John Morales, Author at PPM Healthcare

January 3, 2023

A Dietitian’s Flavor-Forward Meal Plan for 2023

What if, this January, you ignored all the voices telling you what you “should be” and instead focused on finding the healthful habits that feel right for *you*? With ReNew Year, the only thing we’re detoxing from is a restrictive mindset. Pick a goal—movement, food, self care, or all three—and hit refresh. Get the Program

I’ve heard it so many times: New Year, New You. As a trained nutrition professional and cookbook author who works with individuals from diverse backgrounds, I have learned that dominant Western social norms have taught us to believe that come January 1st, we are expected to attempt to transform ourselves into a whole new person—crash dieting and exercising with extreme fervor included. Toxic diet culture has an unfortunate tendency to praise individuals for engaging in restriction and shame those who choose to nourish and rest their bodies. No longer. This year, we’re encouraging you to take it easy and hone in on healthy habits that you can live with for an entire trip around the sun—and beyond.

Before we jump into Well+Good’s annual ReNew Year food program, allow me to introduce myself. I’m Maya Feller, RD, a registered dietitian nutritionist, on-air food and nutrition expert, and author. I am the founder of Maya Feller Nutrition, a private nutrition practice based in Brooklyn, New York, that offers nutrition counseling and wellness coaching from a patient-centered, anti-bias approach to provide culturally-relevant, evidence-based care.

To help you kick your year off feeling energized, balanced, and well-fed, I’ll be sharing some of my key nutrition pillars, customizable tips for cooking and shopping, and deliciously nourishing recipes with you daily throughout the month of January. Over the course of the next four weeks, we’ll take a gentler and more sustainable approach to your new year together. This approach aims to celebrate you, the individual, in all of your glory, respect your heritage and culture, encourage gratitude, and, most importantly, ask you to prioritize the culturally-relevant foods and routines that can be added to your nutrition and wellness routine.

I also want to challenge you to reframe how you think about and define what foods are “good” for you. There are many healthy foods that are not kale, brown rice, and grilled protein. In fact, many of the foods outside of the Western “wellness” scope come from countries and cultures that have historically been marginalized. It’s time to branch out and expand what’s showing up on your plate.

In my upcoming cookbook, Eating From Our Roots (out January 24), I ask readers to shed the negative and harmful social norms around food and nutrition while encouraging them to spend time in the kitchen creating nourishing, nutrient-dense dishes. No more restriction or feeling like you aren’t part of the nutrition elite; no more shame for enjoying foods that haven’t been crowned with a health halo. There is space to include a variety of grains, starchy and non-starchy vegetables, fruits, proteins (yes, both plant- and animal-based), herbs, spices, and so much more in your pattern of eating.

This month, together, we will celebrate flavor! I will encourage you to make mindful and intentional choices about food based on what is accessible to you. You’ll have the opportunity to explore all parts of the grocery store as well as farmer’s markets when available. Additionally, I’ll help you make culturally-relevant food choices that are free of shame or guilt—all while reminding you that you deserve to be well-nourished and satisfied.

Ready to get started? Let’s jump in.

Day 1: Get your kitchen equipment arsenal ready

The many delicious dishes you’ll be making this month require a well-equipped kitchen. Having a reliable supply of basic kitchen gadgets on hand—including pots, pans, sharp knives, cutting boards, and storage containers—and keeping them well-organized will make it so much easier to prepare and serve homemade meals.

Start by surveying your pots and pans. Do you see any rusty spots or places where the surface is peeling? If so, you might need a replacement. (Pro tip: Cast iron pots and pans are brilliant when it comes to longevity; they work on the stovetop as well as the oven and they last a lifetime if well-maintained.) Find a chef’s go-to guide for what pieces of cookware every kitchen needs here.

Next, check your knives—sharp knives are a must, especially when it comes to slicing and dicing fresh produce safely and efficiently. If your knives are not sharp, it is time to invest in a sharpening tool.

A few good cutting boards of varying sizes are always good to have at home, too. And lastly, reusable storage containers allow you to meal-prep dishes ahead of time and safely keep them in the fridge or freezer for later use.

Day 2: Conduct a pantry audit—and consider adding a few new nutritious staples

Now that your kitchen tools are stocked and ready for use, we can focus on your pantry. If you ask me, a well-stocked pantry can save a meal; it can take it from lackluster to spectacular. You don’t need to have an abundance of items, though—it’s all about the curation of ingredients you keep on hand.

