Consumption Room | Translation

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Translated by MC Editorial

[Daniel Alarcón]: This episode includes scenes of drug use. Discretion is recommended. This is Radio Ambulante from NPR. I’m Daniel Alarcón.

[Archive soundbite]

[Advertisement]: Fentanyl is one of the most dangerous drugs you can try. It is very difficult to detect. If you take drugs, you harm yourself. The happiness you need is in you, with your family, your friends, and the community. 

[Daniel]: If you live in Mexico, you’ve probably heard ads like these lately. 

[Archive soundbite]

[Advertisement]: When you are offered any substance, whatever it may be, never accept it. If it enters your body, it will make you drowsy, you will lose interest in daily activities, and you will suffer from anxiety, paranoia and aggressiveness.

[Daniel]: These are part of a massive government campaign to combat the abuse of substances like fentanyl, the synthetic opioid up to 50 times more powerful than heroin, which has caused hundreds of thousands of overdose deaths in the United States and Canada to date.

Now there are fears in Mexico that the epidemic will cross the border and spread throughout the country. So the question is what to do, how to attack the problem before it gets out of control. One option is to warn the population, especially young people, with ads like the ones we heard. Warn them of all the dangers of the drug, to prevent the occurrence of new users. But what about the people in Mexico who already consume fentanyl? What options do they have to take care of themselves?

[Pablo Argüelles]: One, two, one, two… 

[Daniel]: In November 2023, our producer Pablo Argüelles visited the Mexico/US border. The area where, around 2018, news of illicit fentanyl consumption began to be heard in Mexico.

[Said]: Hello, good morning. 

[Pablo]: Hello, Said. How are you? 

[Said]: Well, Pablo. Hey, I’m almost at work. Are you there yet?

[Pablo]: Yes, I just got here.

[Said]: OK, give me about five to eight minutes and I’ll be there, okay?

[Pablo]: No rush. I’ll wait for you here, thank you. 

[Said]: Bye!

[Pablo]: Ciao. 

[Daniel]: It is ten a.m. on a Monday, and there are almost no people on the streets of downtown Mexicali, the capital of the state of Baja California.

Pablo is sitting outside a business that has a closed door and windows protected by metal bars. On its facade there is a faded sign that says, “Community Center, your safe space.”

Safe space for drug users.

Said, the voice we heard on the other end of the phone, is one of the people in charge of this place, but he hasn’t arrived yet. While Pablo waits, let’s take a look at the place where he is:

Imagine Chinatown, like the ones you see in the movies, with the typical restaurants, red paper lanterns, and buildings with curved roofs, as if they were temples. Downtown Mexicali looks something like that. There has been a Chinese community in the city for about a hundred years. But this Chinatown look is new. In 2020, the state government began to give it that appearance to promote tourism and business in the area.

To the right side of Pablo is the Wok Museum, which celebrates the city’s Chinese culinary heritage.

On the opposite side of the street is a large red arch that leads to an alley. There are several murals there: a giant flying dragon, a man with Asian features aiming a gun, and a woman reclining on a large poppy flower, smoking opium. Kind of ironic.

A man approaches Pablo. He also comes looking for Said.

[Mario]: Is he late?

[Pablo]:  Yes. I spoke with Said. He said that he’ll be here soon. 

[Mario]: Really?

[Pablo]: Nice to meet you. I’m Pablo.

[Mario]: Mario. Nice to meet you.

[Pablo]: How are you, Mario? 

[Daniel]: Mario says that he was born in Mexicali, but when he was five, his family took him to the other side, to the United States.

[Mario]: I was deported six years ago, but I spent my entire life there. I don’t know this side.

[Pablo]: Listen… What do you consume? 

[Mario]: Heroin.

[Pablo]: Heroin. 

[Mario]: Hey, but here it is mixed with fentanyl. You have to be careful. Because if your body doesn’t have that resistance, you die. I’ve been using it since I was 17 years old. I’m 55—55. I’m about to turn 55. And now I no longer do it to take the dose, ah, and to party! To feel the euphoria. It’s not because of the euphoria. In fact, it’s because of the pains I have.

[Daniel]: He says that in 2008 he had surgery on his arm, it became infected, and he almost lost it. And now heroin helps him ease the pain.

[Mario]: For the pain. I feel like an old man when I get up. Ooow, everything hurts.

[Daniel]: And at that moment, Said arrives.

[Pablo]: Hello, Said!

[Daniel]: His greeting is somewhat half-hearted. He looks tired. He opens the gate of the Community Center and goes in. Mario and Pablo follow him.

If someone saw them, they wouldn’t pay much attention. Three guys entering a small, run-down building. But this place, a few meters from the U.S. border, is the first line of combat against fentanyl. It’s a fight that uses a different strategy from that of the Mexican government. An old and recognized strategy in other parts of the world, but one that struggles to survive in today’s Mexico.

We’ll be back.

[MIDROLL]

[Daniel]: We’re back with Radio Ambulante. Pablo Argüelles continues the story.

