When Angela Garcia, an anthropologist and professor at Stanford University, arrived in Mexico City in 2011 to begin research for her second book, the war on drugs in Mexico had been in full swing for almost five years. She had planned to write about Health City, a proposed hospital and residential complex intended to address economic and health disparities. But once there, watching coverage of massacres and kidnappings on the news at night, she came to suspect that the big plans for Health City were little more than propaganda, utopian promises that would never be fulfilled.
Adrift in the city, Garcia took a ride with a cabdriver, Manuel, whom she’d hired to take her around the city. He told her he had never heard of Health City, but her description of her previous research on addiction in New Mexico touched a nerve. He took an unexpected turn and drove toward the outskirts of the city, pulling up to a small building with a metal gate. And then he let Garcia in on a difficult secret: he’d shut his youngest daughter, Lili, in an anexo, a residential treatment center where people who use drugs or alcohol—or sometimes just have mental health challenges—are institutionalized for weeks or months, often by family members or friends.
Manuel told Garcia that his daughter used drugs on and off and would sometimes stay out for days at a stretch. It was her third time being institutionalized in this way; after the first two times she’d come home bruised and skinny. But he and his wife still felt Lili was safer in an anexo, even one run clandestinely without permits or government supervision, than outside, where they feared she might be disappeared or killed, like the tens of thousands of people who had already become victims of the drug war by 2011.
As they spoke in the car, a woman walked up to the gate in front of the building, pulling a teenage girl by the ear. The girl squirmed in her grip as the woman banged on the gate and demanded to be let in. The gate opened a crack, and the two disappeared inside. “Health City will never happen,” Manuel told Garcia as he dropped her at home. “But anexos are everywhere.” For weeks Garcia couldn’t get her mind off Lili and the scene in front of the anexo. She soon switched the focus of her research.
There’s a severe shortage of public treatment options in Mexico for people who use drugs and wish to stop. The federal government’s antidrug campaigns promote abstinence in a way that would make Nancy Reagan proud (and that Donald Trump recently promised to emulate). Domestic drug use is downplayed, in part by the government’s failure to collect and update statistics about its prevalence, much less fund research about people who use drugs. Opioid replacement programs are rare.
Mexico has a near total prohibition on narcotics—including cannabis and, incredibly, vaped nicotine. Members of the armed forces, which have received billions of dollars of weapons, vehicles, and training from Washington, are tasked with policing drugs. They shape illicit markets through a combination of violent antagonism toward and quiet cooperation with—or tolerance for—producers, traffickers, and sellers.
The substance most commonly seized by soldiers is marijuana. Meth, which is easier to produce, smuggle, and sell because of its compactness and the fact that it can be made in a lab, has become increasingly popular. This follows the iron law of prohibition, which posits that attempting to stem the flow of a psychoactive substance leads to the introduction of more concentrated substances. A similar logic is part of the explanation for the spread of illicit fentanyl, by far the most potent opioid on the market.
The number of people dying from overdose in the US hit an all-time high of over 110,000 in 2023, most due to fentanyl contamination of the narcotics supply. South of the border, there is no official count of overdoses or people who use drugs. But research suggests thousands of people have died from overdose; a 2016 study found that over 23,000 people had used heroin in Mexico that year, a figure the authors called a gross underestimate.
Fentanyl is increasingly showing up in samples of street narcotics examined by researchers and harm reduction workers in Mexico’s north. “In the case of opioids, and particularly heroin, almost 100 percent contained fentanyl,” Lourdes Angulo Corral, who carries out drug testing as part of her work with Integración Social Verter in the border city of Mexicali, told me. (Most injection drug users in Mexico are in border cities—overall, alcohol and marijuana are still the country’s most commonly used psychoactive substances.)
When President Andrés Manuel López Obrador was elected in 2018, his government initially promised to enact health-centered drug policy but soon abandoned the idea. Months before he took office the Supreme Court declared the total ban on cannabis consumption unconstitutional, which required legislators to regulate its use. An initiative to legalize cannabis made it through the lower house of congress before it stalled in the Senate. A separate initiative to have the government oversee production of opium in an effort to quell drug war violence and guarantee a supply of pain medication in Mexican hospitals fell apart before the end of López Obrador’s first year in office.
