Institutional stakeholder perceptions of barriers to addiction treatment under Mexico's drug policy reform

ABSTRACT

Mexico has experienced disproportionate drug-related harms given its role as a production and transit zone for illegal drugs destined primarily for the USA. In response, in 2009, the Mexican federal government passed legislation mandating pre-arrest diversion of drug-dependent individuals towards addiction treatment. However, this federal law was not specific about how the scale-up of the addiction treatment sector was to be operationalised. We therefore conducted in-depth qualitative interviews with key ‘interactors’ in fields affected by the federal legislation, including participants from the law enforcement, public health, addiction treatment, and governmental administration sectors. Among 19 participants from the municipal, state and federal levels were interviewed and multiple barriers to policy reform were identified. First, there is a lack of institutional expertise to implement the reform. Second, the operationalisation of the reform was not accompanied by a coordinated action plan. Third, the law is an unfunded mandate. Institutional barriers are likely hampering the implementation of Mexico's policy reform. Addressing the concerns expressed by interactors through the scale-up of services, the provision of increased training and education programmes for stakeholders and a coordinated action plan to operationalise the policy reform are likely needed to improve the policy reform process.

KEYWORDS:

• Mexico
• drug policy reform
• addiction treatment
• institutional barriers
• Tijuana

Acknowledgments

All authors contributed substantially to the study. Leo Beletsky designed the study. Emilio Reza carried out the interviews and collected data. Dan Werb prepared the initial draft of this article and all authors contributed to and approved the final version. Leo Beletsky had full access to all the data in the study and had final responsibility for the decision to submit for publication. No funding source played a role in the content of the manuscript or the decision to submit to Lancet Global Health.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The authors express their sincere thanks to the US National Institute on Drug Abuse (NIDA) for support through grant R37 DA019829 and a CHAMPS mechanism. Dan Werb is supported by the Canadian Institutes of Health Research.