The Community Center is very small. At the entrance, there is a reception, like at a hospital, and in the back is a small doctor’s office, half hidden by a curtain. The center has a different name than the sign outside: Integración Social Verter. Or just Verter. It has existed since 2013 and is run by two people: Said…  

[Said]: At Verter, I do everything. Every single thing. I do everything. That is, I sweep, I arrange things, I stock the storehouse, I catch the mice. 

[Lourdes]: It’s working against the current, all the time.

[Pablo]: And Lourdes. 

[Lourdes]: To begin with, financing has always been a constant issue in the organization. And I guess in most organizations that do harm reduction, right? We don’t have stable financing…

[Pablo]: Damage reduction. That’s what Lourdes and Said do at Verter. It involves a number of public health strategies.

It began to be applied in the 80s, in the Netherlands, and then in England. There, heroin users, who often shared syringes, started getting infected with HIV.

The most radical thing that could be done to stop the infections would have been to stop consumption, but the withdrawal syndrome is extremely rough. So maybe those people couldn’t stop consuming. Or maybe they didn’t want to, either.

But they could reduce the chances of becoming infected with a virus that was killing many people. So the simplest solution was found—using new syringes.

And this is the harm reduction strategy that Lourdes and Said use the most at Verter: preventing the exchange of syringes between drug users.

It works like this: You bring in the syringes you’ve used and they give you new ones, free of charge. You can choose between seven types of syringes, with needles of different calibers: 29, 28, 27… whichever is most suited for your skin and your veins.

In addition to the syringes, they also give you other tools so that you can consume safely: a cooker, which is a small saucepan where you prepare your dose; purified water to dissolve it; filters, so that the substance is as pure as possible; and tourniquets to enlarge your vein.

Inside the Community Center, Mario puts his used syringes in a red plastic box. It is almost full and has a small hole in the lid to avoid accidental puncturing when inserting more syringes. Then Lourdes asks for his name and his date of birth. She writes the data into a computer and asks Mario what tools he wants.

[Lourdes]: What else do you need? Water?

[Mario]: Everything. 

[Lourdes]: Everything? Alcohol wipes?

[Mario]: Thank you so much. 

[Lourdes]: You’re welcome.

[Mario]: Hey, take care of yourself, dude!

[Pablo]: “Take care of yourself, dude,” he tells me when he says goodbye. Mario takes his things and goes out into the street. He is the first user of the day. Over the next two days, at least ten more people will come in for syringes and tools. Lourdes and Said help them out.

[Said]: Which needle works best for your vein?

[Man1]: The red one…

[Lourdes]: What number of syringe works for you?

[Man2]: A 29… 

[Lourdes]: A 29 is the thinnest. Do you want that one?

[Said]: OK, do you want water?

[Lourdes]: OK.

[Said]: Cooker?

[Lourdes]: 29. Do you inject into your vein? 

[Said]: Wipes?

[Lourdes]: Water?

[Said]:  Cotton?

[Lourdes]: Alcohol wipes? Did you say filter, too?

 [Pablo]: Most of these people live on the streets. Some, like Mario, are also deportees from the United States, or migrants.

Other people come in for condoms, to be tested for HIV, hepatitis C, syphilis, or to heal their wounds from injecting.

These are other harm reduction strategies practiced at Verter. They are all free.

When they do that, Lourdes and Said, with the help of two collaborators, record every syringe they give out, every test they do, every wound they heal. This data collection is important. And that is something I’m told over and over again: harm reduction is an evidence-based approach that is recognized and recommended by the World Health Organization. In other words, it is not something that’s improvised or done out of pure charity.

Lourdes and Said also take samples of the drugs people bring in, in order to see, before they consume them, whether they are adulterated with fentanyl. And they also distribute naloxone, the medication that can save you from an overdose. In Mexico, it is classified by law as psychotropic medication and its use is very restricted. But at Verter, they bring it from the United States, where you can get it in any pharmacy.

And so, people come and go, each with their own use story. Some don’t want to talk and others do. With those who do, I go out to the street and we talk. 

[Man]: I have consumed everything—everything. Right now I’m taking fentanyl, because it’s not even heroin anymore. 

[Pablo]:  And… what do you think of it?  

[Man]: Well, frankly, I’m already thinking about retirement, about retirement, because my body is telling me that enough is enough… I’m not doing all this because… damn, how awesome it is, or how happy I feel, right? No. Simply stated, if I had not used drugs, I would no longer be alive. Do you understand me? I’d already… There are things from the past, when I was a normal child, things that destroyed me, do you understand? And thanks to drugs, I have been able to cope with that, but then they destroyed me, I became a drug addict, and all the plans I had for my life ended nowhere, because… thanks to other people.

[Pablo]: The man is about sixty years old. He lives on the street and pushes a shopping cart that carries blankets, jackets and water bottles. He tells me that he used to be a sales executive at a warehouse. Today he spends his days outside the border crossing, trying to earn any amount of money to eat and continue consuming. This is similar to what other people tell me. For them, work varies from day to day.

Then I meet a young man, about twenty-five years old. 

[Pablo]: So tell me why you come here,

[Flower Grower]: I come for blood tests and stuff, to see whether I have some disease that someone might have given me. And for that kind of help. 

