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Official websites use. Share sensitive information only on official, secure websites. Over the past decade, Mexico has experienced a significant increase in trafficking of cocaine and trafficking and production of methamphetamine. Increased availability of these drugs at reduced prices has led to a parallel rise in local drug consumption. Methamphetamine abuse is now the primary reason for seeking drug user treatment in a number of cities, primarily in northwestern Mexico. While cocaine and methamphetamine use have been linked with the sex trade and high risk behaviors such as shooting gallery attendance and unprotected sex in other settings, comparatively little is known about the risk behaviors associated with use of these drugs in Mexico, especially for methamphetamines. We review historical aspects and current trends in cocaine and methamphetamine production, trafficking and consumption in Mexico, with special emphasis on the border cities of Ciudad Juarez and Tijuana. Additionally, we discuss the potential public health consequences of cocaine use and the recent increase in methamphetamine use, especially in regards to the spread of bloodborne and other infections, in an effort to inform appropriate public health interventions. Keywords: cocaine, methamphetamine, injection drug use, bloodborne infections, Mexico. Mexico has been an important transit point along cocaine trafficking routes for decades. However, only recently has Mexico become involved in the refining process and taken a more active role in cocaine trafficking. During the past decade, Mexico has also become an important producer of methamphetamine, which in turn has led to growth of local consumption markets. Other drug user treatment clinics in northwestern states, including Ensenada and Mexicali in the state of Baja California, La Paz in the state of Baja California Sur, and Culiacan in the state of Sinaloa, also cite methamphetamine as the most common problem for those seeking drug user treatment SSA, ; Figure 1. Figure 1 illustrates how methamphetamine use is highest in western states whereas cocaine use predominates in the east Maxwell et al. Pie charts above each of the six Mexican states bordering the U. Below, we describe the role of Mexico as a transit route for cocaine, and its increasingly important role in methamphetamine production and trafficking. We also describe recent trends in the use of these drugs in Mexico, and discuss potential public health implications, given that both have been associated with high risk behaviors such as unprotected sex and binge use in other settings Bruneau et al. Among injection drug users IDUs , cocaine use has been closely linked to needle sharing and attendance at shooting galleries Bruneau et al. Injection of methamphetamine has also been associated with more frequent engagement in sexual risk behaviors Semple et al. As a consequence, use of these drugs has subsequently led to the spread of sexually transmitted and bloodborne infections among various populations. We report here on available literature regarding the extent to which these risk behaviors accompany cocaine and methamphetamine use in the Mexican context. To obtain materials for this review we initially performed a broad search of standard medical and social science databases e. We then expanded our search to non-indexed major databases e. Finally, data was obtained from personal contacts with members of non-governmental organizations, drug user treatment centers, and pharmacies. Although coca leaf is not cultivated to any appreciable extent within the country, Mexico has been a major transit point for cocaine since the s. Before that time cocaine seizures by authorities were negligible, at less than ten metric kilograms kg per year. The amount of cocaine seized by drug enforcement officials surpassed kg per year in the s, four metric tons in , and almost fifty metric tons in Astorga, The evolution of Mexico from a transit point to a major player in the cocaine trade grew in part out of intensified prosecution of Colombian drug cartels. In the mids, there was increased enforcement by the U. In light of this crackdown, Colombian cartels permitted Mexico-based traffickers to take a greater role in the cocaine trade Smith and Toro, Initially, Colombian cartels passed on refined cocaine to Mexican middlemen, who would transport it across the U. In , nearly 21 metric tons of cocaine were seized by drug enforcement agencies from the Colombians DEA, That same year, Mexican smugglers, reportedly annoyed with delinquency of payment from their Colombian partners, held back shipments to extort compensation Finckenauer et al. These events led to a dramatic shift in the relationship between Colombian organized crime and Mexican transporters. By the mids, Mexican smugglers received up to half of the cocaine transported across the border as payment for services. This obviated the need for large cash transactions, which could be more easily monitored by prosecutors DEA, Although with this change the Columbian cartels gave up a part of the large wholesale U. In light of stiff prosecutions against Colombian traffickers in the early s, cocaine trafficking further shifted from the Caribbean to Mexico. In , the amount of cocaine seizures was roughly equal between the Caribbean and Mexico, but by seizures in Mexico — believed to roughly reflect the total amount being trafficked — were more than twice that of the Caribbean UNODC, In , according to the U. Customs Service, Mexico and the U. Census Bureau, More than