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The scene which greeted Tijuana's paramedics as they entered 'La Perla' bar in the early hours of the morning was grim. Two men were unconscious - a heavy-set man sprawled on the floor, his friend slumped in a chair - both clinging to life by a thread. Once more, the city's emergency services had been called out following a suspected fentanyl overdose - increasingly part of every nightshift, says paramedic Gabriel Valladares. We're seeing more and more, and it's always fentanyl,' he says. The synthetic opioid is 50 times stronger than heroin and is making the paramedics' job much harder. But we've had as many as six or seven cases in a single call - probably because they all took the same substance,' adds Gabriel. Some in the team quickly began CPR on the two patients while others prepared doses of Narcan, the most effective drug to reverse a fentanyl overdose. The two men may not have even known they were taking fentanyl. Because the opioid is cheap and easy to produce and transport, Mexican drug cartels have begun to cut it into recreational drugs like cocaine. The Mexican border city finds itself in the grip of a full-blown drug epidemic. We don't consume fentanyl here,' he said last year. Following that controversial claim, he has promised to introduce new legislation to Congress to ban the consumption of fentanyl and other synthetic opioids. Those working on Tijuana's frontlines fear that may be too little, too late. The study has shown that around one-in-four bodies in Mexicali contained fentanyl, he says, and last July, the statistics for Tijuana were as high as one-in-three. People working with the living in Tijuana also claim the president has underestimated the scale of the crisis in Mexico. Prevencasa is a harm reduction centre in the city which provides a needle exchange and medical services to addicts. Its director, Lily Pacheco, randomly selects two used needles and two empty drug vials from their disposal unit. All four items of drug paraphernalia test positive for fentanyl. The city is awash with it, says Lily. To suggest otherwise is a lack of recognition of this reality. We have the evidence right here,' she says, pointing at the testing strips. Ignoring the problem won't solve it. On the contrary, people will keep dying. As our interview ends, there is suddenly a much more visceral illustration of the crisis than fentanyl tests on used syringes. Lily is rushed outside where someone is overdosing on the street. She carries Narcan too, donated by a US charity after her federal funding was cut, and saves the man's life. The fentanyl epidemic has hit the neighbouring US - the world's biggest market for illegal drugs - especially hard. There, an estimated 70, people died of overdoses last year. Just 15 when he accidentally overdosed on a counterfeit Xanax pill from Mexico, he had no idea it was fentanyl-laced. Text messages Elijah's mother, Nellie Morales, found afterwards suggest it was his first time experimenting with drugs. A piece of me died that day that he died. Unfortunately, such deaths are common in the US. City police compare the situation to the crack epidemic of the s. When we visited, US customs officers seized 33kg 73lb of fentanyl in a single day, enough to kill everyone in El Paso twice over. Arguments over the drug have even seen some Republicans advocate for sending troops into Mexico to fight the cartels. No doubt such debates will feature highly in the US election campaign. In truth though, given how easily it can be transported, it is almost impossible to stem the flow of fentanyl into the US. He shows me videos of his gang moving the drug through tunnels beneath the US-Mexico border. Kevin has been working with the cartel since he was just nine. But he has never seen anything like fentanyl. He predicts it is the future of the illegal drug trade:. It's going to keep blowing up,' he says. I asked him if he felt any remorse over the deaths of US teens like Elijah. Everyone's responsible for their own acts. Back in Tijuana, it took three doses of Narcan, but the paramedics managed to bring one patient back from the brink in the 'La Perla' bar. For his friend, though, it was too late. He died amid the beer bottles and empty glasses on the barroom floor. The paramedics' dignified silence is pierced by the awful sound of wailing. His mother has made it to the bar only to be told her son, at 27, is another victim of this most powerful of narcotics, his death a footnote in an election year on both sides of the US-Mexico border. Skip to content. US Election. Paramedics in Tijuana say they are seeing increasing numbers of suspected fentanyl overdoses on their nightshift. The Mexican president has played down the extent of the fentanyl problem but authorities in Tijuana disagree. He was lucky. But many were not so fortunate. Elijah Gonzales was one of them. His body simply couldn't cope. Nellie's son Elijah overdosed on a fentanyl-laced pill in El Paso, Texas on the other side of the Mexico border. Gangs are recruiting children to help them traffic fentanyl. Mexico ex-minister convicted of drug trafficking. Fourth wave of fentanyl crisis hits every corner of US. Drug use. Drugs trade.
