. 2021 Feb;6(2):e88-e96.

doi: 10.1016/S2468-2667(20)30260-7.

Geographical and socioeconomic disparities in opioid access in Mexico, 2015-19: a retrospective analysis of surveillance data

Affiliations

¹ Division of Infectious Diseases, University of California, Los Angeles, CA, USA. Electronic address: dgoodman@mednet.ucla.edu.
² David Geffen School of Medicine, Center for Social Medicine and Humanities, University of California, Los Angeles, CA, USA.
³ Department of Family Medicine, University of California, Los Angeles, CA, USA.
⁴ Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA.
⁵ Programa de Política de Drogas, Centro de Investigación y Docencia Económicas, Aguascalientes, Mexico.
⁶ Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico.
⁷ Department of Geography, University of California, Los Angeles, CA, USA.
⁸ Department of Medicine, University of California San Diego, San Diego, CA, USA.

PMID: 33516291
PMCID: PMC7882061
DOI: 10.1016/S2468-2667(20)30260-7

Geographical and socioeconomic disparities in opioid access in Mexico, 2015-19: a retrospective analysis of surveillance data

David Goodman-Meza et al. Lancet Public Health. 2021 Feb.

. 2021 Feb;6(2):e88-e96.

doi: 10.1016/S2468-2667(20)30260-7.

Affiliations

¹ Division of Infectious Diseases, University of California, Los Angeles, CA, USA. Electronic address: dgoodman@mednet.ucla.edu.
² David Geffen School of Medicine, Center for Social Medicine and Humanities, University of California, Los Angeles, CA, USA.
³ Department of Family Medicine, University of California, Los Angeles, CA, USA.
⁴ Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA.
⁵ Programa de Política de Drogas, Centro de Investigación y Docencia Económicas, Aguascalientes, Mexico.
⁶ Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico.
⁷ Department of Geography, University of California, Los Angeles, CA, USA.
⁸ Department of Medicine, University of California San Diego, San Diego, CA, USA.

PMID: 33516291
PMCID: PMC7882061
DOI: 10.1016/S2468-2667(20)30260-7

Abstract

Background: In 2015, Mexico implemented regulatory changes and an electronic system to improve access to prescription opioids. We aimed to investigate trends in opioid dispensing after the implementation of these changes and assess how opioid dispensing varied geographically and by socioeconomic status.

Methods: In this retrospective analysis of prescription medication surveillance data, we analysed dispensing data for group 1 medications (all opioids, including morphine, methadone, hydromorphone, oxycodone, tapentadol, fentanyl, sufentanil, and remifentanil) obtained from the Federal Commission for the Protection against Sanitary Risk database for 32 states and six large metropolitan areas in Mexico. We calculated crude annual opioid prescriptions per 10 000 people at the national, state, and municipal levels. Adapting methods from the report of the Lancet Commission on Palliative Care and Pain Relief, we calculated the need for palliative opioids by state, and then assessed the observed opioid dispensing rates as a percentage of expected need by geographical socioeconomic status. Within the six major metropolitan areas, we mapped the geocoded location of opioid prescriptions and assessed the association between opioid dispensing and socioeconomic status as well as the association between opioid dispensing and time to US border crossing for areas on the US-Mexico border.

Findings: Between June 25, 2015, and Oct 7, 2019, opioid dispensing rates increased by an average of 13% (95% CI 6·8-19·6) per quarter (3 months). The overall national opioid dispensing rate during the study period was 26·3 prescriptions per 10 000 inhabitants. States with a higher socioeconomic status had higher opioid dispensing rates than states with lower socioeconomic status (rate ratio [RR] 1·88, 95% CI 1·33-2·58, p=0·00016) after controlling for the estimated opioid requirement per state, the presence of methadone clinics, and the presence of tertiary hospitals and cancer centres. The same association between opioid dispensing and socioeconomic status was observed in the metropolitan areas, and in those metropolitan areas on the US-Mexico border a 20% decrease (RR 0·80, 95% CI 0·75-0·86) in opioid dispensation was observed per each SD increase (SD 17·1 min) in travel time to the border.

Interpretation: Measures introduced by the Mexican federal Government to increase opioid access for patients with palliative care needs were only marginally successful in raising opioid prescription rates. Opioid access should be improved for patients with palliative care needs who live in geographical areas of lower socioeconomic status.

Funding: US National Institutes of Health.

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Figures

**Figure 1:. Dispensing rates for group 1 opioids in Mexico**
National quarterly rates of group 1 opioid dispensing in Mexico. The vertical dotted line shows the breakpoint, which separates the initial scale-up period (when changes were expected to reflect the adoption of the electronic registry) from the remainder of the study period. QPC=quarterly percentage change. AQPC=average quarterly percentage change.

**Figure 2:. Comparison of observed versus predicted opioid dispensing rates in Mexico**
(A) Scatter plot of observed versus predicted rate of dispensed opioids by state in Mexico between August, 2015, and October, 2019; predicted rates were estimated on the basis of estimated opioid need for each state; X and Y axes are on a logarithmic scale; the diagonal dashed line is a hypothetical equality line, where the observed and expected values are equal; circle sizes are proportional to the population size for each state; the opioid dispensing rate for Tlaxcala was almost zero, thus this state is not shown. (B) The boxplot shows the observed dispensing rate as a percentage of the expected dispensing rate, by state socioeconomic status. Boxes show IQRs, horizontal lines within the boxes show the median, upper and lower whiskers indicate 1·5 × IQR, and dots indicate outliers. BC=Baja California. SON=Sonora. CDMX=Mexico City. JAL=Jalisco. NL=Nuevo Leon. YUC=Yucatan. AGS=Aguascalientes. CHIH=Chihuahua. PUE=Puebla. QRO=Queretaro. COL=Colima. GTO=Guanajuato. BCS=Baja California South. CAMP=Campeche. SLP=San Luis Potosi. NAY=Nayarit. COAH=Coahuila. SIN=Sinaloa. ZAC=Zacatecas. TAM=Tampico. QROO=Quintana Roo. OAX=Oaxaca. MOR=Morelos. TAB=Tabasco. MICH=Michoacan. HGO=Hidalgo. CHPS=Chiapas. MEX=Mexico State. VER=Veracruz.

**Figure 3:. Percentage of dispensed opioids by socioeconomic status in the six metropolitan areas**
(A) Percentage of dispensed opioids by socioeconomic status in the three largest metropolitan areas in Mexico. (B) Percentage of dispensed opioids by socioeconomic status in the three largest metropolitan areas in Mexico situated on the US–Mexico border. Circles indicate the location of pharmacies that dispensed opioids during the study period; the size of the circles are proportional to the number of opioids dispensed.

**Figure 4:. Percentage of dispensed opioids by time to border crossing in the three largest metropolitan areas in Mexico situated on the US–Mexico border**
Circles indicate the location of pharmacies that dispensed opioids during the study period; the size of the circles are proportional to the number of opioids dispensed.

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Comment in

Disparities and crisis: access to opioid medicines in Mexico.
Knaul FM. Knaul FM. Lancet Public Health. 2021 Feb;6(2):e83-e84. doi: 10.1016/S2468-2667(21)00009-8. Lancet Public Health. 2021. PMID: 33516289 No abstract available.

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Geographical and socioeconomic disparities in opioid access in Mexico, 2015-19: a retrospective analysis of surveillance data

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Geographical and socioeconomic disparities in opioid access in Mexico, 2015-19: a retrospective analysis of surveillance data

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