Clara Fleiz

The epicenter of fentanyl use in Mexico has been in Tijuana and Mexicali, two cities on the U.S. border characterized by drug use (Rafful et al., 2015; Goodman-Meza et al., 2022). In recent years, these cities have seen the largest seizures of fentanyl in the country (Comisión Nacional de Salud Mental y Adicciones, 2024a) as well as the exponential growth of its use and that of other adulterants such as xylazine.

Introduction. The use of medical marijuana was legalized in Mexico in 2017. In June 2021, the Supreme Court authorized personal marijuana use, as well as its planting, cultivation, harvest, preparation, possession, and transportation for recreational purposes by persons aged 18 and over, decriminalizing its use. Objectives. 1) To determine which variables are associated with favorable opinions regarding medical use, recreational use, and the legalization of marijuana use; and 2) to determine whether there are differences in the variables that best predict support for medicinal and recreational use and legalization of marijuana among marijuana users and non-users. Method. Data are drawn from the 2016 National Survey on Drug, Alcohol, and Tobacco Use, administered to a nationally representative sample of Mexican households. A validated questionnaire was used with questions on demographic characteristics, marijuana use (including the number of times it has been used), respondents’ opinions regarding the legalization of marijuana and recreational use, whether they have been offered marijuana without having to pay for it, perception of risk associated with marijuana use, and excessive alcohol consumption. Results. Being male and having a low perception of the risks of marijuana use are the variables mostly strongly associated with approving medical and recreational use and its legalization, irrespective of whether respondents used it. Other variables associated with approval are age, educational attainment, and income level. Discussion and Conclusion. Legislators and policy makers should consider the full range of public opinion concerning the use and legalization of marijuana and incorporate it into their proposals.

Background: Substance use disorders are among the most stigmatized conditions worldwide. People with substance use disorder (PWSUD) are often considered responsible for their use of drugs. The objectives are to analyze changes in Mexican attitudes toward PWSUD in the general population over the period 2011 to 2016 and to use the latest Mexican household survey to determine which segments of the population are most likely to have negative attitudes. Methods: Two representative national household surveys employing similar methodologies were conducted in Mexico in 2011 and 2016 with persons aged 12–65 years. Participants were asked about their attitudes toward PWSUD, and changes were compared across GLM. Results: The surveys found a decrease from 2011 to 2016 in the number of respondents who considered PWSUD “sick” or in “need of help” and an increase in the number who believed they were “selfish” or “criminal”. The 2016 survey found that men, people 18 years of age or older, people who do not use drugs and people with lower educational levels were the groups with the most negative attitudes toward PWSUD. Conclusions: These results suggest that it may not be recognized that PWSUD may have a health problem and that this helps to increase stigmatization towards this population.

Background and Aims: In Latin America, Mexico was first to launch a hepatitis C virus (HCV) elimination strategy, where people who inject drugs (PWID) are a main risk group for transmission. In Tijuana, HCV seroprevalence among PWID is > 90%, with minimal harm reduction (HR). We evaluated cost‐effectiveness of strategies to achieve the incidence elimination target among PWID in Tijuana. Methods: Modeling study using a dynamic, cost‐effectiveness model of HCV transmission and progression among active and former PWID in Tijuana, to assess the cost‐effectiveness of incidence elimination strategies from a health‐care provider perspective. The model incorporated PWID transitions between HR stages (no HR, only opioid agonist therapy, only high coverage needle–syringe programs, both). Four strategies that could achieve the incidence target (80% reduction by 2030) were compared with the status quo (no intervention). The strategies incorporated the number of direct‐acting anti‐viral (DAA) treatments required with: (1) no HR scale‐up, (2) HR scale‐up from 2019 to 20% coverage among PWID, (3) HR to 40% coverage and (4) HR to 50% coverage. Costs (2019 US$) and health outcomes [disability‐adjusted life years (DALYs)] were discounted 3% per year. Mean incremental cost‐effectiveness ratios (ICER, $/DALY averted) were compared with one‐time per capita gross domestic product (GDP) ($9698 in 2019) and purchasing power parity‐adjusted per capita GDP ($4842–13 557) willingness‐to‐pay (WTP) thresholds. Results: DAAs alone were the least costly elimination strategy [$173 million, 95% confidence interval (CI) = 126–238 million], but accrued fewer health benefits compared with strategies with HR. DAAs + 50% HR coverage among PWID averted the most DALYs but cost $265 million, 95% CI = 210–335 million). The optimal strategy was DAAs + 50% HR (ICER $6743/DALY averted compared to DAAs only) under the one‐time per‐capita GDP WTP ($9698). Conclusions: A combination of high‐coverage harm reduction and hepatitis C virus treatment is the optimal cost‐effective strategy to achieve the HCV incidence elimination goal in Mexico.