million people, involving upwards of 88 million cars and 4. Customs Service, It is unknown to what extent increased trade flow may have facilitated drug transport, however in some cases the economic changes inherent with free trade may have led certain groups to become involved in the drug trade Smith and Toro, For instance, Quinones et al. This provided a decent living in this poor neighborhood in the pre-NAFTA environment of high tariffs on legally imported consumer goods. DEA, Recent reports indicate that high-level traffickers in Colombia have sought to even further distance themselves from the day-to-day operations of cocaine distribution within the U. Recently, it has also been reported that coca base is now being smuggled into Mexico, whereby processing to cocaine hydrochloride is performed by Mexican traffickers DEA, However, cocaine production is considered the exception rather than the rule, since the vast majority of cocaine trafficked in Mexico is already the finished product. This does not appear to be due to a lack of infrastructure - such as institutional and non-institutional networks required for cultivation, processing, and trafficking - for in the case of heroin, poppy cultivation, processing, and distribution is well organized Bucardo et al. Rather, it may be that the current situation provides the more ideal risk to benefit ratio for Mexican cocaine traffickers. These same routes are also believed to be a transit point for potassium permanganate, which is used in the cocaine purification process UNODC, Eight percent of all cocaine seizures in the world took place in Mexico prior to UNODC, , however, the events following the terrorist attacks on the U. The combined consequences of these two changes are reported to have resulted in increases in availability of illicit drugs in Mexican border towns Bucardo et al. Clandestine labs are believed to have initially obtained precursor chemicals, such as ephedrine and pseudoephedrine, from pharmaceutical or chemical companies producing or importing chemicals into Mexico DEA, In January , Canada, which had been the main supplier of pseudoephedrine to Mexico, enacted legislation to control its distribution Government of Canada, The seizure that same year of 22 million pseudoephedrine tablets en route from Hong Kong to Mexico, however, suggests that Mexican traffickers have been resourceful in finding alternative suppliers DEA, Similar increases have been seen in seizures at the southwestern U. Drug enforcement agencies in Mexico have only recently started to focus on methamphetamine, and thus seizures of clandestine laboratories and their product are comparatively low. The exact number of methamphetamine production sites in Mexico is unknown. The International Narcotics Control Strategy report stated that ten labs were destroyed in Mexico in ; however, Mexican officials in the state of Baja California claimed that 53 labs were closed in Baja California alone that year DEA, These conflicting reports suggest lack of coordination and communication among drug enforcement officials or perhaps a lack of considering methamphetamine supply reduction a priority. Most methamphetamine labs are discovered as the result of fires or complaints of unpleasant odors by neighbors, rather than active investigation. With the increased role of Mexico in the trafficking and production of illicit drugs, the perceived availability of drugs has increased locally and has been associated with increased experimentation and continued use in Mexican adolescents Villatoro et al. Often drug shipments are delayed in Mexican border towns before delivery to the U. A national survey showed that the percentage of the general population 12—65 years of age reporting having ever used an illegal drug was Interestingly, a national survey of students throughout Mexico found that more than a third of those who had used cocaine, crack, or heroin used it for the first time in the United States. The second most common location of initial drug use was in the northern border state of Baja California Medina-Mora et al. A high proportion of initial use was also reported in the western states of Sonora, Sinaloa, and Jalisco Medina-Mora et al. It began in at eight sites in six states, primarily in cities bordering the U. This system compiles data from sources such as forensic services, emergency rooms, and drug user treatment centers to provide broad, annual data on changes in patterns of consumption, risk groups, new drugs, and other factors associated with drug use within Mexico. Occasional in-depth studies by universities and government agencies have further helped to describe the latest trends and concerns regarding drug abuse in Mexico. In the decade between the first National Survey of Addictions in and the most recently published survey results in , the percentage of Mexicans reporting ever having used an illegal drug in their lifetime increased from 3. Nationwide, the most popular drugs used were marijuana, which had been used by 4. The percentage of U. Substance Abuse and Mental Health Services Administration, , and the percentage of Canadians aged 15 and older Although the prevalence of illicit drug use is still comparatively low in Mexico, this does not discount the importance of combating recent increases in the rate of drug use, especially in border areas. Furthermore, of note is the predominance of cocaine use in Mexico. In the s, cocaine and coca wines were commonly prescribed pharmaceuticals in Mexico and were easily available at markets and pharmacies Astorga, Yet only recently has abuse of cocaine become