243 ‒ The fentanyl crisis and why everyone should be paying attention | Anthony Hipolito

1. 0:00 – 0:08

   Intro

   1. PAPeter Attia0:00

      [upbeat music] Hey, everyone. Welcome to "The Drive" podcast. I'm your host, Peter Attia. [upbeat music]

2. 0:08 – 3:46

   Anthony’s life of service in law enforcement

   1. PAPeter Attia0:10

      Anthony, thank you so much for coming over. Not just coming over, coming over on a Sunday. Um, the reason I, I'm-- we're doing this on a Sunday, I don't normally record podcasts on the weekend. But, um, my wife and I saw you speak, um, actually saw a video of you speaking. We couldn't make it to the actual event. And we were both so moved by it and thought-

   2. AHAnthony Hipolito0:30

      Mm-hmm

   3. PAPeter Attia0:30

      ... you know, if there's anything that I can do to use-

   4. AHAnthony Hipolito0:33

      Yeah

   5. PAPeter Attia0:33

      ... sort of my platform to get this message out more broadly, basically to everybody.

   6. AHAnthony Hipolito0:37

      Mm-hmm.

   7. PAPeter Attia0:37

      Because I-- it's hard to say that there's someone who doesn't need to hear what we're about to talk about today.

   8. AHAnthony Hipolito0:41

      Mm-hmm.

   9. PAPeter Attia0:42

      Um, and basically, if, if I had tried to slot this into our normal podcast schedule, we wouldn't be having this discussion till about June. And I was just like, "You know what? Honestly, like if-

   10. AHAnthony Hipolito0:52

       Yeah

   11. PAPeter Attia0:52

       ... if, if it makes the life of one person different-

   12. AHAnthony Hipolito0:54

       Mm-hmm

   13. PAPeter Attia0:55

       ... by doing it now, we're gonna-

   14. AHAnthony Hipolito0:56

       Mm-hmm

   15. PAPeter Attia0:56

       ... we're gonna record this at the beginning of February and turn this around as quickly as possible." So this will probably give listeners a sense of, [chuckles] uh-

   16. AHAnthony Hipolito1:02

       Yeah

   17. PAPeter Attia1:02

       ... why this is an important episode. But, um, let's, let's just start. Who, who are you, Anthony?

   18. AHAnthony Hipolito1:08

       Yeah.

   19. PAPeter Attia1:08

       What do you do, um, and, and, and why is it we're sitting here today?

   20. AHAnthony Hipolito1:11

       Yeah. Well, I appreciate the invite. Um, I'll never say no to talking about fentanyl and talking about the dangers it presents to everybody. It's-- it knows no boundaries, right? It's, it's Black, White, Brown. It's rich, poor. It affects anybody and everybody, not only in Hays County, not only in Travis County, Texas, but the entire world. So that's how prevalent this stuff is, and scary. Um, but I, I-- again, I appreciate the invite and, um, I don't care if it's Sunday. So I really appreciate you fitting this in and getting this, getting this going. Um, I've been in law enforcement for 24 years. I worked at the Austin Police Department for 23 years. I retired July of 2021. Um, I grew, I grew up and basically lived my entire life out in Hays County, and I wanted to get out there and serve in the community that I grew up in, right? So, um, I took the summer off and, and during the 2021 year, and started in September. Um, I've been friends with the sheriff out there for a long, long time, and he consistently recruited me to, to get out there. So, um, I got hired by the Hays County Sheriff's Office September, and I've been there just a, you know, 18 months or so now. Um, I'm currently assigned to the community outreach unit. Um, during my time at the A- at APD, I did, uh... APD's a large department, right, so you're able to do a variety of assignments. Um, obviously, you have to start out on patrol, but I, I worked patrol certain-- several stints. I promoted twice. Um, so each time you promote, you gotta go back to the patrol, um, division and, you know, answer 911 calls and all that good stuff. But I worked in organized crime. I worked in, um, public affairs. I did internal affairs. I did some undercover work. I worked mounted patrol, bike patrol on 6th Street. So in a larger department, you're able to specialize a lot, so I was able to, to experience a lot and learn a lot about the department, the inside, what makes it tick, and all that good stuff. But, um, it was just time for me to, to move on, and I, I reached the point where I was able to retire. So, um, I jumped out to Hays County, and I'm, uh, again, I'm on side of the community outreach unit. And, and all we do is get out in the community and, and, and visit and show the citizens of Hays County that we're human, right? We're, we're police officers, um, yes, or sheriff's deputies, yes. But we're humans, right? And, um, our job is to get out in the community and, and reach people and talk to 'em, and we do that through a variety of ways. We have a Citizens Police Academy. We do Junior Deputy Academies during the summer. We visit HOAs. Um, but obviously now, over the last-- since about August, it's all fentanyl all the time just because

3. 3:46 – 13:12

   Fentanyl: medical use, recreational use, and the recent rise in prevalence

   1. AHAnthony Hipolito3:46

      of what's going on.

   2. PAPeter Attia3:47

      So you retired in the summer of '21.

   3. AHAnthony Hipolito3:49

      Mm-hmm.

