When it landed three years ago, some six guys died here in one week," says 51-year-old Roberto Prado, a homeless man who uses drugs and lives in a community of a few dozen beneath one of Tijuana's canal bridges.
Until recently, people in Tijuana and other Mexican border cities who use heroin almost exclusively consumed the black tar form of the drug, originating from poppy-growing states such as Guerrero and Chihuahua. In 2018, local drug gangs seem to have switched en masse to trafficking "white" or "China white," a synthetic powder that often contains the powerful painkiller fentanyl.
Fentanyl, its base chemicals usually imported from China, is much cheaper to produce than heroin, with a bigger profit margin for traffickers. The shift has gone hand in hand with a considerable spike in overdoses, say a dozen users and harm reduction activists interviewed by Filter in the border cities of Tijuana, Mexicali, and Ciudad Juárez.
In the face of what is by all accounts an emerging fentanyl crisis, people who use drugs encounter indifference, or even outright hostility from both the general public and authorities.
Beneath the bridge where Prado lives, as in other homeless encampments in these cities, the only recourse residents have is each other, or well-meaning activists with limited means. In Ciudad Juárez, ambulances are said to shy away from overdose calls. Police are often physically abusive with users and extort them for money. People who use drugs are often forced into rehab programs—only to emerge with lower tolerance and thus a higher risk of overdose.
The Year of Fentanyl
"2018 for us was undoubtedly the year of fentanyl and more overdoses, often lethal, than we've ever seen," says Luis Alberto Segovia, director of Prevencasa, an organization dedicated to harm reduction among Tijuana's intravenous drug users.
Prevencasa operates out of a house in the city's Zone Norte, a poor and violent neighborhood along the border fence separating Mexico from the United States.
About 150 people, most of them men in their 30s, make daily use of the organization's syringe exchange program (below). Prevencasa's doctors also provide treatment for HIV, hepatitis C, and skin abscesses.
Last year, illicit fentanyl became the leading cause of fatal drug overdoses in the U.S. But whereas the overdose crisis has long made headlines in the U.S, causing the White House to declare a public-health emergency, in Mexico intravenous drug use remains largely invisible.
One reason is that IV drug use is highly concentrated in the northern border region. A large majority of the people who inject drugs there, according to local harm reductionists, are former undocumented immigrants to the U.S., who have been deported and brought their habit back with them. That factor might keep the budding fentanyl crisis from taking hold elsewhere in Mexico, although fentanyl labs have been discovered as far south as Mexico City.
One thing is certain, harm reduction workers say: The local situation requires urgent attention. Yet there are no official statistics about drug overdoses in the region. More often than not, the cause of death of a homeless drug user is left undetermined, according to Prevencasa staff. Baja California's state authorities confirm that, in case of drug overdose deaths, the type of drug is usually not examined.
There is other evidence, however, that fentanyl, which costs as little as 50 pesos ($2.62 U.S.) per dose, has taken over from black tar heroin here. When people register for syringe exchange programs, they're usually asked to list their drug of choice: Both Tijuana and Mexicali have seen a notable shift from black tar to polvo blanco, or "white powder" in these listings, harm reductionists say. Tests on syringes and cookers by harm reduction groups come back positive for fentanyl in all three border cities. And Prevencasa's doctors are now regularly called out to the street to treat overdoses.
"We've definitely noticed something happening; we didn't used to have this many overdoses," says Julián Rojas Padillo of Programa Compañeros in Ciudad Juárez. "But a lot remains unclear, it's hard to really pin it down: we tried to get some numbers from local authorities, but nothing came back.' Rojas says considerable social stigma renders intravenous drug users largely invisible. "Even ambulances routinely shy away from overdose calls, leaving users to their fate."
"I've seen several people die of overdoses before my eyes because of fentanyl," says 72-year-old Pedro León, who lives and uses drugs in Tijuana. "But there's no scandal, no questions, nothing. We don't matter to anyone."
