Beverly Hills board-certified plastic surgeon, started a microdosing clinic after her patients had used the medication to reach their goal weight and hoped to maintain it. She works only with tirzepatide — the drug behind Zepbound that uses both GIP and GLP-1 — which, in her experience, has fewer side effects. She sources the drug from a compounding company that has facilities in Southern California. Trott said she works with her patients to figure out the amount and schedules injections as needed.

“Not all of medicine is science; some of it is an art.”

— Dr. Suzanne Trott, Beverly Hills-based plastic surgeon

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“They can try to microdose however they want it,” she said. “Not all of medicine is science; some of it is an art.”

The microdosing works so effectively that she said it’s cutting into the plastic surgery side of her business. She recommends it as a safer alternative to liposuction for some patients.

No matter how effective doctors and patients say microdosing weight-loss drugs are, this form of medical experimentation may be short-lived. Once shortages ease, companies peddling these alternatives could face a crackdown. Last week, the Food and Drug Administration announced that the shortage of Eli Lilly’s Zepbound was over, though Wegovy remains scarce. Eli Lilly then sent cease-and-desist letters to many companies offering compounded versions of tirzepatide.

Shortly after being sued by the Outsourcing Facilities Assn., a compounding trade group, the FDA reversed its decision and said it would allow pharmacists to continue making compounded versions of the drug while it reexamines the shortage.

Semaglutide compounders could be next: Novo Nordisk has asked the FDA to bar compounding pharmacies from making compounds of its weight loss and diabetes drugs, arguing the medication is too complex for it to be manufactured by others safely.

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With the compounded versions still available (for now), Trott said her clinic is almost at capacity, with a couple dozen patients. She remains optimistic about the widespread appeal of these treatments.

“It’s something that’s become a part of a lot of regular people’s lives,” she said. “Kind of like the way plastic surgery used to be just something that celebrities did, and now this is something that is accessible to everyone.”

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Diablo Canyon clears last California permit hurdle to keep running

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Diablo Canyon clears last California permit hurdle to keep running

Central Coast Water authorities approved waste discharge permits for Diablo Canyon nuclear plant Thursday, making it nearly certain it will remain running through 2030, and potentially through 2045.

The Pacific Gas & Electric-owned plant was originally supposed to shut down in 2025, but lawmakers extended that deadline by five years in 2022, fearing power shortages if a plant that provides about 9 percent the state’s electricity were to shut off.

In December, Diablo Canyon received a key permit from the California Coastal Commission through an agreement that involved PG&E giving up about 12,000 acres of nearby land for conservation in exchange for the loss of marine life caused by the plant’s operations.

Today’s 6-0 vote by the Central Coast Regional Water Board approved PG&E’s plans to limit discharges of pollutants into the water and continue to run its “once-through cooling system.” The cooling technology flushes ocean water through the plant to absorb heat and discharges it, killing what the Coastal Commission estimated to be two billion fish each year.

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The board also granted the plant a certification under the Clean Water Act, the last state regulatory hurdle the facility needed to clear before the federal Nuclear Regulatory Commission (NRC) is allowed to renew its permit through 2045.

The new regional water board permit made several changes since the last one was issued in 1990. One was a first-time limit on the chemical tributyltin-10, a toxic, internationally-banned compound added to paint to prevent organisms from growing on ship hulls.

Additional changes stemmed from a 2025 Supreme Court ruling that said if pollutant permits like this one impose specific water quality requirements, they must also specify how to meet them.

The plant’s biggest water quality impact is the heated water it discharges into the ocean, and that part of the permit remains unchanged. Radioactive waste from the plant is regulated not by the state but by the NRC.

California state law only allows the plant to remain open to 2030, but some lawmakers and regulators have already expressed interest in another extension given growing electricity demand and the plant’s role in providing carbon-free power to the grid.

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Some board members raised concerns about granting a certification that would allow the NRC to reauthorize the plant’s permits through 2045.

