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By Juan Ramón de la Fuente, former Health minister.
Two of the most popular drugs, heroin and morphine, are made with a type of poppy, a plant whose cultivation has grown in Mexico. Guerrero and the so-called "Golden Triangle" (Chihuahua, Durango and Sinaloa) are the regions in which the "business" -i.e. production, refining and export- is going better. It grew more than 60% in recent years, according to the DEA. And this seems to have a direct relation with violence, that has reached epidemic proportions in some of these areas.
Recently it was reported that the government intends to regulate poppies and the opium gum extracted from them for strictly medical and scientific purposes. Morphine and other substances known as opioids are formidable medications to control severe pain when a competent doctor prescribes them.
In Mexico, the largest producer of poppy in the Americas, it is almost impossible to legally get morphine for these purposes. The relatives of patients that need it struggle to get it, even if they have a prescription from the Ministry of Health. People die in pain. We have one of the lowest opioid per capita consumption rates in the world. It has been estimated that there are over twenty million people in pain in Mexico. To meet the needs of 30 percent of them, considered potentially severe cases, and a significant proportion of the nearly 4 million patients that undergo surgery each year in our country, we would need about 20 tons of opioids. A couple of years ago we were importing 480 kilograms per year only. I find it unacceptable.
Producing our own morphine -especially if we teach physicians how to use it and patients to demand it when they need it- is therefore an interesting and welcome option. But beware, it will not be a panacea. The issue is more complex than it seems.
World inventories of morphine for legal purposes -controlled by United Nations agencies- are enough to meet the global demand for medical purposes. It is unlikely that we will be able to export the finished product, much less opium gum, as long as we do not eradicate its clandestine cultivation, i.e., illegal production. For now we could think of a small crop to meet the needs of the domestic market. In this way at least there would be medicine for the patients who need it.
Once you have the plant resin, morphine production is relatively simple and inexpensive. But a limited production to supply a local market would not seem to be profitable enough to help poor farmers now exploited by organized crime. Therefore, it is illusory to think that legal production can replace illegal production, much less in the short term.
We must add to the previous consideration the increase in consumption (and therefore demand) of another poppy alkaloid: heroin. 4.2 million people in the United States have used it at least once. Unlike other illegal drugs, such as cannabis, the number of heroin casualties is alarming: more than 120 people die every day in the United States due to an overdose. Heroin is the drug that causes more deaths. Usually it is injected (hence its association with HIV / AIDS), but it can also be inhaled or prepared in an infusion.
Aware of the growing demand and requirements of American users, Mexican cartels have hired a group of Colombian "cooks" to make white heroin and replace the traditional brown heroin to meet consumer preferences. Tension to control distribution and transportation routes has grown, and it is impossible to think that this can happen without violence. Heroin sales to the United States represent a multi-million business.
This complex plot does not accept simplistic solutions. The State can try to control production in certain territories and to establish a legal, transparent and strict management for medical and research purposes only in order to meet the local needs. To do so, it would have to decriminalize a certain part of this activity. However, it does not have the ability to eradicate illegal cultivation of opium, and as long as this does not happen, it will not be easy for Mexico to be accepted as a "legal exporter". Neither the task is easy, nor the road is short. And there are no shortcuts.
The policies of the countries that have proven successful involve a tight control of illegal production and effective social programs based on two fundamental premises: harm reduction and social reintegration of those affected, i.e. drug addicts. There is a 23%risk of addiction among heroin users, compared to 9% among marijuana users.
The main legal producers (Spain, Australia and France) stopped growing “raw opium” long ago. They produce a concentrate of poppy straw, which requires a more sophisticated technology and a strict quality control. This is what really matters for international pharmaceutical companies that produce morphine and codeine. They are publicly traded and sell their products at international prices. It is impossible to compete with them from the underground, with raw opium produced illegally. They are two different markets.
All opioid medications, whether natural or synthetic, are potentially addictive. Hence it is necessary that health authorities monitor their use. In the United States, its abuse has reached epidemic proportions. Failing to measure this risk is considered one of the gravest mistakes of modern American medicine. A parallel market of opioids that require prescription has emerged. In 2014 more than 200 million prescriptions were issued to buy drugs derived from opium. Among the cases of opioid overdose registered by the Centers for Disease Control and Prevention, they were bought illegally in only 15% of the cases.
It is regrettable that there is no morphine in hospitals or authorized drugstores in Mexico. Thousands of people suffer from it unnecessarily. But thinking that legalizing poppy cultivation may be the simultaneous solution of various problems means not understanding its nature. The risk is that new problems emerge before the existing ones are solved.
It is positive that the issue of drugs gives rise to debate and is discussed by public opinion. We must move towards its gradual and selective decriminalization. Therefore, it would seem sensible to refine the regulatory framework for the use of cannabis, which is halfway in the Senate, and then continue with the rigorous analysis about what should we do with poppy.
