RESUMO
BACKGROUND AND AIMS: In December 2006 the United States regulated sodium permanganate, a cocaine essential chemical. In March 2007 Mexico, the United States' primary source for methamphetamine, closed a chemical company accused of illicitly importing 60+ tons of pseudoephedrine, a methamphetamine precursor chemical. US cocaine availability and methamphetamine availability, respectively, decreased in association. This study tested whether the controls had impacts upon the numbers of US cocaine users and methamphetamine users. DESIGN: Auto-regressive integrated moving average (ARIMA) intervention time-series analysis. Comparison series-heroin and marijuana users-were used. SETTING: United States, 2002-14. PARTICIPANTS: The National Survey on Drug Use and Health (n = 723 283), a complex sample survey of the US civilian, non-institutionalized population. MEASUREMENTS: Estimates of the numbers of (1) past-year users and (2) past-month users were constructed for each calendar quarter from 2002 to 2014, providing each series with 52 time-periods. FINDINGS: Downward shifts in cocaine users started at the time of the cocaine regulation. Past-year and past-month cocaine users series levels decreased by approximately 1 946 271 (-32%) (P < 0.05) and 694 770 (-29%) (P < 0.01), respectively-no apparent recovery occurred through 2014. Downward shifts in methamphetamine users started at the time of the chemical company closure. Past-year and past-month methamphetamine series levels decreased by 494 440 (-35%) [P < 0.01; 95% confidence interval (CI) = -771 897, -216 982] and 277 380 (-45%) (P < 0.05; CI = -554 073, -686), respectively-partial recovery possibly occurred in 2013. The comparison series changed little at the intervention times. CONCLUSIONS: Essential/precursor chemical controls in the United States (2006) and Mexico (2007) were associated with large, extended (7+ years) reductions in cocaine users and methamphetamine users in the United States.
Assuntos
Transtornos Relacionados ao Uso de Anfetaminas/epidemiologia , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Adolescente , Adulto , Idoso , Estimulantes do Sistema Nervoso Central/síntese química , Criança , Cocaína/síntese química , Inibidores da Captação de Dopamina/síntese química , Indústria Farmacêutica/legislação & jurisprudência , Controle de Medicamentos e Entorpecentes , Dependência de Heroína/epidemiologia , Humanos , Cooperação Internacional/legislação & jurisprudência , Legislação de Medicamentos , Metanfetamina/síntese química , México , Pessoa de Meia-Idade , Pseudoefedrina/provisão & distribuição , Compostos de Sódio/provisão & distribuição , Estados Unidos/epidemiologia , Adulto JovemRESUMO
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
BACKGROUND: Research on hepatitis C virus (HCV) prevalence among non-injecting drug treatment clients in the United States, Europe and Asia indicate substantial differences by place. To date, little or no research on HCV and non-injection drug use (NIDU) has been conducted in Mexico. METHODS: We examined the prevalence of HCV, hepatitis B virus (HBV), and HIV among non-injecting drug users (NIDUs) in community-based drug treatment (N=122) and NIDUs in a prison-based drug treatment program (N=30), both located in west central Mexico. RESULTS: Among the community clients, prevalence was 4.1% (95% confidence interval [CI]: 1.8-9.2) for HCV, 5.7% for HBV (95% CI: 2.8-11.4), and 1.6% for HIV (95% CI: 0.4-5.8). Among the in-prison clients, prevalence was 40.0% (95% CI: 24.6-57.7) for HCV, 20.0% for HBV (95% CI: 9.5-37.3), and 6.7% for HIV (95% CI: 1.9-21.3). None of the clients were aware of being infected. CONCLUSION: The HCV prevalence found for the NIDU community treatment clients ranks among the lower HCV estimates published for NIDUs in treatment to date. The prevalence found for the in-prison clients ranks among the higher, raising a concern of possible elevated HCV infection among NIDUs in the west central Mexico prison--one compounded by the finding that none of this study's clients knew they were HCV positive.
Assuntos
Hepatite C/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Fatores Etários , Feminino , Infecções por HIV/epidemiologia , Hepatite B/epidemiologia , Hepatite C/complicações , Humanos , Masculino , México/epidemiologia , Prisões , Fatores de Risco , Assunção de Riscos , Fatores Sexuais , Centros de Tratamento de Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/complicações , Inquéritos e Questionários , Tatuagem , Sexo sem Proteção , Adulto JovemRESUMO
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
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.