Opioids, stimulants, and depressant drugs in fifteen Mexican Cities: A wastewater-based epidemiological study.

BACKGROUND: Monitoring drug use in México is a challenge due to emerging drugs and rapid changes in consumption patterns. The temporal and geographical patterns of cocaine, methamphetamine, amphetamine, MDMA, cannabis, heroin, ketamine, and fentanyl were examined in Mexican cities using wastewater-based epidemiology (WBE). METHODS: 105 daily composite wastewater samples were collected from sewage treatment plants in fifteen Mexican cities. We quantified drug residues using liquid chromatography-high-resolution mass spectrometry, and estimated drug use by back-calculation of drug loads. RESULTS: We identified ten drug target residues in at least one sample across cities. Drugs with the highest median levels were cannabis, methamphetamine, and cocaine. The median range of cannabis for one week was between 147 and 20,364 mg/day/1000inhab across cities, whereas methamphetamine ranged between 5 and 3,628 mg/day/1000inhab. Cocaine was found in levels between 2 and 370 mg/day/1000inhab. The highest levels of methamphetamine and amphetamine were observed in the US border cities of Tijuana and San Luis Río Colorado. The presence of heroin, MDMA, ketamine, and fentanyl was stronger during weekends, while cannabis, cocaine, and amphetamine were found throughout the week. CONCLUSION: This study provides the first report of fentanyl, norfentanyl, and ketamine in wastewater in Mexico. The results indicate an increased presence of drugs on known drug traffic routes, demonstrating that WBE can help identify areas of high drug use and assist governments in developing policies to reduce drug use and harm in the communities.

Fentanyl is used in Mexico's northern border: current challenges for drug health policies.

BACKGROUND AND AIMS: Results from a recent study among 750 heroin users in three Mexico's northern border cities revealed an increase in white powder availability (also known as China white) and preference for this product among heroin users, as well as a general perception of increased overdose cases among this population. Here, we questioned whether those findings reflect an increased presence of heroin laced with fentanyl, which is associated with greater risks of overdose but that, until now, has not been described in Mexico. DESIGN: We tested fentanyl using highly sensitive test strips in syringe plungers, metal cookers and drug wrappings associated with heroin use. SETTING: Three injection sites in Tijuana, Baja California, México. PARTICIPANTS: Eighty-nine heroin users who interchanged paraphernalia for new syringes. MEASUREMENTS: We tested 59 residues of 'pure' white powder. The rest were white powder with black tar (n = 5) or white powder with crystal meth (n = 9), black tar with crystal meth (n = 1), black tar only (n = 13) and crystal meth only (n = 2). FINDINGS: Users believed that they consumed either white powder heroin, white powder heroin with crystal meth, white powder with black tar heroin or black tar heroin only. Analyses revealed that 93% (n = 55) of the 'pure' white powder samples had fentanyl. All (n = 9) the white powder samples mixed with crystal meth and 40% (n = 2) of the white powder with black tar were also laced with fentanyl. CONCLUSIONS: In a sample of 89 heroin users in Mexico, most white powder heroin users were unknowingly exposed to fentanyl, with fentanyl detected in 93% of white powder samples.

Factors Associated with Sexual Debut in Mexican Adolescents: Results of the National Survey on Drug Use among Students in 2014.

INTRODUCTION: Although first sexual experience (understood as first sexual intercourse) is one of the most commonly assessed characteristics of adolescents, recent research emphasizes the importance of understanding other related social factors. This study highlights factors associated with first sexual experience in a nationally representative sample of adolescent students in Mexico. AIMS: The goals of this study were (i) to determine the proportion of adolescents aged 12-17 who had had their first sexual experience; (ii) to identify the factors associated with first sexual experience; and (iii) to analyze the conditions (condom use, substance use) in which first sexual experience takes place. METHOD: The data presented in this study are drawn from the 2014 National Survey on Drug Use in Students (Spanish acronym ENCODE), undertaken with the purpose of identifying the prevalence of drug use and associated variables, including sexual activity, in Mexican students. Kaplan-Meier analysis was used to estimate the probability of first sexual experience at a given age, taking sex as an outcome variable and age as a follow-up period. Logistic regression was used to assess possible factors for sexual initiation. MAIN OUTCOME MEASURES: Validated standard questionnaires were used to assess sociodemographic characteristics, first sexual experience (framed as first sexual intercourse), frequency of sexual relations, sexual partners, sexual preference (framed as preferred sex of partners), substance use, having a physical illness or a behavioral problem, condom or other contraceptive use, as well as the absence or presence of parents, parents' educational attainment, and parents' substance use. RESULTS: A total of 26,187 students aged 12-17 participated. Of this total, 14.8% had already had their first sexual experience, at a median age of 15; 64.5% used some type of contraceptive, and 53.2% used condoms. Proportional probabilities for having first sexual experience using age as a follow-up period showed that the probability of having sex earlier was higher among boys than girls: the probability of having sex at age of 15 was 26.5% for boys and 13.9% for girls. Predictors of first sexual experience included substance use (alcohol OR = 2.5, tobacco OR = 2.6, and other drugs OR = 2.3), having a mother who used drugs (OR= 2.2), sexual preference (female homosexual, OR = 2.2), and sex (male, OR = 2.1). CONCLUSIONS: Boys are more likely to have had a first sexual experience than girls. Future strategies should incorporate specifically targeted elements with different messages that consider adolescents' sex and age. Barragán V, Berenzon S, Tiburcio M, et al. Factors Associated with Sexual Debut in Mexican Adolescents: Results of the National Survey on Drug Use among Students in 2014. J Sex Med 2019;16:418-426.

