Committed to furthering the understanding of "addiction" and promoting effective drug policies. This site contains articles, information and resources related to drugs, drug use and the condition many call "addiction". Created and compiled by Shaun Shelly.
I was recently quoted, along with a colleague and some of our out-reach workers in an article on increased levels of injecting drug use in the Western Cape.
The message is important, and unless substitution therapies are introduced it is likely that there will be a significant increase in overdose deaths and a spread in HIV and other infectious diseases.
This article was originally published on Ground Up and then on allAfrica. The article is by Ian Broughton, and the photo is by Andrea Schneider.
Healthcare workers worry injecting heroin on increase
31 August was International Overdose Awareness Day. Health workers in
Cape Town have warned of a possible increase in drug overdoses and the
spread of infectious diseases, including HIV, if the use of needles to
inject drugs increases.
comes as health workers have noticed drug users turning away from
smoking towards injecting. In response, the TB/HIV Care Association
(THCA) in Observatory are preparing to educate needle using drug users
on the safe use of needles.
Heroin abuse is nothing new in the Western Cape, but injecting
appears to be gaining popularity. Some drug users are also injecting
“Although injecting drug use has not been very visible, it does
exist,” says Catherine Williams, a Professional Nurse Counsellor with
THCA. “Professionals in the field, and reports from the drug using
community suggest that it is on the rise.”
Injecting heroin used to be taboo among coloured users and black
users. This has been a cultural phenomenon for years according to users
and the South African Community Epidemiology Network on Drug Use
‘Only 11% of coloured heroin patients reported injecting the drug
compared to 83% of white heroin patients’, according to SACENDU’s Phase
34 report back.
Whereas once hardcore addicts chose to smoke their unga on tinfoil
and people who “spiked” the drug were shunned and looked down upon, this
is no longer the rule.
“It has become like a fashion. So many people I know are using needles now”
“It has become like a fashion. So many people I know are using
needles now. A few years ago most addicts thought it was crazy to inject
unga,” says Eugene Beukes, a Woodstock addict who has been injecting
drugs for several years.
Another addict said, “I never thought I would be doing this. I used
to think people who spiked were out of their minds. It used to be only
white people who injected and we always thought they were crazy.”
According to the Medical Research council there are an estimated 67,000 people injecting drugs in South Africa.
Figures based only on users seeking help at treatment centres (and
therefore statistics that should be used advisedly), show according
SACENDU that the demographic profile of heroin users in the Western Cape
is changing with coloured users making up 85% of the user population.
In Gauteng, 77% of heroin users were black, a significant increase to
the year before, and in Mpumalanga and Limpopo black users made up 86%
of users compared to 76% the year before.
Injecting heroin increases the chances of death by overdose and the risk of infection with diseases including HIV and Hepatitis.
One such user, Devon-Lee Zeeman (30) of Summergreens overdosed only a
week after coming out of prison after two and a half years. He was left
to die next to a railway line, deserted by those who had been with him.
His father, Joseph, arrived on the scene after someone came to his
house to tell him his son was lying unconscious next to the railway
line. This was about three hours after he last saw Devon-Lee. Had
someone phoned for help or informed him earlier, his son could have
still been alive.
“When I found him I noticed his hands were blue and there was a funny noise coming from his mouth,” says Joseph.
He phoned the paramedics, but it was too late.
He says his son had been struggling with a drug problem since the age of about 15 and that Devon-Lee had been addicted to unga.
A few days earlier, he had come home from a night out with friends.
His sister had noticed that his eyes did not look right. When
questioned, Joseph says his son told his sister that a friend had bought
him a drink.
Joseph says he and his son spent the evening before his death
together and the following morning Devon-Lee asked him for R20 for
airtime. This is the price for a bag of unga in many parts of Cape Town.
South Africa is lagging far behind other countries in dealing with
the problem of needle injecting drug use. THCA works with key
populations who are more at risk of HIV infection. Williams explains
that people who inject drugs have unique health and HIV prevention needs
which have been internationally recognised but have not yet been
effectively met in South Africa.
“People who inject drugs face many obstacles including stigma from
health care providers as well as profiling by police,” she says. “This
exacerbates the risks faced by this already vulnerable population. With
co-operation from local and national authorities many of the barriers
could be overcome.”
Williams says that it is vital for people to step up and face this
growing problem. She adds that worldwide there are harm reduction
programmes which have proven to be effective but hardly any such
services are available yet in SA.
Many global health and law enforcement organisations including WHO,
UNAIDS and UN Office on Drugs and Crime recommend a package of services
to reduce the risks of injecting.
The most essential services include needle and syringe programmes,
HIV counselling, testing and treatment with ARVs, and medically assisted
treatment of opioid dependence.
Shaun Shelly, Program Manager: Addiction Services Hope House
Counselling Centre and currently affiliated with the Addictions
Division, Department of Psychiatry and Mental Health, UCT says,
“Currently, evidence for an increase in injecting drug use is anecdotal.
However, we are seeing an increase on the ground, and injecting drug
use is being seen among demographic groups where is wasn’t previously
“Methadone programs have been running since 1964 and so there has
been a lot of research around them. Consistently they have been shown by
peer-reviewed research to reduce or eliminate the use of heroin, reduce
opioid related mortality and criminality. Importantly, they have also
been shown to reduce the spread of HIV/AIDS and other infectious
diseases. Overall the evidence is extremely strong that these programs
improve the health of both the individual and the community at large.”
“The lack of substitution medications such as methadone and
buprenorphine on the essential drugs list is something that urgently
needs to be addressed if we hope to reduce the number of injecting drug
users in the Western Cape.”
Many harm reduction programs also include overdose awareness and
prevention training for users, their families and first responders such
as firemen and police officers.
With training in the use of naloxone (an antidote to opioids such as
heroin and codeine), witnesses of overdose can buy time until health
care professionals can provide emergency care.
The South African National Drug Master Plan devotes only two
paragraphs to the subject of harm reduction and states that the term
needs to be defined.
Williams says the definition of harm reduction is well established
and that evidence-based services have been around for 20 years already.
“We know it works. We would like to see it work in South Africa …
There is a shortage of services for the entire drug using community. For
those who inject drugs existing services are harder to access, and the
recommended HIV prevention package is essentially absent … The
mortality rates among this group are particularly high, and the rate of
infectious diseases is also high. By focusing on this population we
could prevent deaths and the spread of infectious diseases,” says