Myths and realities about drug addiction in Mexico

16 de janeiro de 201114min10
The Lancet, Volume 377, Issue 9759, Pages 15 – 16, 1 January 2011
doi:10.1016/S0140-6736(10)62322-7Cite or Link Using

Mary Cuddehe

As the death toll from Mexico’s war on drugs continues to soar, a spate of attacks on recovering addicts has focused attention on the country’s domestic drug consumption. Mary Cuddehe reports.
One Sunday in early December, gunmen burst into two drug-rehabilitation centres in Ciudad Juarez, Mexico, killing four patients and wounding five. It was the latest of a series of attacks against drug-treatment facilities in the north of the country that began in the summer of 2008. In October, 13 people were killed in this way in Tijuana. And in a single grim episode in July, 19 were marched out of a clinic, lined up against a wall, and slaughtered. The massacres, cruel and perplexing, have shocked Mexicans, who fail to see the logic of assassinating powerless drug addicts. And while authorities have developed theories about the attacks—they now claim that criminals use the centres as recruiting grounds—the violence has also reminded the nation of the issue of addiction itself.
It is an interesting issue. For a while now, Mexico’s explosive addiction rate has been a feature of political speeches and media reports—part of the larger rationale for the government’s battle against drug organisations that has plunged the country into chaos and resulted in 30 000 deaths. The notion links back to the 2008 release of a national household drug-use survey that showed 51% more Mexicans self-reporting as addicts than did in the previous study from 2002. “It is clear to everyone that our nation has stopped being a transit country for drugs going to the United States and become an important market as well”, Eduardo Medina Mora, then the attorney general, noted. “Mexico confronting a drug addiction epidemic”, read a Houston Chronicle headline. “Mexico struggles with soaring drug addiction rate”, read another, in the Toronto Globe and Mail. Even the USA has acknowledged the problem by pledging funding for treatment and prevention programmes through the Merida Initiative.
In fact, the widely reported data that fuelled the panic—460 000 addicts and 4·5 million citizens who have tried illicit drugs at least once—actually represent a trend that is closer to “slow and steady” than “soaring”. In all, the percentage of the population that has experimented with illegal drugs rose from 4·6 to 5·2. For a country with 110 million people, and arguably more narcotics passing through it at any given time than anywhere in the world, this hardly makes for an epidemic. By contrast, a study assessing WHO data that was published the same year as Mexico’s showed that 42% of Americans had smoked marijuana and 16% had used cocaine. “Mexico doesn’t compare with other countries”, says Luis Solis, director of the National Council Against Addictions (CONADIC), an arm of the Health Ministry. “The problem isn’t as serious as in other countries”, echoes Victor Marquez, the director of treatment at the Youth Integration Center, a non-profit drug-rehabilitation group.
No one is discounting the seriousness of addiction as a threat to public health—or that the Mexican rate is indeed on the rise. But viewed in the context of the cartel war that is currently unravelling the social fabric of Mexico, a curious fact is the relatively small effect on domestic consumption.
Up until the 1990s, South American cocaine found its way to the USA primarily via Caribbean maritime paths. When US agencies shut down those routes, they effectively diverted the transitory trade to overland corridors in Mexico. As Medina Mora himself has said: “Drugs are like water. They always find their course.” More than 90% of cocaine that enters the USA now travels through its southern neighbour, according to US State Department estimates. This figure has been reported at somewhere between 300 and 500 tons per year. Additionally, thousands of pounds of marijuana are grown inside the country, largely in the northwestern region known as the Golden Triangle, where the states of Sinaloa, Durango, and Chihuahua, meet and where the poppy that is the base for opium and heroin is also cultivated.
Targeting the traffickers who run these operations has done little to change the numbers. On the contrary, according to the UN Office on Drug and Crime’s 2010 World Drug Report, opiate production increased 120% in 2008, ranking Mexico as the world’s third largest producing country (although it is still insignificant measured against Afghanistan, which accounts for 90% of the global supply). In 2009, cannabis cultivation spiked 35% to 12 000 hectares—the highest since 1992. Methamphetamine manufacturing, an important source of income for the cartels, has also increased. In August, 2009, authorities raided a crystal-meth laboratory so enormous and complex it took a reporter for a national newspaper 6 hours to cross. The factory, which the press nicknamed “Crystal City”, was said to turn out about 100 kg of methamphetamine a day.
Given the staggering quantities, and the unchecked power that the drug gangs exert in certain regions—residents of a small town in the border state of Tamaulipas recently abandoned their homes en masse, taking shelter as refugees in a neighbouring city, after criminals took over—it would not be unreasonable to expect the cartels to force their product on the local population. But while reported estimates have put the yearly domestic drug sales figure as high as $5 billion, this is small change compared with the $30 billion market in the USA.
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Mexican soldiers guard 4·5 tons of marijuana seized in November last year