“There’s every reason to think the California entities responsible for making the decision about continuing operation, namely the California [Independent System Operator] and the Energy Commission, all of them are sort of leaning toward continuing to operate this facility,” said boardmember Dominic Roques. “I’d like us to be consistent with state law at least, and imply that we are consistent with ending operation at five years.”

Other board members noted that regulators could revisit the permits in five years or sooner if state and federal laws changes, and the board ultimately approved the permit.

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Deadly bird flu found in California elephant seals for the first time

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Deadly bird flu found in California elephant seals for the first time

The H5N1 bird flu virus that devastated South American elephant seal populations has been confirmed in seals at California’s Año Nuevo State Park, researchers from UC Davis and UC Santa Cruz announced Wednesday.

The virus has ravaged wild, commercial and domestic animals across the globe and was found last week in seven weaned pups. The confirmation came from the U.S. Department of Agriculture’s National Veterinary Services Laboratory in Ames, Iowa.

“This is exceptionally rapid detection of an outbreak in free-ranging marine mammals,” said Professor Christine Johnson, director of the Institute for Pandemic Insights at UC Davis’ Weill School of Veterinary Medicine. “We have most likely identified the very first cases here because of coordinated teams that have been on high alert with active surveillance for this disease for some time.”

Since last week, when researchers began noticing neurological and respoiratory signs of the disease in some animals, 30 seals have died, said Roxanne Beltran, a professor of ecology and evolutionary biology at UC Santa Cruz. Twenty-nine were weaned pups and the other was an adult male. The team has so far confirmed the virus in only seven of the dead pups.

Infected animals often have tremors convulsions, seizures and muscle weakness, Johnson said.

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Beltran said teams from UC Santa Cruz, UC Davis and California State Parks monitor the animals 260 days of the year, “including every day from December 15 to March 1” when the animals typically come ashore to breed, give birth and nurse.

The concerning behavior and deaths were first noticed Feb. 19.

“This is one of the most well-studied elephant seal colonies on the planet,” she said. “We know the seals so well that it’s very obvious to us when something is abnormal. And so my team was out that morning and we observed abnormal behaviors in seals and increased mortality that we had not seen the day before in those exact same locations. So we were very confident that we caught the beginning of this outbreak.”

In late 2022, the virus decimated southern elephant seal populations in South America and several sub-Antarctic Islands. At some colonies in Argentina, 97% of pups died, while on South Georgia Island, researchers reported a 47% decline in breeding females between 2022 and 2024. Researchers believe tens of thousands of animals died.

More than 30,000 sea lions in Peru and Chile died between 2022 and 2024. In Argentina, roughly 1,300 sea lions and fur seals perished.

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At the time, researchers were not sure why northern Pacific populations were not infected, but suspected previous or milder strains of the virus conferred some immunity.

The virus is better known in the U.S. for sweeping through the nation’s dairy herds, where it infected dozens of dairy workers, millions of cows and thousands of wild, feral and domestic mammals. It’s also been found in wild birds and killed millions of commercial chickens, geese and ducks.

Two Americans have died from the virus since 2024, and 71 have been infected. The vast majority were dairy or commercial poultry workers. One death was that of a Louisiana man who had underlying conditions and was believed to have been exposed via backyard poultry or wild birds.

Scientists at UC Santa Cruz and UC Davis increased their surveillance of the elephant seals in Año Nuevo in recent years. The catastrophic effect of the disease prompted worry that it would spread to California elephant seals, said Beltran, whose lab leads UC Santa Cruz’s northern elephant seal research program at Año Nuevo.

Johnson, the UC Davis researcher, said the team has been working with stranding networks across the Pacific region for several years — sampling the tissue of birds, elephant seals and other marine mammals. They have not seen the virus in other California marine mammals. Two previous outbreaks of bird flu in U.S. marine mammals occurred in Maine in 2022 and Washington in 2023, affecting gray and harbor seals.

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The virus in the animals has not yet been fully sequenced, so it’s unclear how the animals were exposed.

