Hugo Arroyo’s left arm just hangs by his side. It was broken in two by police while he was sleeping outside in Tijuana; He didn’t get up on time, he explains, and was therefore beaten. Three years have passed and he is still awaiting surgery. Meanwhile, he sweeps, scrubs, trims trees, takes out the trash, and does other odd jobs with one arm: he can do it, but the pain is excruciating.
“I think I’ve managed to endure my arm pain from the fentanyl that’s broken it and I’m pretending I don’t have anything. The doctor asked me if I was sure I wanted to have an operation because it would be a painful procedure, but I told him it couldn’t hurt any more than it does now,” he says with a shy smile. Like many in this frontier town, Arroyo uses fentanyl on a daily basis. The drug is fifty times more potent than heroin and is responsible for 100,000 deaths in the United States each year. There is no official data on its impact in Mexico, but experts and organizations insist it could trigger the next major health crisis in the country.
Fentanyl’s effects are compounded by the fact that it’s extremely cheap, selling for as little as $2.5 a hit. And it only takes a few hits to get you hooked — three, say Uriel and his partner Mari. The high is brief and withdrawal is excruciating, resulting in bone pain, migraines, and gastroenteritis-like symptoms.
Fentanyl is smoked, inhaled, and injected. How often depends. Three times a day is seen by some users as an example of willpower, others can get as high as 10 stitches a day, and still others just get lost. The average number of daily doses for addicts is seven, according to government surveys. Those who use it have turned their lives into a race against the next dose.
Hugo Arroyo at Prevencasa, a charity in Tijuana (Mexico). Gladys Serrano
“The worst thing is waking up in the morning and needing a solution before I can do anything. My bones hurt and I can’t concentrate,” says Arroyo, 53, who was born in Uruapan, Michoacán, and immigrated to the United States for economic reasons, settling in California where he worked in a factory and as a dishwasher. “I worked my way up to become a chef,” he says proudly. He met someone and had a child, but after 20 years in the US, he was deported in 2013 for drunk driving. It was the third time he was caught. When he was sent back to a country he no longer knew, his life spiraled downward.
He started using heroin, became addicted, and spent years trying to kick it off with the help of methadone and rehab centers. So far he has had one success; He was working with a company that was collecting trash in Tijuana’s Plaza Rio when he decided he needed rehab. When he reappeared after three months, he got his job back and remained unemployed for a year before the company went bankrupt. “They owed me six months’ wages,” he says. “All of a sudden, I had no weight and I had nowhere to sleep.” Fentanyl was available on the street to help ease his changing circumstances. The effects were like heroin, only stronger. “I had to use less and it cost me less,” he explains. After his violent clash with the police in 2019, he received medical care from Prevencasa, an aid organization. They gave him a room and a small maintenance job at the center. “Thanks to the fact that I’m here and have something to do, I don’t feel so tempted. It was dose after dose out there.”
Tijuana as a laboratory
Located just meters from the border wall separating Mexico and the United States, Prevencasa’s courtyard has become an oasis in Tijuana. The center provides information and medical care, clean water, a shower, therapy and new syringes to prevent sharing and infection. In this two-headed, English and Spanish-speaking city, where both pesos and dollars are the currency, addicts have become part of the urban landscape. The city is dotted with mostly private rehabilitation clinics and religious organizations offering the famous 12-step program. At the same time, drug dealers are refining their product to make it more addictive and more readily available.
Experts no longer doubt that Tijuana’s endangered species were used as fentanyl lab rats. “Tijuana and Ciudad Juarez acted as a laboratory to determine doses and mix fentanyl with other drugs,” says José Andrés Sumano, drug trafficking and public safety researcher at Colegio de la Frontera Norte (Colef), a public research center. According to reports from Mexican authorities, Tijuana is one of the busiest borders in the world and has been the epicenter of fentanyl raids for years.
A group of drug users on May 10 in Tijuana, Baja California, Mexico. Gladys Serrano
The ingredients come from far away. Most of the molecules used in its manufacture come from China and India, entering Mexico via their ports or Guatemala. Here they are “cooked” and shipped north to the United States and Canada, where the largest market in the world is located. In Mexico, fentanyl is not used as such, but mixed with cocaine, heroin and crystal meth. The question is why?
“Unlike cocaine, which has to be manufactured in the Colombian highlands, or heroin, which requires large opium plantations, fentanyl can be made in a simple, small laboratory with few chemical precursors and does not require large facilities,” explains Sumano. “It’s so effective that a small ingredient can produce a large amount of product. And it’s extremely profitable; They make a lot more money off fentanyl than cocaine or heroin.”
Fentanyl has become something of a gold goose for drug dealers. It is cheaper and less risky as the amounts are smaller for the same effect and therefore easier to transport. This explains why there are now 200 deaths a day from fentanyl in the US. A large proportion of those affected were using their usual dose of cocaine or crystal meth to which fentanyl had been added without their knowledge. “Organized crime is on a learning curve,” says Sumano. “You still don’t have clear control over the doses.”
Karen prepares a dose of heroin with fentanyl. Gladys Serrano
Trial and error has proven deadly, not only in the US but also in Mexico, where many of the experiments were conducted among vulnerable people. “Between 2017 and 2018, we began to observe the behavioral effects of users just a few seconds after administration: episodes of psychosis and hallucinations,” says Lilia Pacheco, general project coordinator at Prevencasa. “It seemed strange because the same thing didn’t happen with heroin. But that only happens at the beginning. Later, the consumer seems to adapt. The other thing we’re concerned about is overdoses.” The organization deals with two to three overdoses a day. According to José Andrés Sumano, overdoses have increased by 200 to 400% in recent years.
