The introduction of fentanyl on the US–Mexico border: An ethnographic account triangulated with drug checking data from Tijuana

Friedman, Joseph; Bourgois, Philippe; Godvin, Morgan; Chavez, Alfonso; Pacheco, Lilia; Segovia, Luis A.; Beletsky, Leo; Arredondo, Jaime

doi:10.1016/j.drugpo.2022.103678

Cited by 22 publications

(17 citation statements)

References 35 publications

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“…The rise of deaths involving cocaine and methamphetamine must be understood in the context of a shifting illicit opioid drug market increasingly dominated by illicit fentanyls 10 . Recent ethnographic and qualitative research suggests that fentanyls have created conditions that make polysubstance use more desirable and commonplace 13,14 . For instance, many individuals report that mixing a small amount of methamphetamine into injected doses of fentanyl subjectively prolongs the onset of withdrawal symptoms, increases euphoria, decreases overdose risk, and improves energy levels required to continue to collect funds for the next set of drug purchases [13][14][15] .…”

Section: Discussionmentioning

confidence: 99%

“…Recent ethnographic and qualitative research suggests that fentanyls have created conditions that make polysubstance use more desirable and commonplace 13,14 . For instance, many individuals report that mixing a small amount of methamphetamine into injected doses of fentanyl subjectively prolongs the onset of withdrawal symptoms, increases euphoria, decreases overdose risk, and improves energy levels required to continue to collect funds for the next set of drug purchases [13][14][15] . These perceived advantages may be particularly important given the short duration of fentanyls, requiring individuals to inject far more frequently than heroin, and the heightened overdose risk from each injection 10 .…”

Section: Discussionmentioning

confidence: 99%

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Charting the Fourth Wave: Geographic, Temporal, Race/Ethnicity, and Demographic Trends in Polysubstance Fentanyl Overdose Deaths in the United States, 2010-2021

Friedman

Shover

2022

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Aims: To characterize polysubstance death in the United States during the transition to the fourth wave of the overdose crisis. To characterize co-involved substances in fatal overdose involving synthetic opioids (mainly illicitly manufactured fentanyl analogs) by year, state, and intersectional sociodemographic groups. Design: Population-based cohort study of national death records. Setting: United States. Participants/Cases: People who died from drug overdose in the United States between 2010-2021. Measurements: Percentage of all fatal overdose involving fentanyls, stimulants, and other drugs. Most commonly co-involved substances in fentanyl overdose by state and year. Percentage of fatal fentanyl overdose co-involving stimulants by state and year. Percentage of fatal fentanyl overdose co-involving stimulants by intersectional region, race/ethnicity, age, and sex. Findings: The percent of US overdose deaths involving both fentanyl and stimulants concurrently rose nearly 60-fold, from 0.6% (n=235) in 2010 to 32.3% (n=34,424) in 2021. In 2010, fentanyl was most commonly found alongside prescription opioids, benzodiazepines, and alcohol. In the Northeast this shifted to heroin-fentanyl co-involvement in the mid-2010s, and nearly universally to cocaine-fentanyl co-involvement by 2021. Universally in the West, and in the majority of states in the South and Midwest, methamphetamine-fentanyl co-involvement predominated by 2021. The proportion of stimulant involvement in fentanyl-involved overdose deaths rose in virtually every state 2015-2021. Cluster analysis reveals particularly high rates for older Black and African American individuals living in the West. Conclusions: By 2021 stimulants were the most common drug class found in fentanyl-involved overdoses in every state in the US. The rise of deaths involving cocaine and methamphetamine must be understood in the context of a drug market dominated by illicit fentanyls, which have made polysubstance use more desirable and commonplace. The widespread concurrent use of fentanyl and stimulants, as well as other polysubstance formulations, presents novel health risks and public health challenges. Ongoing nuanced surveillance is needed to track this rapidly shifting phenomenon.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Charting the Fourth Wave: Geographic, Temporal, Race/Ethnicity, and Demographic Trends in Polysubstance Fentanyl Overdose Deaths in the United States, 2010-2021

Friedman

Shover

2022

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“…Although counterfeit prescriptions are described in the US illicit drug market-and it is well-known that a large portion of the IMF and methamphetamine that are pressed into counterfeit prescription drugs sold in the US originate in Mexico 15,16 -the prevalence of their consumption among PWUD in Mexico is not well-described in academic literature. Previous drug checking and ethnographic studies have characterized the arrival of IMF to Tijuana and elsewhere in Mexico, especially in the form of China White (ostensibly powder heroin, often found containing fentanyl), which has increased in prevalence in recent years 3,17 . However, previous ethnographic literature describing illicit drug supply chains in Mexico indicate that a complicated and varying set of cartel politics and on-the-ground dynamics limit which products are sold in Mexico versus those exclusively earmarked for export to the US 3,18 .…”