Just as you did with your kitchen tools, take stock of what dry and canned goods you already own before buying anything new. See a can of tomato sauce from the ‘90s? Toss it. Discover an unopened, still-fresh jar of chicken broth? Don’t buy a new one this week. Get in the habit of surveying your pantry, fridge, and freezer before you go grocery shopping to cut down on food cost and waste.

Now, onto the fun part—what I recommend adding to your pantry for flavorful, nutritious, and fuss-free meals. Consider stocking up on these options:

Grains: Fonio, black rice
Beans: Low-sodium canned beans (if you can’t find low-sodium beans, rinse your beans to reduce the sodium content) and dried beans
Tinned fish: SMASH fish (this stands for sardines, mackerel, anchovies, salmon, and herring; each of these options contains high amounts of brain-boosting omega-3 fatty acids) and sustainably-caught tuna (look for an MSC certification on the label)
Nuts and seeds: No nuts or seeds are off limits; choose the ones that are culturally relevant to you
Jarred tomatoes
Oils: Plant-based oils are excellent for cooking and finishing; choose the options that fit within your flavor profile and budget. Pumpkin seed oil is one of my personal favorites—it’s an excellent finishing oil and tastes delicious on everything from yogurt to roasted vegetables
Dried herbs: These can add major flavor without being costly. Look for dried herbs that don’t contain added sodium (and season on your own if you want to dial up the saltiness)

Day 3: Identify realistic, attainable health and nutrition goals that work for your body and lifestyle

Now that your kitchen is ready for action, I recommend level-setting with yourself by setting intentions for the weeks ahead. When identifying and setting a health goal, I like to remind my patients that it should be realistic and attainable. So rather than trying to turn back the clock or striving for something insurmountable, let’s work from the “now.”

In my practice, I often work with people who are at risk of developing (or have already developed) a chronic condition. I remind these patients that while a cure or reversal of their diagnosis may be possible, in the event that isn’t, living with a well-managed diagnosis is.

I encourage you to think about your current health situation. Do you have any diagnoses or pre-diagnoses that would benefit from nutrition modification, and what are the small steps that you could take to move toward your goal? Would you benefit from having a consistent bedtime, reducing your alcohol intake on the weekends, or finding ways to include pleasurable and intentional movement into your day? Start by jotting down these health goals in a journal, then try brainstorming some ways to make progress on them that fit within your current lifestyle.

Day 4: Study the most common food label claims to be a savvier shopper

You can’t accomplish your goals without the proper tools, right? We already tackled the kitchen—now we’re diving into the task of understanding food label claims. Because let’s be honest: Grocery shopping has become increasingly complicated. Front-of-box labels on packages make so many claims, and they may or may not actually be relevant to consumers. In order to be a savvy shopper, it’s important to be able to parse out the important information from the superfluous claims. Ultimately, you will need to decide what is valuable to you. Below are some common claims and their current definitions.

Organic (as defined by the USDA):

Produce: “Produce can be called organic if it’s certified to have grown on soil that had no prohibited substances applied for three years prior to harvest. Prohibited substances include most synthetic fertilizers and pesticides.”
Animal proteins: “Regulations require that animals are raised in living conditions accommodating their natural behaviors (like the ability to graze on pasture), fed 100 percent organic feed and forage, and not administered antibiotics or hormones.”
Packaged and multi-ingredient foods: “Regulations prohibit organically processed foods from containing artificial preservatives, colors, or flavors and require that their ingredients are organic, with some minor exceptions.”

Non-GMO Project Verified (as defined by Non-GMO Project): “The Non-GMO Project Verified mark assures consumers that the product bearing the label has been evaluated for compliance with the Non-GMO Standard. The verification mark does not state that a product is ‘GMO Free,’ and it does not state that the product is safer, better, or healthier. It simply states the product is compliant with the Non-GMO Project Standard.”

Regenerative agriculture (as defined by California State University Chico Center for Regenerative Agriculture and Resilient Systems): “Regenerative Agriculture is an approach to farm and ranch management that aims to reverse climate change through practices that restore degraded soils. By rebuilding soil organic matter and soil biodiversity, we significantly increase the amount of carbon that can be drawn down from the atmosphere while greatly improving soil fertility and the water cycle.”

Natural (as defined by Consumer Reports): “Has no clear meaning on a majority of foods.”