[Pablo]: Hey, and tell me what you consume.

[Flower Grower]: Everything: marijuana, fentanyl, heroin, crystal, dm30, pills. 

[Pablo]: And have you been in rehab?

[Flower Grower]: About six or seven times, in Mexicali.

[Pablo]: And did it help you with your consumption?

[Flower Grower]: No, no. I got curious about trying more drugs, just like that. I used to use only marijuana and crystal, and now I smoke shiva, I smoke fentanyl, pills, no, man…  

[Pablo]: Are you working now?

[Flower Grower]: Right now I work at a restaurant around here, but I studied floriculture. I can arrange a church for you, for a wedding. A birthday party, funerals, baptisms. I studied for all those events. I have my degree in floriculture, art and flower design.

[Pablo]: The hours go by. At dusk, a woman in her fifties and a man in his thirties come to the Community Center. The woman asks Lourdes what kind of help they offer at Verter. Lourdes explains that they do harm reduction, they exchange syringes, and they are not looking for abstinence. The woman listens; she looks a little uncomfortable, as if she hadn’t found what she was looking for. After a couple of minutes, she and the man go out into the street.   

[Pablo]: What brings you to this Community Center? 

[Mother]: Well, there is a drug consumption problem in my family. And I saw this place and said, “Well, let’s see whether they can help me there,” because I have placed my family member in rehabilitation centers many times and no, it’s not the… the… I haven’t gotten any, how should I say it? He continues to consume, he goes out and continues using it. So I have to look for a different kind of help.    

[Pablo]: If I may ask, is this a close relative?

[Mother]: Yes. He is one of my sons.  

[Pablo]: How old is he?

[Mother]: 30.

[Pablo]: She tells me that her son has been using drugs for 12 years, that she has tried to take care of him in every possible way, and that at some rehabilitation centers, where they’re looking for abstinence, he has even been mistreated.

[Mother]: When they take him to a rehabilitation center, I feel like I am handing him over to executioners. And if he stays at home, I also see how he is destroying himself. 

[Pablo]: Said tells me that just a few years ago, the Wok Museum a few meters from Verter was a picadero, a shooting gallery, or place where people went to use drugs. And in the surrounding area there were a lot of connections, places where you could buy drugs. So it was a strategic location for a harm reduction program. And that’s why the Community Center was opened there. 

[Said]: All this was full of people who used heroin, methamphetamine, and it was very visible. I have videos of the short path from here to the corner there. We would pick up the syringes… So I said, “If we already have seven, eight, nine people out here every day, let’s just open a place and open the door for them and they can do it inside.”

[Pablo]: It was early 2018, and Lourdes and Said wanted to create a space in the Community Center so that people could bring their doses and get injected without suffering harassment from the police or being stared at by strangers. A supervised use room. They knew that places like that existed in Canada and Europe. But there were none in Mexico or Latin America. This could be the first.

[Said]: I was attracted to the avant-garde in a topic like public health and citizen mobilization. I saw it as a very disruptive topic. I never thought about the political or administrative repercussions.  

[Pablo]: He just thought about providing a space to people who needed it. Said has been working on harm reduction for more than a decade. And he saw it as a necessary thing from the very first. He is a drug user, and many of his friends have been, too. He tells me that at least five of them have died. So a user room was something personal for him. He and Lourdes, who has also been working on this for years, got funding from the federal government. And they began to prepare. They read about the experiences of other user rooms, they got legal advice, because there was no regulatory framework in Mexico in this regard. That meant it was not prohibited. And they also talked to users. 

[Lourdes]: We have to know, of course, what  people think of a space like this. Would they use it, how would they like it to be, what hours, what should we offer in a place like this.

[Pablo]: And one of the first conclusions was that a space like this should focus on serving women first. 

[Lourdes]: User spaces are regularly inhabited or… by men. They are violent spaces, where women experience a lot of abuse, physical abuse, sexual abuse, verbal abuse. The police also abuse them a little more—more than they do men; they criminalize them more for consumption, so women are always hiding. 

[Pablo]: The room would be located in a small area at the back of the Community Center. In it they would put three cubicles, each with a mirror, a light, a metal tray to prepare the dose, and a small box to deposit the used syringe. And the room would be called just that: The Room. 

[Said]: Because when someone comes here, they will say, “I want to use the room, may I come into the room, I’m going to the room.” It’s going to make everything easier.

[Pablo]: They opened in November 2018. And a national newspaper published an article about it. In it they called The Room a “legal injection site.”  

[Lourdes]: Well, the fact is that alarms went off here, that is, the local media found out. And then immediately, the next day, many media outlets were coming here. 

[Said]: We were getting calls from all over. There was a time when we had to unplug the phone.

[Lourdes]: They say it’s a safe shooting gallery. Everyone was decontextualizing the whole topic.

[Said]: Suddenly it reached the ears of the municipal mayor, because the news were on national television, and what he did was send us an operative with four departments at the same time, including urban control, ecology…

[Lourdes]: There was someone from the firefighters department, someone from civil protection.

