The Prevencasa health clinic is an invaluable resource for the people of the impoverished Tijuana neighborhood Zona Norte.
Cash-strapped parents pick up flu medicine for their kids while sex workers get condoms before their shift and drug users exchange their used needles for clean ones.
“This is a very important place in the community because, literally, this is the only harm reduction space in the city,” said Jaime Arredondo, a professor at the University of Victoria who studies substance abuse.
In a city of more than 2 million inhabitants, Prevencasa is also the only place where people can consume drugs like fentanyl under the supervision of staff trained to prevent overdoses.
But the clinic's staff struggles to get access to naloxone — an overdose reversal drug that is a literal lifesaver for people addicted to fentanyl.
This is because Mexico’s restrictive drug policies make naloxone, which goes by the brand name of Narcan, almost impossible to get in Tijuana. So the clinic often relies on volunteers who essentially smuggle the medicine across the border from the United States into Mexico.
“When we have to smuggle naloxone from the U.S. to Mexico there’s something fundamentally wrong with drug policy and that’s something we need to fix,” Arredondo said.
Living in denial
In San Diego, naloxone has helped reduce the number of fatal overdoses. So much so that advocates and county health officials have made it widely accessible. Nasal sprays are available at health clinics throughout the city, inside schools, even in vending machines. First responders regularly carry naloxone and are trained on how to administer the medicine.
Meanwhile, in Mexico, former President Andres Manuel Lopez Obrador has spent years downplaying the country’s role in the fentanyl crisis. At times, he’s gone so far as to say that no one in Mexico produces or consumes the synthetic opioid, which is arguably the most dangerous narcotic on the market.
Lopez Obrador has also blocked off efforts to remove naloxone from a list of banned substances in Mexico, a move that would have allowed people to buy the medicine without a prescription.
President Claudia Sheinbaum, who was sworn in Oct. 1, backs her predecessor’s prohibitionist drug policies. In 2023 she said fentanyl was not a public health concern in Mexico. During a campaign visit to Baja California this Spring, she called fentanyl addiction a U.S. problem.
Any statistics on fentanyl use are hard to come by in Mexico, but Arredondo and other advocates say it is a significant and growing problem, especially in the border region. Sheinbaum has voiced support for more treatment options but has not published specific details.
In 2018, Lopez Obrador cut funding to nonprofits like Prevencasa. It significantly impacted the clinic’s ability to get basic supplies, forcing Arredondo and others to resort to smuggling them across the border.
“Ever since 2018 we have to cross all supplies — syringes, pipes, naloxone, foil — everything that we use for harm reduction, we have to bring from either the United States or Canada,” Arredondo said.
Arredondo said he’s been stopped trying to cross the border while carrying as much as 300 vials of naloxone. Mexican customs officials initially demanded $8,000 and said they’d confiscate his car if Arredondo couldn’t pay.
They let him go after he was able to come up with $2,000, he said.
A 'bold' effort to save lives
In San Diego, there’s a long history of activists willing to risk legal and financial consequences to get medical supplies south of the border, according to April Ella, who runs the naloxone distribution program for the San Diego-based drug treatment nonprofit, A NEW Path.
“They’re bold,” she said. “They’re bold enough to try and make sure that they’re saving lives no matter where they are. And they’re taking that risk to make sure people are protected.”
To Gretchen Burns Bergman, the founder of A NEW Path, lack of access to naloxone in Tijuana is heartbreaking. She believes everybody on the planet should be carrying the overdose reversal medicine.
“Moms aren’t going to be able to save their own sons,” she said. “They’re not going to have it when they need it.”
Burns Bergman began advocating for compassionate drug treatment options after her sons developed heroin addictions. She’s used that first-hand experience to promote alternatives to mass incarceration and social stigmatization.
“After 50-plus years of the drug war, it’s obviously failed,” she said.
Battling stubborn stigmas
Burns Bergman has been trying to expand her advocacy efforts to Tijuana. But she’s struggled to find parents willing to organize. Part of the problem, she believes, is people are reluctant to be associated with drugs.
“If we think the stigma is bad here, it’s even worse in Mexico,” she said.
Doctors at Prevencasa witness some of that stigma first-hand. Sometimes it is from other patients at the clinic who look down on those struggling with addiction.
Other times, it comes in the form of members of the Mexican National Guard harassing patients in front of the clinic.
During a recent visit, KPBS witnessed three soldiers dressed in fatigues and armed with assault rifles surround a homeless man trying to inject medicine just outside the clinic. The man was visibly nervous. His hands shook as he stabbed his forearm multiple times with a syringe, struggling to find a vein.
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He had a prescription with him, which he waved at the soldiers. Yet, it wasn’t until medical staff from the clinic intervened that they left him alone.
“In society, we think that the drug users are criminals,” said Dr. Alejandro Gonzalez, who works at the clinic. “When society, the police, everyone sees you as a criminal you will start to believe you are one.”
Gonzalez said he has seen local police officers and National Guard troops standing right next to someone experiencing an overdose, but refusing to help.
Meanwhile, Gonzalez said paramedics and other first responders show more compassion when they see him prevent overdoses.
“I’ve heard them say, ‘What is that medication? Can I have some so I can treat more people like you did today?’” Gonzalez said.
When they have enough supplies, Prevencasa shares naloxone with local paramedics and police officers. Gonzalez has also led naloxone training sessions.
“They don’t have access to naloxone,” he said of Tijuana’s first responders. “They see a lot of overdoses and the only thing they can offer is oxygen. And that’s a good way to treat it, but it’s not enough.”
