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Fatal drug overdose rates have doubled over the past 15 years in Mexico, according to an investigation led by experts from Mexican and American institutions. The overdoses typically involve psychoactive substances and opiates. The deaths often result from a lack of intervention to reverse the drug's effects.

The study, which involved experts from Drexel University and Temple University in Philadelphia, United States, as well as the National Institute of Public Health and the Psychiatric Care Services of Mexico's Ministry of Health, analyzed overdose mortality trends in the country with data from 2005 to 2021. The results, published in the American Journal of Public Health, revealed that the national rate was 0.53 deaths per 100,000 inhabitants. 

Although various indicators show that fatal overdose rates have increased in several countries in recent decades, the trends have not been clearly described in some of them, including Mexico, making these data valuable estimates.

Border Cities Affected

In the year-by-year analysis, the mortality rate remained stable from 2005 to 2014 but subsequently showed significant growth. It increased from 0.44 in 2014 to a peak of 0.79 in 2021, an increase of 79% in an 8-year span. In addition, the rate in urban areas (0.60 per 100,000) was nearly double that in nonurban areas (0.37 per 100,000).

Between 2014 and 2021, increases were recorded in both types of areas (84% in urban, 65% in nonurban). But throughout the entire period examined (2005-2021), increases were more pronounced in urban areas. The mortality rates were similar around 2000 but began to differentiate in the early part of the following decade.

The research team observed a geographic trend toward higher overdose mortality rates in northwestern cities. The rates gradually decreased toward the southeastern regions of the country. Of the 15 cities with the highest rates recorded during the study, 11 are in the four states furthest west along the border with the United States: Sonora, Chihuahua, Coahuila, and Baja California.

These findings are consistent with historical rates of opioid use reported in other studies and the recent use of drugs adulterated with fentanyl along the northern border. This variation also aligns with the points where drug seizures have occurred between 2018 and 2023 in the northwest states: Baja California, Sonora, and Sinaloa. "These trends suggest that geographic proximity to the United States during its opioid overdose crisis is a risk factor for fatal overdose in Mexico," the authors noted in their report.

"In recent years, fentanyl has been part of the regional agenda in Mexico, the United States, and Canada, but it seems to me that the issue has been focused on each country's national security perspective, and we need to address it from the public health perspective, the needs faced by communities of users of this and other drugs," Clara Fleiz Bautista, PhD, a researcher in medical sciences at the National Institute of Psychiatry in Mexico City, told the Medscape Spanish edition.

A study reports that fatal overdose rates in the United States remained relatively stable between 2005 and 2013 but subsequently increased from 13.8 deaths per 100,000 inhabitants to 32.4 in 2021, a growth of 134% during that period.

Accurately estimating the number of fatal overdoses is very complex, because multiple factors are involved, said Dr Adriana Villafuerte García, a medical surgeon in the Faculty of Medicine at the National Autonomous University of Mexico. It is common for cases to be recorded in death certificates as cardiorespiratory arrest when they were caused by excessive substance use.

"The way fentanyl is consumed now is very different, and we know that it has a 30% higher risk of causing overdoses. However, I believe it is very positive that more studies are trying to estimate this figure of fatal overdoses, as information is corrected in our information systems," said Villafuerte, who specializes in HIV/AIDS, HIV and tuberculosis coinfection, health program evaluation, and opioids.

Focus on Opioids 

While opioid use in Mexico and the United States has shown similar trends in recent years, the crisis in the US has a history that dates back decades. "The problem began with the indiscriminate prescription of opioids for any type of pain," said Fleiz. "Then, users transitioned to heroin use, and finally fentanyl arrived. In contrast, in our country, when we first detected this substance in 2019 as an adulterant in other drugs, we realized that people were consuming it unknowingly." 

These populations of drug users in Mexico were consequently much more exposed to the unwanted effects of overdose. "The problem reached us later, but it has grown very rapidly, and we do not have a sufficient response from health institutions up to this moment," said Fleiz.

In Mexico, simultaneous use of various substances is the second leading cause of hospital admission and death after alcohol. In fact, in 2023, the primary reason for emergency department visits due to illicit drug use was the combined use of multiple substances, according to the Report on the Mental Health Situation and Substance Use in Mexico, 2024. 

The document acknowledges that illicitly produced fentanyl has proliferated in certain northern localities of the country. Since 2018, the use of these psychoactive substances has promoted an increase in demand for treatment. Only 10 cases were recorded in 2018, 25 in 2019, 72 in 2020, 184 in 2021, 33 in 2022, and 518 in 2023. Most of the cases in the last year occurred in Baja California, Sinaloa, Sonora, and Chihuahua. 

During 2023, 179,342 people sought treatment for the use of psychoactive substances in the National Network of Addiction Care. Among psychoactive substances, amphetamine-type stimulants (eg, amphetamine, methamphetamine, ecstasy, or medically used stimulants) stand out because their consumption generated the highest demand for treatment (49% of cases). 

Reducing Consumption and Overdoses

The investigators acknowledged that opioid use in Mexico had been reduced, but from 2015, various factors present at the northern border increased consumption and the risk for overdose. These factors included the greater availability of psychoactive drugs due to cocaine and synthetic opioid trafficking to the United States, regional production of methamphetamines, access to pharmaceutical opioids on the other side of the border, and strong social and economic ties with the United States. 

Hence, the need to invest in data infrastructure to assess the magnitude of overdose mortality in Mexico and monitor trends using standardized protocols to code and report fatal cases associated with drug use was emphasized. The National Mental Health and Addictions Commission, along with civil society organizations, proposed a decentralized national harm reduction strategy.

Suggested initiatives to prevent opioid-related deaths include the community distribution of harm reduction supplies such as strips to detect fentanyl, the training of those accompanying drug users, and the reclassification of naloxone, an opioid receptor antagonist that can be used to counteract overdose effects. Under Mexican law, naloxone is classified as a psychiatric medication and not widely available in pharmacies.

In addition, an analysis based on various sources of information in which Villafuerte participated estimated that between 161 and 1241 opioid-related deaths may occur in the country each year. More than 80% of deaths could be avoided through the prompt use of naloxone. 

In the United States, naloxone is available as part of a rescue kit for people with friends or family members who use opioids in case of overdose. In addition, mobile applications facilitate monitoring and control of rescue kit consumption, said Villafuerte.

"In Mexico, harm reduction policy has its limitations, as described by both researchers and civil society organizations. Therefore, it is necessary to address issues such as needle exchange among injectable drug users or the application of substitution therapies with substances like methadone," said Villafuerte.

"Numerous clinics used to use methadone, but they have been closing and the availability of this drug also decreased just over a year ago. Only the Youth Integration Centers had a small supply. In these conditions, it is not possible to manage a person who uses substances to prevent them from overdosing," she added.

"The prevention work that is being carried out by health institutions is good, especially with an emphasis on young populations, but it must be complemented by harm reduction, since it is a structural problem with complex social determinants that must be addressed from different perspectives," Villafuerte concluded.

This research received support from the Wellcome Trust Initiative Our Planet, Our Health. Fleiz and Villafuerte declared no relevant financial relationships. 

This story was translated from the Medscape Spanish edition using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.