Overdose, according to Mexican officials, is a gringo problem associated with a lack of family values. In 2023 López Obrador criticized the US for making naloxone, a medication used to reverse opioid overdoses, available without a prescription. He said doing so was a palliative measure that served only to “prolong the agony” of people who use drugs. In January his successor, President Claudia Sheinbaum, said fentanyl consumption “isn’t a problem” in Mexico.
Naloxone is barely available in Mexico, where it is listed as a controlled substance. Activists carry the lifesaving medicine across the border from the US to make it available in Mexican communities. From the perspective of the government, there’s no need to prioritize services or treatment options for a problem that doesn’t exist. Despite the efforts of activists, the Mexican government refuses even to count the dead.
The lack of options for people who use drugs in Mexico is filled by anexos, which are privately owned and run by self-trained padrinos (literally, “godfathers”) without any oversight. Early iterations of anexos began to open in Mexico City fifty years ago, emerging from twenty-four-hour Alcoholics Anonymous groups that provided access to peer counseling and rooms where people without other options could sober up. Eventually residential groups focused on the fourth and fifth steps of AA (doing a moral inventory and admitting wrongs to self, God, and another person) proliferated, infusing a strong spiritual and confessional element into recovery and sobriety programs.
The urban anexos Garcia studied are often hosted in small, informal spaces, sometimes in vecindades, low-rise apartment blocks built around a shared courtyard. One anexo she used as a case study is in a cuartito, a small storage room, in a century-old vecindad called Casa San Felipe in Mexico City’s central Tepito neighborhood. Over the years the cuartito was used as temporary housing for recent migrants to the city, as a place for political meetings to organize against eviction and state violence, and as a shelter for people displaced by the 1985 earthquake. In the 1990s it began to be used for twenty-four-hour AA meetings, before eventually becoming a full-time anexo, a transition Garcia connects to the spread of drug use and increased policing in the neighborhood.
Anexos are sometimes called treatment centers, but their programs promote abstinence, and their leaders often profess Catholic faith as a cure, shunning medication, replacement therapies, counseling, and mental health care. Families pay in cash or with goods. Manuel, the cabdriver, paid forty dollars per month to keep his daughter inside. Residents whose families stop paying are forced to do extra chores or are sent out to beg for money.
At the head of anexos stand the padrinos, who for the most part are men who have gone through residential treatment themselves. “Many of the people who create these services, which are based on peer support, were previously users of these services,” Carlos Alberto Zamudio Angles, a Mexican ethnologist who has studied anexos, told me last year. “It’s common that they were abused, beaten, and punished during their treatment, and it worked for them, so they replicate it.”
The padrinos decide everything in anexos, from who goes in and who comes out to who gets access to ibuprofen, and the approach to treatment varies enormously depending on who’s in charge. “Instead of uniform guidelines, there are allegiances and preferences,” writes Garcia. “A neighbor who appeals to a padrino to take her abusive husband is prioritized over an unfamiliar young woman addicted to methamphetamine.” In the vecindades, social and family life carries on around the anexo, bringing comfort to mothers who know that however difficult it is, their children or spouses are safe, right next door.
While there’s no comprehensive registry of anexos in Mexico, a social epidemiologist at Mexico’s National Autonomous University (UNAM) told Garcia that there could be upward of four thousand in Mexico City alone. The government’s National Commission for Mental Health and Addictions recognizes 193 of these centers as meeting national health and hygiene standards; the rest—the vast majority—are clandestine and unregulated. Anexos provide 90 percent of residential treatment for drug use among the country’s poor majority; wealthier Mexicans can access better services via privately funded rehab centers.