   4. PAPeter Attia3:50

      And what-- at, up until the point of your retirement, how big an issue was-

   5. AHAnthony Hipolito3:55

      Mm-hmm

   6. PAPeter Attia3:55

      ... fentanyl making its way into other drugs?

   7. AHAnthony Hipolito3:59

      Yeah. So at that time, uh, fentanyl was, was around. Uh, when I-- at the time I retired, I was in organized crime. I was a sergeant over the criminal interdiction unit, and that's what we did on a daily basis, was battle the Mexican cartel. [chuckles] Um, obviously I-35 runs up and down through the middle of Hays County, through the middle of Austin. Um, so I had, uh, about 10, 10 officers that were assigned to me, and we had officers that did interdiction work up and down I-35. We had officers that worked at ABIA. Um, we also had o- officers that worked with FedEx, with UPS, with the Postal Service to try to interdict not only drugs, but money, guns, and any, uh, any, any type of criminal element. So, um, at that time, uh, I think I did about three, three and a half years in that assignment. Uh, and we started seeing fentanyl probably 2017, 2018, but it was more on the black market. People would order that on the dark web, and it would be sent from China. Um, it would be sent FedEx or UPS, and the majority of our seizures at that time were through FedEx and USPS. We would work with the postal inspectors and security folks with, um, UPS and FedEx, and we, we would intercept boxes and boxes of illegal, uh, illegal, illicit, counterfeit pills. Um, so that's where we started seeing it. What's going on now is the Mexican cartel, um, being that they're very competitive and they want to own the drug market, they have gotten into the fentanyl game, and that's why we're seeing it become more and more prevalent over the, over the last number of years.

   8. PAPeter Attia5:28

      Now, I kind of been sort of asleep at the wheel here and haven't-

   9. AHAnthony Hipolito5:31

      Mm-hmm

   10. PAPeter Attia5:31

       ... paid a lot of attention-

   11. AHAnthony Hipolito5:32

       Sure

   12. PAPeter Attia5:32

       ... to this until maybe the past six months. Um, but back when I worked in a hospital, we used fentanyl all the time.

   13. AHAnthony Hipolito5:40

       Mm-hmm.

   14. PAPeter Attia5:41

       It was a very potent intravenous narcotic.

   15. AHAnthony Hipolito5:44

       Mm-hmm.

   16. PAPeter Attia5:44

       So, um, you had morphine, which you would typically give in milligram doses.

   17. AHAnthony Hipolito5:50

       Mm-hmm.

   18. PAPeter Attia5:51

       Right? So if a patient was having a lot of pain, you would use an intravenous infusion of morphine.

   19. AHAnthony Hipolito5:56

       Mm-hmm.

   20. PAPeter Attia5:57

       One, two, three, four, five milligrams, right? So, uh, you know, thousandths of a gram-

   21. AHAnthony Hipolito6:03

       Mm-hmm

   22. PAPeter Attia6:03

       ... of morphine. Fentanyl was much more potent.

   23. AHAnthony Hipolito6:06

       Mm-hmm.

   24. PAPeter Attia6:06

       Came on quicker, um, and it was dosed in micrograms.

   25. AHAnthony Hipolito6:10

       Mm-hmm.

   26. PAPeter Attia6:11

       Right? So now you're, you're, you're talking about, like, it's, it's a lot smaller a dose.

   27. AHAnthony Hipolito6:16

       Yeah.

   28. PAPeter Attia6:16

       And, um- You know, it was a very good drug for pain and sedation. So, you know, if a patient was having even something like a colonoscopy, for example-

   29. AHAnthony Hipolito6:27

       Mm-hmm

   30. PAPeter Attia6:27

       ... you would use maybe 100 micrograms of fentanyl, so that's .1 milligram-
4. 13:12 – 20:32

   The story of a teenager dying from an accidental overdose of fentanyl

   1. PAPeter Attia13:12

      Maybe before we go any further, 'cause there's so much more I wanna probe on this-

   2. AHAnthony Hipolito13:15

      Sure

   3. PAPeter Attia13:15

      ... um, let's kind of bring it back to a story.

   4. AHAnthony Hipolito13:18

      Mm-hmm.

   5. PAPeter Attia13:19

      Um, so we'll show a video now that you, you shared that night-

   6. AHAnthony Hipolito13:23

      Mm-hmm

   7. PAPeter Attia13:24

      ... when you gave the presentation here at the school district, um, about, uh, the parents of a, of a, of a boy who, who lost his life. So let, let, let's let folks watch that now.

   8. AHAnthony Hipolito13:34

      Yeah.

   9. SPSpeaker13:34

      This is Kevin McConville. [somber music] He was 17 years old. And he was my baby boy, my pride and joy.

   10. SPSpeaker13:49

       Born May 9th, 2005. Uh, amazing kid. Uh, full of life and, uh, loved the outdoors. Very creative. Um, was planning a, a, a career in the military and possibly becoming a welder.

   11. SPSpeaker14:09

       He would've been a senior this year.

   12. SPSpeaker14:12

       He has a little sister that he loves very much.