a public health issue in Mexico. In the decades before this period, consumption was not generalized — reportedly occurring mainly among persons of high socioeconomic status, intellectuals, and artists Tapia-Conyer et al. From to , the percentage of people reporting ever having used cocaine increased from 0. This period also corresponded with new formulations and routes of administration e. An investigation of cocaine use in Ciudad Juarez indicated that on average five different drugs including alcohol and tobacco were used before drug users switched to cocaine. Likewise, poly-drug use has been found to be common in the prison population. A report presented at the U. Mexican Binational Demand Reduction Conference in suggests that cocaine may be replacing marijuana as the drug of choice in young people DEA, Cocaine use is also believed to be a problem in commercial sex workers. Since cocaine was documented as the primary illegal drug among sex workers in Ciudad Cd. Juarez Ramos and Ortega, A survey of commercial sex workers in Cd. More recently, a large, ongoing study of female sex workers in Cd. Juarez suggests that as many as half may be using cocaine Dr. Patterson, personal communication, January A survey in conducted among sex workers in the northwestern border city of Tijuana found that This is in contrast to the Cd. Juarez sex workers use methamphetamines Patterson et al. Despite its increasing use, surveys have indicated that use of cocaine, especially in the form of crack, is met with some degree of social stigma, even among those in drug user treatment Medina-Mora et al. In surveys among women in Ciudad Juarez bars, local jails, and other settings, sedatives, heroin, and non-stimulant drugs in general were preferred Hammet et al. These incarcerated women, who reported using sedatives and occasionally heroin, stated that they did not use crack because they did not like the high. They also mentioned that this was in spite of the generally lower cost of using crack cocaine compared to other drugs. The reason most often mentioned by the women was that crack was considered to cause a high that can cause women to lose control Dr. Ramos, personal communication. However, dislike and even stigma associated with stimulants such as methamphetamines and crack cocaine may be breaking down. In , there is information from Cd. Juarez that suggests the advent of methamphetamine Patterson et al. There is also anecdotal information that crack cocaine in now on the list of drugs used in Cd. Juarez by poly-drug users, although it is not clear to what extent women are now using crack Dr. Following the events of September 11, , there was a reported short-term increase in the consumption of both cocaine and heroin in Mexican populations along the U. Due to reduced demand in the U. This has led to an over-supply of cocaine which has resulted in decreased prices as dealers attempt to unload extra drug along trafficking routes, especially in border areas UNODC, With increased cocaine use, there has been a parallel rise in demand for drug user treatment in Mexico Medina-Mora and Rojas Guiot, Interdiction efforts in the Torreon area by the Mexican army resulted in a build up of drugs in the agricultural town of San Pedro de las Colonias. Small time dealers, many of whom were migrants who had previously lived in the United States, took advantage of the situation to offload their drugs locally, often cutting the drugs with other substances to further increase volume Magis and Badillo, Through in-depth interviews with hospital and drug user treatment personnel, ex- and current IDUs, and by accessing files from health providers and NGOs that work with IDUs, the increase in use and availability was linked with a subsequent epidemic of drug and overdose-related hospitalizations and fatalities as well as the transmission of bloodborne infections. Prior to this period, San Pedro had a total of 20 registered cases of AIDS, two of which were associated with injection drug use. The long term effects of current increased border security on drug availability, consumption, and disease transmission in Mexican border cities requires further study. LSD and other synthetic drugs first began to be used in the s. In the s, the use of synthetic drugs, primarily in the form of amphetamines, re-emerged among young people Medina-Mora and Rojas Guiot, In Mexico, methamphetamine is usually nasally inhaled or smoked after being heated. In the U. Methamphetamine ranked as the primary reason for seeking drug user treatment in many centers in Mexico, including those in the western states of Baja California, Baja California Sur, and Sinaloa SSA, Its cheap price and availability are believed to be major factors leading to its popularity in this city Dr. Isaac Alba, Director, Clinica Ser, private Tijuana drug rehabilitation clinic, personal communication. In Brazil, cocaine has been associated with a high risk of overdose Mesquita, Kral, Reingold, Haddad et al. In the northern Mexican city of Cd. Juarez, cocaine use has been found to be strongly linked to the sex trade. Continual monitoring of drug use trends and administration methods can be of great benefit when developing public health interventions. In Montreal, Canada more frequent injection of cocaine was associated with a lower likelihood of injection cessation Bruneau et al. On the other hand, obtaining syringes at needle exchanges and pharmacies was associated with a greater odds of injection cessation Bruneau et al. However, sterile syringe coverage in the context of high frequency cocaine injection remains a challenge