[Said]: A lot of police officers came. I felt bad, yes, I felt like I thought they were going to beat me. I thought they were going to arrest me. 

[Lourdes]: We were very afraid of maybe being fined; we were very afraid of what was going to happen. 

[Pablo]: And what happened was that they were shut down. 

[Lourdes]: They basically put up a piece of paper that said, “closed,” which they printed and taped to the door, to the windows… everywhere, right? So we could no longer offer services to anyone from the community who came here.

[Pablo]: The reasons for the shutdown were bureaucratic: Verter did not have all the updated permits that the municipal government requires for establishments where services are provided. Said and Lourdes confirmed this to me. But they also told me that, before the closure, they should have received a first notice, a warning.

So they sought help from the state Human Rights Commission to negotiate the reopening with the municipal government. And about six months later, with permits in hand, they reopened the Community Center.

[Lourdes]: On the condition that we did not have a user area. Of course, as we had already learned, it is better to to ask for forgiveness than permission. We had gotten more experience along the road, and we said, “We cannot stop providing this service.” I mean, people were asking us, because the women who had used it before it was closed down were telling us, “Hey, we want to come into the room.” And, well…  

[Pablo]: They also reopened The Room. It was mid-2019. Since then, it has received about 1,900 visits. And there, my last afternoon in Mexicali, I accompany a woman. She asks me to call her Marta, but that is not her real name.

She is about 55 years old. She was born in Mexicali but grew up in California. She was deported in 2020 for possession of methamphetamine. She tells me that she has been using heroin for more than 20 years.

Before knowing The Room, Marta consumed in her house, without anyone’s supervision or help. She even did it in shooting galleries. She told me that she would hide and that she did not dare live with people who were not users.

Now she looks relaxed. She sits in one of the cubicles in The Room. She turns on the white light above the mirror. And she begins to take her tools out of her bag: The cooker, the syringe, alcohol wipes, the filter…

[Pablo]: So what are you going to use now?

[Marta]: Heroin, just heroin. 

[Pablo]: Marta takes the dose out of a plastic bag. She says it cost her about three dollars. It is about the size of a coin, and dark brown in color, it is black rubber heroin. She puts it in the cooker and begins to grind it with the butt of the syringe.

[Pablo]: And are you going to test this one to see if whether has fentanyl or not?

[Marta]: No, it does.

[Pablo]: Yes, it does. Marta gets up to wash her hands. Meanwhile, she tells me that she only tests her dose for fentanyl when she doesn’t buy heroin at her usual place. It doesn’t occur to me to ask her more—whether she likes fentanyl or not, for example. I’m just observing. Marta asks Said for a lighter, she sits down, and heats her dose in the cooker. 

[Marta]: It has to be heated so that it dissolves faster. Look… this is how it’s heating up and it’s breaking down… Even though I like it, I find the smell bad. 

[Pablo]: What does it smell like?

[Marta]: I don’t know. Like heroin. I’m not telling you to smell it, because it will make you crazy.

[Pablo]: When the dose is ready, Marta slowly draws it into the syringe.

[Marta]: You have to be careful, because if you don’t, you’ll make a hook in the syringe and it will hurt.

[Pablo]: Where are you going to inject yourself now?

[Marta]: Here on my hand.

[Pablo]: She wipes the back of her left hand with an alcohol wipe and then attempts to inject a vein. But she doesn’t succeed. She tries again two more times, with no success. I see the blood starting to enter the syringe and mix with the drug.

[Pablo]: What happened? 

[Marta]: It’s clogged…

[Pablo]: She tells me that vein would not take the needle there. So she switches to her left forearm and tries again on a different vein. She starts to look a little uncomfortable.

[Pablo]: Aren’t you able to…?

[Marta]: Mhmhm.

[Pablo]: And I feel this is happening because I am there, watching. So I leave The Room to give her privacy. 

[Marta]: Mhmm, if you want, I’ll let you know once I have managed.

[Pablo]: I wait outside for a couple of minutes, until Marta calls me. It worked.

[Pablo]: And how do you feel now?

[Marta]: Ohh, good, good… 

[Pablo]: Marta begins to quiet down. Her head dips slightly, her hands open. Her entire body relaxes, as if she were half asleep. I am next to her, in silence.

Said and Lourdes are outside the room, just a couple of meters away, doing their work, but also attentive.

If Marta overdosed, if her nails and lips turned blue, if her skin became cold or if she stopped breathing, Lourdes and Said would be there to give her naloxone, the antidote that can block the effect of heroin. And Marta would survive.

So, as I watch her sitting in her cubicle, nearly asleep, still high on the drug, I’m honestly glad she’s here.

About ten minutes pass. Then, suddenly, Marta wakes up. She puts her syringe in the waste box and begins to clean up her entire cubicle with disinfectant: the metal tray, the mirror, the light…

[Marta]: And then the light, look, so you can see yourself properly. I’m telling you, it’s pretty here. With all these little things there are.

[Pablo]: And how do you feel knowing that you are here, accompanied by Said or… ?

[Marta]: Mhm, hey, you’re safe here. 

