What the U.S. Can Learn from the Aftermath of Mexico and Portugal's Opioid Epidemic

By Nadiyah Fisher

“Have you ever used Flonase before?” Confusion was all over her face. I admit, asking someone whether they used an allergy spray for their nose is quite odd. It was disheartening to see my best efforts at removing a negative connotation was met with blank stares. I volunteer in Delaware to teach adults about how to use Naloxone, otherwise known as NarcanNarcan helps reverse drug overdoses in opioid users and restores breathing (NIDA, 2021). I am used to these responses, but they still make my heart drop every time. “Administering Naloxone is just like a nasal spray. If you see someone in your community who is unresponsive, move them to their side and spray Naloxone in each nostril.” Her confusion subsided, but a new emotion emerged on her face: fear. “No, thank you. I do not know how to administer medication to someone. What you are doing for the community is great, though.” I brought the kit back into my arms and assured her that her response was totally fine. Eventually, I was able to convince people to take the Naloxone kits, but I still pondered on the hesitation, fear, and confusion I encountered that day.  

Along with training individuals to administer Narcan, I have also trained people to perform CPR. This time around, I am not faced with blank stares and hesitation, but eager faces and smiles. According to the Cleveland Clinic Heart Survey, 54% of all Americans know how to perform CPR (Sudden Cardiac Arrest Foundation, 2021). I took a CPR class in high school in order to pass my allied health pathway. CPR certifications are needed for almost every healthcare job. However, performing CPR is riskier than administering Narcan. There is a possibility that you could break someone’s ribs by using hard chest compressions, further lodge an object in their throat, or administer CPR incorrectly and lose a life (CPR Select, 2016). Administering Naloxone is quite easy and there is no harm to the person if they are not suffering an opioid overdose. When Narcan is administered, it knocks off opioid ligands off opioid receptors in the brain. Non-opioids will not elicit a response onto opioid receptors. This is where Narcan comes in. Narcan has a greater affinity for opioid receptors than opioid ligands. Basically, the receptors are more likely to bind to Narcan when present. Narcan is the “master key”. When Narcan binds to these receptors, it knocks the opioids off the receptors and allows breathing to occur again for those suffering an overdose. Those who are not suffering from an overdose but are administered Narcan are not affected because the non-opioids cannot bind to opioid receptors (NIDA, 2021). Only 35% of those who are trained to use Naloxone actually administer it (Siegler, et al., 2017). Scientifically, administering Narcan has no negative side effects, but is still given a negative connotation.  

“Are you calling me a junkie?” This time, I had a blank stare on my face. His fear was masked in anger. I scrambled to find the perfect response but, the more I reflected on the encounters I experienced that day, the more I realized that there is even a stigma around administering Narcan to others. Even possessing Naloxone is associated with an overdose. In a 2017 study about the stigma around Naloxone dispersion and consumption, pharmacists found that many providers and consumers had their own stigma around dispersing Naloxone and obtaining Naloxone. Many pharmacists were fearful about the response of patients when providing Naloxone due to stigma (Green et al., 2017). How can we save individuals in our society from overdoses if they are being killed by the stigma of opioid use? 

Along with a worldwide crisis, we are facing another chronic issue right in our backyard: The U.S. Opioid Epidemic. According to Felter (2019), the epidemic has killed up to 50,000 people in 2019. The COVID-19 pandemic has only exacerbated the epidemic. The death toll is estimated to be around 69,000 at the end of 2020. The death toll is not the only factor affected by the epidemic. The study also finds that there is an increase in disease transmission, opioid dependency in infants, and children placed into foster care. Our government has implemented stricter immigration laws, tightened border patrol, limited the supply of opioids to physicians, and donated billions toward treatment and prevention, yet, the epidemic prevails (Felter, 2021).  

Mexico faced a similar opioid epidemic, but differed in their response. In 2006, the War on Drugs was declared due to the country’s spike in overdoses, lack of programs for reform, and cartel violence. Since the War on Drugs was declared, the cartel committed more than 300,000 homicides (Reid, 2019). In 2019, Mexico’s President, Andrés Manuel López Obrador, focused on the safety of the Mexican people and released a plan in response to the opioid epidemic. Upon the release of his Plan Nacional de Desarrollo for 2019-2024, he stated “the only real possibility of reducing the levels of drug consumption is to lift the ban on those that are currently illegal... and redirect the resources currently destined to combat their transfer and apply them in programs— massive, but personalized—of reinsertion and detoxification” (Reid, 2019). Obrador focused less on incarceration of those in possession of drugs and shifted to a medical approach. This new approach could decrease the homicides committed from crossing drugs illegally across the border.  

