2. What is LDN? It is a lower dosage of the FDA-approved drug, naltrexone which is used to treat heroin and opium addiction by blocking the body’s opioid receptors that causes euphoria It was discovered by Dr. Bernard Bihari, MD – He found that when naltrexone is used at a low dose (1.5-4.5mg), instead of blocking the opioid receptors, their numbers and strength increases, producing opioids which in turn, help regulate the body’s natural immune defense system

3. How would LDN help benefit cancer patients on island? Is cancer actually a big issue here?

4. Cancer in the CNMI In an article by Moneth Deposa in Saipan Tribune, according to the Commonwealth Healthcare Corp, as of 2010, non- communicable diseases are part of the Top 5 causes of death in the CNMI and among these NCDs, cancer is the number one killer on the islands

5. Cultural Heritage In an academic journal on cultural alteration of human teeth in the CNMI, excavations at the Academy Gym site located in Guam unearthed four skeletal remains of individuals estimated to be from earlier than the year 1521. Dental studies conducted on the remains of all subjects show signs of dark reddish-brown staining, evidence of areca nut chewing (Ikehara & Douglas, 1997, p. 386).

6. Interview: Johnny S. Aldan What is the most common form of cancer here? – Oral cancer followed by cervical cancer Do we have treatment here? For what type of cancer? – Chemotherapy treatment What happens if there is not treatment for a particular form of cancer on island? – Refer patient off island; Philippines or Hawaii Is there a possibility of importing or bringing new medication for treatment here? – Yes

7. A Work in Progress These are the types of cancers that have been reported to respond to LDN according to Dr. Bernard Bihari: Bladder Cancer Breast Cancer Carcinoid Colon & Rectal Cancer Glioblastoma Liver Cancer Lung Cancer (Non-Small Cell) Lymphocytic Leukemia (chronic) Lymphoma (Hodgkin's and Non-Hodgkin's) Malignant Melanoma Multiple Myeloma Neuroblastoma Ovarian Cancer Pancreatic Cancer Prostate Cancer (untreated) Renal Cell Carcinoma Throat Cancer Uterine Cancer  HPV, an STD that often cervical cancer, can also cause head and neck cancers  Although oral cancer is not listed here, LDN can treat some cancers related to or that can be caused by oral cancer  Since LDN has still not been clinically tested, it leaves open opportunities to finding more diseases it can treat

8. What I learned? What would I have done different?

9. References Aldan, Johnny S. (2013, December 1). Personal Interview with G. Ngiraibuuch. Deposa, Moneth. (2013, January 28). “CHCC: 90 deaths due to NCDs noted in 2010.” Saipan Tribune. Retrieved from http://www.saipantribune.com/newsstory.aspx?cat=1&newsID=124862. Gluck, David. (n.d.). LDN and Cancer. Retrieved from http://www.lowdosenaltrexone.org/ldn_and_cancer.htm. Ikehara-Quebral, Rona & Douglas, Michele Toomay. (1997). Cultural Alteration of Human Teeth in the Mariana Islands. American Journal of Physical Anthropology, 104, 381-391. Retrieved November 29, 2013, from http://www.academia.edu/2511708/Cultural_alteration_of_human_teeth_in_the_Mariana _Islands.