Suicide ideation and behavior in Mexico: Encodat 2016.

OBJECTIVE: To provide updated information regarding the 12-month prevalence and associated sociodemographic factors for suicide ideation and behavior (plan and attempts) to substantiate preventive programs in Mexico. MATERIALS AND METHODS: Cross-sectional nationally representative survey, conducted during 2016 (n=56 877) among those 12-65 years old living in rural, urban and metropolitan dwellings. RESULTS: The prevalence of suicide ideation in the last 12-months was 2.3%, 0.8% of the sample reported a plan and 0.7% reported a suicide attempt. All three outcomes were about two times more common among females and suicide plan and attempt were less common among the elderly (50-65 years old). Suicide attempts were more common in urban than in rural areas. The state of Tabasco showed an increased prevalence of ideation, plan and attempts when compared to national average rates. CONCLUSIONS: Public health measures to diminish and treat suicidal behavior are urgently needed all over the country.

OBJETIVO: Dar información actualizada sobre la prevalencia de 12 meses y los factores sociodemográficos asociados para la ideación y el comportamiento suicida (plan e intentos) para fundamentar programas preventivos en México. MATERIAL Y MÉTODOS: Encuesta transversal representativa a nivel nacional, por sexo y grupos de edad, realizada durante 2016 (n = 56 877) entre personas de entre12 y 65 años de edad en zonas rurales, urbanas y metropolitanas. RESULTADOS: La prevalencia de ideación suicida en los últimos 12 meses fue de 2.3%, 0.8% de la muestra informó un plan y 0.7% informó un intento de suicidio. Los tres resultados fueron aproximadamente dos veces más comunes entre las mujeres y el intento de suicidio fue menos común entre los más viejos (50 a 65 años). Los intentos de suicidio fueron más comunes en las zonas urbanas que en las rurales. El estado de Tabasco mostró una mayor prevalencia de ideas, planes e intentos en comparación con las tasas promedio nacionales. CONCLUSIONES: Es urgente y necesario que existan medidas de salud pública para disminuir y tratar el comportamiento suicida en todo el país.

Suicide ideation and behavior in Mexico: Encodat 2016 / Ideación e intento de suicidio en México: Encodat 2016

Abstract: Objective: To provide updated information regarding the 12-month prevalence and associated sociodemographic factors for suicide ideation and behavior (plan and attempts) to substantiate preventive programs in Mexico. Materials and methods: Cross-sectional nationally representative survey, conducted during 2016 (n=56 877) among those 12-65 years old living in rural, urban and metropolitan dwellings. Results: The prevalence of suicide ideation in the last 12-months was 2.3%, 0.8% of the sample reported a plan and 0.7% reported a suicide attempt. All three outcomes were about two times more common among females and suicide plan and attempt were less common among the elderly (50-65 years old). Suicide attempts were more common in urban than in rural areas. The state of Tabasco showed an increased prevalence of ideation, plan and attempts when compared to national average rates. Conclusions: Public health measures to diminish and treat suicidal behavior are urgently needed all over the country.

Resumen: Objetivo: Dar información actualizada sobre la prevalencia de 12 meses y los factores sociodemográficos asociados para la ideación y el comportamiento suicida (plan e intentos) para fundamentar programas preventivos en México. Material y métodos: Encuesta transversal representativa a nivel nacional, por sexo y grupos de edad, realizada durante 2016 (n = 56 877) entre personas de entre12 y 65 años de edad en zonas rurales, urbanas y metropolitanas. Resultados: La prevalencia de ideación suicida en los últimos 12 meses fue de 2.3%, 0.8% de la muestra informó un plan y 0.7% informó un intento de suicidio. Los tres resultados fueron aproximadamente dos veces más comunes entre las mujeres y el intento de suicidio fue menos común entre los más viejos (50 a 65 años). Los intentos de suicidio fueron más comunes en las zonas urbanas que en las rurales. El estado de Tabasco mostró una mayor prevalencia de ideas, planes e intentos en comparación con las tasas promedio nacionales. Conclusiones: Es urgente y necesario que existan medidas de salud pública para disminuir y tratar el comportamiento suicida en todo el país.

Opioid Crisis Along Mexico's Northern Border: Treatment Needs Mexican Opioid Crisis.

BACKGROUND: Heroin production for external markets and low rates of use in Mexico have had a long history. A recent shift toward an increase in use and related problems calls for the evaluation of treatment needs in order to draw recommendations for policies. METHODS: The objectives were to identify predictors of choice of treatment and barriers to care among persons that had been with no treatment. The study included a convenience sample of 600 face-to-face interviews of people 18 years of age and older and a rapid HIV and HCV tests in three cities on Mexico's Northern Border: Ciudad Juárez, San Luis Río Colorado and Tijuana. The choice of treatment (methadone, other pubic or private treatments with no experience with methadone maintenance and only self-help or religious care), was analyzed though a multiple logistic multimodal regression analysis. Informed consents to be interviewed and for HIC and HIV were signed by interviewers. RESULTS: The majority of persons interviewed were males (89.7%) with an average age of 40. Having emigrated to the United States and a greater length of heroin use predicted seeking methadone treatment versus public or private treatment or informal care. The most important barriers to care were lack of information and stigma. HIC, HIV and other infectious and chronic diseases including depression were often unattended. CONCLUSIONS: There is a need to reform treatment policies in order to cover this w emerging and demanding problem.