There are various theories about why, statistically speaking, Mexicans are justnot that into drugs. One has to do with the government’s substance-abuse prevention programmes. Treatment as a method for drug addiction was written into the 1917 Constitution, but it was not until the 1970s that Mexico’s demand-reduction efforts truly began to take shape. In 1969, the government-funded non-profit Youth Integration Centers opened. The country’s most established organisation, it operates 110 clinics nationwide and gets about 80% of its financing—about $5 million a year—from the Health Ministry. A few years later, the Health Ministry created its own Center for Drug-Dependence Studies (now the National Institute of Psychiatry). By the 1980s, the private rehabilitation industry was expanding as well. The era, it turns out, was pivotal for drugs in Mexico in more ways than one.
Today there are thousands of private and public institutions dealing with all forms of substance abuse, mostly alcohol, according to Solis. Costs and quality range widely. Public outpatient programmes, which have been expanded under President Felipe Calderon, can be as inexpensive as $5 a week—the highest-priced private options cost as much as $10 000 a month. Since Calderon took office in 2006, the new Centers for New Life programme has opened more than 300 treatment centres for at-risk communities. Also, in April, 2009, the law the president had proposed to decriminalise possession of illicit substances was passed. Designed to combat what the government considers to be the rapidly expanding street trade, known as narcomenudeo, the law established personal-use limits. Anyone caught with up to a 0·5 g of cocaine, 50 mg of heroin, or 40 mg of methamphetamine is encouraged to seek treatment, and third-time offenders are required to do so. To many critics, the law was largely pointless because police officers, who are poorly paid and prone to bribes, rarely make small-possession arrests. But it also required the development of a national strategy for prevention and treatment programmes, and the Health Ministry has since taken steps to train and certify drug counsellors. Calderon “has done much more than previous administrations”, says Marquez.
The importance of the Mexican family, the country’s social conservatism, and its deep Catholic roots also help explain the traditionally low incidence of substance abuse. Marcela Lopez, a health researcher with Mexico’s Autonomous University, says “Mexico has more factors of protection than risk”, and this is especially so when compared with the USA. Also important is the fact that fewer Mexicans have the time or financial freedom for the sort of recreational use that fuels much of the drug trade in western Europe and the USA. Roughly half the population lives in poverty.
Ultimately, though, it all comes down to the bottom line—the fact that a pound of marijuana can fetch a higher price in San Francisco than in San Luis Potosi. The Mexican attorney general’s office recently reported that $10·9 billion worth of drugs had been confiscated since the beginning of the war in 2006, and government spokespeople on both sides of the border point out how their bi-national interdiction efforts have made smuggling more difficult for the cartels. But the ever-increasing drug-production efforts and the endless raids on vast, air-conditioned border tunnels, specially designed semi-submersibles, and even shipments of frozen sharks stuffed with cocaine tell a different story. No matter how many seizures are made, the lucrative US market is worth the risk.
Mexico’s cartels operate a wildly profitable, tax-free business. But the fact that most of their customers live in another country is some scant consolation for Mexican public health officials. If the domestic market were anywhere near as enticing, they would surely focus on their home turf instead of the USA. In which case, the government really might have to face an epidemic.

Sobre a UNIAD

A Unidade de Pesquisa em álcool e Drogas (UNIAD) foi fundada em 1994 pelo Prof. Dr. Ronaldo Laranjeira e John Dunn, recém-chegados da Inglaterra. A criação contou, na época, com o apoio do Departamento de Psiquiatria da UNIFESP. Inicialmente (1994-1996) funcionou dentro do Complexo Hospital São Paulo, com o objetivo de atender funcionários dependentes.


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