In 2015 I started joining police in the South African port city of Durban on their “drug operations”. Most of my journeys were at night. They focused mainly on the policing of street level drug users.
The brief of the police was to increase arrests for drug possession, drug use and drug dealing. They were well aware that the easiest way to achieve these targets – critical to their performance management – was to carry out arrests emanating from observing street level drug users engaged in drug transactions.
So began a night of witnessing “buy and busts”. Random searches generally proved to be successful. Predominantly young black men were searched. Small amounts of illicit drugs were found in their possession. They were detained and thrust into the back of the police van where I was sitting, observing and interacting, in my ethnographic mode.
The majority of those apprehended were either in possession of, or using, a drug called “whoonga”. Whoonga – like “sugars”, “nyaope”, “unga” – is essentially poor grade heroin mixed with a variety of bulking agents (some very toxic).
The visible effect of whoonga was a deep feeling of relaxation and even sleepiness. Not surprisingly, the whoonga users who were arrested didn’t resist the police. If anything, they were submissive.
Whoonga users, I realised, are the low hanging fruit that the police target to ensure that their arrests rates look good. But I had a second and more significant realisation as I spoke with the whoonga users – that South Africa falls very short of having the correct approach to dealing with drug user disorders. Arrests and strong arm law enforcement play no role in curtailing whoonga use.
On the contrary, it pushes drug use and drug markets further underground, making it almost impossible to design programmes to reduce the harms associated with drug use. The winners, it’s clear, are the big time dealers who are able to capitalise on dark networks to continue operating.
Other countries have shown that there are better ways of managing the problem. One example is Portugal.
Ineffective war on drugs
The war on drugs in South Africa, as in the US, has in no way reduced the supply or the demand of drugs. And without a doubt it’s led to an increase in the harms associated with drugs as users once incarcerated and left with a criminal record become increasingly marginalised.
Criminalisation results in reduced possibilities for people who use drugs to normalise their lives and to reintegrate. Endless punishment, rather than support, has fundamentally harmful consequences for individual drug users, their families and the broader community.
Fear of arrest and stigmatisation prevents the problems that underlay problematic drug use being talked about, leaving users and their families isolated, hopeless and vulnerable. Failure to see the people behind the drugs, and the real problems that lie beneath drug use, has devastating outcomes.
So what should South Africans be talking about in this context? They should be talking about bringing drug use and the markets into the open, in much the same way as has been done in Portugal since 2001. This means moving away from the senseless and unproductive war on drugs to the possibility of decriminalisation which would allow proper support to be provided to drug users and their families, and would dramatically decrease the power of dark networks.
This sounds radical and counter-intuitive, but the evidence from Portugal speaks for itself.
Since the introduction of decriminalisation of drug use and possession, heroin use in the country has decreased dramatically as have the numbers of overdose. By contrast in the US drug use disorders and drug markets are growing and spreading.
Aside from decriminalisation South Africans should also be talking about the treatment that’s available to people who use drugs, particularly those who have limited financial resources. The country’s public health system offers no proper treatment for drug use disorders, and it has very few public “rehabilitation” centres. Those that are operational have very low retention and success rates. In Durban, for example, there’s one public rehabilitation centre. The waiting list to gain entry is very long and it lacks the medication to assist heroin users through withdrawal and ongoing medical maintenance.
South Africa has found itself stuck in conservative moralistic narratives about drug use that do little to reduce the harms associated with drugs. Those with heroin use disorders are well aware that existing public health and social development facilities are ineffective and inadequate.
Users on the streets talked about the need for opioid substitution therapy. The word Methadone came up constantly, a medicine that’s viewed as the only hope for detox and for long term maintenance.
Methadone and other opioid substitute medications represent the only hope for many with heroin use disorders. But these medications are currently not available in the public sector in South Africa, other than in one hospital in Cape Town for a limited period of time and for a limited number of beneficiaries. This is despite the use of government issued Opioid Substitution Therapy (OST) more than 80 countries worldwide, some for more than 30 years. This list includes countries on the continent such as Tanzania, Mauritius, Kenya and Senegal.
It’s now fallen on universities and NGOs to establish low threshold OST Demonstration Projects. The first project begins in Durban in April 2017, run by the Urban Futures Centre at the Durban University of Technology, together with TB/HIV Care Association.
The Durban OST Demonstration Project has support from both the KwaZulu-Natal and National Department of Health, although not at a financial level. This OST Demonstration Project will use Methadone supplied by Equity Pharmaceuticals and will have a cohort of 50 beneficiaries, all of whom will be from very low income circumstances. This project is guided by very comprehensive protocols which have received ethical clearance from both the KZN Department of Health and the Durban University of Technology.
There have also been public debates, dialogues with police and robust engagements with government officials particularly from the departments of health and social development. As a result views on drug use disorders are slowly shifting, at least in the minds of some key players.
History teaches us time and again that prohibition and silencing seldom had good results. The moment is here to be bold and to ensure that the rights of the most vulnerable are protected and that they are provided the scaffolding (medical and otherwise) to lead productive and connected lives.
Monique Marks receives funding from the National Institute of Humanities and Social Science, Mainline, and Open Society Foundation
Read more on The Conversation.