   13. SPSpeaker14:16

       The night of August 2nd, um, he asked if there was any more pizza, and I told him no, unfortunately, and I could make him his tuna. And he said, "No." He said, "I'm just gonna go upstairs and go to sleep." And I said, "I love you." He said, "I love you, too." The following day, I found him in his bed asleep, what appeared to be asleep. But he was gone, and I couldn't bring him back.

   14. SPSpeaker14:55

       Later, we, we found out that, uh, after their investigation, they, they said that there was a pill found next to Kevin in an Altoids tin, uh, can, uh, with a pill in a bag. It was a, a light blue colored pill with the M30 logo stamped into it, and they said they're believed to be fentanyl. Uh, these are the counterfeit pills that are going around.

   15. SPSpeaker15:20

       I contacted, um, one of his friends shortly after he had passed away to let him know that Kevin was gone. He was very heartbroken. Um, and he had told us that Kevin confided in him that he was taking Percocet and Xanax to help him sleep. I think one of his... I don't wanna call him a friend. I can't call him a friend. Um, was doing it as well, and that friend originally gave him the pills 'cause he probably confided in that person. And Kevin probably took them before, and nothing happened, and so he continued to take them. I can't tell you how many times 'cause I don't know. But it doesn't matter how many times you could take it. It could be your first time. It could be your last time. And no parent wants to see their child in that position, in that... He looked like he was asleep.

   16. PAPeter Attia16:58

       Um, that's a, that's a, that's a hard video to watch.

   17. AHAnthony Hipolito17:01

       Very hard. That's... And it's powerful, right? So, um, and that's one of the reasons I put it at the beginning of our presentations, because I want that to be the attention grabber. I want kids specifically to sit back in their seats and really bring it home, personalize it a little bit, because that's somebody their age that has fallen victim. 'Cause not everybody knows somebody that has died from the fentanyl because it's... Although it's very, very prevalent, these deaths really, uh, in, in the kids hasn't been as prevalent as what we're seeing these days.

   18. PAPeter Attia17:33

       I think the other thing that you made a, a really important point of in your talk is we, we really wanna talk about these as what they are, right? These are accidental deaths.

   19. AHAnthony Hipolito17:44

       Mm-hmm.

   20. PAPeter Attia17:44

       Right? These are not people that are intentionally taking a dose that is so high to end their life.

   21. AHAnthony Hipolito17:52

       Mm-hmm.

   22. PAPeter Attia17:52

       Um, this is someone who thinks, in the case of Kevin, that they're, they're taking something to help them sleep.

   23. AHAnthony Hipolito17:59

       Mm-hmm.

   24. PAPeter Attia18:01

       And then they don't wake up.

   25. AHAnthony Hipolito18:02

       Right.

   26. PAPeter Attia18:04

       Um, let's go back to this idea of... D- do we know, by the way, what dose was in Kevin's system?

   27. AHAnthony Hipolito18:13

       I don't, I, I don't think toxicology has come back on, on, on Kevin's case quite yet.

   28. PAPeter Attia18:17

       Mm.

   29. AHAnthony Hipolito18:18

       Um, but as you mentioned, he was taking Xanax-

   30. PAPeter Attia18:21

       Mm-hmm
5. 20:32 – 27:10

   The scope of deaths being caused by accidental overdoses (the majority of which are from fentanyl)

   1. PAPeter Attia20:32

      I did the calculation the other day with... I was with my wife and my daughter, and I just did some numbers in the back of the, you know... And does, does my calculation come out right to you? By, by my calculation, every five minutes, someone accidentally overdoses in the United States.

   2. AHAnthony Hipolito20:50

      Mm-hmm.

   3. PAPeter Attia20:50

      Meaning dies-

   4. AHAnthony Hipolito20:51

      Yes

   5. PAPeter Attia20:51

      ... as a result of an accidental overdose.

   6. AHAnthony Hipolito20:53

      Yes.

   7. PAPeter Attia20:53

      Does that sound about right to you?

   8. AHAnthony Hipolito20:54

      I, I... Five... Yes, five minutes sounds pretty accurate.

   9. PAPeter Attia20:57

      Yeah.

   10. AHAnthony Hipolito20:57

       And I think I heard that this morning on another... I just happened to be going to the gym this morning to work out, and I popped in my phone, and it was a podcast about fentanyl. Like, I, I-

   11. PAPeter Attia21:04

       Oh, wow

   12. AHAnthony Hipolito21:04

       ... didn't pull it up. That was wicked pretty... It was really... being that I was coming here today to, to talk about fentanyl, and that stat was there, so that's-

   13. PAPeter Attia21:12

       Yeah, I mean, I basically just looked at the last 12 months of CDC-

   14. AHAnthony Hipolito21:15

       Mm-hmm

   15. PAPeter Attia21:15

       ... data-

   16. AHAnthony Hipolito21:16

       Mm-hmm

   17. PAPeter Attia21:16

       ... on how many people have died. And again, it's important to understand, this is not including people who overdose as a way to end their lives.

