title: Institutional stakeholder perceptions of barriers to addiction treatment under Mexico's drug policy reform.
abstract: Mexico has experienced disproportionate drug-related harms given its role as a production and transit zone for illegal drugs destined primarily for the USA. In response, in 2009, the Mexican federal government passed legislation mandating pre-arrest diversion of drug-dependent individuals towards addiction treatment. However, this federal law was not specific about how the scale-up of the addiction treatment sector was to be operationalised. We therefore conducted in-depth qualitative interviews with key 'interactors' in fields affected by the federal legislation, including participants from the law enforcement, public health, addiction treatment, and governmental administration sectors. Among 19 participants from the municipal, state and federal levels were interviewed and multiple barriers to policy reform were identified. First, there is a lack of institutional expertise to implement the reform. Second, the operationalisation of the reform was not accompanied by a coordinated action plan. Third, the law is an unfunded mandate. Institutional barriers are likely hampering the implementation of Mexico's policy reform. Addressing the concerns expressed by interactors through the scale-up of services, the provision of increased training and education programmes for stakeholders and a coordinated action plan to operationalise the policy reform are likely needed to improve the policy reform process.
authors.affiliation: a Department of Medicine , University of California San Diego , San Diego , CA , USA.|b BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada.
authors.forename: Dan
authors.initials: D
authors.lastname: Werb
authors.affiliation: a Department of Medicine , University of California San Diego , San Diego , CA , USA.
authors.forename: Steffanie A
authors.initials: SA
authors.lastname: Strathdee
authors.affiliation: a Department of Medicine , University of California San Diego , San Diego , CA , USA.
authors.forename: Emilo
authors.initials: E
authors.lastname: Meza
authors.affiliation: c Hospital General de Tijuana , Tijuana , Mexico.
authors.forename: Maria Gudelia
authors.initials: MG
authors.lastname: Rangel Gomez
authors.affiliation: d School of Social Work, University of Southern California , San Diego , CA , USA.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Palinkas
authors.affiliation: e Instituto Nacional de Psiquiatriá , Mexico City , Mexico.
authors.forename: Maria Elena
authors.initials: ME
authors.lastname: Medina-Mora
authors.affiliation: a Department of Medicine , University of California San Diego , San Diego , CA , USA.|f School of Law & Bouvé College of Health Sciences, Northeastern University , Boston , MA , USA.
authors.forename: Leo
authors.initials: L
authors.lastname: Beletsky
mesh_terms: D000073316:Addiction Medicine / Q000331:legislation & jurisprudence*; D005260:Female; D018166:Health Care Reform; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008800:Mexico; D011050:Policy Making; D011634:Public Health; D036301:Qualitative Research; D019966:Substance-Related Disorders / Q000188:drug therapy*
keywords: Mexico; Tijuana; addiction treatment; drug policy reform; institutional barriers