title: Police bribery and access to methadone maintenance therapy within the context of drug policy reform in Tijuana, Mexico.
abstract: OBJECTIVE
  In 2009, Mexico passed legislation to decriminalize drug possession and improve access to addiction treatment. We undertook research to assess the implementation of the reform among a cohort of people who inject drugs (PWID) in Tijuana. This study specifically sought to determine whether discretionary policing practices like extortion impact access to methadone maintenance therapy (MMT) in Tijuana, a city characterized by high levels of drug-related harms.
  
  
  METHODS
  Generalized estimating equation analyses were used to construct longitudinal confounding models to determine the association between paying a police bribe and MMT enrolment among PWID in Tijuana enrolled in a prospective cohort study. Outcome of interest was MMT enrolment in the past six months. Data on police interactions and MMT enrolment were also obtained.
  
  
  RESULTS
  Between October, 2011 and September, 2013, 637 participants provided 1825 observations, with 143 (7.8%) reports of MMT enrolment during the study period. In a final confounding model, recently reporting being forced to pay a bribe to police was significantly associated with an increased likelihood of accessing MMT (adjusted odds ratio=1.69, 95% confidence interval: 1.02-2.81, p=0.043). However, in 56 (39.2%) cases, MMT enrolment ceased within six months. The majority of participant responses cited the fact that MMT was too expensive (69.1%).
  
  
  CONCLUSIONS
  Levels of MMT access were low. PWID who experienced police extortion were more likely to access MMT at baseline, though this association decreased during the study period. Coupled with the costs of MMT, this may compromise MMT retention among PWID.
authors: Division of Global Public Health, Department of Medicine, University of California, San Diego, United States; BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.
authors: D
authors: D
authors: Werb
authors: Division of Global Public Health, Department of Medicine, University of California, San Diego, United States.
authors: K D
authors: KD
authors: Wagner
authors: Division of Global Public Health, Department of Medicine, University of California, San Diego, United States; Northeastern University School of Law, Bouvé College of Health Sciences, Boston, United States.
authors: L
authors: L
authors: Beletsky
authors: Division of Global Public Health, Department of Medicine, University of California, San Diego, United States.
authors: Patricia
authors: P
authors: Gonzalez-Zuniga
authors: Secretaria de Salud de Baja California, Tijuana, Mexico.
authors: Gudelia
authors: G
authors: Rangel
authors: Division of Global Public Health, Department of Medicine, University of California, San Diego, United States. Electronic address: sstrathdee@ucsd.edu.
authors: S A
authors: SA
authors: Strathdee
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005607:Fraud; D006291:Health Policy / Q000191:economics / Q000331:legislation & jurisprudence*; D006297:Health Services Accessibility / Q000191:economics / Q000331:legislation & jurisprudence; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D058850:Opiate Substitution Treatment / Q000191:economics / Q000592:standards*; D016495:Police / Q000191:economics / Q000331:legislation & jurisprudence*; D028743:Professional Misconduct; D011446:Prospective Studies; D015819:Substance Abuse, Intravenous / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy
chemical_list: D008691:Methadone
keywords: Discretionary policing; Drug policy; Extortion; Injection drug use; Methadone maintenance therapy; Mexico
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