   18. AHAnthony Hipolito21:25

       Mm-hmm.

   19. PAPeter Attia21:25

       This is people who think they're taking-

   20. AHAnthony Hipolito21:27

       Mm-hmm

   21. PAPeter Attia21:27

       ... either just a straight up recreational drug like-

   22. AHAnthony Hipolito21:30

       Right

   23. PAPeter Attia21:30

       ... cocaine or something that's laced, uh, or too- they take too much of it, or they're, in the case of what we're seeing now, more and more of those. Do you have a sense of what percentage of accidental overdose deaths today are attributable to fentanyl directly? Fentanyl is in the drug that they are taking.

   24. AHAnthony Hipolito21:47

       Uh, I think two-thirds. About two-thirds.

   25. PAPeter Attia21:50

       Oh my God.

   26. AHAnthony Hipolito21:50

       Yeah, and that's why we don't... Um, I catch myself because I, I s- I say overdose a lot, but y- you, you bring it up again, right? It's a poisoning.

   27. PAPeter Attia21:58

       Yeah.

   28. AHAnthony Hipolito21:58

       They're not intentionally trying to kill themselves. They're, they're taking a drug for whatever reason, um, and they're, they're not waking up. So they're being poisoned, um, by these drug dealers, by the Mexican cartel, and that's, um... Yeah, it's sad. Yeah. It's insane.

   29. PAPeter Attia22:14

       So maybe I'm silly for trying to apply logic to this-

   30. AHAnthony Hipolito22:20

       Mm-hmm
6. 27:10 – 35:21

   How young kids are being targeted, and how fentanyl makes it across our borders and gets distributed

   1. AHAnthony Hipolito27:10

      that's strictly because I believe, um, and the DEA believes, that the Mexican cartel are f- specifically targeting our young folks, and that's why that we're seeing that.

   2. PAPeter Attia27:19

      Can, can you say a bit more about what that looks like? How are they doing that?

   3. AHAnthony Hipolito27:22

      Um, one of the ways they're doing that is, um, they've started making what they, what we've, what we call in law enforcement and DEA calls is a rainbow fentanyl or candy fentanyl, and it's made to look just like candy. It, it looks, it's a, it looks attractive to the young folks. Um, it looks pretty, right? "So it's, it won't kill me. It won't happen to me." Um, and they're also targeting young folks because they want to get people addicted a lot younger so they have that customer base a lot longer.

   4. PAPeter Attia27:52

      Tell, tell me what the, the, the chain looks like. So you're, you're saying like if 13-year-olds and 10-year-olds are potentially now being targeted-

   5. AHAnthony Hipolito28:00

      Mm-hmm

   6. PAPeter Attia28:00

      ... you're gonna expand your market, right? What is the... Who's the drug dealer in that situation? How is it getting its way from a Mexican cartel-

   7. AHAnthony Hipolito28:09

      Mm-hmm

   8. PAPeter Attia28:09

      ... to distribute these, you know, much-

   9. AHAnthony Hipolito28:11

      Yeah

   10. PAPeter Attia28:11

       ... more friendly looking drugs?

   11. AHAnthony Hipolito28:13

       Mm-hmm.

   12. PAPeter Attia28:13

       It's no longer a shady looking Percocet with a stamp on it.

   13. AHAnthony Hipolito28:16

       Mm-hmm.

   14. PAPeter Attia28:16

       Uh, by the way, I think we're gonna link to some photos of these that you shared.

   15. AHAnthony Hipolito28:20

       Yes.

   16. PAPeter Attia28:21

       Because this is the other thing that surprised me is how good the counterfeits are.

   17. AHAnthony Hipolito28:26

       You can't tell the difference.

   18. PAPeter Attia28:27

       They're indistinguishable.

   19. AHAnthony Hipolito28:27

       Yes.

   20. PAPeter Attia28:28

       It's n- I would as- I always assumed when people were getting counterfeit Percocet-

   21. AHAnthony Hipolito28:32

       Mm-hmm

   22. PAPeter Attia28:32

       ... I was always like, "Well, they just don't know what real Percocet looks like-

   23. AHAnthony Hipolito28:37

       Right

   24. PAPeter Attia28:37

       ... and that's why they're being fooled."

   25. AHAnthony Hipolito28:38

       Right.

   26. PAPeter Attia28:38

       But that's not true.

   27. AHAnthony Hipolito28:40

       Nope. Not at all.

   28. PAPeter Attia28:40

       This is color matched, printed identical. It w- which by the way, Anthony, you'll have to forgive me.

   29. AHAnthony Hipolito28:47

       No, you're good.

   30. PAPeter Attia28:47

       This brings me back to my frustration. You figured out how to color match, perfectly stamp and manufacture this, and yet you're off by a dose of 1,000 on the active ingredient?
7. 35:21 – 40:28

   What happens to a person when they overdose

   1. PAPeter Attia35:21

      Let's talk a little bit about what happens to a person when they overdose.

   2. AHAnthony Hipolito35:25

      Mm-hmm.

   3. PAPeter Attia35:25

      Um, there's another video you shared from an elementary school, actually.

