Mexico eager to reduce demand for illicit drugs

Abstract

Mexico is spending millions of dollars to set up a national network of prevention and treatment programmes for people who use illicit drugs. David Boddiger reports from Mexico City.In 1972, Mexican President Luis Echeverría met US counterpart Richard Nixon to discuss the latter president's idea for a joint war on drugs to slow the USA's growing dependence on illicit drugs. Today, the USA has the highest demand for illicit drugs in the world, and Mexico has a growing problem of its own.40 years after Nixon announced his war on drugs, both administrations seem eager for a new approach that relies more heavily on evidence-based programmes that target demand as well as supply. After announcing the Obama administration's abandonment of the phrase war on drugs, recently appointed US drug czar Gil Kerlikowske visited Mexico City last July, where he agreed to support Mexico's demand-reduction efforts. 1 month later, Mexico's President, Felipe Calderón signed into law a bill that decriminalises possession of small amounts of illicit drugs. “There has been a 180-degree change of course by the USA in terms of demand reduction, and I can't overstate how important that is for us”, says Carlos Rodríguez, head of Mexico's National Council on Addictions (Conadic), a government-run agency within the health ministry. “It seems to us that (US officials) recognise they have a problem and that we share a common responsibility to address it…This is an excellent opportunity to re-establish our priorities in terms of demand reduction”, Rodríguez said.The law, which targets high-level drug dealers by allowing local authorities jurisdiction in drug cases, also seeks to provide people who use drugs with access to medical treatment instead of sending them to jail on possession charges. In 2006, the same bill was vetoed by then-president Vicente Fox under pressure from the Bush administration. “It doesn't make sense to criminalise an addict”, says Ernesto Saro, president of Mexico's Senate Health Committee. “Before this law, we fostered the cycle of addiction. An addict is not responsible for drug trafficking. An addict is a victim of it”, Saro said.President Calderón's willingness to collaborate with the USA to combat drug trafficking was clear from the start of his administration. In 2008, the two countries announced the Merida Initiative, a US$400 million project to aid Mexico and central America in combating drug trafficking cartels. Only $11 million is to be used to target demand-reduction programmes in Mexico, but Calderón's government has used confiscated drug money to finance drug prevention and treatment programmes throughout the country.The most publicised effort is a national network of prevention and treatment centres in high-risk communities. The programme, called New Life, combines already existing treatment centres with 330 new centres, most of them already built. According to Rodríguez, the Mexican Government has spent $194 5 million in the past 2 years to build and staff these centres. Most of that funding was seized during a 2007 drug raid that netted $250 million from traffickers of ephedrine, a key component used in the manufacture of crystal meth-amphetamines.A recent national drug survey, released last October, shows an increase in consumption of illicit drugs of less than 1% among individuals 12–62 years, from 5 million to 6 million Mexicans. However, the number of people who said they have used cocaine in the last year doubled from 1·2% to 2·4% during the same period.And although the number of Mexicans who say they have used crack cocaine or methamphetamines in the past year is still less than 1% of the population, both numbers have increased six-fold in the past 6 years.“The group that is most likely to experiment with illicit substances and develop a dependency are those aged 12 to 17 [years]”, says Armando Patron, director of addictions at Conadic. “Today's youth are more likely than ever to abuse illegal drugs, and this is where we need to put the brakes on.”Arturo Ortiz, a researcher at Mexico's National Institute of Psychiatry and author of a biannual diagnostic on substance abuse in Mexico City, agrees: “My impression is that there are millions of young Mexicans who are exposed to an increasing supply of cheap drugs. For $2·30 you can buy a bag of cocaine and become a user.”According to Rodríguez, New Life centres can resolve 70% of at-risk cases through early detection, whereas more serious cases are referred to other clinics. Mexico's demand-reduction network also includes 110 treatment clinics operated by the Centre for Youth Integration (CIJ), a government-funded non-profit organisation that treats drug dependency and offers community-based prevention initiatives. All but ten are outpatient or prevention facilities.CIJ's strategy is to approach drug dependency treatment as both a public health issue and an opportunity for community involvement, says Otoniel Cardenas, CIJ's director of treatment and rehabilitation. Community groups are responsible for choosing a centre's location and overseeing its management.The total number of inpatient drug treatment clinics in Mexico is unclear. Estimates range from 1300 to 1730 clinics. Ten are operated by CIJ, and 20 are operated by individual states. The remaining treatment centres are privately managed, and although some of them are staffed with health professionals, hundreds are not.Some private rehabilitation facilities—known locally as annexes because they are offshoots of Alcoholics Anonymous or Narcotics Anonymous centres—have become notorious for abusive or otherwise harmful practices.Although these centres are required by law to be certified by the health ministry, a lack of inspectors means there is little oversight. Run by recovering addicts, family members of addicts, or religious advocates, patients in some of these centres are locked in overcrowded rooms with no access to professional medical treatment.Annexes have also been recent targets of violence, particularly in the border state of Chihuahua. In the past year, 29 people have been murdered in private rehabilitation centres in the state, most of them in Ciudad Juarez. Eight centres have since