Pasture raised (as reported by Certified Humane Raised and Handled): “There is currently no legal definition for ‘Free Range’ or ‘Pasture Raised’ in the United States, therefore these terms are often used on poultry packaging with no unilateral definitions for the consumer to trust.”

Grass fed (as defined by the USDA): “Grass (Forage) Fed means that grass and forage shall be the feed source consumed for the lifetime of the ruminant animal, with the exception of milk consumed prior to weaning. The diet shall be derived solely from forage consisting of grass (annual and perennial), forbs (e.g., legumes, Brassica), browse, or cereal grain crops in the vegetative (pre-grain) state. Animals cannot be fed grain or grain byproducts and must have continuous access to pasture during the growing season.”

Day 5: Craft a personalized grocery list that will set you up for success

We’re officially ready to hit the grocery store, which means it’s time to make a shopping list. Because you are your own individual, I encourage you to honor your likes, dislikes, current health status, finances, cooking abilities, culture, and so much more when deciding what foods to put into your grocery cart. For instance, when working with patients, I often speak with them about their favorite foods and the dishes they find most comforting so that we can find ways to incorporate these foods into their weekly grocery lists without guilt or shame.

Your grocery list should include foods that you are comfortable making, ones you enjoy, and familiar items. In addition, I encourage adding a few partially-prepared foods (or chef’s helpers, as I like to call them)—this might include bagged salad greens, pre-chopped vegetables, frozen fruit, marinades, simmer sauces, dips, and spreads.

Next, think through what boxed, jarred, and canned foods you might need this week, as well as fully-prepared items like rotisserie chicken or fresh bread. And don’t forget an assortment of fresh and dry herbs and spices!

Your grocery list should always reflect your current health needs as well as your personal preferences. Follow this template as a starting point:

Sample Grocery List

Fresh produce:
Frozen produce:
Canned goods:
Dry goods:
Boxed and jarred goods:
Fresh herbs and spices:
Dried herbs and spices:
Dairy products:
Meat and/or poultry:
Seafood:
Prepared foods:
Partially-prepared foods:
New-recipe needs:

Day 6: Get to know the whole grocery store

Nutrition providers—myself included—have been shouting the phrase “Shop the perimeter!” (aka the section of the grocery store where fresh fruits and vegetables are typically found) for many years now. But somewhere along the way, we forgot to remind folks that they should also shop the rest of the grocery store, too—not to mention prioritize food choices that support their current and desired health as well as their budget.

Let this be your reminder to explore all of the lovely aisles of your local grocery store. After all, food is expensive, and we need to find creative, nourishing, and delicious ways to stretch our food dollars. Packaged goods are not off-limits. Here are some tips to help you become an informed consumer when shopping for them:

When looking at the Daily Value (DV) percentage on a product’s Nutrition Facts panel for any given nutrient (i.e. carbohydrates, sodium, saturated fat, potassium, vitamin C, and so on), a number hovering around five percent of the DV would be considered low, and a number close to or above 20 percent of the DV would be considered high. So if the fiber content of the packaged goods is listed as 30 percent of the DV, then that would be considered a high-fiber item; if the sodium content is three percent of the DV, then that would be considered a low-sodium item.
Now that we’ve studied up on label claims, we know not to get too caught up on the front of package labeling like “organic” or “gluten-free.” All that tells you is that the product is organic or gluten-free, right? Instead, flip the package over and read the ingredient list. The first five ingredients make up the majority of packaged goods. If the first five ingredients are something that you want to eat (or have heard of), then great! If not, consider moving onto another option that better suits your needs.

Day 7: Make space for expansion and diversity in your diet

You officially have one inspired and important food shopping trip under your belt. Kudos! Today, as you dig into your delicious groceries, give yourself the space to think about what you can add to your diet (rather than remove) as you continue to introduce new ingredients and dishes into your meal rotation. The goal is to start a pattern of eating that includes all the foods you love and keeps you excited about the new flavors and nutrient-rich foods you might be trying—this is a more sustainable method, and therefore likelier to “stick” in the long term.

If your desire is to increase your intake of plant-based foods, expanding the varieties of plants that you consume is an excellent option. For example, leafy greens can mean collards, dandelion and beet greens, chard, taro leaves, and so much more—it’s not just kale, folks. Or, if you want to increase your intake of seafood, exploring smaller, more sustainable types of fish such as sardines and anchovies is a great place to start.

