The Mexican Experience: Fight Against Consumption

2015

Epidemiology

But Mexico is not only a drug-exporting country. A number of complexly interrelated factors have accounted for an alarming increase in domestic consumption.

Estimates show that the problem is essentially an urban one. In rural areas, although one can find certain towns where drugs still are employed in religious rituals or simply as an element in the subculture of the group, drug abuse as such is not considered a problem that affects public health.

The majority of urban drug abusers range in age from 12 to 21 years. The younger set uses inhalants and solvents, while the older group usually uses marihuana. It seems certain that the use of barbiturates and amphetamines is on the increase. Barbiturates and tranquilizers are preferred by young adults. At present there is a problem of hard drugs such as opium and its derivatives among a group along the northern border of the country, where an increase has been observed in the number of Mexicans taking heroin ().

The highest percentage of drug experimentation and use appears to be among preadolescent and adolescent males and young adult females. In general, however, lower-class youths tend to use industrial-type solvents, which are cheap and easily obtainable, while middle- and upper-class teenagers and young adults favor marihuana, barbiturates, and amphetamines (table General Characteristics of Drug Abuse in Mexico).

Table General Characteristics of Drug Abuse in Mexico

Geography: Urban (Heroin abuse in northern border.)

  • Age: Mainly between 12 and 21 years
  • Adolescents: inhalants
  • Adolescents and young adults: marihuana
  • Young adults: barbiturates and tranquilizers

Sex: Mainly male

  • Social class:
  • Lower: inhalants
  • Middle and upper: marihuana, barbiturates, and amphetamines

Certain figures may give a more accurate image of the magnitude of drug abuse in Mexico. Use of psychotropic drugs and opium derivatives affects great numbers of people. In 1974, 87 percent of the population 14 years and older then living in Mexico City had taken one or more of these drugs, and 35 percent were doing so on a customary basis, that is, every day for a minimal period of one week during at least six months (). Obviously, medical prescriptions are responsible for a high proportion of these cases. Use of amphetamines through prescriptions thus accounts for 90 percent of all users, who, in turn, represent a total of 2.34 percent of the Federal District population. For its part, barbiturate abuse affects 4.20 percent of the capital’s dwellers 14 years of age and older (table Percentage of Drug Users, 14 Years and Older, in the Federal District).

Table Percentage of Drug Users, 14 Years and Older, in the Federal District

Drug Percent of Population
Psychotropic drugs and opium derivatives

87.00

Amphetamines

2.34

Barbiturates

4.20

Marihuana

1.31

Inhalants

0.40

Hallucinogens

0.31

Heroin

0.10

Regarding marihuana, the estimates are that in the Federal District alone 66,000 nonregular users can be found (). After the above-mentioned drugs, marihuana is the most favored drug among the age group 14 and older, of which 1.31 percent have already tried it. Furthermore, eight out of every thousand individuals between 14 and 24 years of age — 0.84 percent — use it on a regular, customary basis ().

Inhalant abuse constitutes one of the worst problems of drug addiction in Mexico. It is estimated that 20,087 individuals representing 0.40 percent of the Federal District population 14 years and older, have used this kind of drug. Three of every thousand individuals between 14 and 24 years of age — 0.31 percent — use it on a regular, customary basis (). These figures, however, do not include two high-risk groups: the home-lacking population and the less-than-14 population, where inhalation is quite common. Indeed, the average starting age of inhalating patients at the Centers of Juvenile Integration — institutions which we will deal with shortly — was 14 years. Nevertheless, several community studies carried out in different areas of the Republic show that starting ages are much earlier, even 5 or 6 years (). In fact, more than half of the patients treated at the Centers of Juvenile Integration — 52 percent — come there because of substance inhalation problems. Figure “Substance Inhalation Incidence Rate for Each Treatment Center in the Mexican Republic 1976” shows the annual incidence rate for each Center. It can be observed that the highest incidence rate is that of Ciudad Netzahualcóyotl, where 87 out of every 100 residents use inhaled substances. It is important to note that Ciudad Netzahualcóyoti is part of Mexico City’s metropolitan area, and a majority of its population is composed of rural immigrants who are extremely marginal economically, socially, and culturally. Figure “Starting Year for Intake of Inhalant Substances” shows the incidence curve representing the number of cases started in different years. An increase beginning in 1968 and continuing from 1970 through 1975 can be observed. One possible explanation for this may be the fact that these Centers of Juvenile Integration, only recently opened, are perhaps treating few cases which started before 1970. We must not dismiss the possibility, however, that a marked increase in the use of inhalants has actually taken place. The 1976 decline is explained by the fact that the diagram was done when only four months of that year had elapsed. This fact might suggest that in 1976 there was really an increase in use (), although further epidemiological studies are required to give this phenomenon an accurate definition. It must be noted, however, that the growth rates of both inhalant and marihuana abuse, estimated from information obtained at the treatment centers, are far from encouraging: growth rates from 1970-1975 throughout the country are 40 percent for marihuana and 45 percent for inhalants

().