“We think the transmission is actually from dead and dying sea birds” living among the sea lions, Johnson said. “But we’ll certainly be investigating if there’s any mammal-to-mammal transmission.”

Genetic sequencing from southern elephant seal populations in Argentina suggested that version of the virus had acquired mutations that allowed it to pass between mammals.

The H5N1 virus was first detected in geese in China in 1996. Since then it has spread across the globe, reaching North America in 2021. The only continent where it has not been detected is Oceania.

Año Nuevo State Park, just north of Santa Cruz, is home to a colony of some 5,000 elephant seals during the winter breeding season. About 1,350 seals were on the beach when the outbreak began. Other large California colonies are located at Piedras Blancas and Point Reyes National Sea Shore. Most of those animals — roughly 900 — are weaned pups.

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It’s “important to keep this in context. So far, avian influenza has affected only a small proportion of the weaned at this time, and there are still thousands of apparently healthy animals in the population,” Beltran said in a press conference.

Public access to the park has been closed and guided elephant seal tours canceled.

Health and wildlife officials urge beachgoers to keep a safe distance from wildlife and keep dogs leashed because the virus is contagious.

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When slowing down can save a life: Training L.A. law enforcement to understand autism

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When slowing down can save a life: Training L.A. law enforcement to understand autism

Kate Movius moved among a roomful of Los Angeles County sheriff’s deputies, passing out a pop trivia quiz and paper prism glasses.

She told them to put on the vision-distorting glasses, and to write with their nondominant hand. As they filled out the tests, Movius moved about the City of Industry classroom pounding abruptly on tables. Then came the cowbell. An aide flashed the overhead lights on and off at random. The goal was to help the deputies understand the feeling of sensory overwhelm, which many autistic people experience when incoming stimulation exceeds their capacity to process.

“So what can you do to assist somebody, or de-escalate somebody, or get information from someone who suffers from a sensory disorder?” Movius asked the rattled crowd afterward. “We can minimize sensory input. … That might be the difference between them being able to stay calm and them taking off.”

Movius, founder of the consultancy Autism Interaction Solutions, is one of a growing number of people around the U.S. working to teach law enforcement agencies to recognize autistic behaviors and ensure that encounters between neurodevelopmentally disabled people and law enforcement end safely.

She and City of Industry Mayor Cory Moss later passed out bags filled with tools donated by the city to aid interactions: a pair of noise-damping headphones to decrease auditory input, a whiteboard, a set of communication cards with words and images to point to, fidget toys to calm and distract.

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“The thing about autistic behavior when it comes to law enforcement is a lot of it may look suspicious, and a lot of it may feel very disrespectful,” said Movius, who is also the parent of an autistic 25-year-old man. Responding officers, she said, “are not coming in thinking, ‘Could this be a developmentally disabled person?’ I would love for them to have that in the back of their minds.”

A sheriff’s deputy reads a pamphlet on autism during the training program.

(Genaro Molina / Los Angeles Times)

Autism spectrum disorder is a developmental condition that manifests differently in nearly every person who has it. Symptoms cluster around difficulties in communication, social interaction and sensory processing.

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An autistic person stopped by police might hold the officer’s gaze intensely or not look at them at all. They may repeat a phrase from a movie, repeat the officer’s question or temporarily lose their ability to speak. They might flee.

All are common involuntary responses for an autistic person in a stressful situation, which a sudden encounter with law enforcement almost invariably is. To someone unfamiliar with the condition, all could be mistaken for intoxication, defiance or guilt.

Autism rates in the U.S. have increased nearly fivefold since the Centers for Disease Control began tracking diagnoses in 2000, a rise experts attribute to broadening diagnostic criteria and better efforts to identify children who have the condition.

The CDC now estimates that 1 in 31 U.S. 8-year-olds is autistic. In California, the rate is closer to 1 in 22 children.

As diverse as the autistic population is, people across the spectrum are more likely to be stopped by law enforcement than neurotypical peers.

