RESUMO
BACKGROUND: The U.S.-Mexico border displays elevated rates of hazardous alcohol and drug use. Whether the co-occurrence of alcohol and drug use and disorders is also high in the border area is unknown. METHODS: Data are from the U.S.-Mexico Study on Alcohol and Related Conditions, a cross-sectional survey of randomly selected respondents interviewed from 2011 to 2013. Participants included 1,690 Mexican Americans from Texas (572 in an off-border city and 1,118 from 3 border cities) and 1,293 Mexicans from Nuevo Leon and Tamaulipas (415 in an off-border city and 878 from 3 Mexican cities bordering Texas) who reported drinking in the last 12 months. Participants were interviewed regarding the prevalence of and risk factors for: (i) co-occurring hazardous alcohol use (5+/4+ at least monthly) and drug use (medical and illicit) and (ii) co-occurring presence of a DSM-5 alcohol use disorder (AUD) and 2 symptoms (hazardous use and quit/control) of drug use disorder (DUD symptoms). RESULTS: Co-occurring hazardous alcohol and drug use was more common in the U.S. border cities (14.7%) than off-border (7.2%), but similar for Mexican border (1.2%) and off-border (1.4%) cities. Co-occurrence of AUD and DUD symptoms was likewise more common at the U.S. border (6.8%) than off-border (3.3%), as well as at the Mexican border (1.3%), compared to off-border (0.6%), but not statistically significant for Mexico. In models adjusting for demographics, mobility factors and exposure to the U.S. culture, border residence in both countries related to a nearly twofold increase in prevalence ratios (PRs) of co-occurring AUD and DUD symptoms (PR = 1.97, 95% CI = 1.36 to 2.85). CONCLUSIONS: Increased rates of co-occurring AUDs and DUDs suggest an added negative impact on already difficult conditions of the border population.
Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Comorbidade , Estudos Transversais , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino , Americanos Mexicanos/estatística & dados numéricos , México/epidemiologia , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Texas/epidemiologia , Adulto JovemRESUMO
Clinical and cultural characteristics of Hispanic adolescent heroin users are not well described. The current exploratory study was conducted to describe a sample of in-treatment Hispanic adolescents with opioid dependence, specifically, cheese heroin. Mexican and Mexican American adolescents with heroin dependence (N = 72) in three treatment programs were interviewed and completed self-report measures. Participants reported, on average, first using cheese heroin at age 13.5 years and daily use at age 14.2 years. The majority (74%) reported a previous overdose. Adolescents being raised by caregivers other than both biological parents, who used drugs with relatives, and whose immediate family members have documentation to be in the United States fared worse on several indicators of drug use severity and other risky behaviors. The self-reported brief time period from first use to daily use strongly suggests the need for early prevention efforts. Additional research is needed to add to these preliminary results and inform prevention efforts.
Assuntos
Overdose de Drogas/epidemiologia , Dependência de Heroína/reabilitação , Americanos Mexicanos/estatística & dados numéricos , Centros de Tratamento de Abuso de Substâncias , Adolescente , Estudos Transversais , Overdose de Drogas/etnologia , Família , Feminino , Dependência de Heroína/etnologia , Humanos , Masculino , México/etnologia , Estados UnidosRESUMO
BACKGROUND: This study examines whether Mexico's controls on ephedrine and pseudoephedrine, the two precursor chemicals that yield the most potent form of methamphetamine, d-methamphetamine, impacted the prevalence/availability of less potent types of methamphetamine in the United States-types associated with the alternative precursor chemical P2P. METHOD: Using ARIMA-intervention time series analysis of monthly drug exhibits (a prevalence/availability indicator) from the System to Retrieve Information from Drug Evidence (STRIDE), we tested whether Mexico's controls, which began in 2005, were associated with growth/decline in d-methamphetamine and growth/decline in P2P-associated, less potent l-methamphetamine, racemic methamphetamine (a 50:50 ratio of d- and l-isomers), and mixed isomer methamphetamine (an unequal ratio of d- and l-isomers). Heroin, cocaine and marijuana exhibits were used for quasi-control (01/2000-04/2011). RESULTS: Mixed-isomer exhibits constituted about 4% of the methamphetamine exhibits before Mexico's controls, then rose sharply in association with them and remained elevated, constituting about 37% of methamphetamine exhibits in 2010. d-Methamphetamine exhibits dropped sharply; l-methamphetamine and racemic methamphetamine exhibits had small rises. d-Methamphetamine exhibits partially recovered in the US West, but little recovery occurred in the US Central/South. Quasi-control series were generally unaffected. CONCLUSION: The US methamphetamine market changed. Widespread emergence of less potent methamphetamine occurred in conjunction with Mexico's controls. And prevalence/availability of the most potent type of the drug, d-methamphetamine, declined, a partial recovery in the West notwithstanding. Granting that lower potency drugs typically engender less dependence and attendant problems, these findings suggest that, following Mexico's controls, the potential harm of a sizeable amount of the US methamphetamine supply decreased.