Other relatively less used drugs are hallucinogens and heroin. Hallucinogens have been used by 0.31 percent of the capital’s population 14 years and older, and heroin by 0.10 percent (Table Percentage of Drug Users, 14 Years and Older, in the Federal District). It must be noted, however, that the latter figure refers to heroin use in the Federal District, whereas heroin abuse is alarmingly increasing in towns along the northern border of the country. Thus, 40 percent of the patients treated in 1973 at the Tijuana, Baja California, Center of Juvenile Integration used opium derivatives, and in 1974 there was a 5 percent increase. In Nogales, Sonora, incidence of heroin abuse was twice as great in 1973 as in 1972, and ten times greater than in 1971. Of the patients treated in 1975 and 1976 at the Nogales Center of Juvenile Integration, 75 percent were heroin addicts ().

In view of this situation, it has been necessary to design an action strategy against drugs that is not limited to the repression of drug traffic but also contemplates, in an integral fashion, the prevention of drug addiction and the treatment and rehabilitation of affected individuals.

Creation of CEMEF

With the purpose of creating an organization to coordinate and promote different activities involved in the struggle against abused drugs, the Mexican Center for Drug Abuse Studies (CEMEF) was officially founded on August 4, 1972, by presidential instructions. In February 1975, it achieved legal status as a decentralized agency of the Federal Executive, with its own budget.

In accordance with its character as a coordinating and promoting organization, CEMEF has had a governing structure whose top authority is represented by the Board of Directors which, in turn, is presided over by the Secretary of Health and Welfare. The Secretaries of the Interior and Public Education, the Attorney General of the Republic, the Attorney General of the Federal District, and the Director General of the Center itself are also members of the Board.

CEMEF has carried out the following activities: biomedical and social research to determine the way in which the drug addict population is affected; evaluation of the incidence and prevalence of specific types of drug use and abuse; predicting the evolution of the problem; training of personnel in diagnosis, treatment, rehabilitation, and primary prevention; provision of research elements for those involved in the area, and technical advice for both public and private organizations on related aspects; publication of its research findings; and the conclusion of agreements with similar national and foreign institutions on matters within its province ().

The government’s solid commitment to the task of fighting drug addiction was internationally acknowledged when CEMEF was designated, in September 1976, as the World Health Organization’s Regional Center for drug addiction research and higher instruction.

Centers of Juvenile Integration

The private sector and the community have played a major role in the struggle against consumption. Centers of Juvenile Integration created in March 1971 sprang from a pilot project initiated in 1970. The Centers have a tripartite structure which includes the federal government, the state governments, and the community. Currently there are 30 Centers throughout the Mexican Republic, which provide an infrastructure for treatment, rehabilitation and prevention work.

The Centers of Juvenile Integration are far-reaching institutions of high standing in the treatment and rehabilitation of drug abusers. Up to 1976, the total number of drug addicts treated at these Centers was 6,630 (). Their staff includes psychiatrists, psychologists, social workers, psychiatric nurses, and volunteers. A wide range of treatment is provided at the Centers, including pharmacotherapy; individual, family and group therapy; occupational therapy; and recreational therapy. Some Centers run employment bureaus; one of them has a day center as well. In addition to secondary and tertiary prevention tasks, the Centers of Juvenile Integration perform community work leading to early case finding and implementation of primary prevention measures.

Other institutions for drug addiction treatment are currently in existence. Special emphasis must be placed upon the Community Mental Health Centers, whose primary purpose is to give both the family and the community the opportunity to learn to treat the patient. The Centers are not limited to illicit drug problems, but also deal with alcohol and other mental health problems. There are six Centers and two hospitals offering this kind of service in key locations throughout Mexico City. There is another in Veracruz, and the northern border will soon see the opening of still one more.

Mexico also benefits from a foster home program for children who inhale solvents. Under this program, ten adopted children are supplied with a home, food, schooling, and affection. The treatment pattern is behaviorally oriented, and the child is encouraged to abandon inhalation practices. The program has a year’s duration, after which the child returns to its own home, if it had one, or is provided with one, with followup studies being done. This program is currently under experimentation at two Centers, one in Acapulco and the other in the Federal District.

On the other hand, a program against alcoholism involves the greater part of the rehabilitation budget. Under this program, an Alcoholic Rehabilitation Center provides a Federal District area with psychiatric, detoxification, and control services benefitting approximately 300,000 residents. There are also aid centers for alcoholics and their relatives which are run by Alcoholics Anonymous. A program against alcoholism in the rural areas is currently under study.

Finally, one more effort in the struggle against drug addiction is embodied in a heroin addiction treatment program sponsored by the Ministry of Health and Welfare. Treatment is based on substitution of morphine for heroin, and it reaches approximately 40 people. This is an old program, now under evaluation. Methadone is not used in Mexico.

Mexico’s experience in fighting drug-related problems has therefore covered all fronts of action, with the participation of wide sectors of society.

 

Selections from the book: “The International Challenge of Drug Abuse”. Robert C. Petersen, Ph.D., editor. A monograph based on papers presented at the World Psychiatric Association 1977 meeting in Honolulu. Emphasis is on emerging patterns of drug use, international aspects of research, and therapeutic issues of particular interest worldwide. National Institute on Drug Abuse Research Monograph 19, 1978.