"In February 2023, Mexico's federal government closed the country's only methadone manufacturing plant, Psicofarma, following concerns about quality control.5 In Mexican-U.S. border cities, such as Ciudad Juarez, Mexicali, and Tijuana, where the prevalence of OUD is among the highest in the country, methadone clinics are turning new clients away as they run out of medication, limiting doses, providing doses only on alternate days, or not dosing altogether.
"The number of unintentional poisoning deaths increased from 12,186 in 1999 to 20,950 in 2004. The annual age-adjusted rate increased 62.5%, from 4.4 per 100,000 population in 1999 to 7.1 in 2004. The increase among females, from 2.3 to 4.7 per 100,000 population (103.0%), was twice the increase among males, from 6.5 to 9.5 per 100,000 population (47.1%) (Table 1). Among males, rates among whites, American Indians/Alaska Natives, and Asians/Pacific Islanders all increased approximately 50%.
"In 2021, the world set ambitious law reform targets to remove criminal laws that are undermining the HIV response and leaving key populations behind. Recognising decriminalization as a critical element in the response, countries made a commitment that by 2025 less than 10% of countries would have punitive legal and policy environments that affect the HIV response. The Global AIDS Strategy set as a target that less than 10% of countries would criminalise sex work, possession of small amounts of drugs, same-sex sexual activity, and HIV exposure, non-disclosure and transmission."
"Globally, some recent changes in cannabis policies have experimented with different ways of regulating the sale and use of cannabis. Evolving cannabis policies raise numerous potential concerns about negative side-effects.
"Some participants noted that in their country there was a move towards greater recognition of the need for public health-oriented approaches to tackle drug problems accompanied by a shift in the goals of drug policies towards reducing drug-related harms. However, the relatively limited set of indicators that has historically been used to evaluate drug policy may have limited utility for informing on outcomes relevant to this perspective.
"Long-term retention on OAT in trials and observational studies is suboptimal, which limits the effect of OAT with regard to reducing drug-related deaths.131 There was consistent evidence that retention was slightly better on methadone than buprenorphine across RCTs and observational studies at timepoints beyond 1 month, although few RCTs examined long-term retention.
"This study also demonstrates that available technologies fail to fully meet the needs of drug checking programs. As legal avenues for drug checking services expand, additional resources at the local, state, and federal levels should be directed towards the improvement of portable spectrometry devices and other technologies that might be useful for drug checking.
"Perhaps our most significant finding is that all of this SSP’s success in implementing drug checking was achieved in spite of, rather than thanks to, the legal and policy environment in which it operates. The COVID-19 pandemic made drug checking practically impossible, but only after systematic police violence against participants and threats against staff had already curtailed provision of this harm reduction service. Indeed, it is likely that drug checking could have persisted during the pandemic absent the very real risk of police interference.