   4. AHAnthony Hipolito35:29

      Yeah.

   5. PAPeter Attia35:30

      It was a surveillance camera.

   6. AHAnthony Hipolito35:31

      Mm-hmm.

   7. PAPeter Attia35:32

      Um, why don't, why don't we, why don't we have folks-

   8. AHAnthony Hipolito35:35

      Yeah

   9. PAPeter Attia35:35

      ... watch that now?

   10. AHAnthony Hipolito35:36

       Yeah, for sure.

   11. PAPeter Attia35:36

       Let, let's, let's put that on.

   12. AHAnthony Hipolito35:37

       Yep.

   13. PAPeter Attia39:26

       So again, Anthony, you know, this is, these are hard videos to watch, but I don't think we're gonna shy away from that. I think it's-

   14. AHAnthony Hipolito39:31

       Mm-hmm

   15. PAPeter Attia39:31

       ... um, I think it is important that-

   16. AHAnthony Hipolito39:33

       Mm-hmm

   17. PAPeter Attia39:33

       ... people understand how-

   18. AHAnthony Hipolito39:34

       Mm-hmm

   19. PAPeter Attia39:34

       ... uncomfortable this is. Um, there's probably a lot of mixed emotions that are going on around the person who stops breathing.

   20. AHAnthony Hipolito39:44

       Mm-hmm.

   21. PAPeter Attia39:44

       On the one level, there's the obvious fear and panic and-

   22. AHAnthony Hipolito39:48

       Mm-hmm

   23. PAPeter Attia39:48

       ... oh my God, what is happening?

   24. AHAnthony Hipolito39:49

       Mm-hmm.

   25. PAPeter Attia39:50

       On the other level, do you, i- is there some sense that you get from talking to people who have been there that there's a hesitation to call police or paramedics-

   26. AHAnthony Hipolito40:00

       Mm-hmm

   27. PAPeter Attia40:00

       ... for fear of, uh, reprimand because, hey, we're, we're obviously doing something wrong here?

   28. AHAnthony Hipolito40:06

       Yeah, yeah. No, I, I think that in, in this particular video, um, the passenger that didn't, wa- wasn't getting poisoned, I, I think it was several, third, 20, 25 minutes, I believe, before he even called 911 and I think that's specifically attributed to not wanting to get in trouble and not believing, um, his friend is dead, right? So, um, I think that's the big, um,

8. 40:28 – 47:16

   Whether laws around drug possession are helping or hurting, and the need to focus on helping people that feel the need to take these counterfeit drugs

   1. AHAnthony Hipolito40:28

      I think that's the big-

   2. PAPeter Attia40:28

      What, what, what is the law with regard to that? I, h- how clear is the law on prosecution of people who are, you know... I- i- let's just say someone calls the police immediately, calls the paramedics, everybody shows up.

   3. AHAnthony Hipolito40:41

      Mm-hmm.

   4. PAPeter Attia40:41

      Are they gonna be prosecuted for, uh, for, for, for drug use?

   5. AHAnthony Hipolito40:46

      Um, for, well, if, if they're in possession of it?

   6. PAPeter Attia40:48

      Yeah.

   7. AHAnthony Hipolito40:49

      If they-

   8. PAPeter Attia40:49

      Let's say they are

   9. AHAnthony Hipolito40:49

      ... so if they are in possession of it, yes. Um, we had a young man who overdosed on one of our high school campuses that had, um, I wanna say three or four illicit counterfeit Percocet pills on him at the time he pretty much died in class. Um, and I think that's still in criminal proceedings, so they're, yes, if you're in possession of it, um, obviously we wanna save your life and we'll deal with the criminal part later. Um, but when you're in possession of it, yes, you're, you're more than likely gonna get charged.

   10. PAPeter Attia41:20

       I know this is beyond both of our pay grades, but I wonder if that's, you know, is that the right solution to the problem-

   11. AHAnthony Hipolito41:28

       Mm-hmm

   12. PAPeter Attia41:28

       ... in that situation?

   13. AHAnthony Hipolito41:29

       Mm-hmm.

   14. PAPeter Attia41:29

       Um, I don't know if you heard this. I just read it this morning. Um, British Columbia being the latest, you know, example of, you know, at least in this case, a province or a state-

   15. AHAnthony Hipolito41:39

       Mm-hmm

   16. PAPeter Attia41:39

       ... is decriminalizing-

   17. AHAnthony Hipolito41:41

       Mm-hmm

   18. PAPeter Attia41:41

       ... from, from a personal possession standpoint any drug.

   19. AHAnthony Hipolito41:44

       Mm-hmm.

   20. PAPeter Attia41:44

       So this is gonna be their attempt-

   21. AHAnthony Hipolito41:46

       Mm-hmm

   22. PAPeter Attia41:46

       ... to say how are we gonna address this problem? Now, I, it's not entirely clear to me how that fixes the problem.

   23. AHAnthony Hipolito41:51

       Mm-hmm.

   24. PAPeter Attia41:52

       I can see scenarios where it makes things better.

   25. AHAnthony Hipolito41:54

       Mm-hmm.