Association between attempted suicide and academic performance indicators among middle and high school students in Mexico: results from a national survey.

BACKGROUND: Students' mental health is associated to academic performance. In high income countries, higher students' grades are related to lower odds of suicidal behaviors, but studies on other indicators of academic performance are more limited, specially in middle income countries. METHODS: Data from 28,519 middle and high school students selected with multistage clustered sampling in the Mexican National Survey of Student's Drug Use. Using a self-administered questionnaire, lifetime suicidal attempt and four indicators of academic performance were assessed: age inconsistency with grade level, not being a student in the last year, perceived academic performance and number of failed courses. Multiple logistic regression models were used to control for sociodemographic and school characteristics. RESULTS: The lifetime prevalence of attempted suicide was 3.0% for middle school students and 4.2% for high school students. Among middle school students, statistically adjusted significant associations of suicide attempt with academic performance indicators were: not being a student the year before, worse self-perceived performance and a higher number of failed courses; among high school students, predictors were failed courses and self-perceived academic performance, with ORs of 1.65 and 1.96 for the categories of good and fair/poor respectively, compared to those who reported very good performance. CONCLUSION: Self-perceived academic performance was the main indicator for suicide in both school levels. Suicide prevention efforts in Mexico's schools should include asking students about the perception they have about their own academic performance.

Social factors, weight perception, and weight control practices among adolescents in Mexico.

We evaluated the association of social factors and weight control practices in adolescents, and the mediation of this association by weight perception, in a national survey of students in Mexico ( n = 28,266). We employed multinomial and Poisson regression models and Sobel's test to assess mediation. Students whose mothers had a higher level of education were more likely to perceive themselves as overweight and also to engage in weight control practices. After adjusting for body weight perception, the effect of maternal education on weight control practices remained significant. Mediation tests were significant for boys and non-significant for girls.

Barriers to accessing substance abuse treatment in Mexico: national comparative analysis by migration status.

BACKGROUND: We examined Mexican migrants' perceived barriers to entering substance abuse treatment and potential differences by gender. METHODS: This study analyzed a subset of household data collected in Mexico in 2011 via the Encuesta Nacional de Adicciones (National Survey of Addictions). A sample of 1,143 individuals who reported using illicit drugs was analyzed using multivariate negative binomial models to determine direct and moderated relationships of gender, migrant status, and drug dependence with perceived barriers to accessing treatment. RESULTS: Significant findings included disparities in drug dependence by migrant status. Compared with non-migrant men, women who have traveled to the United States was associated with fewer (1.3) barriers to access treatment. Fewer barriers to access care were associated with individuals residing in other regions of the country, compared to those living in Mexico City. CONCLUSIONS: Drug dependence, gender, migration status and regional location are factors associated with access to needed treatment. Implications for health care policy to develop treatment services infrastructure and for future research are discussed in the context of ongoing drug policy reform in Mexico.

Mexicans' use of illicit drugs in an era of drug reform: national comparative analysis by migrant status.

BACKGROUND: Although rates of illicit drug use are considerably lower in Mexico than in the United States, rates in Mexico have risen significantly. This increase has particular implications for Mexican women and US migrants, who are considered at increased risk of drug use. Due to drug reforms enacted in Mexico in 2008, it is critical to evaluate patterns of drug use among migrants who reside in both regions. METHODS: We analysed a sample of Mexicans (N=16,249) surveyed during a national household survey in 2011, the Encuesta Nacional de Adicciones (National Survey of Addictions). Comparative analyses based on Mexicans' migrant status - (1) never in the United States, (2) visited the United States, or (3) lived in the United States (transnationals) - featured analysis of variance and Chi-square global tests. Two multilevel regressions were conducted to determine the relationships among migrant status, women, and illicit drug use. RESULTS: Comparative findings showed significant differences in type and number of drugs used among Mexicans by migrant status. The regression models showed that compared with Mexicans who had never visited the United States, Mexican transnationals were more likely to report having used drugs (OR=2.453, 95% CI=1.933, 3.113) and using more illicit drugs (IRR=2.061, 95% CI=1.626, 2.613). Women were less likely than men to report having used drugs (OR=0.187, 95% CI=0.146, 0.239) and using more illicit drugs (IRR=0.153, 95% CI=0.116, 0.202). CONCLUSIONS: Overall, the findings support further exploration of risk factors for illicit drug use among Mexican transnationals, who exhibit greater drug use behaviours than Mexicans never in the United States. Because drug reform mandates referrals to treatment for those with recurrent issues of drug use, it is critical for the Mexican government and civic society to develop the capacity to offer evidence-based substance abuse treatment for returning migrants with high-risk drug behaviours.

