Juan’s journey used to be an easy one.
He would walk over the border from Tijuana to San Diego to pick up bundles of naloxone, the life-saving medicine that reverses opioid overdoses. He would smuggle the medicine, which is highly restricted in Mexico, back over the bridge in his bag and hand it out to drug users he knows, hoping it would save lives; in Mexico’s border cities, the deadly drug fentanyl is increasingly showing up in the local heroin supply.
But since March, COVID-19 travel restrictions across the U.S.-Mexico border have only allowed for essential travel. This means Juan and other naloxone smugglers like him have not been able to make these vital, but illicit, crossings for four months. As a result, naloxone – known under its brand name Narcan in the U.S. – has become a scarce commodity in Mexico’s border cities, and more drug users are dying as a result.
“Since lockdown we’ve seen more fatal overdoses, because naloxone is getting harder and harder to get,” said Juan, whose name has been changed to protect his identity. “Right now, it’s in San Diego, and we can’t cross. There is no one to bring it to us and we don’t have any.”
In Mexicali, a border city a two-hour drive from Tijuana, naloxone is also in short supply. “We’ve given most of our supply away these past months because we’re dealing with a lot of overdoses,” said a source working in harm reduction.
Due to the opioid crisis and a rise of fentanyl-related overdoses, naloxone is widely distributed in the U.S. It has become a fixture in paramedic kits and harm reduction centers. But in Mexico, the medicine is government-restricted, expensive and requires a medical prescription. It is only available in hospitals for in-patients. Few ambulances have it, and none of the government-funded addiction treatment centers or private rehab clinics can buy it legally.
Gady Zabicky, head of Mexico’s federal anti-addiction agency, known as CONADIC, said that government resources in health have been diverted to the COVID-19 crisis, but that he is working to change federal laws and policies that restrict the use and distribution of naloxone. “Before we get a wave of deaths from fentanyl, we have to be ready for it,” he said.
But the wave is already building. Fentanyl first appeared in Mexico’s drug supply last year, mostly in white powder heroin known as “China White” in border cities such as Tijuana and Mexicali. But increasingly it is being detected in black tar heroin in those cities, users and harm-reduction workers told VICE News.
The problem is exacerbated by another consequence of the COVID-19 related border restrictions. “A lot of drugs are staying here now,” said Juan. The need for travel to be “essential” has reduced the amount of cars that can cross the international line. Private vehicles are the primary smuggling method for cartels moving drugs into the United States from Mexico, so some of the heroin meant for the U.S. has ended up staying in Mexico, creating a surfeit of supply and a jump in drug use.
What’s more, fentanyl is no longer just a problem in the border towns.
Ruben Diazconti – who works at a clinic in Mexico City that specialises in HIV-infection prevention and harm reduction for intravenous drug users – showed VICE News test strips he had done on heroin in June that came up positive for fentanyl. “The heroin I tested was China White, and it’s very common here in Mexico,” Diazconti said. He has no naloxone in his clinic.
Without naloxone, users who overdose are subjected to more improvised, mainly ineffective, ways of resuscitation: slaps in the face, salt injections or having the soles of their feet beaten or burned to bring them round.
"We share all the naloxone we can with drug users in Mexico. But because the Mexican government hasn't approved it for use, it's difficult to get," said Gilberto Perez, from the non-profit Alliance of Border Collaboratives in El Paso in the U.S, across the border from Ciudad Juarez.
Compared to the opioid crisis still ravaging the United States – fentanyl-related overdoses killed more than 37,000 people in 2019 – Mexico’s problem is still relatively small. But its exact scale is unknown due to a lack of official data. What information there is offers a blurred picture.
In 2017, 422 people received emergency medical attention for opioid use across the country. This nearly doubled in 2019 to 721 cases, according to data from CONADIC. Mexico reported 181 opioid overdoses in 2017 and 242 during 2019. Drug workers believe that these figures underestimate the scale of the problem. What’s more, drug overdose deaths are rarely registered properly, potentially hiding signs of a growing problem with opioids in Mexico.
“When people die from an overdose we sometimes don’t know, as it is recorded as heart failure or respiratory failure, or even heat stroke,” said Nadia Robles Soto, who oversees anti-addiction programs across the country for CONADIC. “There are often no lab tests to check if the death was due to an overdose. In the forensics departments, there is a real lack of resources, and this doesn’t give us clarity.”
The available government overdose figures for opioids do not discriminate between different types, such as heroin and fentanyl. But the rise in official drug death figures does coincide with the growth of illicit fentanyl production in Mexico by the country’s powerful drug cartels. Large seizures of fentanyl – in both powder and pill form – in Mexico continue, and have increased at the U.S.-Mexico border.
Zabicky said he hopes to make the distribution of naloxone widespread in Mexico before the end of the current administration, in four years. But that may not be soon enough, said Angelica Ospina-Escobar, the president of Mexico’s Harm Reduction Network, Redumex.
“We are talking about human lives that are being lost every day because of a lack of access to this medicine, due to excessive regulation. We need a fast emergency response."