What's Up in Mexico?

#opioidepidemic, #substanceuse, #prescriptionmedication

I was a graduate of University of San Diego. Southern California life brings back wonderful memories including going to Tijuana, Mexico every other weekend to spend money on mud pottery and semi silver and gold jewelry. I was married to a Marine at the time and we drove our vehicles and didn’t worry about auto insurance consequences.

My first cousin was a graduate of the University of El Paso. I visited the Mexican boarder town there.

My former husband was a former Marine, and when my beloved son needed teenage disciple, we send him to summer camp in Harlingen Texan, another boarder town.

I never thought of myself as particularly fond of Mexico boarder towns. Even in college I wanted to go “deeper in “where the beaches were a bit better and the margaritas a bit less watery.

Most recently I went to Playa Del Carmen during the Carnaval event. Totally tourist. Several things took me to a Mexican tourist beach meca. Obviously fun, historical ruins and the joy of travel, but also a memory of medication without prescriptions. It was no big perk back when I was in college or when I was a military wife. Recently great insurance hasn’t been the case. I had a full-time job with a decent salary and had to select high deductible insurance due to cost.

So memories of prescription free medications didn’t flood back to me when I got to Playa del Carmen but I instantly was interested in my options for transport back home. What do I need? I am prescribed thyroid medication and hypertension medication. Every corner had a farmacia. The marque listed what we know as controlled substances like types of opioids and benzodiazepines among other options. Sleeping aid options, vigera and other male enhancement options.

My travel companion purchased over $500 In meds for her senior citizen relatives who were amazed that high cost medication was available prescription free. I purchased $150 worth of meds for myself, and my son who needs an excessively expensive asthma inhaler. I got carried away and purchased meds that I don’t currently need, like UTD meds, which I haven’t had in a while…thankfully, but I’m ready now if it happens.

My internal question soon became, what is the opioid situation here? I heard from credible sources that 1/3 of the Mexican population in the U.S. have an opioid addiction. Hum, I wonder how long they have been in the U.S.?

I started reading articles about opioid use in Mexico and here is what I found interesting.

Though opioid use in Mexico has been low, national and international factors are converging and a threat of increased drug and addiction rates exists. Many of these factors may have originated in the US, making this a potential joint US-Mexico epidemic. Previously, various cultural and legislative factors had combined to keep opioid use low in Mexico. These factors included physicians' difficulties in obtaining special prescription pads for controlled substances that included opioids; limits on the number of prescriptions per prescriber; strict guidelines on opioid storage; and the high cost of opioids in Mexico compared with their cost in North America. There was also a perception among Mexicans that opioids are only for the terminally ill, are illegal and are too expensive.

Yet, Mexico's population of residents ages 65 and older is expected to more than double by 2030, which means more people will be diagnosed with chronic diseases or cancer, calling for the use of opioids to relieve pain. In addition, a number of factors could lead to an overall increase in opioids -- and a potential epidemic -- in Mexico. These include: recent legislative changes there that make it easier to prescribe opioids; national health insurance coverage of opioids; pressure from pharmaceutical companies for Mexico to boost prescriptions to make up for stricter regulations and a dwindling market in the U.S.; increased heroin production and trafficking in Mexico; and the deportation of injection drug users to the country.

(The University of California - Los Angeles Health Sciences)

Misuse of prescription opioids in Mexico has been low. A recent national survey estimated that it occurred among less than 1% of respondents. The low prescription opioid misuse in Mexico is related to structural, cultural, and individual factors as outlined in the next sections.

In 2014, the structural barriers reported previously were highlighted in a report by Human Rights Watch, which stated that the lack of training for medical providers, their difficulties in prescribing opioids, and patient barriers to accessing palliative care services left many terminally ill patients needlessly in pain. This report, in conjunction with pressure from the Mexican Health Foundation (Fundación Mexicana para la Salud) and other palliative care organizations, led to the Mexican federal government approving measures relaxing some restrictions on opioid prescribing in 2015. These measures included an electronic prescription system, a bi-dimensional bar code for authentication of prescriptions, an increase in the number of available prescriptions to providers from 50 to 200 per prescription pad, and a decreased wait time for providers to receive prescriptions. These measures consequently led to a 50 000% increase in prescription opioid dispensations within 1 year. Prescribing providers were mostly pain management specialists, with close to three quarters of prescriptions concentrated in Mexico’s 3 largest metropolitan areas: Mexico City, Guadalajara, Monterrey.

Because of the previous inaccessibility of opioids and low prescribing, Mexican providers (e.g., doctors and dentists) may need additional training to deter inappropriate prescribing and identify and refer opioid misuse. Evidence-based prescribing methods are being adopted and tested in the United States and could be tailored for Mexican providers. Furthermore, future generations of clinicians should receive this training during medical school education. In a 2012 report by the Latin American Association of Palliative Care.

(Goodman-Meza, D., Medina-Mora, M. E., Magis-Rodríguez, C., Landovitz, R. J., Shoptaw, S., & Werb, D. (2019). Where Is the Opioid Use Epidemic in Mexico? A Cautionary Tale for Policymakers South of the US-Mexico Border. American journal of public health, 109(1), e1–e10. Advance online publication. doi:10.2105/AJPH.2018.304767)

So now I’m not only interested but confused as to what specifically requires a prescription in Mexico. What I know for sure is these things in my photo didn’t require a script, so what is a pain pill in that case?

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