After some hesitation Manuel introduced Garcia to his old friend Padrino Francisco and took her inside her first anexo, which was a single room called Serenity in the borough of Iztapalapa, Mexico City’s most populous. Upon entering, Garcia was immediately struck by the rank smell of body odor coming off dozens of people—mostly teenagers, mostly male—sitting cross-legged on the floor of a bare room about fifteen feet by twenty feet. A wooden cross hung on the wall, alongside portraits of Bill S. and Bob W., the cofounders of AA.
Serenity is set up in an apartment in a multifamily housing complex and was opened in 2001 by a local man who had gotten sober. Garcia returned again and again, filling her notebooks with descriptions of life on the inside: buckets of dingy water, sparse meals of soup and tortillas, a worn towel, the din of a celebration outside, seventeen folding chairs. There and in other anexos around Mexico City, young men and women clean, confess, work out, and eat meager rations. At night they roll out their mats and sleep side by side in the same room in which they spent the entire day, sometimes without ever seeing the sun.
Residents take part in detailed confessions during which they talk through their most painful experiences, often including abuse and violence. Sometimes “treatment” involves verbal abuse and degradation, other times physical abuse such as beatings, forced nudity, and the denial of food. While some residents count the days until they can leave, others appear to have no plans beyond the daily routine.
There are residents who enter anexos of their own accord, but others are brought in by force. Garcia describes how one young woman was brought to Serenity rolled up in a carpet—the same way bodies are sometimes transported in disappearances and killings. “But the usual storyline of narco violence didn’t seem to apply here, in Serenity,” writes Garcia. “I wasn’t sure whether something terrible had just happened, or how to respond to the situation at hand.” The carpet was unrolled on the floor, and the woman began to shout and scream. Once she quieted down and began to cry, the rest of the residents went back to cleaning up and exercising as if nothing had happened.
“The fusion of care and violence reflects the burden families and communities shoulder in the contexts of poverty and institutional neglect,” writes Garcia. She notes that it is very easy for a family member to commit a relative: signing a single waiver or a “petition” for care is enough. There is no medical staff to attend to sometimes serious health issues. Sturdy locks bar anyone from leaving, and windows are covered.
“What is this place?” she writes while visiting Serenity. “A prison? A shelter? A church?” Depending on whom you ask, it seems anexos can be all three at once. A 2012 recommendation by the Human Rights Commission of Mexico City lambasted local authorities for removing people living on the street, including children and teenagers, from a downtown area to an anexo where they were held against their will and tortured.
For others, anexos may serve as something closer to a refuge. Garcia points to how the number of young men arriving to an anexo in Tepito doubled within weeks of the disappearance in 2013 of thirteen people, twelve of whom were from the neighborhood. The bodies of the disappeared were later found in a clandestine grave, and media speculation criminalized the victims by linking them with drug cartels. Garcia writes that after the crime locals checked into a nearby anexo to shield themselves from retribution or further violence.
Some residents spend so long in anexos that they go on to become padrinos, never fully transitioning back to the outside. For these men, like Padrino Francisco at Serenity, anexos become sites of redemption. “Neighbors in the apartment building affectionately called him boss and came to him with their troubles,” writes Garcia. “He was a neighborhood success story, and he earned his good standing through his ties to Serenity, where he was once an anexado himself.”
Garcia describes how difficult it was to find research about anexos, though there are a handful of Mexican scholars who have worked on the topic. The social epidemiologist at UNAM suggested that Mexican scholars would never get public funding to study anexos, which are considered irrelevant, their residents likened to trash in popular slang. “You’re the kind of person who can study anexos,” she told Garcia. “Because you’re an American. You have the luxury of doing whatever you want.”
Garcia’s concerns about privilege—despite her own experience, which she weaves through the book, as a homeless teenager in New Mexico with substance abuse in her family—sometimes hamper her research. “I shied away from looking at or speaking to the people stuck in it because I felt too guilty that I could come and go as I pleased,” she writes. “This asymmetry mirrored the unequal relationship between Mexico and the United States.” Her shyness doesn’t abate over time, and each visit to a new anexo makes her feel embarrassed again, “like a new kid walking into a classroom already in session.” Though her ethnography is rich in description, her self-consciousness prevents her from getting to know residents, their families, and their stories in greater depth.