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About 15% of all people in the U.S. ages 18 to 24 have been stopped by police at some point in their lives, according to federal data. While the government doesn’t track encounters for disabled people specifically, a separate study found that 20% of autistic people ages 21 to 25 have been stopped, often after a report or officer observation of a person behaving unusually.

Some of these encounters have ended in tragedy.

In 2021, Los Angeles County sheriff’s deputies shot and permanently paralyzed a deaf autistic man after family members called 911 for help getting him to a hospital.

Isaias Cervantes, 25, had become distressed about a shopping trip and started pushing his mother, his family’s attorney said at the time. He resisted as two deputies attempted to handcuff him and one of the deputies shot him, according to a county report.

In 2024, Ryan Gainer’s family called 911 for support when the 15-year-old became agitated. Responding San Bernardino County sheriff‘s deputies shot and killed him outside his Apple Valley home.

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Last year, police in Pocatello, Idaho, shot Victor Perez, 17, through a chain-link fence after the nonspeaking teenager did not heed their shouted commands. He died from his injuries in April.

Autism Interaction Solutions program in the City of Industry.

Sheriff’s deputies take a trivia quiz using their non-writing hands, while wearing vision-distorting glasses, as Kate Movius, standing left, and Industry Mayor Cory Moss, right, ring cowbells. The idea was to help them understand the sensory overwhelm some autistic people experience.

(Genaro Molina / Los Angeles Times)

As early as 2001, the FBI published a bulletin on police officers’ need to adjust their approach when interacting with autistic people.

“Officers should not interpret an autistic individual’s failure to respond to orders or questions as a lack of cooperation or as a reason for increased force,” the bulletin stated. “They also need to recognize that individuals with autism often confess to crimes that they did not commit or may respond to the last choice in a sequence presented in a question.”

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But a review of multiple studies last year by Chapman University researchers found that while up to 60% of officers have been on a call involving an autistic person, only 5% to 40% had received any training on autism.

In response, universities, nonprofits and private consultants across the U.S. have developed curricula for law enforcement on how to recognize autistic behaviors and adapt accordingly.

The primary goal, Movius told deputies at November’s training session, is to slow interactions down to the greatest extent possible. Many autistic people require additional time to process auditory input and verbal responses, particularly in unfamiliar circumstances.

If at all possible, Movius said, wait 20 seconds for a response after asking a question. It may feel unnaturally long, she acknowledged. But every additional question or instruction fired in that time — what’s your name? Did you hear me? Look at me. What’s your name? — just decreases the likelihood that a person struggling to process will be able to respond at all.

Moss’ son, Brayden, then 17, was one of several teenagers and young adults with autism who spoke or wrote statements to be read to the deputies. The diversity of their speech patterns and physical mannerisms showed the breadth of the spectrum. Some were fluently verbal, while others communicated through signs and notes.

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“This population is so diverse. It is so complicated. But if there’s anything that we can show [deputies] in here that will make them stop and think, ‘Hey, what if this is autism?’ … it is saving lives,” Moss said.

Cory Moss and Kate Movius hug

Mayor Cory Moss, left, and Kate Movius hug at the end of the training program last November. Movius started Autism Interaction Solutions after her son was born with profound autism.

(Genaro Molina / Los Angeles Times)

Some disability advocates cautioned that it takes more than isolated training sessions to ensure encounters end safely.

Judy Mark, co-founder and president of the nonprofit Disability Voices United, says she trained thousands of officers on safe autism interactions but stopped after Cervantes’ shooting. She now urges families concerned about an autistic child’s safety to call an ambulance rather than law enforcement.

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“I have significant concern about these training sessions,” Mark said. “People get comfort from it, and the Sheriff’s Department can check the box.”

While not a panacea, supporters argue that a brief course is better than no preparation at all. Some years ago, Movius received a letter from a man whose profoundly autistic son slipped away as the family loaded their car at the beach. He opened the unlocked door of a police vehicle, climbed into the back and began to flail in distress.

Though surprised, the officer seated at the wheel de-escalated the situation and helped the young man find his family, the father wrote to Movius. He had just been to her training.

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