voluntarily shut down.Most of the violence is attributable to drug cartel assassins. Overall, drug cartel-related violence has claimed the lives of more than 14 000 people in the past 3 years. Cartels have not yet targeted publicly managed clinics, but no one has ruled out the possibility.33-year-old Antonio (not his real name) has seen both the worst and best of Mexico's addiction treatment programmes. Addicted to crack at 25 years, Antonio spent 8 years in a drug and alcohol haze. He lost his job and separated from his wife and young daughter. Antonio sought treatment at two different annexes. In one, they shaved his head and locked him in a room with 30 other men. Treatment was supposed to last 3 months, but within 2 months Antonio was back on the street getting high. “I needed the drugs in my system”, Antonio said. “Those places are horrible. They shouldn't be allowed to exist.”Eventually he made his way to a CIJ treatment clinic—the same one Kerlikowske visited last July. Located in the impoverished Iztapalapa neighbourhood of Mexico City, the 36-bed clinic is an example of Mexico's ability to treat drug addiction given proper funding. The quality of care at the clinic is excellent. For a cost of $2·15 per day—less than a bag of cocaine—patients receive 24-h care in a medical environment for 3 months. Treatment includes detoxification, group and individual therapy, psychological and psychiatric care, access to recreational facilities, post-treatment follow-up care, and family therapy.Psychologist Ricardo Pérez, who has worked at CIJ for 12 years, is the clinic's director. He spends most days with the patients and is involved in every aspect of their treatment. “While our patients come from various circumstances, many seek treatment here because they've been to the annexes and they didn't help”, Pérez says. “By the time they reach us, many patients have post-traumatic stress disorder.”In 2 months, Antonio has made considerable progress. Treatment has given him the means to reintegrate into society and coexist with others, something he had lost while battling his addiction.The Iztapalapa clinic has a yearly operating budget of about $311 000, or about $8639 per patient. For a country with 51% of the population (55 million people) living below the poverty line, it is clear that Mexico needs cost-effective solutions as the availability and potency of illicit drugs continues growing.At the José María Rodríguez New Life Centre in Mexico City, two energetic young psychologists and a receptionist have been running the centre since it opened last May. They mostly work on early detection at three nearby schools. Standard questionnaires have helped identify 60 at-risk students out of 450, says centre coordinator Osvelia Valadez. But only three students have made it to the centre for follow-up intervention sessions, she says.Although Valadez is candid about the centre's little initial success, she is upbeat about the future. “I've worked in the field of addiction for a few years and until now I've never seen a significant budget, government interest, and certainly not a strategy on such a national scale”, she said. Mexico is spending millions of dollars to set up a national network of prevention and treatment programmes for people who use illicit drugs. David Boddiger reports from Mexico City. In 1972, Mexican President Luis Echeverría met US counterpart Richard Nixon to discuss the latter president's idea for a joint war on drugs to slow the USA's growing dependence on illicit drugs. Today, the USA has the highest demand for illicit drugs in the world, and Mexico has a growing problem of its own. 40 years after Nixon announced his war on drugs, both administrations seem eager for a new approach that relies more heavily on evidence-based programmes that target demand as well as supply. After announcing the Obama administration's abandonment of the phrase war on drugs, recently appointed US drug czar Gil Kerlikowske visited Mexico City last July, where he agreed to support Mexico's demand-reduction efforts. 1 month later, Mexico's President, Felipe Calderón signed into law a bill that decriminalises possession of small amounts of illicit drugs. “There has been a 180-degree change of course by the USA in terms of demand reduction, and I can't overstate how important that is for us”, says Carlos Rodríguez, head of Mexico's National Council on Addictions (Conadic), a government-run agency within the health ministry. “It seems to us that (US officials) recognise they have a problem and that we share a common responsibility to address it…This is an excellent opportunity to re-establish our priorities in terms of demand reduction”, Rodríguez said. The law, which targets high-level drug dealers by allowing local authorities jurisdiction in drug cases, also seeks to provide people who use drugs with access to medical treatment instead of sending them to jail on possession charges. In 2006, the same bill was vetoed by then-president Vicente Fox under pressure from the Bush administration. “It doesn't make sense to criminalise an addict”, says Ernesto Saro, president of Mexico's Senate Health Committee. “Before this law, we fostered the cycle of addiction. An addict is not responsible for drug trafficking. An addict is a victim of it”, Saro said. President Calderón's willingness to collaborate with the USA to combat drug trafficking was clear from the start of his administration. In 2008, the two countries announced the Merida Initiative, a US$400 million project to aid Mexico and central America in combating drug trafficking cartels. Only $11 million is to be used to target demand-reduction programmes in Mexico, but Calderón's government has used confiscated drug money to finance drug prevention and treatment programmes throughout the country. The most publicised effort is a national network of prevention and treatment centres in high-risk communities. The programme, called New Life, combines already existing treatment centres with 330 new centres, most of them already built. According to Rodríguez, the Mexican Government has spent $194 5 million in the past 2 years to build and staff these centres. Most of that funding was seized during a 2007 drug raid that netted $250 million from