High dead-space syringe use among people who inject drugs in Tijuana, Mexico Bought drugs that came already prepared in a syringe**,
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Official websites use. Share sensitive information only on official, secure websites. Strathdee, Ph. We identified prevalence and correlates of HDSS use among injection drug users IDU in Tijuana, Mexico, where syringe purchase and possession is legal without a prescription. Beginning in , IDU who reported being 18 years or older, who injected drugs within the last month were recruited into a prospective study. Logistic regression was used to identify correlates of using HDSS. Efforts are needed to expand coverage of low-dead space syringes through existing syringe exchange programs. In Tijuana, besides the direct drug-related characteristics of both substance use and trafficking previously mentioned, there are demographic, social and political factors that contribute to an environment that heightens the risk of blood-borne infections for IDU. In there were 1,, registered people living in Tijuana, the fifth largest city in the country and the largest in the state of Baja California. The Tijuana-San Diego region is the busiest land border crossing in the world, with as many as , individuals crossing between the cities daily. Another factor that may increase the risk of blood-borne infections among IDU is the type of syringe that individuals use. As previously reported, 15 recruitment was conducted through targeted sampling, which consisted of street-based outreach in ten neighborhoods across Tijuana. The inclusion criteria included being 18 years or older, injecting drugs within the last month, being able to speak English or Spanish, currently living in Tijuana with no plans to move outside Tijuana over the next 24 months, and not currently participating in an intervention study. For this analysis, the sample was comprised by IDU that had completed the baseline and second visit and who answered questions about use of HDSS. The interviewer-administered surveys solicited data on sociodemographic, behavioral and contextual factors, including lifetime and 6-month drug use, and behaviors related to drug use such as needle and drug paraphernalia sharing, the type of syringe used, and other health conditions. Frequencies and medians were compared between those who ever used HDSS to those that did not. Univariate and multivariate logistic regressions were conducted to identify lifetime and past 6-months factors associated with HDSS use. For the final model, we tested for multicollinearity through a correlation matrix and a Wald test. Lack of access because of the late hour or because they could not afford to buy a new syringe was reported by 2. Using an HDSS to avoid injecting with a syringe used by someone else was reported by 0. In relation to frequency of injection, This difference was not significant. Both groups were predominantly male with Positive HIV status was reported by 2. Median age, years of injection drug use, monthly income, and HIV status were not significantly different. Descriptive statistics of high dead space syringe use HDSS. In both groups, most of the IDU used heroin the first time they injected drugs Cocaine was the second most common drug of initiation for 3. The age at first cocaine injection was 20 years for both groups, The median lifetime overdoses was one for both groups. Asking for help injecting was reported by None of these differences were significant. Although it is legal to carry syringes in Tijuana, only History of deportation from the US was reported by With respect to risky drug-related behaviors in the past 6 months, Distributive and receptive syringe sharing at least half the time were reported by more than one-third of participants in both groups, as was sharing the same dose with someone else. That is, almost all of those who engaged in syringe sharing have done so in a receptive behavior. Buying syringes that were preloaded with already prepared drug for at least half of injections was reported by only 5. Overall Reporting difficulty avoiding receptive needle sharing and other sharing injection equipment ranged between None of the past 6-month behaviors differed significantly across groups. In the univariate analyses, being male, having ever been stopped or arrested by the police, using cocaine as first drug injected, believing that in Tijuana it is illegal to carry syringes, a longer injection drug use trajectory per 10 year increase , being deported to Tijuana, earlier onset of first heroin injection per 10 year increase , and earlier year of first injection per 10 year increase were all significantly associated with an increased odds of HDSS use. There was collinearity between years injecting, age at first heroin injection and absolute year of first injection. That is, most of PWID used heroin at first injection. For this, we tested each of these variables in different multivariate models. The best fitting model included age at first heroin injection. Surprisingly, few drug-related behaviors were independently associated with use of HDSS; rather, social and structural factors predominated as correlates of HDSS use. IDU who reported ever being arrested by police were nearly twice as likely to report HDSS use, compared to those who had never been arrested. Our findings are consistent with previous evidence of the relationship between policing practices such as arrests and high-risk injection behaviors such as needle sharing in Tijuana and elsewhere. A closer collaboration between public health programs and policing strategies may also reduce the likelihood of engaging in risk behaviors. Those who were deported from the US were 1. The vulnerable condition and increased risk of Mexican IDU repatriated to Tijuana in relation to HIV and other health and behavioral conditions has previously been reported. In a qualitative study, IDU in Tijuana reported difficulties when trying to buy syringes at pharmacies. This conclusion is supported by prior findings of criminalization of syringe possession, which found that this is a risk factor for blood-borne infection among IDU. As such, this population is likely to benefit from interventions that can provide information on strategies to minimize behaviors such as use of HDSS that may heighten the risk of blood borne disease transmission, as well as information on the legality of carrying sterile syringes in Tijuana. Tijuana is one of the few cities with harm reduction programs in Mexico. Increasing the numbers of LDSS distributed, extending operating hours, and implementing educational programs may all improve the service provided by SEP. This study has several limitations. First, the cross-sectional design does not allow causal inferences. Second, there is no information regarding hepatitis C status and there is no statistical power to analyze the relationship between HIV status and HDSS use. Third, because of lack of statistical power it was not possible to analyze past-month HDSS use and hence, it may be that our findings do not represent present injection practices, which may imply that HDSS were used in other conditions such as prior to deportation. Overall, our findings suggest the need for a more extensive harm reduction program that expands the coverage of SEP, as well as education programs highlighting the increased risks associated with HDSS as well as the legal status of syringe possession in Mexico. Considering the geographic location of the study site, any effort to improve the health conditions of IDU in Tijuana may have an impact on international migrant health. The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this paper. As a library, NLM provides access to scientific literature. Am J Drug Alcohol Abuse. Find articles by Claudia Rafful. William Zule , Dr. Find articles by William Zule. Dan Werb , Ph. Find articles by Dan Werb. Carlos Magis-Rodriguez , M. Find articles by Carlos Magis-Rodriguez. Steffanie A Strathdee , Ph. Find articles by Steffanie A Strathdee. Issue date May. PMC Copyright notice. Open in a new tab. Univariate and multivariate analysis of HDSS use. Declaration of interest The authors report no conflicts of interest. 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. Perception of legal status of carrying new syringes in. Cannot avoid receptive needle sharing with someone sick. Cannot avoid receptive needle sharing from a sex partner. Age at first heroin injection per 10 year increase. Perception of legal status of carrying new syringes in Tijuana.
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