Tijuana buying Heroin
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Tijuana buying Heroin
Official websites use. Share sensitive information only on official, secure websites. Corresponding author: Steffanie Strathdee, PhD, sstrathdee ucsd. Although most people who inject drugs PWID in Tijuana, Mexico, primarily inject heroin, injection and non-injection use of methamphetamine and cocaine is common. We examined patterns of polydrug use among heroin injectors to inform prevention and treatment of drug use and its health and social consequences. Latent class analysis was conducted to assign individuals to classes on a probabilistic basis, using four indicators of past 6 month polydrug and polyroute use: cocaine injecting, cocaine smoking or snorting, methamphetamine injecting, methamphetamine smoking or snorting. Latent class membership was regressed onto covariates in a multinomial logistic regression. Latent class analyses testing 1, 2, 3, and 4 classes were fit, with the 3-class solution fitting best. Class 1 was defined by predominantly heroin use Bivariate and multivariate analyses indicated a group of methamphetamine and cocaine users that exhibited higher risk sexual practices and lower heroin injecting frequency, and a group of methamphetamine users who were younger and more likely to be female. Discrete subtypes of heroin PWID were identified based on methamphetamine and cocaine use patterns. These findings have identified subtypes of heroin injectors who require more tailored interventions to reduce the health and social harms of injecting drug use. Keywords: polydrug use, latent class analysis, HIV risk, Tijuana, people who inject drugs. Use of multiple illicit substances, either over a short period or at the same time, has been associated with greater drug dependence, increased risk for overdose, and behaviors that are associated with increased risk for HIV and related infections. Motivations for polydrug use include preference for specific pharmacological effects, experimentation, availability of different drugs at different times, replacing use of one drug with another, and seeking stronger effects from drugs as tolerance increases Brecht et al. Tijuana, Mexico, is located on a major drug trafficking route and is unique as a city where heroin, and to a lesser extent, cocaine and methamphetamine are commonly injected. Heroin in this region is usually in the form of black tar, which is typically injected. Methamphetamine has become a major drug of abuse in Tijuana Brouwer et al. Among people who inject drugs PWID , it has also been associated with higher risk of needle and syringe sharing Rusch et al. Cocaine is also associated with high risk sexual behavior Brouwer et al. Heroin is often injected in combination with methamphetamine or cocaine i. Latent class analysis assigns individuals to classes on a probabilistic basis based on responses to a set of indicator variables, allowing comparison of covariates across classes. This method has been used to model patterns of substance use in general population samples Agrawal et al. Although specific drugs and route of administration varied by population and region, all studies found multiple classes of polydrug use, defined by single drug use, pairs of drug use, route of administration, and level of use. For example, in a sample of inner city heroin and cocaine users in Baltimore, Maryland, Kuramoto et al. In another sample of heroin and cocaine users in Baltimore, Harrell et al. Additionally, in a sample of opioid users in five Canadian cities, Monga et al. Due to different drug availability and contextual factors, drug use profiles of PWIDs in Tijuana are likely to be quite different than those of heroin and opioid users in other parts of North America. The objective of this analysis was to identify classes of polydrug use among heroin users in Tijuana Mexico, and to in turn compare these classes with respect to the HIV risk behaviors associated with each. In this analysis, we applied latent class analysis to describe subgroups or classes of cocaine and methamphetamine injecting and non-injecting polydrug use in a sample of heroin PWID. It was hypothesized that individuals in classes with more polydrug use would report more HIV risk behaviors. Participants were PWID enrolled from to in a prospective study examining contextual and behavioral risk factors for HIV, syphilis, and tuberculosis infection as previously described Strathdee et al. At baseline, eligibility criteria included having injected in the past 30 days, being aged 18 years or older, speaking Spanish or English, and residing in Tijuana with no plans to move over the next 18 months. Participants were recruited by respondent driven sampling to access a more representative sample of this hard-to-reach population Heckathorn, Eligible peers who enrolled in the study were then given the same number of coupons to recruit additional peers who injected drugs. From the initial group, 24 seeds recruited eligible peers. Additional information on recruitment procedures, tolerance, sample convergence, recruitment chains, and sample characteristics has previously been reported Brouwer et al. Of note, all 24 seeds were included in the analyses presented here. Participants provided informed consent and were given pre- and post-test HIV counseling; those testing HIV-positive were referred to local public health providers for free care. The survey included