His left arm hangs limp at his side. Hugo Arroyo was cut in two by police as he slept on the streets of Tijuana; He says he was beaten, he didn’t get up in time. Three years have passed and he is still patiently awaiting surgery to fix the problem. In the meantime, he sweeps, scrubs, trims the trees, takes out the trash, waters, screws, fixes what breaks, and all with just one arm: he’s used to doing his job like this, but the pain is something other. “I think it’s because of the fentanyl I’ve put up with my arm because I broke it and I’m going around pretending I don’t have anything; The doctor asked me if I was sure I wanted the surgery because it hurt a lot and I told him I didn’t think it was any more pain,” he comments with a shy smile. Arroyo uses fentanyl every day, as do hundreds of other people on this frontier. In the United States, this brutal and elusive drug, which is 50 times more potent than heroin, is responsible for 100,000 deaths each year. There is no official data on the impact in Mexico, but experts and organizations insist: this is the next major public health crisis in the country.
Fentanyl seems to be a legend, a story to scare kids. Deadly but dirt cheap, a dose is available for around $2.5; He gets hooked if he just tries it a few times, says Uriel three times, Mari says three times too. Once inside, don’t let it go. The effect, the rush, does not last long and the malilla, as the withdrawal syndrome is called here, spreads quickly: the bones hurt like a flu, the head like a migraine, the stomach like a flu gastroenteritis. The body’s reaction without the drug is violent.
Fentanyl is smoked, snorted, or injected. How often? Those who try to gain time turn into an example of willpower three times a day, others can reach 10 punctures and also lose track. One of the few government polls put the average at seven. Those who consume it have turned their lives into a race against the next dose.
Hugo Arroyo, in the Prevencasa organization, in Tijuana (Mexico). Gladys Serrano
“What hurts me the most, what bothers me the most, is getting up in the morning and I have to take fentanyl because if I don’t, there’s nothing I can do. My bones hurt, my mind won’t stop thinking about it, I can’t concentrate. If I don’t use it, there’s nothing I can do,” says 53-year-old Arroyo. His story is that of many. Born in Uruapan, Michoacán, poverty prompted him to go to the United States where he tried three times before settling in California. He worked in a factory and as a dishwasher. “I worked my way up to become a chef,” he says proudly. He got together, had a son. Life went on. After 20 years in the US, he was deported for drunk driving. It was the third time he was imprisoned and in 2013 he returned to a country he no longer knew. Since then: the spiral.
He became addicted to heroin and later to therapy, methadone and rehabilitation centers to get out of it. He got it once. He was working with a company that collected garbage in Plaza Río de Tijuana and decided to take a break and go inside. Came out clean after three months. He got his job back and remained unemployed for a year until the company went bankrupt. “You owed me six months. That is the cornerstone for you: suddenly I was weightless, without a place to sleep,” says this friendly, wide-eyed man sadly. He came across fentanyl on the street: “The effect was like that of heroin, only much stronger.” The amount I had to use was smaller, it cost me less money.” After the incident with the police, he became Admitted to the Prevencasa organization for medical care in 2019. They gave him a room to live in and a small maintenance job in the center. “Because I’m here and I have things to do, I don’t feel that pressure to do it again. It was dose after dose out there, dose after dose.”
A city became a laboratory
Just a few meters from the wall separating Mexico and the United States, the Prevencasa Terrace has become an oasis in Tijuana. In this free center specializing in harm reduction, drug users can get information and medical care, clean water, a shower, psychological treatment and also new syringes to avoid contamination and infection. In this two-headed city, speaking English and Spanish, where pesos and dollars are distributed, consumers have become invisible; Homeless, folded up or lying in the middle of the street, they are part of the urban landscape. The city is full of rehab clinics, mostly private, and religious organizations that offer the famous 12-step method. At the same time, drug gangs are perfecting the substances: more addictive, more available.
Experts no longer doubt that Tijuana and its consumers have been used as fentanyl guinea pigs. “Tijuana and Ciudad Juárez acted as a laboratory to specify combinations and doses and try to incorporate fentanyl into other drugs,” says José Andrés Sumano, drug trafficking and public safety researcher at Colegio de la Frontera Norte (Choleph). According to reports from Mexican authorities, Tijuana is one of the most active borders in the world and has been the epicenter of fentanyl seizures in Mexico for years.
