Latin America is on alert in the face of an opioid crisis

The region continues to combat cocaine, marijuana and amphetamines trafficking but keeps a wary eye on the US opioid epidemic and its repercussions

Morphine tablets

By Ignacio Torres – If there is one incredibly effective drug for the alleviation of chronic or intense pain, especially in patients in advanced stages of their conditions, it is the opioid. However, the dangerous tendency to misuse it, by consuming higher doses than prescribed, or by using it recreationally, has caused an exponential increase in deaths in the United States and to a lesser extent in Canada. For example, in the United States  alone, 64,000 people lost their lives in 2016 due to overdoses, among them the singer Prince, a pop music icon throughout the 80s and 90s.

This indiscriminate use has triggered an epidemic, which is threatening to spread to other parts of the continent, especially to Latin America. Accusing glances are being thrown towards Purdue Pharma in particular, the pharmaceutical company that manufactures the painkiller Oxycontin, which has been called into question and sued by several states of the United States, including New Hampshire, New Jersey and New York, for its responsibility in the unchecked use of opioids in the world’s largest economy.

Purdue began its expansion strategy to Latin America in 2014 (Brazil, Colombia, Mexico, Argentina, Chile and Uruguay), through the company Mundipharma, and since then has commissioned studies to demonstrate the need for its drug in that region of the world. In Mexico, for example, it has been confirmed that 28 million people suffer from chronic pain, based on data from the International Association for the Study of Pain (IASP). However, globally speaking, opioid use in Latin America is 0.3%, according to data from the latest report of the International Narcotics Control Board (INCB).

Latin America’s real concern

The key problems in this region continue to be cocaine and marijuana. In fact, Mexico has been supplying the US market with illegal opium derivatives for decades, but “has no problems with heroin”, says sociologist Dr. Marcelo Bergman in the study Drug, Drug Trafficking and Power in Latin America. And he adds that, according to the National Survey of Addictions (INPRFM, 2011), the annual prevalence for heroin (that is, the percentage of users within the population in one year) is 0.1% among people aged between 12 and 65 years, 18 times less than for marijuana and 10 times less than for cocaine.

While in Latin America the problem with opioids has not reached an alarming level, it does not mean that we do not pay close attention to what is happening in the United States and the possible repercussions. According to the national study on the use of psychoactive substances in Colombia in 2013, 1.07% of the 32,605 people surveyed (aged between 12 and 65 years old) had used opioids (morphine, oxycodone, fentanyl, hydromorphone, tramadol, meperidine or hydrocodone) at some point without a medical prescription.

To prevent this from becoming a problem, Andrés López Velasco, director of the National Narcotics Fund (FNE), in an interview with the Colombian Society of Anesthesiology and Resuscitation (SCARE), noted, “In our country, opioids with approved medical and scientific uses are strictly controlled. Control is centralized at the FNE, and is exercised through inspection, surveillance and control of the entire chain of commercialization of the substances and medicines in question, and (…) the access to medicines that are state monopolies, including four opioids: morphine, hydromorphone, meperidine and methadone. ”

Opioids spread to Puerto Rico and Canada

The opposite is the case in Puerto Rico, where organizations are concerned that only one in four people have prescriptions for opioids and that 185,000 have problems with addiction. This data comes from the organization Intercambios Puerto Rico, whose president Rafael Torruella has described the deaths from overdosing as a “serious problem for public health”.

And while Canada is not part of Latin America, its proximity to the United States has also become a headache. Fentanyl has taken over the streets of Vancouver, where one person dies every day as a result of overdosing.

At the beginning of January, Statistics Canada published that the mortality rate for opioid use in Quebec is 1.7 deaths per 100,000 inhabitants, compared to the national average of 7.9. The situation is escalating in British Columbia, where deaths per 100,000 inhabitants have reached 20.7.

Faced with this, the Government of Canada has adopted a series of measures such as awareness-raising activities and started finding solutions to problems such as how to access rehabilitation treatments.

Hence, the opioid epidemic is developing into a problem in not only the United States, but also in two thirds of North America, if Canada is included. At the other end of the spectrum is Mexico, which struggles with the high rate of marijuana, cocaine and amphetamine use, a situation also visible in the rest of Latin America. In Chile, cocaine is king. In Argentina marijuana reigns, as in Uruguay, where it has been legalized since 2013.

Restriction on the usage and marketing of opioids in countries in this region also stops indiscriminate use from increasing. With this restriction in place, opioids are not demonized, because when used in appropriate doses and prescribed by a doctor, they have important benefits, especially in patients who require treatments to withstand the severe pain caused by cancer and other diseases.

Main opiate trafficking flows 2011-2015 (Source UNODC)