Considering ways to incorporate more diversity, exploration, and flavor into your meals is a pretty wonderful way to round out the first week of the year, no?

January 3, 2023

Paxlovid ‘last drug in the cupboard’ for Covid as variants in Australia evade other treatments | Australia news

The antiviral Paxlovid is the “last drug still left in the cupboard” to address individuals susceptible to intense condition and loss of life from Covid-19, a major virologist suggests.

The information from Associate Prof Stuart Turville is notably regarding provided the variants circulating now are adept at evading antibodies.

Turville, from the Kirby Institute’s immunovirology and pathogenesis software, says monoclonal antibody treatment options are not helpful versus XBF – presently the dominant variant throughout Australia – and BQ.1.1, which is also circulating.

Monoclonal antibody treatment plans are laboratory-designed proteins made to mimic the organic antibodies created by the immune procedure, halting the virus from replicating. The medications, which consist of Sotrovimab and Evusheld, are shipped intravenously.

A new review that Turville co-authored examined the ability of authorised monoclonal antibody therapies to neutralise at present circulating variants – and the treatments fared poorly.

“The absence of neutralisation activity of Evusheld across a lot of rising variants will have to have to be thought of diligently going forward,” the paper uncovered.

“Whilst Sotrovimab managed action across many variants, it missing neutralisation exercise from BQ.1.1 and XBF.”

The paper concluded that “treatment in the period of a variant combine will deliver a lot of troubles and will involve continued monitoring”.

XBF is the variant most evasive to antibodies derived from immunisation antibody remedy and pure infection, Turville stated.

“The drops in antibody binding and potency vary from 12 fold to 50 fold,” he said. “These are incredibly substantial and the largest drops we have found throughout a lot of variants.”

Paxlovid – an oral antiviral treatment that works by hampering a critical enzyme the virus desires to replicate – stays productive towards the variants, the paper identified.

“The very last drug remaining in the cupboard is Paxlovid,” Turville stated. That signifies procedure options are limited.

Turville’s remarks echo those produced by Prof Sharon Lewin, the head of the Doherty Institute, in December. She claimed development on treatment options to protect the most vulnerable would be vital as Australia tackled the virus into 2023.

“We’ve now bought variants that have knocked out a few of the therapies we had for Covid,” Lewin said.

Turville’s paper identified that even though circulating variants appear really productive at evading antibodies in the human body, they do not appear to be improved able to enter cells and infect persons in the to start with location.

It has been identified considering the fact that the emergence of Omicron variants BA.1 and BA.2 that two-dose vaccination is not adequate for fantastic protection and Turville mentioned this was clearer however with the current BR.2.1 and XBF variants.

“For XBF, we also see numerous persons that have 3 vaccine doses but not a fourth dose following 6 months do not have a fantastic [immune] response,” he reported.

These infected in the present-day wave and who have no vaccination or two doses only want to be reviewed to see why they have “fallen through the cracks,” Turville claimed. But, in very good information, the immune reaction in individuals with three or additional doses is solid towards emerging variants, the virologist explained.

General Covid scenario figures diminished in the course of December but there are a about range of fatalities taking place even with obtain to booster doses and Paxlovid. In the 7 days to 30 December, Victoria recorded 69 fatalities, NSW 32 and South Australia 18.

In Victoria, there was a 47.5{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} increase in Covid-relevant fatalities in the month to December 3o when as opposed to the preceding month. Of the 667 Covid-relevant fatalities in Victoria in the earlier 3 months, 44{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} ended up unvaccinated and 50{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} had not gained their 3rd vaccine dose.

According to Victoria’s wellbeing division, about 60{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} of sufferers aged above 70 presenting to emergency departments with Covid ended up undiagnosed till they were being examined in clinic – when it was by now as well late for Paxlovid. The drug desires to be administered inside five days of symptom onset to be effective.

“It is critically essential that individuals with indications keep on to check for Covid-19 and that people who check good, and are qualified for antiviral remedies, get those treatments as shortly as attainable,” the section explained.

Turville mentioned hunting abroad to understand what may well take place in Australia upcoming is critical – but it is also becoming considerably less handy.

“Many are on the lookout abroad to see what is going on, but the problem is the US and Europe, for occasion, do not have our variant combine,” he mentioned.