[Pablo]: “You are safe here,” she says.

[Marta]: You don’t die. I don’t know. If you overdose, they will help you.

[Pablo]: She continues cleaning, very carefully. And then she leaves.

Everything I have told you so far may give the impression that the work that Lourdes and Said do is simple, free of setbacks or difficulties. As if the Community Ccenter existed in a vacuum and the circumstances outside did not affect them.

But things are not like that. During the days I’m in Mexicali, Lourdes and Said look tired. And they do not hide the fact that Verter is in crisis.

Especially since in 2019, when the López Obrador government cut off funding for all civil organizations in the country, including those that did harm reduction for drug users.

[Said]: Well, ever since then… it was all downhill, you know? I mean, we all said, “We’re going to be worth shit, we’re going to disappear.” 

[Pablo]: Said tells me that because of the cutbacks, many of those organizations have closed. Verter has survived thanks to the support of international organizations. 

[Said]: The financing we have comes from the United States and Europe. We bring the syringes from the United States, and activists from the United States bring them to us. The cookers and the water are also given to us from the United States. Everything comes from the United States. 

[Pablo]: But the problems are not limited to financing. Said tells me that fewer and fewer people are coming to the Community Center. First, because many have died, especially since the arrival of fentanyl. This is difficult to verify. At the time of writing this story, there are no updated official data on the number of deaths due to opioid use in Mexico. The most recent year for which complete data are available is 2021, when only 19 deaths were reported. But the government itself has admitted that there is under-reporting that does not reflect the reality of fentanyl consumption in the country.

Said also tells me that fewer people come to Verter due to the gentrification of downtown Mexicali.

Since then, there have been arrests of users who live on the street, as well as forced transfers to a private rehabilitation center that is not certified by the government and where physical and psychological abuse has been reported.

In addition, merchants in the historic center have spoken out against the Community Center. They want City Hall to close it down, because the people who come to Verter do not fit in with the new appearance of the neighborhood. 

[Lourdes]: For the people around here, people who uses drug are people who… lead bad lives, who don’t love themselves, who want to die. And who are the cause of all the evils that occur here in the city.

[Said]: It’s very disheartening to see that, and see that no one does anything. That people discriminate against them even though they work for people, they wash cars, they do work that no one else wants to do. And, well, that’s where the whole issue of stigma and discrimination comes in, our invisibility when we are carrying out and implementing these programs. We don’t know who sees them as good, who sees them as cost- effective.

[Pablo]: The afternoon I say goodbye to Lourdes and Said, I do so with the feeling that they are under enormous pressure and that the work they do could disappear at any moment. As I get into the taxi that takes me to the bus station, I see Chinatown for the last time. Verter’s small Community Center looks like it’s in the middle of a movie set. 

[Announcer]: Passengers bound for Tijuana, at 3:30 p.m., ABC Plus buses, please transfer to bus 4093 It is departure time…

[Pablo]: Now I’m heading to Tijuana, almost three hours away, to visit another organization that is also engaged in harm reduction. There, in a different context, I will learn more about the harm faced by users. Harm that has less to do with drugs and more to do with the politics, stigma, and illegal markets that have surrounded them for years. 

[Daniel]: We’ll be back after a break. 

[Daniel]: We’re back with Radio Ambulante. Our producer Pablo Argüelles continues the story.

[Pablo]: I’m in an Uber in Tijuana, and I’m heading to a neighborhood called Zona Norte, which is a few meters from the border.

The harm reduction organization PrevenCasa is there. People call it La Preven and it has existed since 2004.

Tijuana has one of the busiest border crossings in the world. And you can see it. On the way to La Preven, I see a lot of people in the streets, open businesses, offices, cars with license plates from Mexico and California, and also National Guard patrols, a federal security force created by President López Obrador. It is deployed throughout the country and most of its members are military. 

[Pablo]: It’s fine here, thank you very much.

When I get off the car outside La Preven, I see three or four men sitting on the sidewalk, surrounded by backpacks and bags. One of them is injecting himself in the arm.

From the outside, La Preven looks like an ordinary two-story house, like most in the neighborhood. The door is open. I go in and see a patio with several plastic chairs under a large tent; it is like an open-air waiting room. To the right is a room.

[Alfonso]: Well, this is the first station, which is the syringe exchange program for injection of methamphetamine and heroin. Or pipes for crystal use or pipes for fentanyl use. These are people who are long-time users, who are dependent, especially on opioids.

[Pablo]: This is Alfonso; he works at La Preven. He was born in the neighborhood and grew up on its streets, living with drug users, sex workers, migrants, and also with local families who have lived there for generations. He speaks of the Zona Norte with great pride. He offers to give me a tour of La Preven, to see the harm reduction services they provide. So we leave the room and return to the patio. I see a nurse taking a man’s vital signs.

[Alfonso]: There is a record of the patients who arrive daily, and from there they go to see a doctor or to whichever service they require. We’ll walk there.

[Pablo]: We advance along a very long corridor that leads to the far end of the property. To the left is a row of three small trucks, parked one behind the other. 