Assuntos
Estimulantes do Sistema Nervoso Central/análise , Controle de Medicamentos e Entorpecentes/legislação & jurisprudência , Metanfetamina/análise , Algoritmos , Cannabis/química , Estimulantes do Sistema Nervoso Central/química , Cocaína/análise , Controle de Medicamentos e Entorpecentes/tendências , Efedrina/química , Geografia , Heroína/análise , Humanos , Metanfetamina/química , México , Modelos Estatísticos , Entorpecentes/análise , Pseudoefedrina/química , Estereoisomerismo , Estados UnidosRESUMO
AIMS: Although illicit drug purity is a widely discussed health risk, research explaining its geographic variation within a country is rare. This study examines whether proximity to the US-Mexico border, the United States' primary drug import portal, is associated with geographic variation in US methamphetamine, heroin and cocaine purity. DESIGN: Distances (proximity) between the US-Mexico border and locations of methamphetamine, cocaine and heroin seizures/acquisitions (n = 239,070) recorded in STRIDE (System to Retrieve Information from Drug Evidence) were calculated for the period of 1990-2004. The association of drug purity with these distances and other variables, including time and seizure/acquisition size, was examined using hierarchical multivariate linear modeling (HMLM). SETTING: Coterminous United States. FINDINGS: Methamphetamine, cocaine and heroin purity generally decreased with distance from the US-Mexico border. Heroin purity, however, after initially declining with distance, turned upwards-a U-shaped association. During 2000-04, methamphetamine purity also had a U-shaped association with distance. For each of the three drugs, temporal changes in the purity of small acquisitions (<10 g) were typically more dynamic in areas closer to the US-Mexico border. CONCLUSIONS: Geographic variance in methamphetamine, cocaine and heroin purity throughout the coterminous United States was associated with US-Mexico border proximity. The U-shaped associations between border-distance and purity for heroin and methamphetamine may be due to imports of those drugs via the eastern United States and southeast Canada, respectively. That said, areas closer to the US-Mexico border generally had relatively high illicit drug purity, as well as more dynamic change in the purity of small ('retail level') drug amounts.
Assuntos
Cocaína/química , Contaminação de Medicamentos/estatística & dados numéricos , Controle de Medicamentos e Entorpecentes/estatística & dados numéricos , Heroína/química , Metanfetamina/química , Modelos Estatísticos , Cocaína/provisão & distribuição , Comércio/legislação & jurisprudência , Comércio/estatística & dados numéricos , Interpretação Estatística de Dados , Composição de Medicamentos , Controle de Medicamentos e Entorpecentes/legislação & jurisprudência , Heroína/provisão & distribuição , Humanos , Armazenamento e Recuperação da Informação , Modelos Lineares , Metanfetamina/provisão & distribuição , México , Fatores de Tempo , Estados UnidosRESUMO
AIMS: To help counter problems related to methamphetamine, Mexico has implemented interventions targeting pseudoephedrine and ephedrine, the precursor chemicals commonly used in the drug's synthesis. This study examines whether the interventions impacted methamphetamine treatment admissions-an indicator of methamphetamine consequences. DESIGN: Quasi-experiment: autoregressive integrated moving average (ARIMA)-based intervention time-series analysis. INTERVENTIONS: precursor chemical restrictions implemented beginning November 2005; major rogue precursor chemical company closed (including possibly the largest single drug-cash seizure in history) March 2007; precursor chemicals banned from Mexico (North America's first precursor ban) August 2008. SETTINGS: Mexico and Texas (1996-2008). MEASUREMENTS: Monthly treatment admissions for methamphetamine (intervention series) and cocaine, heroin and alcohol (quasi-control series). FINDINGS: The precursor restriction was associated with temporary methamphetamine admissions decreases of 12% in Mexico and 11% in Texas. The company closure was associated with decreases of 56% in Mexico and 48% in Texas; these decreases generally remained to the end of the study period. Neither intervention was associated with significant changes in the Mexico or Texas quasi-control series. The analysis of Mexico's ban was indeterminate due largely to a short post-ban series. CONCLUSIONS: This study, one of the first quasi-experimental analyses of an illicit-drug policy in Mexico, indicates that the country's precursor interventions were associated with positive impacts domestically and in one of the Unites States' most populous states--Texas. These interventions, coupled with previous US and Canadian interventions, amount to a new, relatively cohesive level of methamphetamine precursor control across North America's largest nations, raising the possibility that the impacts found here could continue for an extended period.
Assuntos
Transtornos Relacionados ao Uso de Anfetaminas/prevenção & controle , Estimulantes do Sistema Nervoso Central/provisão & distribuição , Controle de Medicamentos e Entorpecentes/legislação & jurisprudência , Metanfetamina/provisão & distribuição , Admissão do Paciente/estatística & dados numéricos , Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos , Transtornos Relacionados ao Uso de Anfetaminas/epidemiologia , Transtornos Relacionados ao Uso de Anfetaminas/reabilitação , Estimulantes do Sistema Nervoso Central/síntese química , Efedrina/química , Efedrina/provisão & distribuição , Humanos , Metanfetamina/síntese química , México/epidemiologia , Admissão do Paciente/tendências , Pseudoefedrina/química , Pseudoefedrina/provisão & distribuição , Texas/epidemiologia , Fatores de TempoRESUMO
This study analyzes trends in treatment admissions and summarizes HIV/AIDS risk factors along the US-Mexican border. Data are presented at the national level and at the state level for states along the border. Client data also are compared for treatment programs located in sister cities on the Texas-Mexico border. These data show that methamphetamine admissions are increasing nationally and methamphetamine use is a major problem in the western states on both sides of the border. Use of Ice (smoked methamphetamine) has increased significantly. Use of crack (smoked cocaine) is a growing problem on the border, and injection is the primary route for using black tar heroin in this area. Each of these drugs is a risk factor, either from drug-influenced risky sexual behaviors or from sharing injection equipment. In addition, the availability of drugs on the border and patterns of risky behaviors among migrants mean that drug users on the border are at risk of HIV/AIDS, and this risk is expected to increase with the spreading methamphetamine epidemic and smoking of crack cocaine. Comparable data on HIV/AIDS are needed for further studies of the relationship of drug use and HIV/AIDS on the border.