questions about demographics, substances used, frequency of use, route of administration, sexual behaviors, and drug use history and behaviors. Regarding substances used, participants were first asked if they have ever used a substance, and in the case of affirmative responses, they were asked to indicate the frequency of use of that substance in the past six months by route of administration injecting, smoking, or snorting. Frequency of substance use was dichotomized into yes or no for past six month use of cocaine or methamphetamine. Due to smaller prevalence and different risks from injecting, use via snorting and smoking was combined into non-injection use, resulting in four indicators of past six month polydrug use: methamphetamine injecting, methamphetamine non-injecting, cocaine injecting, and cocaine non-injecting. Demographic factors included age, gender, education, income, homelessness, deportation history, and being born in Tijuana. Education level was dichotomized as incompletion or completion of secondary school. Income level was dichotomized from an eight level categorical scale to greater than or equal to vs. Sexual behaviors in the past six months included reporting sex in exchange for something e. Drug use behaviors included frequency of heroin injection in the past 6 months, years since first injection, overdose in the past year, receptive needle sharing, and distributive needle sharing. Frequency of heroin injection was dichotomized into more than once a day versus once a day or less. A latent class analysis was conducted to assign individuals to classes on a probabilistic basis, using four indicators of past six month polydrug use: 1 cocaine injecting, 2 cocaine smoking or snorting, 3 methamphetamine injecting, and 4 methamphetamine smoking or snorting. The latent class analysis was conducted in Mplus version 7. Next, several multinomial logistic regression models were fit with the polydrug use latent classes as the outcome variable. To better understand the unique and shared impact of demographics, sex behaviors, and drug use behaviors, three separate models were run with each set of covariates regressed onto the latent class outcome. Peer recruitment through respondent driven sampling may introduce dependence between observations, as participants may tend to recruit others who are similar on given traits of interest. Additionally, to account for the increased similarity among individuals in the same recruitment chain compared with those in different chains, Model 2 used a generalized estimation equation approach like the approach used by Rudolph et al. Finally, a sub-analysis was run examining simultaneous co-injection of substances. Prevalence of co-injection use was assessed for each class and chi-squared tests of association were run between co-injection and drug and sex risk behaviors. Among the participants, Less than half Baseline prevalence of HIV was 4. In the past 6 months, 9. Latent class analyses testing 1, 2, 3, and 4 classes were fit to the data. Latent class probabilities for each class were Class 1 was characterized by low probabilities of all four polydrug use indicators Class 2 had high probabilities of methamphetamine injection and non-injection 1. Class 3 had high probabilities. Despite their increased duration of injecting and more frequent injection of heroin, those using predominantly heroin class 1 shared syringes less class 1: Compared to those using predominately heroin, those in the heroin and methamphetamine use class class 2 were significantly more likely to be female, to use drugs before sex, and to inject with syringes that had previously been used by others. They were also significantly younger and had lower monthly incomes. Compared with predominately heroin users, those using methamphetamine, cocaine and heroin class 3 were significantly more likely in the past six months to have multiple casual sex partners, to participate in sex exchange, to report a prior overdose, to inject with syringes that had previously been used by others and they were less likely to report daily heroin injection. Interestingly, this group had higher levels of education and fewer individuals reporting injection of heroin more than once per day class 3: We assessed recruitment homophily, or the propensity for people to recruit others with similar characteristics, on the outcome of interest polydrug use class using RDSAT 5. Volz et al. Positive values indicate preferential recruitment of peers who are similar on a characteristic, negative values indicate an increased likelihood of recruiting peers who are dissimilar on a characteristic, and zero indicates that peers recruitment is random with respect to a characteristic. Together, the homophily indices and the p-value from the chi-squared test suggest that latent class membership among respondents was not completely independent of the latent class membership of their peer recruiters. As seen in Table 3 , the parameter estimates for Models 1 and 2 were nearly identical, though the confidence intervals were tighter around the parameter estimates in the GEE model. Although these classes were defined by use of methamphetamine or cocaine use by itself, many participants injected combinations of these drugs and heroin, so even in the non-polydrug use class there were individuals who had injected methamphetamine along with heroin, though not methamphetamine by itself. The majority of individuals in