Portugal faced their own opioid epidemic in the 1990s. Portugal looked to their professionals for answers first, before the government. In 2001, Portugal decriminalized drugs and utilized the help of psychologists and healthcare professionals in law enforcement. Those found with drugs were not met with a jail sentence. Instead, they are paired with professionals with an expertise in drug addiction and offered a series of interventions (Clay, 2018). According to Clay (2018), Portugal has the lowest drug-related death rate in Western Europe, significantly lower than Britain and the United States, and the number of HIV diagnoses caused by injection drug use has plummeted by more than 90 percent. Why is this simple approach so effective? Leaders in Portugal not only changed the laws around drugs, but their overall mindset on the problem. Like the COVID-19 pandemic, the opioid epidemic is a public health issue. Instead of telling individuals to stop using drugs, Portuguese psychologists enforced the “harm reduction model”. The harm reduction approach aims to encourage individuals to practice safe drug use by using clean syringes, having someone accompany them during use, and offering programs for education and support (Clay, 2018). Hugo Amaral Faria, for example, manages a mobile methadone program run by a nongovernmental organization called the Ares do Pinhal Association for Social Inclusion in Lisbon." It's not therapy but psychological support," says Faria. The goal is to empower individuals and help them attain autonomy, whether that means helping someone get an identification card to help reintegrate them into society or getting them to the hospital for treatment of HIV” (Clay, 2018).  

We are all humans. Humans are not perfect; we do not always make the best decisions. When we stigmatize and apply negative connotations toward drug use, we strip humans of their autonomy and degrade them. Positive changes start with our language. Viewing drug addiction as a public health issue, rather than a question of a person’s morality, prevents us from dehumanizing those who suffer from drug addiction and aids in their recovery. Portugal’s harm reduction model and Mexico’s proposed Plan Nacional de Desarrollo prioritize the safety of their citizens rather than demonize their addiction. If these programs are being implemented in other countries, why can’t the United States do the same?  

 


 

References 

 

Clay, R. A. (2018, October). How Portugal is Solving Its Opioid problem. Monitor on  Psychology. https://www.apa.org/monitor/2018/10/portugal-opioid  

 

Council on Foreign Relations. (2021, February 26). Mexico's Long War: Drugs, crime, and the cartels. Council on Foreign Relations. https://www.cfr.org/backgrounder/mexicos-long-war-drugs-crime-and-cartels

 

Felter, C. (September, 2021). The U.S. opioid epidemic. Council on Foreign Relations.  https://www.cfr.org/backgrounder/us-opioid-epidemic.  

 

Green et al. (2017). Perpetuating stigma or reducing risk? Perspectives from naloxone  consumers and pharmacists on pharmacy-based naloxone in 2 states. PubMed.  https://pubmed.ncbi.nlm.nih.gov/28214219/ 

 

National Institute on Drug Abuse. (2021, June 1). Naloxone DrugFacts. NIDA.  https://www.drugabuse.gov/publications/drugfacts/naloxone  

 

Reid, D. (2019, May 10). All illegal drugs in Mexico could be decriminalized in radical  government plan. CNBC. https://www.cnbc.com/2019/05/10/illegal-drugs-in-mexico-could-be-decrimi...

 

Select C. P. R. (2021, August 6). Five possible CPR side effects, you should know - CPR SelectCPR Certification Course | First Aid Training - CPR Select Blog | CPR/AED and First Aid certification course. https://www.mycprcertificationonline.com/blog/five-possible-cpr-side-eff... 

 

Siegler et al. (2017). Naloxone use AMONG overdose PREVENTION trainees in New York cityA longitudinal cohort study. Drug and alcohol dependence. https://pubmed.ncbi.nlm.nih.gov/28772172/  

 

Sudden Cardiac Arrest Foundation. New Cleveland CLINIC Survey: Only half of Americans say they Know CPR. Sudden Cardiac Arrest Foundation. (2018, February 1). https://www.sca-aware.org/sca-news/new-cleveland-clinic-survey-only-half... 

 

About Author(s)