[Drugs and public health: where are we heading to?]. / Las drogas y la salud pública: ¿hacia dónde vamos?

This paper describes a plan for the attention of addictions from a public health perspective; it defines strengths of this perspective and its limitations to face the special challenges that the problem represents for social policies; adopts a wider perspective that includes the integration of health and social issues in measuring policy results having as a main aim the benefit of the person and of the communities with a perspective of the populations well being. It describes the challenge the country faces as producer, route of traffic and rates of consumption, analyzes briefly the evidence of public policies and makes a series of recommendations.

Las drogas y la salud pública: ¿hacia dónde vamos? / Drugs and public health: where are we heading to?

El artículo presenta una propuesta para la atención del problema de las adicciones desde un enfoque de salud pública, define sus alcances y limitaciones frente a los retos del fenómeno, especialmente para la formulación de políticas; se suma a las propuestas que buscan integrar los temas sociales en la evaluación del resultado de las acciones y que proponen como meta última el bien de la persona y de las comunidades con una perspectiva de bienestar para la población. Describe el reto que enfrenta México en su papel como país productor, de tránsito y de consumo, analiza brevemente la evidencia sobre las políticas públicas y hace una serie de recomendaciones al respecto.

This paper describes a plan for the attention of addictions from a public health perspective; it defines strengths of this perspective and its limitations to face the special challenges that the problem represents for social policies; adopts a wider perspective that includes the integration of health and social issues in measuring policy results having as a main aim the benefit of the person and of the communities with a perspective of the populations well being. It describes the challenge the country faces as producer, route of traffic and rates of consumption, analyzes briefly the evidence of public policies and makes a series of recommendations.

El consumo de drogas en México: Resultados de la Encuesta Nacional de Adicciones, 2011 / Drug use in Mexico: Results from the 2011 National Addictions Survey

Introduction In the international context, Mexico is a country with low drug use level, in turn, it shows an increase when considering the most recent epidemiologic trends. In order to maintain an updated analysis of drug use in general population and to identify the most at risk groups, the National Survey of Addictions (ENA) was held in 2011. Objetive The aim of the study was to determine the lifetime prevalence for any drug and any illegal drug use at a national and regional level, in population aged 12 to 65 years. Also, to acknowledge drug consumption trends since 2002 in Mexico. Material and methods ENA 2011 survey is a randomized, multistage probabilistic study. It is representative at a national level and also for eight regions of the country, including rural and urban population. The sample was 3 849 adolescents and 12 400 adults who answered a computerized version of a standardized questionnaire containing sections of tobacco, alcohol, medical drugs (opiates, tranquilizers, sedatives, amphetamines) and illegal drugs (marijuana, cocaine, crack, hallucinogens, inhalants, heroin and methamphetamines). All participants read and signed an informed consent. Emphasis was made on the voluntary and confidential use of the information. Results The national lifetime prevalence of any drug grew between 2002 and 2011, increasing significantly from 5.0% to 7.8%, while consumption of any illegal drugs increased from 4.1% to 7.2%. By sex, in men, any drug use increased from 8.6% to 13%. Illegal drugs increased from 8.0% to 12.5%. In women, use of any drug increased from 2.1% to 3.0% and use of any illegal drug increased from 1.0% to 2.3%. Marijuana is the first drug of choice (6.5%) followed by cocaine (3.6%). Considering regions, any drug consumption grew significantly in the Western (5.5% to 10.3%), Northeast (5.5% to 10.3%), North Central (7.5% to 9.2%) and South Central (4.2% to 7.5%). As for illegal drugs, there is also a statistically significant increase in these regions, however, growth was proportionally bigger in South Central region, going from 3.5% to 6.8%. Conclusions Results from this study indicate a growth in the consumption of illegal drugs from 2002 to 2011, especially in marijuana. It also shows that men from 18 to 34 years are the most affected by this consumption, while increases in adolescent men have been low. Moreover, the study shows that those who have received some type of prevention, showed a smaller consumption prevalence, indicating that further work is needed in this area with young people to consolidate activities of health promotion and drug use prevention, working with infant population is needed, including a systematic evaluation of the actions mentioned above. In the international context, data from this study confirms that Mexico continues reporting low levels of drug consumption.

