Poor, terminally ill Mexicans are less likely to obtain opioids for palliative care

If you are poor and terminally ill in southern Mexico, you are much less likely to get the pain relievers you need for palliative care than your cousins ​​in more prosperous areas, especially wealthy areas. in pharmacies along the Mexican-US border, according to UCLA researchers. and colleagues who have studied the levels of opioid distribution across the country.

In addition, the researchers’ article in the journal The Lancet Public Health suggests that some of the opioids intended for Mexican citizens are likely to end 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 marginal increase in distribution levels, and inequalities in distribution have left much to be desired. many of the country’s poorest residents without comforts in their last days, said lead author Dr David Goodman-Meza, assistant professor of medicine in the division of infectious diseases at UCLA’s David Geffen School of Medicine.

People in the poorest regions of Mexico are dying of pain. Much remains to be done to improve access to opioids for those in medical need in Mexico. “

Dr David Goodman-Meza, lead author

Researchers analyzed data on prescription drug distribution from August 2015 to October 2019 for the 32 Mexican states and six major metropolitan areas. They compared prescription opioid levels to the expected need for medication based on the burden of disease in each condition.

While they found that opioid distribution overall increased by an average of 13% per quarter during this period, they also found that distribution levels were almost 10 times higher in states with populations had the highest socioeconomic status than those with the lowest. Additionally, higher socioeconomic status was also associated with increased distribution of opioids in individual neighborhoods in the six metropolitan areas.

The states with the highest opioid prescribing rates were Baja California (234.5 prescriptions per 10,000 population), 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), State of Mexico (4.3 per 10,000) and Tabasco (4.4 per 10,000).

Baja California, Nuevo Leon, and Sonora all border the United States, while Mexico City is its own state and sits between the state of Mexico and Tlaxacala in central Mexico.

Fentanyl was the most frequently distributed drug, at 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 referral hospitals, where advanced disease is treated, tend to be concentrated in Mexico’s larger, more prosperous cities and states. In addition, the high cost of drugs can put them out of reach of the poorest populations, discouraging pharmacies in poorer areas from transporting them.

The researchers also say that the proximity of many pharmacies to ports of entry along the northern border may make it easier for Americans to cross and obtain these drugs, straining U.S. efforts to stem the opioid epidemic. While the researchers did not focus on this and do not have data on cross-border shopping, they note in the article that these potential pathways in bear surveillance in the United States.

“As the United States attempts to curb the prescription opioid epidemic by instituting structural mechanisms such as shutting down ‘pill factories’ and instituting prescription drug surveillance programs, individuals can get around it by going to Mexico to get opioids, ”said Goodman-Meza mentioned. “Continued surveillance at border crossings is necessary to prevent the uncontrolled entry of opioids into the United States”

The results of the study are limited by several other factors, including a lack of data at the patient or provider level, the fact that the researchers did not analyze the differences between the many medical systems providing care and the possibility that some establishments have not submitted data to the Mexican government.