“In the US they are finding anxious about XBB.1.5. It is spreading rapidly and very evasive to antibodies. But in stressing about XXB.1.5, we fail to see that XBF is incredibly, extremely equivalent to XBB.1.5 and XBF is presently the dominant variant across Australia.”

January 3, 2023

Awareness about women’s health issues stressed

LAHORE: The Put up Graduate Health-related Institute Principal Prof Dr Muhammad Al-Fareed Zafar has stated that New Year 2023 requires to be celebrated as the yr of women’s legal rights and self-reliance so that girls can lead to the economic progress and countrywide prosperity by increasing their own overall health. Additionally, recognition about their overall health and wellbeing would not only minimise the women’s challenges but they would also get equivalent options for remedy and wellbeing treatment.

He expressed these sights when addressing a seminar on the subject matter of Women’s Well being and Self-Reliance at Lahore Common Hospital, in which Prof Faheem Afzal, Dr Misbah Javed, Dr Laila Shafiq, Dr Mehwish Ilyas and Dr Rizwana Tariq also expressed their views. Dr Muhammad Safdar and Dr Abdul Aziz ended up also present in the seminar alongside with young medical practitioners.

Prof Al-Fareed Zafar reported that usually females in the modern society wait to explore their well being challenges specially gynecological illnesses, which results in difficulties for them which are also perilous to their well being. He stated that there is a dire need to have to build self-self-confidence in every single woman relating to gynecological difficulties so that they can get timely clinical suggestions from medical professionals and remedy as properly.

Dr Laila Shafiq and healthcare authorities contributed that women of all ages for the duration of menstruation and being pregnant facial area several difficulties about which which it is vital that moms should give their daughters primary info. Moreover, girls must be informed of the troubles so that they don’t deal with any difficulty.

Principal PGMI and renowned Gynecologist Prof Al-Fareed Zafar mentioned that commonly our females are compelled to get amulet and other suggestions as a substitute of getting their appropriate health-related verify-up completed in scenario of childlessness, whereas they will need the direction of a excellent gynecologist.

He added that the formation of glands and cysts in the uterus and ovaries has develop into a widespread disorder, which not only leads to irregularity in women of all ages, but is also a big cause for not having small children and gals want a professional instead of quack for this intent so it is vital to check with a gynecologist and get cure. He said that girl health professionals/gynecologists also have a good obligation to organise more consciousness meetings to build awareness among the young ladies so that they can acquire treatment of their possess wellbeing in foreseeable future. A issue and remedy session was also held at the end of the seminar and the contributors appreciated the organisation of such seminar on this crucial and sensitive subject matter.

January 3, 2023

Drug Overdoses Are On The Rise On Kauai. Meth Is Still The Main Reason

On Kauai, drug overdose deaths have more than quadrupled in 10 years from fewer than five in 2012 to 18 last year, contributing to an alarming rise in fatal drug use statewide.

Drug overdoses were the second-most common cause of fatal injury on the Garden Isle in 2021 — after suicide and surpassing deaths from drowning, car crashes and falls — and the 10th most common cause of death overall, according to Hawaii Department of Health data.

“It’s getting worse fast,” said Dr. Graham Chelius.

He’s lost count of the number of his Kauai patients who’ve died from a drug overdose on an island grappling with a rise in drug abuse, a suicide problem and a longstanding lack of mental health and drug addiction resources.

A family medicine doctor in Waimea, a town of fewer than 2,000 people, Chelius said he has prescribed medication to alleviate withdrawal symptoms and cravings for opioids to hundreds of patients, including inmates at the Kauai Community Correctional Center.

The county built the $7 facility with taxpayer dollars n 2019. But its doors never opened for the center's intended purpose. — Kauai has been without an inpatient drug and alcohol rehabilitation facility since Hurricane Iniki ripped through the island in 1992. A $7 million adolescent treatment facility was constructed with taxpayer money in 2019 but has never opened. Brittany Lyte/Civil Beat/2022

Medication-assisted treatment is not a miracle antidote to drug dependency, but studies have shown that medications like buprenorphine, also known as Suboxone and Sublocade, substantially reduce the risk of overdose deaths from opioid use and help prevent people from falling off treatment.

Another important tool is naloxone, commonly known by the brand name Narcan. The lifesaving opioid overdose antidote can block the effects of opiates on the brain to restore breathing in someone on the verge of an overdose death.