Introducción En el contexto internacional, México es uno de los países con bajo nivel de consumo de drogas, pero que, a su vez, reporta un incremento si se consideran las tendencias epidemiológicas más recientes. Con la finalidad de mantener un diagnóstico actualizado del consumo de drogas en la población general y de identificar los grupos en mayor riesgo, se llevó a cabo la Encuesta Nacional de Adicciones 2011 (ENA). Objetivo Conocer la prevalencia alguna vez en la vida de uso de cualquier droga y de cualquier droga ilegal a nivel nacional y regional en población de 12 a 65 años. Así como conocer las tendencias que ha seguido el consumo a partir de 2002. Material y métodos La ENA 2011 es un estudio aleatorio, probabilístico y polietápico con representatividad nacional y para ocho regiones del país. Incluye poblaciones rurales y urbanas. La muestra fue de 3 849 adolescentes y 12 400 adultos quienes contestaron un cuestionario estandarizado en versión computarizada que contiene las secciones de tabaco, alcohol, drogas médicas (opiáceos, tranquilizantes, sedantes, anfetaminas) e ilegales (mariguana, cocaína, crack, alucinógenos, inhalables, heroína y metanfetaminas). Todos los participantes leyeron y firmaron una carta de consentimiento informado. Se hizo énfasis en el carácter voluntario y confidencial de la información. Resultados La prevalencia de consumo de cualquier droga alguna vez en la vida a nivel nacional creció significativamente entre 2002 y 2011 al pasar de 5.0% a 7.8%, mientras que el consumo de cualquier droga ilegal incrementó de 4.1% a 7.2%. Por sexo, en los hombres el consumo de cualquier droga pasó de 8.6% a 13% y de drogas ilegales de 8.0% a 12.5%. En las mujeres, la primera aumentó de 2.1% a 3.0% y la segunda de 1.0% a 2.3%. Las drogas de preferencia continúan siendo la mariguana (6.5%) y la cocaína (3.6%). A nivel regional el consumo de cualquier droga creció significativamente en la Occidental (5.5% a 10.3%), Nororiental (5.5% a 10.3%), Norcentral (7.5% a 9.2%) y Centro Sur (4.2% a 7.5%). En cuanto a las drogas ilegales, también se encuentra un incremento estadísticamente significativo en estas regiones, sin embargo el crecimiento fue proporcionalmente mayor en la región Centro Sur, al pasar de 3.5% a 6.8%. Conclusiones Los resultados de la ENA señalan un crecimiento en el consumo de drogas ilegales de 2002 a 2011, especialmente de la mariguana. Asimismo, se observa que los hombres de 18 a 34 años son la población más afectada por dicho consumo, mientras que en los adolescentes el aumento ha sido mínimo. Por otra parte, el estudio muestra que quienes han recibido algún tipo de prevención presentan las prevalencias de consumo más pequeñas, lo cual indica que es necesario seguir trabajando en esta área con los jóvenes para consolidar las acciones de promoción de la salud y prevención; así como trabajar más con la población infantil, con una evaluación sistemática de todas estas acciones. En el contexto internacional los datos confirman que México continúa con niveles bajos de consumo.

Volatile substance misuse in Mexico: correlates and trends.

This paper analyzes volatile substance misuse in Mexico since the 1980s. Data were collected from national household and school surveys, epidemiological surveillance systems, and studies among special populations. Volatile substance misuse begins at 12-14 years. Prevalence is approximately 1% in the general population, 7% among high school students, and higher for street children. Toluene is the main solvent used, but preferences vary within population groups. Volatile substance misuse has increased among youngsters that live in families and attend school. Marijuana and volatile substances are now the drugs of choice among Mexican female high school students. The study's limitations are noted.

Distribución y determinantes sociodemográficos de la conducta suicida en México / Distribution and socio-demographic determinants of the suicidal behavior in Mexico

Introduction Mexico has seen constant increases in the rate of completed suicide in the last decades, especially among youth. The Mexican population between 1 5-24 years of age is currently the most affected, with 28% of all suicides in 2007. In this context of increasing suicide mortality, the study of suicide-related behaviors, that is, suicidal ideation, plans, gestures and suicide attempts, has special relevance. All of these are immediate precursors to death by suicide and independent risk factors of subsequent suicide attempts and completed suicides. Episodes that do not result in death, can lead to serious, long-term consequences in one's physical health, as well as being an important cause of psychological suffering on the part of the individual and his/her family. Up until now, research in our country has emphasized the prevalence of lifetime suicidal behavior and its associated factors. However, the current (12-month) prevalences are indispensable in order to define the demographic profile and clinical needs, and to build risk profiles for immediate application by the clinics treating these individuals. Objectives To report the prevalence and sociodemographic characteristics of suicide-related behaviors in the past 12 months in a nationally representative sample of respondents from the Encuesta Nacional de Adicciones (ENA) of 2008. Methods Cross-sectional prevalence study which obtained data from a nationally-representative sample of 22 966 individuals, between the ages of 12 and 65, during 2008, who answered the section on suicidal behaviors. The response rate was 77%. Twelve-month prevalences of suicidality are reported according to different sociodemographic and economic factors. Multiple logistic regression models for odds ratios and 95% confidence intervals, corrected for the study design, are reported. Results We found the prevalence of any suicidal ideation to be 8.79% (ranging from 4.2 to 6.2%, depending on the question used), the prevalence of a suicide plan was 1.22%, and 0.79% of the sample reported to attemp suicide within the past 12 months, with the prevalence of suicide attempts that required medical attention being 0.13%. If we use the sample weights to make estimations regarding the 75 million inhabitants of Mexico that the ENA 2008 represents, we estimate that 6 601 210 Mexicans experienced suicidal ideation in the past 12 months, 918 363 Mexicans planned suicide, a total of 593 600 individuals attempted suicide and 99 731 utilized medical services as a consequence of their attempt. We found that women, people who are not married or in a relationship, those with less education, younger age groups and the unemployed have, in general, a higher risk of exhibiting suicidal behavior. Some regions of the country, especially the southeast, were more affected, whereas individuals who live in rural areas consistently reported lower prevalences of the three suicidal behaviors. Conclusion The epidemiology of completed suicide in Mexico has changed within the last decades by a process that has been gradual but constant. The epidemiology of current suicidal behaviors shows that the problem is already at similar levels to other highly affected countries. Mexico needs immediately to dedicate much more efforts to detection, treatment and prevention of these behaviors to avoid further increases in suicidality and its consequences.