Karen hasn’t kept track of how many times she’s overdosed since she started taking fentanyl in 2020. Is it 12 or 15? She was a mental health student in Guadalajara, Jalisco, when she first tried the drug with an ex-boyfriend. “When I first started taking fentanyl, I put about five drops through my nose,” she says. “It was like I died and then I was revived.”
After this time many more followed; She remembers very few, but she recalls the first charged injection: “I turned purple. They thought I was dead, they poured water on me and suddenly I was trying to breathe like a fish. I was 24.” Looking at a big scar on her arm, she adds, “The thing about my arm was because of the injection, they gave me salt water and it got infected.” She dropped out of college with just one semester to go and now engages in sex work to finance their consumption. What she longs for most, she says, is to get off drugs and out of the hole she’s in: “It’s awful,” she says. “You’re out of control. The drug controls everything, it brings you to your knees, you lose your life, you lose your whole being, you are no longer yourself.”
“Fentanyl? What the hell is that?
Consumption in Mexico has risen sharply within a short period of time. In 2017, in a study called “Cuqueando la chiva” involving more than 600 heroin users, only six had taken fentanyl — the rest didn’t even know what it was. Today, fentanyl users are the majority. “In just four and a half years, we realized that people didn’t know what fentanyl was, and now we realized that it’s the drug they’re looking for,” said Clara Fleiz, a researcher at the National Institute of Psychiatry and one of the first authors in Mexico to investigate the presence and development of fentanyl. “Because that’s what’s available. It’s what’s on the street.”
Melissa and Oscar, fentanyl users, in Tijuana on May 10th. Gladys Serrano
Oscar combs his hair for the interview. Melissa paints her nails electric blue. They’re young, 27 and 24, but they’ve been on drugs for a decade. Her drug use has evolved: marijuana, cocaine, crystal meth, heroin, and finally fentanyl. “About a year ago I wanted to buy Chiva [heroin] and there were none,” says Oscar. “They stopped selling it. They told me, “There’s nothing left but pure white porcelain, pure fentanyl.” ‘What the hell is that?’ I asked and they said, “It’s the same, only stronger, just take half what you were taking before.” And like everyone else, I started. It’s too strong. “If it’s your first time, it doubles you,” Oscar adds, just after his girlfriend injected fentanyl down his throat. “Your body can’t take it,” Melissa clarifies.
Both Oscar and Melissa left home when they were minors, Oscar due to his mother’s beatings, Melissa after a teenage pregnancy. They lived on the streets and started consuming. Oscar has visited rehabilitation centers several times without success; Melissa has heard so many horror stories that she doesn’t want to go. They met on a corner in downtown Tijuana a year and a half ago and have been inseparable ever since. They earn what they need for their next repair by recycling trash and cleaning windows. Sometimes it’s enough for one room. Melissa grew up in San Diego, where her mother and little sister still live. She says she still thinks about her a lot but doesn’t dare call her and doesn’t remember her phone number anyway. “I’m very sad,” she says. “I’m a good bitch, but I’m the black sheep and I’m ashamed. At the moment they don’t know how I am because I haven’t spoken to them. I am strong. But they are very worried,” she says from a sofa in Prevencasa, dipping a chocolate chip cookie into her coffee.
Today is Mother’s Day in Mexico. But in the center everything is going as usual. A full staff is on duty welcoming migrants, consumers and tuberculosis patients. During the morning a man comes in and asks if he can use the phone. Bald and heavily accented, he dials a number and says, “Happy Mother’s Day, Mom.” After hanging up, he picks up his syringes and leaves. The receptionist at the center writes down his name along with everyone who comes each day—about 120. “Ninety percent of those who come here take fentanyl,” says Pacheco.
A Prevencasa employee demonstrates the drug naloxone, which reverses an overdose of fentanyl. Gladys Serrano
A public health crisis looms
The disaggregated numbers from various nonprofit organizations and researchers are the only indication of the impact fentanyl is having in Mexico. There are no official figures. Andrés Manuel López Obrador’s government decided to reduce the cost of the National Addiction Survey (Encodat), which has been conducted roughly every five years since 1998. The last available survey is from 2016, before fentanyl was readily available. The lack of data makes it difficult to respond to the problem.
Fentanyl has become the latest diplomatic issue between the US and Mexico, a hot topic that neither government wants to own. López Obrador insists it is an “imported problem” and there are no labs in the country. He also proposed a ban on the medical use of fentanyl in hospitals, a response that has been harshly criticized by doctors because it is essential for certain procedures. In Spain, for example, it is used in a controlled manner in cancer patients with acute pain. “The federal government’s strategy of denying the problem isn’t helping at all,” says Sumano. “Today, any user of drugs like heroin or methamphetamine in the US or Mexico should assume their drug is adulterated with fentanyl.”
Although use in Mexico remains confined to certain locations, mainly along the northern border, and has not reached US levels, experts fear it will be mixed with crystal meth, a far more popular drug, in the future. There is also the added complication that the main overdose control drug, naloxone, is not sold in pharmacies in Mexico and must be imported. Sumano concludes: “The Mexican government has no strategy and the health crisis is just around the corner.”
The scarred hands preparing a fentanyl pipe once enabled Uriel to make a living from sport. A pro player for Jai Alai, Uriel, now 52, went to Miami to compete in the pro league. “I didn’t drink, I didn’t smoke, I was an athlete,” he says with a smile. When he returned to Tijuana 15 years ago, he began using drugs. He has quit several times, the last time three years ago: “I came back because I was lonely,” he says. “I was clean but without friends or work. I always asked about heroin, but it had fentanyl in it. I noticed it because the first time I used it I doubled it. Now heroin doesn’t do me any good. I’m still a bit afraid of death, so I don’t want to overdose: I only take it three times: breakfast, lunch and dinner, and then leave it until the next day.”
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