[Alfonso]: The trucks are used to apply rapid tests for HIV, syphilis, hepatitis C. Because they are spaces that are, let’s say, a little more confidential. 

[Pablo]: Of course.

And to the right is the house with doors that lead to different rooms.

[Alfonso]: And these spaces are also for medical consultations, psychological consultations, some types of therapies.

[Pablo]: La Preven feels like a small hospital and is much larger than the Community Center in Mexicali. About twenty people work there, most of them volunteers or medical, nursing and psychology interns. Like Verter, La Preven stopped receiving funding from the federal government in 2019. Since then, they have survived on international donations. On the day of my visit, there is a lot of activity. I see users who come to exchange syringes, for medical appointments, or to use the center’s showers. I see a UN official handing out information in Creole for Haitian migrants. And also a group of journalists reporting on the fentanyl issue.

[Alfonso]: To give you some context: in 2018, we saw fentanyl arrive here. It was detected, curiously, by the community members themselves. It was not the Army or the militarization, or customs, or anyone. Instead, it was the users themselves who began to approach us and began to ask, “Hey, what is this substance we have here?” “What is this that is causing us to feel different effects?” “And what is this substance that is making us lose friends and fellow users?”

[Pablo]: So they started hosting community workshops to inform about fentanyl, in addition to distributing naloxone and teaching how to administer it. And then, in October 2022, they opened a safe use room. They followed in Verter’s footsteps. Alfonso tells me they were very afraid of the government’s reaction.

[Alfonso]: Because, although these spaces are not regulated, they can be misinterpreted. And it can stop being seen as a public health intervention and a community space. We already saw Verter’s experience.

[Pablo]: The shutdown by City Hall.

[Alfonso]: What happened there, and I think that caught our attention and also made us pause to think and say, “Well, how can we open it?”

[Pablo]: That is why they did not advertise it in the press or online when they opened in 2022. 

[Alfonso]: What matters here is for the community to know about it. The people who are going to use the space. Yes, we do advertise the space to them so people they will come and use it. 

[Pablo]: The room is at the end of the long path, in the most hidden and quiet part of the property. When you go in, it seems at least three times larger than The Room in Mexicali. There is a very large armchair, a table with chairs… 

[Alfonso]: There are people who come only to relax because they had a very hard day at work. There are people who come only to use a shower and fall sleep in the space or to put on makeup. So the drug suddenly stops being the center of attention. The idea, rather, is to build the community. And people start talking about other things that you can’t talk about outside. And that is very, very important.

[Pablo]: Because out on the street you never know who might be listening. 

[Alfonso]: For example, the clients of sex workers, right? People who are harassing the girls. People who try to abuse people. So indoors they say, “Be careful with that customer, that guy did such-and-such to me, be careful.” And those are things that are not mentioned outside, only in very specific spaces. 

[Pablo]: Mostly women come to the user room. As in Mexicali, the Preven team consulted them before opening the space.  

[Alfonso]: There were girls who didn’t want to go in at first, saying, “No, I want to consume with my friends,” you know? There on the street. So it was quite a challenge to offer the space to them at first, to say, “Look, this space is for you. You can have control of this space. There will be no one judging you.”

[Pablo]: Little by little, they started to come. And it was they who called the space The Zone. First, because the neighborhood where they are is called Zona Norte. But also because that word, “zone”, evokes a different, contained and safe space.

This act of giving users a voice, listening to them, and using their language, and doing nothing without their input is a repeated pattern I see over and over again throughout my journey.

[Lili]: Well, the first thing to do is get to know our community.

[Pablo]: This is Lilia Pacheco, director of La Preven. I talk to her on my second day in Tijuana.

[Lili]: We need to be involved in their customs, in their traditions, in the language. Being a border location is a big influence. It is a big influence that deported people come and that many of them speak only English or speak pocho Spanish, as we call it here. So we do have to engage in those conversations to figure out what they are talking about, when they say, “An erre, I want an erre.”  

[Pablo]: An erre is a syringe, something I didn’t know. 

[Lili]: OK. And then maybe another member of the community says, “Oh, an erre is a cuete.”

[Pablo]: Cuete. Another way to say syringe.

[Lili]: Or sometimes deportees come here and say, “Can you give me some insulin?” So we know they don’t need insulin, which is a hormone for the treatment of diabetes. No, insulin is another word for syringe.

[Pablo]: Many of the people La Preven serves are deported from the United States. People who arrive in Tijuana and have no family or support networks, or a house to live in, or documents to do the most essential paperwork in the city.

[Pablo]: Lili tells me that, over more than ten years of talking with the community, she has learned that people do not consume drugs only to anesthetize physical and emotional pain. Sometimes the reasons are much more routine. 

[Lili]: When I interview people who use methamphetamine or crystal, I say, “Oh, now I understand why they started using crystal.”  I learn that they needed to perform better at work. Someone offered it to them saying, “Look, for your night shift. Use methamphetamine and you will have more energy,” so I understand why they started using it. Because the dynamics of the economy of this city or this country can also lead you to this type of behavior in an attempt to solve a problem.  