Remis et al. In settings outside of Mexico, crack cocaine has been associated with sex trade involvement, including trading sex for drugs Edlin et al. Not surprisingly, crack use has been associated with high rates of HIV infection Edlin et al. In contrast, HIV prevalence in Brazil decreased as injection of cocaine decreased and smoking of crack cocaine increased Mesquita, Kral, Reingold, Bueno et al. These observations suggest that monitoring of drug use patterns may provide advance warning of potential changes in the subsequent spread of bloodborne infections. Crack smokers also have a high prevalence of oral sores, suggesting that in some cases these sores could facilitate oral HIV transmission Faruque et al. In a New York study, crack smoking was independently associated with tuberculin positivity Howard et al. Although the rate of crack use appears to be low in Mexico and even less tolerated than cocaine, the high prevalence of tuberculosis in Mexico suggests that the potential exists for spread of tuberculosis if crack use were to become more common. To our knowledge, only one study has found cocaine use to be associated with tuberculosis in Mexico. In a population-based survey in the southern Mexican state of Veracruz, those with persistent cough were tested for Mycobacterium tuberculosis. A total of patients were followed an average of 32 months to monitor treatment outcome and mortality. Consumption of cocaine was associated with a 20 fold increase in need for re-treatment during the follow-up period Garcia-Garcia et al. This study suggests that there is a need to investigate whether there is a wider link between illicit drug use and tuberculosis, especially in regards to multi-drug resistance in Mexico. Although to our knowledge there are no published reports on particular risk behaviors associated with methamphetamine use in Mexico, use of methamphetamines has been associated with high-risk sexual activity and high HIV and STD prevalence among men having sex with men in the U. Semple et al. An ongoing study in Tijuana suggests that one of the main drugs of choice among female sex workers is methamphetamine, whereas among female sex workers in Cd. Juarez heroin predominates Patterson et al. Binging on stimulant drugs such as crack, cocaine, and methamphetamine has also been associated with sexual behaviors that pose a higher risk of HIV infection, including greater numbers of partners, decreased condom use during vaginal and anal intercourse, and sex trade involvement Chiasson et al. With increasing purity comes an increased chance of health-related problems and use of emergency medical services DEA, , since acute methamphetamine intoxication often results in agitation, violence, and death Richards et al. Although the SISVEA reported emergency department and forensic statistics associated with drug use, information specific to methamphetamine use was not provided SSA, Chronic use of methamphetamines may also lead to heart failure, malnutrition, and permanent psychiatric illness Richards et al. The role of Mexico in trafficking of cocaine and trafficking and production of methamphetamine has increased substantially over the past decade. Only recently, however, has local use of these drugs become recognized as a public health problem. Because of this, many questions remain about the potential role cocaine and methamphetamine use may play in the spread of bloodborne and sexually transmitted pathogens in Mexico. From past studies in other settings, a direct link has been demonstrated between use of these drugs and unsafe sexual behaviors and transition to injection. There is therefore an urgent need to study the relationship between consumption, routes of administration, risky sexual behaviors, transition to injection and needle sharing behaviors in the Mexican context. While studies conducted to date have provided a valuable glimpse at the drug problem in Mexico, there is a need for methodologic approaches which transcend data collection on individual behaviors to include macro-level factors associated with availability, purity, and price of drugs. Restricting studies to linear models when non-linear networks may be involved may lead to inappropriate conclusions and interventions. For this reason, tools such as artificial neural networks and respondent-driven sampling Buscema et al. Because much of the drug abuse in Mexico has concentrated in border areas, it is also imperative to study the complex inter-relationship between drug interdiction, production, trafficking, migration, and risk behaviors along the mile porous border between the U. The daily flow of tourists, migrant workers, and commuters in both directions has enormous potential health implications for both countries. Current and past studies have indicated that the drug use scene in Mexico is complex and may vary between and within states. Therefore, if public officials hope to stem the escalating problem of drug use in Mexico, there is a concomitant need to expand available treatment options and behavioral interventions for cocaine and methamphetamine addiction, especially in the context of poly-drug use. Many thanks to Dr. She joined this faculty in January of Her Ph. Since joining the faculty at UCSD she has collaborated with Mexican researchers in studies of injection drug use in cities along the U. Brouwer is currently principal investigator of a five-year grant to explore social and environmental factors affecting disease transmission and risk behaviors among injection drug users in Tijuana, Mexico. Brouwer's research interests also include studies