Introducción En las últimas décadas, México ha visto incrementos constantes en la tasa de suicidio consumado, especialmente entre la población joven. La población mexicana de entre 15 y 24 años de edad es hoy día de las más afectadas, con 28% de todos los suicidios en 2007. En este contexto de incremento de la mortalidad por suicidio cobra especial relevancia el estudio de las conductas relacionadas con el suicidio, es decir, la ideación suicida, los planes, los gestos y los intentos de suicidio. Todos éstos son precursores inmediatos de la muerte por suicidio y factores de riesgo independientes de intentos subsecuentes de suicidio y de suicidios consumados. Aun cuando estas conductas no lleven a la muerte, pueden acarrear consecuencias graves y de largo alcance para la salud física, y pueden constituir una importante causa de sufrimiento psicológico para el individuo y sus familiares. Hasta ahora, las investigaciones en nuestro país han enfatizado el conocimiento de la prevalencia y los factores asociados con la conducta suicida alguna vez en la vida. Las prevalencias actuales (últimos 12 meses) son, sin embargo, indispensables para definir el perfil demográfico y las necesidades clínicas de atención, y para elaborar perfiles de riesgo de aplicación inmediata para el clínico tratante de estos sujetos. Objetivos En este trabajo reportamos las prevalencias y el perfil sociodemográfico de las conductas relacionadas con el suicidio en los últimos 12 meses en una muestra representativa de la población nacional. Para hacerlo se utilizó la Encuesta Nacional de Adicciones (ENA) del 2008. Métodos Encuesta transversal de prevalencia que obtuvo datos de una muestra representativa de 22 966 miembros de la población nacional, de edades entre los 12 y 65 años, durante el año de 2008, que contestaron la sección de conductas suicidas. La tasa de no respuesta de la ENA 2008 fue de 77%. Se reportan las prevalencias de los eventos relacionados con el suicidio en los últimos 12 meses por diferentes factores sociodemográficos y económicos. Se reportan modelos de regresión logística múltiple con razones de momios y los intervalos de confianza a 95%, que se han corregido por los efectos del diseño de estudio. Resultados Encontramos una prevalencia de cualquier ideación suicida de 8.79% (con variaciones de 4.2 a 6.2%, dependiendo de la pregunta utilizada). La prevalencia de plan suicida fue de 1.22% y 0.79% de la muestra reportó que intentó suicidarse en los últimos 12 meses. La prevalencia de intentos de suicidio que requirieron atención médica fue de 0.13%. Si utilizamos los ponderadores muestrales para hacer estimaciones hacia los 75 millones de habitantes de la República Mexicana que representa la ENA 2008, tenemos que 6 601 210 mexicanos tuvieron ideación suicida en los últimos 12 meses, 918 363 mexicanos planearon suicidarse, un total de 593 600 personas intentaron suicidarse y 99 731 utilizaron servicios médicos como consecuencia de un intento de suicidio. Encontramos que las mujeres, las personas que no están casadas o en unión libre, las de menor escolaridad, los grupos más jóvenes y los subempleados tienen, en general, riesgos más elevados de presentar conducta suicida. Algunas áreas del país, en particular el sureste, se vieron más afectadas, mientras que las personas que viven en áreas rurales reportaron consistentemente menores prevalencias de las tres conductas suicidas. Conclusión La epidemiología del suicidio consumado en México ha cambiado en las últimas décadas, en un proceso paulatino pero constante. La epidemiología de la conducta suicida actual muestra que el problema ha alcanzado ya dimensiones similares a otros países tradicionalmente afectados. México necesita dedicar ya mayores esfuerzos a la detección, tratamiento y prevención de estas conductas para evitar futuros incrementos en la conducta suicida y en sus consecuencias.

Unmet needs for treatment of alcohol and drug use in four cities in Mexico / Necesidades no satisfechas para el tratamiento del uso de drogas y alcohol en cuatro ciudades de México