[Pablo]: Talking to Lili, I realize that harm reduction goes beyond syringes or a safe space to consume.

[Lili]: Harm reduction is offering a lot more services, focusing on what the person needs so that they can have a better quality of life. Many people come here for their syringe every day, but at the same time, we also give them their pill to treat tuberculosis. So, of course it’s a hook. The syringes are the hook. But this help us link them to other health care services that will benefit not only the person who currently has tuberculosis or hepatitis C, because we are also controlling the epidemic. We are also benefiting the community.

[Pablo]: This is something I also heard in Mexicali: Harm reduction helps us all. These are arguments based on evidence and not prejudice.

[Lili]: Well, the main myths are these: that we promote the use of drugs; that if there is a harm reduction program, the number of people injecting themselves or the number of drug users will increase. Those are myths. That is not true. And there is evidence that says that a safe use room, for example, managed to reduce the number of new injectors.

[Pablo]: Studies have been done in the United States, Australia and Canada that suggest that harm reduction programs, including supervised use rooms, do not increase the number of users. In Catalonia it has also been researched that people who go to the rooms are twice as likely to access opioid dependence treatment services.

In Mexico, those who have opposed harm reduction programs have usually been neighbors of the organizations. But lately the criticism has come from elsewhere. In April 2023, the president of Mexico questioned the usefulness of naloxone in combating fentanyl overdoses. He said it was a palliative, not something that solved the underlying problem. 

[Archive Soundbite]

[AMLO]: Could it be that this is going to become a medicine so that the addiction will cease to exist, or is it just prolonging the agony?

[Lili]: I mean, how can a leading person in the country have that type of arguments? For me it was something very serious. Because he is thinking that all the people who use drugs are about to die. And why would you intervene if they are going to die? Why save their life with naloxone in an overdose if they are going to die tomorrow anyway? And I think that those types of arguments just torpedo all the work that so many of us have done for many years in favor of harm reduction.

[Pablo]: But the drug policy of the López Obrador government has also turned towards the criminalization of users and the militarization of the country, including cities that are part of the international drug trafficking corridor, such as Tijuana.

[Lili]: So we began to see the streets flooded with the army and National Guard. They carry out operations in this area because it is called a conflict zone, right?, a drug-trafficking and drug-use area. We notice in our community that, when there is more military presence, people have less access to our services. People hide, they take shelter, they prefer not to come, and since they couldn’t come, they ended up sharing syringes. And that’s a risk factor for the transmission of infections, harming their health further. 

[Pablo]: Although the presence of state forces has increased, violence has gone up. In 2022, Tijuana was the municipality with the highest number of homicides in the country. 

[Lili]: The area is hot. That means there are problems. There are conflicts between cartels. We’ve had murders out here. I mean, shootings very close to us. And it worries us because we are right in the middle of it.

[Pablo]: Because the cartels know who they are and that they offer a service to the community. But for harm reduction to work, it must be carried out in areas where vulnerable populations are located. But those are precisely the areas where the army, police and cartels also tend to be present. 

Lili told me about an episode that happened in 2018. They were doing some diagnostic surveys on heroin use and they asked the community where they got it, in what area… but without giving addresses. And the cartels found out that La Preven was asking this question. 

[Lili]: So someone from our staff comes and tells me, “There is a person there, but it seems like he has a gun and has a very strange attitude.” And he says that he is coming for an interview, for the interviews that we are doing. So I gather my courage and say, “I’ll take care of it.” I went out and asked him, “Are you coming for an interview?” I was very friendly, very cordial to him. And with a defiant look, he said, “Yes, I’m here for the interview.” 

[Pablo]: Lili explained the survey criteria, that he had to sign a consent form and that there was going to be an audio recording of the interview. 

[Lili]: And very defiantly, he answers, “Yes, that’s what I’m here for.” Well, I have no choice but to let him in. I took him to a truck where we were doing the interviews and I continue as if nothing was happening, like I have no idea that you are armed and you’re coming just to check things out.

[Pablo]: Before starting the questionnaire, Lili repeated that he should not say anything compromising. For everyone’s safety.

[Lili]: And with his defiant look, he began to nod. And then I started and he gave me very short answers, like he didn’t want to give much information, but in the end the interview flowed and he gave me more details. Sometimes I had to make signs like, “not that,” “not that”. But he gave me details saying he had recently kidnapped a person, that he was torturing him, that it was a person that had put his finger on him, that is to say, someone who had informed the police where he was.

[Pablo]: The man began to cry. He talked about his partner, his daughter, his family, the place where he was born and from where he fled. 

[Lili]: And, well, I had to give him a Kleenex because he was so emotional. So at the end I thanked him, I told him that his whole story was very important for this study. And, well, he gets up and tells me, “Ah, well I am so-and-so,” because he had given me a false name, “and they call me so-and-so, my nickname is such-and-such, whatever you need, whatever you want, just have someone call me.” And so… I said, “Thank you very much, but look, when we step down from the truck, I’m going to forget everything you told me in the interview.” I said, “In fact, I’m not even going to remember who you are, or your nickname.” And he turned around smiling with a different attitude and he said, “Good for you.” And he left. And we never heard from him again. 