   26. PAPeter Attia41:54

       For example, it would presumably reduce any friction to someone calling for help the moment someone is down.

   27. AHAnthony Hipolito42:01

       Mm-hmm.

   28. PAPeter Attia42:02

       'Cause you now don't have to fear that you're gonna be prosecuted. [lip smack] But I don't know, what are, what are your thoughts on that? I mean, do you... If you go back to the case of that kid, right?

   29. AHAnthony Hipolito42:11

       Mm-hmm.

   30. PAPeter Attia42:11

       Who basically died in class.
9. 47:16 – 52:21

   How fentanyl is being added to all kinds of drugs that you wouldn’t expect

   1. PAPeter Attia47:16

      about that 'cause I think that's sort of why we're sitting down here today, right?

   2. AHAnthony Hipolito47:19

      Sure.

   3. PAPeter Attia47:19

      Which is w- what... You know, I think, uh, uh, one of the things that moved us about kinda your presentation was just how much you were putting of yourself into this, like how much you're going around-

   4. AHAnthony Hipolito47:30

      Mm-hmm

   5. PAPeter Attia47:30

      ... you know, just talking to random parents like us, going to school meetings-

   6. AHAnthony Hipolito47:34

      Mm-hmm

   7. PAPeter Attia47:34

      ... doing all this kinda stuff. Um, but it's, it's... So much of what you talked about blew my mind. I wanna get to a few more of those things before-

   8. AHAnthony Hipolito47:42

      Mm-hmm

   9. PAPeter Attia47:42

      ... I come to the nuts and bolts of it.

   10. AHAnthony Hipolito47:44

       Sure.

   11. PAPeter Attia47:44

       I have a lot of technical questions about Narcan and-

   12. AHAnthony Hipolito47:47

       Yeah

   13. PAPeter Attia47:47

       ... all that kind of stuff, but, um, I've been hearing some other really frightening things.

   14. AHAnthony Hipolito47:52

       Mm-hmm.

   15. PAPeter Attia47:52

       So talked to a friend, um, I don't know, couple weeks ago I was talking to a friend of mine who goes to Burning Man every year.

   16. AHAnthony Hipolito47:58

       Mm-hmm.

   17. PAPeter Attia47:59

       As you know, Burning Man's a place where a lot of drugs get done.

   18. AHAnthony Hipolito48:01

       Mm-hmm.

   19. PAPeter Attia48:02

       And he said, and maybe, may- maybe I heard him wrong or maybe he got his facts wrong, so maybe someone listening to this will, will correct this. But he said that at Burning Man, there were at least two deaths attributed to fentanyl in drugs that normally would never have fentanyl in them.

   20. AHAnthony Hipolito48:18

       Mm-hmm.

   21. PAPeter Attia48:19

       One was cocaine and one was ketamine. Ketamine of all things. Ketamine is a perfectly legal drug. Now, probably was being used, you know, off-label so to speak, but clearly this was a person who was using, you know, counterfeit ketamine.

   22. AHAnthony Hipolito48:36

       Mm-hmm.

   23. PAPeter Attia48:36

       What other, what is the breadth of drugs that you're seeing this? So we've already established it's going into every single counterfeit pill-

   24. AHAnthony Hipolito48:43

       Mm-hmm

   25. PAPeter Attia48:43

       ... out there potentially.

   26. AHAnthony Hipolito48:44

       Mm-hmm. Mm-hmm.

   27. PAPeter Attia48:45

       So that's gonna be all of your pain meds-

   28. AHAnthony Hipolito48:47

       Mm-hmm

   29. PAPeter Attia48:47

       ... of which I'm guessing Percocet, Oxycodone, OxyContin, Dilaudid are your big boys.

   30. AHAnthony Hipolito48:53

       Correct.
10. 52:21 – 56:15

    What can we do as parents?

    1. PAPeter Attia52:21

       So let's, um, let's talk to, uh, I, I would guess that the majority of people listening to this podcast-

    2. AHAnthony Hipolito52:27

       Mm-hmm

    3. PAPeter Attia52:27

       ... um, are parents. That's, that's kind of the demographic I'm, I'm... Or they're gonna share it with someone who's a parent, right?

    4. AHAnthony Hipolito52:34

       Sure.

    5. PAPeter Attia52:34

       I gotta be honest with you. I don't think there's a 13-year-old listening to us right now.

    6. AHAnthony Hipolito52:37

       Sure. [laughs]

    7. PAPeter Attia52:37

       I don't think there's a 19-year-old listening to us.

    8. AHAnthony Hipolito52:38

       They don't like listening to cops either. [laughs]

    9. PAPeter Attia52:39

       Yeah, yeah. But there are a lot of parents listening to us.

    10. AHAnthony Hipolito52:42

        Mm-hmm.

    11. PAPeter Attia52:42

        [lip smack] So what can we do? So let's start with, you're just talking to me and my wife.

    12. AHAnthony Hipolito52:48

        Mm-hmm.

