Preventing an Opioid Crisis in Mexico

While the US continues fighting its opioid epidemic, which has costed thousands of lives, researchers warn that conditions in Mexico could deteriorate and lead to a similar scenario in the country.

The US’s Opioid Crisis

Johnson & Johnson, McKesson, Cardinal Health and Amerisource Bergen agreed to pay US$26 billion to several states affected by the opioid crisis in the US. With this agreement, complaints to the pharmaceutical company and distributors will be withdrawn. The money will be used to support the communities hardest hit by addiction to opioids.

The US opioid crisis began during the 80s, when pain management began to be prioritized. But it was not until mid-90s that pharmaceutical companies began releasing opioid-based products to manage pain, which came with strong promotion campaigns.

The structure of the healthcare system in the US further contributed to the over-prescription of opioids as many doctors in private practices benefited financially by increasing the number of patients they attended and ensuring their satisfaction, which incentivized over-prescription, according to Nature. At the time, medical education on pain management and opioid prescription was very poor, thus pharmaceutical companies such as Purdue Pharma sponsored continuing medical education courses for professional and patient organizations and sent representatives to visit individual doctors. During these activities, representatives emphasized the safety, efficacy and low potential for addiction of prescription opioids.

Opioid overdose rates gradually began to increase and the crisis became evident after the US registered a decrease in life expectancy in 2015, right when the majority of high-income countries reported a sustained growth. According to the World Bank Group, the country’s average life expectancy fell from 78.8 years in 2014 to 78.7 years in 2015, and then to 78.5 years in 2016 and 2017.

By 2017, more than 47,000 Americans died as a result of an opioid overdose, including prescription opioids, heroin and illicitly manufactured fentanyl, a powerful synthetic opioid. That same year, an estimated 1.7 million people in the US suffered from substance use disorders related to prescription opioid pain relievers and 652,000 suffered from a heroin use disorder (which are not mutually exclusive).

Prude Pharma’s federal lawsuit resulted in a US$635 million fine. Cardinal Health’s federal lawsuit was settled in 2016, after the company admitted failure to report suspicious cases to the DEA regarding one of its opioid-based drugs. McKesson Corporation’s federal lawsuit resulted in a US$150 million fine and required the company to suspend sales of controlled substances at distribution centers in Colorado, Ohio, Michigan and Florida for 3, 2, 2 and 1 years, respectively.

Now, Johnson & Johnson, McKesson, Cardinal Health and Amerisource Bergen have settled on cases at the state level in the courts of New York.

Opioids in Mexico

Despite being the third largest opioid producer in the world, Mexico has historically registered a low use of opioids, although heroin use has been documented. However, a study published in the Lancet found that a series of dynamic factors may be converging to increase their use in the country, including legislative changes to opioid prescriptions, national health insurance coverage of opioids, pressure from the pharmaceutical industry, changing demographics and disease burden, forced migration and its trauma and an increase in the production and trafficking of heroin.

In addition, harm-reduction services are scarce. According to the Lancet study, Mexico may transition from a country of low opioid use to high opioid use but can prevent this through a combination measures such as the targeted public health surveillance of high-risk groups, preparation of appropriate infrastructure to support evidence-based treatment and interventions and policies to avoid widespread opioid use.