Background and Aims: Results from a recent study among 750 heroin users in three Mexico's northern border cities revealed an increase in white powder availability (also known as China white) and preference for this product among heroin users, as well as a general perception of increased overdose cases among this population. Here, we questioned whether those findings reflect an increased presence of heroin laced with fentanyl, which is associated with greater risks of overdose but that, until now, has not been described in Mexico.Design: We tested fentanyl using highly sensitive test strips in syringe plungers, metal cookers and drug wrappings associated with heroin use.Setting: Three injection sites in Tijuana, Baja California, México.Participants: Eighty‐nine heroin users who interchanged paraphernalia for new syringes.Measurements: We tested 59 residues of ‘pure’ white powder. The rest were white powder with black tar (n = 5) or white powder with crystal meth (n = 9), black tar with crystal meth (n = 1), black tar only (n = 13) and crystal meth only (n = 2).Findings: Users believed that they consumed either white powder heroin, white powder heroin with crystal meth, white powder with black tar heroin or black tar heroin only. Analyses revealed that 93% (n = 55) of the ‘pure’ white powder samples had fentanyl. All (n = 9) the white powder samples mixed with crystal meth and 40% (n = 2) of the white powder with black tar were also laced with fentanyl.Conclusions: In a sample of 89 heroin users in Mexico, most white powder heroin users were unknowingly exposed to fentanyl, with fentanyl detected in 93% of white powder samples.

Introduction. Mexico northern border has high levels of heroin use. For more than 10 years, the country has implemented several harm reduction interventions to reduce the risks associated with drug use. New strategies such as Safe Consumption Sites (SCS) must be considered as a next step to service vulnerable populations and increase their health outcomes. Objective. This report seeks to measure and compare attitudes on a potential SCS intervention in Tijuana among police and people with lived experience (PLE) in heroin use in the city. Method. Two parallel studies on police practices and everyday experiences of heroin users in Tijuana were able to ask similar questions about attitudes toward SCS and its implementation in the city. They conducted quantitative interviews with 771 active police officers and 200 PLE while in rehabilitation services. Results. Both groups showed a high personal support for SCS of nearly 82% and a perceived implementation success around 80%. Officers reported 58.9% peer support for SCS while PLE 79%. Around 76% of both groups agreed that a SCS would help to improve their personal health. Finally, 86.2% of the officers would refer people to a SCS while 62.5% of PLE would use the service. Discussion and conclusions. The strong positive attitudes from police officers and PLE towards SCS in the city of Tijuana reported in both studies indicate the possibility of a successful implementation of a SCS. This intervention would represent an innovative way to protect PLE from police harassment and victimization, helping reduce HIV and HCV risk behaviors while improving community health.

Objectives: This study analyses changes in drug use in Mexican junior high and high-school students and identifies differences over two decades in the social factors (availability of drugs, perceptions of risk and social tolerance) associated with such use. Method: Data from two national surveys, conducted in 1991 and 2014, were analysed. Results: Data show that the proportion of students who had tried drugs doubled in 2014. In both surveys, substance use was significantly associated with a high perception of availability and use by friends and older siblings; in 2014, there was a decrease in the perception of risk for marijuana use and an increase in social tolerance toward illegal drugs. Conclusions: It can be inferred from this analysis that public policy to prevent drug use has not had the expected impact, at least not on the social factors considered here.

Half of mental disorders have their first onset before adulthood when the presence of a disorder may be particularly disruptive to developmental milestones. Retrospective prevalence estimates have been shown to underestimate the burden of mental illness and scarce data are available on the incidence of disorders throughout the adolescent period, especially in developing countries. Thus, the objective was to determine the incidence of mental disorders in an 8-year period from adolescence to young adulthood, onset of service use and their predictors in a Mexican cohort. 1071 respondents from a representative two-wave panel sample participated in the Mexican Adolescent Mental Health Survey in 2005 and in the follow-up survey in 2013. Disorders were evaluated with the World Mental Health Composite International Diagnostic Interview. 37.9 % experienced the onset of a psychiatric disorder and 28.4 % sought services for the first time. Substance use disorders had the greatest incidence, followed by mood and behavior disorders, anxiety disorders and lastly eating disorders. Sex, age, school dropout, childhood adversities and prior mental disorders predicted the onset of new disorders. Being female, having more educated parents and most classes of disorder predicted first time service use. These findings contribute to a paradigm shift in conceptions of mental disorder similar to how we think of common physical afflictions as near universal experiences across the life course, but less frequent at any given moment. Adolescents are particularly vulnerable. Therefore, public health policy should focus on early universal promotion of positive mental health and structural determinants of mental health.

We examined Mexican migrants’ perceived barriers to entering substance abuse treatment and potential differences by gender.