Introduction Even though heavy alcohol consumption is frequent, alcohol-related consequences are common, and drug use has become more common in this country, we know very little about public health response and the types of treatments available for persons with substance use disorders in Mexico. Current national estimates show that about one in every five persons with alcohol and substance use disorders received treatment in the last 12 months, but to date the rates of treatment for local communities are unknown; these data are needed for policy planning at community level. This study presents data on the treatment for substance use and substance use disorders in three urban areas of Northern Mexico and one state capital in Central Mexico. The Northern region is of particular interest in Mexico because of its proximity to the United States and previous evidence that alcohol and drug use is about twice as common in this region compared with other regions. The city of Queretaro provides a more appropriate comparison for the cities in Northern Mexico than a place as Mexico City, or the national means, due to its level of development, population size, and basic epidemiologic data on drug use. Material and methods The Local Surveys on Addictions 2005 (Encuestas Locales de Adicciones 2005) are part of the Mexican National Survey on Addictions (ENA) series, supported by the Ministry of Health (CONADIC- National Council Against the Addictions), state and local governments, and the National Institute of Psychiatry (INP), and included the cities of Tijuana (Baja California), Ciudad Juarez (Chihuahua), Monterrey (Nuevo Leon) and Queretaro (Queretaro), as part of a continuous effort to monitor use of illicit substances in Mexico. The 12-month prevalence of health and non-health care service use for treatment of substance use was estimated. Correlates of service use, including interference with role impairment, were identified in logistic regression analyses that took into account the complex sample design and weighing process. Results A total of 2,148 completed interviews were obtained for a response rate of 70.5%. About 2.2% of those who used any substance saw any provider in the last 12 months, with the largest prevalence among the health care sector (1.37%), followed closely by the non-health care sector (0.91%). Among the health care sectors, the general medical sector provided more services than mental health specialists. About 11 % of those with any disorder consulted for services, with the health care sector providing many more services than the non-health care sector. The prevalence of use for mental health specialists and the general medical sector is very similar for those with a disorder. The largest prevalence of any service was found in Monterrey (about 15%), while Ciudad Juarez had the lowest (6.6%). Less than 50% of those with an active disorder reported any role impairment, but respondents with high levels of role impairment were more likely to use services. Conclusion We found large unmet needs for substance use services among urban residents of Queretaro and in three major northern cities in Mexico. The two cities that have shown higher rates of substance use in addiction surveys in Mexico (Tijuana and Ciudad Juarez) had the lowest levels of any treatment. We found few predictors of service use among those who used any substance and among those with an active disorder. Among those, respondents with high levels of role impairment were more likely to use services. Treatment for substance use can be effective and is urgently needed if Mexico wants to face the prominent place of alcohol in the burden of disease in the country. The effort to change the current situation of alcohol and drug service utilization, including the low rates of mental health specialists in these cities, is likely to require coordination of research, larger numbers of services, treatment alternatives, and service development.

Introducción Aunque el consumo excesivo de alcohol sea frecuente, las consecuencias de este consumo sean comunes y haya aumentado la disponibilidad de drogas, se sabe poco de las acciones de salud pública y los tipos de tratamiento disponibles para personas con trastornos por el uso de sustancias en México. Estimaciones actuales nacionales muestran que alrededor de una de cada cinco personas con trastornos por el uso de alcohol y drogas recibió tratamiento en los últimos 12 meses. Pese a ello, hasta la fecha no disponemos de estimaciones de las tasas de tratamiento a nivel local, lo que es necesario para la planeación de políticas públicas a nivel comunitario. Este trabajo presenta datos sobre el tratamiento para el uso de sustancias y para los trastornos por el uso de sustancias en tres áreas urbanas del norte de México y una ciudad capital localizada en el centro del país. La región norte es de particular interés por su proximidad con los Estados Unidos y por la evidencia previa de que el alcohol y las drogas es dos veces más común en esta región comparada con otras de la República. Por su nivel de desarrollo, su tamaño poblacional y los datos epidemiológicos básicos que aporta sobre el uso de drogas, la ciudad de Querétaro provee un punto de comparación para las ciudades del norte más apropiado que un lugar como la Ciudad de México o el promedio nacional. Material y métodos Las Encuestas Locales de Adicciones 2005 son parte de la serie de Encuestas Nacionales de Adicciones (ENA), apoyadas por la Secretaría de Salud, el Consejo Nacional Contra las Adicciones (CONADIC), los gobiernos locales y estatales, y el Instituto Nacional de Psiquiatría, e incluyen las ciudades de Tijuana (Baja California), Ciudad Juárez (Chihuahua), Monterrey (Nuevo León) y Querétaro (Querétaro) como parte de un esfuerzo continuo por monitorear el uso de sustancias ilícitas en México. Se estimó la prevalencia en los últimos 12 meses de servicios médicos y no médicos para el tratamiento del uso de sustancias. Los correlatos del uso de servicios, incluida la discapacidad asociada con la interferencia en los roles, se identificaron por medio de regresiones logísticas, mismas que tomaron en consideración el diseño de la muestra y los ponderadores de la encuesta. Resultados Un total de 2148 residentes tuvieron entrevistas completas, para una tasa de respuesta de 70.5%. Solamente 2% de las personas que usaron alcohol o drogas en los últimos 12 meses hicieron uso de algún servicio de tratamiento. La prevalencia más elevada se dio en los servicios de salud (1.37%), seguida de cerca por el sector no médico (0.91%). Entre el sector salud fueron más frecuentes los servicios ofrecidos por el médico general que por los especialistas en salud mental. Alrededor de 11% de aquéllos con algún trastorno por sustancias consultó con los servicios; el sector médico ofreció mucho más servicios que el sector no médico. La prevalencia de uso de servicios de salud mental especializados y la del médico general fueron muy similares para aquellos con un trastorno por sustancias. La prevalencia más elevada de cualquier uso de servicios se dio en la ciudad de Monterrey (alrededor de 15%), mientras que Ciudad Juaréz tuvo la prevalencia más baja (6.6%). Menos de 50% de aquéllos con un trastorno activo mostró algún nivel de discapacidad en el desempeño de roles, pero las personas con mayores niveles de discapacidad tuvieron mayores probabilidades de usar servicios. Conclusiones Encontramos una gran cantidad de necesidades no satisfechas para el tratamiento del uso de sustancias entre residentes de áreas urbanas de cuatro grandes ciudades de México. Las dos ciudades que mostraron las tasas más elevadas de uso de sustancias en otras encuestas de adicciones en México (Tijuana y Ciudad Juárez) mostraron los niveles más bajos de cualquier tratamiento. Encontramos pocos correlatos para el uso de servicios entre aquellos que usaron cualquier sustancia y entre aquellos con un trastorno activo. Entre éstos, los entrevistados con mayores niveles de discapacidad tuvieron mayores probabilidades de usar cualquier servicio. El tratamiento para el uso de sustancias puede ser efectivo y es urgentemente necesario si México quiere enfrentar el lugar prominente que tiene el consumo de alcohol en la carga de la enfermedad en el país. El esfuerzo necesario para cambiar la presente situación del bajo uso de servicios para el tratamiento del consumo de alcohol y drogas, incluidas las bajas tasas de uso de servicios especializados en salud mental, probablemente requiera la coordinación de investigación, mayor número y disponibilidad de servicios, más alternativas de tratamiento y desarrollo de servicios. Son urgentemente necesarias mejorías en la disponibilidad y en los tipos de tratamientos disponibles para los trastornos por uso de sustancias.

