Managing la malilla: Exploring drug treatment experiences among injection drug users in Tijuana, Mexico, and their implications for drug law reform

Syvertsen, Jennifer; Pollini, Robin A.; Lozada, Remedios; Vera, Alicia; Rangel, Gudelia; Strathdee, Steffanie A.

doi:10.1016/j.drugpo.2010.06.006

« Previous Next »International Journal of Drug Policy
Volume 21, Issue 6 , Pages 459-465, November 2010

Managing la malilla: Exploring drug treatment experiences among injection drug users in Tijuana, Mexico, and their implications for drug law reform

Jennifer Syvertsen
- Department of Anthropology, University of South Florida, United States
- Division of Global Public Health, Department of Medicine, University of California San Diego, United States
Robin A. Pollini
- Division of Global Public Health, Department of Medicine, University of California San Diego, United States
- Corresponding author at: Division of Global Public Health, Department of Medicine, University of California San Diego, Department of Medicine, 9500 Gilman Drive, MC 0507, La Jolla, CA 92093-0507, United States. Tel.: +1 858 534 0710; fax: +1 858 534 7566.
Remedios Lozada
- Pro-COMUSIDA, Tijuana, Mexico
Alicia Vera
- Division of Global Public Health, Department of Medicine, University of California San Diego, United States
Gudelia Rangel
- Division of Global Public Health, Department of Medicine, University of California San Diego, United States
- El Colegio de la Frontera del Norte, Tijuana, Mexico
Steffanie A. Strathdee
- Division of Global Public Health, Department of Medicine, University of California San Diego, United States

Received 15 April 2010; received in revised form 25 June 2010; accepted 28 June 2010. published online 27 August 2010.

Abstract

Background

In August 2009, Mexico reformed its drug laws and decriminalized small quantities of drugs for personal use; offenders caught three times will be mandated to enter drug treatment. However, little is known about the quality or effectiveness of drug treatment programs in Mexico. We examined injection drug users’ (IDUs) experiences in drug treatment in Tijuana, Mexico, with the goal of informing program planning and policy.

Methods

We examined qualitative and quantitative data from Proyecto El Cuete, a multi-phased research study on HIV risk among IDUs in Tijuana. Phase I consisted of 20 in-depth interviews and Phase II employed respondent-driven sampling to recruit 222 IDUs for a quantitative survey. We also reviewed national drug policy documents, surveillance data, and media reports to situate drug users’ experiences within the broader sociopolitical context.

Results

Participants in the qualitative study were 50% male with a mean age of 32; most injected heroin (85.0%) and methamphetamine (60.0%). The quantitative sample was 91.4% male with a mean age of 35; 98.2% injected heroin and 83.7% injected heroin and methamphetamine together. The majority of participants reported receiving treatment: residential treatment was most common, followed by methadone; other types of services were infrequently reported. Participants’ perceptions of program acceptability and effectiveness were mixed. Mistreatment emerged as a theme in the qualitative interviews and was reported by 21.6% of Phase II participants, primarily physical (72.0%) and verbal (52.0%) abuse.

Conclusions

Our results point to the need for political, economic, and social investment in the drug treatment system before offenders are sentenced to treatment under the revised national drug law. Resources are needed to strengthen program quality and ensure accountability. The public health impact of the new legislation that attempts to bring drug treatment to the forefront of national drug policy should be systematically evaluated.

Keywords: Drug treatment, Drug law reform, Mexico