What are “Mexis?”
Working in community mental health in Spokane, Washington last year, my coworkers and I started to notice clients and their concerned family members making increasing reference to “mexis.” The street term “mexis” had been in use for a while, but the prevalence of this drug seemed to have grown. We gathered that these were bootleg fentanyl pills imported from Mexico, but it took a while to learn the details. Did they look like a known legitimate opioid pill that had high street value like Oxycontin 80 mg, or did they look like a molly pill with something like a smiley face on it? Did anyone buying these things believe they were real pharmaceutical pills? Why is this method of opioid abuse considered by many to be better than injecting heroin or heroin-like products?
Over time we learned that mexis are a blue pill with a capital “M” on one side and the number “30” on the other. This format is an imitation of a common opioid pill, oxycodone 30 mg, which is branded as “Roxicodone” or “Roxicet.” Oddly, there are legitimate pharmaceutical opioids that carry a higher street value, but maybe having something more common for sale would make people less suspicious of the product. The “M” is for Mallinckrodt Pharmaceuticals, which makes the legitimate form of this pill.
The most common method of administration for these pills is to place them on a piece of aluminum foil, hold a lighter underneath, and then inhale the smoke from the heated pill through a straw in your mouth. Decades ago, in heroin circles, this was called “chasing the dragon,” with the idea that the smoke was like a dragon that you chased with your straw.
The rationale behind smoking is that ingesting pills through your large intestine is a slower route of administration and a lot of the drugs may never make it to your nervous system, but would rather go through your digestive system. Smoking is almost as fast a high as injection because your lungs are a direct route to your blood stream, so you bypass your digestive system. This also makes for a more intense high, but not as long lasting.
Another rationale behind smoking is that users believe that it is safer than injecting because you don’t have to shoot all the drugs into your body at one time, which should help the user manage the dosage and hence the overdose risk. There is also the issue of reduced risk of bloodborne pathogens like hepatitis or HIV that might come from sharing needles, or abscesses that arise whether you share or not. There’s also a lesser stigma to smoking, which appeals to younger or more naïve users. In elementary school in the ‘70’s, we snuck one of my friend’s mom’s Virginia Slims cigarettes into the woods, managed about one or two puffs each and, after we stopped coughing and retching, wondered what the appeal was. We never saw this guy’s mom inject anything and never considered going into the woods with a syringe. Smoking opioids may be safer, but the research is still out on that. Smoking opioids is likely a way station on the road to injecting. Eventually people get tired of wasting their drugs and want to keep all of them, from bag to bloodstream. It’s pretty clear that our lungs weren’t made as an orifice to soak up fentanyl and whatever other substances are present to bulk up the pill.
The news in Washington has been full of stories about cars being stopped with tens of thousands of these pills. Social media in Seattle has pictures of public transportation littered with piles of burnt tinfoil around the backseat and people smoking mexis openly on the bus.
From our anecdotal experience, mexi users seemed to be younger, to not have a history of IV drug use, and by the time their families were calling us, their adult child seemed to need around $60 per day to feel halfway decent, to avoid physical withdrawal and the severe mental dysphoria associated with withdrawal. Basically, it’s the same dynamic as heroin addiction.
A former mexi dealer on the Dopey opioid recovery podcast, said that a person without any opioid tolerance, who orally ingests one mexi pill, will likely overdose to the point of medical emergency because of the strength of the fentanyl. He said the usual customer knows it’s a counterfeit pill and intends to smoke them. I spoke with a 19-year-old client, who believed he was taking a 30 mg oxycodone pill to get a social high. He overdosed and required a substantial amount of Narcan from emergency responders to be revived. There are a lot of people like this 19-year-old out there who are misusing pills, but not addicted, who could wind up dead if nobody calls 911. His friends may not carry Narcan because they don’t think they need it.
These cartels, like most billion-dollar corporations, are pretty smart. They rode the tail end of the opioid epidemic by supplying raw opioids to people who could no longer afford to buy their drugs from Purdue Pharma. Now that it’s becoming almost impossible to get legitimate prescription opioids for legitimate post-surgery pain, the best way to create new entry-level addicts is to try to recreate the glory days of prescription abuse. No doctors needed.