of the epidemiology and molecular epidemiology of tropical infectious diseases. Case has been collaborating on research activities assessing HIV among injecting drug user populations since Her research approach combines field based qualitative methodologies with a more traditional epidemiological perspective in order to contextualize the findings of large quantitative studies. She has made major contributions to the national debate to legalize syringe exchange programs and in extending knowledge of understanding to the health concerns specific to women who have sex with women. Case is currently working on projects at the intersection of policy and behavior and is a NIDA-funded investigator on the Rapid Policy Assessment and Response project that uses rapid assessment techniques to evaluate HIV and drug use policy implementation in Poland, Ukraine and Russia and is collaborating on the development of similar HIV policy evaluation projects in several other countries. Rebeca L. Ramos was born in El Paso, Texas and has lived as a U. She is the Technical Director of the U. She is also the founding associate of the Border Planning and Evaluation Center, a collaborative of public health specialists that fosters cooperation between academics and the community to strengthen processes and outcomes. Ramos has been an innovator in public health, working primarily in the areas of substance abuse, HIV, TB, and diabetes. As head of the Technical Cooperation Division of the USMBHA she has coordinated over health courses, seminars and symposia attended by an estimated 10, health and allied social services professionals. Since , Dr. Since he has been interested in injection drug use and HIV. In he began a risk intervention project on the U. Jesus Bucardo, M. He maintains a clinical practice with focus on cultural and community psychiatry at UCSD in a community mental health center near the U. His current research interests include cultural adaptation of prevention interventions, psychosocial rehabilitation in schizophrenia, cultural psychiatry and use of traditional and alternative medicine methods in psychiatry with Latino populations in Mexico and the United States. Thomas L. He received his Ph. Patterson has been conducting psychosocial research with HIV-positive populations since He is the Principal Investigator of a U. In addition, he is Principal Investigator of a National Institute on Drug Abuse funded project testing a risk reduction intervention for HIV-positive methamphetamine-using men who have sex with men. Patterson is also the principal investigator of an NIMH-funded sexual risk reduction intervention for HIV-negative, heterosexually-identified, meth-using men and women. He has published many papers and chapters in the field and serves on a number of AIDS review committees. Patterson is currently the editor of the journal AIDS and Behavior , and has served as co-editor and on the editorial boards of a number of other journals. Steffanie A. Strathdee is an infectious disease epidemiologist who has spent the last two decades focusing on underserved, marginalized populations in developed and developing countries. Her recent work has focused on the prevention of blood borne infections and barriers to care among injection drug using populations, specifically HIV and viral hepatitis. In the last decade, she has published over peer-reviewed publications on HIV prevention and the natural history of HIV infection. She is the principal investigator of several behavioral intervention studies among drug users, and has played a leading role in evaluations of needle exchange programs in Canada, the United States and India. Currently, she is engaged in research projects in a number of international settings, including Mexico, Brazil, Canada, Pakistan, India, Tajikistan and Russia. She is also principal investigator of a five year grant to characterize the epidemiology of blood borne infections among injection drug users in Tijuana, Mexico. As a library, NLM provides access to scientific literature. Subst Use Misuse. Published in final edited form as: Subst Use Misuse. Find articles by Kimberly C Brouwer. Patricia Case , Sc. Find articles by Patricia Case. Rebeca Ramos , M. Find articles by Rebeca Ramos. Jesus Bucardo , M. Find articles by Jesus Bucardo. Thomas L Patterson , Ph. Find articles by Thomas L Patterson. Steffanie A Strathdee , Ph. Find articles by Steffanie A Strathdee. PMC Copyright notice. The publisher's version of this article is available at Subst Use Misuse. Open in a new tab. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.

5. The Civil War Drug Boom

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Your purchase has been completed. Your documents are now available to view. Purchase chapter. Cite this Share this. Showing a limited preview of this publication:. Cite this chapter. Marshall, Jonathan. The Civil War Drug Boom'. Marshall, J. The Civil War Drug Boom. Redwood City: Stanford University Press. Redwood City: Stanford University Press, pp. Redwood City: Stanford University Press, Marshall J. Redwood City: Stanford University Press; Copied to clipboard. Copy to clipboard. Share this chapter. Supplementary Materials. Please login or register with De Gruyter to order this product. Register Log in. The Lebanese Connection. Chapters in this book 15 Frontmatter. Hashish, the Petroleum of Lebanon. The French Connection. The Intra Bank Connection. The Path to Civil War. The Syrian Connection. The Drug Melting Pot. From Narco-State to Failed State. Downloaded on

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