BORDER EPIDEMIOLOGY WORK GROUP

1. BORDER EPIDEMIOLOGY WORK GROUP • Annual meetings jointly planned & convened by NIDA and the Mexican Ministry of Health.   • Presentation and review of data on drug abuse patterns and trends by and across border areas with emphasis on sister cities. • Development of BEWG as a surveillance system. • Identification of issues for future research. • Collaboration on border research issues.

2. Drug Use and Risk of HIV/AIDS on the Mexico – U.S. Border Jane C. Maxwell, University of Texas at Austin, Patricia Cravioto, Fernando Galvan, & Mario Cortés Ramírez, General Directorate of Epidemiology, Mexican Ministry of Health

3. Data Sources • Mexico—Epidemiological Surveillance System of Addictions. • US—SAMHSA Treatment Episode Data Set. • Texas—DSHS Client Data System & Secondary School Survey. • Maxwell, J., Cravioto, P., Galvan, F., Cortes, M., Wallisch, L., Spence, R., (2006). Drug use and risk of HIV/AIDS on the Mexico-U.S. Border: A comparison of treatment admissions in both countries. Drug and Alcohol Dependence (in press).

4. Risk Factors for HIV on the Border: Population Movements • Risk of HIV/AIDS heightened by high rates of border crossings and migration into U.S. Immigrants becoming younger & from more urban areas. • In 2000, 12.7% of all AIDS cases in Mexico involved people who had lived in the US. • Migrants are at risk because of their transient lifestyles and exposure to US culture.

5. Risk Factors for HIV: Changing Drug Use Patterns • Use of needles to inject antibiotics and vitamins in Mexico & sharing these needles is a risk. • Time spent in the US or unprotected sex with someone who has been in US is risk factor for HIV. • US-born Hispanics more likely to have ever injected drugs or be at risk of HIV through drug use. • Drug users are at high risk of HIV due to sharing injecting equipment, burns & sores on lips from hot crack or methamphetamine pipes, & risky sexual behaviors while intoxicated or on drugs. • Drug use patterns are related to trafficking patterns.

6. Principal Trafficking Routes: 2004 Methamphetamine Heroin Cocaine Fuente: SISVEA-PGR

7. Heroin • Two kinds in the US—higher quality white South American and less pure Mexican. • South American is more inhalable. • Mexican heroin is either Black Tar or brown (Tar which has been ground with a filler to produce a powder). Mexican heroin is more likely to be injected, due to lower potency.

8. Heroin Purity: 2003 10% 40% 48% 54% 16% 61% 60% 35% 20% 19% 11% 14% 30% 57% 45% 45% 13% 45% 32% 27% 26% West Average Purity: 26% Mexican East Average Purity: 42% So. American

9. Routes of Administration of Heroin Admissions to Treatment Programs in States on the US-Mexico Border

10. HEROIN Arizona Heroin 6% California Heroin 19% New Mexico Heroin 10% Texas Heroin 10% Baja California Heroin 34% Sonora Heroin 13% Tamaulipas Heroin 18% Chihuahua Heroin 43% Coahuila Heroin 6% Nuevo Leon Heroin 1%

11. Cocaine • Different routes of administration. • Injecting cocaine and heroin either together or sequentially (“Speedball”). • Risky sexual behaviors while smoking crack and trading drugs for sex in crack houses. • Danger of disease transmission through burned lips from crack pipes. • Increasing cocaine use among Hispanics. Will Hispanics be the next victims of the crack and HIV epidemic?

12. Race-Ethnicity of Texas Cocaine Admissions: 1993 v. 2004

13. % Texas Secondary Students Who Had Ever Used Powdered Cocaine and Crack, by Grade: 2004 L. Liu, Survey of Texas Secondary School Students, 2004. Austin, TX: 2005.

14. Routes of Administration of Cocaine Admissions to Treatment Programs in States on the US-Mexico Border

15. Arizona Cocaine 9% COCAINE California Cocaine 12% New Mexico Cocaine 9% Texas Cocaine 26% Baja California Cocaine 3% Sonora Cocaine 35% Tamaulipas Cocaine 35% Chihuahua Cocaine 19% Nuevo Leon Cocaine 28% Coahuila Cocaine 25%

16. Methamphetamine Forms Methamphetamine Powder Base / Paste Methamphetamine Crystal Methamphetamine--Ice

17. Methamphetamine • Different types and names: Ice, Speed, Tina, La Tina, Chalk, Base, Red Neck Cocaine, Crystal, Shards, etc. • Risk of HIV due to IDU and high-risk sex. Both heterosexuals ad homosexuals report sex on methamphetamine as “compulsive” and “obsessive.” • Use on the job? Truckers, migrant laborers, people working long hours in boring jobs or working multiple jobs? • Ice is purer and more potent. It is usually smoked, powder is inhaled or injected, base is injected or swallowed.

18. > 58 35 - 58 12 - 35 < 12 No data Primary Amphetamine/Methamphetamine TEDS Admission Rates: 1992(per 100,000 aged 12 and over)

19. > 58 35 - 58 12 - 35 < 12 No data Primary Amphetamine/Methamphetamine TEDS Admission Rates: 1997(per 100,000 aged 12 and over) < 12

20. > 58 35 - 58 12 - 35 < 12 No data Primary Amphetamine/Methamphetamine TEDS Admission Rates: 2003(per 100,000 aged 12 and over)

21. Routes of Administration of Methamphetamine Admissions to Treatment Programs in States on the US-Mexico Border

22. Methamphetamine is major problem on western end of the border & Ice use is up. Need research on use while working long hard jobs—day laborers, migrant farm workers, truckers, maquiladoras? • Smoking crack is increasing on the border. Will the HIV increases seen among Blacks due to crack spread to Hispanics? • Injection risks continue: tradition of needle-sharing for antibiotics & vitamins, injecting heroin.

23. Drug patterns on the border are more similar north to south than east to west. • Stock piling on the Mexican side leads to spillage in Mexican border towns. • “Mules” now paid in drugs rather than $$, which means drugs are more available to residents of border towns. Half in Texas border survey said easy or very easy to obtain drugs (besides marijuana). • HIV/AIDS rates on the border now are low, but signs point to increases.