A group of drug users on May 10 in Tijuana, Baja California, Mexico. Gladys Serrano
Traces of this drug are international. Most of its precursors — the molecules used to make it — leave China and India, come via their ports or via Guatemala to Mexico, where they are cooked, assembled, and shipped north to the United States and Canada, its largest consumers become in the world. At the final destination, fentanyl is generally not sued alone, but smuggled in by cartels under the guise of cocaine, heroin and crystal. The question is repeated: Why?
“It’s convenient for them to do that because it’s much more profitable. Unlike cocaine, which they have to produce in the Colombian mountains, or heroin, which they have to produce along with opium and large plantations, fentanyl is produced in a humble laboratory. Small, with few chemical precursors, they do not require large facilities. Their power is such that they can create a lot of product with just a little active ingredient. It is highly profitable, they make a lot more money on fentanyl than on cocaine or heroin,” explains José Andrés Sumano.
Fentanyl has thus become a kind of golden goose for drug dealers, which also enables them to sell it much more cheaply: production is cheaper and the risks are lower, and they can also transport less product because it is much more effective. Behind this simple assumption are the 200 deaths per day in the US from fentanyl. The majority of those affected consumed the usual doses of cocaine or crystal, which contained fentanyl without their knowledge. “Organized crime learned they didn’t have very clear control over the doses, they send out mixed fentanyl but without precision,” says the Colef investigator.
Karen prepares a dose of heroin with fentanyl. Gladys Serrano
Trial and error was deadly. In the US, but also across the border, where much of the adaptation experimentation has been conducted on the most vulnerable population. “Between 2017 and 2018, we could see effects on the behavior of users just seconds after administration: episodes of psychosis, hallucinations. It seemed strange to us because it didn’t happen with tar. “It was just at the beginning, then it’s like there was an adjustment,” points out Lilia Pacheco, general project coordinator at Prevencasa. “The other issue that we find worrying about is overdoses,” he points out. The organization typically treats two to three overdoses a day. José Andrés Sumano puts it in a nutshell: they have grown between 200 and 400% in recent years.
Karen has lost track of how many she has taken since she started taking fentanyl directly in 2020. is it 12 is it 15 She was studying Psychopedagogy in Guadalajara (Jalisco) when she tried the drug with an ex-boyfriend. “When I first took fentanyl, I died. About five drops flowed through my nose, which I couldn’t resist, and then they revived me. “I was 24 years old,” he says.
After that time, many followed, he remembers few, but he remembers the first charged injection: “I turned purple. They thought I was dead, they poured water on me and suddenly I jumped like a small fish gasping for air. The arm thing was from the injection, they gave me salt water and it got infected,” he points out, pointing to a large scar on his right arm. He dropped out of college one semester before the end and now offers sexual services to pay for consumption. What he longs for most, he says, is to stop using the drug and get out of this hole: “It’s horrible. You are no longer in control. Now 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 kind of mother is that?
Consumption exploded very quickly in Mexico. In 2017, in the Cuqueando la chiva study conducted with more than 600 heroin users in Baja California, Sonora and Chihuahua, only six of them had taken fentanyl, the rest didn’t even know. Today they are the majority who consume it. “In just four and a half years we found that people didn’t know what fentanyl was but were exposed to it and are now looking for it. They look for it because it’s what it is, what’s on the street,” explains Clara Fleiz, a researcher at the National Institute of Psychiatry and one of the first authors in Mexico to study the presence and evolution of fentanyl .
Melissa and Óscar, fentanyl users, in Tijuana on May 10. Gladys Serrano
Óscar combs his hair for the interview. Melissa paints her nails electric blue. They are young, 27 and 24 years old, but they have been using for a decade. They climbed like a ladder: marijuana, cocaine, crystal, heroin and fentanyl. “About a year ago I came to Conecta and wanted to buy Chiva [heroína] and there was nothing left, they sold no more. “All I have left is pure china white, pure fentanyl, they told me.” What kind of mother is that? “This mother is the same only stronger if you apply a black cure then only half.” And like everyone else I started doubling down. It’s too strong. you bend “If it’s your first time, you bend over,” says Óscar after the dose his girlfriend gave him, adding, “Your body can’t take it.”
