Drug-involved couples in resource-poor communities in Mexico do not get treatment because of financial, social, and institutional barriers, a new study led by a School of Public Health researcher has found.
The study, published online in the Journal of Substance Abuse Treatment, found that while two-thirds of a group of drug-using female sex workers and their intimate male partners in two Mexican border cities reported needing help with drug cessation, only one-third had ever accessed treatment services.
Partners often reported negative past experiences with drug treatment services, which they characterized as being of poor quality and limited accessibility and affordability. Outpatient methadone was experienced more positively, but financial constraints limited couples’ access and treatment duration, the study found. Relapse was common, particularly when one partner enrolled alone while the other continued using drugs.
Study participants who had never accessed treatment reported mistrust of service providers and reluctance to enter in-patient residential programs and become isolated from partners and families.
The study, led by Angela Robertson Bazzi, assistant professor of community health sciences, recommends several improvements, including improving partners’ abilities to enter treatment at the same time, increasing access to methadone and other outpatient services, and expanding mental health and social support services for affected couples and families.
The study relied on surveys and interviews of female sex workers and their primary male partners in Tijuana and Ciudad Juarez, communities along Mexico’s northern border with the US where the prevalence of drug use has increased dramatically in recent years, mapping on to international trafficking patterns.
Bazzi said the study sought to explore drug treatment and recovery experiences among socially marginalized drug users in hopes of helping to identify opportunities for improving services. Mexico first passed federal drug policy reforms in 2009 that partially decriminalized the possession of small quantities of drugs for personal use and called for national expansion of drug treatment services, including opioid substitution therapy.
“In the context of Mexico’s ongoing decriminalization of drug use and expansion of substance-use treatment services nationally, our study points to a need for programs to consider the social and structural contexts that support or hinder recovery efforts in underserved urban communities,” Bazzi says. “Overall, our findings suggest that, in addition to improving and expanding access to methadone clinics, additional outpatient treatment and recovery-support services and better linkages to mental and physical healthcare services are also urgently needed.”
Besides Bazzi, researchers were from: Ohio State University; the University of California, San Diego; Facultad de Medicina, Universidad Xochicalco; Federación Mexicana de Asociaciones Privadas; Comisión de Salud Fronteriza México–Estados Unidos; Secretaría de Salud; the School of Social Work and Department of Preventive Medicine, Keck School of Medicine, University of Southern California; Alliant International University-San Diego; and University of California, Davis.