the methamphetamine, cocaine, and heroin use class In a sub-analysis, we assessed whether simultaneous use of pairs of drugs was associated with variation in sex and drug use behaviors. Chi-square tests of association between each pair of simultaneous drug injection and sex and drug use behaviors showed that injection of heroin and cocaine together i. In these bivariate analyses, simultaneous injection of heroin and cocaine or methamphetamine was associated with syringe sharing, and simultaneous injection of methamphetamine with heroin or cocaine was associated with increased sex risk behaviors. In this analysis of polydrug use among heroin injectors in Tijuana, we identified discrete subtypes of heroin injectors based on patterns of concurrent methamphetamine and cocaine use. Substance use type informed the formation of latent classes, but the route of administration did not. Bivariate and multivariate analyses indicated a group of methamphetamine and cocaine users that exhibited higher risk sexual practices and decreased heroin injecting frequency and a group of methamphetamine users who were younger, more likely to be female, and with lower incomes. In general, the classes defined by use of more substances were associated with higher risk for overdose and with higher levels of HIV drug use and sexual risk behaviors. Receptive syringe sharing was more common in both of the polydrug use classes compared with the predominantly heroin using class. Though prevalence of HIV and syphilis were similar across the classes, higher prevalence of receptive syringe sharing and higher risk sex behaviors in the polydrug use classes especially the cocaine and methamphetamine use class poses a greater likelihood of transmission of blood-borne and sexually transmitted infections. The methamphetamine and cocaine class class 1 had a higher proportion of females, greater involvement in sex exchange, more casual sex partners, and more drug use before sex, suggesting that cocaine use may be driving these sexual risk behaviors. Interestingly, this group had higher levels of education and lower levels of daily heroin injection, likely supplemented by use of methamphetamine and cocaine. This class was also more likely to have reported an overdose in the past, which may be partly explained by the higher rates of simultaneous injecting drug use. Overall, polydrug use of methamphetamine, cocaine, and heroin compared with predominantly heroin use appears to be associated with more overdoses, more syringe sharing, and higher risk sex behaviors. We also observed higher prevalence of overdose for the two polydrug use classes: 9. Although this relationship only retained significance for the methamphetamine and cocaine class in multivariate analyses, polydrug use was in general more common among those with more polydrug use. Previous research on latent class analysis of polydrug use in users of illicit drugs has been conducted among illicit opioid users in Canada Monga et al. Though these studies had different indicators of polydrug use and were conducted in samples of injection and non-injection drug users in locations with less methamphetamine use, there were several notable consistencies between the present analysis and previous research. Among illicit opioid users in a multisite study in Canada, Monga et al. In the same sample Patra et al. In a sample of heroin and cocaine users in Baltimore, Kuramoto et al. And in another sample of heroin and cocaine users in Baltimore, Harrell et al. There were several limitations to this analysis. Generalizability of these findings to other drug using populations may be limited as these drug use patterns and contextual risk factors may be unique to Tijuana e. Additionally, to describe basic patterns of use, variability in frequency of use was reduced to any use in the past 6 months. Though there may have been some misclassification into classes, the average probability for most likely class membership was fairly high at Finally, with this cross sectional assessment we are only able to determine association, not causation. Through this analysis, we identified subtypes of heroin injectors who may require more tailored interventions to reduce the health and social harms of injecting drug use in Tijuana. In this and other resource limited settings, this work may be of value where there is greater need to tailor targeted interventions based on types of concurrent drug use. For example, PWID who use both heroin and cocaine may benefit from interventions that address both injection and sexual risk behaviors. Expanded access to sterile syringes through syringe exchange programs or pharmacies and overdose prevention efforts should be targeted to both groups of polydrug users, who reported higher levels of syringe sharing and overdose history. Future research is needed to explore variability in frequency of use and simultaneous drug use to determine if these patterns predict longitudinal patterns and changes in polydrug use. As a library, NLM provides access to scientific literature. Subst Use Misuse. Published in final edited form as: Subst Use Misuse. Find articles by MC Meacham. Find articles by AE Rudolph. Find articles by SA Strathdee. Find articles by ML Rusch. Find articles by KC Brouwer. Find articles by TL Patterson. Find articles by A Vera. Find articles by G Rangel. Find articles by SC Roesch. Issue date 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.
