To combat the fentanyl crisis in Tijuana, San Diego residents are smuggling naloxone into Mexico

The Prevencasa health clinic is an invaluable resource for people in Tijuana's impoverished Zona Norte neighborhood.

Cash-strapped parents get flu medicine for their children, sex workers get condoms before their shift, and drug users swap their used needles for clean ones.

“This is a very important space in the community because it is literally 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 people, Prevencasa is also the only place where people can use drugs like fentanyl under the supervision of staff trained in overdose prevention.

But clinic staff are having trouble getting access to naloxone — an overdose-reversal drug that is literally life-saving for people addicted to fentanyl.

This is because Mexico's restrictive drug policies make it nearly impossible to obtain naloxone, known by the brand name Narcan, in Tijuana. As a result, the clinic often relies on volunteers to essentially smuggle the drugs across the border from the United States into Mexico.

“If we have to smuggle naloxone from the United States into Mexico, there is something fundamentally wrong with drug policy, and we have to fix that,” Arredondo said.

Living in denial

In San Diego, naloxone has helped reduce fatal overdoses. So much so that advocates and county health officials have made it widely available. Nasal sprays are available at clinics across the city, in schools and even at vending machines. First responders regularly carry naloxone and are trained to administer the drug.

Meanwhile, in Mexico, former President Andres Manuel López Obrador spent years downplaying the country's role in the fentanyl crisis. At times he even went so far as to say that no one in Mexico makes or uses the synthetic opioid, which is arguably the most dangerous narcotic on the market.

Lopez Obrador has also blocked efforts to remove naloxone from a list of banned substances in Mexico, a move that would have allowed people to buy the drug without a prescription.

President Claudia Sheinbaum, who was sworn in on October 1st, supports her predecessor's prohibitive drug policy. In 2023, she said fentanyl was not a public health problem in Mexico. During a campaign visit to Baja California this spring, she described fentanyl addiction as a U.S. problem.

Statistics on fentanyl use are hard to come by in Mexico, but Arredondo and other advocates say it is a significant and growing problem, particularly in the border region. Sheinbaum has expressed support for more treatment options but has not released specific details.

In 2018, Lopez Obrador cut funding to nonprofits like Prevencasa. This had a significant impact on the clinic's ability to obtain basic supplies, forcing Arredondo and others to smuggle them across the border.

“Since 2018, we have to cross all supplies – syringes, tubing, naloxone, foil – anything we use for harm reduction we have to bring from either the United States or Canada,” Arredondo said.

Arredondo said he was stopped while trying to cross the border while carrying up to 300 vials of naloxone. Mexican customs officials initially demanded $8,000 and said they would confiscate his car if Arredondo couldn't pay.

They let him go after he was able to raise $2,000, he said.

A “courageous” attempt to save lives

According to April Ella, who runs the naloxone distribution program for the San Diego-based nonprofit drug treatment organization A NEW Path, there is a long history in San Diego of activists willing to risk legal and financial repercussions for medical care south of the border to obtain .

“You are brave,” she said. “They are brave enough to make sure they save lives no matter where they are. And they take that risk to make sure people are protected.”

For Gretchen Burns Bergman, founder of A NEW Path, the lack of access to naloxone in Tijuana is heartbreaking. She believes that everyone on the planet should carry the anti-overdose drug.

“Mothers will not be able to save their own sons,” she said. “They won’t have it when they need it.”

Burns Bergman began advocating for compassionate drug treatment after her sons developed a heroin addiction. She has used these firsthand experiences to promote alternatives to mass incarceration and societal stigma.

“After more than 50 years of drug war, it has obviously failed,” she said.

The fight against stubborn scars

Burns Bergman has tried to expand her lobbying efforts to Tijuana. But she's having a hard time finding parents willing to organize. She believes part of the problem is that people are wary of being associated with drugs.

“If we think the stigma is bad here, it’s even worse in Mexico,” she said.

The doctors at Prevencasa witness this stigma firsthand. Sometimes it comes from other patients in the clinic who look down on those struggling with addiction.

In other cases, this takes the form of harassment of patients outside the clinic by members of the Mexican National Guard.

During a recent visit, KPBS observed three soldiers dressed in combat fatigues and armed with assault rifles surrounding a homeless man who was trying to inject medication right outside the clinic. The man was visibly nervous. His hands shook as he stabbed his forearm several times with a syringe and struggled to find a vein.

He had a prescription with him and waved to the soldiers. But it wasn't until the clinic's medical staff intervened that they left him alone.

“In society we think that drug users are criminals,” said Dr. Alejandro Gonzalez, who works at the clinic. “If society, the police, everyone sees you as a criminal, you will start to believe that you are one.”

Gonzalez said he saw local police and National Guard troops standing right next to someone who was overdosing but refusing to help.

Meanwhile, Gonzalez said paramedics and other first responders showed more compassion when they saw him preventing overdoses.

“I heard them say, ‘What kind of medicine is this? Can I have some so I can treat more people like you did today?'” Gonzalez said.

When there are 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.”