traffickers of ephedrine, a key component used in the manufacture of crystal meth-amphetamines. A recent national drug survey, released last October, shows an increase in consumption of illicit drugs of less than 1% among individuals 12–62 years, from 5 million to 6 million Mexicans. However, the number of people who said they have used cocaine in the last year doubled from 1·2% to 2·4% during the same period. And although the number of Mexicans who say they have used crack cocaine or methamphetamines in the past year is still less than 1% of the population, both numbers have increased six-fold in the past 6 years. “The group that is most likely to experiment with illicit substances and develop a dependency are those aged 12 to 17 [years]”, says Armando Patron, director of addictions at Conadic. “Today's youth are more likely than ever to abuse illegal drugs, and this is where we need to put the brakes on.” Arturo Ortiz, a researcher at Mexico's National Institute of Psychiatry and author of a biannual diagnostic on substance abuse in Mexico City, agrees: “My impression is that there are millions of young Mexicans who are exposed to an increasing supply of cheap drugs. For $2·30 you can buy a bag of cocaine and become a user.” According to Rodríguez, New Life centres can resolve 70% of at-risk cases through early detection, whereas more serious cases are referred to other clinics. Mexico's demand-reduction network also includes 110 treatment clinics operated by the Centre for Youth Integration (CIJ), a government-funded non-profit organisation that treats drug dependency and offers community-based prevention initiatives. All but ten are outpatient or prevention facilities. CIJ's strategy is to approach drug dependency treatment as both a public health issue and an opportunity for community involvement, says Otoniel Cardenas, CIJ's director of treatment and rehabilitation. Community groups are responsible for choosing a centre's location and overseeing its management. The total number of inpatient drug treatment clinics in Mexico is unclear. Estimates range from 1300 to 1730 clinics. Ten are operated by CIJ, and 20 are operated by individual states. The remaining treatment centres are privately managed, and although some of them are staffed with health professionals, hundreds are not. Some private rehabilitation facilities—known locally as annexes because they are offshoots of Alcoholics Anonymous or Narcotics Anonymous centres—have become notorious for abusive or otherwise harmful practices. Although these centres are required by law to be certified by the health ministry, a lack of inspectors means there is little oversight. Run by recovering addicts, family members of addicts, or religious advocates, patients in some of these centres are locked in overcrowded rooms with no access to professional medical treatment. Annexes have also been recent targets of violence, particularly in the border state of Chihuahua. In the past year, 29 people have been murdered in private rehabilitation centres in the state, most of them in Ciudad Juarez. Eight centres have since voluntarily shut down. Most of the violence is attributable to drug cartel assassins. Overall, drug cartel-related violence has claimed the lives of more than 14 000 people in the past 3 years. Cartels have not yet targeted publicly managed clinics, but no one has ruled out the possibility. 33-year-old Antonio (not his real name) has seen both the worst and best of Mexico's addiction treatment programmes. Addicted to crack at 25 years, Antonio spent 8 years in a drug and alcohol haze. He lost his job and separated from his wife and young daughter. Antonio sought treatment at two different annexes. In one, they shaved his head and locked him in a room with 30 other men. Treatment was supposed to last 3 months, but within 2 months Antonio was back on the street getting high. “I needed the drugs in my system”, Antonio said. “Those places are horrible. They shouldn't be allowed to exist.” Eventually he made his way to a CIJ treatment clinic—the same one Kerlikowske visited last July. Located in the impoverished Iztapalapa neighbourhood of Mexico City, the 36-bed clinic is an example of Mexico's ability to treat drug addiction given proper funding. The quality of care at the clinic is excellent. For a cost of $2·15 per day—less than a bag of cocaine—patients receive 24-h care in a medical environment for 3 months. Treatment includes detoxification, group and individual therapy, psychological and psychiatric care, access to recreational facilities, post-treatment follow-up care, and family therapy. Psychologist Ricardo Pérez, who has worked at CIJ for 12 years, is the clinic's director. He spends most days with the patients and is involved in every aspect of their treatment. “While our patients come from various circumstances, many seek treatment here because they've been to the annexes and they didn't help”, Pérez says. “By the time they reach us, many patients have post-traumatic stress disorder.” In 2 months, Antonio has made considerable progress. Treatment has given him the means to reintegrate into society and coexist with others, something he had lost while battling his addiction. The Iztapalapa clinic has a yearly operating budget of about $311 000, or about $8639 per patient. For a country with 51% of the population (55 million people) living below the poverty line, it is clear that Mexico needs cost-effective solutions as the availability and potency of illicit drugs continues growing. At the José María Rodríguez New Life Centre in Mexico City, two energetic young psychologists and a receptionist have been running the centre since it opened last May. They mostly work on early detection at three nearby schools. Standard questionnaires have helped identify 60 at-risk students out of 450, says centre coordinator Osvelia Valadez. But only three students have made it to the centre for follow-up intervention sessions, she says. Although Valadez is candid about the centre's little initial success, she is upbeat about the future. “I've worked in the field of addiction for a few years and until now I've never seen a significant budget, government interest, and certainly not a strategy on such a national scale”, she said.