Every day, people cross the US-Mexico border with drugs – but not all of them are going north. Some head in the opposite direction with a hidden cargo of naloxone, a life-saving medicine that can reverse an opioid overdose but is so restricted as to be practically inaccessible in Mexico.
This humanitarian contraband is necessary because Mexico’s border cities have their own problems with opioid use – problems that activists and researchers say are being made more deadly by government policy.
“Mexico has long seen itself as a production and transit country, but not a place of consumption,” said Cecilia Farfán Méndez, a researcher at the University of California at San Diego. “And a lot of the conversation is still around that being a US problem – not a Mexican one.”
There are no accurate estimates of the number of opioid users in Mexico. A national survey in 2016 suggested that roughly 23,000 had used heroin in the previous year, but this is likely a gross underestimate of the true number.
Opioid use is concentrated in tourist spots like Cancún and cities along the US-Mexico border, and perhaps especially in Tijuana, the key node in fentanyl trafficking to the US.
Fentanyl, a potent synthetic opioid, has largely replaced heroin, causing a surge in overdoses – and more than 70,000 deaths in the US in 2022.
The number in Tijuana is unknown, because Mexico’s forensic service does not always test cadavers for fentanyl. And even when it does, it does not quantify the the amount of drugs in a body, meaning that the cause of death cannot be established as an overdose.
But Jaime Arredondo, a researcher associated with PrevenCasa, an NGO that helps drug users in Tijuana, estimates hundreds a year are dying from fentanyl overdoses in the city.
The situation has been exacerbated by a government policy that, aside from cutting budgets for harm reduction services like PrevenCasa, has also created shortages of life-saving medicines for opioid users.
In response to the fentanyl crisis, authorities in the US made naloxone available without a prescription. Naloxone vending machines have proliferated across the country.
But in Mexico naloxone remains strictly controlled – despite the efforts of some senators from Andrés Manuel López Obrador’s own party, Morena, who proposed a law to declassify it.
The president, popularly known as Amlo, has criticised naloxone, asking whether it did any more than “prolong the agony” of addicts, and questioning who stood to profit from its sale.
Olga Sánchez Cordero, one of the senators pushing to declassify naloxone, admitted there is resistance from those who view it as enabling addiction. But she thinks such concerns are far outweighed by the upside: “What is at stake is life itself.”
The restrictions in Mexico have been partly offset by people bringing small amounts of naloxone from the US, at the risk of being arrested and extorted by border officials.
The Guardian spoke to several people involved in this, all of whom asked to remain anonymous. They described the absurdity of handing contraband naloxone to Mexican police, firefighters and emergency responders, none of whom can readily access it themselves.
“There’s no doubt in my mind that most of the naloxone being used in Tijuana is being brought in from the US,” said one of them. “And beyond Tijuana, too.”
The lack of naloxone in Mexico has been made all the more dangerous by the ongoing shortage of methadone, another opioid provided to those who are trying to control or kick an addiction.
The shortage began after the government suspended production at Psicofarma, the only company that made methadone in Mexico, in February 2023, citing irregularities at the plant.
This caused the public methadone clinic in Tijuana to close, while private clinics went bust.
According to Steffanie Strathdee, a researcher studying the fallout, perhaps 1,000 people were receiving treatment at these clinics. Many relapsed, and went to buy what they could on the street. Today, that’s fentanyl – something far stronger than anything before.
Andrea, a 40-year-old woman who spoke on the condition of anonymity, said she started taking methadone when she got her first formal employment.
“I never thought I would be able to hold down a job,” said Andrea. “To have a life like normal people.”
She used to go to the clinic every morning and pay a few dollars for an oral dose that held the symptoms of withdrawal at bay.
One day, without warning, the clinic didn’t have any. And so she started buying on the street again. Her boyfriend injects it into her feet, so no one at work can see the marks.
It is unclear what happened to the many others who lost their treatment.
“There was no plan B: they simply cut the supply,” said Alfonso Chávez, PrevenCasa’s coordinator in Tijuana. “We’ve seen people coming to [PrevenCasa] who had been on methadone for 15 years.”
The suspension on Psicofarma was lifted in August, but there is still a shortage of methadone in Tijuana. Psicofarma did not respond to written questions.
The lack of naloxone and methadone are emblematic of the government’s turn away from a public health approach to drug use, and towards renewed criminalisation.
Public funds for health and harm reduction have stagnated or fallen, leaving PrevenCasa as the only organisation of its kind in Tijuana. Meanwhile media campaigns stigmatise drug use and soldiers fill the streets of the city.
“I voted for [López Obrador]. His discourse on drugs was completely different back then,” said Alfonso Chávez, PrevenCasa’s coordinator in Tijuana. “Instead, we’ve gone back 15 years.”
But with the national election in June 2024, there is potential for a change in policy.
Morena seems likely to retain the presidency through Claudia Sheinbaum, the former mayor of Mexico City who presents herself as a continuity candidate. Yet there are divergent voices within the party regarding drug policy – voices that may assert themselves once López Obrador leaves power.
One such voice is Senator Sánchez Cordero, who insists she still wants to see progress on laws to regulate marijuana and declassify naloxone, which stalled during the current government.
“I think we need to bet on prevention and rehabilitation – not on law enforcement,” said Sánchez. “On a society that can build peace and harmony – not threat and repression.”