Prevalence and correlates of drug use disorders in Mexico.

OBJECTIVE: To describe the prevalence of drug use disorders, the correlates of drug use, and the utilization of specialized treatment services for drug users among the Mexican urban population 18-65 years old. METHODS: The data were collected in 2001 and 2002 in the Mexican National Comorbidity Survey. The sample design was stratified probabilistically for six geographical areas of the country in a multistage process for census count areas, city blocks, groups of households, and individuals. The data were weighted, taking into account the probability of selection and the response rate. The information was collected using a computerized version of the World Mental Health Survey edition of the Composite International Diagnostic Interview. The weighted response rate for individuals was 76.6%. RESULTS: Overall, 2.3% of the population reported any illicit use of drugs in the preceding 12 months; marijuana and cocaine were the substances most often used. Low levels of education were significantly associated with use, abuse, and dependence. Use of any drug was significantly more common among those who were in the youngest age group (18-29 years), were male, or were living in the Northwest region of the country. Overall, 1.4% had a lifetime history of drug abuse or dependence, with this being much more common for men (2.9%) than for women (0.2%). The 12-month prevalence of drug abuse or dependence was 0.4% overall (0.9% for men, and 0.0% for women). The rate of treatment during the preceding 12 months for those with the 12-month criteria for abuse or dependence was 17.1%; 14.8% were seen in specialized treatment centers; 2.8% reported having attended self-help groups. CONCLUSIONS: A noticeable number of Mexicans have a drug use disorder, but demand for treatment is limited, in part due to stigma. Our results indicate that there is an urgent need to organize the specialized services for persons with a substance abuse disorder according to the prevalence of dependence on different substances and the variation in prevalence in the different regions of the country.

Prevalence and correlates of drug use disorders in Mexico

OBJETIVO: Describir la prevalencia de tastornos relacionados con el consumo de drogas, sus factores asociados, y la utilización de servicios terapéuticos especializados por usuarios de drogas en la población urbana de México entre los 18 y 65 años de edad.MÉTODOS: Los datos se reunieron en 2001 y 2002 mediante la Encuesta Nacional de Epidemiologia Psiquiátrica de México. El muestreo se llevó a cabo por estratificación probabilística de seis regiones geográficas del país en un proceso polietápico que comprendió, en orden sucesivo, áreas censuales, manzanas urbanas, grupos de domicilios, e individuos. Los datos se ponderaron teniendo en cuenta la probabilidad de selección y el porcentaje de respuesta. La información se recogió mediante una versión computadorizada de la edición de la Entrevista Diagnóstica Internacional Compuesta usada para la Encuesta Mundial de Salud Mental. El porcentaje de respuesta ponderado para individuos fue de 76,6.RESULTADOS: En general, 2,3% de la población declaró haber incurrido en el consumo ilícito de drogas durante los 12 meses anteriores a la encuesta; la marijuana y la cocaína fueron las sustancias consumidas con mayor frecuencia. La baja escolaridad mostró una asociación significativa con el consumo, el abuso y la dependencia de drogas. El consumo de cualquier tipo de droga tuvo una frecuencia significativamente mayor en personas pertenecientes al grupo de edad más joven (18–29 años), en varones, o en habitantes de la parte noroccidental del país. De la muestra en general, 1,4% había abusado o dependido de las drogas en algún momento de la vida, y ello ocurrió con mucha más frecuencia en varones (2,9%) que en mujeres (0,2%). La prevalencia del abuso o de la dependencia de drogas en el transcurso de los 12 meses anteriores a la encuesta fue de 0,4% en general (0,9% en varones y 0,0% en mujeres). La tasa de tratamiento durante los 12 meses anteriores a la encuesta entre quienes cumplían los criterios de abuso o dependencia durante ese período fue de 17,1%; 14,8% fueron atendidos en centros de tratamiento especializados, y 2,8% dijeron haber asistido a grupos de autoayuda. CONCLUSIONES: Un número apreciable de mexicanos tienen un trastorno relacionado con el consumo de drogas, pero la demanda de un tratamiento es poca, en parte debido a temor al estigma...