Compassion outweighs criminalisation
Durban drug solution project a compelling case study
South Africa is stuck in conservative moralistic narratives about drug use but little is done to reduce the associated harms, according to Professor Monique Marks, who heads Durban University of Technology’s (DUT) Urban Futures Centre and a trans-discplinary project, called Pathways into and out of street level drug use in Durban.
The project is underpinned by the National Institute for the Humanities and Social Sciences (NIHSS) through its Catalytic Research Projects which assists in and promotes the development of research undertaken through a network of researchers across the university system in South Africa and beyond.
The NIHSS mandate promotes public discourse about crucial social issues to help influence the character of the South African community and to create a more humane, responsible and just society.
Marks, advocates that SA should follow Portugal and decriminalise drug use, she says, "The war on drugs in South Africa, as in the US, has not reduced the supply or the demand of drugs. It has instead led to an increase in the harms associated with drugs. Users once incarcerated and left with a criminal record, become increasingly marginalised and more likely to engage in problematic drug use.
"Our work is geared toward finding solutions that support drug users, rather than punishing them. Only ten percent of users become problematic, and the majority of these have generally experienced high levels of trauma and/or disconnect from family and community. Moreover, most are from low income communities and use drugs as a solution to an existing problem. Yet the concept of drugs being used as problem solver is vigorously contested in a society like ours. Instead prohibition and abstinence are viewed as the correct approach."
Criminalisation, Marks adds, results in reduced possibilities for users to normalise their lives and to reintegrate. "Endless punishment, rather than support, has fundamentally harmful consequences for them, their families and the broader community. Fear of arrest and stigmatisation leave users and their families isolated, hopeless and vulnerable."
The project Pathways into and out of street level drug use has various research and engagement outputs. Heavily transdisciplinary, it brings together scientists from the humanities and medicine as well as practitioners in health, social development and policing.
"This," she elaborates, "has allowed for a range of knowledges, expertise and resources to make sense of drug use disorders in Durban and the rest of the country."
Shortly after the research endeavour began, the Urban Futures Centre hosted a small symposium on drug use disorders that included Australian Professor of Family Medicine, Nick Croft and Irish Criminologist Prof Lucy Pickering. The KZN Harm Reduction Advocacy Network was formed, and has joined hands with other harm reduction advocates in South Africa and internationally. Since then police have been engaged in ongoing dialogues about drug use and harm reduction by the Urban Futures Centre because they are critical partners and potential champions of harm reduction policy and practice.
She speaks of achievements, "We have, for example, already published two articles in leading criminology journals on the policing of illicit drug use. Another two, on the link between drug use and HIV prevalence, were published in medical journals. A book chapter on the current legislative environment in South Africa in regard to drug use, drug possession and drug markets will be published later this year. Three more articles are currently being written on various components of the project.
"At an engagement level, the outcomes have been spectacular. A community theatre group, the Big Brotherhood, has a powerful new production. Called Ulwembu (isiZulu for Spider web) it was presented at numerous venues in Durban and recently at the Hillbrow Theatre in Johannesburg. Far more than a play, it is an immersive social learning tool, that brings together diverse citizens and civil servants into a transformative and transgressive empathetic space."
Ulwembu was recently awarded best script, best director (Coppen), best-led actress (Mthombeni) and best supporting actor (Ngubane) and best newcomer (Ngcebo) at the 2017 Durban Theatre Awards.
Last month Durban joined 120 cities across the world in the ‘Support Don’t Punish’ campaign. This was organised by the Urban Futures Centre at DUT and resulted in the linking of the work with similar harm reduction work being conducted globally. The Urban Futures Centre and the TB/HIV Care Association were provided a Harm Reduction Networking Zone at the Aids Conference in 2016. Placed within the Global Village, it provided a number of services to drug users and shared various forms of knowledge with the general public.
She emphasises, "By far the most significant research and innovation work is the recently launched Opioid Substitution Therapy (OST) Demonstration Project. Following months of preparation, we researched best international practice to inform our very detailed protocols which received ethical clearance from the KZN Department of Health and from DUT.
"It is the first project of its kind in South Africa and is already generating much media and government agency attention.
The aim being to demonstrate that opioid substitutes (in this case Methadone) improve quality of life for people with heroin disorders (mostly Whooonga/Nyaope users).
It is also shows government health workers how to run a low threshold OST Programme, which we hope will eventually be rolled out in the national public health system. "
The significant intervention has a variety of expected qualitative and quantitative research outputs and an economic analysis will also advocate for public policy transformation. Prof Marks advocates that South Africans should be talking about bringing drug use and its markets into the open, as Portugal did 16 years ago. "I know this is counterintuitive, the Portuguese evidence speaks for itself." Heroin use has decreased dramatically as have the numbers of overdose. By contrast, US drug use disorders and drug markets are growing and spreading.
She concludes, "South Africans should also be talking about the treatment available, particularly for those users with limited financial resources. 'Our 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 is only one. The waiting list is very long and it lacks the medication to assist heroin users through withdrawal. There is also no ongoing medical maintenance."
Elaborating on the OST Programme, Marks says qualitative and quantitative data is collected to assess changes in quality of life of the beneficiaries. After a fairly short time a range of quality of life improvements have been noted and recorded. Clients, while knowing the possible dangers of methadone as a medication, and the reality of long term maintenance, are very clear about the improvement to their lives since joining the programme.
"Many have reunited with family and about half have stopped all illicit drug use. Others have reduced their use dramatically." she adds.
"There is also a marked change in the personal health and hygiene of the 34 services users currently recruited. They are generally adhering to other chronic medication. Notable improvements include quality of life, although it is too soon to assess whether these will be sustained. Four have found employment and one has gone back to school after dropping out three years ago. Perhaps most importantly, beneficiaries have found a space where they are not judged and this has allowed them to form strong connections with the staff and with others on the programme who provide ongoing mutual support.”
Scenes from Ulwembu theatre production
Professor Monique Marks