Bluetooth nyaope, dagga, dealers and associated rhetoric often dominate the headlines on the issue of drug use. The supply and consumption of drugs — legal or illegal — is blamed for all manner of social ills, including crime, unemployment, corruption and the “moral decay” of communities. Meanwhile, political campaigns promise the unreachable dream of a “drug-free” community.
In this context, human rights violations against people who use drugs and militarised approaches to policing, such as police carrying automated weapons when they raid drug dens and cordoning off whole communities to “search for drugs”, are often considered justified. Certain members of the South African Police Service (SAPS) and politicians with a “moral” agenda continue to oppose health services, such as needle exchange programmes, for people who use drugs despite official health department support for these initiatives.
Needle exchange programmes have been credited with helping to cut HIV prevalence rates by almost half in just three years among British drug users who inject, 1995 research published in the journal AIDS found. In South Africa, data on HIV infection rates among people who inject drugs are scarce but a small, five-city study conducted in 2013 and published in the International Journal of Drug Policy found that about 14% of those surveyed were living with HIV. One in two people had used dirty equipment the last time they injected drugs, the research found. The lack of sterile injecting equipment fuels high rates of HIV infection among people who use drugs.
Although many South Africans are calling for harsher drug policies, internationally there is increasing recognition that criminal justice approaches are not effective. Last year, a panel of international experts convened by the medical journal The Lancet reviewed global evidence on the effect of drug policies. Citing dismal results from “the war on drugs” in places such as Latin America, the panel recommended countries decriminalise nonviolent drug offences such as the use or possession of substances and instead focus on targeting only the most violent armed criminals.
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Kofi Annan, former United Nations secretary general and commissioner on the Global Commission on Drug Policy, has said: “Drugs have destroyed many lives, but wrongheaded governmental policies have destroyed many more. I think it’s obvious that, after 40 years of the war on drugs, it has not worked.”
But data from countries such as Tanzania and Mauritius show harm reduction initiatives, or practical and inclusive policies that reduce the risk associated with drug use, work.
In 2006, Mauritius became the first African country to debut a harm reduction policy that legalised needle exchange programmes. Within seven years, the HIV prevalence rate of prisoners — of whom about 70% were drug users — fell by more than half, shows research published in 2016 in the International Journal of Drug Policy.
Harm reduction services include opioid substitution therapy and providing people with not only clean needles but also other equipment — such as sterile water — they need to inject without the health risks caused by reusing needles. Opioid substitution therapy supplies people who use illegal drugs with a prescribed replacement medication such as methadone.
These programmes do not just lower people’s risk of HIV infection, they also reduce drug-related deaths and crime, argues a 2015 research review published by the United Nations Office on Drugs and Crime in the International Journal of Drug Policy.
Despite the evidence and the need, harm reduction has had few champions in South Africa.
The National Drug Master Plan outlines the country’s policies on substance use, theoretically informing the response to drugs and substance use across all branches of government. The responsibility for developing this plan falls on the underfunded, under-resourced and often undermined Central Drug Authority (CDA).
The country’s master plan expires this year and its replacement, which will guide the country’s drug response for the next five years, is being developed. Although it seems improbable that the new plan will revolutionise the response to drug use in South Africa, there have been positive moves towards ensuring a nuanced, pragmatic and evidence-based approach.
In leading the development of the new plan, recently appointed CDA chairperson David Bayever, a 15-year veteran of the authority, faces a challenging task.
In a recent discussion, he acknowledged that rapid changes in the international landscape, such as the shift away from a criminal justice approach, and also little data on the prevalence and nature of drug use would complicate matters. It is clear that he, and other members of the CDA, know that there needs to be a new approach.
“It is no longer simply a case of arresting people. There are much broader issues and responses that need to be included. We need a ‘living’ document that allows for movement — to wait five years before a policy shift can happen is no longer practical,” he said. “We hope that by having clear deliverables for each government department we can produce a document that continues to be relevant and ensures a level of accountability.”
Previous plans have lacked clear objectives for government departments.
Last year, at the UN Commission on Narcotic Drugs, a forum that debates international drug policy and controls, Social Development Deputy Minister Hendrietta Bogopane-Zulu represented the African Union. There, she called for the promotion of harm reduction. She also advocated for people who use drugs to be consulted on the decisions that affect them.
In the months that followed, the CDA’s executive committee published positions on both cannabis and harm reduction in the South African Medical Journal. The statements called for the use of evidence-based approaches, harm reduction and the potential decriminalisation of cannabis.
South Africa’s next drug master plan will be the first ever to have consulted the people most affected by drug policy — people who use illicit drugs.
Certainly, it seems as if the CDA wants to develop a more effective and evidence-based road map to dealing with drugs. That alone would differentiate the forthcoming drug plan from previous versions but, despite the authority’s best attempts, it is entirely possible that the National Drug Master Plan (2018-2022) will be hijacked and compromised.
The CDA executive committee warns in its cannabis position statement that the recommended harm reduction and decriminalisation approaches are unlikely to find favour with “those wishing to continue a ‘war on drugs’ ”. The paper also notes that the CDA includes branches of government that support, and perhaps even benefit from, the war on drugs.
At March’s session of the Commission on Narcotic Drugs, the South African delegation did not include any members of the CDA executive committee. But the departments of international relations and justice, as well as the SAPS, were well represented by senior officials.
It’s worth remembering that the 2013–2017 drug master plan also sought to include “harm reduction”, but opposition by politically connected organisations saw this watered down to a “localised version” of harm reduction that focused on treatment, aftercare and the reintegration of people who use drugs into society. The plan made almost no reference to, for instance, needle exchange or opioid substation programmes, or any other forms of harm reduction.
Calls for the decriminalisation of drug use were removed from the final draft of the recently launched national HIV strategic plan although the plan does support some HIV prevention services for people who inject drugs, such as needle exchange programmes.
To fulfil its mandate of addressing substance use, the CDA will need to address similar attempts to rewrite the next National Drug Master Plan.
But the most obvious failing may lie beyond the authority’s control. Although the CDA is developing the National Drug Master Plan, to be released later this year, other government segments such as the health department and the SAPS are also writing the internal drug plans that the drug master plan is meant to inform. Without a new plan, this means these processes are still guided by government’s previous strategy, which is out of date and no longer representative of the realities our communities face.
Put another way: no matter how progressive, appropriate and structured the CDA’s National Drug Master Plan 2018–2022 is, it has already been rendered obsolete.
Shaun Shelly is the head of policy, advocacy and human rights for people who use drugs for the TB/HIV Care Association and a researcher at the University of Pretoria’s department of family medicine. Follow him on Twitter @shaunshelly