Trends in drug overdose deaths in Mexico (1999-2019). A national descriptive analysis and interstate comparison.

BACKGROUND: We assess trends in overdose mortality rates in Mexico from 1999 to 2019 and identify the states with the highest overdose mortality rates over time. METHODS: The analysis using mortality statistics examined deaths related to drug use. We estimated general overdose mortality rates at the national and state levels and calculated specific mortality rates associated with opioid and stimulant use using central rate estimation. We used joinpoint regression to analyse national and state-specific trends in overdose mortality from 1999 to 2019. FINDINGS: Nationally, the general overdose mortality rate increased annually by 10.49 % (p < 0.01, CI=11.4-18.9) from 2015 to 2019. The northern states of Baja California and Chihuahua were the states with the higher annual increases (18.6 %, p < 0.01, CI=4.2-29.6; and 15.6 %, p < 0.01, CI=12.9-19.7, respectively). By substance type, the national opioid-related mortality rate increased by 29.82 % per year from 2014 to 2019 (p < 0.01; CI=20.1-40.3), compared with an annual decrease of 11.43 % in the previous period (2005-2014) (p < 0.01; CI=-14.7- 8.0). Baja California was the state with the highest rise in opioid-related mortality from 2013 to 2019, with an annual increase of 15.84 % (p < 0.01; CI=1.4-32.3). Stimulant-related mortality increased by 21.79 % per year since 2013 (p < 0.01; CI=16.9-26.9), but it was not possible to calculate state-level trends. CONCLUSIONS: Drug-related mortality rates have increased in Mexico since 2015, particularly in the northern states of Baja California, Chihuahua, Sonora and Sinaloa. Improving harm reduction programmes and local surveillance of fatal and non-fatal overdoses is essential to address the silent escalation of overdose mortality.

Transition from first illegal drug use to first injection among people who inject drugs in Northern Mexico: A retrospective survival analysis / Transición del primer consumo de drogas ilegales a la primera inyección entre las personas que se inyectan drogas en el norte de México: un análisis retrospectivo de supervivencia

Abstract Introduction There is little information in Mexico about the transition to injecting drugs among drug users in cities other than Tijuana. Objective We compare characteristics of the onset of drug use and first injection among people who inject drugs (PWID) from Ciudad Juárez and Hermosillo, two cities of Northern Mexico and identify factors associated with faster rates of transition from first drug use to the first injection. Method 841 PWID were interviewed in 2012 in Ciudad Juárez (n = 445) and Hermosillo (n = 396). Using lifetables, we describe timing at the onset of drug use and first injection. Cox regression analysis was used to determine factors associated with the transition hazard to first injection. Results Median age at onset of drug use was 15.5 years old (standard deviation [SD] = 5.73). The median age at first injection was 21.30 (SD = 7.22). The median duration-time between first drug use and transition to injection was 4.8 years (SD = 5.6). Controlling for sociodemographics, factors that increase the hazard of transitioning to injection are age at onset of drug use (adjusted-hazard-rate [AHR] = 1.04, 95% confidence-interval CI [1.03, 1.05], p<.01) having used cocaine, heroin, or methamphetamine at the onset of drug use (AHR = 1.14, 95% CI [1.03, 1.27], p = .01), and having received assistance at first injection (AHR = 1.25, 95% CI [1.17, 1.33], p<.01). Discussion and conclusion Results show the need to enhance harm reduction programs among non-injecting drug users so as to prevent the spread of injecting drugs in Mexico.

Resumen Introducción Existe poca información en México sobre los calendarios al uso inyectado de drogas en ciudades distintas a Tijuana. Objetivo Comparamos las características del inicio del consumo de drogas y la primera inyección entre las personas que se inyectan drogas (PID) de Hermosillo y Ciudad Juárez e identificamos factores asociados con la transición a la primera inyección. Método En 2012 encuestamos a 841 PID en Ciudad Juárez (n = 445) y Hermosillo (n = 396). Utilizando tablas de vida analizamos las edades al primer uso de sustancias ilícitas y de la primera inyección. Ajustamos un modelo de regresión Cox para determinar los factores asociados con el riesgo de transición a la primera inyección. Resultados La edad mediana al primer consumo de drogas fue 15.5 años (desviación estándar [DE] = 5.73). La edad mediana a la primera inyección fue 21.30 (DE = 7.22). La duración mediana entre el primer uso de drogas ilícitas y la primera inyección fue de 4.8 años (DE = 5.6). Controlando los factores sociodemográficos, los factores que aumentan el riesgo de transición a la inyección son la edad al inicio de uso de drogas ([AHR] = 1.04, intervalo de confianza [IC] del 95% [1.03, 1.05], p<.01) uso de cocaína, heroína o metanfetamina como droga de inicio (AHR = 1.14, IC 95% [1.03, 1.27], p = .01) y haber recibido asistencia en la primera inyección (AHR = 1.25, IC 95% [1.17, 1.33], p<.01). Discusión y conclusión Es necesario mejorar los programas de reducción de daños entre los consumidores de drogas no inyectables para prevenir la propagación del uso inyectado de sustancias en el norte de México.

