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By MARK LORENZANA

Mexican President Andrés Manuel López Obrador (AMLO) on Wednesday, March 15, proposed the banning of medical fentanyl in Mexico as a countermeasure to the black-market variety produced by drug cartels in the country, which is eventually trafficked into the United States and has contributed to the ongoing opioid crisis there.

“I am going to ask Mexican doctors and scientists to analyze the possibility that we can replace fentanyl for medical purposes with other analgesics,” said López Obrador in his daily morning press conference at the National Palace in Mexico City.

López Obrador added that, unlike in the past, medical fentanyl is now a controlled substance.

“So now we have more control of the medical variety, which we did not have before. In any case, we are looking to prohibit it and replace it with other analgesics,” AMLO said. “If that’s the case, there would no longer be any possibility that it could be smuggled into other countries, specifically to the United States, if we replace it with other analgesics. Let’s see if it’s viable.”

López Obrador said he believes that there should be a commitment with the United States: Mexico will continue to combat the illegal entry of chemical precursors to produce fentanyl that enter the country illegally, but that if the synthetic opioid is banned for medical purposes in Mexico, the United States must also follow suit.

Several physicians in the country immediately pushed back on AMLO’s suggestion.

Gilberto Castañeda, a pharmacology specialist from the Center of Investigation and Advanced Studies (Cinvestav), said that the illicit trafficking and consumption of street fentanyl has nothing to do with medical use, and that in low doses the medical variety helps reduce chronic pain in patients.

Gina Tarditi, an expert at Mexico’s National Cancer Institute, said that “banning fentanyl for medical use is totally absurd.”

“Living with pain is not living. It is condemning to a living death many people who, with the appropriate and legal use of these medications, can have a better quality of life,” she said.

For her part, Silvia Lorenia Cruz, another Cinvestav researcher, said that the fentanyl circulating on the streets and produced by cartels is not fit for medical use. She added that medical fentanyl has been on the market since the 1960s, and has been highly touted for its advantages over other opioids.

“It is very effective in reaching the central nervous system because it crosses the blood-brain barrier very quickly, and this has made it extremely useful for certain surgeries,” explained Cruz. “It usually works in combination with other anesthetics, because it’s not only very powerful, but also very effective.”

According to Cruz, the illicit fentanyl-laced pills being trafficked on the streets — which are commonly blue or rainbow colored — are known as “M30” and are oftentimes distributed or packaged as different types of pharmaceutical pills, which contributes to overdose deaths.

One thing is for sure, however: Cruz said she believes that it is virtually impossible to get fentanyl off the streets by prohibiting its medical use.

“It is impossible to prohibit its use, and doing so would affect the work of anesthesiologists in the country, and even doctors who are in charge of treating pain,” she said, adding that medical fentanyl is indispensable to the medical community in the country.

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