Hidden panels, counterfeit bottles, fentanyl: A year of buying drugs in Mexican pharmacies
Tijuana buying Heroin
Credit: Los Angeles Times. Young men in plain T-shirts draw near and call out their wares: Pills. But if you wave them away and go just a few feet farther, you can walk into a pharmacy where you might get something just as dangerous. A Los Angeles Times investigation has found that pharmacies in several northwestern Mexican cities are selling counterfeit prescription pills laced with stronger and deadlier drugs and passing them off as legitimate pharmaceuticals. Hands in blue gloves pour liquid from a container into a tube. Testing on an Adderall pill came back positive for methamphetamine in Cabo San Lucas. Many are nearly indistinguishable from their legitimate counterparts. A team led by UCLA researchers recorded similar results in a study last week, but this phenomenon has otherwise gone largely unnoticed. The new findings could represent a dangerous shift in the fentanyl crisis. Until now, it was unclear that the powerful synthetic opioid had made its way into pharmacy supply chains. Even though Mexican drugstores are known for selling a wide range of medications over the counter — many of which require a prescription in the United States — experts generally believed those pills were at least what store owners said they were. But how often that happens is impossible to tell. A street with shops. While more than 91, people died of overdoses in the U. Fewer than two dozen of those, according to the data, were from opioids, compared with more than 68, opioid overdose deaths in the U. Carlos Briano, a spokesperson for the U. Multiple local and national government agencies in Mexico also ignored requests for comment. McKinsey, was found unresponsive at home in Buckeye. A small baggie containing blue pills and aluminum foil were found in his wallet. David Trone D-Md. State Sen. Fentanyl has been infiltrating the illicit drug supply for roughly a decade, since traffickers seized on the synthetic drug as a cheaper alternative to traditional opiates — and one with a higher profit margin. The U. Centers for Disease Control and Prevention has described fentanyl as up to 50 times stronger than heroin. A dose as small as 2 milligrams can be fatal. Light blue pills. Fentanyl-laced fake oxycodone pills. Then, it began appearing in counterfeit pills made to look like the real thing. Getting one of those pills still required a willingness to engage in illicit street deals. But to many users, the faux pharmaceuticals seemed safer than drugs that required shooting or snorting. Accordingly, street pills found a much larger market than powders. If those pills can now be purchased in legitimate pharmacies, that market becomes larger still. Were you or someone you know harmed by pills in Mexico? We want to hear from readers about their experience. Let us know by filling out this brief form. Stroll past the picturesque stores and yacht-lined docks of Cabo San Lucas. A harbor with yachts and buildings on hills in the background. Cabo San Lucas. Some have sandwich board signs on the sidewalk advertising pills. In Cabo San Lucas, one shop near a large dockside shopping mall featured a few racks of toys inches away from stacked boxes of medication. Illustration of three pills. They asked how strong the pills were. None of the pharmacists inquired further. Invariably, the tablets were kept in some hidden spot. Though bottles of less tightly controlled medications like Xanax or Viagra or Ultram were often on display in glass cases, more powerful and more closely regulated substances like oxycodone — whether real or fake — were secreted away. Pharmacies such as these accept payment in most any format — credit card, pesos or dollars. At one store in Tijuana, all the drugs turned out to be legitimate — or at least they did not contain fentanyl. A pill on a piece of paper. Testing on an Adderall pill came back positive for meth in Cabo San Lucas. Among the three cities, several stores declined to sell the pills individually, and two refused to sell them without a prescription. Though roughly a third of the 40 pharmacies targeted in the study would not sell high-powered prescription drugs over the counter, the majority did. With their more precise equipment, the researchers were able to get more granular results — and to determine that three of the oxycodone samples were positive for heroin. They, like The Times, also found that all of the counterfeit pills came from stores in areas frequented by tourists, in locations that often featured English-language medication advertisements. A silhouetted person walks by a pharmacy. A pharmacy in Cabo San Lucas. State Department, meanwhile, noted two drug-related deaths of Americans in Mexico that year. Cabo San Lucas is a major draw for American tourists. But cartels knew they could make more money by producing it themselves. In the years that followed, the amount of fentanyl seized by U. Customs and Border Protection more than tripled, from 4, pounds in to 14, pounds last year. But pharmacy owners are most likely not buying directly from the criminal organizations. When reporters visited last month, at least a few drugstore workers seemed aware their over-the-counter offerings were unusually potent. He was differentiating between two pills he presented when asked for oxycodone: the one he pointed out, which later tested positive for fentanyl, and one that came up negative. Given the shortcomings in Mexican death data, spotting those deaths could be difficult — which means cartels will have little reason to curb their pill trade. Over the course of a year, we recently lost , sons, daughters, moms, and dads to drug overdoses. Millions are suffering from mental illness, exacerbated by the pandemic. Together, we must take action to save lives. For more resources click here. February 02, Some pharmacies in Mexico passing off fentanyl, meth as legitimate pharmaceuticals. Are you, or someone you know, struggling with a mental health or substance use disorder? You are not alone.
Tijuana buying Heroin
Some pharmacies in Mexico passing off fentanyl, meth as legitimate pharmaceuticals
Tijuana buying Heroin
Tijuana buying Heroin
Some pharmacies in Mexico passing off fentanyl, meth as legitimate pharmaceuticals
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Tijuana buying Heroin
Tijuana buying Heroin
Tijuana buying Heroin