[Pablo]: In La Preven I met this woman:

[Mari]: Look, son, I’m from Baja California. I was born here, in Tijuana. 

[Pablo]: Mari is 57 years old. An elegant woman in makeup, rings, and bracelets. She comes to clean La Preven once a week. She started using heroin when she was thirty years old. She went to rehab centers and then began receiving opioid substitution therapy at a government clinic. 

[Mari]: There, in those institutions, they give you the treatment in the form of some pills in some juice. You take it, and you stop pricking your hands. And you have to go every day for the program to work for you, and then they lower the amount, they keep lowering it, until you leave. 

[Pablo]: Opioid substitution helps gradually reduce the use of illicit opioids, such as heroin.

It can be done with several substances, including one called methadone. According to the World Health Organization, it is an essential medicine. It has been used in Mexico since the 1970s.

But in February 2023, the Mexican government temporarily shut down the factories of the only methadone distributor in the country after finding, and I quote, “critical deficiencies” in its production process. So there began to be shortages all over the country. In mid-2023, Mari was told at the clinic that they no longer had methadone. 

[Mari]: Because the government had removed it or stopped it. So it made me panic. I was afraid because I used this substance, but there was nowhere to get it.

[Pablo]: The government suspension lasted until August 2023, and Mari’s clinic had methadone again in October. During those months, she was at risk of going back to heroin, which is very dangerous because now most of it is adulterated with fentanyl. And during those months, Mari came to La Preven, with a prescription for antidepressants and anticonvulsants that they had given her at the clinic. She got them at La Preven. But Mari also tells me something else, something that is perhaps more important, but that at the moment, I didn’t fully grasp: 

[Mari]: So I try to come here with these people to… because it is good for me to spend time with them. I spend a lot of time at the institution.

[Pablo]: I don’t pay that much attention to this. Instead, I ask: 

[Pablo]: And do you sometimes also use The Zone room to consume? 

[Mari]: Yes, when sometimes I have something that I can’t solve. We are used to it…

[Pablo]: I’m trying to find out whether Mari still consumes.

[Pablo]: How long have you consumed?  

[Mari]: I used heroin for about six years, and methadone for 20. 

[Pablo]:  And what do you use now? 

[Mari]: Nothing, just the medications they give me here. Which are not controlled medications.  

[Pablo]: Mm-hmm. Just to confirm, so you don’t use The Zone to consume substances? OK.

She shakes her head. It is a moment of confusion. Does she consume or not? I don’t know whether it’s because I wasn’t more specific. Or because she got uncomfortable with my insistence and decided to change her answer. What I know is that part of me wants to know more about Mari’s drug use, as if that will allow me to get to know her better.

But in reality, knowing it is not relevant. So what if she uses drugs? What she is telling me, and what I don’t seem to grasp, is that in The Zone she is not alone.

[Mari]: That’s why I come, because if I were at home, well, I would get depressed and then relapse. So you have to avoid those relapses. 

[Pablo]: I speak with Mari in the La Preven storeroom, where medicines, supplies, and also donated clothes are stored. At the end of the interview, Mari stands up and starts rummaging through the clothes, with her bracelets jingling. She tells me that she is looking for clothes with long sleeves.

[Mari]: Yes, whenever I wear something that is a change, it has to be long sleeves, son…

[Pablo]: She feels that if people saw her arms…  

[Mari]: Well… they don’t stare at me, but… but I know that they do look…

[Pablo]: She continues searching until she finds two blouses. Those blouses will hide the injection scars. She will be more protected. Because outside of The Zone, she tells me, people who consume are still singled out.

[Mari]: That taboo should no longer exist. Because you are a human being and so am I. The only thing different is that you don’t use it and I do.

[Pablo]: The only thing different is that she uses drugs and I don’t.

 [Daniel]: Pablo Argüelles is a producer for Radio Ambulante and lives in Mexico City. This story was edited by Camila Segura, Luis Fernando Vargas and me. Desirée Yépez did the fact-checking. The sound design is by Andrés Azpiri and Rémy Lozano, with original music by Rémy. 

Thanks to Jaime Arredondo and Adriana Muro for their help. 

The rest of the Radio Ambulante team includes Paola Alean, Lisette Arévalo, Adriana Bernal, Aneris Casassus, Diego Corzo, Emilia Erbetta, Selene Mazón, Juan David Naranjo, Ana Pais, Melisa Rabanales, Natalia Ramírez, Natalia Sánchez Loayza, Barbara Sawhill, Bruno Scelza, David Trujillo, Ana Tuirán, and Elsa Liliana Ulloa.

Carolina Guerrero is the CEO. 

Radio Ambulante is a podcast by Radio Ambulante Estudios, produced and mixed on the Hindenburg PRO program. 

If you enjoyed this episode and want us to continue producing independent journalism about Latin America, support us through Deambulantes, our membership program. Visit radioambulante.org/donate and help us continue narrating the region.

Radio Ambulante tells the stories of Latin America. I’m Daniel Alarcón. Thanks for listening.