But no medication has been approved by the Food and Drug Administration for use with methamphetamine, the leading cause of fatal drug overdoses in Hawaii.

Dr. Graham Chelius abortion pill — Dr. Graham Chelius said said drug addiction is a staggering problem on Kauai. Courtesy: Graham Chelius

Although highly addictive opioids kill more people any other drug nationwide, causing nearly two-thirds of the 107,622 drug overdose deaths in the U.S. in 2021, methamphetamine continues to be the deadliest drug in the islands.

“The research for treatment of methamphetamine use is really limited,” said Heather Lusk, executive director of the Hawaii Health & Harm Reduction Center.

On Oahu, fatal overdoses involving methamphetamine outnumbered those involving opioids from 2017 to 2021 by a ratio of more than 3-to-1. On Kauai that ratio is closer to 2-to-1, with meth-related overdoses increasing from zero in 2012 to 14 in both 2020 and 2021.

Most of the 107 drug overdose deaths on Kauai in the decade ending in 2021 were unintentional, except for 20 suicides and five deaths for which the intent could not be determined, according to data analyzed by Daniel Galanis, an epidemiologist at the state Department of Health.

Opioids contributed to about a third of the deaths. Ten of the 11 opioid-related deaths in 2021 involved synthetic opioids, assumed to be fentanyl.

“Substance abuse is often actually a symptom of deeper social problems,” said Life’s Choices Kauai Coordinator Michael Miranda. “I think it’s an indicator of the quality of our education system, the cost of living, the lack of housing. People are self-medicating with illicit substances to cope with all the socioeconomic stressors they are facing.”

The Statewide Picture

Fatal overdoses from all drugs have generally increased in Hawaii over the last five years, although there was a stark decrease in deadly overdoses on Oahu from 210 in 2020 to 163 in 2021.

Heather Lusk press conference homeless count. — Heather Lusk, executive director of Hawaii Health & Harm Reduction Center, said Narcan, the lifesaving opioid overdose antidote, is more readily available than ever in Hawaii. But there is no similar drug to help people battling addiction to methamphetamine. Cory Lum/Civil Beat/2018

It’s unclear why Oahu experienced a drop in overdose deaths last year, but Lusk said one contributing factor may be that in 2021 the brunt of the fentanyl epidemic hadn’t hit Hawaii yet. And at the same time, the availability of life-saving Narcan in Hawaii was on the rise, helping to reverse opioid overdoses at higher rates.

Since August 2016, HHHRC has distributed 40,000 doses of Narcan statewide as the overseer of the state’s Overdose Prevention and Response Program. Half of those doses were distributed this year to opioid addicts, drug treatment counselors, mental health providers, homeless shelter workers, police officers and other people in the community who’ve undergone training.

Opioids are the main driver of drug overdose deaths in the U.S., with fentanyl and other synthetic opioids involved in more than 82{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} of opioid overdose deaths, according to the Centers for Disease Control and Prevention.

Opioid-involved deaths in Hawaii are more likely to be from fentanyl and other illicit synthetic opioids than from legal prescription pills, such as oxycodone.

In Hawaii, fentanyl is typically sold on the street for $15 to $17 a pill, an indicator that the supply is not as plentiful as it is in places like Los Angeles, where a pill sells for about a dollar, according to DEA Hawaii District Office Assistant Special Agent in Charge Victor Vazquez.

“Meth has been the primary choice drug in Hawaii, whereas we’re seeing fentanyl being seized in much larger quantities — up to a million pills at a time — in places like California, Arizona and Texas because it’s coming from the Mexican cartels,” Vazquez said.

“I think the reason we haven’t seen as much fentanyl here in Hawaii is that we’re naturally protected by the ocean from the Mexican border,” he added. “If it’s being driven through the border, it’s not going to be immediately driven into Honolulu or Waikiki Beach.”

When fentanyl does reach Hawaii shores, it arrives primarily through the postal system or commercial airline luggage, Vazquez said.

One pill can be deadly. Across the nation this year the DEA seized over 50 million fentanyl-laced fake prescription pills and 10,800 pounds of fentanyl powder — the equivalent of about 379 million deadly doses.

“That’s enough to wipe out the whole U.S. population,” Vazquez said.

Civil Beat’s health coverage is supported by the Atherton Family Foundation, Swayne Family Fund of Hawaii Community Foundation, Cooke Foundation and Papa Ola Lokahi.