The origin of his story is the same. Both left home as minors, he due to his mother’s abuse and she after a teenage pregnancy. Once on the road, Tijuana swallowed them up. Óscar has visited rehabilitation centers several times, but it has not worked. Melissa has heard so many horror stories that she didn’t want to go to the hospital. As luck would have it, they met on a corner in downtown Tijuana a year and a half ago and have not been separated since. They make a living from recycling garbage and cleaning windows, which gives them enough for cans; sometimes, few, for a 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, she doesn’t even remember her phone. “I’m very sorry, I’m a good girl, but I’m the black sheep, I’m ashamed. Right now they don’t know I’m fine because I haven’t spoken to them, but damn they know I’m strong. But they are very concerned,” he says, while dipping a chocolate chip cookie into coffee on a Prevencasa sofa.
Today is Mother’s Day in Mexico. Nothing seems to change in the damage reduction hub. The staff constantly and very kindly takes care of all arrivals: migrants, consumers, tuberculosis patients. During the morning a man comes in and asks if he can use his phone. Bald and with a ragged accent, the man writes, “Happy day, Mom.” After hanging up, he picks up his syringes and leaves. The person in charge of the center window writes her name along with everyone who comes daily, about 120 a day. “You have to remember that 90% of those who come here are already taking fentanyl,” says Lilia Pacheco.
Melissa injects Óscar, her partner, with fentanyl. Gladys Serrano
A public health crisis is upon us
The disaggregated numbers from the organizations and researchers are the only ones that serve to get closer to the reality fentanyl is leaving behind in Mexico. There are no official figures. Andrés Manuel López Obrador’s government has decided to cancel the National Addiction Research (Encodat), which has been held every five years since 1998, due to the high costs. The latest available value is from 2016, when traces of fentanyl were minimal. The lack of data makes it difficult to take action.
Fentanyl has become the latest diplomatic issue between the United States and Mexico, a hot topic that no government wants to deal with. López Obrador insists it is an “imported problem” and there are no labs in the country. He also proposed banning the medical use of fentanyl in hospitals, a response widely criticized by doctors because it is essential in very painful surgeries. In Spain, for example, it is used in a very controlled manner in cancer patients who have severe pain peaks. “The federal government’s strategy of denying the problem doesn’t help at all,” criticizes José Andrés Sumano. The researcher says bluntly, “Any user of drugs like heroin or methamphetamine in the United States or Mexico today should assume their drug is adulterated with fentanyl.”
Although use remains limited to certain locales, particularly on the northern border, and is not reaching the same levels in the United States, experts fear it will be mixed with crystal, a far more popular drug, in the future. With the added disadvantage that in Mexico the main anti-overdose drug, naloxone, is not sold in pharmacies and has to be imported. Sumano concludes: “There is no strategy from the Mexican government and the health crisis is just around the corner.”
Hands full of wounds now preparing a fentanyl pipe enabled Uriel to make a living from the sport. This 52-year-old man, a Jai Alai pro who played the Basque pelota game with a basket, went to Miami to compete in the pro league. He also assembled baskets and studied mechanics. “I didn’t drink, I didn’t smoke, I had an athlete’s life,” he says, smiling. He started taking it after his return to Tijuana 15 years ago. He has come out of the addiction several times, most recently three years ago: “I came back from loneliness. You look clean, but you don’t have friends or work.” He came back and went straight to the fentanyl: “He asked for heroin, but it had fentanyl in it. I realized that because when I first took it, I doubled the dose. Heroin doesn’t bother me anymore. I’m still a little afraid of death, so I don’t want him to overdose me: I only take it three times: breakfast, lunch, dinner and see you next day.”
A Prevencasa doctor treats a woman found by a group of nuns on the streets of Tijuana: Gladys Serrano
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