    13. PAPeter Attia52:48

        Okay? We've got a 14-year-old daughter-

    14. AHAnthony Hipolito52:50

        Mm-hmm

    15. PAPeter Attia52:50

        ... 8-year-old, and a five-year-old boy.

    16. AHAnthony Hipolito52:53

        Yep. So that's one of the reasons I'm pretty passionate about it. I've got kids, right? I got, I got a freshman in high school and a senior in high school. Um, and I see, I've seen firsthand how it's affected my community. Um, but as parents, we have to be nosy, right? We, we, we have to take off the blinders, and we have to say, we have to stop saying, "My kid won't do this."

    17. PAPeter Attia53:12

        Yep.

    18. AHAnthony Hipolito53:13

        Um, and we-

    19. PAPeter Attia53:13

        How, how many of the parents, Anthony, that you've met who have lost a child were so shocked that it, it was, "I never even knew this was happening," versus I'm sure there are some cases where, "My son has struggled with drugs his whole life."

    20. AHAnthony Hipolito53:31

        Yeah.

    21. PAPeter Attia53:31

        How many are in that former category, where they literally are dealing with two complete shocks-

    22. AHAnthony Hipolito53:38

        Yep

    23. PAPeter Attia53:39

        ... the loss of their child-

    24. AHAnthony Hipolito53:40

        Mm-hmm

    25. PAPeter Attia53:40

        ... and the fact that they had no idea their child was in need or in use of this? How-

    26. AHAnthony Hipolito53:44

        Yeah, no-

    27. PAPeter Attia53:44

        How often is it the la- that case?

    28. AHAnthony Hipolito53:46

        You hear it a lot. Um, I don't have an exact percentage, but you, you, you hear it a lot. And it, it may not be because they, they don't know. It's that they d- they, they, they refuse to believe it, right? Um, and I get it. Um, and it goes back to the stigma. Like, I don't, I don't... I'm embarrassed if my kids are doing drugs, or I'm embar- I'm embarrassed if my kid's a druggie. So I, I, I stress the stigma. Like, we, we have to stop with the stigma, the stop with the judging, and we have to work together as a community to, to get this a- as low as possible. We're not gonna get rid of it. But if we can, if we can move, move the, you know, move it around a little bit, then we're doing what we can. Um, but yeah, I hear, I hear it too much, right? And as a parent, I c- I, I catch myself sometimes, uh, like, "My k- no, not my kid," right? Um, but I have to remind myself, because I see it so often, like, it could be my kid, right? So, um, social medias, if y- my k- both my kids have phones. They, they have social media. Um, actually, my freshman no longer has social media. Um, but you have to be nosy. You have-

    29. PAPeter Attia54:52

        How do you do... Like, so, so luckily my 14-year-old's not on social media.

    30. AHAnthony Hipolito54:56

        Mm-hmm.
11. 56:15 – 1:03:44

    Narcan: a treatment for opioid overdoses

    1. PAPeter Attia56:17

       Um, tell, tell us about Narcan.

    2. AHAnthony Hipolito56:18

       Mm.

    3. PAPeter Attia56:18

       So, you know, we used to use Narcan in the hospital.

    4. AHAnthony Hipolito56:21

       Mm-hmm.

    5. PAPeter Attia56:22

       Um, mostly the use was at the end of surgery.

    6. AHAnthony Hipolito56:26

       Mm-hmm.

    7. PAPeter Attia56:26

       If a patient needs to be brought back and you mistimed the opioid dose, you know, you would use it. But sometimes you would, you know, a lot of times you'd use it in the situation I described earlier, which is, um, oh, you accidentally gave that person, you know, 120 or 125 micrograms of fentanyl-

    8. AHAnthony Hipolito56:42

       Mm

    9. PAPeter Attia56:42

       ... but in reality, that was a bit too much for them.

    10. AHAnthony Hipolito56:44

        Right.

    11. PAPeter Attia56:44

        Their breathing rate is slowing. We gotta back that off.

    12. AHAnthony Hipolito56:46

        Mm-hmm.

    13. PAPeter Attia56:47

        Um, I've already forgotten how long Narcan lasts for, but what, what is the approximate... Like, if you, if, if a kid is down-

    14. AHAnthony Hipolito56:55

        Mm-hmm

    15. PAPeter Attia56:55

        ... and you give them Narcan, are they out of the woods?

    16. AHAnthony Hipolito56:59

        No.

    17. PAPeter Attia56:59

        Or is there a chance that the drug, they have so much drug in them that even though they start breathing again, they're gonna crash?

    18. AHAnthony Hipolito57:06

        Yeah, that's, that's one of the things we, we, we try to talk about, um, because kids have started going out and buying Narcan and carrying it with them and saying, "Hey, I'm, I'm gonna pop this pill. Can... Ho- talking-

    19. PAPeter Attia57:17

        "Hold my Narcan."