Age-specific rates of onset of cannabis use in Mexico.

BACKGROUND: Over the previous two decades, the lifetime prevalence of cannabis use has risen among Mexico's population. AIMS: Estimate the sex- and age-specific rates of onset of cannabis use over time. DESIGN: Five nationally representative cross-sectional surveys, the Mexican National Surveys of Addictions (1998, 2002, 2008, 2012) and the Mexican National Survey on Drugs, Alcohol, and Tobacco Consumption (2016). SETTING: Mexico. PARTICIPANTS: Pooled sample of 141,342 respondents aged between 12 and 65 years of which 43.6%(n = 61,658) are male and 56.4% (n = 79,684) are female. MEASUREMENTS: We estimated the age-specific rates of onset of cannabis as the conditional rate of consuming cannabis for the first time at a specific age. METHODS: Time-to-event flexible-parametric models with spline specifications of the hazard function. Stratified analysis by sex and control for temporal trends by year of data collection or decennial birth cohort. FINDINGS: Age-specific rates of onset of cannabis use per 1,000 individuals increased over time for females and males. Peak rates of onset of cannabis use per 1,000 ranged from 0.935 (95%CI = [0.772, 1.148]) in 1998, to 5.391 (95%CI = [4.924, 5.971]) in 2016 for females; and from 7.513 (95%CI = [6.732, 10.063]) in 1998, to 26.107 (95%CI = [25.918,30.654]) in 2016 for males. Across decennial birth-cohorts, peak rates of onset of cannabis use per 1,000 individuals for females ranged from 0.234 (95%CI = [0.078, 0.768]) for those born in the 1930s, to 14.611 (95%CI = [13.243, 16.102]) for those born in the 1990s; and for males, from 4.086 (95%CI = [4.022, 7.857]) for those born in the 1930s, to 38.693 (95%CI = [24.847, 48.670]) for those born in the 1990s. CONCLUSION: Rates of onset of cannabis increased over the previous two decades for both females and males but remained higher for males. Across recent cohorts, the rates of onset have increased at a faster rate among females than males.

Gender matters? How does gender shape risk environment for syringe sharing among people who inject drugs in northern Mexico. Results from a cross-sectional survey / ¿Importa el género? Evaluando el género como un componente del entorno de riesgo para el uso compartido de jeringas entre personas que se inyectan drogas en el norte de México. Resultados de una encuesta transversal

Abstract Introduction HIV prevalence among people who inject drugs (PWID) is 5%. Studies have found a HIV prevalence around 10% among women who inject drugs (WWID) and 5% among men. Objective To describe characteristics of risk environment that play different roles among men and women who inject drugs in Mexico that could be associated with those differentials. Method In 2012 were interviewed in Hermosillo and Ciudad Juarez in places where population gathered. From them, 824 PWID 74.0% were men and 26.0% were women. Using chi-square test we analyzed associations of gender with demographics characteristics, drug use dynamics, and injecting behaviors. We fitted different generalized linear mixed models with random effects to test the hypothesis that predictors of receptive needle sharing have different effects on men and women. Results Descriptive analysis showed that women live in conditions of higher vulnerability than men in terms of migration, educational attainment, occupation, and income. Women also reported a higher frequency of drug injection, a higher number of drugs used, and a higher prevalence of sharing needles. Variables significantly associated with the likelihood of sharing needles were: having being injected for someone else at first drug injection (adjusted odds ratio [AOR] = 1.60, 95% confidence interval CI [1.11, 2.25], p < .05); injecting once a day or more (AOR = 1.80, 95% CI [1.17, 2.70], p < .05), using alcohol or drugs at least half of the time at their sexual encounters (AOR = 1.64, 95% CI [1.16, 2.47], p < .05), experience of syringe confiscation by police (AOR = 1.54, 95% CI [1.13, 2.19], p < .05), and perceiving syringe availability as hard or very hard (AOR = 2.29, 95% CI [1.49, 3.32], p < .01). For women the most significant variable associated with syringe sharing was perception of syringe availability (AOR = 3.15, 95% CI [1.25, 7.91], p < .05), while for men was syringe confiscation by police (AOR = 1.74, 95% CI [1.20, 2.50], p < .05). Discussion and conclusion Results suggests the need to design and implement harm reduction programs that tackle the specific need of WID. Enhancing syringe availability through permanent harm reduction programs, implemented in coordination between public health authorities and community-based organizations, is a basic action to stop HIV spreading among PWID in northern Mexico, along with the decriminalization policies towards these population.