Garcia also documents anexo-style organizations founded by Mexicans in the US, including at least twenty-three in the Bay Area. Most are attended by undocumented immigrants who fear seeking more formal care. She visited one in Oakland that serves only women, run by a woman called Madrina (“Godmother”) Trini who had gotten involved with fourth-and-fifth-step groups after suffering from repeated sexual violence on her trip to the US and feeling unsafe in the crowded group home she found her husband living in when she joined him.
Madrina Trini took Garcia and several other women to a fourth-and-fifth-step meeting, and here Garcia finally let her guard down—introduced as a new member of the group, she admitted to the others that she suffers from depression. Later Madrina Trini invited her to attend seven preparatory meetings and an overnight experience for women struggling with substance use, turning Garcia from researcher to participant.
In the expanded war on drugs, anexos themselves have become targets of criminal organizations, who infiltrate them, hide their members inside, or massacre residents, accusing them of belonging to a rival group. The first such massacre took place in Ciudad Juárez in 2008. In 2010 neighbors of an anexo called Faith and Life in the border city described hearing pounding noises as the metal door of the two-story sky blue blockhouse was broken down just before midnight. The gunshots lasted about ten minutes. Nineteen men were killed. In 2020 twenty-seven residents were killed in the largest massacre at an anexo to date in Irapuato, in the state of Guanajuato. According to Zamudio Angles, dozens of people have been killed in anexos in cities and towns around the country, often in prolonged attacks against different anexos in the same area, which can last for days or weeks.
The Way That Leads Among the Lost doesn’t delve into the causes and consequences of these killings, which have largely taken place outside the capital. The bulk of Garcia’s research was carried out over a decade ago, and her analysis of how the drug war was further militarized under López Obrador, who also cut federal spending on mental health and HIV prevention, is superficial. Her near-exclusive focus on Mexico City sidesteps the fact that some of the most innovative organizing around the rights of people who use drugs is led by grassroots activists along the US–Mexico border.
Occasionally Garcia’s taste for French anthropology and Greek philosophy undermines the local specificity of the text. Sometimes she unsuccessfully tries to link disparate events with sweeping statements. “The earthquake was like the narco war,” she writes in one such passage.
The real problem wasn’t just the collision of tectonic plates or, in the case of the war, rival cartels. It was, as Elena Poniatowska writes, the corruption and neglect of governments who couldn’t care less about poor people.
In focusing on the state’s inaction, her comparison omits the ways the militarized enforcement of prohibition is itself a driver of war.
A greater engagement with Mexican academics and activists working on issues related to violence, drug use, and prohibition—such as Angulo Corral and her colleagues at Mexicali’s Integración Social Verter and Tijuana’s Prevencasa, progressive think tanks like Elementa and Instituto Ria, and scholars like María Elena Medina-Mora and Clara Macedonia Fleiz Bautista—would likely have yielded a more fertile discussion. Nonetheless Garcia powerfully documents the complicated, deeply ambiguous ways that regular people come together to do the work the state won’t.
In December Mexico became the first country in the world to ban fentanyl at the constitutional level, which means harsher penalties for traffickers and the potential for the criminalization of harm reduction. A constitutional reform passed in late September permanently moves the National Guard, meant to be a civilian-led federal police force, under the Secretary of Defense. In response to Trump’s tariff threats in February, Sheinbaum announced the deployment of an additional 10,000 National Guard soldiers to the border to control migration and fentanyl. This means the control of people who use drugs in Mexico (including alcohol and marijuana) will increasingly be under the purview of soldiers.
Amid extreme violence and without any recognition from the state, it can be hard to see the people and collectives fighting for harm reduction and for drug policy that promotes health, choice, and individual and collective rights. These include organizations distributing naloxone and clean syringes on the US–Mexico border, but also antiwar and antimilitarist organizers from feminist and community groups in Mexico City, Guadalajara, and elsewhere. While they barely appear in Garcia’s book, they’re out there, working tirelessly against a rising tide of death and militarization.
English (US) · 