    20. AHAnthony Hipolito57:17

        ... to my friend, 'Hold my Narcan. I'm gonna snort this pill. If I fall out, can you please shoot me up?" Um, what they're not know- what, what they really don't understand is this, this fentanyl is so powerful. It's not one, one injection of Narcan or one nasal spray of Narcan is not helping because it's so fast-acting. And it, there, I don't think there's a set time because everybody's different, right? Everybody, you know, is, is built differently, metabolism different. Um, so there's not a set, there's not a set time. I try to explain that in my presentation as well. But if you can, the quicker you get Narcan into that person's system, the better chance they have to live, right? So, but what we're seeing in a lot of these overdoses and poisonings throughout Hays County is one, one injection's not working. We had a kid two weeks ago that took 15 doses of Narcan.

    21. PAPeter Attia58:03

        15-

    22. AHAnthony Hipolito58:03

        15

    23. PAPeter Attia58:04

        ... doses-

    24. AHAnthony Hipolito58:04

        Yes

    25. PAPeter Attia58:05

        ... in the field.

    26. AHAnthony Hipolito58:06

        In the field before they were

    27. PAPeter Attia58:08

        And, and just to play ignorant, I'm sorry.

    28. AHAnthony Hipolito58:10

        Mm-hmm.

    29. PAPeter Attia58:10

        The paramedics are not yet there, or they're g- they're there, but they don't wanna intubate yet.

    30. AHAnthony Hipolito58:14

        Correct. Paramedics are there. Um-
12. 1:03:44 – 1:13:21

    Importance of awareness, having conversations with kids early in life, and other key takeaways for parents

    1. AHAnthony Hipolito1:03:44

       Yeah.

    2. PAPeter Attia1:03:44

       Um, Anthony, anything else parents can be thinking about here to, uh... 'Cause I, I have to be honest with you. There's a part of me that's... And maybe this is just the, the skeptic in me that's thinking, "Wait, Peter, don't overreact to this. Don't freak out. Don't..." You know, 'cause I mean, I mean, of course you can believe it. I had a discussion with our eight-year-old.

    3. AHAnthony Hipolito1:04:03

       Mm-hmm.

    4. PAPeter Attia1:04:04

       Right? And I'm like, "Okay, Reese, if anybody ever gives you candy at school, unless it's in the wrapper, you don't eat it." You know, I'm going down the path of, I don't know how... You're, you... I don't know if you're as old as I am, Anthony, but I don't know. How old are you?

    5. AHAnthony Hipolito1:04:16

       47.

    6. PAPeter Attia1:04:16

       Yeah. See, I'm older than you, but I bet you still remember. When we were kids, do you remember all the panic about app- g- never eat an apple at Halloween?

    7. AHAnthony Hipolito1:04:25

       100%.

    8. PAPeter Attia1:04:25

       'Cause of razor blades in it.

    9. AHAnthony Hipolito1:04:26

       I, I, yep, I talk about that in my presentation.

    10. PAPeter Attia1:04:28

        Oh, [chuckles] yeah.

    11. AHAnthony Hipolito1:04:29

        Because of the, the candy fentanyl.

    12. PAPeter Attia1:04:30

        Yeah.

    13. AHAnthony Hipolito1:04:30

        Right? It was, uh, just e- right before Halloween I would get the question all the time at every presentation: "Should I let my kids go trick-or-treating?" Or, "Can I go trick-or-treating?" And what I told them is like, "Your neighbor's not trying to poison you. Go out and have a good time. Let your g- kid go trick-or-treating." But then I referenced the '80s when I was trick-or-treating.

    14. PAPeter Attia1:04:46

        Yeah.

    15. AHAnthony Hipolito1:04:46

        I had to come home and dump it out because of the razor blades and stuff that was being-

    16. PAPeter Attia1:04:49

        The razor blade, yeah.

    17. AHAnthony Hipolito1:04:50

        Yeah. But yeah.

    18. PAPeter Attia1:04:50

        Right. So, so you grew up in Texas. I grew up in Canada. It's amazing to think that everybody was putting razor blades in apples apparently across the globe, right?

    19. AHAnthony Hipolito1:04:57

        [chuckles] Yeah.

    20. PAPeter Attia1:04:57

        It, it probably happened three times, right?

    21. AHAnthony Hipolito1:04:59

        Yeah. Yep.

    22. PAPeter Attia1:04:59

        And yet it somehow created a moral panic.

    23. AHAnthony Hipolito1:05:01

        Mm-hmm.

    24. PAPeter Attia1:05:02

        And I think that... I, I, I guess I think about this sometimes, right? Is where, where is the line here? And, um, I think when I look at these stats, it's hard to say this is a moral panic, right? Like, w-when you think of other examples of moral panics, things that were... W-like, what was the most comm- what was... There was a very prominent one, right? Which was, um, like all the Satanic, uh, cults that were, like, killing babies all over the place.

    25. AHAnthony Hipolito1:05:28

        Yes.

    26. PAPeter Attia1:05:28

        Remember that whole thing?

    27. AHAnthony Hipolito1:05:28

        Yes.

    28. PAPeter Attia1:05:28

        That was kind of another '80s weird thing.

    29. AHAnthony Hipolito1:05:30

        Correct. Yeah.

    30. PAPeter Attia1:05:30

        Along with... Turned out not to even be the case.

Episode duration: 1:13:27