If you are poor and terminally ill in southern Mexico, there is a much lower chance of you getting the burn pills you need for palliative care than your cousins in more affluent regions, especially those areas full of pharmacies along the Mexico-US border, say UCLA researchers and colleagues who have studied opioid distribution rates across the country.
In addition, the researchers’ paper in the journal Lancet Public Health suggesting that some of the potential opioids for Mexican citizens appear to be ending up in American pockets.
Despite a Mexican government initiative launched in 2015 to improve access to prescription opioids among palliative care patients, the country has seen only a small increase in distribution rates, and inequalities in contentment has left many of the country’s poorest residents without comfort in their final days, said lead author Dr. David Goodman-Meza, a professor of medicine in the infectious diseases department at UCLA’s David Geffen School of Medicine.
People in the poorest areas of Mexico are dying in pain. Much work needs to be done to increase access to opioids for those in medical need in Mexico. “
Dr. David Goodman-Meza, Lead Author
The researchers analyzed data on the distribution of prescription drugs from August 2015 to October 2019 for the 32 states of Mexico and six major metropolitan areas. They compared opioid prescribing levels against the expected need for drugs based on disease burden in each state.
While they found that opioid distribution had increased 13% in the quarter overall over that period, they also found that release rates were nearly 10 times higher in states at whether the socio-economic status was higher than those with the lowest. In addition, higher socioeconomic status was also associated with increased opioid distribution within individual neighborhoods in the six metropolitan areas.
The states with the highest opioid prescribing rates were Baja California (234.5 prescriptions per 10,000 inhabitants), Mexico City (65.8 per 10,000), Nuevo Leon (58.7 per 10,000), Sonora (56.5 per 10,000) and Jalisco (51.9 per 10,000). Those with the lowest rates were Tlaxacala (0 per 10,000), Guerrero (0.6 per 10,000), Durango (2.7 per 10,000), the state of Mexico (4.3 per 10,000), and Tabasco (4.4 per 10,000).
Baja California, Nuevo Leon and Sonora all orbit the U.S., while Mexico City is a state of its own and sits between the state of Mexico and Tlaxacala in central Mexico.
Fentanyl was the most commonly prescribed medication, accounting for 35.7% of the total, followed by methadone (26.5%), morphine (23.8%), tapentadol (7.3%), oxycodone (6.9%) and hydromorphone (0.2%).
The researchers note that large transmission hospitals, where advanced stage diseases are treated, tend to be larger in cities and larger states in Mexico. In addition, the high cost of medicines may make them out of reach for poorer populations, discouraging pharmacies in deprived areas from transporting them.
The researchers also say that the proximity of many shops at ports of entry on the northern border may make it easier for people in the U.S. to cross and get these drugs, underscoring efforts the US to prevent their opioid addiction. Although the researchers did not focus on this and do not have cross-border purchase data, they note in the paper that there is an analysis of possible pathways in the US.
“How the U.S. has sought to prevent drug-related opioids-related epilepsy by implementing structural measures such as the closure of‘ pill mills ’and the introduction of drug testing programs order, individuals may get around them by going to Mexico to get opioids, “Goodman – Meza said. “Cross-border ongoing monitoring is needed to avoid the entry of opioids into the U.S..”
The findings of the study are limited by a number of other factors, including a lack of patient or provider-level data, which the researchers did not analyze for differences between the many medical systems providing care. and the possibility that some institutions did not submit data to the Mexican government.
Source:
University of California – Los Angeles Health Sciences