Pressing Demand for Harm Reduction
Harm reduction groups in northern Mexico have recently started to distribute overdose-reversing naloxone, better known by the brand name Narcan. Many street-level users now carry it around, and administer it to others on a regular basis, they tell Filter.
"I use it on someone several times a week," says Roberto Prado, who has been addicted to heroin for 15 years. At one point he went to a rehab facility and quit using the drug for a year, but he relapsed shortly after his release. "There are just no options here, no work, nothing. That's why it's so hard to move on for everyone."
"We've had two overdose deaths in the past two days," says José Luis Sánchez, 27. Formerly addicted to heroin, he now runs a syringe exchange stand in the rundown city center of Mexicali, a border city 110 miles east of Tijuana, also in Baja California state. "The situation is getting dangerous. There's no doubt that there's a fentanyl epidemic, it's very much real."
Verter, the harm reduction organization he works for, has started to distribute naloxone around Mexicali and surrounding cities, even as far as the state of Sonora, and teaching people who use drugs how to administer it. "And there's demand for it," he says. "People always come back for more, which indicates that overdoses are spiraling out of control."
Verter recently made local headlines after it opened a safer consumption space for women, where they were able to inject under medical supervision, using sterile materials. It was the first of its kind in Latin America.
The municipal government shut it down after barely a week, citing administrative reasons. José Luis and his colleagues believe otherwise. "We think it was an excuse, because they really weren't too happy about it."
Why Fentanyl Remains Off the Radar
"Baja California is a fentanyl factory," read the cover of Zeta, a Tijuana-based investigative journalism weekly, last September. State authorities have dismantled several small and large fentanyl laboratories equipped with pill presses that reportedly supplied drug markets in Boston, Chicago, New Jersey, and New York, where fentanyl is prevalent. Baja California has thus morphed from a mere transit point for drugs into a producing state.
Zeta reporter Inés García points to the soaring violence in her city as a reason why fentanyl overdoses remain off the radar. "San Diego, right across the border, averages about 60 homicides per year," she says. "We have that in 10 days, most of it due to disputes over the sale of crystal meth—which, by the way, is more prevalent than heroin or fentanyl. Medical examiners are so saturated they don't even notice fentanyl overdoses."
In the U.S., fentanyl has been turning up in a whole array of street drugs, such as cocaine, methamphetamine, MDMA, and counterfeit Xanax, causing concern among experts about the next wave in a seemingly never-ending crisis.
As well as these implications north of the border, the ascent of fentanyl in northern Mexico also affects Mexicans involved in the production of regular heroin. Poor poppy farmers in Chihuahua and Guerrero—as Simon Schatzberg reports for Filter—are finding that the price of their product has fallen, as it is displaced by cheaper-to-produce fentanyl.
"Over the past few years, poppy production in Mexico really increased because of soaring demand in the U.S.," says Jorge Hernández Tinajero, an independent Mexican drug researcher working with international organizations. "But now, fentanyl is causing the price of opium to drop steadily. If you cut your heroin with fentanyl, which is much stronger, and another substance, that heroin now goes a much longer way and less of it is needed."
Might fentanyl at some point entirely displace heroin? "I don't think so," Hernández Tinajero says. "First of all, it presents problems for users, in that it's hard to find the right dosage, and not overdose. Moreover, heroin has come and gone in waves since the 19th century. Demand might soar and drop, but there will always be demand. There's a culture surrounding it."
Asked to comment, Tijuana's municipal government says it isn't aware of any increase in overdose deaths because of fentanyl, referring to federal authorities. Federal judicial authorities say they don't keep statistics about it.
Meanwhile, harm reduction groups, together with the Mexican National Institute for Psychiatry, are preparing a study about IV drug use and fentanyl on the northern border. That would constitute a first broad examination into the issue and help to ensure that the people affected don't remain invisible.
"It's more than necessary," says Prevencasa's harm reduction program coordinator, Alfonso Chávez, "because it's precisely this lack of hard data about overdose deaths that's causing authorities to remain passive."