Resumen Introducción La prevalencia del VIH entre personas que se inyectan drogas (PIDs) es del 5%. Los estudios han encontrado que la prevalencia del VIH es aproximadamente del 10% entre las mujeres que se inyectan drogas (MIDs) y del 5% entre los hombres. Objetivo Este artículo busca describir detalladamente diferencias en las características que forman ambientes de riesgo diferenciados al VIH entre hombres y mujeres que se inyectan drogas en México. Método Se entrevistó a 824 personas que se inyectan drogas (PIDs) en Hermosillo y Ciudad Juárez en 2012 en lugares de encuentro de población. El 74.0% fueron hombres y el 26.0% mujeres. Mediante la prueba de chi-cuadrada, se caracterizan perfiles sociodemográficos, dinámicas de uso de drogas y de inyección por sexo. Se ajustan diferentes modelos lineales mixtos generalizados para probar la hipótesis que los predictores del uso compartido de jeringas tienen efectos distintos en hombres y mujeres. Resultados El análisis descriptivo mostró que las mujeres viven en condiciones de mayor vulnerabilidad que los hombres en términos de migración, logros educativos, ocupación e ingresos. Las mujeres también informaron una mayor frecuencia de inyección de drogas, mayor número de drogas usadas y mayor prevalencia de uso compartido de jeringas. Las variables significativamente asociadas con la probabilidad de compartir jeringas fueron haber sido inyectado por alguien más al momento de la primera inyección (Razones de momios ajustadas [AOR] = 1.60, 95% intervalo de confianza IC [1.11, 2.25], p < .05), inyectarse una vez al día o más (AOR = 1.80, 95% IC [1.17, 2.70], p < .05), consumir alcohol o drogas en al menos la mitad de sus encuentros sexuales (AOR = 1.64, 95% IC [1.16, 2.47], p < .05), haber enfrentado confiscación de jeringas por parte de la policía (AOR = 1.54, 95% IC [1.13, 2.19], p < .05) y tener una mala percepción de la disponibilidad de jeringas (AOR = 2.29, 95% IC [1.49, 3.32], p < .01). Entre las mujeres, la variable más significativa asociado a la probabilidad de compartir jeringas fue la mala percepción de la disponibilidad de jeringas nuevas (AOR = 3.15, 95% IC [1.25, 7.91], p < .05), mientras que en los hombres fue la experiencia de acoso policial (AOR = 1.74, 95% IC [1.20, 2.50], p < .05). Discusión y conclusión Los resultados sugieren la necesidad de diseñar e implementar programas de reducción de daños que tomen en cuenta las necesidades específicas de las MIDs. Es urgente mejorar la disponibilidad de jeringas entre PWIDs en el norte de México por medio de programas permanentes de reducción de daños, implementados en coordinación entre las autoridades de salud pública y las organizaciones comunitarias y en conjunto con políticas de descriminalización de esta población.

Comparing risk environments for HIV among people who inject drugs from three cities in Northern Mexico.

BACKGROUND: A large body of research has investigated the rise of injection drug use and HIV transmission in Tijuana and Ciudad Juarez (CJ). However, little is known about the dynamics of injecting in Hermosillo. This study compares drug-related behaviors and risk environment for HIV of people who inject drugs (PWID) across Tijuana, CJ, and Hermosillo to identify factors that could explain differences in HIV prevalence. METHODS: Data from Tijuana belong to a prospective study (El Cuete IV). Data from Hermosillo and Ciudad Juarez belong to a cross-sectional study. Both studies collected data in places where PWID spend time. All participants completed quantitative behavioral and serological testing for HIV. Datasets were merged using only comparable variables. Descriptive statistics tests were used to compare sociodemographic and behavioral characteristics of people who inject drugs PWID sampled in each city. A logistic regression model was built to identify factors independently associated with the likelihood of reporting receptive syringe sharing in the past 6 months. RESULTS: A total of 1494 PWID provided data between March 2011 and May 2012. HIV prevalence differed significantly between participants in Tijuana (4.2%), CJ (7.7%), and Hermosillo (5.2%; p < 0.05). PWID from Hermosillo reported better living conditions, less frequency of drug injection, and lower prevalence of syringe sharing (p < 0.01). PWID from CJ reported a higher prevalence of syringe sharing and confiscation by police (p < 0.01). In a multivariable logistic regression model, living in Hermosillo compared to Tijuana (adjusted odds ratio [AOR] = 0.42, 95% confidence interval [CI] 0.29-0.61) and being female (AOR = 0.61, 95% CI 0.45-0.83) were protective against syringe sharing. Having used crystal meth (AOR = 1.62, 95% CI 1.24-2.13, p = 0.001), having experienced syringe confiscation by police in the last 6 months (AOR = 1.78, 95% CI 1.34-2.40), and lower perception of syringe availability (AOR = 2.15, 95% CI 1.59-2.91) were significantly associated with syringe sharing (p < 0.05). CONCLUSIONS: Differences in HIV prevalence across cities reflect mainly differences in risk environments experienced by PWID, shaped by police practices, access to injection equipment, and dynamics of drug markets. Findings highlight the importance of ensuring sterile syringe availability through harm reduction services and a human rights approach to drug harms in northern Mexico and to generate better understanding of local dynamics and contexts of drug use for designing proper harm reduction programs.