Section: Introductionmentioning

confidence: 99%

“…Previous drug checking and ethnographic studies have characterized the arrival of IMF to Tijuana and elsewhere in Mexico, especially in the form of China White (ostensibly powder heroin, often found containing fentanyl), which has increased in prevalence in recent years 3,17 . However, previous ethnographic literature describing illicit drug supply chains in Mexico indicate that a complicated and varying set of cartel politics and on-the-ground dynamics limit which products are sold in Mexico versus those exclusively earmarked for export to the US 3,18 . It should therefore not be assumed that illicit drug products produced in Mexico for export to the US-including counterfeit pills-are consumed by PWUD in Mexico.…”

Section: Introductionmentioning

confidence: 99%

“…Our ethnographic team has conducted longitudinal research focused on illicit drug markets in Northern Mexico since 2018 [1][2][3][4] . In 2021-2022, study participants-especially those who were US citizens that frequently visited in or stayed in Mexico to consume illicit drugs-began describing new, unusually potent medications, sold ostensibly as controlled substances, from pharmacies that cater to US tourists.…”

Section: Introductionmentioning

confidence: 99%

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Fentanyl, Heroin, and Methamphetamine-Based Counterfeit Pills Sold at Tourist-Oriented Pharmacies in Mexico: An Ethnographic and Drug Checking Study

Friedman

Godvin

Molina

et al. 2023

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Background Our ethnographic team has conducted longitudinal research focused on illicit drug markets in Northern Mexico since 2018. In 2021-2022, study participants described the arrival of new, unusually potent tablets sold as ostensibly controlled substances, without a prescription, directly from pharmacies that cater to US tourists. Concurrently, fentanyl- and methamphetamine-based counterfeit prescription drugs have driven escalating overdose death rates in the US, however their presence in Mexico has not been assessed. Aims To characterize the availability of counterfeit and authentic controlled substances at pharmacies in Northern Mexico available to English-speaking tourists without a prescription. Methods We employed an iterative, exploratory, mixed methods design. Longitudinal ethnographic data were used to characterize tourist-oriented micro-neighborhoods and guide the selection of n=40 pharmacies in n=4 cities in Northern Mexico. In each pharmacy, samples of 'oxycodone', 'Xanax', and 'Adderall' were sought as single pills, during English-language encounters, after which detailed ethnographic accounts were recorded. We employed immunoassay-based testing strips to check each pill for the presence of fentanyls, benzodiazepines, amphetamines, and methamphetamines. We used Fourier-Transform Infrared Spectroscopy to further characterize drug contents. Results Of 40 pharmacies, these controlled substances could be obtained in any form with no prescription at 68.3% and as single pills at 46.3%. Counterfeit pills were obtained at n=11 (26.8%) of pharmacies. Of n=45 samples sold as one-off controlled substances, n=20 were counterfeit including 9 of 11 (81.8%) of samples sold as 'Adderall' that contained methamphetamine, and 8 of 27 (29.6%) of samples sold as 'Oxycodone' that contained fentanyl, and n=3 'Oxycodone' samples containing heroin. Pharmacies providing counterfeit drugs were uniformly located in tourist-serving micro-neighborhoods, and generally featured English-language advertisements for erectile dysfunction medications and 'painkillers'. Pharmacy employees occasionally expressed concern about overdose risk and provided harm reduction guidance. Discussion The availability of fentanyl-, heroin-, and methamphetamine-based counterfeit medications in Northern Mexico represents a public health risk, and occurs in the context of 1) the normalization of medical tourism as a response to rising unaffordability of healthcare in the US, 2) plummeting rates of opioid prescription in the US, affecting both chronic pain patients and the availability of legitimate pharmaceuticals on the unregulated market, 3) the rise of fentanyl-based counterfeit opioids as a key driver of the fourth, and deadliest-to-date, wave of the opioid crisis. It is not possible to distinguish counterfeit medications based on appearance, because identically-appearing authentic and counterfeit versions are often sold in close geographic proximity. Nevertheless, US tourist drug consumers may be more trusting of controlled substances purchased directly from pharmacies. Due to Mexico's limited opioid overdose surveillance infrastructure, the current death rate from these substances remains unknown.

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Impact of an overdose reversal program in the context of a safe consumption site in Northern Mexico

Goodman‐Meza¹,

Slim²,

Angulo³

et al. 2022

Drug and Alcohol Dependence Reports

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The introduction of fentanyl on the US–Mexico border: An ethnographic account triangulated with drug checking data from Tijuana

Cited by 22 publications

References 35 publications

Charting the Fourth Wave: Geographic, Temporal, Race/Ethnicity, and Demographic Trends in Polysubstance Fentanyl Overdose Deaths in the United States, 2010-2021

Charting the Fourth Wave: Geographic, Temporal, Race/Ethnicity, and Demographic Trends in Polysubstance Fentanyl Overdose Deaths in the United States, 2010-2021

Fentanyl, Heroin, and Methamphetamine-Based Counterfeit Pills Sold at Tourist-Oriented Pharmacies in Mexico: An Ethnographic and Drug Checking Study

Impact of an overdose reversal program in the context of a safe consumption site in Northern Mexico

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